Public Health Management Corporation Research Articles

Abstract C090: Associations between neighborhood green space and breast cancer outcomes among Philadelphia neighborhoods

Abstract Access to green space has been shown to be associated with decreased incidence of cancer. The goal of this study is to identify associations between neighborhood green space indicators and breast cancer outcomes at the neighborhood level in Philadelphia. Green space indicators were sourced from the National Land Cover Database (2006-2016), VT Spatial Analysis Lab (2008-2013) and Philadelphia Parks and Recreation (2016), and included average percent tree cover, average tree canopy, average low vegetation, count of public parks, and percent vacant lots. Breast cancer data from the PA Cancer Registry (2005-2014) included standardized incidence ratio (SIR), standardized mortality ratio (SMR), and mean aggressiveness (MA) of cancer. Neighborhood-level covariates were gathered from U.S. Census (American Communities Survey, 2008-2012) and the Public Health Management Corporation’s Household Health Survey (2012) for Philadelphia neighborhoods. Pearson correlations were calculated to identify associations between environmental and green space indicators and breast cancer outcomes. Multivariable linear regression was used to identify if significant relationships persisted in the presence of demographic and socioeconomic disparities at the neighborhood level. Significance was determined at p-values < 0.05. SIR was significantly correlated with % of vacant lots (r=-.186), % of tree canopy cover within 50 meters from neighborhood centroid (r=.139) and the number of public parks (r=.125) per neighborhood. SMR was significantly correlated with vacant lots (r=.184) and tree canopy cover (r=-.104). MA was significantly correlated with tree canopy (r=-.124), tree canopy within fifty meters of neighborhood centroid (r=-.146), number of public parks (r=-.141), and % of vacant lots (r=.157). After controlling for covariates in multivariable linear regression models, the significant relationships between neighborhood green space indicators and breast cancer outcomes were no longer significant. For SIR, the significant associations with green space indicators suggest that Philadelphia neighborhoods with a higher incidence of breast cancer have more green space and a lower % of vacant lots. For SMR and MA, associations suggest that neighborhoods with higher breast cancer mortality and aggressiveness have less green space and a higher % of vacant lots. The direction of these relationships makes sense, given the % and quality of neighborhood green space correlate closely with indicators of socioeconomic status. The lack of significance when controlling for confounders likely represents the limitations of using neighborhood-level data, rather than patient-level data, to measure the impact of green space on breast cancer outcomes. Future studies should identify green space exposure indicators at the individual level in order to more accurately identify the impact of urban green space on breast cancer outcomes. These data could inform city planning to decrease the burden of breast cancer among vulnerable populations. Citation Format: Benjamin C. Keating, Joseph Lombardo, Charnita Zeigler-Johnson, Alex M. DesJarlais, Taylor Micua, Nicole L. Simone, Russell K. McIntire. Associations between neighborhood green space and breast cancer outcomes among Philadelphia neighborhoods [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C090.

Estimating Eligibility for Lung Cancer Screening by Neighborhood in Philadelphia Using Previous and Current USPSTF Guidelines.

The National Lung Screening Trial established the benefits of low-dose computed tomography for lung cancer screening (LCS) to identify lung cancer at earlier stages. In February 2021, the US Preventive Services Task Force (USPSTF) revised the eligibility recommendations to increase the number of high-risk individuals eligible for LCS and, in effect, expand screening eligibility for vulnerable populations. One strategy for facilitating LCS is to implement targeted screening in geographic areas with the greatest need. In Philadelphia, although neighborhood smoking rates have been defined, it is not known which neighborhoods have the greatest number of people eligible for LCS. In this study, the authors estimate eligibility for LCS within Philadelphia neighborhoods using both previous and current USPSTF guidelines. They used the Public Health Management Corporation's Household Health Survey from 2010, 2012, and 2015 to identify the number of people within ever-smoker groups (current every day, current occasional, and former smokers) by neighborhood in Philadelphia. Using the 2015 National Health Interview Survey (NHIS) Cancer Supplement, they identified the percentages within ever-smoker groups that were LCS eligible using the previous and current USPSTF guidelines. Finally, they applied the percentages eligible for the ever-smoker groups from the NHIS to the numbers in these groups within Philadelphia neighborhoods. They found that the number of Philadelphians eligible for LCS increased from 41,946 to 89,231 after the revised USPSTF guidelines. The current USPSTF guidelines increased eligibility for LCS within all Philadelphia neighborhoods, with the greatest increases in the River Wards planning district. Local providers should use these results to prioritize LCS services within neighborhoods with greatest eligibility.

