Mapping Cumulative Risk in Delaware: Approach and Implications for Health Equity.

Background: Addressing health equity requires attention to upstream determinants of health, including environmental and social factors that act in tandem to increase communities' exposure to and vulnerability to toxicants. Cumulative risk assessment, which evaluates combined risks from environmental and social factors, is a useful approach for estimating potential drivers of health disparities. We developed a cumulative risk score of multiple indices of environmental and social conditions and assessed block group-level differences in New Castle County, Delaware.

Caregiving During the COVID-19 Pandemic: A Cross-Sectional Study with Older Cisgender Sexual Minority Women in the United States.

This study describes prevalence of caregiving before and after the onset of the COVID-19 pandemic among racially diverse older cisgender sexual minority women, examines factors associated with caregiving, and assesses relationships between caregiving and health. A convenience sample of participants aged ≥50 years completed self-administered online surveys assessing sociodemographic characteristics, caregiver status, self-rated health, and depressive symptoms. Bivariate statistics compared response variables by race, caregiver status, and timing of caregiving relative to the pandemic.

"I Think There's Only Two Fields for That": Hospital Registrar Attitudes and Practices for Collecting Patient Gender Identity Data.

Purpose: This study aimed to understand the experiences of hospital registrars in collecting gender identity data.

Methods: A qualitative study that thematically analyzed key informant interviews with 37 registrars regarding their attitudes and practices in collecting gender identity data.

Results: Collection of gender identity is influenced by (1) system-level barriers, (2) discrepancies in source of truth for documentation, and (3) registrars' underlying attitudes and behaviors.

Neighborhood factors and triple negative breast cancer: The role of cumulative exposure to area-level risk factors.

Background: Despite similar incidence rates among Black and White women, breast cancer mortality rates are 40% higher among Black women. More than half of the racial difference in breast cancer mortality can be attributed to triple negative breast cancer (TNBC), an aggressive subtype of invasive breast cancer that disproportionately affects Black women. Recent research has implicated neighborhood conditions in the etiology of TNBC.

Reducing Exposure to Tobacco Retailers with Residential Zoning Policy: Insights from a Geospatial Analysis of Wilmington, Delaware.

Cigarette use remains the leading preventable cause of premature mortality in the US, with declines in smoking rates slowing in recent years. One promising target for improved tobacco control is the expanded regulation of tobacco retailers. Evaluations of such policy attempts have largely produced mixed results to date.

Policy Recommendations for Reducing Tobacco Exposure for Youth and Adults in Wilmington, Delaware.

Objective: To highlight and recommend policies that can be projected to reduce disproportionate tobacco exposure for youth and adults in Wilmington, Delaware's densest and most disadvantaged neighborhoods. Four policy options were drawn from the literature: pharmacy tobacco bans, zoning-based tobacco retailer reductions, residential density caps, and buffers around K-12 schools.

Method: Changes in tobacco retailer density and resident-to-retailer distance in Wilmington's medium- and high- density residentially zoned neighborhoods were projected using GIS analysis of current conditions and projections for each of the four policies.

Aggregated spatial intensity as a method for estimating point-level exposures within area-level units: The case of tobacco retailer exposure in census tracts.

Background: Aggregating point-level events to area-level units can produce misleading interpretations when displayed via choropleth maps. We developed the aggregated intensity method to share point-level location information across unit boundaries prior to aggregation. This method was applied to tobacco retailers among census tracts in New Castle County, DE.

Racial disparities in triple negative breast cancer: toward a causal architecture approach.

Background: Triple negative breast cancer (TNBC) is an aggressive subtype of invasive breast cancer that disproportionately affects Black women and contributes to racial disparities in breast cancer mortality. Prior research has suggested that neighborhood effects may contribute to this disparity beyond individual risk factors.

Methods: The sample included a cohort of 3316 breast cancer cases diagnosed between 2012 and 2020 in New Castle County, Delaware, a geographic region of the US with elevated rates of TNBC.

A Population Health Assessment in a Community Cancer Center Catchment Area: Triple-Negative Breast Cancer, Alcohol Use, and Obesity in New Castle County, Delaware.

