Publications by authors named "Alva O Ferdinand"

21 Publications

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Emerging Science, Personal Protective Equipment Guidance, and Resource Scarcity: Inaction and Inequity for Workers in Essential Industries.

Health Secur 2021 Jun 9. Epub 2021 Jun 9.

Abigail E. Lowe, MA, is Director, Ethics and Public Health Preparedness; Jocelyn J. Herstein, PhD, MPH, is a Research Assistant Professor; David M. Brett-Major, MD, MPH, is a Professor; and Rachel E. Lookadoo, JD, is Director, Legal and Public Health Preparedness, and Instructor; all in the College of Public Health, University of Nebraska Medical Center, Omaha, NE. Kelly K. Dineen, JD, PhD, is Director, Health Law Program; an Associate Professor of Law; and a Professor of Medical Humanities; all at Creighton University School of Law, Omaha, NE. Matthew K. Wynia, MD, MPH, is Director, Center for Bioethics and Humanities, and a Professor of Medicine and Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO. Joshua L. Santarpia, PhD, MS, is an Associate Professor, College of Medicine; Research Director, Chemical and Biological Programs, National Strategic Research Institute; and Co-Director of Biological Defense and Health Security-Sub Plan, Graduate Studies; all at the University of Nebraska Medical Center, Omaha, NE. Lisa M. Lee, PhD, MA, MS, is Associate Vice President, Research and Innovation; Director, Scholarly Integrity and Research Compliance, Office of the Vice President for Research and Innovation; and a Research Professor, Department of Population Health Sciences; all at Virginia Tech, Blacksburg, VA. Alva O. Ferdinand, DrPH, JD, is an Associate Professor and Director of Southwest Rural Health Research Center, Texas A&M University School of Public Health, College Station, TX. Sara K. Donovan, MPH, is a Doctoral Student, Graduate Studies, and Graduate Research Assistant, Global Center for Health Security; both at the University of Nebraska Medical Center, Omaha, NE. Teck Chuan Voo, PhD, is an Assistant Professor, Centre for Biomedical Ethics, NUS Yong Loo Lin School of Medicine, Singapore. Seema Mohapatra, JD, MPH, is a Dean's Fellow and Associate Professor, Robert H. McKinney School of Law, Indiana University, Indianapolis, IN.

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http://dx.doi.org/10.1089/hs.2021.0040DOI Listing
June 2021

Identifying and prioritizing benefits and risks of using privacy-enhancing software through participatory design: a nominal group technique study with patients living with chronic conditions.

J Am Med Inform Assoc 2021 May 19. Epub 2021 May 19.

Population Informatics Lab, School of Public Health, Texas A&M University, College Station, Texas, USA.

Objective: While patients often contribute data for research, they want researchers to protect their data. As part of a participatory design of privacy-enhancing software, this study explored patients' perceptions of privacy protection in research using their healthcare data.

Materials And Methods: We conducted 4 focus groups with 27 patients on privacy-enhancing software using the nominal group technique. We provided participants with an open source software prototype to demonstrate privacy-enhancing features and elicit privacy concerns. Participants generated ideas on benefits, risks, and needed additional information. Following a thematic analysis of the results, we deployed an online questionnaire to identify consensus across all 4 groups. Participants were asked to rank-order benefits and risks. Themes around "needed additional information" were rated by perceived importance on a 5-point Likert scale.

Results: Participants considered "allowance for minimum disclosure" and "comprehensive privacy protection that is not currently available" as the most important benefits when using the privacy-enhancing prototype software. The most concerning perceived risks were "additional checks needed beyond the software to ensure privacy protection" and the "potential of misuse by authorized users." Participants indicated a desire for additional information with 6 of the 11 themes receiving a median participant rating of "very necessary" and rated "information on the data custodian" as "essential."

Conclusions: Patients recognize not only the benefits of privacy-enhancing software, but also inherent risks. Patients desire information about how their data are used and protected. Effective patient engagement, communication, and transparency in research may improve patients' comfort levels, alleviate patients' concerns, and thus promote ethical research.
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http://dx.doi.org/10.1093/jamia/ocab073DOI Listing
May 2021

Rural and Urban Differences in COVID-19 Prevention Behaviors.

