Abstracts - Community Health

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    Experience of Switching from a Traditional Sitting Workstation to a Sit-Stand Workstation in Sedentary Office Workers
    N. Dutta, T. Walton, and M. Pereira
    Kansas City University of Medicine and Biosciences, 1750 Independence Avenue, Kansas City, MO 64106.

    PURPOSE. A randomized cross-over trial aimed at deciphering whether use of sit-stand desks (SSDs), where participants can work sitting or standing, can be used to increase light activity and reduce sedentary time. Here we report the experience of the participants of using these desks. METHODS. The study took place from January to April, 2012 in sedentary office workers at a small business in Minneapolis, Minnesota. Out of a volunteer sample of 35 adults, 29 were randomized, and 28 were included for analysis. A four week intervention period consisted of using a SSD with the goal of gradually replacing half of sitting time with standing during the workday. Individual interviews, focus group sessions, and self-reported productivity surveys were conducted. RESULTS. Productivity in the control period was not significantly different from intervention period. After an initial adjustment period, the experience with the SSDs was overwhelmingly positive. As subjects got accustomed to the SSDs, they reported feeling more energetic and alert at work. They also reported an increase in face-to-face interaction with coworkers. Lack of work-surface was the biggest problem with the use of SSDs. CONCLUSIONS. Taken together the experiences, authors make some recommendations for implementing SSDs at workplace and for future research.


    Bicycling Polices of Major U.S. Metropolitan Areas are Associated with Health Outcomes
    E. Freeman , K. Braunlich , T. Phamudy , C. Mayfield, and R. Suminski
    Kansas City University of Medicine and Biosciences, 1750 Independence Avenue, Kansas City, MO 64106.

    BACKGROUND. Physical activities, such as bicycling, protect against chronic disease. Recent efforts to promote bicycling have focused on policies to induce large-scale, sustainable alterations to the built environment, and subsequently better infrastructures for supporting bicycling. To date, little has been published about such policies especially how they relate to health outcomes. Purpose: This study used data from several national surveys to explore associations between bicycling policies in place in 51 U.S. metropolitan areas and various indicators of chronic disease. METHODS. 2009 data from the Centers for Disease Control and Prevention, US Department of Transportation, Alliance for Biking and Walking, and the National Complete Streets Coalition were subjected to bivariate and multivariate analyses. Outcome variables were the total number of policies related to bicycling in-place in each city, percentage of workers bicycling to work, and the prevalence rates of diabetes, asthma, heart disease (CHD), hypertension, overweight, and obesity as well as the death rate for cardiovascular disease (CVD) in each city. RESULTS. Having more bicycling policies in place was significantly related to a greater percentage of residents bicycling to work. In turn, bicycling to work was negatively correlated with CHD, CVD deaths, overweight, obesity, and hypertension (all p<0.05). The number of policies was not related to health outcomes once the percentage of workers bicycling to work was accounted for. CONCLUSION. The results of this study suggest that cities with more policies aimed at promoting bicycling have healthier populations partially because the policies are related to more resident workers acquiring the health benefits of bicycling.


    Validation of an Objective 3rd Party Visual Scale for Child Obesity Status
    A. Kheyfets, L. Mathias, C. Mayfield, and R. Suminski
    Kansas City University of Medicine and Biosciences, 1750 Independence Avenue, Kansas City, MO 64106.

    Currently, the most efficient way to screen for obesity is using Body Mass Index (BMI), a calculation based on height and weight measurements. There have been studies looking at self-reporting of BMI, but are not validated as an objective third party scale. The purpose of this study is to validate an objective, third party visual scale that categorizes children into obesity status groups. A third party visual scale that depicted silhouettes of children across various BMI categories was created by a medical artist and tested by 2 blinded data collectors. Participants included children between the ages of 8 and 12 who were attending a local health fair. Data collectors ranked children on the scale, and BMI was collected as an objective measurement. Based on the objective measure of BMI, results showed that 20.9% of children were obese, while the scale showed between 17.2 and 20.3% were obese. Inter-rater reliability showed a significant (κ =.80, p<.001) relationship between raters for obese vs. normal weight categories. The sensitivity of the scale is 100% accurate in correctly identifying an obese child, and the specificity of the scale is 91.2% accurate in correctly identify a non-obese child. The scale is reliable and valid for identifying obesity status in children between the ages of 8 and 12. Results from the scale do not replace necessity of a standard BMI screening, but it can be used by individuals who work with children to identify the need for a screening.


    Longitudinal study of the Prevalence of Methicillin-Resistant Staphylococcus Aureus in Homeless and Economically Disadvantaged Populations in Kansas City
    A. Roller, E. Cooper, J. Marlin, C. Williams, R. Newman, L. Segars, J. Wasserman, and T. Taylor
    Kansas City University of Medicine and Biosciences, 1750 Independence Avenue, Kansas City, MO 64106.

