Philadelphia County Research Articles

Examining multilevel neighborhood socioeconomic characteristics associated with colorectal cancer screening in Vietnamese Americans residing in Philadelphia County.

Colorectal cancer (CRC) is one of the most predominant cancers in the USA and ranks third among all cancers in incidence and mortality. Vietnamese Americans exhibit persistently lower screening rates compared to the general U.S. population, due to cultural, economic, and environmental barriers. The impact of environmental factors in particular is not well known, and lack of geographical access may be a significant barrier to accessing screening. This study aims to elucidate build and neighborhood environmental factors affecting CRC screening rates among Vietnamese Americans. A total of 517 Vietnamese Americans 50 years and older residing in Philadelphia County were included in the study. Surveys were collected to determine CRC screening behavior and sociodemographic characteristics. Individual neighborhood characteristics, which included the Walk Score, was obtained based on the participant's address. Neighborhood characteristics were calculated using census-tract level data for the social deprivation index, ethnic composition, and presence of hospitals or federally qualified health centers (FQHC). The generalized linear mixed model revealed that residing in an ethnically dense neighborhood was negatively associated with CRC screening (β = -0.67, SE = 0.29, p = .01), while social deprivation (β = 0.30, SE = 0.27, p = .27) and presence of FQHCs or hospitals (β = 0.16, SE = 0.30, p = .58) were not. Individual neighborhood characteristics including the Walk Score (β = 0.21, SE = 0.26, p = .43) was not associated with CRC screening behavior. Neighborhood characteristics, specifically ethnic density is associated with lower uptake of screening in this population. Future interventions should aim to target specific Vietnamese American and other Asian ethnic neighborhoods that may experience disparities in screening.

Assessing proximate intermediates between ambient temperature, hospital admissions, and mortality in hemodialysis patients.

Typical thermoregulatory responses to elevated temperatures among healthy individuals include reduced blood pressure and perspiration. Individuals with end-stage kidney disease (ESKD) are susceptible to systemic fluctuations caused by ambient temperature changes that may increase morbidity and mortality. We investigated whether pre-dialysis systolic blood pressure (preSBP) and interdialytic weight gain (IDWG) can independently mediate the association between ambient temperature, all-cause hospital admissions (ACHA), and all-cause mortality (ACM). The study population consisted of ESKD patients receiving hemodialysis treatments at Fresenius Medical Care facilities in Philadelphia County, PA, from 2011 to 2019 (n=1981). Within a time-to-event framework, we estimated the association between daily maximum dry-bulb temperature (TMAX) and, as separate models, ACHA and ACM during warmer calendar months. Clinically measured preSBP and IDWG responses to temperature increases were estimated using linear mixed effect models. We employed the difference (c-c') method to decompose total effect models for ACHA and ACM using preSBP and IDWG as time-dependent mediators. Covariate adjustments for exposure-mediator and total and direct effect models include age, race, ethnicity, blood pressure medication use, treatment location, preSBP, and IDWG. We considered lags up to two days for exposure and 1-day lag for mediator variables (Lag 2-Lag 1) to assure temporality between exposure-outcome models. Sensitivity analyses for 2-day (Lag 2-only) and 1-day (Lag 1-only) lag structures were also conducted. Based on Lag 2- Lag 1 temporal ordering, 1°C increase in daily TMAX was associated with increased hazard of ACHA by 1.4% (adjusted hazard ratio (HR), 1.014; 95% confidence interval, 1.007-1.021) and ACM 7.5% (adjusted HR, 1.075, 1.050-1.100). Short-term lag exposures to 1°C increase in temperature predicted mean reductions in IDWG and preSBP by 0.013-0.015% and 0.168-0.229mmHg, respectively. Mediation analysis for ACHA identified significant indirect effects for all three studied pathways (preSBP, IDWG, and preSBP+IDWG) and significant indirect effects for IDWG and conjoined preSBP+IDWG pathways for ACM. Of note, only 1.03% of the association between temperature and ACM was mediated through preSBP. The mechanistic path for IDWG, independent of preSBP, demonstrated inconsistent mediation and, consequently, potential suppression effects in ACHA (-15.5%) and ACM (-6.3%) based on combined pathway models. Proportion mediated estimates from preSBP+IDWG pathways achieved 2.2% and 0.3% in combined pathway analysis for ACHA and ACM outcomes, respectively. Lag 2 discrete-time ACM mediation models exhibited consistent mediation for all three pathways suggesting that 2-day lag in IDWG and preSBP responses can explain 2.11% and 4.41% of total effect association between temperature and mortality, respectively. We corroborated the previously reported association between ambient temperature, ACHA and ACM. Our results foster the understanding of potential physiological linkages that may explain or suppress temperature-driven hospital admissions and mortality risks. Of note, concomitant changes in preSBP and IDWG may have little intermediary effect when analyzed in combined pathway models. These findings advance our assessment of candidate interventions to reduce the impact of outdoor temperature change on ESKD patients.

