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Topics
- Access to Care (2)
- Asthma (1)
- Behavioral Health (1)
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- Children/Adolescents (3)
- Chronic Conditions (3)
- Community-Based Practice (2)
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- Disparities (2)
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- Racial and Ethnic Minorities (2)
- Respiratory Conditions (1)
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- Rural/Inner-City Residents (1)
- Rural Health (1)
- Screening (2)
- Sickle Cell Disease (1)
- (-) Social Determinants of Health (15)
- (-) Urban Health (15)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 15 of 15 Research Studies DisplayedShi M, Fiori K, Kim RS
Social needs assessment and linkage to community health workers in a large urban hospital system.
The purpose of this study was to determine predictors of successful linkage with a community health worker (CHW) in patients with social needs. The researchers utilized a cross-sectional analysis of social needs assessments administered in an urban health system between April 2018 and December 2019. Social needs in the study included safety, getting along with household members, housing quality, housing instability, food insecurity, care for dependents, healthcare cost, healthcare related transportation, utilities, and legal assistance. Patients were entered into a separate database when they encountered a CHW. The main outcome was a successful "linkage," which was defined as having a positive social needs assessment in the medical record with a corresponding record in the CHW database. The study found that 25% of patients with at least 1 social need accepting help were linked to a CHW. Positive predictors included female gender, Spanish language preference compared to English, and having a food-related need. Negative predictors included age 18 to 65 and 0 to 5 compared to over 65, non-Hispanic White race compared to Hispanic race, and having needs of getting along with household members and safety.
AHRQ-funded; HS026396.
Citation: Shi M, Fiori K, Kim RS .
Social needs assessment and linkage to community health workers in a large urban hospital system.
J Prim Care Community Health 2023 Jan-Dec; 14:21501319231166918. doi: 10.1177/21501319231166918..
Keywords: Urban Health, Healthcare Delivery, Social Determinants of Health, Community-Based Practice, Rural/Inner-City Residents
Kim B, Mulready-Ward C, Thorpe LE
Housing environments and asthma outcomes within population-based samples of adults and children in NYC.
This study assessed the relationship between housing type (i.e., home ownership, public housing, rental assistance, rent-controlled housing, and other rental housing) and asthma outcomes among New York City (NYC) adults and children (ages 1-13). The authors used the 2019 NYC Community Health Survey (CHS) and 2019 NYC KIDS survey to analyze associations between housing type and ever having been diagnosed with asthma (“ever asthma”) and experiencing an asthma attack within the past year. They also examined whether associations were modified by smoking status (among adults), smoking within the house (among children), and overweight/obesity. Among adults, living in public housing, compared to home ownership, was associated with higher odds of ever asthma and past-year asthma attack. Rental assistance housing living was also significantly associated with ever asthma. Public or rental assistance housing associations and ever asthma were marginally significant among children but were more pronounced among ever smokers than among never smokers.
AHRQ-funded; HS026120.
Citation: Kim B, Mulready-Ward C, Thorpe LE .
Housing environments and asthma outcomes within population-based samples of adults and children in NYC.
Prev Med 2022 Aug;161:107147. doi: 10.1016/j.ypmed.2022.107147..
Keywords: Children/Adolescents, Asthma, Respiratory Conditions, Social Determinants of Health, Vulnerable Populations, Urban Health, Chronic Conditions
Heller CG, Rehm CD, Parsons AH
The association between social needs and chronic conditions in a large, urban primary care population.
This study sought to understand the association between social needs and chronic health conditions using a screening tool and clinical data from Electronic Health Records. From April 2018 to December 2019, 33,550 adult patients completed a 10-item social needs screening tool during primary visits in Bronx and Westchester Counties, NY. A positive, cumulative association between social needs and each of the eight outcomes asked about was found. The relationship was strongest for elevated PHQ-2 (depression screening), alcohol/drug use disorder, and smoking. Those with 3 or greater social needs were 3.9 times more likely to have an elevated PHQ-2 than those without needs. Healthcare transportation challenges was associated with each condition and was the most strongly associated need with half of conditions in the fully-adjusted models. Examples included those with an alcohol/drug use disorder (84% more likely), and smokers (41% more likely).