J Rural Health 2021 03 22;37(2):287-295. Epub 2021 Feb 22.

Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, Texas, USA.

Purpose: To examine whether the adoption of COVID-19-related preventive health behaviors vary in rural versus urban communities of the United States while accounting for the influence of political ideology, demographic factors, and COVID-19 experiences.

Methods: We rely on a representative survey of 5009 American adults collected from May 28 to June 8, 2020. We analyze the influence of rural status, political ideology, demographic factors, and COVID-19 experiences on self-reported adoption of 8 COVID-19-related preventive health behaviors.

Findings: Rural residents are significantly less likely to have worn a mask in public, sanitized their home or workplace with disinfectant, avoided dining at restaurants or bars, or worked from home. These findings, with the exception of dining out, are robust to the inclusion of measures accounting for political ideology, demographic factors, and COVID-19 experiences.

Conclusions: Rural residents are significantly less likely to participate in several COVID-19-related preventive health behaviors. This reality could exacerbate existing disparities in health access and outcomes for rural Americans. Health messaging targeted at improving COVID-19 preventive behavior adoption in rural America is warranted.
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http://dx.doi.org/10.1111/jrh.12556DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8013340PMC
March 2021

Communicating With Patients About Software for Enhancing Privacy in Secondary Database Research Involving Record Linkage: Delphi Study.

J Med Internet Res 2020 12 15;22(12):e20783. Epub 2020 Dec 15.

Population Informatics Lab, Department of Health Policy & Management, Texas A&M University School of Public Health, College Station, TX, United States.

Background: There is substantial prior research on the perspectives of patients on the use of health information for research. Numerous communication barriers challenge transparency between researchers and data participants in secondary database research (eg, waiver of informed consent and knowledge gaps). Individual concerns and misconceptions challenge the trust in researchers among patients despite efforts to protect data. Technical software used to protect research data can further complicate the public's understanding of research. For example, MiNDFIRL (Minimum Necessary Disclosure For Interactive Record Linkage) is a prototype software that can be used to enhance the confidentiality of data sets by restricting disclosures of identifying information during the record linkage process. However, software, such as MiNDFIRL, which is used to protect data, must overcome the aforementioned communication barriers. One proposed solution is the creation of an interactive web-based frequently asked question (FAQ) template that can be adapted and used to communicate research issues to data subjects.

Objective: This study aims to improve communication with patients and transparency about how complex software, such as MiNDFIRL, is used to enhance privacy in secondary database studies to maintain the public's trust in researchers.

Methods: A Delphi technique with 3 rounds of the survey was used to develop the FAQ document to communicate privacy issues related to a generic secondary database study using the MiNDFIRL software. The Delphi panel consisted of 38 patients with chronic health conditions. We revised the FAQ between Delphi rounds and provided participants with a summary of the feedback. We adopted a conservative consensus threshold of less than 10% negative feedback per FAQ section.

Results: We developed a consensus language for 21 of the 24 FAQ sections. Participant feedback demonstrated preference differences (eg, brevity vs comprehensiveness). We adapted the final FAQ into an interactive web-based format that 94% (31/33) of the participants found helpful or very helpful. The template FAQ and MiNDFIRL source code are available on GitHub. The results indicate the following patient communication considerations: patients have diverse and varied preferences; the tone is important but challenging; and patients want information on security, identifiers, and final disposition of information.

Conclusions: The findings of this study provide insights into what research-related information is useful to patients and how researchers can communicate such information. These findings align with the current understanding of health literacy and its challenges. Communication is essential to transparency and ethical data use, yet it is exceedingly challenging. Developing FAQ template language to accompany a complex software may enable researchers to provide greater transparency when informed consent is not possible.
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http://dx.doi.org/10.2196/20783DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7772068PMC
December 2020

Emergency department visits for nontraumatic dental conditions: a systematic literature review.

J Public Health Dent 2020 09 1;80(4):313-326. Epub 2020 Oct 1.

Department of Health Policy and Management, Texas A&M School of Public Health, College Station, TX, USA.

Objective: To summarize the literature on factors associated with emergency department (ED) use for nontraumatic dental conditions (NTDCs).

