Generating Subcounty Health Data Products: Methods and Recommendations From a Multistate Pilot Initiative.

BACKGROUND: County Health Rankings & Roadmaps (CHR&R) makes data on health determinants and outcomes available at the county level, but health data at subcounty levels are needed. Three pilot projects in California, Missouri, and New York explored multiple approaches for defining measures and producing data at subcounty geographic and demographic levels based on the CHR&R model. This article summarizes the collective technical and implementation considerations from the projects, challenges inherent in analyzing subcounty health data, and lessons learned to inform future subcounty health data projects. METHODS: The research teams used 12 data sources to produce 40 subcounty measures that replicate or approximate county-level measures from the CHR&R model. Using varying technical methods, the pilot projects followed similar stages: (1) conceptual development of data sources and measures; (2) analysis and presentation of small-area and subpopulation measures for public health, health care, and lay audiences; and (3) positioning the subcounty data initiatives for growth and sustainability. Unique technical considerations, such as degree of data suppression or data stability, arose during the project implementation. A compendium of technical resources, including samples of automated programs for analyzing and reporting subcounty data, was also developed. RESULTS: The teams summarized the common themes shared by all projects as well as unique technical considerations arising during the project implementation. Furthermore, technical challenges and implementation challenges involved in subcounty data analyses are discussed. Lessons learned and proposed recommendations for prospective analysts of subcounty data are provided on the basis of project experiences, successes, and challenges. CONCLUSIONS: This multistate pilot project offers 3 successful approaches for creating and disseminating subcounty data products to communities. Subcounty data often are more difficult to obtain than county-level data and require additional considerations such as estimate stability, validating accuracy, and protecting individual confidentiality. We encourage future projects to further refine techniques for addressing these critical considerations.

Association Between Food Distress and Smoking Among Racially and Ethnically Diverse Adults, Schenectady, New York, 2013-2014.

INTRODUCTION: Smoking and poor nutrition are 2 leading preventable causes of death. This study investigated associations between smoking and indicators of individual- and neighborhood-level food distress among racially and ethnically diverse urban adults. METHODS: We analyzed data from a health interview survey and a food environment assessment collected in 2013 and 2014 in Schenectady, New York. We constructed logistic regression models for current smoking with 6 indicators of food distress as exposure variables and sociodemographic characteristics, depression, anxiety, perceived stress, alcohol binge drinking, and disability as covariates. RESULTS: The analytic sample consisted of 1,917 adults; 59.4% were female, more than half were racial/ethnic minorities (26.2% non-Hispanic black, 10.3% Hispanic, 10.9% Guyanese, 4.0% multiracial and other), and 37.1% were current smokers. All indicators of food distress remained in the parsimonious final model: consuming 0 or 1 serving of fruits and vegetables daily more than doubled the odds of smoking, compared with consuming 5 or more servings (odds ratio [OR], 2.05). Food insecurity (OR, 1.77), receiving Supplemental Nutrition Assistance Program benefits (OR, 1.79), using a food pantry (OR, 1.41), living in a neighborhood with low access to healthy food (OR, 1.40), and shopping for food often at a store with limited healthy food choices (OR, 1.38) were also associated with significantly higher odds of smoking. CONCLUSION: Recognizing that smoking and food distress are independently associated would lead to innovative public health intervention strategies. We suggest stronger collaboration between tobacco and nutrition public health professionals to synergistically reduce tobacco use and improve nutrition behavior and food environments in communities.

Longitudinal Trends in Tobacco Availability, Tobacco Advertising, and Ownership Changes of Food Stores, Albany, New York, 2003-2015.