Behavioral health service use post-jail release and reduced risk of return to jail.

This study examined whether behavioral health service use post-jail release was associated with reduced risk of jail reincarceration. The study sample included 20,615 individuals who had behavioral health diagnoses and were released from the Philadelphia County jail. Using administrative records of the county jail and state-, county-, and Medicaid-funded behavioral health service use from 2010 to 2018, we conducted Cox proportional hazard analyses to estimate the association between behavioral health service use post-jail release and the risk of return to jail within 3 years. Nearly 50% of the sample returned to jail within 3 years. Individuals who used behavioral health services were 26%-38% less likely to return to jail within 3 years than were individuals who did not. The study results suggest that connecting individuals with behavioral health services upon release from jail can reduce the risk of repeated jail incarceration.

Abstract PO-054: Evidence-based sexual health education program among at-risk youth baseline findings

Abstract Background: Of the estimated 26 million new diagnosis of sexually transmitted infections (STIs) each year, youth aged 15 – 24yo constitute half of these. The most common STI, Human Papillomavirus (HPV), is the primary cause of cervical, anal, and oropharyngeal cancers. Racial and ethnic minority youth are at increased risk for STIs such as HPV. Lack of access to comprehensive sexual health education leave youth vulnerable to STI's which increase their risk of certain cancers. This study describes characteristics of participants regarding engagement in sexual behaviors and knowledge and attitudes towards STI protection. Methods: Proud-Teens of Philly (PTOP), an evidence-based program, was implemented in youth (n=212) aged 12-19 years in Philadelphia County recruited from a network of partner sites. Program implementation occurred over nine one-hour virtual sessions. The program aimed to reduce risky sexual behaviors by promoting healthy choices and increasing knowledge of sexual health. Participants completed a pre-survey administered online prior to starting the program. Results: Participants' average age was 14.2 years old, 49.2% of participants identified as Hispanic/Latino, and (21.2%) of participants were Non-Hispanic Black, followed by Non-Hispanic white (30.7%). At baseline, 12.8% of participants have been or are currently sexually active, and about half felt strongly about delaying sexual behavior (52.8%). Findings revealed gaps in communication about barrier protection with sexual partners. While 82.0% indicate they agree condoms are effective in preventing STI transmission, there was a low perceived susceptibility of contracting an STI. Conclusion: Findings suggest implementing Proud Teens of Philly may be beneficial in reducing STIs and HPV related cancers among at-risk youth by promoting healthy sexual behaviors. Citation Format: Ra'Ann Merceir, Aisha Bhimla, Adebola Duro-Aina, Yin Tan, Sabrina Liao, Min Qi Wang, Renee Jackson, Grace X. Ma. Evidence-based sexual health education program among at-risk youth baseline findings [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-054.

Funding from Pennsylvania for drop‐in centers

Funding for substance use disorder (SUD) drop‐in centers is open to existing drop‐in centers in Allegheny, Philadelphia, Bucks, Delaware and Montgomery counties in Pennsylvania. Single county authorities (SCAs) are not eligible to apply, nor are Department of Drug and Alcohol Programs–licensed treatment providers. The purpose is to expand drop‐in center services for individuals with SUD in areas of the commonwealth experiencing high overdose deaths. About two to three grants of up to $650,000 each will be awarded. The application deadline is Dec. 13. For more information, go to https://www.ddap.pa.gov/DDAPFunding/Pages/Funding‐Opportunities.aspx. The source of the funding is federal.

Philadelphia's Excise Tax on Sugar-Sweetened and Artificially Sweetened Beverages and Supplemental Nutrition Assistance Program Benefit Redemption.