Methods: Following a database search, empirical studies were included if they examined factors associated with ED visits for NTDCs. The factors identified in these studies were further categorized using the Andersen Behavioral Model. Where appropriate, odds ratios (ORs) predicting the likelihood of NTDC ED visits were extracted to obtain summary estimates using random effects models.

Results: Sixty-three articles were included. Nontraumatic dental ED visits made up about 2.2 percent of all ED visits. Having public health insurance coverage such as Medicaid [OR = 2.17, 95 percent confidence interval (CI) = 1.79-2.64], and being uninsured (OR = 2.80, 95 percent CI = 2.39-3.39) were predictive of ED visits for NTDCs. Adults were more likely to use the ED for NTDCs compared to children and older adults. Rural adults had increased odds of ED use for NTDCs compared to urban adults (OR = 1.31, 95 percent CI = 1.12-1.52). Among younger children, regular dental care without sealant placement was associated with increased ED use for NTDCs. In the United States, both expansion and restriction of Medicaid dental coverage for adults were associated with increased ED visits for NTDCs.

Conclusions: Policy makers and health care providers should address modifiable factors such as accessible dental care for the uninsured, and comprehensive dental coverage for those with public dental benefits. Targeted interventions should focus on young adults, children with special needs, and subpopulations with low socioeconomic status and chronic health conditions.
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http://dx.doi.org/10.1111/jphd.12386DOI Listing
September 2020

High impact nutrition and dietetics journals' use of publication procedures to increase research transparency.

Res Integr Peer Rev 2020 31;5:12. Epub 2020 Aug 31.

Department of Health Policy & Management, School of Public Health, Texas A&M University, College Station, TX USA.

Background: The rigor and integrity of the published research in nutrition studies has come into serious question in recent years. Concerns focus on the use of flexible data analysis practices and selective reporting and the failure of peer review journals to identify and correct these practices. In response, it has been proposed that journals employ editorial procedures designed to improve the transparency of published research.

Objective: The present study examines the adoption of editorial procedures designed to improve the reporting of empirical studies in the field of nutrition and dietetics research.

Design: The instructions for authors of 43 journals included in Quartiles 1 and 2 of the Clarivate Analytics' 2018 Journal Citation Report category were reviewed. For journals that published original research, conflict of interest disclosure, recommendation of reporting guidelines, registration of clinical trials, registration of other types of studies, encouraging data sharing, and use of the Registered Reports were assessed For journals that only published reviews, all of the procedures except clinical trial registration were assessed.

Results: Thirty-three journals published original research and 10 published only reviews. Conflict of interest disclosure was required by all 33 original research journals. Use of guidelines, trial registration and encouragement of data sharing were mentioned by 30, 27 and 25 journals, respectively. Registration of other studies was required by eight and none offered Registered Reports as a publication option at the time of the review. All 10 review journals required conflict of interest disclosure, four recommended data sharing and three the use of guidelines. None mentioned the other two procedures.

Conclusions: While nutrition journals have adopted a number of procedures designed to improve the reporting of research findings, their limited effects likely result from the mechanisms through which they influence analytic flexibility and selective reporting and the extent to which they are properly implemented and enforced by journals.
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http://dx.doi.org/10.1186/s41073-020-00098-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457801PMC
August 2020

Factors affecting the likelihood of a hospitalization following a diabetes-related emergency department visit: A regional and urban-rural analysis.

J Diabetes 2020 Sep 27;12(9):686-696. Epub 2020 Jun 27.

Department of Health Policy & Management, Texas A&M University, School of Public Health, College Station, Texas, USA.

Background: The objective of this study is to examine place-based and individual-level predictors of diabetes-related hospitalizations that stem from emergency department (ED) visits.

Methods: We conducted a pooled cross-sectional analysis of the National Inpatient Sample (NIS) for 2009 to 2014 to identify ED-initiated hospitalizations that were driven by the need for diabetes care. The odds of an ED-initiated diabetes-related hospitalization were assessed for the United States as a whole and separately for each census region.

