HELLO EVERYONE. MY NAME IS
JANET FROM THE GNASHNA INSTITUTE
OF DRUG ABUSE NIDA. I WOULD LIKE
TO WELCOME YOU TO GEOSPATIAL
DATA SCIENCE AND DRUG USE
RESEARCH. ON BEHALF OF THE
MEMBERS WHICH INCLUDE MYSELF,
DR. COURTE VAN VOORHEES, WE
THANK YOU FOR JOINING THE WORK
SHOT. WE HAVE AN EXCITING
PACKED AGENDA WITH WELCOMING
REMARKS FOLLOWED BY NIH GUEST
SPEAKER AND SIX OUTSTANDING
RESEARCHERS ACROSS THE COUNTRY
ENGAGING IN GEOSPATIAL DATA
SCIENCE RESEARCH AS RELATES TO
DRUG USE. BEFORE WE GET
STARTED, I WOULD LIKE TO SHARE
WITH YOU A FEW HOUSEKEEPING
ITEMS. FIRST THIS MEETING LAB LB
REPORTED RECORDED. T THE
PARTICIPANTS CAN USE THE Q&A BOX
ON THE MENU BAR TO ASK
QUESTIONS. WE KINDLY ASK IF YOU
ARE ASKING A QUESTION TO NAME
THE PARTICULAR SPEAKER THAT THE
QUESTION IS ATTENDED FOR --
INTENDED FOR. IT CAN ENABLE
CLOSE CAPTIONING USING THE
BUTTON ON THE BOTTOM OF THE
SCREEN. HERE WE ARE EXCITED TO
HAVE TWO OVERRIDING LEADERSHIP
JOINING US TODAY. IT IS MY
PLEASURE TO INTRODUCE YOU,
(INAUDIBLE) WHO WILL BE
PROVIDING WELCOMING REMARKS.
FIRST I WOULD LIKE TO WELCOME
DR. NORA VOLKOW, NATIONAL
INSTITUTE ON DRUG ABUSE. SHE'S
STREW MENTAL DEMONSTRATING DRUG
ADDICTION IS A BRAIN DISORDER
AND AS RESEARCH PSYCHIATRIST SHE
PIONEERED IN BRAIN IMAGING TO
SEE HOW SUBSTANCE ABUSE AFFECTS
BRAIN FUNCTION. WE ARE PROUD TO
LEVERAGE DATA SCIENCE AND
ANALYTICS TO FURTHER UNDERSTAND
THE REAL WORLD COMPLEXITY WHICH
WAS HIGHLIGHTED IN THE NIDA
STRATEGIC PLAN. AFTER DR.
VOLKOW'S OPENING REMARKS, I
WOULD LIKE TO INTRODUCE DR. CA
BLONCO, DIRECTOR OF DIVISION OF
EPIDEMIOLOGY, SERVICES
PREVENTION RESEARCH. DR. BANCO
IS A NATIONAL KNOWN EXPERT IN
EPIDEMIOLOGY AN TREATMENT OF
ADDICTIVE BEHAVIORS. PRIOR TO
NIDA HE WAS PROFESSOR PSYCHIATRY
AT COLUMBIA UNIVERSITY MEDICAL
CENTER AND RESEARCH SCIENTIST AT
NEW YORK STATE PSYCHIATRIC
INSTITUTE. HE IS INFLUENTIAL IN
EMPHASIZING RESEARCH AND
APPROACHES FOCUSING ON DATA AND
USERS SO WITHOUT FURTHER ADIEU,
PLEASE HELP ME WELCOME DR. NOVA
VOLKOW. THANK YOU.
>> THANKS VERY MUCH. GOOD
AFTERNOON, EVERYONE. IT IS A
PLEASURE TO BE HERE WITH ALL OF
YOU. I ALSO WANT TO THANK NOT
JUST JANET BUT ALSO
(INDISCERNIBLE) VOORHEES FOR
ORGANIZING THIS EXTREMELY
EXCITING MEETING. I HAVE BEEN
AWARE ABOUT THE IMPORTANCE OF
GEOSPATIAL RESEARCH, CLOSE TO
TWO DECADES AGO, I HAD FLUTE
SLEUTHLY NO IDEA IT WOULD BE SO
GREATLY IMPORTANT NOT JUST IN
ADDICTION SCIENCE BUT IN IN
GENERAL. IN THE MEETING YOU WILL
BE HEARING WHY THIS ASPECT OF
SCIENCE IS SO VERY IMPORTANT FOR
US AND AGENCY AT NIDA BUT ACROSS
ALL THE NIH. JANET WAS SAYING,
YES, WE -- PART OF MY CAREER HAS
BEEN VERY MUCH TRYING TO
UNDERSTAND HOW DRUGS AFFECT THE
HUMAN BRAIN WHICH IS WHAT LED TO
PROVIDE EVIDENCE THAT ADDICTION
IS A DISEASE OF THE BRAIN BUT
ALL THE DATA THAT HAS COME FROM
EPIDEMIOLOGY ALSO SHOWS THAT
YES, IT IS ADDICTION IS OF BRAIN
BUT IT IS STRONGLY INFLUENCED BY
OUR CONTEXT OUR ENVIRONMENTS.
AND OUR CULTU CULTURE. HERE IS E
WE HAVE THE EXTRAORDINARY VALUE
THAT GEOSPATIAL SCIENCE HAS,
BECAUSE IT PROVIDES THOSE
OBJECTIVE TOOLS WE CAN ACTUALLY
UNDERSTAND THAT INTERACTION THAT
COMES ABOUT BETWEEN THE AFFECTS
OF DRUGS IN THE BRAIN AND
ULTIMATELY OUR SOCIAL
ENVIRONMENTS OR OTHER ASPECTS OF
THAT ENVIRONMENT THAT SURROUND
US AND THAT INFLUENCES OUR
DEVELOPMENT AS HUMAN BEINGS FROM
INCEPTION ONWARD. AS I THINK
ABOUT THE VALUE OF YOUR SPATIAL
SCIENCE IN ADDICTION RESEARCH I
WOULD LIKE TO ANCHOR IT INTO
THREE MAIN AREAS IN TERMS OF
PRIORITIES OF NIDA. WITH DO
SCIENCE FOR A PURPOSE, A PURPOSE
THAN CAN HELP US ADVANCE
PREVENTION OF SUBSTANCE USE AND
SUBSTANCE USE DISORDERS. TO HELP
US ADVANCE THE TREATMENT OF
SUBSTANCE USE DISORDERS, AND
THAT HELPS US DEVELOP POLICIES
THAT ARE GOING TO BE INFLUENTIAL
AT LEVEL OF THE POPULATION. IF
YOU THINK ABOUT EACH ONE OF
THEM, YOU CAN CLEARLY SEE HOW
CRUCIAL GEOSPATIAL SCIENCE IS.
FOR EXAMPLE, IN THE FIELD OF
PREVENTION I CANNOT NOT THINK
ABOUT HOW IT HAS INFORMED TO
PARTICULARLY THE MOST AMBITIOUS
STORIES WE HAVE LAUNCH IN BRAIN
DEVELOPMENT AND THAT'S THE ABCD,
IT STARTED THROUGH THE USE OF
GEOSPATIAL SCIENCE HAS BEEN ABLE
TO DELINEATE WHAT WE HAVE KNOWN
ALL ALONG, ADVERSE SOCIAL
ENVIRONMENTS NEGATIVELY AFFECT
US. BUT HOW DOES THAT TRANSLATE
INTO THE BRAIN AND INTO
BEHAVIORS? AND THIS IS POSSIBLE
BECAUSE OF THE MARRIAGE OF
GEOSPATIAL SCIENCE WITH THE
CHARACTERIZATIONS WE ARE DOING
ON THE ABCD STUDY. LAST YEAR WE
INITIATED AN EQUIVALENT TO THE A
B C D SAW STUDY BUT STARTING IN
INFANCY RATHER THAN ADOLESCENCE.
WE ARE ALSO GOING TO CAPITALIZE
ON THE POWER OF GEOSPATIAL
SCIENCES TO INVESTIGATE HOW
ENVIRONMENTS INFLUENCE EARLY
DEVELOPMENT OF THE HUMAN BRAIN
AND BEHAVIORS. IN THE FIELD OF
TREATMENT, I CAN ACTUALLY
REALIZE ONE OF THE THINGS I COME
TO REALIZE THIS LATER HOW
FUNDAMENTALLY IMPORTANT CONTEXT
ARE AND HOW WE HAVE NEGLECTED
THAT ASPECT OF SCIENCE WHEN
TRYING TO INTERPRET THE RESULTS
OF RANDOMIZE CLINICAL TRIALS OR
OTHER TYPES OF CLINICAL TRIALS,
WHERE WE EVALUATE HOW EFFECTIVE
OUR INTERVENTION IS. WHAT WE
HAVE NEGLECTED TO CONSIDER THAT
IT WOULDN'T BE SURPRISING THAT
IT WOULD GIVE MEDICATION OR
ANOTHER TYPE OF TREATMENT ON
SOMEONE WHOSE ENVIRONMENT IS
VERY DISRUPTIVE, THAT IS GOING
TO EFFECT HOW AFFECTIVE THAT
MEDICATION MAY BE, OR THE
ABILITY OF THAT INDIVIDUAL TO
ACHIEVE REMISSION AND ULTIMATELY
RECOVERY. WE CAN BECOME VERY
SOPHISTICATED IN THAT MARRIAGE
OF SCIENCE WHICH IS ACTUALLY HAS
BEEN SHOWN HOW IMPORTANT IT IS
THAT CONTEXT IN WHICH INDIVIDUAL
THAT IS AIMING TO ACHIEVE
RECOVERY IS IN DETERMINING THE
RISK OF RELAPSE. THIS CAN BE NOW
TRACED REAL TIME USING GPS
DEVICES THAT CAN ALERT THE
INDIVIDUAL WHEN IN ENVIRONMENTS
OF HIGH RISK. FINALLY, THE AREA
OF OF POLICY, IN MANY WAYS IT
ALMOST SPEAKS BY ITSELF, IT IS
SO VERY EVIDENT. FOR EXAMPLE AN
AREA THAT WE HAVE BEEN VERY
INTERESTED ON EXPANDING AND I
HOPE TO ACTUALLY SEE IT FURTHER
TAKEN ADVANTAGE OF, IS THE
MARRIAGE OF WASTE WATER
GEOSPATIAL INDICATORS, AND
EPIDEMIOLOGY AND TREATMENT AND
PREVENTION IN WAYS THAT CAN HELP
GUIDE POLICY. SO TO WASTE WATER
WE CAN FOR EXAMPLE DETERMINE IF
AN AREA IS AT HIGHER RISK THAN
ANOTHER ONE AND THAT CAN FOR
EXAMPLE HELP TAYLOR LOCAL
INTERVENTIONS AND RESOURCES IN
AREAS THAT ARE OF GREAT NEED. I
COULD GO ON AND ON AND ON GIVING
EXAMPLES ABOUT HOW EXTREMELY
IMPORTANT THIS AREA OF SCIENCE
IS, TO WHAT WE DO. AND NOW THAT
WE ARE IN THE AREA OF DATA
SCIENCE AND ARTIFICIAL
INTELLIGENCE IT BEHOOVES US AND
I LOOK FORWARD TO GETTING THE
RECOMMENDATIONS THAT COME OUT OF
THESE MEETING TO SEE WAYS WE CAN
CONTINUE TO FURTHER INNOVATE SO
WE CAN TAKE THE MOST ADVANTAGE
OF THE DATA WE ARE OBTAINING. SO
I WANT TO THANK EVERYONE FOR
PARTICIPATING IN THIS MEETING
AND NOW I'M GOING TO PASS THE
MICROPHONE TO DR. CA BLANCO.
>> THANKS, NORA I WANT TO ECHO
YOUR WORDS THANKING JANET TAMARA
AND COURTE FOR ORGANIZING THIS
SUCCESSFUL WORKSHOP, CLOSE TO
200 PARTICIPANTS SO THAT IS
AMAZING. I WANT TO FOR YOUR
LEADERSHIP ORGANIZING THE
WORKSHOP AND TO THANK THE
PARTICIPANTS WITHOUT WHICH
DOESN'T MAKE ANY SENSE. I WANT
TO ALSO ECHO NORA'S WORD WORDS.D
EMPHASIZE POTENTIAL DIRECTIONS
AS WE MOVE THROUGH THE WORKSHOP.
ONE IS AS NORA SAID, ONE OF THE
EMPHASIS THAT WE HAVE AT NIDA
AND IN PARTICULAR IN OUR
DIVISION IS THAT WE AS
SCIENTISTS ARE CURIOUS AND WE
WANT TO KNOW THINGS BUT AS
PRACTITIONERS WE WANT THAT
KNOWLEDGE TO HAVE SOME USE. SO
WE ARE VERY, VERY FOCUSED ON
USING APPROACHES AN AS WE MOVE
THROUGH THE WORKSHOP I WANT YOU
TO THINK FOR WHOM OR WHAT THIS
KNOWLEDGE WOULD BE USEFUL. NOT
ONLY WHY IS THIS INTERESTING
ASPECT BUT WHAT ARE THE
PRACTICAL APPLICATIONS IN TERMS
OF ADVANCING PUBLIC HEALTH.
THOSE COULD BE AS NORA
MENTIONED, IMPROVED
SURVEILLANCE, BETTER PREVENTION,
FACILITATING TREATMENT, IT COULD
BE EVALUATING POLICIES. IT COULD
BE GIVE US US IDEAS HOW TO
BETTER UNDERSTAND OR GENERAL
RATE HYPOTHESIS FOR
NEUROBIOLOGICAL STUDIES FOR
INTERACTIONS BETWEEN BIOLOGY AND
ENVIRONMENT. SO THAT'S ONE
DIRECTION. HOW ARE THESE DATA
USEFUL? SECOND DIRECTION, I HOPE
THAT AS INDIVIDUALS YOU ARE
HAPPY BUT I MOPE SOCIETY YOU ARE
UNHAPPY BECAUSE WE NEED TO BE
UNHAPPY TO CONTINUE TO MOVE
FORWARD. I WANT YOU DISSATISFIED
WITH WHAT WE HAVE. SO I WANT YOU
TO THINK HOPEFULLY THESE ARE
GOOD METHODS BUT WHAT OTHER
METHODS WHAT BETTER METHODS DO
WE NEED TO CONTINUE TO MAKE
PROGRESS? HOW CAN NIDA SUPPORT
THESE ADVANCES? THE THIRD AREA
IS THAT WORKSHOP IS ENTITLED
GEOSPATIAL METHODS BUT AT THE
END OF THE DAY YOU FORGET ABOUT
GEO AND FOCUS ON SPATIAL, THE
SPACE IS REALLY JUST THE
RELATIONSHIP BETWEEN THINGS, NO?
AND THE MORE YOU GOT IT THE MORE
ABSTRACT. SO THESE METHODS WE
ARE GOING TO EXAMINE TODAY FOCUS
ON GEOSPATIAL DOES BUT IF WE GO
MORE GENERALLY, HOW COULD THE
METHODS WE USE AND THE METHODS
WE COULD DEVELOP HELP MAP OTHER
SPACES? NOVA OF COURSE HAS
DEVELOPED HER CAREER TO STUDY
THE BRAIN. SO COULD WE USE SOME
OF THESE SPECIAL METHODS TO
UNDERSTAND THE BRAIN BETTER,
COULD WE INTERACT WITH OTHER
DATA SCIENTISTS AND WORK ON
OTHER AREAS TO IMPROVE OUR
METHODS AND ALSO IMPROVE THEIR
METHODS WITH WHAT WE KNOW? WE
ALSO HAVE IN PSYCHOPATHOLOGY
CONSTELLATION OF SYMPTOMS THAT
ARE RELATED TO THE OTHERS SO WE
CAN THINK OF SPACE OF
PSYCHOPATHOLOGY CAN WE USE THESE
METHODS TO UNDERSTAND
PSYCHOPATHOLOGY BETTER BASIC
THAN INTERESTS OF BEHAVIOR? SO I
ENCOURAGE YOU TO NOT ONLY THINK
HOW TO ADVANCE METHODS BUT HELP
TO HAVE DIALOGUE IN OTHER YARRS
OF SCIENCE AND SIGNS IN GENERAL
SO WE CAN -- AREAS OF SCIENCE SO
WE CAN ADVANCE IN DIFFERENT
DIRECTIONS SO TO RECAPITULATE
THE THREE THINGS I WOULD LIKE TO
ADVANCE, WHAT ARE THE USER
ACCEPT TRICK APPROACHES OR
APPLICATIONS FOR THE KNOWLEDGE
YOU ARE GOING TO PRESENT AND
DISCUSS, WHAT METHODS COULD WE
DEVELOP THAT WE WILL HELP
ADVANCE SCIENCE AND WHAT WE HAVE
A DIALOGUE BETWEEN METHODS WE
HAVE AND THE METHODS BASICALLY
HAVE DEVELOPED TO APPLY TO OTHER
POTENTIAL SPACES NOT ONLY
GEOSPATIAL APPLICATIONS. SO WITH
THAT, I HAND IT BACK TO JANET.