Objectives. To assess the effect of a 2017 excise tax on sugar and artificially sweetened beverages in Philadelphia, Pennsylvania, on the shopping patterns of low-income populations using Supplemental Nutrition Assistance Program (SNAP) data. Methods. I used a synthetic controls approach to estimate the effect of the tax on Philadelphia and neighboring Pennsylvania counties (Bucks, Delaware, and Montgomery) as measured by total SNAP sales ("SNAP redemption") and SNAP redemption per SNAP participant. I assembled biannual data (2005-2019) from all US counties for SNAP redemption and relevant predictors. I performed placebo tests to estimate statistically significant effects and conducted robustness checks. Results. Detectable increases in SNAP spending occurred in all 3 Philadelphia neighboring counties. Per-participant SNAP spending increased in 2 of the neighboring counties and decreased in Philadelphia. These effects were robust across multiple specifications and placebo tests. Conclusions. The tax contributed to increased SNAP shopping in Philadelphia's neighboring counties across both outcome measures, and decreased spending in Philadelphia (at least by 1 measure). This raises questions about retailer behavior, the effectiveness of the tax's public health aim of reducing sugar-sweetened beverage consumption, and policy aims of investing in low-income communities. (Am J Public Health. 2021;111(11):1986-1996. https://doi.org/10.2105/AJPH.2021.306464).

A Synthetic Control Analysis of Philadelphia, Pennsylvania’s Excise Tax on Sugar-Sweetened and Artificially Sweetened Beverages and Supplemental Nutrition Assistance Program Benefit Redemption

Objectives: To assess the effect of a 2017 excise tax on sugar and artificially-sweetened beverages in Philadelphia, Pennsylvania on the shopping patterns of low-income populations using Supplemental Nutrition Assistance Program (SNAP) data. Methods: A synthetic controls approach was used to estimate the effect on Philadelphia and neighboring Pennsylvania counties (Bucks, Delaware, Montgomery) as measured by total SNAP sales (“SNAP redemption”) and SNAP redemption per SNAP participant. Biannual data (2005-2019) were assembled from all US counties for SNAP redemption and relevant predictors. Placebo tests were performed to estimate statistically significant effects, and robustness checks were conducted. Results: Detectable increases in SNAP spending were observed in all Philadelphia neighbors. Increases in per-participant SNAP spending were detected in two neighbors, and a decrease was detected in Philadelphia. These effects were robust across multiple specifications and placebo tests. Conclusions: The tax contributed to increased SNAP shopping in Philadelphia’s neighbors across both outcome measures, and decreased spending in Philadelphia (at least by one measure). This raises questions about retailer behavior, the effectiveness of the tax’s public health aim of reducing SSB consumption, and policy aims of investing in low-income communities.

How has the COVID-19 Pandemic Impacted the Clinical Volume and Variety of an Academic Oral and Maxillofacial Surgery Program?

PurposeAttempts to mitigate the coronavirus disease of 2019 (COVID) have disrupted the delivery of non-pandemic care. The purpose of this study was to evaluate the effects of the COVID pandemic on surgical volume and variety at an academic oral and maxillofacial surgery program. Materials and methodsA retrospective cohort study was conducted using the surgical logs of the University of Pennsylvania, Department of Oral and Maxillofacial Surgery from January 2012 through January 2021. Each record identified patient demographics and case classifications. Of note, the surgical logs analyzed were only those which were performed in the operating room and not the outpatient clinic nor emergency department. The study predictor was timing of care, which was divided into pre-pandemic, peak pandemic, or post-peak pandemic. The primary study outcomes were the monthly procedure count and the procedure categories. The secondary dependent variables were patient age and race. Multivariate and univariate analyses of variance were used to determine whether pandemic effects existed within outcome groups. ResultsThe final sample included 64,709 surgical procedures (Table 1). Before, during, and after the pandemic peak, there were means of 691.0, 209.0, and 789.4 procedures per time period, respectively (p < 0.01) (Table 2). There were significantly more infection (baseline 2.2%, peak 6.0%, post-peak 2.0%, p<0.01) and trauma (baseline 5.3%, peak 26.7%, post-peak 3.9%, p<0.01) cases during the pandemic peak (Table 3). The mean percentage of pediatric patients increased during the peak and post-peak periods (baseline 2.4%, peak 12.9%, post-peak 10.2%, p<0.01) (Table 3). No differences were observed among the mean percentage of white (p=0.12), black (p=0.21), and Hispanic (p=0.25) patients treated (Table 3). ConclusionAlong with a predictable decline in surgical numbers, a greater proportion of infection and trauma procedures were performed at the pandemic's peak; trauma accounted for over a quarter of surgical cases during this peak. One potential reason for this could be due to an increase in at-home domestic violence. Pennsylvania issued a stay-at-home order for Philadelphia County from March 23 until May 8, 2020. A recent study highlighted that there was a regional decrease in the overall volume of trauma at the University of Pennsylvania [1]. This was largely driven by parallel decreases in the number of unintentional injury mechanisms, such as motor vehicle collisions. Interestingly, there was a paradoxical increase in the number of intentional interpersonal injuries [1]. In fact, the number of domestic assault cases grew by at least 5% during this time at the national level [2].The increase in infections may be due to outpatient dental services being inaccessible during the pandemic's peak, causing patients with odontogenic infections to have limited care options. Furthermore, because most patients were avoiding local emergency departments that were overwhelmed with COVID, it is probable that certain mild infections that otherwise could be treated in-office may have transformed into more severe airway threatening conditions that required operating room drainage. Despite all these changes, surgery volume normalized, and case variety returned to pre-pandemic levels in the post-peak period. Our study suggests that the addition of COVID restrictions did not change the case volume or variety in the months after the initial crisis.

