Browsing by Author "Baker, Charlotte"
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- An Aggregate Measure of Bicycle Commuting and its Relationship with Heart Disease Prevalence in the United StatesTodoroff, Emma Coleman (Virginia Tech, 2021-11-19)United States bicycle commuting rates are low compared to similarly developed countries like the Netherlands and Denmark. However, bicycle commuting shows promise for positive health outcomes, especially those related to chronic diseases like obesity, diabetes, and heart disease. Little research has been conducted in the U.S. to study the association between bicycle commuting and heart disease. Furthermore, U.S. cities need guidance on how to increase bicycle commuting rates. The purpose of this study was to evaluate the association between U.S. bicycle commuting rates and heart disease prevalence and to identify infrastructure and policy factors most significantly associated with bicycle commuting rates in large U.S. cities. This research quantitatively defined infrastructure and policy factors and analyzed ecologic associations across the 50 most populous U.S. cities. The results of this study are based on an ecologic analysis that evaluated associations at the census tract and city levels. Secondary data from nine sources as used to conduct the analysis. Data sources include the League of American Bicyclists Benchmarking Report, PeopleForBikes bicycle network analysis, the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System, the U.S. Census Bureau American Community Survey, and more. A principal components analysis was conducted to identify relevant infrastructure factors for research question one; ordinary least squares regression models were derived to compare associations between infrastructure and policy factors for research question two, and latent class cluster analysis was conducted to calculate the prevalence odds ratios of the association between bicycle commuting rate and heart disease for research question three. Three factors accounted for 70% of the variation in bicycle commuting rates. Those three factors include the average number of cyclist fatalities, the number of city employees working on bicycle projects, and bicycle network connections to public transit. The results also show that the association between bicycle commuting rate and heart disease prevalence was only statistically significant in census tract populations with predominantly high socioeconomic status, low health risk factors, and white race. The ecologic study design likely masked any positive health outcomes in populations with low socioeconomic status. The findings of this study provide valuable insights for transportation and public health practitioners, and the conclusions set the stage for future research on cycling and chronic disease outcomes in the United States.
- EpidemiologyBaker, Charlotte (Open Education Initiative at Virginia Tech, 2023)
Epidemiology is an openly licensed text designed for medical degree–seeking clinical students without a prior background in public health. Using sports medicine and injury prevention examples and applications, it aims to provide students with the basics of epidemiology terms and concepts and is intended to guide medical school students as they prepare for the USMLE Step 1 Exam and to transition from student to clinician. It includes an introduction to general concepts and terminology of epidemiology, study designs and their relationship to clinical questions, and the use of epidemiology in clinical diagnosis and screening of disease. Concluding sections of the book present sources of errors in epidemiologic studies, including bias, confounding, and effect modification. The book is notable for its use of accessible, inclusive figures and examples, and end-of-chapter study guides that summarize the chapter visually. Are you reviewing or adopting this book for a course?
Please help us understand your use by filling out this form. How to access the book - The main landing page for this book is https://doi.org/10.21061/epidemiology. - The open textbook is freely available online in multiple formats, including PDF, ePub, and Pressbooks. - A paperback print version (in color) is available for order here. ISBNs
ISBN (PDF): 978-1-957213-63-7
ISBN (Pressbooks): 978-1-957213-65-1
ISBN (EPUB): 978-1-957213-64-4
ISBN (print): 978-1-957213-62-0 Table of contents 1. Epidemiology in Sum 2. Measuring Things in Epidemiology 3. Study Designs 4. Diagnostics and Screening 5. The Wrecking Ball: Bias, Confounding, Interaction and Effect Modification About the author
Charlotte Baker, DrPH, MPH, CPH
Charlotte is the director of Epidemiology and Health Equity Lead at Truveta. She was formerly a member of the faculty in the Virginia Tech Data and Decisions Destination Area and PI of the analytic epidemiology I-SPY DATA Lab in the Department of Population Health Sciences in the Virginia-Maryland College of Veterinary Medicine. As a certified data nerd, her research lab and consulting efforts prioritize bridging the methodological and data gaps in sports injury research by using advanced statistical analysis and large data sets, especially to address disparities in sport and recreation caused by social and structural determinants of health. A former epidemic intelligence service officer at the Centers for Disease Control and Prevention, her favorite use of data includes helping communities improve themselves, keeping kids safe when being physically active, and helping all of us to live our best (and healthy) lives no matter where we started. Project support
Support for editorial work, graphic design, accessibility, publication assistance, and project management was provided by the Open Education Initiative of the University Libraries at Virginia Tech. Suggested citation
Baker, Charlotte (2023). Epidemiology. Blacksburg: Charlotte Baker. https://doi.org/10.21061/epidemiology. Licensed with CC BY-NC-SA 4.0.
