Ohio Department Of Health Research Articles

Application of The Healthy Migrant Theory to Maternal Morbidity and Mortality Data in Ohio

BACKGROUND: The Healthy Migrant Theory is a phenomenon describing a protective effect regarding specific health outcomes when a person of color is born outside of the U.S. Previous literature has focused on the application of this theory to infant outcomes, leaving its application to maternal outcomes mostly unstudied. The objective of this research is to determine whether the Healthy Migrant Theory holds true to maternal morbidity in the Ohio population. METHODS: Birth record data from the Ohio Department of Health was analyzed from 2015-2020 that included mothers identifying as White or Black and data where country of birth was available (n=717,300). Mothers were grouped by race and nationality. Maternal morbidity and socioeconomic status (SES) were analyzed. One-way ANOVA was used to examine associations between SES and number of maternal morbidity events. Binary logistic regression models were developed to examine the relationships among race, nationality, and occurrence of maternal morbidity events. Interaction between race and nationality was also evaluated. RESULTS: Among black mothers, nationality was significantly associated with the likelihood of any maternal morbidity event occurring (OR= 1.659; 95% CI= 1.534, 1.795; p< 0.001), with foreign-born mothers having about 1.66 times greater odds of having a maternal morbidity event. This relationship persisted after adjusting for SES. No statistical difference in low SES indicators was found between foreign-born Black mothers and US-born Black mothers (p= 0.349, 95% CI= -0.007, 0.030). DISCUSSION: Our findings appear to contradict the Healthy Migrant Theory. More research regarding treatment and outcomes of foreign-born Black mothers must be implemented to better understand the nuances of the application of this theory to maternal outcomes. Caution should be taken when comparing infant and maternal outcomes and interventions since they may not be as closely connected as previously thought. Limitations of this project include inaccuracies in data collection from birth certificates, limited morbidity variables, and lack of stratification based on country of origin.

Racial Fairness of Individual- and Community-Level Proxies of Socioeconomic Status Among Birthing Parent-Child Dyads.

While precision medicine algorithms can be used to improve health outcomes, concerns have been raised about racial equity and unintentional harm from encoded biases. In this study, we evaluated the fairness of using common individual- and community-level proxies of pediatric socioeconomic status (SES) such as insurance status and community deprivation index often utilized in precision medicine algorithms. Using 2012-2021 vital records obtained from the Ohio Department of Health, we geocoded and matched each residential birth address to a census tract to obtain community deprivation index. We then conducted sensitivity and specificity analyses to determine the degree of match between deprivation index, insurance status, and birthing parent education level for all, Black, and White children to assess if there were differences based on race. We found that community deprivation index and insurance status fail to accurately represent individual SES, either alone or in combination. We found that deprivation index had a sensitivity of 61.2% and specificity of 74.1%, while insurance status had a higher sensitivity of 91.6% but lower specificity of 60.1%. Furthermore, these inconsistencies were race-based across all proxies evaluated, with greater sensitivities for Black children but greater specificities for White children. This may explain some of the racial disparities present in precision medicine algorithms that utilize SES proxies. Future studies should examine how to mitigate the biases introduced by using SES proxies, potentially by incorporating additional data on housing conditions.

The cost of doing nothing: Preventable premature births for at-risk women

Background: The effects of poverty in the United States are growing, and the impacts are most severe for the already vulnerable populations. This analysis looks at the cost of doing nothing for at-risk pregnant women in one county in NE Ohio. Most of these women are living at or below the poverty level, lack safe, affordable, and stable housing, and often do not receive recommended levels of prenatal care. This examination uses data from Mahoning County, Ohio, where one program has provided wrap-around support for any at-risk pregnant mother since 2016. Objective: Examine the cost/savings of providing wrap-around support services to at-risk pregnant women. Methods: Data was provided by the Mahoning County Pathway HUB (MCPH) regarding all births since its 2016 inception. Data was extracted from the Ohio Department of Health, the CDC, and other sources regarding the cost of births and specifically premature births. These sources of data were analyzed using causal-comparative methods, in order to understand the frequency of premature births, with, and without the support services provided by the MCPH. Conclusion: The results of these causal-comparative analyses suggest that the cost of doing nothing for at-risk pregnant women is substantial for all stakeholders. Results demonstrate a savings of 2.45 million dollars for the five years included in the analysis. Because most of the services provided by the MCPH are billable to public health insurance, this model of supporting pregnant mothers who are at risk is important. The cost of doing nothing can lead to a lifetime of avoidable suffering and financial hardship for the women and infants who are born premature. The results from the MCPH suggest that this model of support and service delivery is making a difference, based on the lower-than-expected pre-term births over their tenure of operation.

