Impact of public water supply unreliability on residential property prices in Marion County, West Virginia

Water supply unreliability in many public water systems stems from aging infrastructure. We measure unreliability by the issuance of boil water notices (BWNs) within one year prior to single-family residential sale observations. Using a spatial quantile regression framework on transactions between 2012 and 2017, we find statistically significant, negative relationships between BWNs and residential properties. The estimated impacts of unreliability on residential housing prices, however, are not uniform across the distribution of prices. Specifically, we find that BWNs have a larger impact on medium- to low-priced houses (at or below the 60 percent quantile) compared with high-priced houses. An aggregate marginal willingness-to-pay value of $4.2 million was computed for a one-day reduction in annual BWN throughout Marion County.

Methods to Conduct a Health Impact Assessment Learning Collaborative

Background: Indiana University Richard M. Fairbanks School of Public Health (IU FSPH) and the Health and Hospital Corporation of Marion County, through the Marion County Public Health Department (MCPHD), created a Health Impact Assessment (HIA) Learning Collaborative. The purpose of the HIA Learning Collaborative was to strengthen the capacity of both the academic and community partners to carry out HIAs. Entities recognize the value of creating a collaborative team to assure personnel are trained and available to provide time and expertise for plan reviews, formal feedback, data reports, literature summaries, and input in potential health/social impacts related to projects, which can ensure these impacts are considered in development work. In addition, the MCPHD and IU FSHP intend to increase HIA capacity in Indiana and remain committed to including health impact data into non-health sector decision making. Methods: The group planned to meet monthly over the year with the following learning objectives. A survey was created in Survey Monkey in order to evaluate the overall HIA Learning Collaborative experience and to assess whether or not the learning objectives were met. The survey consisted of 11 questions: nine were multiple choice and two were open-ended. Results: The majority of the objectives were met. Conclusion: There is interest in conducting HIAs in the future and several ideas were generated.

4409 Indiana Clinical & Translational Science Monon Collaborative – Community Impact Hubs

OBJECTIVES/GOALS: Conduct an environmental scan of Marion County (Indianapolis) neighborhoods using electronic medical record data, state health data, and social and economic dataDevelop strong network of community collaboratorsConduct a thorough assessment for each targeted neighborhood by listening and understanding the pressing health issues in the community and working together to design and deliver solutionsMETHODS/STUDY POPULATION: Identify measures in the 3 domains of vulnerability, health and assets for the targeted neighborhoods and conduct bivariate descriptive statistics and multivariable regression analyses to investigate association between measures of vulnerability and health outcomes.Initiate relationships with leaders and residents in targeted neighborhoodsLocate organizations working in targeted neighborhoods through online mapping software and word-of-mouth at neighborhood events, and created a spreadsheet with contact information.Conduct multidisciplinary assessment (i.e. key informant interviews, focus groups, town hall meetings) of the targeted neighborhood.Iteratively synthesize assessments to develop areas of interest and relevance to the community.Develop a road map for solutions identified by the community.RESULTS/ANTICIPATED RESULTS: The results from the environmental scan conducted will be displayed in a report and visual “map” of health outcomes and health determinants, including assets and barriers for the targeted neighborhoods. The research team will use results from the environmental scan coupled with listening activities including attendance at community events, key informant interviews and focus groups to develop relationships and strong collaborations with the targeted neighborhood stakeholders. The relationship building between the research team and community will provide increased trust and engagement that will further enhance the effectiveness of the assessments completed with the targeted neighborhood. The assessments will help to empower communities to develop sustainable solutions and drive future work that will lead to future grant applications and larger-scale implementation in other community impact hub neighborhoods. DISCUSSION/SIGNIFICANCE OF IMPACT: Through the community impact hub work, we will develop collaborative efforts with targeted neighborhoods with the greatest health inequities in the Marion County area. In partnership with these neighborhoods, we will build a foundation – a network of community collaborators and a focused plan – upon which we will improve the health outcomes of residents while learning best practices on how to do so.

Validating Imputation Procedures to Calculate Corrected Opioid-Involved Overdose Deaths, Marion County, Indiana, 2011-2016

Objectives: Understanding the scope of the current opioid epidemic requires accurate counts of the number of opioid-involved drug overdose deaths. Given known errors and limitations in the reporting of these deaths, several studies have used statistical methods to develop estimates of the true number of opioid-involved overdose deaths. This study validates these procedures using a detailed county-level database of linked toxicology and vital records data. Methods: We extracted and linked toxicology and vital records data from Marion County, Indiana (Indianapolis), during a 6-year period (2011-2016). Using toxicology data as a criterion measure, we tested the validity of multiple imputation procedures, including the Ruhm regression-based imputation approach for correcting the number of opioid-involved overdose deaths. Results: Estimates deviated from true opioid-involved overdose deaths by 3% and increased in accuracy during the study period (2011-2016). For example, in 2016, 231 opioid-involved overdose deaths were noted in the toxicology data, whereas the corresponding imputed estimate was 233 opioid-involved overdose deaths. A simple imputation approach, based on the share of opioid-involved overdose deaths among all drug overdose deaths for which the death certificate specified ≥1 drug, deviated from true opioid-involved overdose deaths by ±5%. Conclusions: Commonly used imputation procedures produced estimates of the number of opioid-involved overdose deaths that are similar to the true number of opioid-involved overdose deaths obtained from toxicology data. Although future studies should examine whether these results extend beyond the geographic area covered in our data set, our findings support the continued use of these imputation procedures to quantify the extent of the opioid epidemic.

