County-Level Geographic Disparities in Disabilities Among US Adults, 2018.

Introduction: Local data are increasingly needed for public health practice. County-level data on disabilities can be a valuable complement to existing estimates of disabilities. The objective of this study was to describe the county-level prevalence of disabilities among US adults and identify geographic clusters of counties with a higher or lower prevalence of disabilities.

Model-based community health surveillance via multilevel small area estimation using state behavioral risk factor surveillance system (BRFSS): a case study in Connecticut.

Purpose: The main objective of state behavioral risk factor surveillance system (BRFSS) is to produce reliable state-level estimates of various population health outcomes. A multilevel Regression and Post-stratification (MRP) methodology for small area estimation has been applied to the 500 Cities Project to provide population estimates at both city-level and census tract-level using national BRFSS data. To date, MRP has not been applied to any state BRFSS to produce health data at local geographic areas.

Multilevel Small Area Estimation for County-Level Prevalence of Mammography Use in the United States Using 2018 Data.

The U.S. Preventive Services Task Force recommends biennial screening mammography for average-risk women aged 50-74 years.

Constructing Statistical Intervals for Small Area Estimates Based on Generalized Linear Mixed Model in Health Surveys.

Generalized Linear Mixed Model (GLMM) has been widely used in small area estimation for health indicators. Bayesian estimation is usually used to construct statistical intervals, however, its computational intensity is a big challenge for large complex surveys. Frequentist approaches, such as bootstrapping, and Monte Carlo (MC) simulation, are also applied but not evaluated in terms of the interval magnitude, width, and the computational time consumed.

Multilevel small area estimation for county-level prevalence of colorectal cancer screening test use in the United States using 2018 data.

Purpose-: National screening estimates mask county-level variations. We aimed to generate county-level colorectal cancer (CRC) screening prevalence estimates for 2018 among adults aged 50-75 years and identify counties with low screening prevalence.

Methods-: We combined individual-level county data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) (n = 204,947) with the 2018 American Community Survey county poverty data as a covariate, and the 2018 U.

Multilevel Small Area Estimation of Prostate-Specific Antigen Screening Test in the United States by Age Group: 2018 Behavioral Risk Factor Surveillance System.

Background: In 2018, the US Preventive Services Task Force (USPSTF) recommended prostate cancer screening for men aged 55 to 69 years who express a preference for being screened after being informed about and understanding prostate-specific antigen (PSA) test benefits and risks. USPSTF recommended against screening men aged ≥70 years. We aim to generate county-level prevalence estimates, masked by national and state estimates, to identify counties with high PSA screening prevalence.

Measuring Alcohol Outlet Density: An Overview of Strategies for Public Health Practitioners.

Context: Excessive alcohol use is responsible for 88 000 deaths in the United States annually and cost the United States $249 billion in 2010. There is strong scientific evidence that regulating alcohol outlet density is an effective intervention for reducing excessive alcohol consumption and related harms, but there is no standard method for measuring this exposure.

Program: We overview the strategies available for measuring outlet density, discuss their advantages and disadvantages, and provide examples of how they can be applied in practice.

The Use of Small Area Estimates in Place-Based Health Research.

Interest in the impact of the built environment on health behaviors, outcomes, and disparities is increasing, and the growing development of statistical modeling techniques has allowed researchers to better investigate these relationships. However, without enough data that are identifiable at smaller geographic levels (e.g.

Geospatial distribution of periodontists and US adults with severe periodontitis.

Background: In this study, the authors report on the geospatial distributions of periodontists and adults with severe periodontitis in the United States.

Methods: The authors used geospatial analysis to describe the distribution of periodontists and adults, periodontists vis-à-vis estimated density of adults with severe periodontitis, and their ratios to adults with severe periodontitis. The authors identified locations of 5,415 practicing periodontists through the 2014 National Provider Identifier Registry, linked them with the weighted census number of adults, and estimated the number of adults within a series of circular distance zones.

Using 3 Health Surveys to Compare Multilevel Models for Small Area Estimation for Chronic Diseases and Health Behaviors.

Background: We used a multilevel regression and poststratification approach to generate estimates of health-related outcomes using Behavioral Risk Factor Surveillance System 2013 (BRFSS) data for the 500 US cities. We conducted an empirical study to investigate whether the approach is robust using different health surveys.

Methods: We constructed a multilevel logistic model with individual-level age, sex, and race/ethnicity as predictors (Model I), and sequentially added educational attainment (Model II) and area-level poverty (Model III) for 5 health-related outcomes using the nationwide BRFSS, the Massachusetts BRFSS 2013 (a state subset of nationwide BRFSS), and the Boston BRFSS 2010/2013 (an independent survey), respectively.

Multilevel Regression for Small-Area Estimation of Mammography Use in the United States, 2014.

Background: The U.S. Preventive Services Task Force recommends biennial screening mammography for average-risk women aged 50-74 years.

Quantifying spatial accessibility in public health practice and research: an application to on-premise alcohol outlets, United States, 2013.

Objective: To assess spatial accessibility measures to on-premise alcohol outlets at census block, census tract, county, and state levels for the United States.

Methods: Using network analysis in a geographic information system, we computed distance-based measures (Euclidean distance, driving distance, and driving time) to on-premise alcohol outlets for the entire U.S.