AND I HOPE THAT YOU CAN GUIDE US
THROUGH THIS VERY EXCITING
WORKSHOP.
>> THANK YOU VERY MUCH, DR.
VOLKOW AND BLANCO FOR YOUR
WELCOMING REMARKS AND YOUR
SUPPORT FOR THIS WORKSHOP. NOW
TO DELVE DEEPER INTO THIS TOPIC
I WOULD LIKE TO INTRODUCE OUR
NIH GUEST SPEAKER, DR. SAM
(INAUDIBLE) LEAD PROGRAM
DIRECTOR FOR THE NIH ARTIFICIAL
INTELLIGENCE MACHINE LEARNING
CONSORTIUM TO ADVANCE RESEARCH
AND DIVERSITY. ALSO KNOWN AS THE
AIM AHEAD PROGRAM AT THE OFFICE
OF DATA SCIENCE AND STRATEGY
ALSO KNOWN AS ODSS. HIS ROLE
DR. GEBREAB IS RESPONSIBLE FOR
OVERALL MANAGEMENT OVERSIGHT AND
IMPLEMENTATION OF THE AIM AHEAD
PROGRAM AND FOR ENSURING THE
BENEFITS OF BIG DATA AND AI
TECHNOLOGIES ARE EQUALLY FELT
ACROSS DIVERSE POPULATIONS.
PREVIOUSLY DR. GEBREAB WAS
PROGRAM DIRECTOR AT THE NCI TO
REDUCE CANCER HEALTH DISPARITIES
AN PRIDE THE NCI HE WORKED AT
FDA AND NHGRI. DR. GEBREAB
RECEIVED HEARSAY MSD AND Ph.D.
IN GEOSPATIAL TECHNOLOGY FROM
UTAH STATE AND RECEIVED HIS MSC
IN GEOGRAPHIC INFORMATION
SCIENCE FROM (INAUDIBLE)
UNIVERSITY IN THE NETHERLANDS.
DR. GEBREAB COMPLETED
POST-DOCTORAL TRAINING AT
MICHIGAN SCHOOL OF HEALTH. WOW
FURTHER ADIEU I WOULD LIKE TO
WELCOME DR. GEBREAB, THANK YOU
FOR JOINING US TODAY.
>> THANK YOU SO MUCH, JANET, FOR
THAT WONDERFUL INTRODUCTION.
GOOD AFTERNOON, EVERYONE. CAN
YOU HEAR ME? OKAY. MY NAME IS
SAMSON GEHREAB, I WORK FOR THE
OFFICE OF THE DIRECTOR OFFICE OF
DATA SCIENCE STRATEGY, AS JANET
MENTIONED IT IS AN
INTERDISCIPLINARY STUDY,
EPIDEMIOLOGICAL STUDY, TODAY I
WILL PROVIDE HIGHLIGHTS ON NIH
LANDSCAPE IN APPLICATION OF
GEOSPATIAL DATA AND PRIOR
APPROACHES IN THE SAME
CHALLENGE. WE ARE AT THE
EXCITING MOMENT FOR GEOSPATIAL
DATA BECAUSE GEOSPATIAL DATA ARE
INCREASINGLY BEING COLLECTED
FROM VARIETY OF SOURCES
INCLUDING GPS, SATELLITES,
DRONES AN SENSORS THAT COLLECT
BEHAVIORAL AND ENVIRONMENTAL
DATA, SMART PHONES AN SOCIAL
MEDIA. ALL THOSE DIVERSE
GEOSPATIAL DATA OFFER NEW
OPPORTUNITIES FOR NUMEROUS
PUBLIC HEALTH AND ALSO
BIOLOGICAL AND BEHAVIORAL
RESEARCH. RECEIVE WHY CARE ABOUT
GEOSPATIAL DATA? AS DR. VOLKOW
MENTION, IN THE CONTEXT WHERE WE
LIVE IS IMPORTANT AND RESEARCH
HAS SHOWN THAT IT IS CRITICAL IN
BETTER MINING HEALTH OUTCOMES
ALSO MORE THAN GENETIC CODE
ITSELF, THIS IS BECAUSE WHERE WE
LIVE CAN PROFOUNDLY AFFECT MANY
DIFFERENT FACETS OF HEALTH
INCLUDING QUALITY OF HEALTHCARE;
FOOD, SAFE NEIGHBORHOOD AND
THOSE OTHER PLAY A ROLE IN
HEALTH OUTCOMES AND BEHAVIORAL
HEALTH INCLUDING LIVE
EXPECTANCY, RATES IN OVERALL
QUALITY OF LIFE. I'M GOING TO
GIVE YOU TWO (INAUDIBLE) OF THE
GEOSPATIAL DATA IN THIS CASE. AS
YOU CAN SEE I -- PUBLISHED BY
CUSPER IN 2015 I BELIEVE, SHOWS
THE DRAMATIC CHANGE IN
GEOGRAPHIC PATTERNS OF HEALTH
MORTALITY OVER THE 40 YEARS FROM
HIGH RATES OF (INAUDIBLE) IN THE
NORTHEAST YOU CAN SEE HERE THE
DEEP SOUTH. THIS INDICATES THAT
GEOGRAPHIC PATTERNS JOG PATTERNS
LIKE ECONOMIC FACTORS AND
BEHAVIORAL AND SOCIAL AND
ENVIRONMENTAL FACTORS ARE
IMPORTANT FOR HEALTH CASES.
SIMILARLY YOU CAN SEE IN THE
OTHER ALSO GEOGRAPHIC PATTERNS
FAIRLY CANCER IS ALSO AFFECTED
BY DEMOGRAPHIC AND ECONOMIC
BEHAVIORAL AND OUTCOMES. THOSE
THREE EXAMPLES SHOWS THAT
GEOGRAPHIC GEOSPATIAL DATA CAN
HELP UNCOVER GEOGRAPHIC PATTERNS
ACROSS VARIOUS CHRONIC DISEASE
AS DR. CALOS MENTIONED THESE
STUDIES GENERATE EQUITABLE
DISEASE AND IDENTIFY HOT SPOTS
FOR INTERVENTION BUT ALSO HELP
INFORM -- MAKE INFORM POLICY
DECISIONS. SO WHAT ARE THE IN
TERMS OF GEOSPATIAL DATA BY
AREA? THERE IS LEGISLATION
GEOSPATIAL DATA APP OF 2018
WHICH TRIES TO ESTABLISH ACCESS
IN TERMS OF VALIDITY AND
TRANSPARENCY OF GEOSPATIAL DATA
ALONG THE PROGRAM PUBLISHED
WHICH IS CALLED THE NATIONAL
SPATIAL DATA INFRASTRUCTURE
WHICH TRIES TO INTERCONNECT A
SYSTEM OF SPATIAL DATA ADDRESS
VARIOUS CHALLENGES LOCAL AND
NATIONAL. WITHIN THE HHS
DEPARTMENT THERE IS STRATEGIC
PLAN THAT EMPHASIZE LEVERAGING
GEOSPATIAL DATA ANDS TO AND
MAKING THEM ACCESSIBLE
INTEROPERABLE AND ACTIONABLE TO
SUPPORT HHS MISSION TO IMPROVE
PUBLIC HEALTH OUTCOME. THIS IS
IN LINE WITH GEOSPATIAL DATA APP
IN NCDR. WITHIN THE NIH OFFICE
OF DATA SCIENCE STRATEGY WHICH
OVERALL OBJECTIVE OF THIS OFFICE
IS TO PROVIDE NIH WIDE
LEADERSHIP AND COORDINATE FIZZ
-- COORDINATE DATA SCIENCE
ESPECIALLY MODERNIZING DATA
SCIENCE ECOSYSTEM AND
INFRASTRUCTURE INCLUDING
GEOSPATIAL ACROSS THE NIH BUT
ALSO TO PROVIDE ENHANCE DIVERSE
DATA SCIENCE WORK FORCE AND
BUILD STRATEGY PATTERN
PARTNERSHIP TO ADVANCE METHODS.
THIS OFFICE HAS MANY PROGRAMS
AND UNITS THAT SUPPORT IN TERMS
OF MODERNIZE DATA SOURCE
ECOSYSTEM INCLUDING GEOSPATIAL
DATA. THE OFFICE IS NOW
CURRENTLY FINALIZING STRATEGIC
PLAN AND THIS PLAN GEOSPATIAL
DATA ALONG SOCIAL DATA
DETERMINANTS OF HEALTH WHICH
CORRESPONDS WITH GEOSPATIAL DATA
IS THERE AND I INVITE YOU TO
READ IT WHEN OFFICIALLY
RELEASED. SO WITHIN NIH THE
GEOSPATIAL DATA HAS BEEN IN --
HAS BEEN IN NUMEROUS BIOMEDICAL
AND PUBLIC HEALTH RESEARCH. AS
YOU CAN SEE IN THIS LAST TEN
YEARS NIH HAS FUNDED NEARLY
2,000 PROJECTS USING BIOMEDICAL
AND BEHAVIORAL RESEARCH. MANY
INSTITUTES AND CENTERS
INCREASINGLY RECOGNIZE THE
IMPORTANCE OF GEOGRAPHIC CONTEXT
IN ADVANCING BIOLOGICAL RESEARCH
AND PUBLIC HEALTH FOR EXAMPLE,
THE NCI USES AS YOU CAN SEE
HERE, GEOSPATIAL GIS AND SPATIAL
MODELING TO UNDERSTAND CANCER
OUTCOMES. IN ADDITION THE NIMHD
HERE WE WILL SEE SOON, THE
NATIONAL INSTITUTES OF MENTAL
AND HEALTH DISPARITY, USE
GEOSPATIAL DATA TO STUDY HOW
CONNECTORS IMPACT MENTAL HEALTH,
CHRONIC STRESS AND
CARDIOVASCULAR HEALTH AND OTHER
CHRONIC DISEASES. THEN THE
NATIONAL ENVIRONMENTAL HEALTH
SCIENCE TRIES TO USE GEOSPATIAL
STUDY GEOSPATIAL DATA TO STUDY
ENVIRONMENTAL HEALTH
INTERACTION. IN THIS CASE THEY
USE GEOSPATIAL DATA TO
ENVIRONMENTAL. FOR ALL THIS
SHOWS NIH INSTITUTES AND CENTERS
RECOGNIZE IMPORTANCE OF
GEOGRAPHIC IN ADVANCING HEALTH
RESEARCH. IN ADDITION AS WE KNOW
THERE IS INTERSECTION BETWEEN
GEOSPATIAL DATA AND SOCIAL
DETERMINANTS OF HEALTH AS ONE
CAN MENTION, THIS INTERSECTION
IS BECAUSE THESE HEALTH OUTCOMES
IN SOCIAL DETERMINANTS OF HEALTH
ARE NOT ACROSS (INAUDIBLE) AND
THIS IS THE REASON WHY NIH IS
HIGH PRIORITY IN TRYING TO
IMPROVE HEALTH AND ADVANCE
HEALTH EQUITY. HENCE IN PHYSICAL
22 ONLY NIH FUNDED ABOUT
$4.1 BILLION RELATED TO SDOH AND
TRAINING PROGRAMS WHICH IS OVER
8,000 PROJECTSS. AND THIS
APPROACH TO LEVERAGE THE
INTERDISCIPLINARY COLLABORATION
BETWEEN GEOSPATIAL SCIENCES AND
SOCIAL SCIENCES IS TO PROVIDE
POWERFUL LENS TO UNDERSTAND AND
ADDRESS HEALTH DISPARITIES. AN
EXAMPLE, THERE (INAUDIBLE) BY
MANY INSTITUTES INCLUDING NIDA
THAT LEVERAGE GEOSPATIAL DATA TO
(INAUDIBLE) GEOGRAPHIC PATTERNS,
ENVIRONMENTAL FACTORS AND SOCIAL
DETERMINANTS ON DISEASE
DEVELOPMENT AND HEALTH OUTCOMES.
SO I ENCOURAGE YOU AGAIN HERE TO
LOOK AT THIS NOSI. SO WITH
NUMEROUS BENEFITS OF GEOSPATIAL
DATA, THERE IS ALSO SOME
SIGNIFICANT CHALLENGES. FOR
EXAMPLE DATA ABILITY AND --
AVAILABILITY AND QUALITY IS AN
IMPERFECT ISSUE ESPECIALLY WE
ARE INCREASING COLLECTING
GEOSPATIAL DATA, THERE IS
LIMITED DATA IN UNDERSERVED
COMMUNITIES. THERE IS CHALLENGE
OF DATA INTEGRATION AND
STANDARDIZATION INCONSISTENT OF
DATA FORMAT, DEFINITIONS ACROSS
DIFFERENT, MAKE IT DIFFICULT TO
INTEGRATE DATA FROM DIFFERENT
SOURCES. THERE IS THE PRIVACY
CONCERN AS WE COLLECT MORE
LOCATIONS OF INDIVIDUALS THIS
COULD BE A CONCEPT AS WELL AS WE
NEED OTHERS. AND THERE IS ALSO
AN ISSUE MANAGING THIS VAST
GEOSPATIAL DATA COLLECTED
INCLUDING THE TECHNICAL
CHALLENGE SUCH AS COMPLETING
INFRASTRUCTURE AND STORING
PROCESSING AND ANALYZING DATA.
SPECIALIZED SKILLS WE NEED TO
TRAIN NEXT GENERATION THAT COULD
BE GEOSPATIAL DATA AND ANALYZE
AND CHALLENGES FOR
INTERDISCIPLINE COLLABORATION,
THOSE ARE SOME EXAMPLE OF THE
CHALLENGES THAT WE NEED TO
ADDRESS IN THE COMING MONTHS AND
WEEKS AND YEARS. SO WHAT ARE
THOSE OPPORTUNITIES? TO OTHERS
THOSE CHALLENGES IN MAXIMIZING
IMPANG OF GEOSPATIAL DATA IS --
IMPACT OF GEOSPATIAL DATA IS TO
DEVELOP THEIR GEOSPATIAL DATA
SET. OUR OFFICE IS ONE OF THE
TASK IS TO MAKE THE ECOSYSTEM
INCLUDING GEOSPATIAL DATA ADHERE
TO THE FAIR PERSON WHICH IS
FINDABLE ACCESSIBLE AND
INTEROPERABLE AND REUSABLE. SO
THIS REQUIRES IMPLEMENTING
COMPREHENSIVE DETAILED MYOMA
DATA, STANDARDIZED DATA FORMATS,
CLEAR ACCESS PROTOCOLS AND
PROPER DOCUMENTATION. IF WE ARE
TO ENABLE THE PRINCIPLE IN THE
RESEARCHERS TO QUICKLY FIND
EXISTING GEOSPATIAL POTENTIAL
ACCELERATE RESEARCH AND IMPACT
ON HEALTH. BUT ALSO TO ENHANCE
AND INTEGRATE COMBINE GEOSPATIAL
DATA WITH OTHER DATA SETS SUCH
AS SENSORS AND SUCH AS
ELECTRONIC METHOD RECORDS TO
UNDERSTAND AND ADDRESS HEALTH
DISPARITY. THE OTHER
OPPORTUNITIES WE HAVE IS TO USE
COMMON DATA ELEMENTS, NIH
ENCOURAGES USE OF COMMON DATA
ELEMENTS. GEOSPECIAL DATA COMMON
DATA ELEMENTS THAT STANDARDIZE
WAY OF LOCATION BASED
INFORMATION. THIS ENABLES
RESEARCHERS TO USE, TO COLLECT
STANDARDIZE GEOSPATIAL DATA AND
COLLECT AND SHARE AND ALSO THEY
CAN MAXIMIZE THAT IMPACT. FOR
EXAMPLE WE HAVE THE HEAL STUDY
USING GEOSPATIAL DATA ELEMENTS
TO CHECK STANDARDIZE GEOGRAPHIC
INFORMATION, THAT CAN BE LINKED
TO CLINICAL DATA SET AND OTHER
DATA SET WHICH ALLOWS TO BETTER
UNDERSTAND HOW GEOSPATIAL TERMS
ARE RELATED TO PAIN AND OTHER
CONDITIONS. WHICH I ENCOURAGE
YOU TO VISIT ABOUT THIS ALSO.