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Virginia Tech is committed to making its publications accessible in accordance with the Americans with Disabilities Act of 1990. The Open Education Initiative is committed to continuous improvement regarding accessibility. The text, images, headings, and links in the PDF and HTML versions of this text are tagged structurally and include alternative text, which allows for machine readability. Please contact openeducation@vt.edu if you are a person with a disability and have suggestions to make this book more accessible. Cover image: Clay Banks via Unsplash | Unsplash license
Illustration and cover design: Kindred Grey - The Impact of Race on Plantar Loading and Research EngagementBrisbane, Julia (Virginia Tech, 2022)African Americans (AA) are twice as likely as White Americans (WA) to experience diabetes-related foot amputation due to foot ulcers. Foot ulcers are often caused by high plantar pressure, and several factors can impact plantar loading. Thus, there is a need to determine if race is a significant predictor of plantar loading. Additionally, with the current state of racial health disparities there is a need to determine racial differences in research engagement and mistrust between AA and WA. Data was collected from 107 participants, aged 18-30, in this Institutional Review Board approved study. An EMED pressure-measurement system (Novel Electronics, St. Paul, MN, USA) was used to collect plantar loading data. Additional measurements collected from each participant included arch height index (AHI), standing height, gait speed, and weight. Participants also completed two surveys focused on research engagement and research mistrust. A multiple linear regression was used to test if race and other factors significantly predicted plantar loading. Non-parametric tests were used to test if there were significant differences in research engagement and mistrust between AA and WA. The analysis determined that race was a significant predictor for plantar loading, along with age, AHI, gait speed, sex, and body mass index (BMI). Additionally, it was found that research engagement practices and feelings of research mistrust differed significantly between AA and WA young adults. These findings could improve our understanding as to why AA are more likely to have diabetic foot ulcers than WA, and why AA are less likely to participate in research than WA.
- Maternal Residential Proximity to Central Appalachian Surface Mining and Adverse Birth OutcomesButtling, Lauren G. (Virginia Tech, 2020)Maternal residency in Central Appalachian coalfields has been associated with low birth weight at the county-level. To refine the relationship between proximity and adverse birth outcomes, this study employs finer spatial scales of exposure. Spatiotemporal characterizations of surface mining boundaries in Central Appalachia between 1986-2015 were developed using Landsat data. The maternal address field on births records from VA, WV, KY, and TN were geocoded and assigned amount of surface mining within a 5km radius of residence (street-level). Births were also assigned exposures based on the amount of surface mining within residential ZIP code tabulation area (ZCTA) (ZIP code-level). Using linear and logistic regression, associations between surface mining activities during gestation and birth weight, preterm birth, low birth weight, and term low birth weight were determined, adjusting for available demographic factors. An increase in surface mining activities was negatively associated with birth weight at the street-level (β = −8.93g; (95% CI = -12.69 -5.7, P= <0.001) and ZIP code-level (β = −4.41g ; 95% CI = -6.30, -2.52, P= <0.001). Small, statistically significant associations were also found between preterm birth and mining within 5km of residence (OR = 1.003; 95% CI = 1.001, 1.005, P= 0.003) and within maternal ZCTA (OR = 1.002; 95% CI = 1.001, 1.003, P=0.001). Relationships were also found between amount of mining within 5km of residence and low birth weight and term low birth weight outcomes. This study found subtle, but significant associations between proximity to active surface mining during gestation and adverse birth outcomes.