Results: Nationally, residents of noncore areas (odds ratio [OR] 1.10; CI 1.08, 1.12), the South (OR 8.03; CI 6.84, 9.42), Blacks (OR 2.49; CI 2.47, 2.52), Hispanics (OR 2.32; CI 2.29, 2.35), Asians or Pacific Islanders (OR 1.20; CI 1.16, 1.23), Native Americans (OR 2.18; CI 2.10, 2.27), and the uninsured (OR 2.14; CI 2.11, 2.27) were significantly more likely to experience an ED-initiated hospitalization for diabetes care. Census region-stratified models showed that noncore residents of the South (OR 1.17; CI 1.14, 1.20) and Midwest (OR 1.06; CI 1.02, 1.11) had higher odds of a diabetes-related ED-initiated hospitalization.

Conclusions: As continued efforts are made to reduce place-based disparities in diabetes care and management, targeted focus should be placed on residents of noncore areas in the South and Midwest, racial and ethnic minorities, as well as the uninsured population.
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http://dx.doi.org/10.1111/1753-0407.13066DOI Listing
September 2020

Congestive heart failure-related hospital deaths across the urban-rural continuum in the United States.

Prev Med Rep 2019 Dec 6;16:101007. Epub 2019 Nov 6.

Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX 77843-1266, USA.

Congestive heart failure (CHF) is a growing public health problem that affects nearly 6.5 million individuals nationwide. Access to quality outpatient care and disease management programs has been shown to improve disease treatment and prognosis. Rural populations face unique challenges in the availability and accessibility of quality cardiovascular care. In 2018, we conducted a pooled cross-sectional analysis of the Nationwide Inpatient Sample (NIS) for 2009-2014 to examine recent trends in CHF-related hospital deaths in the United States, highlighting urban-rural differences within each census region. We performed a multivariable logistic regression analysis to compare the odds of CHF-related hospital death by levels of rurality and within each census region. Most CHF-related hospital deaths occurred in the South and Midwest census regions and in large central metropolitan areas. Findings from census region stratified models revealed that non-core residents living within the West (OR 1.47, CI 1.26, 1.71), Midwest (OR 1.30, CI 1.17, 1.44), and South (OR = 1.21, 95% C.I. = 1.12-1.32) had a higher relative risk (but not higher absolute numbers) of experiencing death during a CHF-related hospitalization, compared to patients in large central metropolitan areas. Within each census region, there were also differences in odds of a CHF-related hospital death depending on patient sex, comorbidities, insurance type, median annual income, and year. As efforts to reduce rural health disparities in CHF morbidity continue, more work is needed to understand and test interventions to reduce the risk of death from CHF in noncore areas of the West, Midwest, and South.
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http://dx.doi.org/10.1016/j.pmedr.2019.101007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883321PMC
December 2019

Healthy People 2020: Rural Areas Lag In Achieving Targets For Major Causes Of Death.

Health Aff (Millwood) 2019 12;38(12):2027-2031

Melonie Heron is a health scientist in the Division of Vital Statistics, NCHS.

For the period 2007-17 rural death rates were higher than urban rates for the seven major causes of death analyzed, and disparities widened for five of the seven. In 2017 urban areas had met national targets for three of the seven causes, while rural areas had met none of the targets.
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http://dx.doi.org/10.1377/hlthaff.2019.00915DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7365241PMC
December 2019

Diabetes-related hospital mortality in the U.S.: A pooled cross-sectional study of the National Inpatient Sample.

J Diabetes Complications 2019 05 23;33(5):350-355. Epub 2019 Feb 23.

Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, TX, United States of America; Southwest Rural Health Research Center, School of Public Health, Texas A&M University, College Station, TX, United States of America.

Aims: Despite advancements in the diagnosis and treatment of diabetes in the U.S., place-based disparities still exist. The purpose of this study is to determine place-based and other individual-level variations in diabetes-related hospital deaths.

Methods: A pooled cross-sectional study of the 2009-2015 National Inpatient Sample was conducted to examine the odds of a diabetes-related hospital death. The main predictors were rurality and census region. Individual-level socio-demographic factors were also examined.

Results: Approximately 1.5% (n = 147,069) of diabetes-related hospitalizations resulted in death. In multivariable analysis, the odds of diabetes-related hospital deaths increased across the urban-rural continuum, except for large fringe metropolitan areas, with the highest odds of such deaths occurring among residents of micropolitan (OR = 1.16, 95% C.I. = 1.14, 1.18) and noncore areas (OR = 1.21, 95% C.I. = 1.19, 1.24). Compared to residents of the Northeast, residents in the South, West and Midwest regions were significantly more likely to experience a diabetes-related hospital death. Asian or Pacific Islanders, Medicaid-covered patients and the uninsured were also more likely to die during a diabetes-related hospitalization.