Socioeconomic Disparities in Hypertension by Levels of Green Space Availability: A Cross-Sectional Study in Philadelphia, PA.

Green spaces have been proposed as equigenic factors, potentially mitigating health disparities. We used data from the 3887 participants residing in Philadelphia who participated in the Public Health Management Corporation’s Southeastern Pennsylvania Household Health Survey in 2014–2015 to assess whether socioeconomic disparities in hypertension are modified by availability of neighborhood-level green spaces. Socioeconomic status (SES) was measured using individual-level education and neighborhood-level median household income. Green space availability was measured using surrounding percent tree canopy cover, mean normalized difference vegetation index (NDVI), and proximity to nearest park. Using logistic regression models adjusted for age, sex, and race/ethnicity, we found that adults with higher educational attainment had significantly lower levels of hypertension (OR = 0.63, 0.57, and 0.36 for high school, some college, and college graduates, respectively, as compared to those with less than high school education), and this pattern was similar for median household income (higher prevalence in lower income areas). We found no significant interaction between education and percent tree canopy cover (p = 0.83), meaning that educational disparities in hypertension were similar across all levels of green space availability. These results held when using mean NDVI or distance to nearest park as availability measures, or when considering neighborhood-level median household income as the socioeconomic measure, although the specific patterns and significance of interactions varied by exposure and modifier. While socioeconomic disparities in hypertension are strong for adults residing in Philadelphia, green spaces did not seem to modify them.

Neighborhood Racial/Ethnic Composition and Medical Discrimination’s Relation to Mammograms: A Philadelphia Case Study

Late-stage breast cancer diagnosis is common for women of color even though cancer screening rates in this group have increased over time. Perceived medical discrimination from health care providers is a key culprit of this inconsistency, discouraging women of color from seeking out timely preventative care. Non-white neighborhoods offer social support structures that mitigate discrimination. However, it is not clear whether this mitigation applies to the chance women of color get timely mammograms. This study addresses that question, applying Hierarchical Linear Modeling methods onto the Public Health Management Corporation’s 2006 and 2008 survey, as well as the 2005–2009 American Community Survey. Findings indicate that while neighborhood racial/ethnic composition does not directly reduce medical discrimination’s association to screening, factors closely connected to place, like health care access, do have a mitigating influence on this association. Also, neighborhood racial/ethnic composition and social support have a positive direct relation with screening.

Abstract 2354: Multilevel analysis of colorectal cancer screening in southeastern Pennsylvania

