Large Metropolitan Areas Research Articles

Spatial system perspective of understanding “fuel-sensitive routes” using regional-scale case studies

Eco-routing is widely researched as a promising way to reduce traffic-related environmental externalities. Past studies indicate that fuel-sensitive eco-routing trades the fastest routes with shorter, slower urban roads to take advantage of the “optimal fuel economy”. However, past studies focusing on individual routes often fail to depict the spatial redistribution of traffic being closer to the residential areas when eco-routing is adopted at a large scale. This research conducts city-scale fuel-sensitive routing simulations for two large metropolitan areas: the San Francisco Bay Area case and the Tokyo Area case. Combining agent-based simulations with data-driven fuel model, it is revealed that fuel-sensitive routing exerts heavier traffic on the local streets and increases residents’ direct exposure to traffic. Furthermore, by comparing different sub-areas, the varied degrees of traffic redistribution are found to be mainly dependent on the availability of major roads as alternative routes, and existing traffic congestion levels in an area.

Association between parental resource depletion and parent use of specific food parenting practices: An ecological momentary assessment study

The resource depletion model proposes that self-control is a limited resource that may become depleted after repeated use. This study aimed to improve our understanding of the correlates of resource depletion in parents, examine the association between resource depletion and use of coercive food parenting practices, and explore the relationship between resource depletion and stress. Children aged 5–9 and their parents (n = 631 dyads) were recruited from primary care clinics in a large metropolitan area in the United States in 2016–2019. Ecological momentary assessment was carried out over seven days with parents. Frequency tabulations and descriptive statistics were calculated to examine the overall, between-participant, and within-participant frequency of resource depletion, stress, and coercive food parenting practices. Resource depletion was higher among mothers (as compared to fathers) and native born participants (as compared to immigrants). Resource depletion was found to decrease significantly with each increase in household income level and perceived co-parenting support was negatively associated with resource depletion. Greater resource depletion earlier in the day was positively associated with coercive food parenting practices (e.g., food restriction, pressure-to-eat) at dinner the same night. Further, prior day resource depletion was associated with greater pressure-to-eat the next day. Parents with lower chronic stress were found to engage in pressuring when experiencing higher depletion. Clinicians and public health professionals should be aware of the role the resource depletion can play in parent's use of specific food parenting practices and seek to provide parents with the support they need to manage the cognitive load they are experiencing.

Optimizing the Selection of Mass Vaccination Sites: Access and Equity Consideration.

In the early phases of the COVID-19 pandemic, vaccine accessibility was limited, impacting large metropolitan areas such as Los Angeles County, which has over 10 million residents but only nine initial vaccination sites, which resulted in people experiencing long travel times to get vaccinated. We developed a mixed-integer linear model to optimize site selection, considering equitable access for vulnerable populations. Analyzing 277 zip codes between December 2020 and May 2021, our model incorporated factors such as car ownership, ethnic group disease vulnerability, and the Healthy Places Index, alongside travel times by car and public transit. Our optimized model significantly outperformed actual site allocations for all ethnic groups. We observed that White populations faced longer travel times, likely due to their residences being in more remote, less densely populated areas. Conversely, areas with higher Latino and Black populations, often closer to the city center, benefited from shorter travel times in our model. However, those without cars experienced greater disadvantages. While having many vaccination sites might improve access for those dependent on public transit, that advantage is diminished if people must search among many sites to find a location with available vaccines.

The rural side of the rainbow: Mental health and the intersections of geography, sexuality, and partnership.

Lesbian, gay, and bisexual (LGB) persons tend to be geographically concentrated in larger metropolitan areas and research persistently observes LGB persons as a disadvantaged population for mental health outcomes when compared to their heterosexual counterparts. Conflicting evidence suggests that mental health risk exposures are greater for LGB people in rural spaces while other research posits that urban residency is more detrimental for LGB mental health. One positively contributing factor to the mental well-being of LGB persons is their partnership status. To date, no study estimates how partnership may ameliorate unfavourable mental health outcomes for LGB populations in urban and rural areas. Using 10 years of pooled data from the nationally representative Canadian Community Health Survey (CCHS), this study examines mental health and the intersection of sexuality, geographic residency, and partnership. Logistic regression models estimate the intersections of sexuality, geography, and partnership status on mental health, stratified by respondents' gender. Findings show partnered gay men in rural areas experiencing better mental health than their partnered heterosexual counterparts in the largest urban cities. Although not significant, the same pattern is observed for partnered lesbian women who do not experience a significant mental health disadvantage at any geographic level. Regardless of partnership and geographic space, bisexual men, and especially bisexual women, exhibit worse mental health outcomes compared to their heterosexual counterparts.