WHAT DO NURSING HOMES RECEIVING HIGH COMPLAINTS GOT TO DO WITH RESIDENTS’ QUALITY OF LIFE?

Abstract Residents’ quality of life is important to understand nursing home (NH) quality. Official complaints are another NH quality indicator. However, little research has examined the two quality measures together. To fill this gap, this study aims to investigate the association between resident satisfaction and NH complaints. 2018–2019 complaints data from the Ohio Department of Health, 2017 Ohio Biennial Survey of Long-Term Care Facilities, and 2017 Ohio Nursing Home Resident Satisfaction Survey were merged (N=629). Eight outcome variables were used: overall resident satisfaction score and seven individual domain scores. They range from 0 (low) to 100 (high). For independent variables, we labeled NHs received 6 or more complaints per 100 residents in both 2018 and 2019 as ‘high complaint repeaters.’ Multiple linear regression was conducted. There is a statistically significant relationship between official complaints and resident satisfaction. High complaint repeaters had lower overall satisfaction score by 1.48 (p < .01); lower moving in score by 2.16 (p < .01); lower spending time score by 1.30 (p < .05); lower caregivers score by 1.20 (p < .05); lower meals and dining score by 2.18 (p < .05); lower environment score by 1.13 (p < .05); and lower facility culture score by 2.14 (p < .01) than non-high complaint repeaters. However, there is no association between complaints and care and services domain score. State policy makers need to consistently monitor high complaint repeaters and support them to reduce complaints. Also, providers should allocate resources and design strategies to improve residents’ experiences.

Using Bandit Algorithms to Maximize SARS-CoV-2 Case-Finding: Evaluation and Feasibility Study.

The Flexible Adaptive Algorithmic Surveillance Testing (FAAST) program represents an innovative approach for improving the detection of new cases of infectious disease; it is deployed here to screen and diagnose SARS-CoV-2. With the advent of treatment for COVID-19, finding individuals infected with SARS-CoV-2 is an urgent clinical and public health priority. While these kinds of Bayesian search algorithms are used widely in other settings (eg, to find downed aircraft, in submarine recovery, and to aid in oil exploration), this is the first time that Bayesian adaptive approaches have been used for active disease surveillance in the field. This study's objective was to evaluate a Bayesian search algorithm to target hotspots of SARS-CoV-2 transmission in the community with the goal of detecting the most cases over time across multiple locations in Columbus, Ohio, from August to October 2021. The algorithm used to direct pop-up SARS-CoV-2 testing for this project is based on Thompson sampling, in which the aim is to maximize the average number of new cases of SARS-CoV-2 diagnosed among a set of testing locations based on sampling from prior probability distributions for each testing site. An academic-governmental partnership between Yale University, The Ohio State University, Wake Forest University, the Ohio Department of Health, the Ohio National Guard, and the Columbus Metropolitan Libraries conducted a study of bandit algorithms to maximize the detection of new cases of SARS-CoV-2 in this Ohio city in 2021. The initiative established pop-up COVID-19 testing sites at 13 Columbus locations, including library branches, recreational and community centers, movie theaters, homeless shelters, family services centers, and community event sites. Our team conducted between 0 and 56 tests at the 16 testing events, with an overall average of 25.3 tests conducted per event and a moving average that increased over time. Small incentives-including gift cards and take-home rapid antigen tests-were offered to those who approached the pop-up sites to encourage their participation. Over time, as expected, the Bayesian search algorithm directed testing efforts to locations with higher yields of new diagnoses. Surprisingly, the use of the algorithm also maximized the identification of cases among minority residents of underserved communities, particularly African Americans, with the pool of participants overrepresenting these people relative to the demographic profile of the local zip code in which testing sites were located. This study demonstrated that a pop-up testing strategy using a bandit algorithm can be feasibly deployed in an urban setting during a pandemic. It is the first real-world use of these kinds of algorithms for disease surveillance and represents a key step in evaluating the effectiveness of their use in maximizing the detection of undiagnosed cases of SARS-CoV-2 and other infections, such as HIV.