THE OTHER EXAMPLE IS THAT THERE
IS ALSO SIMILAR RESEARCH BY
NIMHD SHARE AND PHOENIX COMMON
DATA ELEMENTS THIS FOCUSES ON
THE SOCIAL DETERMINANTS OF
HEALTH WHICH ARE ALSO ANOTHER
RESOURCES FOR RESEARCHERS TO
EXPLORE. SO ONCE WE BUILD THE
GEOSPATIAL DATA SET BASED ON
FAIR PRINCIPLES WE NEED TO
DEVELOP ALSO A CULTURAL FREEZE
OF GEOSPATIAL DATA -- REUSE OF
GEOSPATIAL DATA SO THAT WE CAN
USE IT MANY TIMES AND ALSO
ACROSS MULTIPLE DISCIPLINES AND
APPLICATIONS SO WE CAN MAXIMIZE
THE VALUE AND THE EFFECT OF THIS
INVALUABLE DATA SETS BEING
COLLECTED FROM DIFFERENT
RESOURCES. THIS HELPS US TO
ACCELERATE THE PACE OF RESEARCH,
FUTURE RESEARCH BUT ALSO TO
VALIDATE OUR RESEARCH FINDINGS
AND ALSO FOSTER
MULTI-DISCIPLINARY COLLABORATION
IN THE ERA OF MULTI-DISCIPLINARY
BECAUSE SILOING RESEARCH IS NOT
GOOD AT THIS TIME BECAUSE WE
NEED DATA SCIENTISTS AND SOCIAL
DETERMINANTS AND CONTEXT EXPERTS
TO WORKING TO AND LEVERAGE AND
HARNESS THE POWER OF THE
GEOSPATIAL DATA. THEN WE HAVE AN
OPPORTUNITY TO INTEGRATE
GEOSPATIAL DATA WITH SOCIAL
DETERMINANTS OF HEALTH WEARABLE
AND CLINICAL DATA. AND ALSO DATA
THAT COMES FROM SOCIAL MEDIA%
THIS IS WHERE AN OPPORTUNITY
NEEDED IN ORDER FOR THIS TO
HAPPEN THOUGH I THINK AS I
MENTION, WE NEED TO STANDARDIZE
THE WAY WE COLLECT THE DATA, WE
NEED TO MAKE THEM FINDABLE AND
ACCESSIBLE INTEROPERABLE. AND
ONCE WE DO THAT, THE
INTERVENTION WILL BE MUCH EASIER
AND WE CAN HARNESS THAT POWER OF
INTEGRATION TO STUDY SO MANY
ISSUES RELATED TO BEHAVIORAL AND
HEALTH OUTCOMES. THE OTHER
OPPORTUNITY WE HAVE IS WE NEED
TO ADDRESS HEAD-ON THE ETHICAL
AND PRIVACY HERE. AS WE COLLECT
GEOSPATIAL DATA WHICH IS LINKED
TO INDIVIDUAL LOCATIONS, THIS IS
A SIGNIFICANT ISSUE FOR ETHICAL
AND PRIVACY CONCERNS, ESPECIALLY
FOR THOSE COMMUNITIES THAT ARE
VULNERABLE AND MARGINALIZED, IT
CAN CREATE A STIGMA OR SHOW OF
DISCRIMINATION. SO WE NEED TO
PRIORITIZE ETHICAL AND PRIVACY
CONCERNS. SO PRACTICING INFORMED
CONSENT, ANALLIZATION AND ROBUST
MEASURES AND TRANSPARENCY IN
ALGORITHMS AND MAKING SURE THE
DATA IS INCLUSIVE, IT DOESN'T --
DATA IS NOTTER NO GAPS IN
MARGINALIZED COMMUNITY AND ALSO
MAYBE USE APPROACHES LIKE
FEDERATED DISTRIBUTED APP TO
ANALYZE AND INTEGRATE DIFFERENT
DATA RESOURCES. THE OTHER
OPPORTUNITIES WE ARE IN THE ERA
OF ARTIFICIAL INTELLIGENCE AND
MISSION DIFFUSION OF GEOSPATIAL
DATA AND AI BECOMES THE GEOAI.
THIS IS AN EMERGING AREA THAT IS
-- COMBINES AI WITH DATA MINING
AND COMPUTING PERFORMANCE TO
EXTRACT KNOWLEDGE FROM
GEOSPATIAL DATA. WE NEED TO
LEVERAGE ALL THOSE INCLUDING THE
DIGITAL TWINS WHICH WILL ALSO
HELP US IN TERMS OF SIMULATION.
THOSE TOOLS CAN HELP CRITICAL
OUTBREAKS AND IDENTIFY HEALTH
RISK AND UNDERSTAND THE
SEVERITIES AS WELL AS FUTURE
HEALTH TRENDS FROM LAUNCH OF
GEOSPATIAL DATA IN FORMATS,
ENGLISH TEXT AND SOCIAL MEDIA.
THIS CAN ALSO INCREASE THE
COMPUTATIONAL EFFICIENCY, THE
FLEXIBILITY OF ALGORITHMS AND
WORK FLOWS, IN OUR ANALYSIS. AND
SCALABILITY OF THE MODELS TO
UNDERSTAND AND TO GENERATE OTHER
GEOGRAPHIC AREAS OR HEALTH AND
BEHAVIORAL OUTCOMES.S. AS WELL.O
THE NIH SPECIAL OFFICE TRYING TO
DEMOCRATIZE ACCESS OF THE
INFRASTRUCTURE SO WE HAVE THIS
STRIDE INITIATIVE THAT I
ENCOURAGE YOU TO VISIT AND
EXPLORE. THIS INITIATIVE IS THAT
FOR BOTH THE NIH INTRAMURAL AND
EXTRAMURAL RESEARCHERS
COMMUNITIES, THE POWER OF CLOUD
TO ACCELERATE BIOMEDICAL AND
BEHAVIORAL RESEARCH. IN USING
THIS CLOUD, YOU CAN CONDUCT YOUR
GEOSPATIAL ANALYSIS IN A CLOUD
AND INTEGRATE AI AS I MENTION IN
OTHER TOOLS TO DO CUTTING-EDGE
RESEARCH. AND CLOUD COMPUTING IS
A GREAT EQUALIZER. IT HELPS
DEMOCRATIZE THE ACCESS TO
RESEARCH AND DATA SIZE BY
LEVELING THE PLAYING FIELD
ESPECIALLY FOR UNDER-REPRESENTED
RESEARCHERS IN BIOMEDICAL
RESEARCH. WE ALSO HAVE THE NIH
CLOUD FOR SOME OF YOU ESPECIALLY
THOSE INVESTIGATORS, POST DOCS
OR Ph.D.. I INVITE YOU TO
EXPLORE THE CLOUD NIH CLOUD LAB.
THERE IS NO FEE. YOU CAN BE ABLE
TO EXPERIMENT, USE THE TOOLS AS
WELL. SO IN CLOSING, WE ARE OF
THE EXCITING TIME FOR GEOSPATIAL
DATA IN PUBLIC HEALTH RESEARCH.
AND THIS IS ALSO IN ACTION TO
THE NIH ICs AND OFFICES,
RECOGNIZING THE VALUE OF
GEOSPATIAL DATA IN THE COMPLEX
CHALLENGE IN BIOMEDICAL AND
BEHAVIORAL RESEARCH SO THERE IS
A LOT OF FUNDING IN THIS AREA
ESPECIALLY IF YOU COMBINE
INTERCEPT WITH SOCIAL
DETERMINANTS OF HEALTH
ENVIRONMENTAL DETERMINANTS OF
HEALTH AS WELL. SO THEN THE
VISION OF GEOSPATIAL DATA WITH
ADVANCE OF AI AND CLOUD
COMPUTING AND DIGITAL TOOLS
ALONG WITH IMPLEMENTATION OF THE
FAIR PRINCIPLE AND ETHICAL
PRACTICES, ALL THIS WILL
TRANSFER THE WAY WE LEVERAGE
GEOSPATIAL DATA. TO UNDERSTAND
THE NUMEROUS HEALTH AND
BEHAVIORAL ISSUES WHILE ENSURING
THAT THOSE -- THE BENEFIT OF
THOSE ADVANCE GEOSPATIAL DATA
ADVANCE IN AI ARE EQUITABLY FELT
ACROSS ALL COMMUNITIES INCLUDING
THOSE THAT ARE MARGINALIZED AND
UNDERSERVED. WITH THAT I THANK
YOU. I'M HAPPY TO ANSWER ANY
QUESTIONS.
>> GREAT. THANK YOU SO MUCH,
DR. GEBREAB FOR THIS INFORMATIVE
PRESENTATION. WE DO HAVE ONE
QUESTION. WE ARE MINDFUL OF THE
TIME AS WELL SO IF YOU DON'T
MIND ANSWERING THE QUESTION AT
THE TIME WHILE THE PRESENTATION
IS ONGOING WE APPRECIATE IT. NOW
I WOULD LIKE TO TURN OVER TO DR.
COURTE VOORHEES WHO WILL
MODERATE THE NEXT SESSION ON
PREVENTION RESEARCH. THANK YOU
SO MUCH.
>> HELLO. THANK YOU AGAIN FOR
JOINING US. WELCOME TO THE
SESSION ON PREVENTION RESEARCH.
MY NAME IS COURTE VAN VOORHEES,
PROGRAM OFFICER IN THE
PREVENTION RESEARCH BRANCH OF
THE DIVISION OF EPIDEMIOLOGY
SERVICES AND PREVENTION
RESEARCH. WE HAVE TWO GREAT
SPEAKERS TODAY I WILL INTRODUCE
IN A MOMENT. WE ARE LOOKING
FORWARD TO YOUR QUESTIONS, SO
REMINDER DURING THE SESSION
PLEASE TYPE QUESTIONS INTO THE
Q&A BY CLICKING ON THE ICON AT
THE BOTTOM OF THE ZOOM WINDOW,
INCLUDE THE LAST NAME OF THE
PRESENTER AT THE BEGINNING OF
THAT QUESTION. THAT WILL HELP US
IDENTIFY FOR DISCUSSION PERIOD
TO MAKE IT SMOOTHER. THE FIRST
PRESENTATION WE HAVE IS
COMMUNITY LEVEL MEASURES OF RISK
AND RESILIENCY IN OPIOID RELATED
MORTALITY BY DR. LANCE WALLER,
Ph.D. ARE DR. WAHLER IS
PROFESSOR FORMER CHAIR
DEPARTMENT OF BIOSTATISTICS AND
BIOINFORMATICS, WHILE IN SCHOOL
OF PUBLIC HEALTH EMORY
UNIVERSITY. HIS CO-CHAIR OF THE
NATIONAL ACADEMIES COMMITTEE ON
APPLIED THEORETICAL STATISTICS
AND MEMBER OF THE U.S. CENSUS
SCIENTIFIC AND ADVISORY
COMMITTEE. A FELLOW OF THE
AMERICAN STATISTICAL ASSOCIATION
AND FELLOW OF THE LOYAL
GEOGRAPHICAL SOCIETY. HIS
RESEARCH INVOLVES DEVELOPMENT OF
METHODS FOR GEOGRAPHIC DATA
INCLUDING APPLICATIONS AND
ENVIRONMENTAL JUSTICE,
EPIDEMIOLOGY, DISEASE
SURVEILLANCE, HIS RESEARCH IS IN
ENVIRONMENTAL HEALTH AND ECOLOGY
JOURNALS AND TEXTBOOK APPLIED
STATISTICS FOR PUBLIC HEALTH
DATA. OUR SECOND PRESENTATION IS
SPATIAL EPIDEMIOLOGY AND
GEOSPATIAL DATA SCIENCE IN
OPIOID RELATED RESEARCH. BY DR.
SOME STOPKA Ph.D. MHS. DR.
STOPKA IS EPIDEMIOLOGIST AND
PROFESSOR WITH THE DEPARTMENT OF
PUBLIC HEALTH AND COMMUNITY
MEDICINE AT THE TUFTS UNIVERSITY
SCHOOL OF O MEDICINE. DR. STOPKA
IS CURRENT MIXED METHODS
RESEARCH FOCUSES ON INTERSECTION
OF SUBSTANCE USE, OPIOID
OVERDOSE AND INFECTIOUS DISEASE.
HE EMPLOYS GIS SPATIAL
QUALITATIVE AND BIOSTATISTICAL
APPROACHES TO MULTI-SITE
INTERDISCIPLINARY STUDIES AN
PUBLIC HEALTH INTERVENTIONS TO
UNDERSTAND OPIOID MORTALITY AND
MORALED. MPI ON FOUR CLINICAL
TRIALS AND OBSERVATIONAL STUDIES
FUNDED BY NIH, CDC AND SAMHSA.
HE IS CO-CHAIR OF THE TUFTS
RESEARCH CLUSTER ON EQUITY AND
HEALTH WEALTH AND CIVIC
ENGAGEMENT AND CO-CHAIR PUBLIC
HEALTH COMMUNITY MEDICINE
DEPARTMENTAL RESEARCH COMMITTEE
AT TUFTS. HE TEACHES COURSES IN
G IS AND SPECIAL EPIDEMIOLOGY,
RESEARCH METHODS PUBLIC HEALTH
AND EPIDEMIOLOGY. ENJOYS
MENTORING RESEARCH ASSISTANTS
POST-DOCTORAL FELLOWS AND
FACULTY. NOW I WILL HAND THE
PRESENTATION OFF TO CAPABLE
HANDS OF DR. WAHLER, THANK YOU
SO MUCH. DR. WALLER, THANK YOU
SO MUCH.
>> THANKS TO THE ORGANIZERS FOR
THIS WORKSHOP. I NOTICED MY
SLIDES THE SMALLER ESTIMATION IS
IN A SMALLER FONT SO I GUESS
THAT'S A LITTLE BIT OF AN EASTER
EGG TO START THINGS OFF. THIS IS
JOIN WORK WITH (INDISCERNIBLE)
HANNAH COOPER AND JANET
CUMMINGS, SOMETIME BEFORE THE
PANDEMIC. THIS WAS A PROJECT WE
WERE WRITING UP AS THE PANDEMIC
HIT AND IT'S BEEN ON THE BACK
BURNER SO I WANT TO BRING THIS
BACK UP AND WHAT I WILL TALK
ABOUT ARE QUESTIONS AND ANSWERS
THAT WE DO WITH GEOSPATIAL DATA
AND GEOSPATIAL ANALYSES, NOT
JUST WHERE IS THE HIGHEST RATE
OR WHERE THE ASSOCIATIONS AND
HOW ASSOCIATIONS CHANGE BUT MORE
HOW DO YOU THINK ABOUT PROBLEMS
LIKE THIS. AND WE WILL USE
OPIOID OVERDOSE MORTALITY
STATISTICS AND THINK ABOUT WHERE
THESE CAME, WHAT ARE WE SEEING
GEOGRAPHIC PATTERNS OF? THERE'S
THE ACTUAL OUTCOME WE ARE
INTERESTED IN BUT ALSO
GEOGRAPHIC PATTERNS HOW DATA ARE
COLLECTED AND ACCESSED THAT I
WANT TO ADDRESS. SO WHAT DATA DO
WE NEED TO ANSWER QUESTIONS,
WHAT DATA DO WE WANT. BECAUSE --
WHAT DATA CAN WE ACTUALLY SEE,
WHAT QUESTIONS CAN WE ANSWER
WITH THE DATA WE HAVE IN THE
METHODS AND WHAT PATTERNS AND
WHY, WHY ARE THESE THINGS
HAPPENING? SO A LONG TIME AGO A
TOXICOLOGIST EPA REGION 4 IN
ATLANTA DREW THIS PICTURE FOR ME
AND I HAVE BEEN USING IT IN MY
GIS CLASS FOR 25 YEARS NOW. SO
WE START UPPER LEFT, THIS IS A
SCIENTIFIC PROCESS BUT IT'S IN A
CIRCLE SO WE HAVE A QUESTION TO
ANSWER BOX ONE, WE CAN THINK
ABOUT BEFORE WE COLLECT DATA OR
SEEK OUT DATA WHAT DATA WOULD BE
THE PERFECT DATA FOR THIS, WHAT
DATA AND METHODS ANSWER THAT
QUESTION ONCE AND FOR ALL? BUT
WE NEVER GET TO SEE EVERYTHING
WE LIKE TO IN GEOSPATIAL DATA
EVEN THOUGH WE HAVE SEEN A LOT
OF EXAMPLES OF THE GREAT
ADVANCES IN DATA ACCESSIBILITY
WE HARDLY EVER SEE EXACTLY WHAT
WE WANT. SO THERE'S DATA WE CAN
GET AND THERE'S METHODS AN TOOLS
WE HAVE AVAILABLE, THOSE ALLOW
US TO MOVE TO BOX 4, THE
QUESTIONS WE CAN ANSWER WITH THE
DATA AND METHODS WE HAVE AND THE
REALLY IMPORTANT PART HOW CLOSE
ARE ARE THE QUESTIONS WE DID
ANSWER IN BOX 4 TO QUESTION WE
WANTED TO ANSWER IN BOX 1.
