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Transcript of Public Health Informatics – New Opportunities for Public Health Practitioners The Children’s...
Public Health Informatics – New Opportunities for Public Health Practitioners
The Children’s Hospital of Philadelphia’s Seventh Annual Mid-Atlantic Healthcare Informatics Symposium
April 25, 2014Giridhar Mallya, MD, MSHP
Director of Policy and PlanningPhiladelphia Department of Public Health
Tobacco and obesity surveillance, research, and evaluation
Challenges• Chronic disease are the leading causes of death and disability• Robust surveillance systems don’t exist• Individual and environmental variables are critical
Solutions• Creating registries of food and tobacco retailers• Conducting geospatial analyses of retailers, built environment• Collecting primary data on tobacco/food/beverage ads, bike racks, food
purchases• Analyzing secondary data on food purchases, public health and health care
service use• Augmenting health behavior surveys• Modeling policy impacts
Registries and geospatial analysis – healthy food retailers
~61,000 fewer Philadelphians living in low-income neighborhoods with limited access to healthy foods
Registries and geospatial analysis – healthy food retailers
• There was a strong relationship between WIC/SNAP status and indoor and outdoor advertising for tobacco and sugary beverages.
Primary data – advertising at WIC/SNAP stores
Tobacco products Sugary beverages Tobacco products Sugary beveragesOutdoor Indoor
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
60.3%
52.6%
70.0% 68.2%69.1%65.5%
78.5%
71.2%75.6%
68.8%
86.5%
77.9%
Non-WIC/SNAP SNAP only WIC (&SNAP)
Philadelphia Department of Public Health, Penn Design, 2012.
Primary data – bike racks via smartphone app
Philadelphia Department of Public Health; Mayor’s Office of Transportation and Utilities.
ESRI data collector tool Inventory Center City bike racks and
assess their condition and use
Identify areas of further need
Identify and dispose of abandoned bikes
4 interns collected 2,084 points in summer 2013
Primary data – food purchase in restaurants – menu labeling evaluation
Customers in unlabeled
restaurants(n=321)
Customers in labeled
restaurants(n=327)
Adjusted difference*
P-value
Calories in food purchased
1,691 kcal 1,556 kcal -151 kcal(-270.0, -32.6)
0.013
Sodium in food purchased
3,315 mg 3,111 mg -224 mg(-457.0, 8.0)
0.059
Saturated fat in food purchased
36.5 g 33.5 g -3.7 g(-7.4,-0.1)
0.047
Carbohydrates in food purchased
131 g 115 g -14.7 g(-25.8,-3.6)
0.010
Auchincloss A et al. Customer responses to mandatory menu labeling at full-service restaurants. American Journal Preventive Medicine. 2013 Dec;45(6):710-9.
*Adjusted for age, race/ethnicity, income, education, day of the week, frequency of dining out, and body size
Secondary data – vending sales
• City of Philadelphia• Over 220 vending machines with healthier mix,
smaller sizes, calorie labeling, and healthy marketing, affecting 25,000 employees
• Nearly 100 machines with healthier snacks
Philadelphia Department of Public Health, Vending sales data.
Secondary data – height and weight collected in schools
Robbins et al, Preventing Chronic Disease, 2012Accompanying editorial from RWJF, “Philadelphia Freedom”
5% decrease
8% decrease 7% decrease
Secondary data – calls to PA Free Quitline
Start of state NRT giveaway
Start of City secondhand smoke media campaign
PA Department of Health, PA Free Quitline. Analysis by Philadelphia Department of Public Health.
Secondary data – hospital discharges
PA Health Care Cost Containment Council. Analysis by Philadelphia Department of Public Health, Office of Health Information and Improvement.
Augmenting health behavior surveys – SSB consumption in Philadelphia
CDC, Youth Risk Behavior Surveillance Survey; PHMC, Southeastern PA Household Health Survey.
20% reduction 5% reduction
Modeling – impact of $2/pack cigarette tax
Adapted from Stehr M. The Effect of Tobacco Control Policies and a City Wide $2 per Pack Cigarette Tax on Smoking, Health Care Costs, and Productivity in Philadelphia. LeBow College of Business, Drexel University, March 2012.
Over 5 years, a $2/pack local tax would result in an additional…
8,000 fewer adult smokers
$15 million in annual health care savings
$9 million in annual productivity gains
Smoking prevalence,
2010
Smoking prevalence,
2015
Annual health care savings,
2015
Annual productivity gains, 2015
Existing tobacco control efforts
25.2% 22.0% $33.2 million $19.1 million
Existing efforts + $2/pack tax
25.2% 21.3% $48.1 million $28.1 million
Thank you!
www.phila.gov/health www.phila.gov/gethealthyphilly
www.smokefreephilly.org www.foodfitphilly.org