Differences in obesity-related health behaviors and health outcomes by rural and Appalachian residency

PurposeObesity and health behaviors are the major modifiable contributors to cancer and health disparities. We examined the differences in obesity-related health behaviors, and health outcomes by rural and Appalachian residency in Ohio.MethodsCross-sectional survey data from the 2011–2019 Behavioral Risk Factor Surveillance System were obtained from the Ohio Department of Health. County-level identifiers were used to classify urban non-Appalachian, urban Appalachian, rural non-Appalachian, and rural Appalachian residency. Self-reported weight, height, health behaviors, and health conditions were used. Logistic regression was used to assess the difference in health behaviors and health outcomes by rural and Appalachian residency. All analyses incorporated with sample weights.ResultsAmong Ohio residents, compared to urban non-Appalachian residents, urban Appalachian and rural Appalachian residents had a higher prevalence of obesity, hypertension, high cholesterol, and cardiovascular diseases, as well as lower rates of healthy diet and physical activity. No difference was found in trends of obesity and obesity-related health outcomes in 2011–2019 by rural and Appalachian residency. However, rural Appalachian residents had a greater increase in obesity, hypertension, and diabetes, whereas rural non-Appalachian had favorable changes in obesity-related health behaviors. Additionally, associations between health behaviors and obesity-related health outcomes differed by rural and Appalachian residency.ConclusionsFindings underscore the importance of distinguishing between urban non-Appalachian, urban Appalachian, rural non-Appalachian, and rural Appalachian populations when assessing health disparities. While the trends of obesity and obesity-related health outcomes did not differ, the association between health behaviors and obesity-related outcomes differed by rural and Appalachian residency.

Projecting COVID-19 cases and hospital burden in Ohio

As the Coronavirus 2019 disease (COVID-19) started to spread rapidly in the state of Ohio, the Ecology, Epidemiology and Population Health (EEPH) program within the Infectious Diseases Institute (IDI) at The Ohio State University (OSU) took the initiative to offer epidemic modeling and decision analytics support to the Ohio Department of Health (ODH). This paper describes the methodology used by the OSU/IDI response modeling team to predict statewide cases of new infections as well as potential hospital burden in the state. The methodology has two components: (1) A Dynamical Survival Analysis (DSA)-based statistical method to perform parameter inference, statewide prediction and uncertainty quantification. (2) A geographic component that down-projects statewide predicted counts to potential hospital burden across the state. We demonstrate the overall methodology with publicly available data. A Python implementation of the methodology is also made publicly available. This manuscript was submitted as part of a theme issue on “Modelling COVID-19 and Preparedness for Future Pandemics”.

Acceptability to and Engagement With a Virtual Sickle Cell Trait Education Program (SCTaware): Single-Center Prospective Study.

Public health programs are tasked with educating the community on health topics, but it is unclear whether these programs are acceptable to learners. Currently, these programs are delivered via a variety of platforms including in-person, virtually, and over the telephone. Sickle cell trait (SCT) education for parents of children with this trait is one of many education programs provided by the Ohio Department of Health. The novel SCTaware videoconference education program was developed by a research team after central Ohio's standard program transitioned from in-person to telephone-only education during the COVID-19 pandemic. Our objectives were to investigate the acceptability of the format and engagement with the SCTaware education and assess parental worry about having a child with SCT before and after receiving SCTaware. This was a single-center, prospective study of English-speaking parents of children <3 years of age identified to have hemoglobin S trait by newborn screening. Parents who previously received SCT education by telephone, were able to be contacted, and had access to an electronic device capable of videoconferencing were eligible to complete surveys after receiving the virtual SCTaware education program. The SCTaware educator also completed a survey to assess participant engagement. Data were summarized descriptively and a McNemar test was used to compare parental worry before and after receiving SCTaware. In total, 55 participants completed follow-up surveys after receiving standard SCT telephone education and then completing SCTaware. Most (n=51) participants reported that the SCTaware content and visuals were very easy to understand (n=47) and facilitated conversation with the educator (n=42). All of them said the visuals were respectful and trustworthy, helped them understand content better, and that their questions were addressed. Nearly two-thirds (62%, n=34) reported that the pictures appeared very personal and applied to them. The educator noted most participants (n=45) were engaged and asked questions despite having to manage distractions during their education sessions. Many participants (n=33) reported some level of worry following telephone-only education; this was significantly reduced after receiving SCTaware (P<.001). Our results suggest that SCTaware is acceptable and engaging to parents. While telephone education may make SCT education more accessible, these findings suggest that many parents experience significant worry about their child with SCT after these sessions. A study to evaluate SCTaware's effectiveness at closing parents' SCT knowledge gaps is ongoing.