Abstract Background: Colorectal cancer (CRC) is a leading cause of mortality in the US. There are racial and socioeconomic disparities in CRC incidence and mortality, in part due to underuse of CRC screening. The goal of this cross-sectional study was to examine multilevel factors associated with CRC screening in Southeastern PA. Methods: We conducted a cross-sectional study using the Public Health Management Corporation's Community Health Database household survey (2010-2015) and American Community Survey data (2010-2014) to examine multilevel factors related to CRC screening via sigmoidoscopy and colonoscopy. We compared adults age 50+ that received CRC screening within 10 years (N=12963) to non-compliant individuals (N=4585), according to American Cancer Society guidelines. We conducted descriptive analyses to compare individual and residential census tract characteristics of the compliant and non-compliant groups. Multilevel regression models including random intercepts for census tracts (CTs) and CT-level socioeconomic status (SES) were used to examine independent associations with CRC screening compliance. P-values <0.05 were considered statistically significant. Results: In bivariate analysis, we observed that individuals that did not comply with CRC screening recommendations were more likely to be younger, male, non-black, unmarried, less educated, uninsured, and current smokers than those in compliance. Non-compliant individuals were also more likely to live in areas with lower SES, shorter distance to public transportation, lower educational attainment, lower median income, and higher percentages of uninsured, unemployed, poverty and households on public assistance compared to those in compliance. In multilevel regression analysis, being unmarried (OR=1.49, 95% CI=1.34-1.65), uninsured (OR=1.65, 95% CI=1.30-2.10), or living in lower SES census tracts (below the first SES quartile: OR=1.48, 95% CI=1.30-1.69 and between the 2nd and 3rd quartile: OR=1.51, 95% CI=1.29-1.75 vs. above the highest quartile) were associated with non-compliance in CRC screening recommendations. There were no interactions detected between race and census tract SES in these models. Conclusions: We identified multilevel factors (marital status, health insurance status, and residential SES) significantly associated with non-compliance to CRC screening recommendations. Individuals and CTs with low levels of compliance can be identified and targeted for tailored interventions, such as peer support and community education about CRC in future studies. Future studies might examine how the availability and location of screening facilities may relate to CRC screening recommendation compliance rates in different neighborhoods. Citation Format: Charnita M. Zeigler-Johnson, Scott Keith, Kari Moore, Russell McIntire, Preethi Selvan, Steven Melly, Ana Diez-Roux. Multilevel analysis of colorectal cancer screening in southeastern Pennsylvania [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2354.

Evaluating the Relationship of Social Service Usage to Neighborhood Community for Older Adults: A Case Study

Older adults who live in cities can cultivate a sense of neighborhood community that mitigates problems like poverty and ill health. However, it is not certain residence in urban neighborhoods is always related to community. This study investigates the potential of social services to positively associate with neighborhood community. Offering chances for older adults to interact with each other and with service providers who render basic services like social activities, meals, and housing, social services are a unique source of such community. We utilized hierarchical linear models with individual data from the Public Health Management Corporation’s Southeastern Pennsylvania Household Health Survey and neighborhood data from the American Community Survey. Findings suggest that the association with neighborhood community depends on the type of service and that race/ethnicity has an impact. For older adult Black respondents, residence in mostly Black neighborhoods increases the chances some services will relate to neighborhood community.

Muslim-Non-Muslim Locational Attainment in Philadelphia: A New Fault Line in Residential Inequality?

This study examines Muslim-non-Muslim disparities in locational attainment. We pool data from the 2004, 2006, and 2008 waves of the Public Health Management Corporation's Southeastern Pennsylvania Household Survey. These data contain respondents' religious identities and are geocoded at the census-tract level, allowing us to merge American Community Survey data and examine neighborhood-level outcomes to gauge respondents' locational attainment. Net of controls, our multivariate analyses reveal that among blacks and nonblacks, Muslims live in neighborhoods that have significantly lower shares of whites and greater representations of blacks. Among blacks, Muslims are significantly less likely than non-Muslims to reside in suburbs. The Muslim disadvantages for blacks and nonblacks in neighborhood poverty and neighborhood median income, however, become insignificant. Our results provide support for the tenets of the spatial assimilation and place stratification models and suggest that Muslim-non-Muslim disparities in locational attainment define a new fault line in residential stratification.

Do gentrifying neighbourhoods have less community? Evidence from Philadelphia

One of the more detrimental effects of gentrification is the potential for a decreased sense of neighbourhood community. Systematic analysis of the effect of gentrification on communities has been limited. This study investigated how an individual’s sense of connection to neighbourhood community, as measured by trust, belongingness and sense of cooperation, was influenced by their residence in a gentrifying neighbourhood. We utilised hierarchical linear models with individual data from the 2014/2015 Public Health Management Corporation’s Southeastern Pennsylvania Household Health Survey and neighbourhood data from the 2000 Decennial Census and 2010–2014 American Community Survey. We find that gentrification overall has a negative relation with neighbourhood community, but this relationship varied by the racial/ethnic turnover underlying the changes taking place in these neighbourhoods. Specifically, we find that gentrification marked by increases in Whites and decreases in non-Whites had no measurable relation with neighbourhood community; that gentrification marked by increases in non-Whites alone had a positive effect on neighbourhood community for Black and Hispanic residents; and that gentrifying neighbourhoods which experienced an increase in both Whites and non-Whites had a negative overall relation with neighbourhood community.