Multilevel Small-Area Estimation of Colorectal Cancer Screening in the United States.

The U.S. Preventive Services Task Force recommends routine screening for colorectal cancer for adults ages 50 to 75 years.

Multilevel model to estimate county-level untreated dental caries among US children aged 6-9years using the National Health and Nutrition Examination Survey.

Because conducting population-based oral health screening is resource intensive, oral health data at small-area levels (e.g., county-level) are not commonly available.

Comparison of Methods for Estimating Prevalence of Chronic Diseases and Health Behaviors for Small Geographic Areas: Boston Validation Study, 2013.

Introduction: Local health authorities need small-area estimates for prevalence of chronic diseases and health behaviors for multiple purposes. We generated city-level and census-tract-level prevalence estimates of 27 measures for the 500 largest US cities.

Methods: To validate the methodology, we constructed multilevel logistic regressions to predict 10 selected health indicators among adults aged 18 years or older by using 2013 Behavioral Risk Factor Surveillance System (BRFSS) data; we applied their predicted probabilities to census population data to generate city-level, neighborhood-level, and zip-code-level estimates for the city of Boston, Massachusetts.

Individual and Joint Effects of Early-Life Ambient Exposure and Maternal Prepregnancy Obesity on Childhood Overweight or Obesity.

Background: Although previous studies suggest that exposure to traffic-related pollution during childhood increases the risk of childhood overweight or obesity (COWO), the role of early life exposure to fine particulate matter (aerodynamic diameter <2.5 μm; PM) and its joint effect with the mother’s prepregnancy body mass index (MPBMI) on COWO remain unclear.

Objectives: The present study was conducted to examine the individual and joint effects of ambient PM exposures and MPBMI on the risk of COWO.

Multilevel Small-Area Estimation of Multiple Cigarette Smoking Status Categories Using the 2012 Behavioral Risk Factor Surveillance System.

Background: Smoking is the leading preventable cause of death; however, small-area estimates for detailed smoking status are limited. We developed multilevel small-area estimate mixed models to generate county-level estimates for six smoking status categories: current, some days, every day, former, ever, and never.

Method: Using 2012 Behavioral Risk Factor Surveillance System (BRFSS) data (our sample size = 405,233 persons), we constructed and fitted a series of multilevel logistic regression models and applied them to the U.

Periodontitis prevalence in adults ≥ 65 years of age, in the USA.

The older adult population is growing rapidly in the USA and it is expected that by 2040 the number of adults ≥ 65 years of age will have increased by about 50%. With the growth of this subpopulation, oral health status, and periodontal status in particular, becomes important in the quest to maintain an adequate quality of life. Poor oral health can have a major impact, leading to tooth loss, pain and discomfort, and may prevent older adults from chewing food properly, often leading to poor nutrition.

Geographic Accessibility of Pulmonologists for Adults With COPD: United States, 2013.

Background: Geographic clusters in prevalence and hospitalizations for COPD have been identified at national, state, and county levels. The study objective is to identify county-level geographic accessibility to pulmonologists for adults with COPD.

Methods: Service locations of 12,392 practicing pulmonologists and 248,160 primary care physicians were identified from the 2013 National Provider Identifier Registry and weighted by census block-level populations within a series of circular distance buffer zones.

Prevalence of Doctor-Diagnosed Arthritis at State and County Levels - United States, 2014.

Doctor-diagnosed arthritis is a common chronic condition that affects approximately 52.5 million (22.7%) adults in the United States and is a leading cause of disability (1,2).

Intrauterine Inflammation and Maternal Exposure to Ambient PM2.5 during Preconception and Specific Periods of Pregnancy: The Boston Birth Cohort.

Background: Prenatal exposure to ambient PM2.5, (i.e.

Population-based geographic access to endocrinologists in the United States, 2012.

Background: Increases in population and life expectancy of Americans may result in shortages of endocrinologists by 2020. This study aims to assess variations in geographic accessibility to endocrinologists in the US, by age group at state and county levels, and by urban/rural status, and distance.

Methods: We used the 2012 National Provider Identifier Registry to obtain office locations of all adult and pediatric endocrinologists in the US.

Park Access Among School-Age Youth in the United States.

Background: Fewer than 30% of U.S. youth meet the recommendation to be active ≥ 60 minutes/day.

Changes in density of on-premises alcohol outlets and impact on violent crime, Atlanta, Georgia, 1997-2007.

Introduction: Regulating alcohol outlet density is an evidence-based strategy for reducing excessive drinking. However, the effect of this strategy on violent crime has not been well characterized. A reduction in alcohol outlet density in the Buckhead neighborhood of Atlanta from 2003 through 2007 provided an opportunity to evaluate this effect.

Validation of multilevel regression and poststratification methodology for small area estimation of health indicators from the behavioral risk factor surveillance system.

Small area estimation is a statistical technique used to produce reliable estimates for smaller geographic areas than those for which the original surveys were designed. Such small area estimates (SAEs) often lack rigorous external validation. In this study, we validated our multilevel regression and poststratification SAEs from 2011 Behavioral Risk Factor Surveillance System data using direct estimates from 2011 Missouri County-Level Study and American Community Survey data at both the state and county levels.