Investigating the role of clinical measures before dialysis treatment as mediators in the association between ambient temperature and mortality/hospital admissions

BACKGROUND AND AIM: Typical thermoregulatory responses among healthy individuals include reduced blood pressure and perspiration. Individuals living with end-stage renal disease (ESRD) are susceptible to physiological fluctuations caused by ambient temperature changes that may increase health complications. We investigated whether systolic blood pressure (preSBP) and interdialytic weight gain change (IDWG) can independently mediate the association between ambient temperature and hospital admissions and between mortality outcomes among ESRD patients. METHODS: The study population consisted of ESRD patients in Philadelphia County, PA, from 2011 to 2019 (n=1981). Within a time-to-event framework, we estimated the association between daily maximum dry-bulb temperature (TMAX) and, in separate models, all-cause hospital admissions (ACHA) and all-cause mortality (ACM) outcomes during warmer calendar months. The study employed the difference (c-c') method to decompose total effect models for ACHA and ACM using preSBP and IDWG as time-dependent mediators and then applied proportion mediated (PM) using indirect effects. Covariate adjustments for total and direct effect models include age, race/ethnicity, blood pressure medication use, treatment location, preSBP, and IDWG. RESULTS:Based on Lag 2- Lag 1 temporal ordering, 1°C TMAX increase in was associated with an increased hazard of ACHA by 7.6% (adjusted hazard ratio (HR), 1.076; 95% confidence interval, 1.070-1.082) and ACM 7.5% (adjusted HR, 1.075, 1.050-1.100). Mediation analysis for hospital admission events identified significant indirect effects for all three studied pathways and significant indirect effects for IDWG and conjoined preSBP + IDWG pathways for mortality. The mechanistic path for IDWG, independent of preSBP, demonstrated inconsistent mediation in ACHA (-2.67%) and ACM (-6.26%). PM estimates from the conjoined pathway suggest that it is likely not a candidate path in combined pathway models. CONCLUSIONS:This work has provided a step toward understanding physiological linkages that may explain or suppress temperature-driven hospital admissions and mortality risks. These findings could help discern candidate heat-adaptation interventions. KEYWORDS: Survival, temperature, Short-term exposure, Epidemiology, Mortality, Environmental epidemiology

SARS-CoV-2 Infection in Public School District Employees Following a District-Wide Vaccination Program - Philadelphia County, Pennsylvania, March 21-April 23, 2021.

The School District of Philadelphia reopened for in-school instruction the week of March 21, 2021, and required weekly testing for SARS-CoV-2, the virus that causes COVID-19, for all employees returning to in-school responsibilities. The resumption of in-school instruction followed a mass vaccination program using the Pfizer-BioNTech 2-dose vaccine offered under a partnership between the Philadelphia Department of Public Health and Children's Hospital of Philadelphia to all 22,808 School District of Philadelphia employees during February 23-April 3, 2021.* The subsequent mandatory testing program provided an opportunity to assess the percentage of positive BinaxNow point-of-care antigen tests (Abbott Laboratories) identified among school staff members based on their self-reported vaccination status (i.e., received zero, 1, or 2 vaccine doses) at the time of testing. During the initial 5 weeks after schools reopened, 34,048 screening tests were performed. Overall, 0.70% of tests returned a positive result. The percentage of positive test results was lower among persons who reported receipt of 2 vaccine doses (0.09%) compared with those who reported receipt of 1 dose (1.21%) or zero doses (1.76%) (p<0.001) representing a 95% reduction in percentage of positive SARS-CoV-2 test results among persons reporting receipt of 2 compared with zero doses of Pfizer-BioNTech vaccine. Vaccination of school staff members has been highlighted as an important strategy to maximize the safety of in-person education of K-12 students this fall (1). These findings reinforce the importance of promoting COVID-19 vaccination among school staff members before commencement of the 2021-22 school year.