STUDENTS ASK HOW DO WE KNOW WHEN
WE ARE DONE IN THIS CIRCLE AND
THE ANSWER IS WE ARE NO SINGLE
STUDY WILL ANSWER THE QUESTION
ONCE AND FOR ALL, THE REAL GOAL
IS CAN WE LEARN MORE BY GOING
AROUND THIS DATA ANALYSIS, THAN
CAN WE LEARN MORE THAN WE KNEW
WHEN WE STARTED? THAT'S THE
SWIRLING VORTEX. WE WILL KEEP
GOING AROUND THAT. SO THE
QUESTIONS YOU MIGHT WANT TO
ANSWER HERE IN SOME OF THE
SUBSTANCE USE DISORDER ARE THE
OUTCOMES, OUTCOMES MIGHT BE
MORTALITY, MORBIDITY, MIGHT BE
USE, WHAT POPULATION AT RISK AND
IF WE ARE USING CENSUS DATA WE
ARE THINKING EVERYONE IS AT
RISK, THAT MIGHT NOT BE, MIGHT
NOT ALL BE EQUALLY AT RISK.
SALES, WHERE IS THE -- WHERE ARE
THE SUBSTANCES BEING DRIBD? WHO
BEING ARREST AND WHERE? --
DISTRIBUTED, WHO IS ARRESTED AND
WHERE? WHERE IS TREATMENT
AVAILABLE AND WHO HAS ACCESS TO
IT? WHAT ARE THE RISK FACTORS WE
HAVE BEEN DISCUSSING SOME OF THE
SOCIAL DETERMINANTS FACTORS AND
THE INDIVIDUAL FACTORS AND
INSIDE THE INDIVIDUAL FACTORS.
WHAT ARE RESILIENCY FACTOR, YOU
TAKE THE SAME INDIVIDUAL AND PUT
THEM IN DIFFERENT SOCIAL
ENVIRONMENTS, THEY MAY WELL
RESPOND TO A STIMULUS OR
EXPOSURE IN DIFFERENT WAYS. WHAT
SCALE ARE THESE RESILIENCY
FACTORS OCCURRING? IS IT THE
INDIVIDUAL? IS IT SOMETHING WE
CAN TRAIN INDIVIDUALS WITH, IS
IT NEIGHBORHOOD, COMMUNITIES,
STATE LEVEL, IS IT A COMBINATION
OF ALL THESE? ALL THESE
INTERACT. AND SOCIAL
DETERMINANTS OF HEALTH WE HAVE
BEEN TALKING ABOUT AND SOCIAL
DETERMINANTS OF RISK I THINK
PLAY A LARGE ROLE IN THIS. EVEN
THOUGH AS WE WERE DISCUSSING THE
LONG HISTORY OF SEEING ADDICTION
AS A MENTAL PROCESS, BUT THAT
CAN BE INFLUENCED BY THE SOCIAL
ENVIRONMENT. SO THIS IS A
DIAGRAM THAT I FIND HELPFUL.
WHAT DO WE GET TO SEE? I WORK
WITH PEOPLE IN DISEASE ECOLOGY
WHAT WE ARE LOOKING A ONE HEALTH
ENVIRONMENT WITH PATHOGENS AN
VECTORS AN ANIMALS AND PEOPLE
INTERACTING BUT WE CAN THINK
ABOUT THIS IN SUBSTANCE USE AS
WELL. IF EACH ONE OF THESE
SHAPES IS A MAP, AND WE START ON
THE LEFT, WE MIGHT HAVE A MAP OF
THE SUBSTANCE DISTRIBUTION, A
MAP OF SOCIAL SUPPORT, A MAP OF
LAW ENFORCEMENT, A MAP OF THE
SOCIAL ENVIRONMENT, ALL THESE
INTERACT TOGETHER AS INDIVIDUALS
LIVE AND WORK AND MOVE AROUND
AND THEY GENERATE THE MAP WITH
THE DOTS AROUND IT IN THE MIDDLE
WHICH IS REALLY LIKE TO SEE,
THIS IS THE MAP WHERE THE
OUTCOMES OF INTEREST ARE REALLY
HAPPENING, WHETHER INCREASED
RISK OR EXPOSURE, OR DEATH, OR
TREATMENT ACCESS, THERE IS A MAP
WE REALLY LIKE TO SEE THAT WE
DON'T GET TO SEE BECAUSE EVENTS
THERE NEED TO BE DETECTED, THEY
MOVE TO THE RIGHT THROUGH A
FILTER THAT IS ALSO A MAP ITSELF
IN BETWEEN THESE TWO MAPS. SOME
PLACES AN EVENT OCCURS IN THE
TRUE MAP AND GETS DETECTED RIGHT
AWAY. SO A DEATH MIGHT OCCUR AND
MIGHT BE CLEAR THAT IT'S AN
OVERDOSE DUE TO PARTICULAR
SUBSTANCE AND THAT GETS RIGHT IN
THERE DETECTED BUT IT MIGHT BE
THAT THE OVERDOSE IS HIDDEN
BECAUSE IT WAS INVOLVED IN A CAR
ACCIDENT AND THAT DOESN'T GET
REPORTED. SO WE HAVE DETECTING
THE EVENT, WE HAVE THE REPORTING
EVENT TO GET O THE FINAL DATA
SET THAT IS AVAILABLE PERHAPS
THROUGH FAIR STANDARDS, AND WE
IN PUBLIC HEALTH WE START ON THE
RIGHT HAND SIDE WHAT DATA ARE
AVAILABLE AND TRY TO BACK INTO
THE MIDDLE. AND WITH SOME OF THE
INDIVIDUAL BASED MODELS AGENT
BASED MODELS, DYNAMIC SYSTEMS,
SIR TYPE MODELS WE ARE FAMILIAR
WITH FROM COVID WE MIGHT START
ON THE LEFT WITH WHAT KIND OF
ENVIRONMENT ARE YOU IN, WHAT
SORT OF RISK WOULD THAT GROW. SO
ANYWHERE ALONG THIS CONTINUUM
THERE ARE SPATIAL AND GEOSPATIAL
ASPECTS AND SOME OF THE DATA
AVAILABLE AT DIFFERENT
RESOLUTIONS. SO I FIND THIS,
THIS IS USUALLY FIGURE ONE IN
MOST OF MY GRANT PROPOSALS SO
FOR THOSE OF YOU WHO REVIEWED
THEM MAY HAVE SEEN THIS BEFORE.
ALSO THINKING WHAT ARE
GEOSPATIAL METHODS, I'M LOOKING
AT THE INTERSECTION OF
STATISTICAL SCIENCE, GEOGRAPHIC
INFORMATION SCIENCE AND THE DATA
SCIENCE HERE. PUTTING THE
INTERSECTION IS GEOANALYTIANALYO
THOSE MIGHT BE METHODS USED TO
DO GEOSPATIAL ANALYSIS AND WE
MIGHT HAVE ANALYTICS AT THE
INTERSECTION OF DATA SCIENCE,
STATISTICAL SCIENCE, DOESN'T
HAVE THE GEOGRAPHY PIECE, LOOK
AT SOCIAL MEDIA TRENDS AND SO ON
BUT ONCE GEOTAGGED NOW WE ARE
MOVING TO A JOG IN THIS CASE
INFORMATION SYSTEM, WE HAVE
LOCATION BASED SERVICES WE MIGHT
MOVE TOWARD THE MIDDLE WHEN
DOING ANALYTICS. SIMILARLY GI
SCIENCE SIDE WE MIGHT HAVE
GEODEMOGRAPHICS. WHERE PEOPLE
LIVE, WHO DOES THE RACIAL AND
SOCIOECONOMIC STRUCTURE
NEIGHBORHOODS CHANGE? AND THAT
CAN BE PULLED INTO STATISTICAL
SCIENCE AS WELL. ON THE
STATISTICAL SCIENCE PIECE, WE
MIGHT HAVE SOME OF THE THINGS
FAMILIAR WITH LIKE DIFFERENT
TYPES OF REGRESSION,
SENSITIVITY, SPECIFICITY AND
POWER, BUT IN A GEOSPATIAL, WHAT
IF THE POWER TO DECK AN EFFECT
IS INCREASING A CERTAIN LOCATION
AND THEN WE PUT DATA SCIENCE IN
THERE, WE CAN GET GEOGRAPHIC
ANALYTICS. NOT SURE WHO IS
SNORING BUT I SEEM TO HAVE PUT
SOMEBODY TO SLEEP. SO IF WE CAN
CHECK WHO IS MUTED OR NOT.
THANKS. SO WHAT DATA CAN WE SEE?
FROM A PUBLIC HEALTH
SURVEILLANCE PERSPECTIVE YOU
MEMBER PUBLIC HEALTH
SURVEILLANCE YOU SAW BACK DURING
COVID BUT THIS GOES BACK TO
REPORTABLE DEI AND WE BILL A
SURVEILLANCE SYSTEM FROM
EXISTING DATA SOURCES THAT MIGHT
BE BASED ON MORTALITY, MIGHT BE
BASED ON COMMUNITY MEASURES, WE
WILL TALK ABOUT VULNERABILITY
INDICES IN A MOMENTMENT ALSO
FROM LAW ENFORCEMENT, THOSE WHO
WORKED WITH SUBSTANCE USE HAVE
SEEN ARRESTS RECORDS, MEDICAL
RECORDS, ELECTRONIC MEDICAL
RECORDS MENTIONED, EMERGENCY
RESPONSE DATA, WHERE DID EMS
CALLS COME FROM, AND TREATMENT,
TREATMENT ACCESS, TREATMENT
LOCATION, TREATMENT UPTAKE. ALL
THESE HAVE DIFFERENT PATTERNS
BUT NONE ARE SORT OF SIMPLE
RANDOM SAMPLES OF SPACE AND GIVE
US A CLEAR PICTURE OF THINGS.
THEY ARE ALL GATHERED FOR
DIFFERENT REASONS THAN WE USE
THEM FOR SO PUTTING TOGETHER WE
NEED TO UNDERSTAND THE REPORTING
AND DETECTION FILTERS. LAW
ENFORCEMENT IS AN IMPORTANT ONE
IN THAT THERE IS A LOT OF
LITERATURE ON WHO IS BEING
CHECKED FOR SUBSTANCE USE,
SALES, WHERE IS INCARCERATION,
WHERE ARE LAWS ENFORCED. SO WHAT
QUESTIONS CAN WE GIN TO ANSWER?
-- BEGIN TO ANSWER, THE GOAL OF
MORTALITY, WHAT ARE THE GOALS OF
MORTALITY, RATES HIGHER OR LOWER
BUT ALSO PATTERNS OF REPORTING.
HOW THINGS GET INTO THE DATA
SETS WE USE? AND THIS TYPE OF
EPIDEMIOLOGY REPORTING IS ALSO
REALLY INTERESTING AND IMPORTANT
UNDERSTANDING OF THOSE FILTERS.
SO THERE'S PATTERNS OF RISK
FACTORS ABOUT WE MIGHT COMPARE
DATA SCIENCE PERSPECTIVE WHERE
YOU USE LARGE MACHINE LEARNING
ALGORITHM ON HUNDREDS AND
HUNDREDS OF VARIABLES OR
TRADITIONAL VARIABLE SELECTION
FROM THE OLDEN DAYS WHEN WE DID
STATISTICS THIS WAY, AND I WANT
TO BRING UP SOME OF THIS WHEN WE
TALK ABOUT SOCIAL VULNERABILITY
AND DISEASE IN A MOMENT. ALSO I
MENTION RESILIENCY, THIS TERM
COMES UP FROM TIME TO TIME, WHAT
IS IF AN INDIVIDUAL IS IN A
SUPPORTIVE VERSUS NOT SUPPORT TV
ENVIRONMENT, JUST TREAT EXPOSURE
TO RESILIENCY ANOTHER RISK
FACTORS ONE WE HOPE A NEGATIVE
IMPACT THAT REDUCES THE RISK AND
WE SHOULD THINK HOW THINGS
INTERACT WHEN IT COMES TO
REPORTING OR REPORTING INTERACT
WITH MORTALITY, CORRELATING WITH
MORTALITY? INDEPENDENT? WHAT
CONFOUNDING ARE WE GOING TO
HAVE? WHAT AFFECT MODIFICATION,
HOW DOES CAUSATION WORK? WHAT DO
WE CARE ABOUT HERE WHEN WE ARE
REPORTING IT. SOMETIMES THE
CAUSAL INFERENCES PRIMARY
INTEREST. WHAT IS DRIVING THE
RESULT? BUT SOMETIMES I THINK
THE DESCRIPTIVE PART HAS BEEN
PLAYED DOWN IN NOT CAUSAL BUT
STILL IMPORTANT FOR ASSESSING
HOW WELL POLICY IMPLEMENTED IN A
CERTAIN LOCATION MIGHT INFLUENCE
THE PATTERNS OF RISKS AROUND IT
SO IN TRENDS IN MORTALITY AND
REPORTING, THE WORK WE WERE
DOING BEFORE THE -- BEFORE COVID
WE WERE LOOKING AT NATIONAL
CENTER FOR HEALTH STATISTICS
MULTIPLE CAUSES OF DEATH DATA.
THIS INCLUDES UNDERLYING PRIMARY
AND ICD 9 CODE AND UP TO 20
CONTRIBUTING CAUSES ABOUT STATE
AND COUNTY OF RESIDENCE SO
LOOKING A SMALL AREA ESTIMATION
AT THE COUNTY LEVEL. DEFINE
OPIOID MORTALITY, USING THE 2018
GUIDANCE FROM THE CDC, THIS IS
UPDATE AD BIT, THE UNDERLYING
OVERDOSE DEATH COULD APPEAR IN
THREE DIFFERENT SETS OF CODES
THAT GO INTO THE DEATH
CERTIFICATE. UNINTENTIONAL AND
INTENTIONAL POISONINGS ARE THE X
CODES. OVERDOSE OF UNDETERMINED
INTENT WHERE YOU CAN TELL IF
INTENTIONAL OR NOT AND Y CODES
AND HOMICIDE BY DRUGS ARE X
CODES. THESE ARE UNDERLYING
CAUSES OF DEATH BUT THERE IS
ALSO CONTRIBUTING CAUSES I
TALKED ABOUT THE AUTOMOBILE
ACCIDENT WITH UNDERLYING
OVERDOSE. THISs ARE
CLASSIFIED BY DIFFERENT DRUGS,
FOR OPIOID WE WERE THINKING
TAKING THE CODES FOR OPIUM
HEROINE AND OTHER OPIOID
INCLUDED HERE AND UNSPECIFIED
NARCOTICS WHICH IS A T CODE AND
ANY OPIOID INCLUDING ALL SIX T
CODES. SO THIS OVER-- OPIOID
OVERDOSE IS -- CAN BE RECORDED
MULTIPLE WAYS AND THE ANALYSTS
THE GEOSPATIAL ANALYST WILL MAKE
SOME DECISIONS HOW TO DO SO.