Assortative mixing among vaccination groups and biased estimation of reproduction numbers

Assortative mixing among vaccination groups and biased estimation of reproduction numbers

Statewide transfer policy impact for parturients with severe features of hypertensive disorders of pregnancy

To address increases in severe maternal morbidity (SMM) and mortality, systematic improvements in the care of high-risk parturients at facility and population levels have been advocated. Part of this effort involves levels of maternal care which account for perinatal regionalization and risk-appropriate maternal care for high-risk patients. In 7/2019, the Ohio Department of Health’s Maternity Licensure requirements established transfer of patients ≥37 weeks from Level 1 and ≥34 weeks from Level 2 to Level 3 or 4 perinatal centers for hypertensive disorders of peripartum with severe features (HDP-SF).

When Is a Nursing Home Complaint Really a Complaint? Making Sense Out of Increased Complaints in U.S. Nursing Homes

Resident distress behavior, a prevalent challenge in long-term care, contributes to resident morbidity, staff burden, and turnover. We describe an education model developed in the Veterans Administration (VA) Community Living Centers (CLC) through a CONCERT (VA CLCs’ Ongoing Center for Enhancing Resources & Training) quality improvement series. The Distress Behavior Conversation (DBC) uses a team meeting structure and process. Informed by unmet need and relational coordination theories, it guides the whole team, inclusive of interdisciplinary team members and front-line staff with resident contact, through a collaborative problem-solving action-planning discussion. DBC uses facilitated round-robins to identify potential resident behavior causes and individualized solutions. DBC supports the team in maintaining whole person and whole team mindsets, thus challenging the narrower medical model of discipline-specific clinical mindsets and staff level hierarchies. Over two years we have co-created and refined DBC through trainings and team debriefings with over 80 CLCs. Care teams reported “aha” moments during DBCs their thinking shifted (“we are now looking at the REAL why”; “we went from asking, how did he fall? to, why did he fall?; “tended to try to treat falls in a standardized way, [but] when you focus on a specific person you get to focus on HIS needs”; “personal information about the Veteran is the 5th vital sign!”). Teams additionally reported reduced strain and improved collaborative thinking (“I feel better about what I’m doing...more motivated to keep going!; “Now I see it is a team approach – don’t have to do it by myself.”).

When Is a Nursing Home Complaint Really a Complaint? Making Sense Out of Increased Complaints in U.S. Nursing Homes

Intergenerational engagement provides a rich environment for people of different ages to come together and exchange life stories, skills, and knowledge. Today, intergenerational interactions are decreasing, however, these exchanges can have positive implications for seniors in residential care homes (RCHs) and younger persons. A scoping review following Arksey and O’Malley’s five-step framework was conducted to investigate the impact of intergenerational engagement and programs (IGPs) on older adults in RCHs. A systematic search of ten electronic databases and hand search of references was carried out; thematic content analysis to established key themes. A total of 1,183 academic and grey literature sources were reviewed, with 66 full-text studies assessed for eligibility. Of these sources, 35 studies met inclusion criteria. Studies highlighted four main themes: 1. Types of IGPs, 2. Psycho-social benefits for older adults and improved status among elders with cognitive impairments, 3. Younger person benefits, suggesting reduced ageism and improved social and communication skills, and 4. Program recommendations, including the need for enthusiastic program facilitators, coordination between facilities, sensitivity training for younger persons, detailed advertisements, and appropriate activities for different age groups. Findings inform future practice and research, highlighting that IGPs are an effective strategy to alleviate negative health outcomes for seniors in RCHs. Future research is needed to evaluate long-term effects and further health outcomes. IGPs provide an opportunity to facilitate purposeful and reciprocal relationships between generations, fostering intergenerational understanding. By studying IGPs and intergenerational interactions, we can better determine practices that meaningfully engage elders in RCHs in Canada.