161 Importance of Hospital Centrality Analysis in Brain Metastasis

INTRODUCTION: Management of patients with brain metastasis (BrM) is complex and interdisciplinary, with patients transitioning between distinct hospitals within an interconnected network at different points of their disease. Prior neurosurgical health delivery quality studies often analyze hospitals in isolation, negating the complexities of patient journey. A facility’s position in an integrated clinical network may therefore play a critical consideration in patient management and outcomes. METHODS: We selected BrM patients using ICD codes from the Healthcare Cost and Utilization Project (HCUP) inpatient and emergency department databases from Massachusetts (2018-2019). Hospitals were separated into quartiles based on connectivity, defined as sum of all weighted ties to other hospitals in MA. We compared patient and hospital characteristics across connectivity quartiles and determined impact of hospital connectivity on all-cause mortality, readmission rates, and length of stay using multivariate regression. RESULTS: A total of 4679 BrM patients were mapped across MA. While highly connected hospitals were on average larger than peripheral hospitals (p < 0.001), many highly connected hospitals had a low number of patient beds. Patients who visit highly connected hospitals were more likely to live in large metropolitan areas and higher income neighborhoods, and be covered by private insurance (all p < 0.001). Comorbidity scores and age were not meaningfully different between hospitals of varying connectivity scores. Hospital centrality, but not hospital volume, was inversely associated with mortality and readmissions rate, with highly connected hospitals having a lower risk of death (Q1: 2.4 (1.46-3.83); Q2: 1.6 (1.07-2.29); Q3: 1.4 (1.11-1.86); Q4 (ref)). CONCLUSIONS: We demonstrate a vital role for hospital connectedness in impacting BrM patient outcome, independent of hospital volume and patient characteristics. Structural barriers, such as insurance or patient residence, may impede patients from receiving care at highly connected hospitals.

100 The Impact of Race and Social Determinants of Health on Clinical Outcome of Glioblastoma Multiforme Patients Over a Decade.

OBJECTIVES/GOALS: While the evolving treatment paradigm for Glioblastoma (GBM) leverages different modalities to improve outcomes, treatment access might be limited by cost and disparities. This study explores the influence of race and social determinants of health (SDoH) on healthcare access and outcomes of GBM patients in a large metropolitan area over a decade. METHODS/STUDY POPULATION: Our institution’s tumor registry (2009-2019) was queried to identify our GBM cohort. Data were supplemented by electronic health records to include demographics, outcome, NCI Comorbidity Index, and the Agency for Healthcare Research and Quality (AHRQ) socioeconomic status (SES) index. RESULTS/ANTICIPATED RESULTS: Of the 559 GBM records, 361 unique patients met the inclusion criteria, and 43% were Non-White. Non-White patients predominantly comprised the lowest AHRQ SES index quartile and had longer hospital stays (LOS; p<0.001). White patients accounted for 61% of privately insured patients (p<0.001). Private insurance (p= 0.02) and age < 65 years (p= 0.039) were associated with a higher rate of home discharge. Patients diagnosed with GBM in the emergency department were more likely to be discharged to acute rehab than home (p<0.001). At 2 years, privately insured patients had longer OS (HR= 1.46; p= 0.04). DISCUSSION/SIGNIFICANCE: In contrast to previous studies, the study demonstrates that GBM affected a higher proportion of Non-White patients. Our data show that SDoH influences multiple outcomes in GBM patients. Efforts to identify and correct these barriers are needed to improve the care of all GBM patients.