THESE ARE OVERALL TRENDS, UP TO
2017, I KNOW WE ARE AWARE OF THE
LEVELING OFF AND SOME OF THE
DECREASE OF THIS BUT YOU CAN SEE
THE RISE OF FENTANYL AND
SYNTHETIC OPIOID IN BLUE LINE
STARTING HERE. THE PUBLIC HEALTH
EMERGENCY DECLARATION FOR OPIOID
OVERDOSE IS PRECEDED COVID
OUTBREAK. THAT MADE FEDERAL
FUNDS AVAILABLE TO STATES FOR
TRACKING. SOME OF THE VALUES
THAT GO UP NOW THERE IS
INCENTIVE FROM UNSPECIFIED
NARCOTIC TO DETERMINE WHETHER
OPIOID OR NO NOT. SOME OF THESE
WILL DRIVE PATTERN. SO WE SEE
PATTERNS OF TYPE OF OPIOID
AVAILABLE HERE, BUT WE ARE ALSO
LOOKING AT HERE IS THE OPIOID
MORTALITY TRENDS PRE-2017 BY
STATE AND TYPE. SO THERE IS 50
GRAY LINES HERE BUT IN ORDER TO
SEE WHAT IS GOING ON THE BLACK
LINE IS THE MEDIAN ACROSS ALL
THE STATES, THE RED LINE IS THE
MEDIAN OF THE TEN STATES WITH
THE HIGHEST OVERDOSE RATES SO WE
CAN SEE HEROINE BEING HIGHER IN
THOSE STATES. AND THE BLUE LINE
IS THE MEDIAN OF TEN STATES WITH
THE LOWEST REPORTED OVERDOSE
RATES. THOSE ARE THE BLUE LINE
WE SEE HERE. SO FOR HEROINE IT
MIGHT BE WHAT WE EXPECT STATES
WITH HIGHEST OVERDOSE HAD HIGHER
HEROINE. METHADONE A LITTLE MORE
MIXED BAG. OTHER SYNTHETIC
NARCOTICS THE HIGHEST OVERDOSE
RATES ALSO FASTERS INCREASE. --
FASTEST INCREASE. UNSPECIFIED
NARCOTICS IS GOING DOWN BUT SOME
REPORTING HAS GONE DOWN AS FEWER
OVERDOSE DEATHS ARE CLASSIFIED
UNSPECIFIED. AND IT IS FITTING
INTO THE CATEGORIES HERE. NOW
WHAT DEATH MIGHT BE HIDDEN? WHAT
AM I REPORTING FILTER AND HOW
THAT MIGHT CHANGE FROM LOCATION
TO LOCATION? OVERDOSES THAT ARE
RECORDED AS A CONTRIBUTORY CAUSE
BUT UNDERLYING CAUSE NOT
OVERDOSE, THIS MIGHT BE THE CAR
ACCIDENT EXAMPLE, THE UNDERLYING
CAUSE WOULD NOT INCLUDE ANY OF
THE X OR Y OVERDOSE CODES
BECAUSE IT IS NOT THE PRIMARY
CAUSE. BUT LIST OF UP TO 20
CONTRIBUTING CAUSES DOES INCLUDE
OVERDOSE. WE MIGHT HAVE
OVERDOSE RECORDED AS PRIMARY
CAUSE OF DEATH BUT CONTRIBUTING
CODE LISTS ONLY UNSPECIFIED
DRUG. SO IT MIGHT NOT COME IN AS
A OPIOID OVERDOSE. SOME
OVERDOSES MAYBE CODED AS OTHER
AND UNSPECIFIED DRUGS. NOT ALL
ARE OPIOID DEATHS BUT SOME MAY
BE SO CHRISTOPHER DID NICE WORK
ON THIS, CONTINUES TO DO NICE
WORK ON THIS. AND WHAT PATTERNS
HOW DOES THIS VARY
GEOGRAPHICALLY? SO I HAVE A
SLIDE THE GRAPH ON THE LEFT HAS
THE OVERDOSE WITH OPIOID
CONTRIBUTING AND THEN OVERDOSE
IS CONTRIBUTING. THE COMBINATION
BY STATE, MAP ON THE RIGHT HAS
THE 50 STATES LISTED AND THEN
THE BLUE REMEMBER IS THE LOWEST
OVERALL OVERDOSES BUT THOSE ARE
THE HIGHEST NUMBER OF DEATHS
THAT ARE POTENTIALLY MISSING. SO
WHAT I'M PLOTTING ON THE Y AXIS
HERE IS HOW MANY DEATHS FELL
INTO THE CATEGORY OF POTENTIALLY
MISSING OVERDOSE OPIOID
OVERDOSE? AND IN SOME OF THE
STATES WITH LOWEST TOTAL
OVERDOSES SO IT IS AN EXAMPLE
THAT THERE MAYBE MORE HIDDEN
VALUES THERE, IN THE LOW RATES
THAN HIGH RATES. SO THE RED
LINE IS THE LOWEST. AND I KNOW
THIS IS A -- IT TOOK ME A WHILE
TO GO THROUGH THESE AGAIN, TO BE
ABLE TO EXPLAIN IT BUT WHAT THE
PATTERN WE ARE SEEING IN THIS
PLOT AND IN UNSPECIFIED CASES AS
THE CONTRIBUTING CAUSE, THIS IS
ONE WHERE THE OVERDOSE IS AN
UNSPECIFIED DRUG BUT NOT OPIOID,
AGAIN THE BLUE LINE IS ON THE
TOP. THE ONES WHERE -- THESE ARE
MEDIAN OF TEN STATES OF LOWEST
OVERALL OVERDOSES HAVE
POTENTIALLY HIGHEST NUMBER
FALLING INTO THIS CATEGORY OF
POTENTIALLY HIDDEN DEATHS THAT
MIGHT MERIT CLOSER LOOK. SO
WHAT ARE WE SEE SOMETHING A
COMBINATION OF MORTALITY MA
ATTORNEYS AN REPORTING PATTERNS
THE GEOSPATIAL ANALYSIS IS NOT
JUST MORTALITY OUTCOME BUT THOSE
DIMENSIONS OF MORTALITY IN THE
DEATH RECORDS. STATES WITH THE
LOWER OVERDOSE MORTALITY RATES
HAVE HIGHER NUMBERS OF DEATH AND
POTENTIALLY HIDDEN CATEGORIES
WHICH MAY MEAN THEY HAVE A
HIGHER OVERDOSE MORTALITY RATE
THAN WERE ORIGINALLY SEEING.
THERE IS A FASTER THE RECLINE IN
HIDDEN CATEGORIES IN STATE WITH
HIGHER OVERDOSE MORTALITY RATES,
THESE ARE STATES THAT MAY BE
MOVING NOT MOVING BUT INSTEAD OF
SETTLING FOR AN UNSPECIFIED
OVERDOSE THEY MAY DO THE AUTOPSY
SO TRY TO CATEGORIZE THE DEATH.
SO NEGATIVE CORRELATION BETWEEN
CONTRIBUTING SYNTHETIC OPIOID
CONTRIBUTING TO CAUSE OF DEATH
SYNTHETIC OVERDOSE AND
CONTRIBUTING ONLY OVERDOSE AND
NEGATIVE CORRELATION
CONTRIBUTING SYNTHETIC OPIOID
AND CONTRIBUTING UNSPECIFIED
DRUGS SO THERE'S PATTERNS THAT
SEEM CONSISTENT WITH CHANGES IN
REPORTING THAT HAPPEN AS THE
OVERDOSE NUMBERS GET HIGHER. NOW
WHEN WE TALK SOCIAL DETERMINANTS
OF HEALTH SOMETIMES WE THINK OF
VULNERABILITY INDICES OR
RESILIENCY INDICES OR SOME OTHER
INDICES. TRADITIONALLY
MEASURING ASSOCIATION BETWEEN
OUTCOME AN RISK FACTORS,
VULNERABILITY INDICES LIKE THE
CDC SOCIAL VULNERABILITY INDEX
PULL TOGETHER CENSUS INFORMATION
INTO INDEX AND TRY TO HELP
IDENTIFY VULNERABILITY OR SOCIAL
DETERMINANTS, GET BACK TO ONE
NUMBER OR COVARIANT. AND THE
CLASSIC EXAMPLE OF THIS IS THE
CDC VULNERABILITY INDEX IN SCOTT
COUNTY, INDIANA, WHERE THE
OPIOID INJECTION USE WENT UP AND
RESULTED IN OUTBREAK OF HIV OR
INCREASE RISK FOR HIV.
VULNERABILITY INDICES OFTEN COME
FROM MULTIPLE SOCIO DEMOGRAPHIC
VARIABLES OFTEN FROM CENSUS FINE
COMBINED IN IN PRINCIPLE
COMPONENTS FACTOR ANALYSIS AND
VARIABLE SELECTION AND THE GOAL
FOR IDENTIFYING VULNERABILITY
INDEX IS DIFFERENT FROM TYPICAL
EPIDEMIOLOGY GOALS IN THE
FOLLOWING WAY. RISK FACTOR
SELECTION IN TRADITIONAL
EPIDEMIOLOGY WHEN WE FIRST
STARTED EPIDEMIOLOGY WE ARE
TRYING TO FIGURE WHAT ARE CAUSES
OF DISEASE, RISK FACTOR
ASSOCIATIONS CAN WE MOVE TOWARD
THIS. WITH RESILIENCY FACTORS
MAYBE NOT JUST RISK FACTOR MAYBE
SHOULD BE INTERACTING WITH THE
RISK FACTOR SO WE HAVE SOMETHING
POLICY TO CONTROL BUT MAYBE
OTHER FEATURES IN THE SOCIAL
ENVIRONMENT THAT MAKE THAT WORK
BETTER OR WORSE FROM ONE COUNTY
OR ONE NEIGHBORHOOD TO ANOTHER.
MAYBE CHANGES HOW WELL POLICY
WORKS, MAYBE FACTORS AFFECT --
MODIFY THE AFFECT OF THE POLICY.
MAYBE WE HAVE THE SAME SCALES,
WHAT HAS HAPPENED AT THE SEPSIS
TRACK LEVEL VERSUS THE COUNTY
LEVEL. HOW DO WE ADJUST
VULNERABILITY? SO THERE IS A LOT
OF INTERESTING QUESTIONS HERE,
NOT JUST TREATING VULNERABILITY
INDEX AS A COVARIANT. SO SOCIAL
VULNERABILITY INDEX MEASURES --
THE ONE FROM CDC IS ONE OFTEN
USED WE NEED TO REMEMBER IT IS
INDEX, IT IS A SUMMARY OF OTHER
MEASURES, SO SOCIAL DETERMINANTS
OF HEALTH ARE REAL THINGS BUT
THEY ARE HARD TO MEASURE
DIRECTLY. SO WE ARE TRYING TO
PUT TOGETHER DIFFERENT ASPECTS
AND THE SOCIAL VULNERABILITY
INDEX THAT APPEARS IN A LOT OF
LITERATURE AND WE USE IN OUR
PAPERS AS WELL, 16 SOCIAL
FACTORS INCLUDING POUF SAY, LACK
OF VEHICLE ACCESS THAT CAN HAVE
INFLUENCE ON ACCESS TO
HEALTHCARE. CROWDED HOUSING AND
SO ON, GROUPED INTO FOUR RELATED
THEMES, SOCIOECONOMIC STATUS,
HOUSEHOLD CHARACTERISTICS,
RACIAL ETHNIC MINORITY STATUS
HOUSING TYPE AND TRANSPORTATION.
EACH HAS A SPATIAL PATTERN TO
IT. SO HERE IS AN EXAMPLE, THIS
IS FROM THE CDC WEBSITE, I PUT
THE MAPS OVER THE WORDS,
APOLOGIZE FOR THAT. THIS IS
REPEATING THE FOUR CATEGORIES
WHICH YOU CAN SEE ON THE RIGHT.
AND THE MAP ON THE OVERALL OPT
LEFT, FULTON COUNTY, GEORGIA,
CITY OF ATLANTA. AND YOU CAN SEE
THE COUNTY LINES ARE THICK IN
THE CENSUS TRACKS ARE THE SMALL
AREAS. SO THERE ARE DIFFERENT
SPATIAL PATTERNS AND
CARDIOGRAPHICLY I LIKE THE
DIFFERENT COLOR SCHEME FOR EACH
FOUR SO YOU CAN TELL THEM APART
BUT YOU SEE A PATTERN
SOCIOECONOMIC STATUS ON THE
HIGHEST FOLLOWS THE DARKER CASH
FLOWS. THEN -- COLORS.
HOUSEHOLD CHARACTERISTICS IS
SIMILAR BUT NOT THE SAME. RACIAL
AND ETHNIC MINORITY STATUS AND A
LOT OF U.S. CITIES HAVE THIS,
ATLANTA IS NO EXCEPTION, IN FACT
MAYBE STRONGER, YOU SEE THE
NORTH, SOUTH, SPLIT, I 20 RUNS
THROUGH HERE AND YOU HAVE
HISTORICALLY BLACK COMMUNITY IN
THE SOUTH AND HISTORICALLY WHITE
COMMUNITY IN -- AND A GROWING
HISPANIC COMMUNITY IN THE PURPLE
CLOUDCLOUD. HEN WE HAVE HOUSINE
APPROXIMATE TRANSPORTATION WHICH
IS RED OUT. THE FOUR LAYERS GO
TOGETHER AND MAKE THE SOCIAL
VULNERABILITY INDEX WHICH HAS
PATTERN TO IT, YOU CAN SEE THE
SOCIALIBILITY INDEX FOLLOW IT IS
ROADS BECAUSE OF THE
TRANSPORTATION TYPE. BUT THIS
COMBINATION OF MULTIPLE THINGS
GOING ON, AND ONE NEIGHBOR.
THERE IS A GEOSPATIAL TA PATTERN
TO IT AN IT IS DIFFERENT OR
DIFFERS BETWEEN THE FOUR
CATEGORIES SO THERE'S DEEP
THINKING TO GO ON THAT WOULD BE
REALLY HELPFUL AND I LOOK
FORWARD TO FOLLOWING
THERE IS A NICE INTERACTIVE MAP
FOR THOSE WHO HAVEN'T USED IT ON
THE CDC.
SEARCH ON CDC SOCIAL
VULNERABILITY INDEX.
WHERE I GOT THE IMAGES.
DOWNLOAD THE DATA AT THE CENSUS
TRACK AND COUNTY LEVEL AND WATCH
THE SOCIAL YOU WILL HAVE --
VULNERABILITY.
THE CDC SOCIAL VULNERABILITY
INDEX IS THE ONE AND ONLY?
IT IS NOT.
S AS I SAID YOU ARE MEASURING AN
IMPORTANT BUT ONE MEASURABLE
QUANTITY FEE WITH WHAT YOU HAVE
AVAILABLE.
IN A SENSE WHAT DATA IS
AVAILABLE AND CREATE AN INDEX
AND CONSIDER WHAT IS THE BETTER
INDEX AND GO AROUND.
IT IS IMPORTANT TO EPIDEMIOLOGY.
AND I WANT TO HIGHLIGHT THIS
PAPER BY RICKLES AT ALL.
TENNESSEE WAS LOOKING FOR AN
INSTATE FOR HIV, HEPATITIS C AND
OPIOID MISUSE.
THEY FOUND THE SOSOCIAL VULNERA
HELPFUL AND THEY HAD A OUTLINE
OF USING PRINCIPAL COMPONENTS,
MACHINE LEARNING ASPECTS TO
IDENTIFY COMPONENTS AND THEN
THINNING THE LIST DOWN AND
LOOKING AT THOSE ONE AT A TIME.
I THINK NOT SO MUCH WHAT THE
INDEX IS BUT WHERE IT CAME FROM
AND IT IS IMPORTANT TO KNOW WHAT
WE ARE USING AND NOT JUST A
NUMBER AND NOT JUST A
NEIGHBORHOOD.
WHY MIGHT YOU DEVELOP YOUR OWN?
I AM NOT SAYING THAT EVERYBODY
NEED TO DO THEIRS FROM SCRATCH,
THE BENEFIT OF USING A INDEX
VALUE IS COMPARABILITY BETWEEN
THINGS, BETWEEN STUDIES IN
DIFFERENT STATES, SAY, BUT
TENNESSEE FOUND -- THE TENNESSEE
DEPARTMENT OF HEALTH FOUND IT
WASN'T AS HELPFUL FOR THEM AS
CUSTOMIZING IT TO THEIR OWN.
WE NEED TO TRADE OFF WHAT IS
HELPFUL AND WHAT YOU ARE USING
FOR.
AND BE SURE TO DOCUMENT IT SO IT
IS REPRODUCIBLE AND PEOPLE
UNDERSTAND WHAT CHOICES YOU
MADE. SO EARLIER INDICES, YOU
HAD A FEW VARIABLES AND YOU USED
THE SAME WEIGHTS FOR A LOT OF
APPLICATIONS.
NOW WE HAVE A MORE PIPELINE-TYPE
WORLD WHERE WE CAN ACCESS MANY
VARIABLES AND TELL PEOPLE HOW TO
USE THEM IF WE MADE ANY
CUSTOMIZATION AND CALCULATIONS.
SO THE LAST COUPLE OF MINUTES
HERE JUST TO SUMMARIZE.
WE HAVE QUESTIONS WE WANT TO
ANSWER.
THERE IS A SET OF DATA YOU WOULD
NEED TO ANSWER THAT PERFECTLY.
AND MOST OF THAT YOU PROBABLY
CAN'T GET.
BUT THERE IS A SET OF DATA AND
LOTS OF SETS OF DATA AND
GEOSPATIAL DATA THAT YOU CAN GET
THAT GIVES US PICTURE AND IMAGES
OF IT.
NOT TO JUST ANSWER OUR QUESTION
BUT HELP US REFINE THE QUESTION,
GET SUPPLEMENTAL DATA.
FIND OTHER SOURCES OF DATA TO
FILL IN THE GAPS.
IDENTIFYING THE QUESTIONS WE
CAN'T ANSWER FROM THE DATA WE
CAN GET AND THEN CAREFULLY
THINKING HOW CLOSE ARE THE
QUESTIONS WE CAN ANSWER TO THE
QUESTIONS WE WANT TO ANSWER.
I WANT US TO REMEMBER THAT THE
PATTERNS WE OBSERVE IN
GEOSPATIAL DATA ANALYSIS ARE
ECHOS OF WHAT IS REALLY
HAPPENING, THE PATTERN OF
OBSERVATION AND PATTERN OF
REPORTING THAT WENT INTO
OBSERVATION.
THERE IS A TRUE MAP WE DON'T GET
TO SEE THAT GETS FILTERED
THROUGH.