AHRQ-funded; HS026396.
Citation: Heller CG, Rehm CD, Parsons AH .
The association between social needs and chronic conditions in a large, urban primary care population.
Prev Med 2021 Dec;153:106752. doi: 10.1016/j.ypmed.2021.106752..
Keywords: Chronic Conditions, Urban Health, Primary Care, Low-Income, Social Determinants of Health, Screening
Loo S, Brochier A, Wexler MG
Addressing unmet basic needs for children with sickle cell disease in the United States: clinic and staff perspectives.
The purpose of this study was to assess pediatric hematology clinic staff's perspectives regarding barriers and facilitators in addressing unmet basic needs for children with sickle cell disease. Six focus groups were held at urban pediatric hematology clinics in the Northeastern region of the U.S. Four themes emerged: families of children with SCD have numerous unmet basic needs; clinic staff felt they had a role to play in addressing these needs; staff felt their ability to address these needs depended upon caregivers' capacity to act on staff recommendations; clinic staff's ability to address these needs was limited by organizational and systemic factors beyond their control. These findings have important implications for how best to address adverse social determinants of health for this vulnerable pediatric population so that urban-based pediatric hematology clinics can more equitably support families.
AHRQ-funded; HS022242.
Citation: Loo S, Brochier A, Wexler MG .
Addressing unmet basic needs for children with sickle cell disease in the United States: clinic and staff perspectives.
BMC Health Serv Res 2021 Jan 12;21(1):55. doi: 10.1186/s12913-020-06055-y..
Keywords: Children/Adolescents, Sickle Cell Disease, Chronic Conditions, Social Determinants of Health, Provider: Clinician, Provider: Physician, Provider, Urban Health
Fiori KP, Heller CG, Rehm CD
Unmet social needs and no-show visits in primary care in a US Northeastern urban health system, 2018-2019.
This study used results from a 10-item social needs screener conducted across 19 primary care practices in Bronx County, New York to determine reasons for no-show appointments between April 2018 and July 2019. They examined the association between unmet needs and a 2-year history of missed appointments from 41,637 patients. Overall, the no-show appointment rate was 26.6%. Patients with 1 or more unmet social needs had a significantly higher no-show proportion (31.5%) than those without (26.3%). The strongest association with no-shows was with transportation problems.
AHRQ-funded; HS026396.
Citation: Fiori KP, Heller CG, Rehm CD .
Unmet social needs and no-show visits in primary care in a US Northeastern urban health system, 2018-2019.
Am J Public Health 2020 Jul;110(S2):S242-s50. doi: 10.2105/ajph.2020.305717..
Keywords: Urban Health, Primary Care, Access to Care, Social Determinants of Health
Heller CG, Parsons AS, Chambers EC
Social risks among primary care patients in a large urban health system.
The objective of this study was to understand the variability in the number and types of social risks overall and in population subgroups among primary care patients routinely screened in a large urban health system. Participants across nineteen ambulatory sites in the Bronx, New York, completed a 10-item screener. Findings showed that there were important differences in the prevalence of overall and individual social risks by subgroup. These findings should be considered to inform clinical care and social risk screening and interventions.
AHRQ-funded; HS026396.
Citation: Heller CG, Parsons AS, Chambers EC .
Social risks among primary care patients in a large urban health system.
Am J Prev Med 2020 Apr;58(4):514-25. doi: 10.1016/j.amepre.2019.11.011..
Keywords: Social Determinants of Health, Primary Care, Urban Health, Risk, Vulnerable Populations
Smith NA, Voisin DR, Yang JP
Keeping your guard up: hypervigilance among urban residents affected by community and police violence.