    Methicillin-resistant Staphylococcus aureus (MRSA) are infectious bacteria that are resistant to many current antibiotic treatments and are a threat to public health. Based on previous work in our lab, we hypothesized that a two-year MRSA prevalence in the homeless and economically disadvantage population of Kansas City would remain stable and that the rate would be higher than the general population. Our goal was to begin a longitudinal analysis of MRSA prevalence in this specified population. This year, we collected nasal swab samples and survey information from 87 homeless and economically disadvantaged persons at a Kansas City homeless shelter. Samples were cultured on MRSA selective-media and positive results confirmed with Gram staining, catalase and coagulase tests. spa gene sequencing was performed for strain typing. Over two years, 198 total swabs were collected and we have found a MRSA carriage prevalence of 9.6%. Church attendance was the only biopsychosocial factor that we found to be correlated with MRSA positive carriage status. The findings of this study demonstrate that homeless persons carry MRSA at higher rates than the average population and that the rates of MRSA in the homeless might be gradually increasing. Longitudinal continuation of this study will provide more data about the prevalence of MRSA in the homeless and will reveal clinically relevant information regarding where the shelter occupants may be exposed to this pathogen. These findings provide valuable insight into the health and improvement of care for medically underserved homeless populations.


    Association between ADHD and Ambulatory Care for Non-Severe Injury
    L. Segars, J. Thorpe, D. Willsie, R. Suminski, J. Wasserman, and C. Mayfield
    Kansas City University of Medicine and Biosciences, 1750 Independence Avenue, Kansas City, MO 64106.

    PURPOSE. Describe the association between ADHD and seeking ambulatory medical care for a non-severe injury and compare differences in types of ambulatory-treated injuries between ADHD and non-ADHD patients, stratified by select patient demographics. METHODS. National cross-sectional surveys of ambulatory medical visits (NAMCS/NHAMCS) by U.S. patients, ≤18 years of age in 2002-2007. Weighted data were used for analyses allowing for generation of national estimates. Odds ratios and 95% confidence intervals were determined via multiple logistic regression with an a priori level of 0.05. Stata SE (v. 9.2) was utilized for all analyses. RESULTS. An estimated 1.45 billion ambulatory visits occurred by U.S. children aged ≤18 years during 2002-2007. Of these, 6.6% were related to non-severe injury. ADHD patients were significantly less likely to present to an ambulatory setting for a non-severe injury and significantly less likely to incur all but two of the injury categories. ADHD patients presenting for non-severe injury were significantly more likely to be male, ≥7 years of age, and present to an emergency department-setting for care. Patients presenting for a non-severe injury were less likely to be minorities, treated by a primary care provider, or to have a psychiatric comorbidity. CONCLUSIONS. Our novel findings significantly add to the previous literature by evaluating additional settings for medical care and focusing on non-severe (non-hospitalization) injuries.


    The Reliability of the National Program for Playground Safety Checklist
    R. Suminski, C. Mayfield, J. Norman, and J. Gavin
    Kansas City University of Medicine and Biosciences, 1750 Independence Avenue, Kansas City, MO 64106.

    BACKGROUND. Each year over 200,000 youth are treated at emergency departments for injuries that occurred on playgrounds. The National Program for Playground Safety (NPPS) developed a checklist that can be used to audit playgrounds to determine their level of safety and propensity to increase the risk of injury. Purpose: This study was conducted to provide evidence concerning the inter-reliability of the NPPS checklist. METHODS. Three researchers completed in-person audits at 37 playgrounds and parks located in the Kansas City urban core. During the audits they obtained independent assessments regarding the presence or absence of 24 items related to playground safety. Statistical indicators of reliability [percent agreement, Fleiss’ Kappa (κ), and two-way, random inter-class correlations (ICC)] were calculated for an overall score (sum of 24 items), sub-scores pertaining to supervision (4 items), design (6 items), equipment (8 items), and surfaces (6 items), and each item. RESULTS. Moderate agreement was reached for the overall score (ICC=0.57). The κ for the sub-scores were 0.24 for supervision (fair agreement), 0.80 for design (substantial agreement), 0.82 for equipment (almost perfect agreement), and 0.52 for surfaces (moderate agreement). Moderate or better agreement (κ = 0.42 to 0.60) was displayed by 15 items, slight to fair agreement (κ = 0.01 to 0.32) for two items, and less than chance agreement (κ < 0) for five items. CONCLUSIONS. In its present form, the NPPS checklist for playground safety provides moderately reliable information when used by multiple raters. Revisions of items related to supervision and surfaces should improve the checklist’s reliability.


    A Virtual Street Audit Procedure Validation for SPACES Using Google Street View
    R. Suminski, C. Mayfield , and D. Price
    Kansas City University of Medicine and Biosciences, 1750 Independence Avenue, Kansas City, MO 64106.

    BACKGROUND/PURPOSE: It has been broadly acknowledged that factors of the built environment (e.g. sidewalks) have a profound impact on the physical activity of community residents and their subsequent health outcomes. The current study investigates the validity and reliability of virtual audits using the omnidirectional imaging of Google Street View. METHODS. Audits were conducted using the Systematic Pedestrian and Cycling Environment Scan instrument (SPACES), a research audit tool developed for the assessment of the physical environment for use in walking and cycling. Population: The study area consisted of the metropolitan area of Kansas City, Missouri. A total of 28 street segments were audited, measuring 300ft in length and were located in 2 different neighborhoods (Neighborhood 1 and Neighborhood 2). Identical segments in both neighborhoods were assessed using the standard SPACES in- person audit, as well as a virtual audit through Google Street View. RESULTS. Results showed that all items were significantly correlated with a p-value ranging from .01 to .05. For the inter-rater reliability, the comparison of each data collector (KZ vs. KZ, and ZE vs. ZE) for both categories of data collection results showed that all items were significantly correlated with a p value ranging from .001 to .05. CONCLUSION/DISCUSSION. Our study expands on these observations by using more in-depth measures, for example rather than just focusing on the presence or absence of a walking path our study also examines the path material, conditions and other qualities in a ranked ordinal measure.