Conclusions: Place-based disparities in diabetes-related hospital deaths exist. Targeted focus should be placed on the control of diabetic complications in the South, West and Midwest census regions, and among rural residents.
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http://dx.doi.org/10.1016/j.jdiacomp.2019.01.007DOI Listing
May 2019

Texting-While-Driving Bans and Motor Vehicle Crash-Related Emergency Department Visits in 16 US States: 2007-2014.

Am J Public Health 2019 05 21;109(5):748-754. Epub 2019 Mar 21.

At the time of this study, all authors were with the Department of Health Policy and Management at the Texas A&M University School of Public Health, College Station.

Objectives: To examine the impact of state texting bans on motor vehicle crash (MVC)-related emergency department (ED) visits.

Methods: We used ED data from 16 US states between 2007 and 2014. We employed a difference-in-difference approach and conditional Poisson regressions to estimate changes in counts of MVC-related ED visits in states with and without texting bans. We also constructed age cohorts to explore whether texting bans have differential impacts by age group.

Results: On average, states with a texting ban saw a 4% reduction in MVC-related ED visits (incidence rate ratio = 0.96; 95% confidence interval = 0.96, 0.97). This equates to an average of 1632 traffic-related ED visits prevented per year in states with a ban. Both primary and secondary bans were associated with significant reductions in MVC-related visits to the ED regardless of whether they were on all drivers or young drivers only. Individuals aged 64 years and younger in states with a texting ban saw significantly fewer MVC-related ED visits following its implementation.

Conclusions: Our findings suggest that states' efforts to curb distracted driving through texting bans and decrease its negative consequences are associated with significant decreases in the incidence of ED visits that follow an MVC.
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http://dx.doi.org/10.2105/AJPH.2019.304999DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6459634PMC
May 2019

The Changing Landscape of Diabetes Mortality in the United States Across Region and Rurality, 1999-2016.

J Rural Health 2020 06 25;36(3):410-415. Epub 2019 Feb 25.

Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, Texas.

Purpose: This brief report examines place-based differences in diabetes mortality in order to understand whether disparities in diabetes mortality have changed across United States Census regions and levels of rurality over time.

Methods: We use data from the National Center for Health Statistics from 1999 to 2016 to analyze changes in diabetes mortality over time and across geographical regions of the United States.

Findings: We find evidence that diabetes mortality has declined in the United States over the past 2 decades, but that improvements in mortality vary considerably by place. Improvements are observed in urban America and in the Northeast and Midwest while diabetes mortality has remained largely unchanged in rural areas, particularly in the rural South.

Conclusions: Diabetes is one of the leading causes of death in the United States, but important differences have emerged in the burden of this disease. Reductions in diabetes mortality are lagging in rural areas, and the rural South in particular, relative to other areas of the country. Continued innovations in care and targeted interventions in rural areas are warranted.
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http://dx.doi.org/10.1111/jrh.12354DOI Listing
June 2020

The Impact of IRS Tax Policy on Hospital Community Benefit Activities.

Med Care Res Rev 2019 04 6;76(2):167-183. Epub 2017 Apr 6.

3 Richard M. Fairbanks School of Public Health at Indiana University, Indianapolis, IN, USA.

The Internal Revenue Service (IRS) recently introduced tax code revisions requiring stricter oversight of community benefit activities (CBAs) conducted by tax-exempt, not-for-profit hospitals. We examine the impact of this tax requirement on CBAs among these hospitals relative to for-profit and government hospitals that were not subject to the new policy. We employed a quasi-experimental, difference-in-difference study design using a longitudinal observational approach and used secondary data collected by the American Hospital Association (years 2006-2010 including 20,538 hospital year observations). Findings show a significant increase in the reporting of 7 of the 13 CBAs among tax-exempt, not-for-profit hospitals compared with other hospitals after the policy change. Examples include partnering to conduct community health assessments ( b = 0.035, p = .002) and using capacity assessments to identify unmet community health needs ( b = 0.041, p = .001). Recent tax revisions are associated with increases in reported CBAs among tax-exempt, not-for-profit hospitals. As the debate continues regarding tax exemption status for not-for-profit hospitals, policy makers should expand efforts for enhanced accountability.
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http://dx.doi.org/10.1177/1077558717703215DOI Listing
April 2019

Local Public Health Department Characteristics Associated With Likelihood to Participate in National Accreditation.