Path-Based Formulations for the Design of On-demand Multimodal Transit Systems with Adoption Awareness

This paper reconsiders the On-Demand Multimodal Transit Systems (ODMTS) Design with Adoptions problem (ODMTS-DA) to capture the latent demand in on-demand multimodal transit systems. The ODMTS-DA is a bilevel optimization problem, for which Basciftci and Van Hentenryck proposed an exact combinatorial Benders decomposition. Unfortunately, their proposed algorithm only finds high-quality solutions for medium-sized cities and is not practical for large metropolitan areas. The main contribution of this paper is to propose a new path-based optimization model, called P-Path, to address these computational difficulties. The key idea underlying P-Path is to enumerate two specific sets of paths which capture the essence of the choice model associated with the adoption behavior of riders. With the help of these path sets, the ODMTS-DA can be formulated as a single-level mixed-integer programming model. In addition, the paper presents preprocessing techniques that can reduce the size of the model significantly. P-Path is evaluated on two comprehensive case studies: the midsize transit system of the Ann Arbor – Ypsilanti region in Michigan (which was studied by Basciftci and Van Hentenryck) and the large-scale transit system for the city of Atlanta. The experimental results show that P-Path solves the Michigan ODMTS-DA instances in a few minutes, bringing more than two orders of magnitude improvements compared with the existing approach. For Atlanta, the results show that P-Path can solve large-scale ODMTS-DA instances (about 17 millions variables and 37 millions constraints) optimally in a few hours or in a few days. These results show the tremendous computational benefits of P-Path which provides a scalable approach to the design of on-demand multimodal transit systems with latent demand. History: Accepted by Andrea Lodi, Design & Analysis of Algorithms—Discrete. Funding: This work was partially supported by National Science Foundation Leap-HI [Grant 1854684] and the Tier 1 University Transportation Center (UTC): Transit - Serving Communities Optimally, Responsively, and Efficiently (T-SCORE) from the U.S. Department of Transportation [69A3552047141]. Supplemental Material: The software that supports the findings of this study is available within the paper and its Supplemental Information ( https://pubsonline.informs.org/doi/suppl/10.1287/ijoc.2023.0014 ) as well as from the IJOC GitHub software repository ( https://github.com/INFORMSJoC/2023.0014 ). The complete IJOC Software and Data Repository is available at https://informsjoc.github.io/ .

Outcomes related to hospital characteristics of heart transplant centers: A National Readmission Database analysis

IntroductionThis study showcases an analysis performed using the National Readmission Database (NRD) from 2016 to 2019 to analyze the impact of ownership, location, size, and teaching status of transplant centers on cardiac transplant outcomes. MethodsDemographic variables and hospital characteristics were identified using NRD data and International Classification of Diseases,10th revision (ICD-10) codes. Comorbidities were assessed using the Elixhauser comorbidity index. Multi-variable linear and logistic regression analysis were used to assess in-hospital mortality, 30-day and 180-day readmission rates, length of stay, days from admission to procedure, transfer to a rehab center, graft rejection, graft failure, and index admission total cost. ResultsMost cardiac transplants occurred in privately owned, large metropolitan areas, large bed size, and teaching centers. No significant difference was seen in In-hospital mortality, graft rejection, or graft failure by hospital ownership, location, size, or teaching status. Patients in private hospitals were more likely to be readmitted at 180 days and less likely to be transferred to rehab center compared to government owned hospitals. Patients in private, small bed size, and teaching centers were more likely to have shorter length of stay. Additionally, days of admission to procedure was shorter in small bed size and teaching centers. Furthermore, the cost of index-hospital stay was higher in privately owned, large metropolitan areas, large bed size, and teaching centers. ConclusionWhile in hospital mortality was not significantly different, various other outcomes related to cost and efficiency seem to be impacted by hospital characteristics.

Challenges and opportunities of low-cost sensors in capturing the impacts of construction activities on neighborhood air quality