THE BETTER WE UNDERSTAND THOSE
FILTERS AND DRIVERS OF THOSE
FILTERS THE BETTER WE CAN GET
PICTURE OF THAT TRUE UNDERLYING
MAP.
LEARN TO SEE THE ECHOS OF THE
REPORTING PROCESS.
MEASURE THEM AND ADJUST ADJUST.
THINGS TO THINK OF IN AGREE GEE
CONTEXT.
CAN WE LEARN TO SEE THE FACTOR
THAT ARE ECHOS THESE.
WE ARE THINKING OF A
EPIDEMIOLOGY OF REPORTING AND
NOT AS GAM RUSS AS THE FINAL
HEALTH OUTCOME BUT MAY BE USEFUL
FOR THE FINAL HEALTH INCOME TO
BE MORE PRECISE.
I WANT TO THANK YOU FOR YOUR
TIME.
I MENTIONED THE CDC GUIDANCE.
PAPER BY RICKLES.
CHRISTOPHER RUM'S PAPER AND
THE VIN DIAGRAM I HAVE OF
BUILDING THE ANALYTICAL TOOLBOX
FOR GEOSPATIAL DATA.
THANK YOU SO MUCH FOR YOUR TIME.
>> THANK YOU, DR. WALLER.
THAT WAS VERY INFORMATIVE.
I LOOK FORWARD TO THE DISCUSSION
PERIOD WHERE WE CAN DIG IN
FURTHER.
NOW HAND THE DIGITAL PODIUM OVER
TO DR. STOP CA.
>>Tom Stopka: THANK YOU VERY
MUCH, DR.VAN VOOHHEES.
LOOKING FORWARD TO TALK TO YOU
OF GEOSPATIAL DATA AND
PARTICULARLY LOOKING AT THROUGH
A PREVENTION LENS.
SLIDES.
HERE WE GO. SO I WILL GO OVER
SOME CONCEPTS RELATED TO
GEOSPATIAL EPIDEMIOLOGY, AND WE
WILL LOOK AT A NUMBER OF
APPLICATIONS OF GEOSPATIAL
EPIDEMIOLOGY IN PREVENTION WORK,
RIGHT, IN IDENTIFYING AND
CHARACTERIZING THE RISK
LANDSCAPE AND ASSESSING ACCESS
TO SERVICES AND RESOURCE
ALLOCATIONS AND SOCIAL
DETERMINANCE AND MONITORING
INTERVENTIONS AND CHANGE AND
CONDUCTING PREDICTIVE ANALYTICS
AND SIMULATION MODELING.
I WILL DO THROUGH NIH FUNDED
STUDY.
GREATLE FOR NIDA FOR FUNDED
STUDY BUT FOCUS ON RURAL
INITIATIVE IN NEW ENGLAND.
PREDICT TO PREVENT OVERSHOWN
STUDY AND PORTIONS OF THE
EPIDEMIOLOGY STUDY IN
MASSACHUSETTS.
WHEN I PRESENT ON OVERDOSE AND
RELATED SENSITIVE OUTCOMES, I
WOULD LIKE TO BE SURE TO
ACKNOWLEDGE THAT THE SYMBOLS
THAT WE SHARE ON OUR MAPS
REPRESENT MUCH MORE THAN DATA.
RIGHT.
THEY REPRESENT LIVES LOST.
AND WITH RESPECT TO THE
CONFIDENTIALITY FOR FAMILY
MEMBERS AND NEIGHBORS WHO HAVE
LOST PEOPLE WHO HAVE PASSED ON,
THESE MAPS THAT I SHOW TODAY
MASK THE GEOLOCATIONS OR THE
EXACT LOCATIONS OF DECEASED
RESIDENCES.
I TRY TO ENCOURAGE MY STUDENTS
TO BE THE PAUL REVERE OF PUBLIC
HEALTH, BRINGING IMPORTANT
INFORMATION TO KEY STAKEHOLDERS.
AND I POSE THIS QUESTION TO YOU.
CAN SPATIAL ANALYSIS AND FORM
HELP WITH DISEASE PREVENTION?
WE VISIT THAT AS WE MOVE
FORWARD.
GEOSPATIAL DATA IS DESCRIPTION
AND OF DISEASE AND TAKES INTO
CONSIDERATION THAT PLACE
MATTERS.
THAT WHERE WE ARE BORN.
WHERE WE LIVE.
WHERE WE WORK.
WHERE WE GO TO SCHOOL.
WHERE WE PLAY AND RECREATE AND
PLAY AND COMMUTE CAN HAVE ALL
IMPORTANT IMPACTS ON OUR HEALTH
BY EITHER EXPOSING US IN RISK
FACTORS THAT CAN INCREASE OUR
RISK FOR SPECIFIC HEALTH
OUTCOMES OR INFLUENCE ACCESS TO
SERVICE THAT CAN DECREASE RISK.
THROUGH SPATIAL EPIDEMIOLOGY WE
CAN TEASE APART THESE
RELATIONSHIPS.
UPWARDS OF 85% OF SPATIAL DATA
HAS A SPATIAL COMPONENT TO THEM.
WHEN I THINK OF GI CIRCUMSTANCES
AND SPATIAL ANALYTIC APPROACHES
AND PREVENTION, I THINK OF THREE
LARGE DOMAINS: MASK DESCRIPTIVE
AND RISK MAPPING.
VARIABLES THAT WE CAN USE FOR
OUR STATISTICAL MODELS.
THEN WHEN IT STARTS TO GET
REALLY ONE, THE GUY YO
STATISTICAL AN ALL RIGHTICS AND
EPIDEMIOLOGY ANALYSES AND
EXPLORATORY DATA ANALYSES
OR ESDA EXPANDS THIS AS WELL.
DIG IN MORE IN DEPTH OF
APPLICATIONS OF IDENTIFYING AND
CHARACTERIZING THE RISK
LANDSCAPE AND HOT SPOTS.
A FEW YEARS AGO WE FOCUSED ON
IDENTIFYING AND CHARACTERIZING
HEPATITISC IN MASSACHUSETTS WITH
THE MASSACHUSETTS DEPARTMENT OF
PUBLIC HEALTH THROUGH SPATIAL
EPIDEMIOLOGY APPROACH.
WE DEVELOPED DESCRIPTIVE MAPS
AND DELVED INTO IDENTIFYING HOT
SPOTS FOR CALCULATIONS AND
SPACE-TIME CLUSTER ANALYSES AS
WELL TO UNDERSTAND WHERE AND
WHEN HEP C MORTALITY WAS
CLUSTERING ACROSS MASSACHUSETTS.
WE IDENTIFIED NINE HCV MORTALITY
CLUSTERS.
OUR HOT SPOTS THROUGH
STATISTICAL ANALYSES WERE FOUND
TO BE POSITIVELY ASSOCIATED WITH
THE PERCENTAGE OF THE POPULATION
THAT IS HISPANIC, PERCENTAGE OF
HOUSEHOLDS RECEIVING FOOD STANT,
STAMPS.
AND AT SPOTS WERE NEGATIVE OF
THE POPULATION THAT ARE HIGH
SCHOOL GRADUATES OR HIGHER OR
OTHER RACIAL AND ETHNIC
CATEGORIES.
MORE RECENTLY COLLEAGUES IN
RHODE ISLAND HAVE LOOKED AT
CHARACTERIZING OPIOID OVERDOSE
HOT SPOTS FOR BASED PREVENTION
AND TREATMENT INTERVENTION.
THEY IDENTIFIED SEVEN NONFATAL
THREE FATAL OVERDOSE HOT SPOTS
ACROSS RHODE ISLAND AND THEY HAD
HIGHER PROPORTION OF BLACK AND
LATIN X, RENT OR OCCUPIED,
VACANT HOUSING, UNEMPLOYMENT AND
COST-BURDENED HOUSE POELDZ.
NO
-- HOUSEHOLDS.
THEY FOUND INTERESTINGLY, HIGHER
PROPORTIONS OF HOT SPOT
NEIGHBORHOODS THAT HAD A
RELIGIOUS ORGANIZATION, A HEALTH
CENTER OR POLICE STATION, RIGHT.
THESE COULD BE LOCATIONS WHERE
INTERVENTIONS COULD BE
IMPLEMENTED AND ENHANCED TO HELP
TO COMBAT OVERDOSE RISKS.
LET'S PIVOT TO LOOK AT ASSESSING
ACCESS TO SERVICES AND RESOURCE
ALLOCATI
ALLOCATIONS AND SOME EXAMPLES.
MULTIPLE OF ACCESSIBILITY.
A FEW.
EUCLIDIAN DISTANCES, BUFFER
ZONES, DRIVE AND WALK TIME
ANALYSES, ENHANCED TWO OR THREE
FLOATING CATCHMENT ANALYSES.
RISK TERRAINAL MALL IN CEASE.
LOCATION AND ALLOCATION
ANALYS
ANALYSES. WE ARE NOT ASCERTAIN
ACCESS TO KEY PUBLIC HEALTH
SERVICES.
PHARMACY IN SAN FRANCISCO
SHOWING SYRINGES OVER THE
COUNTER AND IDENTIFYING
NEIGHBORHOODS BECAUSE OF THE
EXISTENCE OF THOSE PHARMACIES
THAT HAVE STERILE SYRINGES WERE
MORE DISTANT, OF HUNTER MARKET
BAY AREA NEIGHBORHOODS THAT HAVE
HIGH HIV RISKS OF PEOPLE THAT
ADO DRUGS.
AND CATCHMENT AREAS.
ONE OF THE FIRST STUDIES IN
MASSACHUSETTS ABOUT TEN YEARS
AGO.
I WAS WORKING WITH THE THEN FIVE
EXISTING SYRINGE SERVICE
PROGRAMS ACROSS THE STATE THAT
ARE NOW, THANKFULLY MORE THAN
65.
BUT WE COULD LOOK AT THE GEO
LOCATION, RIGHT. THE ZIP CODE OF
RESIDENTS OF THE CLIENTS GOING
TO THE SYRINGE SERVICE PROGRAM.
NOTICE THE DISTANCE TRAVEL TO
ACCESS SERVICES TO REDUCE
HEPATITIS C.
AND WESTERN MASSACHUSETTS AND
HIGHLY RULE AREAS IN THE
BERKSHIRES, PEOPLE TRAVELING
QUITE SOME BUSINESS TO GET TO
NORTHHAMPTON AND HOLYOKE.
OF COURSE, WE CAN MAP THE
GEOLOCATIONS OF TREATMENT
CENTERS.
MORE TALKS ON THIS, BUT WET YOUR
APPETITE, METHADONE TREATMENT
PROGRAMS AND CALCULATE DRIVE
TIMES AND WALK TIMES BASED ON
NETWORKS TO THOSE LOCATIONS AND
WITH THE BUREAU AND THE
MASSACHUSETTS DEPARTMENT OF
PUBLIC HEALTH.
IN THE REPORT FOR, GOVERN
GOVERNOR HEALY.
ONLY 15% LIVED WITHIN A MARK OF
THE OPT.
WE CAN OVERLAY THIS DEE SEND
INCIDENT DATA BY RACE AND
ETHNICITY.
AND IN DOING SO, WE FOUND THAT
ONLY 9% OF DECEDENTS LIVED
WITHIN 15-MINUTE WALKING TIME TO
A ODP ACROSS MASSACHUSETTS.
WE LOOKED COMPREHENSIVELY ACROSS
ALL OF OUR ANALYSES, 90% LIVED
WITHIN 0-MINUTE DRIVE TIME.
80% LIVED WITHIN A 15 MINUTE
DRIVE TIME AT THE TIME OF THEIR
FATAL OVERDOSE.
2% OF DECEDENTS LIVED WITHIN A
30-MINUTE WALK AND ONLY 9% OF
15-MINUTE WALK OF A ODP.
ACCESS IS OKAY, RIGHT, IF YOU
HAVE A CAR OR ACCESS TO A RIDE
FROM A FRIEND.
BUT THINK OF STILL DRIVING 15
MINUTES TO ARE 30 MINUTES EACH
WAY TO GET TO YOUR SERVICES.
ANTI-HYPER TEN SIEVE REDS.
IF WE HAD TO DO THAT EVERY DAY,
WHAT WOULD THAT DO FOR THE
CONTINUITY OF TREATMENT OVER
TIME.
WE ALSO HAVE BEEN ABLE TO LOOK
AT TWO-STAGE FLOATING CATCHMENT
DATA ANALYSES AND THAT ALLOWS US
TO CALCULATE ACCESSIBILITY
THROUGH A COUPLE OF STEPS.
TO ASSESS THE TO PORTION OF
SERVICES, LET'S SAY TREATMENT
PROVIDERS TO THE POPULATION IN
NEED WITHIN THE DESIGNATED
SEARCH AREA.
WE LOOK AT SERVICEABILITY WITHIN
THAT 30-MINUTE DRIVE TIME AND A
MEAN TIME TO COMMUTING TO WORK
IN MASSACHUSETTS.
AND WHEN WE DO THIS PROCESS, I
WILL GO INTO DETAIL -- I WILL
GIVE YOU A VISUAL OF THIS IN A
BIT.
LOCATION, ALLOCATION IS ANOTHER
TOOL THAT WE EMPLOY TO ASSESS
WHETHER EXISTING SERVICES, GREEN
SQUARES, REPRESENT EXISTING ODPs
IN THE GREATER BOSTON AREA.
WE CAN WEIGHT THESE ANALYSES IN
THE MODELS BASED ON DECEDENT
DATA OR NONFATAL OVERDOSE DATA
AND LOCATIONS WHERE THERE IS
UNMET NEED IN TERMS OF TREATMENT
AND WHERE NEW ODPs CAN BE PLACED
MOVING FORWARD.
IN ASSESSING SOCIAL DETERMINANTS
OF HEALTH, DR. WALLER WENT INTO
GREAT DETAIL OF THE SOCIAL
VULNERABILITY INDEX.
I WON'T DESCRIBE WHAT IT IS,
BECAUSE HE JUST DID THAT.
IN SOME WORK THAT WE DID AT THE
EARLY STAGES OF THE COVID
PANDEMIC, WE AIM TO SEE WHERE
COVID-19 TESTING WAS TAKEN PLACE
IN MASSACHUSETTS.
ZIP CODE ON THE LEFT.
AND BOSTON NEIGHBORHOODS ON THE
RIGHT.
WE JUXTAPOSED THE LOCATION OF
TREATMENT CENTERS WITH THE
SOCIAL VULNERABILITY INDIANA
DECKS.
THE THEMATIC COLORS THAT YOU SEE
AND WAS ABLE TO DETERMINE UNMET
NEEDS AND SOCIAL AND
VULNERABILITY COMMUNITIES HAD
LIMITED ACCESS IN MANY PARTS OF
THE STATE TO TESTING.
IN MONITORING INTERVENTIONS AND
CHANGE, GEOSPATIAL DATA AND
EPIDEMIOLOGY ANALYSIS CAN HELP
WITH PREVENTION EFFORTS.
WE ARE LOOKING THE AUTO HOLYOKE,
MASSACHUSETTS IN WESTERN
MASSACHUSETTS ON I-91.
LOWER LEFT PORTION OF THE MAP,
YOU WILL SEE A GREEN SQUARE.
THAT WAS THE INITIAL ODP
AVAILABLE IN MASSACHUSETTS
SEVERAL YEARS AGO.
AND IN HOLYOKE SEVERAL YEARS
AGO.
AND QUITE DISTANT FROM THE
CENTRAL LOCATION WHERE THERE IS
MORE DENSE POPULATION.
AND AS A RESULT, MORE DENSELY
PACKED OVERDOSES.
FATAL OVERDOSES.
A NEW ODP, THIS PURPLE SQUARE
WAS IDENTIFIED AND PLACED BASED
ON LOCAL DATA IN A VERY
HIGH-RISK AREA.
WHAT THAT DOES IN TERMS OF DRIVE
TIME ACCESS IN THE LEFT.
WALK TIME ACCESS IN THE UPPER
RIGHT, FIVE-MINUTE, TEN-MINUTE,
15-MINUTE DRIVE TIME TO
COMMUNITIES -- OR FROM
COMMUNITIES OF RESIDENCE NEARBY
GREATLY IMPROVED ACCESS.
THE PURPLE LINES AND DOTS ON
THIS MAP REPRESENT BUS STOPS AND
BUS LINES.
AND THERE ARE SEVERAL BUS STOPS
THAT PASS THROUGH THE NEW ODP.
SO IN GENERAL, WE ARE NOW
DIGGING INTO THIS DATA IN MORE
DETAIL TO DETERMINE WHAT THE
IMPACTS HAVE BEEN ON OVERDOSE.
I AM GOING TO GO IT IN DETAIL IN
MY TALKS OF PREDICTIVE ANALYTICS
AND HOW GEOSPATIAL DATA CAN COME
INTO PLAY, BUT LET'S JUMP INTO
SOME OF THE APPLICATIONS ON SOME
OF OUR NIDA FUNDED STUDIES.