- Neighborhood historical redlining, present-day social vulnerability and sports and recreational injury hospitalizations in the United StatesOgunmayowa, Oluwatosin Thompson (Virginia Tech, 2023-07-14)Historical redlining, a discriminatory practice of the 1930s, present-day social vulnerability (SVI), and sports and recreational injury (SRI) hospitalizations are interconnected topics that highlight the intersection of race, class, and health in the United States but the relationships have not been studied to date. Thus, the overall aim of this dissertation is to examine the effects of historical redlining and present-day social vulnerability on SRI hospitalizations in the United States. The first study systematically reviewed studies that examined the relationships between neighborhood characteristics and SRI using multilevel modeling approach. Studies reviewed show that certain neighborhood factors, such as living in urban communities, were associated with increased risk of SRI. The second study examined the association between historical redlining and present-day neighborhood SVI in the United States. Results show that formerly redlined areas have higher SVI presently. The third study examined the association between historical redlining and present-day SRI hospitalization in the United States. Results show that redlining was not associated with increased odds of SRI hospitalizations, but was associated with longer length of hospital stay (LOS) among Black and Hispanic patients, and higher total hospital charges among Hispanic patients. The fourth study examined the association between individual and neighborhood social vulnerability and sports and recreation-related traumatic brain injury (SR-TBI) hospitalizations among pediatric patients in the United States. Results show that Native American children had higher odds of hospitalization for SR-TBI, longer LOS, but lower odds of discharge to post-acute care compared to White children. Older age was associated with higher odds of hospitalization and longer LOS while male sex was associated with shorter LOS for SR-TBI in children. Compared to children with private insurance, children with public insurance had longer LOS while uninsured children had shorter LOS. Also, hospitalization in neighborhood with higher overall SVI was associated with longer LOS. This study advances our knowledge on the impact of structural racism on present-day SRI outcomes and will inform policy makers to prioritize health equity by addressing the underlying social determinants of health and the root causes of disparities in SRI outcomes.
- Neighborhood risk factors for sports and recreational injuries: a systematic review of studies applying multilevel modeling techniquesOgunmayowa, Oluwatosin; Baker, Charlotte (2022-02-21)Background: Sports and recreational activities are the most commonly reported cause of injury-related emergency department (ED) visits among children and young adults in developed countries, yet studies about the effect of neighborhood environment on sports and recreational injuries (SRI) are very limited. The aim of this study was to systematically review studies that apply multilevel modeling approach in examining the relationships between SRI and neighborhood-level risk factors. Data sources: A systematic search of peer reviewed English language articles was conducted in four electronic databases including PubMed (1992–2020), CINAHL (2000–2020), Sports Medicine and Education Index (1996–2020), and Web of Science (1991–2020). Study selection: Selected studies were observational or experimental studies of people of all ages across the world that assessed neighborhood risk factors for SRI (or all injuries including SRI) using multilevel regression analysis. Data synthesis: Nine studies—five cross-sectional, two prospective cohort, and two incidence studies—were selected out of a potential 1510. Six studies used secondary data and three used primary data. Only three studies examined SRI as the main or one of the main outcomes. These studies showed that neighborhood-level factors, such as higher socioeconomic context, lower street connectivity, and living or attending schools in urban communities, were associated with increased risk of SRI. Most studies did not provide a justification for the use of multilevel regression and the multilevel analytical procedure employed and quantities reported varied. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies (National Institutes of Health) was used to assess the quality or risk of bias of each study. Four quality assessment criteria out of 15 were met by all nine studies. The quality assessment ratings of the reviewed studies were not correlated with the quality of information reported for the multilevel models. Conclusion: Findings from this review provide evidence that neighborhood-level factors, in addition to individual-level factors, should be taken into consideration when developing public health policies for injury prevention. Considering the limited numbers of studies that were identified by this systematic review, more multilevel studies are needed to strengthen this evidence in order to better inform SRI prevention policy decisions.
