Chi-Squared Automatic Interaction Detection Decision Tree Analysis of Social Determinants for Low Birth Weight in Virginia.

This study provides additional context to the literature regarding the social inequities that impact birth outcomes in Virginia using a decision tree analysis. Chi-squared automatic interaction detection data analysis (CHAID) was performed using data from the Virginia birth registry for the years 2015-2019. Birth weight was the outcome variable, while sociodemographic factors and maternity care deserts were the explanatory variables. The prevalence of low birth weight in Virginia was of 8.1%. The CHAID decision tree model demonstrated multilevel interaction among risk factors with three levels, with a total of 34 nodes. All the variables reached significance in the model, with race/ethnicity being the first major predictor variable, each category of race and ethnicity having different significant predictors, followed by prenatal care and maternal education in the next levels. These findings signify modifiable risk factors for low birth weight, in prioritizing efforts such as programs and policies. CHAID decision tree analysis provides an effective approach to detect target populations for further intervention as pathways derived from this decision tree shed light on the different predictors of high-risk population in each of the race/ethnicity demographic categories in Virginia.

Assessing asthma self-management education among US children with current asthma, Asthma Call-back Survey (ACBS) 2015-2017.

OBJECTIVE: Asthma self-management education (AS-ME) is an effective strategy to help children with asthma achieve better asthma control and outcome. The objective of this study is to assess the association between the prevalence of receiving AS-ME curriculum components and sociodemographic characteristics among children with current asthma. METHODS: Behavioral Risk Factor Surveillance System, child Asthma Call-back Survey 2015-2017 aggregated data were used. Multivariable logistic regression models were used to assess associations of each AS-ME component question and sociodemographic characteristic, adjusting for sample weighting. RESULTS: Among 3,213 children with current asthma, 52% of children reported ever being given an asthma action plan by a doctor or other healthcare professional. After adjusting for other variables, boys and Non-Hispanic Black children were more likely to report being given an action plan (APR= 1.15[95% CI 1.00-1.32] and APR= 1.28[95% CI 1.07-1.54] respectively). Non-Hispanic Black (APR = 2.15 [95% CI 1.30-3.55]), non-Hispanic, other race (APR = 1.95 [95% CI1.04-3.66]), and Hispanic children (APR = 1.84 [95% CI 1.18-2.89]) were more likely to report taking a course to learn how to manage asthma than non-Hispanic White children. Hispanic children (40.8%) were more likely to report being advised to change home environment compared to non-Hispanic Whites (31.5%) (APR =1.28 [95% CI 1.01-1.63). CONCLUSION: The prevalence of some elements of asthma-self management education was relatively low and there were differences observed in the prevalence of receiving AS-ME by race/ethnicity, parental education, and income. Targeted implementation of asthma self-management components and interventions may improve asthma control and reduce asthma morbidity.

Social Determinants of Health and Racial/Ethnic Disparities in COVID-19 Mortality at the County Level in the Commonwealth of Virginia.

BACKGROUND: Mortality due to coronavirus disease-2019 (COVID-19) among Black and Hispanic populations is disproportionately high compared to white populations. This study aimed to explore the association between COVID-19 mortality and social determinants of health (SDOH) among Black and Hispanic populations in Virginia. METHOD: County-level publicly available COVID-19 mortality data from Virginia, covariates, and SDOH indicators were used. An independent t-test and hierarchical multiple regression analysis were performed to assess the association between SDOH and COVID-19 death rates, with a focus on racial/ethnic disparities. RESULTS: Counties in the lowest quartile had a mean death rate of 44.72 (SD = 13.8), while those in the highest quartile had a mean death rate of 239.02 (SD = 123.9) per 100, 000 people ( P < .001). Counties with the highest death rates had significantly lower mean socioeconomic status. The regression analysis revealed that 32% of the variance in the COVID-19 mortality rate was associated with SDOH after controlling for the covariates ( P < .01). Identifying as Hispanic ethnicity accounted for 8.5% of the variance, while median household income, being uninsured, and education accounted for 32.7%, 12.9%, and 7.1%, respectively. CONCLUSIONS: The findings provide evidence that disparities in SDOH experienced by Hispanic populations play a significant role in increased COVID-19 mortality, thus highlighting the social needs of low-income, low-education, and Hispanic populations to advance equity in health outcomes.

A Comparison of Acute Ischemic Stroke Patients Discharged to Inpatient Rehabilitation vs a Skilled Nursing Facility: The Paul Coverdell National Acute Stroke Program.