The Effect of Segregated Cities on Ethnoracial Minority Healthcare System Distrust

Distrust of the health system is a longstanding issue for ethnoracial minorities, especially for Blacks. Not well understood, however, is the role that ethnoracial segregation within a city plays in this distrust. While segregation is typically associated with neighborhood ills, there is evidence that it can also moderate distrust. This study draws on the 2008 wave of the Public Health Management Corporation's Southeastern Pennsylvania Household Health Survey and the 2005–2009 American Community Survey to explore the possibility that segregation affects healthcare system distrust. Using hierarchical linear modeling, we find that residence in predominantly Black neighborhoods was associated with less distrust in the healthcare system for Black respondents, while residence in mixed neighborhoods was associated with more distrust for Black respondents. These findings call for a reevaluation of how healthcare system distrust is understood. Distrust has been connected to poorer health outcomes, playing into wider gaps in ethnoracial minority health outcomes.

Are gentrifying neighborhoods more stressful? A multilevel analysis of self-rated stress

Gentrification, the increase of affluent residents into low-income neighborhoods, is thought to heighten self-rated stress, especially for residents of color. However, the relationship between gentrification and stress has not been directly measured. This study took advantage of the 2008 and 2010 waves of the Public Health Management Corporation’s Southeastern Pennsylvania Household Health Survey, the 2000 Census, and the 2006–2010 American Community Survey to investigate the relationship of gentrification to above-average self-rated stress. We paid attention to how racial/ethnic differences in gentrification may uniquely affect stress. We also measured factors associated with gentrification with implications for one’s stress including housing cost insecurity and community connection. Using multilevel modeling, we found that gentrifying tracts marked by increases in White residents and declines in non-Whites were more likely to report above-average stress. This study provides evidence that gentrification is related to stress, emphasizing the important role racial/ethnic change has in this process. These findings call for research to unpack the causal mechanisms through which gentrification affects stress.

Integration of Hepatitis C Treatment in a Primary care Federally Qualified Health Center; Philadelphia, Pennsylvania, 2015-2017.

Hepatitis C virus (HCV) infection remains a pressing public health issue. Identification of long term infection in primary care settings and community health centers can facilitate patients’ access to appropriate care. Given the increase in HCV prevalence in the United States, improving the HCV care continuum and expanding medication access to disproportionately affected populations can help reduce disease burden, health care system costs, and transmission. Innovative treatment programs developed in the primary care setting are needed to deliver quality care to meet the demand of those engaging in treatment. This article describes an HCV treatment program developed within a primary care federally qualified health center (FQHC) using physician assistants (PAs) and nurse practitioners (NPs) to address the high number of HCV positive patients identified at the clinic. An interdisciplinary care team was established to optimize patient experience around HCV care and treatment, using on-site primary care behavioral health consultants, an HCV treatment coordinator, and a 340B contracted specialty pharmacy. From January 2015 to April 2017, the Public Health Management Corporation (PHMC) Care Clinic medical providers referred 189 patients for HCV treatment. Of those referred, 102 patients successfully obtained a sustained virologic response (SVR), representing a 53.7% success rate from referral to cure. This treatment program successfully integrated HCV treatment in a patient population heavily affected by substance use and mental illness. Support and adoption of similar programs in primary care community health centers testing for HCV can help meet the clinical/behavioral needs of these marginalized populations.