Am J Public Health 2015 Aug 11;105(8):1653-9. Epub 2015 Jun 11.

Valerie A. Yeager is with the Tulane School of Public Health and Tropical Medicine, New Orleans, LA. Alva O. Ferdinand is with the Texas A&M Health Science Center and School of Public Health, College Station, TX. Leslie M. Beitsch is with the Florida State University College of Medicine, Tallahassee. Nir Menachemi is with the University of Alabama, Birmingham School of Public Health, Birmingham.

Objectives: We examined factors associated with completing, initiating, or intending to pursue voluntary national accreditation among local health departments (LHDs).

Methods: We examined National Association of County and City Health Officials 2010 and 2013 profile data in a pooled cross-sectional design with bivariate and multivariable regression analyses. We conducted individual multivariable models with interest in accreditation and likely to accredit as outcome variables, comparing changes between 2010 and 2013.

Results: LHDs with formal quality improvement programs are significantly more likely to have initiated or completed the accreditation process (odds ratio [OR] = 7.99; confidence interval [CI] = 1.79, 35.60), to be likely to accredit (OR = 2.41; CI = 1.65, 3.50), or to report an interest in accreditation (OR = 2.32; CI = 1.67, 3.20). Interest was lower among LHDs in 2013 than in 2010 (OR = 0.56; CI = 0.41, 0.77); however, there was no difference regarding being likely to accredit. LHDs with a high number of full-time equivalent employees were more likely to indicate being likely to accredit or interest in accreditation.

Conclusions: Quality improvement may facilitate the accreditation process or be a proxy measure for an unmeasurable LHD attribute that predicts accreditation.
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http://dx.doi.org/10.2105/AJPH.2014.302503DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504315PMC
August 2015

Rural Healthy People 2020: New Decade, Same Challenges.

J Rural Health 2015 7;31(3):326-33. Epub 2015 May 7.

Department of Health Policy & Management, Texas A&M School of Public Health, College Station, Texas.

Purpose: The health of rural America is more important than ever to the health of the United States and the world. Rural Healthy People 2020's goal is to serve as a counterpart to Healthy People 2020, providing evidence of rural stakeholders' assessment of rural health priorities and allowing national and state rural stakeholders to reflect on and measure progress in meeting those goals. The specific aim of the Rural Healthy People 2020 national survey was to identify rural health priorities from among the Healthy People 2020's (HP2020) national priorities.

Methods: Rural health stakeholders (n = 1,214) responded to a nationally disseminated web survey soliciting identification of the top 10 rural health priorities from among the HP2020 priorities. Stakeholders were also asked to identify objectives within each national HP2020 priority and express concerns or additional responses.

Findings And Conclusions: Rural health priorities have changed little in the last decade. Access to health care continues to be the most frequently identified rural health priority. Within this priority, emergency services, primary care, and insurance generate the most concern. A total of 926 respondents identified access as the no. 1 rural health priority, followed by, no. 2 nutrition and weight status (n = 661), no. 3 diabetes (n = 660), no. 4 mental health and mental disorders (n = 651), no. 5 substance abuse (n = 551), no. 6 heart disease and stroke (n = 550), no. 7 physical activity and health (n = 542), no. 8 older adults (n = 482), no. 9 maternal infant and child health (n = 449), and no. 10 tobacco use (n = 429).
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http://dx.doi.org/10.1111/jrh.12116DOI Listing
July 2016

The impact of texting bans on motor vehicle crash-related hospitalizations.

Am J Public Health 2015 May 19;105(5):859-65. Epub 2015 Mar 19.

At the time of this study, Alva O. Ferdinand and Michael Morrisey were with the Department of Health Policy and Management, Texas A&M Health Science Center School of Public Health, College Station, TX. Nir Menachemi, Justin L. Blackburn, Bisakha Sen, and Leonard Nelson were with the Department of Health Care Organization and Policy, University of Alabama, Birmingham.