Surveilling Non-Opioid Substance Use: Utilizing Multiple Data Sources in Marion County, Indiana

ObjectiveTo assess the prevalence of non-opioid substance use—including cocaine, methamphetamine and “spice”—within Marion County, Indiana and propose response recommendations utilizing a current opioid response plan.IntroductionCocaine, methamphetamine, and “spice” are addictive, non-opioid substances that negatively impact a person’s health through direct and indirect means. Direct health concerns of non-opioid substance use include anxiety, paranoia, seizure, heart attack, stroke, and potentially death while indirect health concerns include the acquisition of disease and infections, particularly sexually transmitted infections (STIs). Substance users experience an increased risk of acquiring STIs since they may exchange sex for substances, use substances within a social setting that may lead to sexual activity, or engage in risky sexual behavior as a result of impaired judgement associated with substance use. The current study evaluated the use of multiple data sources to monitor changes in the rate of cocaine, methamphetamine, and “spice” related emergency department visits as well as cocaine- and methamphetamine-related death rates, within Marion County, Indiana between 2013 and 2017.MethodsTwo data sources were used in this study. First, prevalence rates of non-opioid substance related emergency department (ED) visits were calculated using Marion County (IN) ED data from Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE) between 2013 and 2017. Second, cocaine and methamphetamine death rates were calculated using coroner toxicology data related to Marion County deaths between 2013 and 2017. Cocaine and methamphetamine deaths were defined as any death in which cocaine and methamphetamine was found in the toxicology results, respectively. All rates were calculated per 100,000 and age-adjusted to the 2000 U.S. Census using SAS Enterprise Guide v7.1.ResultsNon-opioid substance related ED visits have persistently risen between 2013 and 2017 (Figure 1). Methamphetamine and “spice” related ED visits exhibited similar prevalence patterns, increasing from 0.99 (0.72, 1.58) to 5.32 (4.67, 6.21) and 0.46 (0.28, 1.00) to 4.13 (3.57, 4.94) per 100,000, respectively, between 2013 and 2016. Cocaine-related ED visits consistently exhibited the highest prevalence rates, ranging from 3.72 (3.17, 4.44) to 23.56 (22.16, 25.11) per 100,000 in 2013 and 2016, respectively. In 2017, all non-opioid substance related ED visits drastically increased to 47.78 (45.79, 49.91), 48.48 (46.48, 50.67), and 42.08 (40.23, 44.13) per 100,000 for cocaine, methamphetamine, and “spice,” respectively. Further, we looked at cocaine- and methamphetamine-related death rates using coroner toxicology results. We found that between 2013 and 2017, the cocaine-related death rate nearly tripled, from 4.82 (4.20, 5.64) per 100,000 in 2013 to 13.01 (11.97, 14.23) per 100,000 in 2017 (Figure 2). Similarly, methamphetamine-related death rates increased from 1.31 (0.99, 1.92) per 100,000 in 2013 to 10.15 (9.25, 11.28) per 100,000 in 2017 (Figure 2). We did not calculate death rates of those who were found to have “spice” in their system at the time of death due to low prevalence.ConclusionsThe increase of non-opioid substance related ED visits in Marion County may indicate that non-opioid substance use—particularly cocaine, methamphetamine, and “spice”—may be an emerging public health issue in Marion County. This growing concern is further supported by the consistent increase in cocaine- and methamphetamine-related death rates. A limitation to our study is the inconsistent reporting of the substance in ED chief complaints and missing fields for discharge diagnoses and triage notes. As such, this inconsistency may have led to an underestimation of the prevalence rates of non-opioid substance related ED visits. The addition of triage notes and more reliable discharge diagnoses in 2017 ultimately culminated in a sharp increase in non-opioid substance related ED visits in 2017.Certain aspects of Marion County Public Health Department’s established opioid response plan may be used to address the growing concern of non-opioid substance use. These aspects include, but are not limited to, engaging community partners, creating a task force, establishing focus groups, and providing resources. While these aspects are critical to effectively respond to non-opioid substance use epidemics, establishing the various components prior to an outbreak enable communities to reduce the impact of such epidemics, if not prevent them from occurring. Additionally, it is important to incorporate participatory aspects into a non-opioid substance response plan such that community members are the driving force to provide context for the impact that non-opioid substance use is having on the community while also offering insight into which interventions would be most effective.