Relationship between Helicobacter pylori and Rosacea: review and discussion

BackgroundRosacea is an inflammatory disease affecting the central part of face characterized by persistent or recurrent episodes of erythema, papules, pustules and telangiectasias of unknown etiology. Helicobacter pylori (H. pylori) is a gram-negative bacillus, which is one of the main causes of chronic gastritis, gastric cancer and gastrointestinal ulcers. Recent evidences have suggested that H. pylori infection is closely related to the occurrence of diseases. In recent years, studies have found that Helicobacter pylori infection is associated with the occurrence of acne rosacea. So the treatment of Helicobacter pylori infection may be a therapeutic method of acne rosacea. But it continues to be controversial. In other studies, the treatment of Helicobacter pylori did not significantly reduce the severity of acne rosacea. To further explore the association between acne rosacea and Helicobacter pylori infection, a summarize method was used to study the relationship between acne rosacea and Helicobacter pylori, providing reference for clinical acne rosacea therapy.MethodsSystematic searches were conducted on Wanfang Data, CQVIP, Springer, Public Health Management Corporation (PHMC), CNKI, and Pubmed, from January 1,2008 to Mar. 1, 2018, using Helicobacter pylori and rosacea to retrieve the literature. Depending on the inclusion and exclusion criteria, 27 articles considered or confirmed the correlation between H. pylori and rosacea.ResultsEpidemiological investigations and experiments have confirmed that H. pylori infection is associated with the development of rosacea. The effect of anti-H. pylori therapy is better than the routine therapy for rosacea. H. pylori can stimulate the immune system to produce a large number of inflammatory mediators, leading to the occurrence and aggravation of rosacea inflammation.ConclusionsIt is confirmed that H. pylori infection is involved in the development of rosacea. It is suggested that rosacea patients should be tested for H. pylori infection, the H. pylori-positive rosacea patients should be treated with eradication of H. pylori, so as to enhance the therapeutic effect of rosacea. This study adds that H. pylori infection is involved in the development of rosacea. Epidemiological investigations and experiments have confirmed the rationality. The effect of anti-H. pylori therapy is better than the routine therapy for rosacea. H. pylori-positive rosacea patients should be treated with the therapeutic method of eradication of H. pylori.

Effects of dexmedetomidine versus midazolam for premedication in paediatric anaesthesia with sevoflurane: A meta-analysis.

BackgroundDexmedetomidine (DEX), an α2-adrenergic receptor agonist, produces ideal sedation and early postoperative recovery for premedication in paediatric surgery, reducing preoperative anxiety and facilitating smooth induction of anaesthesia. We performed a meta-analysis to compare the effects of DEX and midazolam (MDZ) in paediatric anaesthesia with sevoflurane.MethodsPubMed, Ovid, Web of Science, and Public Health Management Corporation were searched through December 2016 for randomized controlled trials (RCTs) that compared DEX and MDZ in children undergoing sevoflurane anaesthesia. The risk ratio (RR) with 95% incidence interval (95%CI) was used for dichotomous variables.ResultsTwelve RCTs involving 422 patients in the DEX group and 448 patients in the MDZ group were included. Patients in the DEX group had a significantly lower incidence of unsatisfactory sedation (RR [95%CI] = 0.71 [0.57–0.89]), unsatisfactory parental separation (RR [95%CI] = 0.56 [0.35–0.87]), and rescue analgesia (RR [95%CI] = 0.52 [0.35–0.77]) than patients in the MDZ group. However, both groups had a similar incidence of unsatisfactory mask acceptance, emergence agitation, and postoperative nausea and vomiting.ConclusionCompared with MDZ, DEX is beneficial in paediatric anaesthesia with sevoflurane because of its lower incidence of unsatisfactory sedation, parental separation, and rescue analgesia.

Searching for Silver Linings: Is Perceived Medical Discrimination Weaker in Segregated Areas?

An ongoing obstacle in dealing with minority health disparities is discriminatory behavior from healthcare practitioners, also known as medical discrimination. It is not clear, however, if the effects of medical discriminations onto health are constant across space. For example, there is evidence to suspect minorities in racially segregated neighborhoods suffer less from discrimination compared to those living elsewhere. To determine the presence of spatial heterogeneity underlying medical discrimination, we implement logistic geographically weighted regression (GWR) using individual data in the city of Philadelphia from the 2006 and 2008 Public Health Management Corporation's Southeastern Pennsylvania Household Health Surveys. Evaluating the potential role residential segregation has in offsetting medical discrimination, we compare the GWR results to tract data from the 2005-2009 American Community Survey. Through this comparison, we find that the effects of medical discrimination on self-rated health are weaker in magnitude in areas that are mostly minority. However, evidence of direct health benefits for minorities in segregated communities is inconclusive. Thus, while we cannot say living in segregated neighborhoods leads to better minority health, the sting of medical discrimination can be weaker in these places. These results emphasize the importance of local variation, even within a city like Philadelphia, challenging the aspatial one-model-fits-all approach normally found in population studies.