INTRODUCTION: Frequency of visiting convenience and corner grocery stores that sell tobacco is positively associated with the odds of ever smoking and the risk of smoking initiation among youth. We assessed 12-year trends of tobacco availability, tobacco advertising, and ownership changes in various food stores in Albany, New York. METHODS: Eligible stores were identified by multiple government lists and community canvassing in 2003 (n = 107), 2009 (n = 117), 2012 (n = 135), and 2015 (n = 137). Tobacco availability (all years) and advertising (2009, 2012, and 2015) were directly measured; electronic cigarettes (e-cigarettes) were included in 2015. RESULTS: Percentage of stores selling tobacco peaked at 83.8% in 2009 and declined to 74.5% in 2015 (P for trend = .11). E-cigarettes were sold by 63.7% of tobacco retailers. The largest decline in tobacco availability came from convenience stores that went out of business (n = 11), followed by pharmacies that dropped tobacco sales (n = 4). The gain of tobacco availability mostly came from new convenience stores (n = 24) and new dollar stores (n = 8). Significant declining trends (P < .01) were found in tobacco availability and any tobacco advertising in pharmacies and in low (<3 feet) tobacco advertising in convenience stores and stores overall. Only one-third of stores that sold tobacco in 2003 continued to sell tobacco with the same owner in 2015. CONCLUSION: The observed subtle declines in tobacco availability and advertising were explained in part by local tobacco control efforts, the pharmacy industry's self-regulation of tobacco sales, and an increase in the state's tobacco retailer registration fee. Nonetheless, overall tobacco availability remained high (>16 retailers per 10,000 population) in this community. The high store ownership turnover rate suggests that a moratorium of new tobacco retailer registrations would be an integral part of a multi-prong policy strategy to reduce tobacco availability and advertising.

Food Shopping Venues, Neighborhood Food Environment, and Body Mass Index Among Guyanese, Black, and White Adults in an Urban Community in the US.

OBJECTIVE: To investigate relationships among food shopping venues, food environment, and body mass index (BMI). DESIGN: Cross-sectional survey data and directly assessed food environment data were linked at the neighborhood level. SETTING: Schenectady, NY. PARTICIPANTS: A sample of Guyanese, black, and white adults (n = 226, 485, and 908, respectively). MAIN OUTCOME MEASURES: BMI. ANALYSIS: Linear regression models were constructed with 10 food shopping venues and neighborhood food environment as explanatory variables, controlling for sociodemographics, dietary behavior, physical activity, and perception of healthy food access. RESULTS: On average, respondents used 3.5 different food shopping venues. Supermarkets and ethnic markets were associated with a lower BMI in Guyanese adults. Among black adults, farmers' markets were associated with a lower BMI, whereas supermarkets, wholesale clubs, and food pantries were associated with a higher BMI. Among white adults, food coops and supermarkets were associated with a lower BMI and wholesale clubs were associated with a higher BMI. Neighborhoods with less a favorable food environment (longer travel distance to a supermarket) were associated with a lower BMI in Guyanese adults. CONCLUSIONS AND IMPLICATIONS: Both primary (ie, supermarkets) and secondary food shopping venues could be independent determinants of BMI. The observed variations by race and ethnicity provided insights into a culturally tailored approach to address obesity.

Spatial Access to Faith-based Diabetes Intervention for Guyanese Adults in Schenectady, New York.

PURPOSE: The purpose of this study is to examine whether travel distance would pose a barrier to participation in proposed diabetes intervention programs for Guyanese immigrants at faith-based organizations (FBOs). This study also suggests the most collectively accessible set of FBOs that could serve as intervention sites. METHODS: Data were extracted from a cross-sectional health interview survey conducted in Schenectady, New York, in 2011. The shortest driving distances from homes to FBOs and to the city's only diabetes education center (DEC) were analyzed among Guyanese and non-Guyanese adults with diabetes and prediabetes (n = 238), using spatial algorithms and Geographic Information System resources. RESULTS: The Guyanese were more likely to belong to a FBO than the non-Guyanese (77.8% vs 61.2%). The mean driving distance to FBO was 1.19 miles (95% CI, 0.98-1.39) for the Guyanese, which was significantly shorter than that for the non-Guyanese (2.87 miles, 95% CI, 1.93-3.82). The Guyanese had uniformly shorter mean and median driving distances in all sociodemographic and health status subcategories as well. Moreover, a higher percentage of the Guyanese lived closer to FBO than to DEC compared to non-Guyanese (52.2% vs 34.7%). It was found that having diabetes intervention at the 4 most popular FBOs (2 Hindu temples and 2 Christian churches) and DEC would provide the most collectively accessible arrangement for the Guyanese. CONCLUSIONS: The results suggest that the short driving distance to FBO is a likely enabler that can encourage regular utilization of the faith-based intervention for the Guyanese.