Association of Lifetime History of Traumatic Brain Injury With Prescription Opioid Use and Misuse Among Adults

To investigate associations of lifetime history of traumatic brain injury (TBI) with prescription opioid use and misuse among noninstitutionalized adults. Ohio Behavioral Risk Factor Surveillance System (BRFSS) participants in the 2018 cohort who completed the prescription opioid and lifetime history of TBI modules (n = 3448). Secondary analyses of a statewide population-based cross-sectional survey. Self-report of a lifetime history of TBI using an adaptation of the Ohio State University TBI-Identification Method. Self-report of past year: (1) prescription pain medication use (ie, prescription opioid use); and (2) prescription opioid misuse, defined as using opioids more frequently or in higher doses than prescribed and/or using a prescription opioid not prescribed to the respondent. In total, 22.8% of adults in the sample screened positive for a lifetime history of TBI. A quarter (25.5%) reported past year prescription opioid use, and 3.1% met criteria for prescription opioid misuse. A lifetime history of TBI was associated with increased odds of both past year prescription opioid use (adjusted odds ratio [AOR] = 1.52; 95% CI, 1.27-1.83; P < .01) and prescription opioid misuse (AOR = 1.65; 95% CI, 1.08-2.52; P < .05), controlling for sex, age, race/ethnicity, and marital status. Results from this study support the "perfect storm" hypothesis-that persons with a history of TBI are at an increased risk for exposure to prescription opioids and advancing to prescription opioid misuse compared with those without a history of TBI. Routine screening for a lifetime history of TBI may help target efforts to prevent opioid misuse among adults.

During the COVID-19 Pandemic, Opioid Overdose Deaths Revert to Previous Record Levels in Ohio.

Objective:During the COVID-19 pandemic, states have had to confront a drug overdose problem associated with the pandemic. The objective of this study was to identify the impact of the COVID-19 pandemic on the opioid epidemic in the state of Ohio by describing the changes in the quarterly opioid overdose deaths (OOD) over the last 10 years.Methods:This longitudinal study included OOD data from death records obtained through the Ohio Department of Health. Temporal trend analysis and visualizations were performed on the OOD death rate per 100,000 quarterly from 2010 to 2020. Age, sex, and ethnicity were also analyzed.Results:The OOD rate of 11.15 in Q2 of 2020 was statistically equivalent to the previous peak level of 10.87 in Q1 of 2017. There was a significant increase in the OOD rate from Q1 to Q2 of 2020 and a significant difference between the actual Q2 of 2020 OOD rate and the predicted OOD rate. The poisoning indicator fentanyl was present in 94% of OOD during Q2 of 2020. The total number of OOD remains highest in the White population. There was no significant difference between the actual and predicted OOD rates in the Black population of Q2 of 2020 based on the trend line. However, the OOD rate of 14.29 in Q2 of 2020 was significantly higher than the previous peak level of 8.34 in Q2 of 2017. The Q2 of 2020 OOD rates for 18 to 39 and 40+ age groups were significantly higher from what would be expected from the trend predictions.Conclusions:Based on these findings, Ohio has entered a COVID-19 pandemic mediated fourth wave in the opioid epidemic. These findings further suggest that as efforts are made to address the worldwide COVID-19 pandemic, states need to maintain their vigilance toward combating the local opioid epidemic.

Supplemental Intraoperative Oxygen and Long-term Mortality: Subanalysis of a Multiple Crossover Cluster Trial.