I WILL START BY MOBILE TELE
MEDICINE BASED TREATMENT OF
CHRONIC HEPATITIS C OF PEOPLE
WHO INJECT DRUGS IN NORTHERN
RURAL NEW ENGLAND.
AND WE WERE ONE OF EIGHT SITES
ACROSS THE U.S. THAT WERE PART
OF THE RURAL NEW ENGLAND
INITIATIVE NETWORK.
WE WERE FOCUSING IN THE
NORTHEAST ON MASSACHUSETTS,
VERMONT AND NEW HAMPSHIRE.
11 COUNTIES ALONG THE I- I-91 A
THE CONNECTICUT RIVER.
AND BEFORE WE STARTED OUR
INTERVENTION, WE WERE CONDUCTING
MIXED METHOD AKROECHS OF
EPIDEMIOLOGY POLICY AND LEGAL
ENVIRONMENTAL SCANS.
AND WE WORKED WITH STATE
EPIDEMIOLOGISTS AND WAS ABLE TO
COMPILE SURVEILLANCE DATA TO
IDENTIFY RISKS AS IT RELATES TO
FATAL OVERDOSES, HEPATITIS C
PREVALENCE, AND PEOPLE LIVING
WITH HIV/AIDS.
WE LOOKED AT SOCIOECONOMIC
INEQUITIES IN TERMS OF INCOME,
UNEMPLOYMENT AND UNINSURED
RATES.
AND LOOKED AT ACCESSIBILITY TO
SYRINGE SERVICE PROGRAMS, FIRST
WITH EUCLIDIAN DISTANCES AND
THEN THE SERVICE ENVIRONMENT
THROUGH DRIVE-TIME ANALYSIS
BASED ON STREET NETWORKS AND
ASSESS ACCESS TO SERVICES BASED
ON DRIVE TIMES TO CERTAIN
SERVICE PROGRAMS ON THE LEFT,
DRUG TREATMENT PROGRAMS IN THE
MIDDLE AND NALOXONE IN THE
RIGHT-HAND SIDE.
WHERE YOU SEE THE BROWN SHADING
ON THE MAPS, THAT IS WHERE THE
DRIVE TIME TO THOSE SERVICES WAS
30 MINUTES EACH WAY.
ONE MORE.
WHEN WE TRIANGULATED THE SPATIAL
DATA WITH OUR QUALITATIVE
IN-DEPTH DATA AND SURVEYS WITH
600 PEOPLE WHO USED DRUGS ACROSS
NORTHERN NEW ENGLAND, WE
IDENTIFIED HIGH HCV POSITIVITY
RATES AND HIGH LEVELS OF SHARING
PARTICULARLY IN NEW HAMPSHIRE.
AND OVERALL, LIMITED ACCESS TO
INJECTION EQUIPMENT AND
HEPATITIS C TESTING AND
TREATMENT, RISK FOR HIV
OUTBREAKS OF THE LACK OF HARM
REDUCTION SERVICES AND REUSE OF
SYRINGES THAT WERE HAVING IN
HIGH HCV RATES.
THAT HELPED TO INFORM THE
LOCATION AND THE FOCUS OF OUR
INTERVENTION, THE UH-3 PHASE,
THE FUNDING, WHERE WE REALLY
DEVELOPED A RANDOMIZED CONTROL
TRIAL AND IMPLEMENTED IT TO
EVALUATE MOBILE TELEMEDICINE
CARE WITH SERVICES AND ENHANCED
USUAL CARE THAT INCLUDED
REFERRAL AND CARE NAVIGATION TO
A LOCAL ORIGINAL PROVIDER.
SKIPPING TO -- JUMPING TO THE
KEY OUTCOMES.
THROUGH OUR STUDY, WE IDENTIFIED
SEVEN-FOLD INCREASE.
DIRECT ANTI-VIRAL INITIATION
AMONG PEOPLE WITH OUR MOBILE
TELEMEDICINE GROUP COMPARED TO
ENHANCED REGIONAL CARE.
FOURFOLD INCREASED ODDS OF
CLEARANCE IN BUY LOG CAL
RESPONSE.
WE DID NOT RECOGNIZE ANY
DIFFERENCE BETWEEN OUR GROUPS
ENSURING SHARING PRACTICES AT
FOLLOW-UP.
YOU HAVE ALL HEARD OF THE
COMMUNITIES STUDIES AND MAIN
OUTCOMES.
WE HAVE CONDUCTED OUR SPATIAL
EPIDEMIOLOGICAL AND OVERDOSE
PREVENTION ANALYSIS HERE AT
TUFTS FOR OUR MASSACHUSETTS
SITE.
IN COLLABORATION WITH THE
OTHER HCS SITES.
THE MASSACHUSETTS HEALING
COMMUNITY STUDIES SITES, WAVE
ONE AND WAVE TWO, URBAN AND
RURAL.
AND WE HAD AN OPPORTUNITY TO
LOOK AT RELATIONSHIPS BETWEEN
PLACES OF RESIDENCE, INJURY AND
DEATH THROUGH SPATIAL AND
STATISTICAL ANALYSIS OF FATAL
OPIOID OVERDOSES.
APPLIED RISK MAPPING OF
ANALYTICS TO INFORM OVERDOSE
INTERVENTIONS AND WE SHARE THESE
RESULTS OVER THE COURSE OF THE
STUDY THROUGH THE COMMISSION.
WAVE ONE AND WAVE TWO.
WE HAVE ACCESS TO PRESCRIBERS
FOR MORPHINE.
AND TO ASSESS OPPORTUNITIES TO
OPTIMIZE HARM REDUCTION SERVICES
IN THIS WORK FOCUSED ON OVERDOSE
EDUCATION, NALOXONE DISTRIBUTION
THROUGH LOCATION ANALYSES.
LET'S DIG INTO IT A BIT MORE
DEPTH.
THIS WORK WAS LED BY MY
COLLEAGUE JENNIFER PUTZ AT
TUFTS.
WAS ABLE TO LOOK AT DESCRIPTIVE
MAPPING BUT THE CLUSTER
ANALYSES.
AND SOME LOCAL INDICATORS OF
SPATIAL ASSOCIATION TO IDENTIFY
CLUSTERS OF OVERDOSES OCCURRING,
PARTICULARLY OF NOTE IN NORTH
CENTRAL MASSACHUSETTS.
THAT IS THE FITCHBURG AREA.
SOUTHEASTERN MASSACHUSETTS, THE
UPPER CAPE -- OR KEEP C-- CAPE
COD AREA.
WE HAVE MODELS FOR GEOSPATIAL
DATA MODELS THAT DETERMINE THE
ASSOCIATION BETWEEN OVERDOSE AND
THE NUMBER OF CO-VAR RANTS
ACROSS THE STATE.
IN THESE ANALYSES, WE IDENTIFIED
OLDER INDIVIDUALS.
WERE MORE LIKELY TO OVERDOSE IN
THEIR OWN HOME IN WESTERN AND
CENTRAL MASSACHUSETTS AND
EASTERN MASSACHUSETTS.
SIMILARLY WE FOUND THAT HISP
HISPANIC DESCEDENTS WAS LESS
LIKELY TO OVERDOSE THAN IN
WORCESTER AND BOSTON MASS AND
THE EAST.
IMPLICATIONS IN TERMS OF THOR.
>> VENTUALS NEEDED WITHIN
COMMUNITIES AND HOW THEY MIGHT
VARY GEOGRAPHICALLY ACROSS THE
STATE BASED ON SPATIAL DATA.
LET'S LOOK NOR CLOSELY AT OU
OUR BUFOMORPHINE INDEX.
KUDOS TO MY COLLEAGUE WHO
IDENTIFIED IN VISUALIZATION.
LET'S PRESENT THESE ARE CENSUS
TRACTS AS ADMINISTRATIVE
BOUNDARY.
WITHIN THEM, WE CAN LOOK AT THE
LOCATI
LOCATIONS OF SERVICE PROVIDERS
IN GREEN, POPULATION IN RED.
AND AROUND NOSE, WE CAN LOOK AT
THE SERVICE CATCHMENT AREA,
POPULATION CATCHMENT.
TWO-STAGE FLOATING CATCHMENT
ANALYSES THAT TAKES INTO
ASSOCIATION THE SERVICE
PROVIDERS, THOSE WHO MIGHT AVAIL
THEY BELIEVE SELVES OF THE
SERVICES AND THE SERVICE
CATCHMENT AREA 30-MINUTE DRIVE
TIME.
AGAIN A FEEL FOR GENERAL OR MORE
IMPROVED ACCESS TO BUFO MORPHINE
PROVIDERS.
WE ARE GOING BEYOND I DID
STANCES, TWO, FIVE ARE, OR
TEN-MILE BUFFER ZONES.
GOING BEYOND ANALYSES THAT ARE
HELPFUL.
BUT MOVING ON TO AN OF DIFFERENT
AREAS OF THE STATE OF THE HIGH
AND LOW ACCESSIBILITY AND CAN
HELP WITH OVERDOSE AND WHERE
MORE PROVIDERS ARE NEEDED.
FINALLY, I WILL TALK ABOUT OUR
PREDICT TO PREVENT STUDY WHERE
WE FOCUS ON DYNAMICS OF ANALYSES
OF OPIOID OVERDOSE TO GUIDE
PREEMPTIVE PUBLIC HEALTH
RESPONSES.
WHAT DO I MEAN?
THINK OF WHAT METEOROLOGISTS DO
REGULARLY DURING THE SUMMER
MONTHS, RIGHT.
PREDICTING WHERE FUTURE
HURRICANES.
THEY DEVELOP SPATIAL TEMPORAL
MODELS BASED ON A WEALTH OF DATA
AND ABLE TO DETERMINE WHEN AND
IF A HURRICANE WILL HIT AND HELP
INFORM DECISION-MAKING ON THE
LOCAL LEVEL.
WHO NEEDS TO GET TO THE GROCERY
STORE BEFORE IT SHUTS DOWN.
PEOPLE NEED TO BAT DOWN THE
HATCHES, IF YOU WILL, TO OR
EVACUATE THEIR HOME TO HIGHER
YOURPD.
WE WANT -- GROUND.
HE WANT TO DO THE SAME OPIOID
OVERDOSE.
THIS IS WORK THAT I AM
CO-LEADING WITH MY COLLEAGUE,
DR. CC POWER.
A STELLAR INVESTIGATIVE TIME
FROM TUFTS, UMASS LOWELL.
AND THE MASSACHUSETTS DEPARTMENT
OF PUBLIC HEALTH AND KEEN ON
COMMUNITY ENGAGED RESOURCE.
YES THIS IS SECONDARY ANALYSIS
OF EXIST CAN DATA.
WE SAY THAT COMMUNITY ENGAGED
RESEARCH IS PARAMOUNT IN ORDER
TO ENSURE THAT OUR MODEL INPUTS
ARE RIGHT.
OUR MODEL OUTPUTS ARE CORRECTLY
INTERPRETED.
AND THAT THE DATA ULTIMATELY CAN
HELP TO INFORM DECISION MAKING.
AND OUR CAB INCLUDES PEOPLE WHO
WORK AT LOCAL HEALTH
DEPARTMENTS, HEALTH AGENCIES AND
PEOPLE WITH LIVED EXPERIENCES.
WE USE THE SOCIAL ECOLOGICAL
MODEL TO INFORM OUR ANALYSES,
THICK OF THE MULTIPLE LEVELS OF
FACTORS THAT CAN IMPACT RISKS
RELATED TO OVERDOSE.
WE HAVE AGREE OPPORTUNITY HERE
IN MASSACHUSETTS TO WORK WITH
THE PUBLIC HEALTH DATA
WAREHOUSE.
THIS IS CREATED BY THE
MASSACHUSETTS DEPARTMENT OF
PUBLIC HEALTH.
IT INCLUDES AS ITS SPINE, ALL
PAIR CLAIMS DATA AND A WEALTH OF
PUBLIC HEALTH, PUBLIC SAFETY,
CRIMINAL, LEGAL, HEALTH CARE,
COMMUNITY-LEVEL DATA THAT LET'S
US LOOK AT THE VIRTUAL CENSUS OF
THE MASSACHUSETTS POPULATION AND
THEIR RISKS AS IT RELATES TO
OVERDOSE.
WE CAN EMPLOY SPATIAL AND
TEMPORAL MODELING AND TAKING
STEPS TO DEVELOP THESE MODELS
AND A LIKELY OF FUNCTIONS TO
CALCULATE DISTRIBUTIONS
INCLUDING TIME IN GEE YAFK AREA
AND ADDITIONAL INFORMATION OF
SOUTHBOUNDING AREAS AND
CONTINUING TIMES AND OU
OUR BAYESIAN SPATIOTEMPORAL WILL
HAVE EFFECTS AND CORRELATION,
TIME EFFECTS.
TIME DURING CO-VARIANTS AND
SPACE-TIME INTERACTION EFFECTS.
ONE OF THE EARLY STUDIES FOR OUR
TEAM.
WE LOOKED AT OVERDOSE DATA ABOUT
15 TO 20 YEARS OF DATA ACROSS
MASSACHUSETTS ZIP CODES.
AND WE TRAINED OUR PREDICTIVE
MODEL ON ABOUT 15 YEARS OF DATA
TO THEN DETERMINE WHEN AND WHERE
FUTURE SPIKES IN OVERDOSE WOULD
TAKE PLACE.
THE SPAGHETTI PLOT AT THE TOP OF
THE SLIDE REPRESENT THE 540 ZIP
CODES ACROSS MASSACHUSETTS,
CHARACTERIZED AS RURAL OR URBAN.
THE MAPS SHOW THE LOCATIONS OF
PREDICTED FATAL OVERDOSE RATES
AND COUNTS ACROSS MASSACHUSETTS.
WE HAVE ALSO LOOKED AT OPIOID
RELATED MORTALITY THROUGH
DYNAMIC TEMPORAL AND SPATIAL
TRENDS BY DRUG TYPE AND
DEMOGRAPHIC POPULATIONS.
AND THROUGH THESE ANALYSES, WE
UNCOVERED NEW TIME VARYING A
AND SPACIOTEMPORAL PATTERNS THAT
WERE NOT PREVIOUSLY REPORTED.
TO TAKE A CLOSER LOOK AT
FENTANYL-RELATED OVERDOSES.
YOU CAN SEE ON THE UPPER-LEFT
HAND CORNER THE TREND OF
REDUCING OPIOID DEATHS ACROSS
TOWN.
YOU CAN SEE THAT MALE OVERDOSES
RELATED TO FENTANYL LARGELY
DROVE THOSE TRENDS.
BUT YOU CAN SEE THAT BY RACE AND
ETHNICITY, THE TRAJECTORIES ARE
A BIT DIFFERENT ACROSS WHITE,
BLACK AND HISPANIC COMMUNITY
MEMBERS.
SEEING A BISMULDMORDAL AGE
DISTRIBUTION OF INCREASED
OVERDOSE AMONG BLACK DECEDENTS
AND THAT WAS CLOSELY MIRRORED
WITH STIMULATED OVERDOSES.
WE LOOK AT URBAN AND RURAL
DIFFERENCES IN THE TRAJECTORY AS
WELL.
AND THEN CAN LOOK AT SPATIAL
DISTRIBUTION AND SPACIOTEMPORAL
OF OVERDOSE OF HEROIN, SYNTHETIC
OPIOID AND STIMULANTS.
WE ARE TAKING DATA-TO-ACTION
APPROACH.
DATA DASHBOARDS THAT WERE
DISTRICT MODELS AND SIMULATION
MODELS OF THE EFFECTS OF AN
INDIVIDUAL AND COMBINED
INTERVENTIONS THAT CAN BEND THE
CURVE IN LOCAL PUBLIC HEALTH
COMMUNITIES AND LOCAL
POLICYM
POLICYMAKERS.
TO RECAP, WE TALKED OF SPATIAL
EPIDEMIOLOGY CONCEPTS AND
APPLICATIONS.
SPATIAL PREVENTION HIGHLIGHTED
IN OUR NIDA.
AND RELOOK AT THIS QUESTION OF
SPATIAL AND CAN AFFECT DISEASE
PREVENTION.
YES IT CAN, MONITOR PREVENTION
INTERVENTIONS.
GUIDE HEALTH COMMUNITY AND
ECONOMIC REQUIREMENTS.
TARGET LOCATIONS FOR NEW HEALTH
SERVICES.
INFORM LOCAL COMMUNITIES AND
POLICYMAKERS.
AND ALLOW US TO USE SPATIAL AN
LIT TALL SCHOOLS FOR
SURVEILLANCE.
I THANK YOU VERY MUCH FOR YOUR
TIME AND LOOK FORWARD TO THE
QUESTION AND ANSWER SESSION.