Our Relationships Carry the Movement

AbstractThe radical HIV prison activist movement has always been, in practice, an abolitionist movement. Set in Philadelphia in the early 2000s, this article centers the relationships through which leaders of ACT UP Philadelphia, the Philadelphia County Coalition for Prison Health Care, TEACH Outside, and Project UNSHACKLE worked to transform the social conditions for which prisons have been posited as the solution and to create a prison-free future in real time. Its pages unfold a three-part methodological toolkit for HIV prevention justice. First, harm reduction demands that one show up and provide relief, no questions asked. Second, mutual aid grounds the forging of new social relations that are more survivable than those produced by HIV stigma, mass criminalization, and organized abandonment. Third, transformative justice offers both a vision and a practice for challenging criminalization in all its intimate, communal, and structural forms, and building a racially just and strategic HIV movement.

No Evidence of Food or Alcohol Substitution in Response to a Sweetened Beverage Tax

Evidence suggests real-world beverage taxes reduce sweetened beverage purchases, but it is unknown if consumers consequently increase food or alcohol purchases. This study examines whether Philadelphia's 1.5 cents/ounce beverage tax was associated with substitution to 3 kinds of hypothesized substitutes: snacks, nontaxed beverage concentrates, and alcohol. Using commercial retail sales data and a difference-in-differences approach, analyses compared logged volume and dollar sales of snacks and beverage concentrates between 2016 (pretax) and 2017 (post-tax) at chain food retail stores in Philadelphia (n=180) and Baltimore (nontaxed control city; n=60), and logged volume and dollar sales of wine and spirits at liquor stores in Philadelphia (n=44) and nearby Pennsylvania counties (alternate control; n=66). Additional food analyses examined change in logged volume sales of hypothesized products compared to control products (other foods). Analyses were conducted in 2020. Across store types, analyses showed no statistically significant increases in logged volume or dollar sales of snacks or spirits in Philadelphia stores compared to control sites (decreased, ranging from -10% to 0%). Supermarket analyses showed substitution to nontaxed beverage concentrates (27% increase in volume, 36% increase relative to other food) but remained a relatively small percentage of overall beverage dollar sales (12% at baseline, 15% at post). At the population level, there is no evidence that Philadelphia's decline in taxed beverage purchases is offset by increases in snacks or spirits purchasing, but there is evidence of substitution to beverage concentrates in supermarkets. Future studies should explore individual-level purchasing changes.

434. Tracking COVID-19 in Real Time: Leveraging Public Data Sources to Inform Infection Prevention Practices

BackgroundGlobal spread of SARS-CoV-2 led to an urgent need for data on national and regional prevalence to inform public health policy. Healthcare systems were also in need of data to develop best practices around defining patient risk. We describe a data analytics tool developed at our institution which uses public data sources to track county-level prevalence of COVID-19 so as to delineate risk for individual patients.MethodsWe investigated a number of data sources tracking COVID-19 case counts, assessing for (1) frequency of updates, (2) granularity of geographic detail (optimally to zip-code or county) and (3) completeness of the data. We chose the Johns Hopkins University CSSE COVID-19 data set. This contains counts of new diagnoses per day by county using Federal Information Processing System (FIPS) codes. The dataset is updated daily with adjustments made for backdated corrections.We developed a data analytics tool which allowed for direct comparison of county period prevalence. We developed a metric of 10-day rolling period prevalence calculated as a total case count from the preceding 10 days, divided by county population from 2018 American Community Survey (ACS) estimates.ResultsBenchmarking against local (peak of 3.12 cases per 1,000 persons) and regional prevalence, we set 6 cases/1,000 persons as the threshold for a Geographic Region with Widespread Community Transmission (GReWCoT). Counties have to reach this threshold for at least 4 out of 7 days within the period 3 to 10 days prior to the evaluation, to adjust for bulking of test results and delayed reporting.We used the analytics tool to support a semimonthly review of geographic regions, and made specific recommendations for patients from qualifying regions including use of modified enhanced precautions (including surgical mask and eye protection), as well as restricted visitation of caregivers.Figure 1. Epidemic curves for 10-day rolling period prevalence of COVID-19 in the Mid-Atlantic Region: Philadelphia County, PA Figure 2. Epidemic curves for 10-day rolling period prevalence of COVID-19 in the Mid-Atlantic Region: Westchester County, NY Figure 3. Epidemic curves for 10-day rolling period prevalence of COVID-19 in the Mid-Atlantic Region: Bergen County, NJ ConclusionThis approach allowed for a nuanced investigation of COVID-19 prevalence in real-time, and provided support for risk stratification of patients throughout our large catchment area. The dashboard was shared on an inward-facing site to support staff messaging about regions of increased risk. Next steps include leveraging international data to inform a similar approach to international travel for our patients and staff.Disclosures All Authors: No reported disclosures