Background: The NCI requires designated cancer centers to conduct catchment area assessments to guide cancer control and prevention efforts designed to reduce the local cancer burden. We extended and adapted this approach to a community cancer center catchment area with elevated rates of triple-negative breast cancer (TNBC).

Methods: Cancer registry data for 462 TNBC and 2,987 "Not-TNBC" cases diagnosed between 2012 and 2020 at the Helen F.

Operationalizing the Population Health Framework: Clinical Characteristics, Social Context, and the Built Environment.

As a framework, population health emphasizes health outcomes for entire populations, the broad range of determinants of these outcomes, and the comparative effectiveness of medical and public health interventions. In practice, however, many contemporary population health programs instead focus on small subsets of patients who account for a disproportionate share of health care utilization, often with disappointing results. The authors proposed a new approach to operationalize population health in clinical settings, with the example of tobacco use.

The co-occurrence of smoking and alcohol use disorder in a hospital-based population: Applying a multimorbidity framework using geographic information system methods.

Tobacco and alcohol use are leading causes of premature mortality in the US and concurrent use is associated with even greater health risks. A cross-sectional study of 20,310 patients admitted to a Mid-Atlantic acute health care system between July 1, 2018 and June 30, 2019 were categorized according to smoking and alcohol use disorder (AUD) status. Of the total admissions, 1464 (7.

Characterizing the spatial relationship between smoking status and tobacco retail exposure: Implications for policy development and evaluation.

Tobacco retail density and smoking prevalence remain elevated in marginalized communities, underscoring the need for strategies to address these place-based disparities. The spatial variation of smokers and tobacco retailers is often measured by aggregating them to area-level units (e.g.

Examining the relationship between food environment and gestational diabetes.

Background: Studies have shown an association between the incidence of gestational diabetes and living in neighborhoods oversaturated with unhealthy foods.

Objective: This study sought to determine if the food environment also affects the management of gestational diabetes. We hypothesized that living in areas with a higher quality of food decreased the risk of requiring medication to treat gestational diabetes.

Social Determinants of Health, From Assessment to Action:: A Review of 3 Studies from the Value Institute at ChristianaCare.

Introduction: The COVID-19 crisis highlights the importance of screening for and managing adverse social determinants of health (SDoH). Many of the same SDoH items that put individuals at increased risk of COVID-19 infection have increased dramatically due to the economic repercussions of slowing the viral spread.

Methods: This is a review of 3 studies conducted by the Health Services Research Core in the Value Institute at ChristianaCare.

Mapping the ChristianaCare response to COVID-19:: Clinical insights from the Value Institute's Geospatial Analytics Core.

Introduction: COVID-19 exemplifies the spatial nature of infectious disease in both its mechanism of transmission and the community-level conditions that facilitate its spread. With a long history of use for infectious disease applications, maps and geographic information systems (GIS) have been widely used in recent months for surveillance and risk prediction mapping. The Value Institute's Geospatial Analytics Core applied spatial methodologies to inform ChristianaCare's pandemic response around telehealth, testing disparities, and test site prioritization.

Mapping the Burden of Chronic Diseases in Delaware for Public Health Decision Making.

Public health decision-makers need to consider geographic differences in rates of chronic disease risk factors and outcomes in order to focus intervention efforts on populations exhibiting the greatest burden of disease. Increasingly, public health agencies are using geographic information systems (GIS) to analyze area-based variations and identify geographic priority areas for health promoting interventions. The articles in this issue are descriptive studies presenting the geographic distribution of select chronic disease risk factors and outcomes among Delaware communities.

A Retrospective Analysis of Nursing Students' Clinical Experience in an All-Male Maximum Security Prison.

Prisons provide an ideal learning experience to prepare prelicensure students with the knowledge and skill set needed for practice in the 21st century. Beginning descriptive evidence demonstrates that correctional health is an innovative community resource to educate nursing students in today's changing model of health care delivery and practice. This article shares results from a retrospective analysis of the perceptions and experiences of nursing students during their community clinical rotation in an all-male maximum security prison.