AJPH January 2016 highlights

Date: Jan 21 2016

AJPH Research: Google Street View improves study of pedestrian injuries, supermarket distance affects child fruit and vegetable intake and BMI, government funds majority of U.S. health care costs

CONTACT: For copies of articles or full table of contents of an issue, contact Mandi Yohn at amanda.yohn@apha.org or at 202-777-2509.

American Journal of Public Health highlights:

1. Google Street View improves assessment of pedestrian injury risk

2.
Kids in obesity intervention who lived closer to supermarkets had greater fruit and vegetable intake, better BMI

3.
Governments funds nearly two-thirds of U.S. health care costs

Google Street View improves assessment of pedestrian injury risk

Google Street View and similar information technology can improve efficiency when assessing environment characteristics associated with pedestrian injuries, according to a new study in the American Journal of Public Health.

Researchers from Columbia University’s Mailman School of Public Health used imagery captured by Google Street View from 2007-2011 to examine nine characteristics of 532 intersections in New York City. The pedestrian environment at each intersection was assessed with the Computer Assisted Neighborhood Visual Assessment System, a tool that enhances virtual street audit reliability and efficiency. Researchers controlled for estimated pedestrian count and relation between intersections’ characteristics and frequency of injurious collisions.

Consistent with in-person site visits, results showed that more pedestrian injuries occurred at intersections with marked crosswalks and pedestrian signals. Injury incidence per pedestrian was lower at intersections with higher estimated pedestrian volumes. Nearby billboards and bus stops were also associated with more pedestrian injuries.

“In 2013, an estimated 70,000 pedestrians were injured or killed by motor vehicles in the United States. Investments in pedestrian safety infrastructure may be a particularly cost-effective way to improve population health,” the authors explain. “Using Google Street View to assess intersection characteristics and Walk Score to estimate pedestrian counts may enable a much more efficient data-collection regime with relatively little cost to validity.”

[“Use of Google Street View to Assess Environmental Contributions to Pedestrian Injury.” Contact: Andrew Rundle, DrPH, MPH, Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.]

Kids in obesity intervention who lived closer to supermarkets had greater fruit and vegetable intake, better BMI

According to new research in the American Journal of Public Health, children in an obesity intervention who lived closer to a supermarket ate more fruits and vegetables and had a better body mass index – or BMI – compared to those who lived farther away.

Researchers examined 498 children 6-12 years old with a BMI at or above the 95th percentile participating in a Massachusetts obesity trial from 2011-2013. The trial’s practice-based behavioral interventions included a computerized clinician decision support plus a family self-guided behavior change or health coaching. Distance to the closest supermarket was also examined. Outcomes measured were one-year change in BMI, sugar-sweetened beverage intake and fruit and vegetable intake.

Results showed that distance to supermarkets had a significant effect on one-year change in BMI and fruit and vegetable intake. Intervention participants who lived closer distances to supermarkets increased their fruit and vegetable intake and decreased their BMI compared to controls. Sugar-sweetened beverage intake, however, was not affected by distance to supermarkets.

“The prevalence of childhood obesity remains high despite public health and clinical efforts to prevent and manage obesity. Our results suggest that access to a healthier food environment facilitates improvement in body mass index and health behaviors among children and families attempting to reduce obesity,” the authors explained. “Policymakers and community leaders should continue to look for creative ways to improve families’ access to healthy foods.”

[“Effects of Proximity to Supermarkets on a Randomized Trial Studying Interventions for Obesity.” Lauren Fiechtner, MD, MPH, Massachusetts General Hospital, Boston, Massachusetts.]

Government funds nearly two-thirds of U.S. health care costs

Contrary to public perceptions and official figures, the government funds most health care costs in the United States, according to a new study in the American Journal of Public Health.

David Himmelstein, MD, and Steffie Woolhandler, MD, MPH, of the City University of New York School of Public Health at Hunter College estimated total taxpayer expenditures for health care in 2013 by summing direct government payments for Medicare, Medicaid and other public programs; government agencies’ expenditures for public employees health insurance coverage; and federal, state and local tax subsidies for health care. They also looked at figures through 2024 using Centers for Medicare and Medicaid Services’ projections.

Results showed that tax-funded expenditures for U.S. health care totaled $1.877 trillion in 2013, and are projected to increase to $3.642 trillion in 2024. The government’s share of overall health spending was 64.3 percent of total national health expenditures in 2013, and is projected to rise to 67.1 percent in 2024. Further, government health expenditures in the U.S. account for a larger share of gross domestic product than total health expenditures in any other nation.

“Americans pay the world’s highest health-related taxes. Yet many perceive that the U.S. health care financing system is predominantly private,” the authors explained. “Appreciation of the magnitude of government funding might encourage more explicit, appropriate and equitable targeting of these expenditures as components of a total health budget.”

[“The Current and Projected Taxpayer Shares of US Health Costs.” David Himmelstein, MD, City University of New York School of Public Health, Hunter College, New York, New York.]

Find a full list of research papers published online on January 21, 2016, at 4 p.m. EST below:

  • Characterizing Community Health Workers on Research Teams: Results From the Centers for Population Health and Health Disparities
  • Disparities by Sexual Orientation in Frequent Engagement in Cancer-Related Risk Behaviors: A 12-Year Follow-Up
  • Use of Google Street View to Assess Environmental Contributions to Pedestrian Injury
  • The Effects of Cumulative Victimization on Mental Health Among Lesbian, Gay, Bisexual, and Transgender Adolescents and Young Adults
  • Mental Health of Transgender Veterans in US States With and Without Discrimination and Hate Crime Legal Protection
  • Massachusetts Inpatient Medicaid Cost Response to Increased Supplemental Nutrition Assistance Program Benefits
  • Social Determinants of HIV-Related Stigma in Faith-Based Organizations
  • Socioeconomic Position and Premature Mortality in the AusDiab Cohort of Australian Adults
  • Effects of Proximity to Supermarkets on a Randomized Trial Studying Interventions for Obesity
  • E-Cigarette Use and Intention to Initiate or Quit Smoking Among US Youths
  • The Current and Projected Taxpayer Shares of US Health Costs
  • Wastewater Disposal Wells, Fracking, and Environmental Injustice in Southern Texas
  • Public Funding for Contraception, Provider Training, and Use of Highly Effective Contraceptives: A Cluster Randomized Trial
  • Socioeconomic Inequalities in Low Birthweight in the United States, the United Kingdom, Canada, and Australia
  • Heterogeneous Effects of Housing Vouchers on the Mental Health of US Adolescents
  • Sexual-Orientation Differences in Positive Youth Development: The Mediational Role of Bullying Victimization
  • Consistent Estimates of Very Low HIV Incidence Among People Who Inject Drugs: New York City, 2005–2014

The articles above will be published online January 21, 2016, at 4 p.m. EST by the American Journal of Public Health under “First Look.” “First Look” articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. The American Journal of Public Health is published by the American Public Health Association, and is available at www.ajph.org.

Complimentary online access to the Journal is available to credentialed members of the media. Address inquiries to Mandi Yohn at APHA, 202-777-2509, or email her. A single print issue of the Journal is available for $35 from the Journal’s Subscriptions department. If you are not a member of the press, a member of APHA or a subscriber, online single issue access is $30 and online single article access is $22 at www.ajph.org or for direct customer service, call 202-777-2516, or email.

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The American Journal of Public Health is the monthly journal of the American Public Health Association. APHA champions the health of all people and all communities by strengthening the profession of public health, sharing the latest research and information, promoting best practices and advocating for public health issues and policies grounded in research. More information is available at www.apha.org.