Preparing pharmacists to increase naloxone dispensing within community pharmacies under the Pennsylvania standing order.

Opioid misuse and overdose deaths remain a public health concern in the United States. Pennsylvania has one of the highest rates of opioid overdose deaths in the country, with Philadelphia County's being 3 times higher than the national average. Despite several multimodal interventions, including use of SBIRT (screening, brief intervention, and referral to treatment) methods and naloxone distribution, the rate of overdose deaths remains high. To gain insights on strategies for improving access to naloxone and naloxone distribution by pharmacists in Philadelphia County, a study was conducted in 11 community pharmacies (chain and independent) in Philadelphia. Twenty-four pharmacists were recruited and completed SBIRT and naloxone trainings. Each pharmacy elected to have at least 1 pharmacy champion who received additional training on and helped develop pharmacy site-specific naloxone dispensing protocols. Pre-post survey results showed a reduction in stigmatizing attitudes regarding naloxone dispensing and an increase in pharmacists' understanding of the standing order and appropriate naloxone use. There was an increase in pharmacists' self-reported confidence in their ability to appropriately identify, discuss, and dispense naloxone to patients. All pharmacies increased their average monthly dispensing rate following protocol implementation. Pharmacists who received both trainings were more likely to change naloxone dispensing practices, leading to an overall increase in naloxone dispensing by community pharmacists. The study addressed overall gaps in pharmacists' knowledge, reduced stigma, and prepared pharmacists to address opioid use and overdose prevention with their patients. The described pharmacist-led patient counseling and intervention service for overdose prevention may be explored as a model for other community pharmacies to adopt to improve naloxone dispensing and similar interventions to reduce overdose deaths.

The Burden of Gastroenteritis Outbreaks in Long-Term Care Settings in Philadelphia, 2009–2018

Background: Gastroenteritis causes significant morbidity and mortality in long-term care facility (LTCF) residents, a growing population within the United States. Methods: We conducted a retrospective cross-sectional study in LTCFs in Philadelphia County from 2009 to 2018. Outbreak characteristics and interventions were extracted from Philadelphia Department of Public Health’s (PDPH) database, and quality data on all LTCFs was extracted from the CMS Nursing Home Compare database. Results: We identified 121 gastroenteritis outbreaks in 49 facilities. Numbers of affected patients ranged from 2 to 211 patients (median patient attack rate, 17%). Staff were reported ill in 94 outbreaks (median staff attack rate, 5%). Outbreak facilities were associated with higher occupancy rates (91% vs 88%; P = .033) and total bed numbers (176 vs 122; P = .071) when compared to nonoutbreak facilities. Higher rates of staff illness were associated with prolonged outbreaks (13% vs 4%; P &lt; .001) and higher patient illness rates (9% vs 4%; P = .012). Prolonged outbreaks were associated with lower frequency of cohorting for outbreak management (13% vs 41%; P = .046). Conclusions: This study is the largest published analysis of gastroenteritis outbreaks in LTCFs. Facility characteristics and staff disease 20 activity were associated with more severe outbreaks. Heightened surveillance for gastrointestinal symptoms among staff and increased 21 use of cohorting might reduce the risk of prolonged gastroenteritis outbreaks in LTCF.Funding: NoneDisclosures: None

Are Charter Schools Safer than District-Run Schools? Evidence from Pennsylvania

ABSTRACT Access to public charter schools could theoretically reduce school safety problems by increasing competitive pressures, improving matches between schools and students, enhancing discipline policies, and allowing students to relocate to peer groups and cultures that discourage risky behaviors. Using publicly available data from the Pennsylvania Department of Education, this study examines differences in reports of 58 school safety problems between public charter and district-run public school sectors in the 2018–19 school year. After controlling for several differences in students between sectors, public charter schools generally report fewer school safety problems than district-run public schools in Pennsylvania. These charter school sector advantages are generally more pronounced for cyber charter schools than brick-and-mortar charter schools, and for charter schools located in Philadelphia County than charter schools located in the rest of the state.