- Opportunities and Challenges in Identification and Classification of Heat Stress Risk Based on Analysis of Individual and Neighborhood Level FactorsWang, Suwei (Virginia Tech, 2021-05-27)Heat-related illnesses and deaths are significant public health problems. Extreme heat is the No.1 deadliest form of weather on average in 1990-2019 in the US according to the National Weather Service. Measurements and forecasts made at regional weather stations are a common data source of Heatwave Early Warning Systems. However, regional weather stations provide inaccurate estimates of the heat index that people experience in different microclimates. Introducing a direct measurement of heat index experienced by individuals via wearable sensors will allow more accurate exposure assessment and identification of factors associated with dangerous exposures to extreme heat. The goal of this dissertation is to characterize the individually experienced heat index exposure via wearable sensors in an urban and a rural location in summer in a southern part of the United States. In the first study, 51 outdoor workers in Birmingham, Alabama wore a small thermometer attached to their shoe. Their occupational Wet Bulb Globe Temperatures (WBGT), a comprehensive heat exposure index, was estimated from either temperature from the shoe thermometers or nearby weather stations. In the second and third studies, 88 urban participants and 89 rural participants completed a seven-day intervention where they performed normal activity on Days 1-2 and spent an additional 30 minutes outdoors daily on Days 3-7. Participants wore a small thermometer attached to the shoe and a pedometer at their waist to track steps. Neighborhood hygrometers/thermometers were deployed close to participants' homes to measure neighborhood level heat indexes. In the fourth study, we conducted a phone survey including 101 participants in the same urban and rural locations to examine how their heat-health behaviors changed due to COVID-19 and high profiles of police brutality cases in Summer 2020 compared to previous summers. The results demonstrated that (1) a wearable thermometer on the shoe was a feasible way to measure individually experienced temperatures; (2) among outdoor workers, WBGT from shoe thermometer temperatures estimated more hours in dangerous exposure categories and recommended more protective work-rest schedules compared to WBGT from weather station temperatures; (3) neighborhood level heat indexes improved the prediction of individually experienced heat indexes compared to weather station data alone; (4) rural participants experienced higher heat index exposures than urban participants, after accounting for ambient conditions; (5) spending a small amount of additional time outdoors was a feasible and effective intervention where participants walked more steps and had lower individually experienced heat indexes during the intervention days compared to baseline days; (6) a significantly lower percent of participants reported they would use public cooling centers in Summer 2020 compared to previous summers. Taken together, the results of these studies identified methods for more accurate heat exposure assessment and its application in monitoring heat-safety while promoting physical activity via time spent outdoors in the summer. Future work could incorporate physiological response monitoring linked to simultaneous individually experienced heat exposure to further characterize exposure-response relationships across different populations. Additionally, a longer intervention and more advanced wearable devices such Fitbit, Apple Watches could be used to monitor sustainability of the intervention and intervention benefits beyond short term increases in physical activity, respectively.
- The time is now: why we must identify and address health disparities in sport and recreation injuryBaker, Charlotte; Chinaka, Oziomachukwu; Stewart, Elizabeth C. (2021-06-14)Background Social and structural determinants of health (SDOH) are the conditions in which individuals are born, live, learn, work, play, worship, and age. These drivers of health are integral in contextualizing the understanding and prevention of sport and recreation injury (SRI), and recognizing their impact is necessary to provide a complete and accurate picture of health and health outcomes related to injury. Main Reducing disparities and achieving equity in sports and recreation is possible in part by improving data collection methodologies and utilization. Often, many SDOH have considerable effect on SRI. Although SRI epidemiology frequently examines differences by sex, there is limited inclusion of factors such as socioeconomic status, housing, gender, and food security, in sport specific data sources or in analysis of sport recreation and injury using other sources (e.g. administrative data). The ongoing dual epidemics in the United States – racism and COVID-19 – have emphasized the importance of having and utilizing SDOH data to reduce the burden of injury and disproportionate effects on our diverse population. Conclusion Moving forward, to address disparities in SRI, SDOH must be included as a part of research priorities, health related goals, and policies. This difference can be made in developing consistency in data collection and utilization. This will provide an accurate picture of the intersections and interdisciplinary changes required to design the best approach to problems to develop solutions. Future data collection and utilization should prioritize SDOH.