We used a panel design and the Nationwide Inpatient Sample from 19 states between 2003 and 2010 to examine the impact of texting bans on crash-related hospitalizations. We conducted conditional negative binomial regressions with state, year, and month fixed effects to examine changes in crash-related hospitalizations in states after the enactment of a texting ban relative to those in states without such bans. Results indicate that texting bans were associated with a 7% reduction in crash-related hospitalizations among all age groups. Texting bans were significantly associated with reductions in hospitalizations among those aged 22 to 64 years and those aged 65 years or older. Marginal reductions were seen among adolescents. States that have not passed strict texting bans should consider doing so.
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http://dx.doi.org/10.2105/AJPH.2014.302537DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4386499PMC
May 2015

Impact of texting laws on motor vehicular fatalities in the United States.

Am J Public Health 2014 Aug 12;104(8):1370-7. Epub 2014 Jun 12.

At the time of this study, Alva O. Ferdinand, Nir Menachemi, Bisakha Sen, Justin L. Blackburn, and Michael Morrisey were with the Department of Health Care Organization and Policy, University of Alabama at Birmingham. Leonard Nelson was with the Cumberland School of Law, Samford University, Birmingham, AL.

Using a panel study design, we examined the effects of different types of texting bans on motor vehicular fatalities. We used the Fatality Analysis Reporting System and a difference-in-differences approach to examine the incidence of fatal crashes in 2000 through 2010 in 48 US states with and without texting bans. Age cohorts were constructed to examine the impact of these bans on age-specific traffic fatalities. Primarily enforced laws banning all drivers from texting were significantly associated with a 3% reduction in traffic fatalities in all age groups, and those banning only young drivers from texting had the greatest impact on reducing deaths among those aged 15 to 21 years. Secondarily enforced restrictions were not associated with traffic fatality reductions in any of our analyses.
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http://dx.doi.org/10.2105/AJPH.2014.301894DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103220PMC
August 2014

Associations between driving performance and engaging in secondary tasks: a systematic review.

Am J Public Health 2014 Mar 16;104(3):e39-48. Epub 2014 Jan 16.

At the time of this work, Alva O. Ferdinand and Nir Menachemi were with the Department of Health Care Organization and Policy, University of Alabama at Birmingham.

We conducted a systematic review and meta-analysis of the literature examining the relationship between driving performance and engaging in secondary tasks. We extracted data from abstracts of 206 empirical articles published between 1968 and 2012 and developed a logistic regression model to identify correlates of a detrimental relationship between secondary tasks and driving performance. Of 350 analyses, 80% reported finding a detrimental relationship. Studies using experimental designs were 37% less likely to report a detrimental relationship (P = .014). Studies examining mobile phone use while driving were 16% more likely to find such a relationship (P = .009). Quasi-experiments can better determine the effects of secondary tasks on driving performance and consequently serve to inform policymakers interested in reducing distracted driving and increasing roadway safety.
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http://dx.doi.org/10.2105/AJPH.2013.301750DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3953770PMC
March 2014

Overstatement of results in the nutrition and obesity peer-reviewed literature.

Am J Prev Med 2013 Nov;45(5):615-21

Department of Health Care Organization and Policy, School of Public Health and Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, Alabama. Electronic address:

Background: Scientific authors who overreach in presenting results can potentially, without intending to, distort the state of knowledge and inappropriately influence clinicians, decision makers, the media, and the public.

Purpose: The goal of the study was to determine the extent to which authors present overreaching statements in the obesity and nutrition literature, and whether journal, author, or study characteristics are associated with this practice.

Methods: A total of 937 papers on nutrition or obesity published in 2001 and 2011 in leading specialty, medical, and public health journals were systematically studied to estimate the extent to which authors overstate the results of their study in the published abstract. Focus was placed on overreaching statements that may include (1) reporting an associative relationship as causal; (2) making policy recommendations based on observational data that show associations only (e.g., not cause and effect); and (3) generalizing to a population not represented by their sample. Data were compiled in 2012 and analyzed in 2013.