What explains the housing boomlet in the city of Philadelphia?

Since 2003 a sizeable shift has occurred in the location of new housing units in the Pennsylvania portion of the Philadelphia metropolitan area, which consists of four suburban counties and Philadelphia County (the central city). The percentage of units located in the city of Philadelphia increased from an average of 4.6 per cent per year in the 1990s, to over 20 per cent during 2004–11, and to over 40 per cent starting in 2012. This paper stipulates that demand for new housing in the central city appears to be driven by the large increase in employment in the education and health services and, to a lesser extent, employment in business services. On the supply side, the city of Philadelphia facilitated housing supply in the central city by providing a ten-year abatement of property taxes for new housing and initiated the Neighborhood Transformation Initiative (NTI). NTI involved the sale of bonds to finance the demolition of abandoned structures and the assembly of land for development.

The burden of gastroenteritis outbreaks in long-term care settings in Philadelphia, 2009-2018.

Gastroenteritis causes significant morbidity and mortality in long-term care facility (LTCF) residents, a growing population within the United States. We set out to better understand gastroenteritis outbreaks in LTCF by identifying outbreak and facility characteristics associated with outbreak incidence as well as outbreak duration and size. We conducted a retrospective cross-sectional study on LTCFs in Philadelphia County from 2009 to 2018. Outbreak characteristics and interventions were extracted from Philadelphia Department of Public Health (PDPH) database and quality data on all LTCFs was extracted from Centers for Medicare and Medicaid Services Nursing Home Compare database. We identified 121 gastroenteritis outbreaks in 49 facilities. Numbers of affected patients ranged from 2 to 211 patients (median patient illness rate, 17%). Staff were reported ill in 94 outbreaks (median staff illness rate, 5%). Outbreak facilities were associated with higher occupancy rates (91% vs 88%; P = .033) and total bed numbers (176 vs 122; P = .071) compared to nonoutbreak facilities. Higher rates of staff illness were associated with prolonged outbreaks (13% vs 4%; P < .001) and higher patient illness rates (9% vs 4%; P = .012). Prolonged outbreaks were associated with lower frequency of cohorting for outbreak management (13% vs 41%; P = .046). This study is the largest published analysis of gastroenteritis outbreaks in LTCFs. Facility characteristics and staff disease activity were associated with more severe outbreaks. Heightened surveillance for gastrointestinal symptoms among staff and increased use of cohorting might reduce the risk of prolonged gastroenteritis outbreaks in LTCF.

Abstract C022: Effect of migration to the US on health characteristics of the African diaspora