In large metropolitan areas such as Toronto, planners are increasingly relying on urban densification to accommodate population growth sustainably. While infill developments support the city's long-term climate goals, on-going construction impacts air quality for local communities. Understanding how neighborhoods are impacted by these localized sources can be achieved by implementing a network of low-cost sensors. In this study, we placed twelve low-cost sensors on balconies in a Toronto neighborhood impacted by various construction projects. The study aims to capture the impact of construction and heavy-duty traffic and provide a better understanding of spatial variability in fine particulate matter (PM2.5). The locations were compared using time series analysis, inverse distance weighing (IDW) for spatial heterogeneity, and spectral analysis to quantify the contribution of local sources. Sensors exhibited inter-sensor variability, which was corrected upon calibration. Sensors located near and far from construction sites showed similar temporal trends, however locations near construction sites measured greater PM2.5 concentrations, where the hourly average concentration for sensors near construction sites ranged between 6.8 and 8.5 μg/m3 and sensors further away ranged between 5.4 and 6.2 μg/m3. Spatial variability was also captured by IDW where sensors near construction sites were more heterogenous and exhibited greater concentrations. Spectral analysis demonstrated that local sources contributed up to 23% of PM2.5 levels near construction while distant locations had a maximum of 11% local contribution. By using a network of sensors, we explore how construction sites create localized hotspots within a neighborhood.

Exploring safety culture within inpatient mental health units: The results from participant observation across three mental health services.

In Australia, acute inpatient units within public mental health services have become the last resort for mental health care. This research explored barriers and facilitators to safe, person-centred, recovery-oriented mental health care in these settings. It utilised participant observations conducted by mental health nurses in acute inpatient units. These units were located in three distinct facilities, each serving different areas: a large metropolitan suburban area in a State capital, a mid-sized regional city, and a small city with a large rural catchment area. Our findings highlighted that, in the three inpatient settings, nurses tended to avoid common areas they shared with consumers, except for brief, task-related visits. The prioritisation of administrative tasks seemed to arise in a situation where nurses lacked awareness of alternative practices and activities. Consumers spent prolonged periods of the day sitting in communal areas, where the main distraction was watching television. Boredom was a common issue across these environments. The nursing team structure in the inpatient units provided a mechanism for promoting a sense of psychological safety for staff and were a key element in how safety culture was sustained.

Behavior Change Among HIV-Negative Men Who Have Sex with Men Not Using PrEP in the United States.

This study measures changes in condomless anal sex (CAS) among HIV-negative men who have sex with men (MSM) who are not taking pre-exposure prophylaxis (PrEP). It considers the 2014-2019 cycles of the American Men's Internet Survey, a serial, cross-sectional web-based survey of US cisgender MSM aged ≥ 15years, in which ~ 10% of each year's sample is drawn from the previous year. Among those surveyed for 2years who remained HIV-negative and off PrEP, reports of having any CAS and of CAS partner number were compared across years. We disaggregated by partner HIV status, and considered demographic predictors. The overall population saw a significant 2.2 percentage-point (pp) increase in reports of any CAS year-over-year. Sub-populations with the largest year-on-year increases were 15-24-year-olds (5.0-pp) and Hispanic respondents (5.1-pp), with interaction (young Hispanic respondents = 12.8-pp). On the relative scale, these numbers correspond to 3.2%, 7.2%, 7.3% and 18.7%, respectively. Absolute increases were concentrated among partners reported as HIV-negative. Multivariable analyses for CAS initiation found effects concentrated among Hispanic and White youth and residents of fringe counties of large metropolitan areas. CAS partner number increases were similarly predicted by Hispanic identity and young age. Although condom use remains more common than PrEP use, increasing CAS among MSM not on PrEP suggests potential new HIV transmission pathways. Concentration of increases among 18-24-year-old MSM portends future increases in the proportion of newly diagnosed HIV that occur among youth. Concentration among young Hispanic MSM will likely expand existing disparities. Although reducing barriers to PrEP remains vital, condom promotion for MSM remains a key public health practice and appears to be missing key audiences. LGBTQ+-inclusive sex education is one avenue for enhancing these efforts.

Exploring the Use of Socially Assistive Robots Among Socially Isolated Korean American Older Adults.

This pilot study explored whether a socially assistive robot (SAR) would have positive effects on Korean American immigrant older adults' health behaviors and emotional well-being and whether the older adults would be receptive to the SAR. A total of 30 participants (age 65+) in a large metropolitan area participated in the study, and each participant was provided a SAR named Hyodol for 4 months and interacted with it in ways that they saw appropriate. We used one-group pre- and post-test design to assess changes between baseline and follow-up in medication adherence, depressive symptoms, loneliness, and disability. Additionally, we employed in-depth qualitative interviews to explore participants' perceptions about the SAR. At post-test, participants showed improved medication adherence, reduced depressive symptoms, and a slightly and statistically nonsignificant decrease in loneliness scores. Qualitative data suggested high adoptability of this particular SAR among the participants.

