Co-Authorship Network Analysis of Prevention Research Centers: An Exploratory Study.

OBJECTIVE: The Centers for Disease Control and Prevention's Prevention Research Centers (PRCs) collaborate on public health activities with community agencies and organizations. We evaluated these collaborations by studying the relationships between co-authors from the PRCs and community agencies that published at least 1 article together in the first year of the program. METHODS: We identified all the authors of articles published by PRCs and collaborating members in peer-reviewed journals between September 2014 and September 2015 and constructed a network showing the links between and among all the authors. We characterized the network with 4 measures of social structure (network components, network density, average clustering coefficient, average distance) and 3 measures of individual author performances (degree-, betweenness-, and closeness-centrality). RESULTS: The 413 articles had 1804 individual authors and 7995 co-authorship relationships (links) in 212 peer-reviewed journals. These authors and co-authors formed 44 separate, nonoverlapping groups (components). The largest "giant" component containing most of the links involved 66.3% (n = 1196) of the authors and 73.7% (n = 5889) of the links. We identified 136 "information brokers" (authors with high closeness centrality: those who have the shortest links to the most authors). Two authors with high betweenness centrality (who had the highest number of co-authors; 104 and 107) had the greatest ability to mediate co-authorships. Network density was low; only 0.5% of all potential co-authorships were realized (7995 actual co-authorship/1 628 110 potential co-authorships). CONCLUSION: Information brokers and co-authorship mediators should be encouraged to communicate more with each other to increase the number of collaborations between network members and, hence, the number of co-authorships.

Trends and Factors Associated with Hospitalization Costs for Inflammatory Bowel Disease in the United States.

BACKGROUND: Few studies have addressed recent trends in hospitalization costs for inflammatory bowel disease (IBD). OBJECTIVE: We explored trends and described patient and hospital factors associated with hospitalization costs for IBD. METHODS: Using data from the 2003-2014 National Inpatient Sample for adults aged ≥ 18 years, we estimated costs using multivariable linear models and assessed linear trends by time periods using piecewise linear regressions. RESULTS: In 2014, there were an estimated 56,290 hospitalizations for Crohn's disease (CD), with a mean cost of US$11,345 and median cost of US$7592; and 33,585 hospitalizations for ulcerative colitis (UC), with a mean cost of US$13,412 and median cost of US$8873. Higher costs were observed among Hispanic [adjusted cost ratio (ACR) = 1.07; 95% confidence interval (CI) = 1.00-1.14; p = 0.04] or other non-Hispanic (ACR = 1.09; 95% CI = 1.02-1.17; p = 0.01) CD patients than for non-Hispanic White CD patients. For UC patients, higher costs were observed among men (ACR = 1.09; 95% CI = 1.05-1.13; p < 0.001) compared with women and among patients aged 35-44 years, 45-54 years, and 55-64 years compared with those aged 18-24 years. Among all patients, factors associated with higher costs included higher household income, more comorbidities, and hospitals that were government nonfederal versus private, were large versus small, and were located in the West versus Northeast regions. From 2003 to 2008, total costs increased annually by 3% for CD (1.03; 95% CI = 1.02-1.05; p < 0.001) and 4% for UC (1.04; 95% CI = 1.02-1.06; p < 0.001), but remained unchanged from 2008 to 2014. CONCLUSIONS: The findings are important to identify IBD patients with higher hospitalization costs and to inform policy plans on hospital resource allocation.

The Economic Value of Informal Caregiving for Persons With Dementia: Results From 38 States, the District of Columbia, and Puerto Rico, 2015 and 2016 BRFSS.

OBJECTIVES: To estimate the economic value from a societal perspective of informal caregiving of persons with dementia in 38 states, the District of Columbia, and Puerto Rico. METHODS: Using a cost replacement method and data from the 2015 and 2016 Behavioral Risk Factor Surveillance System caregiver module, the US Bureau of Labor Statistics May 2016 Occupation Profiles, and the US Department of Labor, we estimated the number and economic direct cost of caregiving hours. RESULTS: An estimated 3.2 million dementia caregivers provided more than 4.1 billion hours of care, with an average of 1278 hours per caregiver. The median hourly value of dementia caregiving was $10.28. Overall, we valued these caregiving hours at $41.5 billion, with an average of $13 069 per caregiver. CONCLUSIONS: Caregivers of persons with dementia provide care that has important economic implications. Without these efforts, many people would either not receive needed care or have to pay for that support. Surveillance data can be used to estimate the contributions of informal caregivers and the economic value of the care they provide.

Cost Analysis of Prevention Research Centers: Instrument Development.

The 2014-2019 Prevention Research Centers (PRC) Program Funding Opportunity Announcement stated that "all applicants will be expected to collaborate with CDC to collect data to be able to perform cost analysis." For the first time in the 30-year history of the PRC Program, a cost indicator was included in the PRC Program Evaluation and a cost analysis (CA) instrument developed. The PRC-CA instrument systematically collects data on the cost of the PRC core research project to eventually answer the CDC PRC Program Evaluation question: "To what extent do investments in PRCs support the scalability, sustainability, and effectiveness of the outcomes resulting from community-engaged efforts to improve public health?" The objective of this article is to briefly describe the development of the PRC-CA instrument. Data obtained from the PRC-CA instrument can be used to generate cost summaries to inform decision making within the PRC Program and each individual PRC.

Measuring Audience Engagement for Public Health Twitter Chats: Insights From #LiveFitNOLA.

