Health Forecasting at UCLA

March 2011


In This Edition:

 

Air Quality in Placer County

 

Decline in Sugar-Sweetened Beverages

 

Arkansas' Quitline Reach

 

New Projects

 

Conference Presentations

 

New Team Members

 

About Us

 

 

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Health Forecasting Quarterly Newsletter •  March 2011

Making informed policy and programmatic public health decisions today means preparing and planning for what the population health landscape will look like tomorrow. Our goal at the UCLA Health Forecasting Project at the UCLA School of Public Health is to provide sound, credible forecasts of health and related outcomes to support policy and programmatic decisions that improve population health and reduce health disparities.  There is no other tool that examines the long-term impact of programmatic interventions and policies while considering changing population dynamics. The topics examined by UCLA Health Forecasting represent some of today’s most pertinent health issues that are responsible for a large share of preventable disease and death locally and nationally. We have expanded our work to other states, which is helping us make Health Forecasting a tool that can be used nationally.

 

Our first newsletter of 2011 highlights findings from our work on forecasting the health, educational, and economic effects resulting from cleaner air in Placer County, California, understanding the potential of decreases in sugar-sweetened beverage consumption in reducing childhood obesity, and the effects of changes in Quitline funding to health outcomes in Arkansas.  We have also shared our findings at conferences and through publications, leveraged additional funding, and expanded our team.

 

We invite you to learn more about the Health Forecasting Tool at www.health-forecasting.org, where users can input unique demographics of a population of interest and generate reports of long-term outcomes associated with changes in risk factors and interventions.   We also invite you to sign up for the UCLA Health Forecasting email list to receive updates and notifications.  

 

Issue briefs, published papers, and our information sheet are also available for download on our website.  Please email us at info@health-forecasting.org for inquiries.


Current UCLA Health Forecasting Projects & Partnerships

Expanding the capabilities of the UCLA Health Forecasting Tool by incorporating education and income, two critical social determinants of health, and focusing on interventions relevant to underserved individuals and communities in California. (The California Endowment)

 

Incorporating additional risk factors (i.e. smoking) and disease outcomes (i.e. lung cancer) into the forecasting model and applying the model to other states, beginning with Arkansas and Wisconsin. (Robert Wood Johnson Foundation)

 

Supporting local not-for-profit hospitals in assessing current and future characteristics of the populations they serve and identifying long-term planning needs of local communities.  Providing information on future health and health disparities among subpopulations in the absence of additional effective health promotion and disease prevention efforts. (UniHealth Foundation)

 

Examining drivers of health and longevity among Latinos in California and understanding the effects of interventions focusing on diabetes and cardiovascular disease for this population. (National Institute of Environmental Health Sciences)

Cleaner Air Can Improve Health, Education, & Productivity in Placer County

placerPoor air quality is linked to both acute and chronic conditions, including asthma and other respiratory illnesses, cancer, and cardiovascular disease.  Improving air quality is a shared goal for environmental, health, and community groups.  The San Joaquin and Sacramento Valleys suffer from the worst air quality in California. Placer County, an inland county situated northeast of the two valleys, routinely experiences poor air quality.  We partnered with the Placer County Department of Health and Human Services (DHHS) to understand how changes in air quality in the San Joaquin and Sacramento Valleys potentially impact the health of children and adults in Placer County.

 

Using local air quality data from 1998-2008, our team developed a model that explored the impact of four scenarios between 2010 and 2030: 1) no change in pollutant levels, 2) lengthening summers due to climate change, 3) increase in wildfires, and 4) 20% targeted reduction of fine particulate matter and ozone, which are associated with adverse health effects.

 

Targeted reduction led to a decrease in the number of days during which state-set standards for fine particulate matter (67%) and ozone (92%) were exceeded.  The number of school days missed due to respiratory illness among students 5 -17 years declined by 33% (73,500 days) over the 20 years.  Targeted reduction also decreased hospital admissions for acute bronchitis for children 5-17 years (10%), ER asthma visits for both children and adults (10%), and all-cause mortality (2%). 

 

Respiratory conditions are a leading cause of days of school lost (2 days annually/student in Placer County), and student absences result in lost funding for school districts.  By decreasing school absences, targeted reduction results in more funding for schools, an estimated $2.5 million over 20 years.  Moreover, it also reduces the number of days of work lost by 9000, improving economic productivity. 

 

Placer County DHHS plans to incorporate these findings into its community outreach activities and mobilize and empower community leaders to find and advocate for policy solutions to promote clean air. 

 

Data analysis results are available on the UCLA Health Forecasting web interface www.health-forecasting.org, where users can access results from one of the scenarios for user-defined populations within Placer County.

 

More detailed results are available in our issue brief, “Forecasting Health Outcomes Related to Air Quality for Placer County”.

 

Decline in Sugar-Sweetened Beverage Consumption Possibly Contributing to Leveling California’s Childhood Obesity Epidemic sos

After decades of rising overweight and obesity among children, rates appear to be leveling off in both California and nationally. Public health experts are unsure about the causes of this decline, as many programs and policies have been implemented to combat childhood obesity.  Sugar-sweetened beverages (SSBs) have long been recognized as a culprit in the obesity epidemic, and in California, policy was enacted in 2003 (SB 677) to limit the availability of SSBs in public schools.    

 

The biennial California Health Interview Survey (CHIS) started collecting data on SSB consumption among children and adolescents in 2003.  We examined trends in SSB consumption by age group (2-5, 6-11, and 12-17 years) and BMI or weight-for-age collected by CHIS in 2003, 2005 and 2007. 