Integrating Routine HCV Testing in Primary Care: Lessons Learned from Five Federally Qualified Health Centers in Philadelphia, Pennsylvania, 2012-2014.

An estimated 2.7-3.9 million Americans are infected with hepatitis C virus (HCV). Despite being the most common blood-borne virus in the United States, routine HCV testing is not commonly practiced. To address this gap, we measured the impact of integrated routine HCV testing on patient care. As part of CDC's Hepatitis Testing and Linkage to Care initiative, which promoted viral hepatitis B and hepatitis C screening, posttest counseling, and linkage to care at 34 U.S. sites, National Nursing Centers Consortium integrated a routine opt-out HCV testing and linkage-to-care model at five federally qualified health centers in Philadelphia, Pennsylvania, from October 1, 2012, to June 30, 2014. The model included medical assistant-initiated testing, reflex laboratory-based HCV tests, and electronic health record modifications to prompt, track, and facilitate reimbursement for tests performed on uninsured patients. During the study period, 4,207 unique patients received HCV antibody (anti-HCV) testing, of whom 488 (11.6%) tested anti-HCV positive. Of those testing positive, 433 (88.7%) received a confirmatory HCV RNA test; of these 433 recipients, 313 (72.3%) were diagnosed with current infection (overall prevalence = 7.4%), of which 243 (77.6%) received their HCV RNA-positive results, 184 (58.8%) were referred to an HCV care provider, and 121 (38.7%) were linked to care. The highest rates of current infection were among non-Hispanic white patients (18.1%, 90/496); patients from the Public Health Management Corporation Care Clinic, which treats HIV and HCV patients on-site (14.3%, 200/1,394); and patients aged 50-69 years (10.7%, 189/1,767). Our model successfully integrated HCV testing and linkage to care into routine primary care. This study also identified potential successes and barriers that may be experienced by other primary care health centers that are integrating HCV testing.

Connecting Across the Divides of Race/Ethnicity

There exists an active discussion as to the effects of racial/ethnic composition on community connection. Research has suggested that racial segregation is beneficial to one’s community connection. To explore this dynamic, we investigate how an individual’s community connection is determined by the racial/ethnic segregation of his or her neighborhood, among other independent variables. We implement multilevel models using individual data from the 2008 and 2010 Public Health Management Corporation’s Southeastern Pennsylvania Household Health Survey and tract data from the 2006–2010 American Community Survey. We find that though the overall socioeconomic status of a neighborhood explains much of the variations in community connection, non-Hispanic Blacks living in predominantly White or mixed communities tend to have a weaker community connection than their counterparts in other types of neighborhood. This demonstrates that segregation and socioeconomic status explain community connection.

Evaluation of lisdexamfetamine alone and lisdexamfetamine + modafinil for cocaine use disorder