BACKGROUND: Little empirical evidence exists on the effectiveness of using Twitter as a two-way communication tool for public health practice, such as Twitter chats. OBJECTIVE: We analyzed whether Twitter chats facilitate engagement in two-way communications between public health entities and their audience. We also describe how to measure two-way communications, incoming and outgoing mentions, between users in a protocol using free and publicly available tools (Symplur, OpenRefine, and Gephi). METHODS: We used a mixed-methods approach, social network analysis, and content analysis. The study population comprised individuals and organizations participating or who were mentioned in the first #LiveFitNOLA chat, during a 75-min period on March 5, 2015, from 12:00 PM to 1:15 PM Central Time. We assessed audience engagement in two-way communications with two metrics: engagement ratio and return on engagement (ROE). RESULTS: The #LiveFitNOLA chat had 744 tweets and 66 participants with an average of 11 tweets per participant. The resulting network had 134 network members and 474 engagements. The engagement ratios and ROEs for the #LiveFitNOLA organizers were 1:1, 40% (13/32) (@TulanePRC) and 2:1, -40% (-25/63) (@FitNOLA). Content analysis showed information sharing (63.9%, 314/491) and health information (27.9%, 137/491) as the most salient theme and sub-theme, respectively. CONCLUSIONS: Our findings suggest Twitter chats facilitate audience engagement in two-way communications between public health entities and their audience. The #LiveFitNOLA organizers' engagement ratios and ROEs indicated a moderate level of engagement with their audience. The practical significance of the engagement ratio and ROE depends on the audience, context, scope, scale, and goal of a Twitter chat or other organized hashtag-based communications on Twitter.

Community Health Assessment and Improved Public Health Decision-Making: A Propensity Score Matching Approach.

OBJECTIVES: We analyzed the likelihood of chronic disease prevention activities delivery, as a proxy measure of public health decision-making and actions, given that local health agencies (LHAs) implemented a community health assessment and improvement plan in their communities. METHODS: Using a propensity score matching approach, we linked data from the 2010 National Association of County and City Health Officials profile of LHAs and the 2010 County Health Rankings to create a statistically matched sample of implementation and comparison LHAs. Implementation LHAs were those that implemented a community health assessment and improvement plan. We estimated the odds of chronic disease prevention activities delivery and the average treatment effect on the treated. RESULTS: Implementation group LHAs were 2 times as likely (95% confidence interval = 1.60, 2.64) to deliver population-based chronic disease prevention programs than comparison group LHAs. Furthermore, chronic disease prevention activities were more likely to be delivered among implementation group LHAs (6.50-19.02 percentage points higher) than in comparison group LHAs. CONCLUSIONS: Our results signal that routine implementation of a community health assessment and improvement plan in LHAs leads to improved public health decision-making and actions.

Economic Evaluation Enhances Public Health Decision Making.

Contemporary public health professionals must address the health needs of a diverse population with constrained budgets and shrinking funds. Economic evaluation contributes to evidence-based decision making by helping the public health community identify, measure, and compare activities with the necessary impact, scalability, and sustainability to optimize population health. Asking "how do investments in public health strategies influence or offset the need for downstream spending on medical care and/or social services?" is important when making decisions about resource allocation and scaling of interventions.

A Cost Analysis of the 1-2-3 Pap Intervention.

BACKGROUND: Cervical cancer places a substantial economic burden on our healthcare system. The three-dose human papillomavirus (HPV) vaccine series is a cost-effective intervention to prevent HPV infection and resultant cervical cancer. Despite its efficacy, completion rates are low in young women aged 18 through 26 years. 1-2-3 Pap is a video intervention tested and proven to increase HPV vaccination completion rates. PURPOSE: To provide the full scope of available evidence for 1-2-3 Pap, this study adds economic evidence to the intervention's efficacy. This study tested the economies of scale hypothesis that the cost of 1-2-3 Pap intervention per number of completed HPV vaccine series would decrease when offered to more women in the target population. METHODS: Using cost and efficacy data from the Rural Cancer Prevention Center, a cost analysis was done through a hypothetical adaptation scenario in rural Kentucky. RESULTS: Assuming the same success rate as in the efficacy study, the 1-2-3 Pap adaptation scenario would cover 1000 additional women aged 18 through 26 years (344 in efficacy study; 1346 in adaptation scenario), and almost three times as many completed series (130 in efficacy study; 412 in adaptation scenario) as in the original 1-2-3 Pap efficacy study. IMPLICATIONS: Determination of the costs of implementing 1-2-3 Pap is vital for program expansion. This study provides practitioners and decision makers with objective measures for scalability.

Regulatory enforcement and fiscal impact in local health agencies.

OBJECTIVES: We used a cross-sectional, retrospective study design to analyze the association between local health agency regulatory activities and revenues from nonclinical fees and fines (NFF). METHODS: We extracted data from the 2010 National Association of County and City Health Officials (NACCHO) Profile Survey, the most recent report including NFF information, and used 2-part multivariable regression models to identify relationships between regulatory activities and revenue. We also interviewed LHD directors on access to revenue from fines. RESULTS: NFFs generated substantial revenue for most LHDs, increasing in scope and amount with jurisdiction size for all but the largest municipalities. The greatest proportion of net revenue came from public pools, campgrounds and recreational vehicles, and solid waste disposal. For small and mid-sized LHDs, enforcement activities generated revenue in a dose-response pattern, with higher returns for increased activities. LHDs in decentralized governance states collected more NFF revenue than those in centralized states. States vary regarding LHD access to revenue from sanctions. CONCLUSIONS: The fiscal impact of changes in regulatory activity needs careful assessment to avoid unanticipated consequences of applicable law.