 

All age groups experienced a decline in high SSB consumption (>1 SSB daily), with significant changes among younger children (2-5 and 6-11 years), independent of demographics and socioeconomic indicators. This finding corroborates those from other cities and states with bans or limitations on the sale of SSBs in schools.

 

While the decline in SSB consumption cannot be directly linked to the leveling off of childhood obesity, it does indicate that efforts to change behaviors, especially among younger children, are succeeding. 

 

Detailed findings are available in the article, Substantial Decline in Sugar-Sweetened Beverage Consumption among California's Children and Adolescents, published in the International Journal of General Medicine.

Small Changes in Arkansas’ Quitline Reach Yields Large Changes in sodaHealth Outcomes 

Funding for smoking cessation quitlines has come under scrutiny by lawmakers nationally and is a target for state budget cuts. Quitlines are a proven smoking cessation tool that combines telephone counseling and pharmacological cessation assistance.  Despite an increase in demand, total funding for all U.S. quitlines decreased for the first time ever in fiscal 2010. Arkansas is contemplating whether to further cut funding for its Quitline despite documented success in achieving smoking cessation in a state with one of the highest adult smoking rates.  Between July 2009 and June 2010, Arkansas’ Quitline has assisted more than 5500 smokers to kick the habit, at a cost of $443 per quitter. 

 

UCLA Health Forecasting examined four scenarios to understand the effects of program funding on smoking prevalence and disease-free life years (DFLY) gained among Arkansas’ adults. The scenarios are:  1) “budget cuts” that decrease Quitline reach from the current 4% to a steady 2%, 2) current funding and reach remain “unchanged”, 3) reach increases to 6%, as recommended by the Arkansas Department of Health and CDC, and 4) reach gradually increases 0.4% annually to 8% in 2020, the highest level among states in 2009. 

 

Despite small differences in Quitline reach, significant differences in smoking prevalence exist early on between the scenarios examined, and the gap widens annually.  By 2035, the best performance scenario generates a smoking prevalence rate that is 23.5% lower than what is forecasted under the budget cut scenario.  In fact, best performance achieves Healthy Arkansas’ stated goal of reducing adult smoking prevalence to below 16%.  Cumulative DFLY gained between 2011 and 2035 is almost 20,000 for the best performance scenario, compared to the budget cut scenario.       

 

Our model suggests that a small difference in Quitline reach translates into a sizable, long-term difference in smoking prevalence rates and disease-free life years in Arkansas.  As years pass, these differences will only magnify.  Policymakers must consider these benefits when making decisions regarding funding for Quitlines.

 

Please visit the Health Forecasting website to read the full issue brief, "Long-Term Implications of Quitline Reach in Arkansas".

New Health Forecasting Projects

UCLA Health Forecasting was awarded a 2-year NIH grant to examine the relationship between acculturation and physical activity among California’s Latinos.  Latinos comprise 37% of the state’s population and are expected to become the largest racial/ethnic group in California by 2020.  Although Latinos experience better overall health outcomes than other racial/ethnic groups in relation to their socioeconomic status, acculturation leads to worse health outcomes.

 

With these funds, the team will forecast disease trends and health outcomes for diabetes and cardiovascular disease in relation to physical activity, smoking, and obesity and examine the effects of interventions that aim to improve Latino health. Cardiovascular disease and diabetes account for nearly 30% of all deaths among California’s Latinos.  By examining drivers of health and longevity, these efforts will help elucidate the contribution of acculturation on disease and death in this population. 

Conference Presentations

UCLA Health Forecasting researcher Lu Shi presented at the CDC’s “Modeling for Public Health Action: From Epidemiology to Operations” conference in Atlanta in December 2010.  Dr. Shi presented on the potential impact of health care reform on smoking prevalence and lung cancer mortality in Arkansas, which has some of the highest rates in the nation. Reimbursement for smoking cessation medication through reform is a strategy to decrease both smoking rates and lung cancer deaths. Dr. Shi’s research shows that while reimbursement of smoking cessation medication will reduce smoking prevalence, it will not bring about a substantial decline in lung cancer mortality.  Thus, other tobacco control strategies should be implemented and expanded such as education, policy, and increased funding for and access to other cessation techniques.  

New Health Forecasting Team Members

Kara MacLeod has experience as a health researcher and analyst and joined the UCLA Health Forecasting team as a Research Associate. She was a Statistical Analyst and Research Consultant for ICON Clinical Research and the University of Washington, respectively, and worked on studies of health outcomes and economics.  She was a Research Associate at the UC Berkeley School of Public Health where she conducted data and spatial analyses for neighborhood health, injury prevention, and transportation studies. She is interested in the contextual and behavioral factors of health and vulnerable populations.

 

Donglan Zhang, a 2nd-year doctoral student in the Department of Health Services, joined the UCLA Health Forecasting team as a Graduate Student Researcher. Her work focuses on exploring and explaining determinants of obesity-related health behaviors, building models based on multi-scale causal thinking, and analyzing local data to help hospitals with long-term planning.  Prior to starting her doctoral work, she interned at the China Health Economics Institute, where she researched prospective payment reform and projected health care expenditures for rural hospitals.


 

About Us

Health Forecasting is based at the UCLA School of Public Health, and is a collaborative effort with the California Department of Public Health and the Los Angeles County Department of Public Health. Health Forecasting is supported by The California Endowment, Robert Wood Johnson Foundation, UniHealth Foundation, and the National Institutes of Health.

Health Forecasting

UCLA School of Public Health
CHS 61-253, Box 951772
Los Angeles, CA 90096-1772
Phone: 310-206-1141

 

www.health-forecasting.org

 

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