Whether supplemental oxygen worsens long-term mortality remains unclear, with contradictory trial results. The authors therefore tested the hypothesis that supplemental oxygen (80% vs. 30%) increases the hazard for long-term mortality. The authors conducted a post hoc analysis of a large multiple crossover cluster trial in which more than 5,000 colorectal surgeries on 4,088 adults were allocated to receive either 30% or 80% inspired oxygen during general anesthesia. The authors assessed the effect of 80% versus 30% target-inspired oxygen on long-term mortality and calculated Kaplan-Meier survival estimates. Analysis was restricted to patients with a home address in Ohio because the authors could obtain reliable vital status information from the Ohio Department of Health (Columbus, Ohio) for them. A total of 3,471 qualifying colorectal surgeries performed in 2,801 patients were analyzed, including 1,753 (51%) surgeries in 1,577 patients given 80% oxygen and 1,718 surgeries in 1,551 patients given 30% oxygen. The observed incidence of death after a median of 3 yr was 13% (234 of 1,753) in the 80% oxygen group and 14% (245 of 1,718) in the 30% oxygen group. The estimated hazard ratio for mortality was 0.94 (95% CI, 0.78 to 1.13; P = 0.493). In this post hoc analysis of a large, controlled trial, supplemental oxygen did not increase postoperative mortality.

A spatiotemporal analysis of opioid poisoning mortality in Ohio from 2010 to 2016

Opioid-related deaths have severely increased since 2000 in the United States. This crisis has been declared a public health emergency, and among the most affected states is Ohio. We used statewide vital statistic data from the Ohio Department of Health (ODH) and demographics data from the U.S. Census Bureau to analyze opioid-related mortality from 2010 to 2016. We focused on the characterization of the demographics from the population of opioid-related fatalities, spatiotemporal pattern analysis using Moran’s statistics at the census-tract level, and comorbidity analysis using frequent itemset mining and association rule mining. We found higher rates of opioid-related deaths in white males aged 25–54 compared to the rest of Ohioans. Deaths tended to increasingly cluster around Cleveland, Columbus and Cincinnati and away from rural regions as time progressed. We also found relatively high co-occurrence of cardiovascular disease, anxiety or drug abuse history, with opioid-related mortality. Our results demonstrate that state-wide spatiotemporal and comorbidity analysis of the opioid epidemic could provide novel insights into how the demographic characteristics, spatiotemporal factors, and/or health conditions may be associated with opioid-related deaths in the state of Ohio.

PERKAWINAN SESAMA JENIS DAN HAK ASASI MANUSIA: PENERAPAN PRINSIP EQUALITY DALAM PUTUSAN OBERGEFELL, et.al. v. HODGES, USA SERTA ANALISIS MENGENAI PERKAWINAN SESAMA JENIS DI INDONESIA

The ‘rights’ and ‘equality’ arguments have been widely used in the last couple of years by the same-sex marriage supporters in claiming the legalization of same-sex marriage. The principle of equality in same-sex marriage legalization claims is closely related with the concept of human rights on the ground that the principle of equality is considered as one of the most important principles in the said concept. The decision of the Supreme Court of the United States of America in Obergefell et al. v. Hodges, Director, Ohio Department of Health is the latest decision concerning the legalization of same-sex marriage that changes radically the legality of same-sex marriage in the United States and may affect other nations. This research analyzes the said Decision, specifically on the application of the principle of equality. This research also analyzes the same-sex marriage issue in Indonesia from the perspective of universality and cultural relativism of human rights. The conclusion of this research is that the principle of equality in the Decision of the Supreme Court of the United States of America was not correctly applied and therefore it cannot be used in the same-sex marriage claims. And in Indonesia, it can be concluded that from the perspective of universality and cultural relativism of human rights, same-sex marriage cannot be legalized.Keywords: human, rights, same-sex, marriage, equality, universality, cultural, relativism.

Responsible Return to Essential and Non-Essential Surgery During the COVID-19 Pandemic

Non-essential surgery had largely been suspended during the COVID-19 Pandemic. Enormous amounts of resources were utilized to shift surgical practices to a “disaster footing” with most elective surgeons assuming new roles to offset the anticipated burden from surgical and medical personnel delivering acute care. As the number of COVID-19-infected patients began to plateau in the state of Ohio, a four-phase “Responsible Return to Surgery” approach was adopted in concert with the Ohio Department of Health and the Ohio Hospital Association. This approach was adopted understanding that a simple return to the status quo prior to the COVID-19 pandemic might be harmful to patients, providers, and staff. The discrete phases undertaken at our quaternary care institution for a responsible return to non-essential surgery are outlined with the goal of ensuring timely care, minimizing community transmission, and preserving personal protective equipment. Operationalizing these phases relied upon the widespread use of telehealth, systematic COVID-19 testing, and real-time monitoring of hospital and personal protective equipment resources.