This study’s aim was to quantify the effects of hypervigilance among urban residents affected by community and police violence. A survey of 504 adults in Chicago in 2018 was done in a neighborhood affected by high levels of violence. It was found that exposure to police violence was associated with a 9.8% increase in hypervigilance while exposure to community violence caused a 5.5% increase. Among participants who had a police stop, it was associated with 20% increase in hypervigilance. Overall, the highest quartile of hypervigilance was associated with higher systolic blood pressure.
AHRQ-funded; HS023007.
Citation: Smith NA, Voisin DR, Yang JP .
Keeping your guard up: hypervigilance among urban residents affected by community and police violence.
Health Aff 2019 Oct;38(10):1662-69. doi: 10.1377/hlthaff.2019.00560..
Keywords: Urban Health, Social Determinants of Health, Behavioral Health, Patient-Centered Outcomes Research, Evidence-Based Practice
Rundle AG, Chen Y, Quinn JW
Development of a neighborhood walkability index for studying neighborhood physical activity contexts in communities across the U.S. over the past three decades.
To examine how urban form shapes physical activity and health over time, a measure of neighborhood walkability is needed that can be linked to cohort studies with participants living across the United States (U.S.) that have been followed over the past decades. In this study, the Built Environment and Health-Neighborhood Walkability Index (BEH-NWI), a measure of neighborhood walkability that can be calculated for communities across the United States between 1990 and 2015, was conceptualized, developed, and tested using data from the New York City Tri-State Area.
AHRQ-funded; HS026120.
Citation: Rundle AG, Chen Y, Quinn JW .
Development of a neighborhood walkability index for studying neighborhood physical activity contexts in communities across the U.S. over the past three decades.
J Urban Health 2019 Aug;96(4):583-90. doi: 10.1007/s11524-019-00370-4
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Keywords: Urban Health, Lifestyle Changes, Health Status, Social Determinants of Health
Fiori K, Patel M, Sanderson D
From policy statement to practice: integrating social needs screening and referral assistance with community health workers in an urban academic health center.
The authors described their experience implementing a novel social needs screening program at an academic pediatric clinic. They found that, on average, 76% of providers had their patients screened on more than half of eligible well-child visits. Their experience suggested that screening for social needs at well-child visits is feasible as part of routine primary care. They recommended that success would best be achieved by leveraging resources, obtaining provider buy-in, and defining program components to sustain activities.
AHRQ-funded; HS026396.
Citation: Fiori K, Patel M, Sanderson D .
From policy statement to practice: integrating social needs screening and referral assistance with community health workers in an urban academic health center.
J Prim Care Community Health 2019 Jan-Dec;10:2150132719899207. doi: 10.1177/2150132719899207..
Keywords: Children/Adolescents, Community-Based Practice, Healthcare Delivery, Implementation, Screening, Social Determinants of Health, Urban Health, Workflow, Primary Care
Oates GR, Hamby BW, Bae S
Bikeshare use in urban communities: individual and neighborhood factors.
This study examined factors associated with bikeshare use in a metropolitan area in the southern United States. The study found that higher neighborhood socioeconomic disadvantage was associated with higher bikeshare use. Bikeshare was a viable transportation option in low-resource neighborhoods and may be an effective tool to improve the connectivity, livability, and health of urban communities.
AHRQ-funded; HS023009.
Citation: Oates GR, Hamby BW, Bae S .
Bikeshare use in urban communities: individual and neighborhood factors.
Ethn Dis 2017 Nov 9;27(Suppl 1):303-12. doi: 10.18865/ed.27.S1.303..
Keywords: Health Status, Social Determinants of Health, Urban Health
Tung EL, Wroblewski KE, Boyd K
Police-recorded crime and disparities in obesity and blood pressure status in Chicago.
The purpose of this study was to examine associations between several types of police-recorded crime (violent, nonviolent, and homicide) and cardiometabolic health (obesity and elevated blood pressure [BP]), and to determine if associations were modified by age and sex. It concluded that in a densely populated, high-poverty region in Chicago, recurrent exposure to high rates of violent crime was consistently associated with obesity and elevated BP, but rare exposure to homicide was not.