Adult ADHD Symptoms in a Large Metropolitan Area From Brazil: Prevalence and Associations with Psychiatric Comorbidity, Bullying, Sexual Abuse, and Quality of Life

There is scant data about the prevalence and correlates of ADHD in middle-income countries. Objective: The aim of this study was to investigate the prevalence and psychiatric correlates of symptomatic ADHD in a large metropolitan area of a middle-income country. Methods: An in-person household survey with randomly selected 2,297 adults aged 19 to 60 from Rio de Janeiro, Brazil, assessed by trained lay interviewers. The Adult Self-Rating Scale Screener (ASRS-6) was used. Chi-square and logistic regression were conducted. Results: ADHD prevalence was 4.59 (95% CI [3.56, 5.44]). Those with ADHD were younger and more often unemployed; they displayed more psychiatric symptoms (depression, anxiety, and alcohol abuse) and a history of bullying and sexual abuse. They also had worse physical health indicators. Findings remained significant when controlling for socioeconomic variables. Conclusion: Adults with symptomatic ADHD from a large metropolitan area in Brazil show a pattern of findings consistent with what has been observed in higher-income countries

Transport-related social exclusion and mobility in developing countries: the South African case

IntroductionTransport-related social exclusion has been studied in many countries, and from many different perspectives. In Africa, however, there is little recent research into the phenomenon, even though African cities tend to have poor transport services, urban sprawl is extensive usually resulting in long travel times and high travel costs, and certain areas experience high levels of crime. By implication, there are several factors that impact the ability of people to access economic and societal opportunities, however these are not well documented. Building on previous work from several authors, this research sought to describe transport-related social exclusion in a large metropolitan area in an emerging economy.MethodsUsing a qualitative methodology, 60 interviews were conducted with City of Johannesburg residents. The data was analyzed using manual thematic and classic content analysis.ResultsThe study found that residents often did not have access to services due to availability, but also that economic, geographic and fear-based exclusion were particularly prevalent in the sample, although there were several other psychological exclusion dimensions, as well as information exclusion.DiscussionThis study is the first recent study in South Africa to consider a wide range of commuters from varying demographic strata, thus providing a novel perspective on TRSE in a major urban area in the country. The study recommends that policy actions be considered, taking into account the minibus taxi industry, which is often overlooked in government policy. TRSE should also be an inherent element in urban (and other) transport planning, as well as take into account the broader societal realities faced by citizens. Future research directions include conducting broader quantitative studies across a variety of urban areas in South Africa, and beyond, to determine specific TRSE dimensions in various urban areas. Policy analysis is also recommended, to determine TRSE policy gaps and align interventions with specific commuter needs.

(110) Socioeconomic Factors Impacting Density of Certified Sex Therapists in the United States

Abstract Introduction An exploratory study mapping sex therapists based on the top ten Google results in each state concluded that most sex therapists were located in larger metropolitan areas, and importantly, they found that only 18.2% of clinicians offering sex therapy services were certified by a national organization such as AASECT. Objective To map where certified sex therapists practice and what variables influence where they practice in the United States. Methods The American Association of Sexuality Educators, Counselors, and Therapists online directory was queried for certified sex therapists in each state. Univariable and multiple linear regression analyses were utilized to assess the relationship between the density of certified sex therapists in each state with various training and socioeconomic factors. Results Across all 50 states and the District of Columbia the median density of sex therapists per 500,000 people was 1.28 (IQR 0.82, 1.83). On univariable linear regression, median household income (p < .01, R2 = .20), percent of state population with a bachelor’s degree or higher (p < .01, R2 = .57), and percent of state population living in an urban setting (p < .01, R2 = .18) were significantly correlated with the density of certified sex therapists in each state. On multiple linear regression, percent of state population with a bachelor’s degree or higher (p < .01) and percent of population not in poverty (p < .01) remained significantly correlated with the density of certified sex therapists in each state. Conclusions Certified sex therapists are more likely to practice in urban settings with populations that have a higher median income and are more educated. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Boston Scientific, Coloplast.

Rural-Urban Disparities in Telemedicine Use Among U.S. Adults with Cancer.