OBJECTIVE: To compare the sociodemographic, clinical, and hospital related factors associated with discharge of acute ischemic stroke (AIS) survivors to inpatient rehabilitation (IRF) and skilled nursing facility (SNF) rehabilitation services. DESIGN: Retrospective descriptive study from the Paul Coverdell National Acute Stroke Program (PCNASP) participating hospitals during 2016 to 2019. SETTING: 9 Participating states from PCNASP in United States. PARTICIPANTS: 130,988 patients with AIS from 569 hospitals (N=337,857). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Discharge to IRF and SNF. RESULTS: Patients discharged to a SNF had longer length of hospital stay, more comorbidities, and higher modified Rankin scores compared with patients discharged to an IRF. Nine characteristics were associated with being less likely to be discharged to an IRF than an SNF: older age (85+ years old, adjusted odds ratio [AOR]=0.20 [confidence interval [CI]=0.18-0.21]), identifying as non-Hispanic Black (AOR=0.85 [CI=0.81-0.89]), identifying as Hispanic (AOR=0.80 [CI=0.74-0.87]), having Medicaid or Medicare (AOR=0.73 [CI=0.70-0.77]), being able to ambulate with assistance from another person (AOR=0.93 [CI=0.89-0.97]), being unable to ambulate (AOR=0.73 [CI=0.62-0.87]) and having comorbidities, prior stroke (AOR=0.69 [CI=0.66-0.73]), diabetes (AOR=0.85 [CI=0.82-0.88]), and myocardial infraction or coronary artery disease (AOR=0.94 [CI=0.90-0.97]). Four characteristics were associated with being more likely to be discharged to an IRF than an SNF: being a man (AOR=1.20 [CI=1.16-1.24]), and having a slight disability (Rankin Score 2) (AOR=1.41 [CI=1.29-1.54]), being at larger hospitals (200-399 beds: AOR=1.31 [CI=1.23-1.40]; 400+ beds: AOR=1.29 [CI=1.20-1.38]), and being at a hospital with stroke unit (AOR=1.12 [CI=1.07-1.17]). CONCLUSION: This study found differences in demographic, clinical, and hospital characteristics of AIS patients discharged for rehabilitation to an IRF vs SNF. The characteristics of patients receiving rehabilitation services may be helpful for researchers and hospitals making policies related to stroke discharge and practices that optimize patient outcomes. Populations experiencing inequities in access to rehabilitation services should be identified, and those who qualify for rehabilitation in IRF should receive this care in preference to rehabilitation in SNF.

Computer-usage and associated musculoskeletal discomfort in college students.

BACKGROUND: High use of computers among college students and the resulting musculoskeletal disorders raises concerns regarding healthy usage patterns. OBJECTIVE: The purpose of this study is to examine college student's computer usage and related musculoskeletal discomfort. METHODS: A sample of 338 college students completed a cross-sectional survey consisting of demographic questions, musculoskeletal discomfort indicators and questions regarding computer use. RESULTS: The sample included 232 (68.6%) females and 106 (31.3%) males. 61% students had reported discomfort during or after working using computers with greatest discomfort in the neck (68.5%) and lower back (66%). Female students were more likely than male students to report any musculoskeletal discomfort (66% vs 51%), p < .05. Sitting duration, awkward postures and length of time (more than eight hours) were significantly associated with musculoskeletal discomfort (R2 = 0.24, p < .01). CONCLUSION: Most female college students reported musculoskeletal discomfort during or after computer use. Daily use of computer for more than eight hours, assuming awkward postures and sitting for long duration without breaks were found to be significantly related to musculoskeletal discomfort. Emphasizing good computing habits in college students to avoid musculoskeletal symptoms in the future will prevent morbidity in future workforce.

A qualitative study of health information-seeking behavior on the Internet among information technology professionals.

BACKGROUND: The motivation to seek health information on the Internet for individuals has been varied. The purpose of this paper was to explore the perspectives and experiences about online health information seeking in information technology (IT) professionals. MATERIALS AND METHODS: A qualitative case study research design was employed to examine the behavior of 15 IT professionals from a state organization in the East Coast of the United States of America. Convenience sampling was used to identify the setting, and purposeful sampling was used to select the participants. A survey questionnaire was used as a recruitment tool, and in-depth individual interviews with standardized semi-structured questions were used to collect data. RESULTS: Findings illustrated that the Internet was the first source of reference for wellness and prevention information to maintain a healthy lifestyle, and to alleviate and prevent work-related musculoskeletal disorders (WMSDs). The themes that emerged from the study were that the IT professionals searched the Internet for information to self-educate about medical conditions, to maintain fitness, communicate with health-care professionals, decide their treatment options, and to make lifestyle modifications such as ergonomic adjustment of their workstation, postural adjustments, and changing negative health behaviors. CONCLUSION: The results of this study provide practical implications for organizations and health professionals in providing health education to prevent WMSDs as participants sought health information online to take actions and collaborate with their health-care professionals and actively contributed to their medical health decisions. This underscores a valuable opportunity for health-care providers and public health officials to become more proactive by providing their patients with quality health information outside their office through the Internet by referring them to credible website sources.