Ohio First Steps for Healthy Babies: A Program Supporting Breastfeeding Practices in Ohio Birthing Hospitals

Background: Ohio First Steps for Healthy Babies (First Steps) is a free, voluntary statewide designation program coadministered by the Ohio Department of Health and the Ohio Hospital Association that promotes breastfeeding-supportive maternity practices aligned with the Baby-Friendly Hospital Initiative (BFHI).Materials and Methods: We examined Ohio birthing hospitals’ participation in First Steps, and changes in breastfeed-ing rates at hospital discharge, over the first 12 quarters of the program (July 15, 2015, to July 14, 2018) for all 110 licensed Ohio birthing hospitals. The 81 (73.6%) that achieved at least 1 step over the study period (designated as First Steps hospitals) were compared to the 29 non-First Steps hospitals, and the 17 that began participation at First Steps startup (July 15, 2015) were identified for additional analysis. Changes in breastfeeding rates were examined using a mixed effects multivariate regression model.Results: Breastfeeding increased significantly over the program period from 73.8% to 76.7% (mean 0.19% per quarter, p = .0002), but without a significant difference in breastfeeding rates between First Steps and non-First Steps hospitals. However, in a pre- and post-program analysis for the 17 hospitals that began participation at First Steps startup (excluding an additional 6 hospitals with BFHI designation), number of quarters in the program, number of steps completed, and number of births in 2015 were significantly associated with breastfeeding rates. Hospitals that completed at least 2 steps every 5 quarters in the First Steps program increased breastfeeding when compared to those not participating in the program.Conclusion: These encouraging results provide a formal evaluation of a best practices BFHI-modelled statewide program.

Abstract C057: Neighborhood disadvantage is associated with liver cancer treatment and survival

Abstract Liver cancer is the 5th leading cause of cancer mortality in the United States and is predicted to increase in the US as a consequence of the opioid epidemic. Associations between individual-level risk factors, such as socioeconomic status, and liver cancer survival have been explored; however, the role of neighborhood-level factors, such as neighborhood deprivation, are noticeably absent from the literature. We explored the association between greater neighborhood deprivation and disparities in tumor characteristics, treatment and 5-year survival among primary liver cancer patients in Ohio diagnosed between 2003 and 2016 using data from the Ohio Cancer Incidence Surveillance System. We restricted our sample to only patients who were 18 years older and who could be geographically linked to a census tract based on their address at diagnosis. We created a neighborhood deprivation index (NDI) using nine variables at the Census tract level including: % less than high school diploma, % college graduates, % at or below the federal poverty line, % unemployed, median household income, % vacancy, % owner occupied unites, median house/unit value and % African American. We used principal component analysis to create the index and derived quintiles of deprivation with the higher quintiles reflective of areas with higher deprivation. We examined associations between tumor characteristics and NDI quintile using chi-square tests and ANOVA. We examined concordance with treatment guidelines as binary variable using log-binomial regression. For 5-year survival we utilized Cox proportional hazard models. Confounding variables for each regression model were selected using Directed Acyclic Graphs. After exclusion criteria were applied, 8,208 primary liver cancer patients were included in the study. We observed no statistically significant differences in tumor characteristics by quintile of NDI. However, we found a clear gradient between levels of deprivation and decrease likelihood of receiving guideline-concordant care. Specifically, between the most and least deprived areas, a 25% lower risk (Risk ratio [RR]=0.75; 95% Confidence Interval [CI]=0.67, 0.85) of receiving guideline-concordant care was observed in our adjusted log-binomial regression model. In adjusted survival models we observed an increased risk of death comparing the most and least deprived areas (Hazard ratio [HR]=1.14, 95% CI=1.02, 1.27). Our study suggests a potential negative effect of neighborhood deprivation on treatment concordance and liver cancer survival. Interventions targeting disparities in liver cancer should focus on not only individual level factors but address larger neighborhood level factors as well. Future analyses are needed to confirm these disparities observed and determine if similar neighborhood level effects occur in other cancer disparities. This study includes data provide by the Ohio Department of Health which should not be considered an endorsement of this study or its conclusions. Citation Format: Robert B Hood, Ashley Felix. Neighborhood disadvantage is associated with liver cancer treatment and survival [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C057.