Introduction: The COVID-19 pandemic has resulted in significant changes in health care delivery worldwide, including the widespread adoption of telemedicine. This study examines the prevalence of telemedicine use among cancer survivors in the United States based on rurality and investigates its association with telemedicine use. Methods: The 2021 National Health Interview Survey was used to analyze telemedicine use among cancer survivors during the pandemic. Telemedicine use was the primary outcome, and rurality was the main exposure. Descriptive statistics and multiple logistic regression models were used to examine the association. Results: Out of 27,500 eligible cancer survivors, 51.6% reported using telemedicine in 2021. Telemedicine usage varied across rural areas, with 41.4% of rural cancer survivors using telemedicine compared with 57.5% of cancer survivors in large metropolitan areas (p < 0.001). Rural cancer survivors had significantly lower odds of using telemedicine during the pandemic compared with large metropolitan cancer survivors. Cancer survivors residing in rural areas were 0.56 times less likely (odds ratio [OR] = 0.56; 95% confidence interval [CI] = 0.41-0.75), and those residing in medium and small metropolitan areas were 0.69 times less likely (OR = 0.69; 95% CI = 0.56-0.86) to report telemedicine use compared with cancer survivors in large metropolitan areas. Conclusions: Substantial disparities in telemedicine use were observed between rural and urban areas among cancer survivors. Rural cancer survivors were less likely to utilize telemedicine during the COVID-19 pandemic. Ensuring equitable access to telemedicine requires continued reimbursement for telemedicine services, along with additional efforts to improve access to and utilization of health care for rural cancer survivors.

How do Cancer Patients in Economically Marginalized Neighborhoods Decide Where to Seek Care: Perspectives From Cancer Patients and Healthcare Professionals.

The quality of cancer care affects patient outcomes. It is therefore important to understand what factors and/or barriers shape a cancer patient's decision about where to seek care. We sought to understand factors influencing decision-making for historically marginalized communities in a large metropolitan area with multiple options for cancer care, including a National Cancer Institute (NCI)-designated comprehensive cancer center. We conducted semi-structured interviews with cancer patients from economically marginalized neighborhoods in Washington D.C., and with healthcare professionals who work with patients from these areas. Participants were recruited through flyers, social media posts, and word of mouth. Two researchers analyzed the data using a combination of inductive and deductive approaches supported by the ATLAS. ti software. A total of 15 interviews were conducted. Analysis revealed 3 major factors influencing where patients decide to seek care: health insurance, transportation, and prioritization of needs. Participants repeatedly identified navigating the bureaucracy of insurance enrollment and high medical costs as prohibitive to seeking care. Transportation was often mentioned in terms of convenience of use and proximity to the care center. Prioritization of needs refers to circumstances such as unstable housing, poverty, and mental illness, that some patients prioritize over seeking quality cancer care. Across these themes 2 findings arose: a discrepancy between stated and actual factors in choosing an oncologist, and the extent to which a cancer patient is able to choose their oncologist. This study helps explain some of the factors that influence how cancer patients in urban settings choose an oncology center, and the barriers which prohibit access. This study aimed to understand how cancer patients decide where to seek treatment.

Adolescent E-Cigarette Expectancies: Measure Development and Preliminary Validity of the Electronic Nicotine Vaping Outcomes Measure for Youth.