AHRQ-funded; HS023007.
Citation: Tung EL, Wroblewski KE, Boyd K .
Police-recorded crime and disparities in obesity and blood pressure status in Chicago.
J Am Heart Assoc 2018 Mar 24;7(7). doi: 10.1161/jaha.117.008030.
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Keywords: Blood Pressure, Disparities, Risk, Social Determinants of Health, Urban Health
Beck A, Davidson AJ, Xu S
A multilevel analysis of individual, health system, and neighborhood factors associated with depression within a large metropolitan area.
This study geocoded depression diagnosis and demographic data from electronic health records to obtain both individual and neighborhood factors related to depression. The researchers found higher depression rates associated with greater age, female gender, white race, medical comorbidities, and with lower rates of home owner occupancy, residential stability, and higher educational attainment, but not with economic disadvantage. Among the cohort, higher depression rates were associated with higher crime rates and a lower percent of foreign born residents and single mother households.
AHRQ-funded; HS022143.
Citation: Beck A, Davidson AJ, Xu S .
A multilevel analysis of individual, health system, and neighborhood factors associated with depression within a large metropolitan area.
J Urban Health 2017 Dec;94(6):780-90. doi: 10.1007/s11524-017-0190-x..
Keywords: Depression, Electronic Health Records (EHRs), Social Determinants of Health, Urban Health
Tung EL, Cagney KA, Peek ME
Spatial context and health inequity: reconfiguring race, place, and poverty.
The authors build on the Chicago School of Sociology's contributions in urban research and one of its contemporary elaborations, often described as the "neighborhood effects approach," to propose a three-axis model of health inequity. This model, in alignment with Chicago School theory, postulates a dynamic and adaptive relationship between spatial context and health inequity. Compositional axes of race and poverty form the foundation of the model.
AHRQ-funded; HS023007.
Citation: Tung EL, Cagney KA, Peek ME .
Spatial context and health inequity: reconfiguring race, place, and poverty.
J Urban Health 2017 Dec;94(6):757-63. doi: 10.1007/s11524-017-0210-x.
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Keywords: Disparities, Low-Income, Racial and Ethnic Minorities, Social Determinants of Health, Urban Health
Caldwell JT, Ford CL, Wallace SP
Intersection of living in a rural versus urban area and race/ethnicity in explaining access to health care in the United States.
The researchers examined whether living in a rural versus urban area differentially exposes populations to social conditions associated with disparities in access to health care. They cocluded that rural status confers additional disadvantage for most of the health care use measures, independently of poverty and health care supply.
AHRQ-funded; HS022811.
Citation: Caldwell JT, Ford CL, Wallace SP .
Intersection of living in a rural versus urban area and race/ethnicity in explaining access to health care in the United States.
Am J Public Health 2016 Aug;106(8):1463-9. doi: 10.2105/ajph.2016.303212.
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Keywords: Rural Health, Urban Health, Racial and Ethnic Minorities, Access to Care, Social Determinants of Health
Rokicki S, Montana L, Fink G
Impact of migration on fertility and abortion: evidence from the household and welfare study of Accra.
The researchers used detailed pregnancy and migration histories collected as part of the Household and Welfare Study of Accra (HAWS) to examine the association between migration and pregnancy outcomes among women residing in the urban slums of Accra, Ghana. They found that the completed fertility patterns of lifetime Accra residents are remarkably similar to those of residents who migrated.
AHRQ-funded; HS000055.
Citation: Rokicki S, Montana L, Fink G .
Impact of migration on fertility and abortion: evidence from the household and welfare study of Accra.
Demography 2014 Dec;51(6):2229-54. doi: 10.1007/s13524-014-0339-0..
Keywords: Pregnancy, Urban Health, Social Determinants of Health, Labor and Delivery