s / Drug and Alcohol Dependence 146 (2015) e202–e284 e231 Financial support: NIH NIDA 5R01DA019999 and 5T32DA022981; NIH CTSA program UL1T39 and KL2T63. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.094 Evaluation of lisdexamfetamine alone and lisdexamfetamine+modafinil for cocaine use disorder Alex Brewer1, Daisy G. Thompson-Lake2, James J. Mahoney2, Thomas F. Newton2, Richard De La Garza II 1,2 1 Pharmacology, Baylor College of Medicine, Houston, TX, United States 2 Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX, United States Aims: Modafinil and sustained release (SR) amphetamine (AMPH) have each shown efficacy for cocaine use disorder, albeit with equivocal results. We hypothesize that a combination medications approachmay bemore efficacious for cocaine use disorder. Thespecificaimof this study is todetermine theeffectsof treatment with lisdexamfetamine alone, and lisdexamfetamine+modafinil, versus placebo, on the subjective and reinforcing effects produced by cocaine in non-treatment-seeking individuals with cocaine use disorder. Methods: In this ongoing study, participants are being recruited from the Houston metropolitan area. All participants meet DSM-IV criteria for cocaine use disorder, and are not seeking treatment. Participants are randomized to placebo, lisdexamfetamine (30mg/day), ormodafinil (200mg/day) + lisdexamfetamine (30mg/day) for 4 days. On day 4, participants complete two selfadministration sessions involving 5 choices for either cocaine (20mg/infusion) or saline. Primary outcome measures include number of choices made for cocaine/saline, and changes in subjective effects and cardiovascular measures. Results: To date, the majority of enrolled participants (N=18) are African American males who smoke cocaine. The majority of individuals also smoke cigarettes, anduse alcohol andmarijuana. In comparison to saline, exposure to cocaine resulted in significantly greater choices for an infusion, increased heart rate and blood pressure, and greater self-reports of positive subjective responses (e.g., “High”, “Any Drug Effect”) (all p’s <0.001). To date, no medication effects have been observed among treatment groups as compared to placebo. Conclusions: Thepreliminaryanalysesdidnot reveal any significant effects produced by the test compounds; however, the group sizes are small (N∼6/group) and data collection is ongoing (final N=20/group). Financial support: Supported by DA023625 (DLG). This work was conducted at, and supported by, the Michael E. DeBakey VA Medical Center, Houston, TX, USA. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.095 Screening and brief treatment for illicit drug use in primary care: Feasibility and acceptability Adam C. Brooks1, Carolyn M. Carpenedo1, Jennifer Lauby2, David Metzger1,3, Elizabeth Byrne2, Kevin Favor4, K.C. Kirby1,3 1 Treatment Research Institute, Philadelphia, PA, United States 2 Public Health Management Corporation, Philadelphia, PA, United States 3 Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States 4 Department of Psychology, Lincoln University, Lincoln University, PA, United States Aims: Brief intervention in primary care settings for illicit drug use has a mixed track record in reducing drug use. We are conducting a randomized clinical trial of a brief intervention (SBIRT) against a 2–6 sessions intervention of brief treatment in three urban federally qualified healthcare centers (FQHCs). Feasibility and acceptability results are reported here. Methods: Primary care patients were screened for risky substance use (alcohol and drug) as they attend regularly scheduled appointments. Consenting patients who screened positive were randomized to receive: (1) SBIRT, conducted in one session and boosted with a 10–15min follow-up within the next month, or (2) SBIRT+, 2–6 sessions incorporating MET, CBT, and boosted with ongoing monthly brief recovery check-ups. Results: 7162 patients were prescreened, and 745 patients demonstrated drug or alcohol risk on the DAST or AUDIT; 414 patients have currently enrolled. Enrolled patients demonstrate a relatively even split between primary alcohol (35%), primarymarijuana (37%) and other illicit drugs (28%). Patients reported frequent drinking days (M=10.07, SD=9.89) and days of drug use (M=14.63, SD=12.08) in the past 30 days. Engagement with both study conditions has been acceptable; SBIRT+ patients attended M=3.56 sessions (SD=1.74). Patient satisfaction and perception of utility regarding clinical procedures has been very high. Approximately 49% of patients to date have been referred to addiction treatment, and 24% have entered treatment. Conclusions: Screening and onsite brief intervention/brief treatment is feasible in urban FQHCS. Heavy substance users enrolled in an ongoing trial in primary care find returning for multiple brief treatment sessions acceptable. Financial support: Commonwealth of Pennsylvania Department of Health SAP 4100055578. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.096 Evaluation of an electronic information system to enhance practice at a medication-assisted opioid treatment program Lawrence S. Brown, Steven Kritz, Melissa Lin, Ben Louie, Roberto Zavala START Treatment and Recovery Centers (formerly ARTC), Brooklyn, NY, United States Aims: START is an outpatient substance abuse program that provides primary care for approximately 3000 adults in NYC. We received funding to evaluate implementation of an electronicmedical record integrating all services. Methods: Quality, Satisfaction, Productivity, and Financial Performance were evaluated utilizing a pre and post-implementation research design. The capabilities of the electronic system were utilized to evaluate Quality, Compliance, and Productivity in all

Getting Black Men to Undergo Prostate Cancer Screening: The Role of Social Capital.