Results: Results indicate that 8.9% of studies have overreaching conclusions with a higher percentage in 2011 compared to 2001 (OR=2.14, risk difference=+3.9%, p=0.020). Unfunded studies (OR=2.41, p=0.039) were more likely to have an overstatement of results of the type described here. In contrast, those with a greater number of coauthors were significantly less likely than those with four or fewer authors (the reference group) to have overstated results (seven or eight authors: OR=0.30, risk difference=-6.1%, p=0.008; ≥9 authors: OR=0.41, risk difference= -4.0%, p=0.037).

Conclusions: Overreaching in presenting results in studies focused on nutrition and obesity topics is common in articles published in leading journals. Testable strategies are proposed to reduce the prevalence of such instances in the literature.
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http://dx.doi.org/10.1016/j.amepre.2013.06.019DOI Listing
November 2013

Community benefits provided by religious, other nonprofit, and for-profit hospitals: a longitudinal analysis 2000-2009.

Health Care Manage Rev 2014 Apr-Jun;39(2):145-53

Alva O. Ferdinand, JD, MPH, is Doctoral Candidate, Department of Health Care Organization and Policy, University of Alabama at Birmingham. Josué Patien Epané, MBA, is Doctoral Candidate, Department of Health Services Administration, University of Alabama at Birmingham. Nir Menachemi, PhD, MPH, is Professor and Doctoral Program Director, Department of Health Care Organization and Policy, University of Alabama at Birmingham. E-mail:

Background: Nonprofit hospitals (NFPs) are expected to provide community benefits to justify the tax benefits they receive, but recent budgetary constraints have called into question the degree to which the tax benefits are justified. The empirical literature comparing community benefits provided by NFPs and their for-profit counterparts is mixed. However, NFPs are not a homogenous group and can include religious hospitals, community-owned hospitals, or academic medical centers.

Purpose: This longitudinal study examines how religious hospitals compare with other NFPs and for-profit hospitals with respect to providing community benefits and how the provision of community benefits by hospitals has changed over time.

Methodology: Using a pooled cross-sectional design, we examine two summated scores based on questions from the American Hospital Association annual survey that focus on community orientation among hospitals. We analyze two regressions with year, facility, and market controls to determine how religious hospitals compare with the other groups over time.

Findings: Overall, 11% of U.S. hospitals are religious. Religious hospitals were more likely to engage in each individual community benefit activity examined. In addition, the mean values of community benefits provided by religious hospitals, as measured on two summated scores, were significantly higher than those provided by other hospital types in bivariate and regression analyses. Overall, community benefits provided by all hospitals increased over time and then leveled off during the start of the recent economic downturn.

Practice Implications: As the debate continues regarding federal tax exemption status, policymakers should consider religious hospitals separately from NFPs. Managers at religious hospitals should consider how their increased levels of community benefits are related to their missions and set benchmarks that recognize and communicate those achievements.
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http://dx.doi.org/10.1097/HMR.0b013e3182993b52DOI Listing
November 2014

The relationship between built environments and physical activity: a systematic review.

Am J Public Health 2012 Oct 16;102(10):e7-e13. Epub 2012 Aug 16.

Department of Health Care Organization and Policy, University of Alabama at Birmingham, USA.

Objectives: We conducted a systematic review of the literature examining the relationship between built environments (e.g., parks, trails, sidewalks) and physical activity (PA) or obesity rates.

Methods: We performed a 2-step inclusion protocol to identify empirical articles examining any form of built environment and any form of PA (or obesity rate) as the outcome. We extracted data from included abstracts for analysis by using a standard code sheet developed for this study.

Results: Of 169 included articles, 89.2% reported beneficial relationships-but virtually all articles utilized simple observational study designs not suited for determining causality. Studies utilizing objective PA measures (e.g., pedometer) were 18% less likely to identify a beneficial relationship. Articles focusing on children in community settings (-14.2%), those examining direct measures of obesity (-6.2%), or those with an academic first author (-3.4%) were less likely to find a beneficial relationship.

Conclusions: Policymakers at federal and local levels should encourage more rigorous scientific research to determine whether altered built environments will result in increased PA and decreased obesity rates.
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http://dx.doi.org/10.2105/AJPH.2012.300740DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3490655PMC
October 2012