Abstract Introduction: The current US Black population is heterogeneous, consisting of individuals of US ancestry (direct descendants of enslaved Africans in the US) and individuals of African and Caribbean ancestry (descendants or individuals who have voluntarily migrated to the US post-slavery). Our previous work has shown distinct differences between Black immigrants and US-born Blacks in cancer survival, and cancer fatalism. This study will assess the differences in cancer risk factors, risk behaviors and health-seeking patterns among the African diaspora living in Philadelphia County compared to that of their native countries. Methods: STEPs data Forty-eight countries were defined as Sub-Saharan Africa (SSA) and 29 islands/island groupings were defined as the Caribbean (CA). Sixteen variables of interest were selected including: percentage overweight, percentage who currently smoke tobacco daily, percentage of current drinkers, and average BMI. CAP3 data Recruitment activities took place throughout Philadelphia County beginning in 2012 and is ongoing. Subjects completed a detailed questionnaire assessing behavioral, nutritional, demographics and provided bio-specimens. Results: Data were available for 39 SSA countries and nine CA islands and were included in the analysis for this study. The CAP3 dataset has a high response rate and most variables of interest included the full study population. Mean BMI reported from the STEPS data was 22.8 (95% CI 19.6-26.1) and 27.1 (95% CI 26.6-27.5) kg/m2 for the SSA and the CA, respectively; BMI for African and Caribbean immigrants were 28.6 (95% CI 27.6-29.6) and 28.8 (95% CI 27.5-30.2), respectively, a considerable increase among African immigrants. Alcohol consumption was highest in the Caribbean (54% [95% CI 52.1-55.9] vs 26.5% [95% CI 25.4-27.8]) and Caribbean immigrants in the CAP3 population (23.7% [95% CI 14.7-32.6] vs 16% [95% CI 10.6-21.4]) when compared to SSA and African immigrants, respectively. A noticeable difference was also observed in the proportion of individuals that currently used tobacco. A higher proportion of individuals reported current daily tobacco use in SSA and the CA when compared to immigrants in the CAP3 dataset (SSA: 8.2% [95% CI: 6.2-10.3]; CA 12.2% [95% CI: 10.1-14.2] vs. African immigrant 0%; and Caribbean immigrants 4.6% (95% CI: 2.7-18.0). BMI, alcohol consumption and current daily tobacco use was highest among US-born blacks in the CAP3 dataset (30.6 [95% CI: 29.7-31.5]; 38.6% [95% CI: 33.4-43.3]; and 14.1% [95% CI: 10.7-17.4]. Conclusion: The healthy immigrant affect has been well described in the literature and is apparent in our study population, where immigrants are healthier than native-born individuals. However, we also observed that immigrants were healthier than individuals in their native country, prompting the need for further investigation of this phenomena. Citation Format: Elizabeth L Blackman, Jenisha Stapleton, Brian L Egleston, Camille CR Ragin. Effect of migration to the US on health characteristics of the African diaspora [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 C022.

Abstract C017: Breast cancer trends and disparities in an urban setting

Abstract Background: Although efforts have been made to decrease breast cancer disparities, recent changes in breast cancer screening recommendations can influence cancer trends by race/ethnicity. The goal of this descriptive study was to determine how recent trends in breast cancer vary by race/ethnicity in a multiethnic, urban setting. Methods: We obtained PA cancer registry data and female breast cancer rates of patients residing in Philadelphia County (2005-2014). Race was categorized based upon data in the Cancer Registry as all cases (all races), and the most prevalent groups of cases, including white/Caucasian (47%), black/African American (46%), Hispanic (4%) and Asian (3%). Our sample of the 4 major race/ethnic groups included 10,801 women. We conducted descriptive analyses using chi-square tests for categorical variables and Kruskal-Wallis tests for continuous variables. Patient characteristics included incidence, advanced tumor stage (regional and distant disease), and advanced tumor grade (poorly differentiated or undifferentiated). We also calculated the percent change in incidence and mortality rates by race/ethnicity. A cut-point of 50 years were used to examine trends in incidence among younger vs. older patients. Results: The median age at breast cancer diagnosis differed significantly by race/ethnicity (p&amp;lt;0.001). White women were among the oldest at diagnosis (median age 65). Asian women were among the youngest (median age 53). More black women (18%) died from breast cancer compared to white (13%), Hispanic (12%) and Asian women (11%, p&amp;lt;0.001). Advanced tumor grade was most common among Asian women (51%) and lowest among white women (33%, p&amp;lt;0.001). Distant stage was most common among black women (10%) and compared to each of the other groups of women (8%, p&amp;lt;0.001). Breast cancer rates were not available across many of the years for Asian and Hispanic women. However, trends in breast cancer incidence showed that Hispanic women had lower incidence at every point in time than black or white women. Percent change in incidence rates increased by 17% in Hispanics vs. 11% in white and 4% in black women. Among older women (age 50+), breast cancer incidence increased by 17% among black women and 10% among white women. Among young women (&amp;lt;age 50), the incidence increased by 32% among white women but decreased by 16% among black women. Among older women, advanced-stage breast cancer was consistently most common among blacks. However, among younger women, recent trends show that white women now have the highest rates of advanced-stage disease. Breast cancer mortality was consistently highest for black women, although mortality rates have decreased over time. The decrease in mortality was 21% in white women and 15% in black women. Conclusion: We observed race/ethnic differences in breast cancer trends in patient age, tumor characteristics, and disease rates. Future studies should examine factors that have influenced recent shifts in breast cancer incidence and mortality among diverse populations. Citation Format: Hee-Soon Juon, Russell McIntire, Scott Keith, Charnita Zeigler-Johnson. Breast cancer trends and disparities in an urban setting [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C017.