Despite higher rates of prostate cancer-related mortality and later stage of prostate cancer diagnosis, Black/African American men are significantly less likely than non-Hispanic White men to use early detection screening tools, like prostate-specific antigen (PSA) testing for prostate cancer. Lower screening rates may be due, in part, to controversy over the value of prostate cancer screenings as part of routine preventive care for men, but Black men represent a high-risk group for prostate cancer that may still benefit from PSA testing. Exploring the role of social factors that might be associated with PSA testing can increase knowledge of what might promote screening behaviors for prostate cancer and other health conditions for which Black men are at high risk. Using multilevel logistic regression, this study analyzed self-report lifetime use of PSA test for 829 Black men older than 45 years across 381 Philadelphia census tracts. This study included individual demographic and aggregated social capital data from the Public Health Management Corporation's 2004, 2006, and 2008 waves of the Community Health Database, and sociodemographic characteristics from the 2000 U.S. Census. Each unit increase in community participation was associated with a 3 to 3.5 times greater likelihood of having had a PSA test (odds ratio = 3.35). Findings suggest that structural forms of social capital may play a role in screening behaviors for Black men in Philadelphia. A better understanding of the mechanism underlying the link between social capital and screening behaviors can inform how researchers and interventionists develop tools to promote screening for those who need it.

The role of social capital in African–American women's use of mammography

Black/African–American women are more likely to get breast cancer at a young age and/or be diagnosed at a late disease stage, pointing to a greater need to promote mammography for Black women at earlier ages than are currently recommended. This study explores how perceived neighborhood social capital, that is, perceptions of how tight-knit a neighborhood is and what power that confers to neighborhood members, relates to use of mammography for Black women in Philadelphia. Living in a community with tight social ties (social cohesion) or that have a collective motivation for community change (collective efficacy) may increase the likelihood that an individual woman in that community will hear health messages from other community members and neighbors (diffusion of information) and will have access to health-related resources that allow them to engage in healthy behaviors. No prior studies have explored the role of social capital in decisions for mammography use. Using multilevel logistic regression, we analyzed self-report of mammography in the past year for 2586, Black women over age 40 across 381 Philadelphia, Pennsylvania USA census tracts. Our study included individual demographic and aggregates of individual-level social capital data from the Public Health Management Corporation's 2004, 2006, and 2008 Community Health Database waves, and 2000 US Census sociodemographic characteristics. Individual perceptions that a Black woman's neighborhood had high social capital, specifically collective efficacy, had a positive and statistically significant association with mammography use (OR = 1.40, CI: 1.05, 1.85). Our findings suggest that an individual woman's perception of greater neighborhood social capital may be related to increased mammography use. Although this analysis could not determine the direction of causality, it suggests that social capital may play a role in cancer preventive screening for African–American women in Philadelphia, which warrants further study.

Surveying Linguistically Challenged Southeast Asian American Populations: Use of a Community-Partnered Methodology

Southeast (SE) Asians suffer from health disparities often caused by lack of preventive care, exacerbated by linguistic barriers which exclude many from surveys that fail to include minorities. This survey of linguistically-challenged SE Asians captured health status indicators, behaviors and access. Items were based upon Public Health Management Corporation's Household Health Survey. Participants were recruited by a community-based organization serving SE Asians; interviews were conducted in nine languages. Data were weighted to match age-sex distributions of Asians in Philadelphia. Of 527 interviews completed, 57% were U.S. citizens, 48% uninsured, 23% had gone without care due to cost. English was the main language at home for 3%, yet 53% reported their primary health care site did not have an interpreter. Nearly half reported health as fair/poor, and 22% had a chronic health condition. This community survey illuminates the need to profile the health care needs of these immigrant populations.