Electronic nicotine delivery systems ("e-cigarettes") are the nicotine product most commonly used by adolescents. Research, treatment, and policy could benefit from measures of adolescent e-cigarette beliefs about outcomes of use (ie, expectancies). In the current study, we developed and tested an adolescent electronic nicotine vaping expectancy measure. A focus group with adolescents evaluated potential e-cigarette expectancy items. A panel of national experts assisted in revision of these items. Finally, items were administered to a sample of adolescents 14-17years old (N = 267, Mean age 15.6, SD = 1.1, 50.9% Female, 50.2% Non-Hispanic White, 22.5% Non-Hispanic Black, 14.2% Hispanic) in a large Southeastern metropolitan area in the United States. Exploratory Factor Analysis revealed a four factor solution: Negative Consequences (Cronbach's α = .92); Positive Reinforcement (α = .83); Negative Affect Reduction (α = .95); and Weight Control (α = .89). Subscales were significantly correlated with vaping susceptibility and lifetime vaping. Subscales successfully differentiated susceptible adolescents from confirmed non-susceptible adolescents, with susceptible adolescents reporting more positive expectancies, eg, Positive Reinforcement, M = 5.0, SD = 2.0 vs M = 3.0, SD = 2.1, P < .001, η2 = 0.19, and less negative expectancies, M = 5.5, SD = 2.3 vs M = 6.5, SD = 2.6, P = .001, η2 = 0.04. Similar results were found comparing adolescents who have never vaped nicotine with those who have vaped nicotine. Hierarchical linear regression demonstrated subscales were significant predictors of lifetime vaping after controlling for demographics, vaping ad exposure, and peer/family vaping. A preliminary version of an adolescent expectancy measure appears reliable and valid based on expert input and pilot testing with adolescents. Promising results were found in the domains of concurrent validity, discriminant validity, and incremental validity. Future research and evaluation efforts will be able to use this tool to further prevention and treatment goals.

Abstract 139: Regional Disparities in Mechanical Thrombectomy Utilization for Treatment of Acute Ischemic Stroke in the United States

Background: A current national priority is to understand geographic disparities in mechanical thrombectomy (MT) provision for patients with acute ischemic stroke (AIS). We examine variation in rates of MT by geographic region and urban-rural areas to identify utilization disparities across the United States. Methods: The state-specific annual incidence of AIS in 2019 was determined using data from the Global Burden of Disease Collaborative Network. We determined the number of patients who were admitted with AIS due to thrombosis or embolism of anterior circulation arteries and those who received MT in a particular region/state based on the State Inpatient Database of NIS. The National Inpatient Sample data were used to create national weighted estimates of the size of subject populations, age at admission, length of stay, and discharge status. Results: In the United States, approximately 28,165 MT were performed in 2019, representing 4% of the AIS population. In large central metropolitan areas, the proportion of thrombectomies performed to the AIS patient population was significantly higher than the national estimate (4.34%, P &lt; 0.001); small metropolitan areas and rural settings (micropolitan and noncore) had significantly lower proportions of MT-treated patients with 3.2% and 2.9%, respectively (P &lt; 0.001), when compared with the national estimate. West region had significantly higher proportions of MT-treated patients with 4.3%, compared with the national estimate (P &lt; 0.001), whereas South region had significantly lower proportions with 3.8% (P &lt; 0.001). Conclusions: We found prominent regional disparities in the utilization rates of MT in acute ischemic stroke patients in the United States, which may have implications for Regional Stroke Destination Plans in Rural, Suburban, and Urban Communities.

Self-Reported Visual Disability and Unemployment: Findings from the National Health Interview Survey

ABSTRACT Purpose To investigate the association between visual impairment and employment status due to disability, utilizing data from the 2022 National Health Interview Survey (NHIS). Methods Adults 18 years of age and older were extracted from the 2022 NHIS dataset. A multivariable logistic regression model was created to evaluate the odds of unemployment (“laid off” and “looking for work”). Persons over the age of 65, as well as persons retired, going to school, self-employed, seasonal, or contract workers were excluded. Independent variables for the model included gender, race, Hispanic ethnicity, urban residency, level of education, citizenship, and self-reported vision. The latter variable was categorized as seeing with “some” difficulty, with “severe” difficulty, “can’t see at all,” and “a lot of difficulty.” Outcomes were reported as odds ratios (OR) with 95% confidence intervals (CI). Results Associations with unemployment included education less than high school (OR 6.05, 95% CI: 3.98-9.18) and high school (OR 3.80, 95% CI 2.78-5.21); severe vision difficulty (OR 3.68 95% CI 1.73-7.86); Asian race (OR 2.53, 95% CI 1.64-3.89); and Black race (OR 1.78, 95% CI 1.31-2.41). The odds of unemployment were marginally elevated for those living in large metropolitan areas, while being born in the United States had a modest protective effect (OR 0.53, 95% CI 0.42-0.66). Conclusion The degree of visual impairment in this post-COVID-19 pandemic survey substantially affects employment, which is consistent with historical studies. Education among those with impaired vision is an important and modifiable variable that can positively influence the chances of employment.