>> GREAT.
THANK YOU SO MUCH, HAVE STOPKA.
THAT WAS WONDERFUL AND I AM
HAVING A HARD TIME ABSORBING IT
ALL BECAUSE SO MUCH THAT YOU
EXPERTLY PUNT INTO SUCH A SHORT
TIME.
I WILL START WITH SOME
QUESTIONS.
AND I WILL TRY TO FOCUS ON THE
ONES THAT OTHER PEOPLE WROTE
INSTEAD OF ALL THE ONES I WROTE
DOWN.
BECAUSE I HAVE A LOT OF
QUESTIONS TOO.
BUT IT IS JUST EXCITING. FIRST
OF ALL, WE ARE GOING TO START --
WE HAVE ABOUT TEN MINUTES HERE.
START WITH QUESTIONS FOR DR.
WALLER.
WE ALSO HAVE QUESTIONS FOR BOTH
PEOPLE.
I AM GETTING THEM FROM DIFFERENT
SOURCES.
SO TIME JUGGLING HERE A LITTLE
BIT.
SO LET'S SEE.
THESE DON'T HAVE NAMES ON THEM.
OKAY. SO FOR DR. WALLER, YOU
SPOKE ABOUT THE ECOLOGY AND
CATCHMENT FOR DATA TO UNDERSTAND
THE SYSTEMS AND ENVIRONMENTS OF
SUBSTANCE ABUSE.
HOW ARE THOSE TOOLS AND THE
DATA.
AND ALONGSIDE OTHER METHODS WITH
STAKEHOLDERS OF COMMUNITY
ENGAGEMENT AND POTENTIALLY
INCREASE THE RICHNESS OF THAT
DATA CATCHMENT THROUGH THAT
ENGAGEMENT PROCESS.
>> THANKS.
I THINK THAT IS A VERY GOOD
QUESTION.
TOWARD THE END OF INTEREST
STOPKA'S PRESENTATION, THE
DASHBOARDING AND THOSE KIND OF
ACCESS.
MORE DATA SETS AVAILABLE NOW AND
IF YOU HAVE A COMMON PLATFORM
FOR PEOPLE OBSERVING THEM, I
THINK YOU CAN GET MORE FEEDBACK
FROM COMMUNITY MEMBERS, THE
COMMUNITY ENGAGEMENT.
I WILL SAY ON OUR ENVIRONMENTAL
STATISTIC SLIDE, WE DID A PUBLIC
USE DATA COURSE FOR COMMUNITY
GROUPS WORKING ON ENVIRONMENTAL
JUSTICE ISSUES IN THE
METROPOLITAN ATLANTA AREA.
AND I THINK A LOT OF US A THAT
ARE DOING STATISTICS FOR A LONG
TIME, YOU DON'T YOU HAVE TO LOOK
AT EIGHT YEARS OF STATISTICS
BEFORE YOU LOOK AT DATASETS.
PEOPLE CAN ACCESS THE SOCIAL
VULNERABILITY INDEX.
THE MAPS ARE POWERFUL
INFORMATION BECAUSE THE
COMMUNITY MEMBERS AND THOSE WHO
LIVED CONCERNS ABOUT ARE
BRINGING THEIR INSIGHT TO THE
PATTERNS AS WELL.
SO THE NUMBERS, BUT I THINK AS
-- IT IS PUT VERY WELL AT THE
BEGINNING OF THE LAST
PRESENTATION, THERE ARE PEOPLE.
THESE ARE PEOPLE WE ARE TALKING
ABOUT.
AND THAT CONTEXT, A LOT OF THAT
IS NOT MEASURED.
SO I WILL STOP THERE.
>> OKAY.
THANK YOU.
GREAT RESPONSE.
SO I AM GOING TO SWITCH BACK AND
FOR THE.
A QUESTION FOR DR. STOPKA, GIVEN
THE LARGE PORTION OF THE
POPULATION OF PEOPLE WHO USE
DRUGS HAVE UNSTABLE OR
TRANSITIONAL HOUSING, HOW DO YOU
THINK THIS AFFECTED YOUR
ANALYSES THAT RELY ON DECEDENTS'
HOME ADDRESSES?
>>Tom Stopka: THAT IS A GREAT
QUESTION.
WE HAVE ACCESS TO TWO ADDRESSES
-- WE HAVE ACCESS TO THREE
ADDRESSES.
PLACE OF RESIDENCE, PLACE OF
INJURY, AND A PLACE OF DEATH.
THE MOST COMPLETE DATA ARE THE
PLACE OF RESIDENCE AT TIME OF
THE FATAL OVERDOSE.
PLACE OF INJURY DATA IS ONLY
ABOUT 50% COMPLETE.
A LOT MISSING TO THAT DATA.
PLACE OF DEATH IS HIGHLY BIASED
PAUSE RELEGATED TO A HOSPITAL
WHERE THE DEATH IS DECLARED.
THE INJURY OR THE ACCIDENT, THE
OVERDOSE REALLY HAPPENED AT A
LOCAL COMMUNITY OR SOMEONE'S
HOME.
ONE OF THE PAPERS THAT WE
HIGHLIGHTED TRYING TO TEASE THIS
APART.
THERE ARE CERTAINLY LIMITATIONS
BUT WE TRIED TO LOOK VERY
CLOSELY AT DIFFERENCES BETWEEN
PLACE OF RESENSE, PLACE OF
INJURY.
PLACE OF DEATH.
AND TO LOOK AT THE DISTANCE OF
SPATIAL DISTANCE BETWEEN POLICE
OF RESIDENCE AND PLACE WHERE THE
INJURY TOOK PLACE AND PLACE
WHERE THE DEATH WAS RECORDED. WE
-- YOU KNOW, THERE ARE -- THERE
ARE CHALLENGES.
AND WE ACKNOWLEDGE THOSE.
BUT WE TRY TO REALLY TEASE APART
ALL THESE DIFFERENT ADDRESSES TO
GIVE THE BEST PICTURE OF THE
RISK LANDSCAPE AS IT PERTAINS TO
FATAL OVERDOSE.
WE ARE TRYING TO DO THE SAME
WITH NONFATAL OVERDOSE BASED ON
AMBULANCE TRIP DATA AS WELL.
>>Courte Van Voorhees: GREAT.
THANK YOU.
IN QUESTION CAME IN EARLIER, BUT
I THINK EITHER OF YOU COULD
ANSWER THIS ONE.
WHAT RECOMMENDATIONS DO YOU HAVE
FOR EARLY CAREERS OR TRAINEES
WHO ARE INTERESTED IN PURSUING
THIS FIELD OF RESEARCH?
>> I WOULD SAY, FIRST OF ALL,
JUST READ.
YOU SAW A LIST OF PAPERS --
THOMAS'S GROUP HAS A WIDE
SELECTION OF THEM.
SEE WHAT PEOPLE DO.
A LOT OF TIMES WHEN YOU START,
YOU JUST THINK IT IS THE MAP
WITH THE RATES ON IT.
AS YOU SAW EACH ONE HAD MAPS OF
ACCESS, ATTRIBUTION.
DIFFERENT TYPES OF MEASUREMENT.
IF YOU READ -- I THINK READING
AS MUCH AS YOU CAN IS ALWAYS A
GOOD THING.
SOME AUTHORS WILL SPEAK TO YOU A
LITTLE BETTER.
ALL HAVE DIFFERENT LEARNS STYLES
AND DIFFERENT TEACHING STYLES.
THAT IS THE GOOD WAY.
FIND WHAT COURSES OR SHORT
COURSES ARE AVAILABLE.
HONEST RECOMMENDATIONS YOU MIGHT
HAVE?
>> THOSE ARE GREAT
RECOMMENDATIONS.
I TRY TO GIVE MY STUDENTS THE
OPPORTUNITY TO WORK WITH LIVE
DATA.
I TYPICALLY SEND OUT E-MAILS TO
COLLEAGUES NEAR AND FAR A COUPLE
OF WEEKS BEFORE THE CLASS STARTS
IN THE CRETE TO YOU HAVE
SPATIALLY ORIENTED DATA YOU
WOULD LIKE TO HAVE MAPPED?
BECAUSE THIS IS A WIN-WIN
OPPORTUNITY TO GET YOUR DATA
MAPPED AND WOULDN'T HAPPEN
OTHERWISE AND A STUDENT FOR
PRODUCTS THAT WILL HELP INFORM
DECISION MAKING.
I WILL LOOK FOR CLASSES THAT
ALLOW FOR THAT HANDS ON APPLIED
OPPORTUNITY TO WORK WITH LOCAL
DATA.
HERE AT TUFTS, WE HAVE
RESIDENTIAL CLASS.
WE HAVE ONLINE CLASS IN SPATIAL
EPIDEMIOLOGY.
A LOT OF OFFERING AROUND THE
COUNTRY THROUGH UNIVERSITIES,
THROUGH COMPANIES THAT MAKE THE
SOFTWARE.
AND -- AND READING AND ALSO
LOOKING AT ONLINE TUTORIALS CAN
BE USEFUL AND STUDENTS COME TO
ME AND SAY I WANT TO DEVELOP A
MAP OR DO SOME SPATIAL ANALYSES
FOR MY CAPSTONE PROJECT.
THE FIRST QUESTION, HAVE YOU
TAKEN A CLASS?
TAKE A CLASS FIRST, BECAUSE MANY
DIFFERENT CONSIDERATIONS AS DR.
WALLER HIGHLIGHTED IN HIS
PRESENTATION AND I HIGHLIGHTED
AND AS WE WILL HEAR THROUGH THE
REST OF THE AFTERNOON.
>>Courte Van Voorhees: GREAT.
THANK YOU, BOTH, VERY MUCH.
THIS QUESTION CAME IN AND CAN BE
FOR ANYBODY, BUT I WILL ASK IT.
AND IT IS A GOOD ONE.
PERHAPS ANOTHER CHALLENGE IN
GEOSPATIAL DATA IS TO SHARE THE
DATA WITH THE COMMUNITY IN
IDENTIFYING THE GEOSPATIAL DATA.
HOW SHOULD WE ADDRESS THIS
ISSUE?
I SEE THIS AS BEING TO A CERTAIN
DEGREE PART OF SOME LARGER
ISSUES OF ACCESS AND ETHICS
WHICH BOTH OF YOU TOUCHED ON,
BUT WOULD LOVE TO HEAR YOUR
DIRECT RESPONSE TO THAT.
>> YES.
I SAW ANOTHER QUESTION IN THE
CHAT ALONG THIS LINE TOO.
YOU KNOW, WE GEO MASK OUR DATA
IN A RANDOM DIRECTION AND RANDOM
DISTANCE.
WE USE THE BIMODALITY GALION
APPROACH TO RAMP OUR DATA THAT
THEY ARE RANDOMLY DISPLACED SO
DON'T IDENTIFY THE EXACT HOME OR
RESIDENCE, BUT IN THE VICINITY,
BECAUSE THE NUMBERS ARE
RELATIVELY LARGE OVER A NUMBER
OF YEARS, WE ARE ABLE TO SEE
MEANINGFUL PATTERNS.
I THINK THAT IS SUPER IMPORTANT.
ONE, TO PROTECT THE CONFIDENTIAL
OF FAMILY MEMBERS AND FRIENDS
AND NEIGHBORS AND COMMUNITIES.
I THINK THAT -- I THINK THAT THE
COMMUNITY EN GAEN /*GAGEG --
ENGAGE IT PARAMOUNT TO ENSURE WE
ARE GETTING THINGS RIGHT AND THE
GROUND TRUTH AND WHAT ARE WE
MISSING AND NOT CONSIDERED IN
OUR SPATIAL ANALYTICS AND OUR
MODELS?
>> THANK YOU.
>> I THINK THAT IS A GREAT
RERESPONSE.
I THINK ALSO WE SHOULD KEEP IN
MIND WE PROBABLY CAN'T GUARANTEE
PROTECTING.
SO YOU ALWAYS NEED -- IF SOMEONE
SAYS IS THIS ETHICAL ENOUGH?
PROBABLY A GOOD TIP IT IS NOT.
FOR ANY DATA ETHICS QUESTION.
I DO THINK IT IS A VERY
CHALLENGING ASPECT BECAUSE WE
WILL -- WE ADD ENOUGH NOISE TO
PROT
PROTECT MIGHT HIDE A SIGNAL AT A
LOWER SCALE.
I THINK IT IS -- NOT IS A WARY
CONSUMER BUT A INFORMED CONS
CONSUMERS OF THE TOOLS YOU HAVE
TO PROTECT IDENTITY AND WHAT
REMAINS DETECTABLE.
SO I THINK WE SAW A REALLY GOOD
BALANCE OF THOSE AND DR.
STOPKA'S PRESENTATION, BUT IT IS
AN ONGOING CHALLENGE AND
SOMETHING TO KEEP IN MIND AS A
USER OF GEOSPATIAL DATA.
>> CERTAINLY.
SO WE DON'T HAVE A TON OF TIME.
I DON'T KNOW IF WE WILL GET TO
ALL OF THEM, BUT THIS IS ANOTHER
ONE FOR BOTH OF YOU WHICH IS
WORKING SO PAR.
HI, DR. STOPKA AND WALLER.
TALK ABOUT SPATIAL SCALE AND ANY
CONSIDERATIONS FOR LOW DENSITY
POPULATION AREA OR WHERE THE
SAMPLING SHOW LOW INCIDENCE OR
DATA GAPS?
>> THIS IS AN ISSUE WE ARE
GRAPPLING WITH ALWAYS.
SOMETIMES WE ARE RELEGATED TO
THE SOURCE THAT THE DATA COME
FROM.
WITH DECEDENTT DATA AND
NONOVERDOSE DATA.
WE CAN MAKE DECISIONS.
NOT ONLY DEPEND ON POLITICAL
BOUNDARIES SUCH AS ZIP CODES,
CENSUS TRACTS, BLOCK GROUPS.
WE ARE LOOKING AT EXPLORING
FISHNET-BASED ANALYSES.
THROW A FISHNET OVER YOUR
CATCHMENT STUDY AREA AND VARYING
SIZES TO AGGREGATE THE DATA AT
THOSE LEVELS AND SEE WHAT THAT
DOES IN IMPLICATIONS WITH
CLUSTER ANALYSES AND WHAT
INDICATION WITH ANALYTIC
APPROACHES.
>> YEAH, I THINK IT IS IMPORTANT
TO KEEP IN MIND THAT THERE IS
NOT -- THERE IS NOT A SINGLE
SCALE.
YOU KNOW THINGS HAT AN DIFFERENT
SCALES.
ONE OF THE THINGS THAT IS HARD,
WE OBSERVE SOMETHING AT A
DIFFERENT SCALE THAN THE
PROCESSES OPERATING IT.
SOMETHING IS VERY LOCAL AND WE
LOOK AT A BIG AGGREGATION.
WE CAN MISS IT BECAUSE IT GETS
WASHED OUT.
AND I HAD SMALLER ESTIMATION IN
MY TITLE AND DIDN'T DO A LOT OF
THAT BUT THE MODELS THAT WERE
MENTIONED CATCHING THE TENSION
BETWEEN GEOGRAPHIC PRECISION,
REALLY LOCAL SCALES, AND
STATISTICAL AND BIG SAMPLE
SIZES.
YOU TRY TO GET STATISTICAL
PREVISION YOU LOSE GEOGRAPHIC.
AND THE RANDOM EFFECTS IS TO
JUST RIGHT BORROWING OF
INFORMATION FROM NEARBY
OBSERVATIONS.
AND THE THIRD TENSION AND MAKE A
TRIANGLE.
PRIVACY.
THE MORE NOISE THE MORE PRIVACY.
TO SEE HOW YOU I HAVE VAT.
CONFIDENTIAL AND GEOGRAPHIC
PRECISION AND A CHALLENGE.
TOOLS TO HELP WITH THAT.
BUT THINGS DO HAPPEN AT
DIFFERENT SCALES.
AND I THINK YOU WANT TO KEEP
THAT IN MIND.
>> THANK YOU SO MUCH.
SO, UNFORTUNATELY, WE ARE OUT OF
TIME FOR QUESTIONS.
THANK YOU, BOTH, SO MUCH THIS IS
VERY INFORMATIVE.
WE HAVE A FIVE-MINUTE BREAK NOW
AND LOOK FORWARD TO SEEK YOU ON
THE OTHER SIDE OF THE BREAK.
HELLO, EVERYONE.
WELCOME BACK FROM THE BREAK THAT
WE HAVE.
I WOULD LIKE TO INTRODUCE OUR
MODERATOR FOR THE NEXT SESSION
TAMARA HAEGERICH WHO WILL BE
ANNOUNCING THE SPEAKERS FOR THE
RESEARCH SECTION.
THANK VERY MUCH.
>> THANK YOU, JANET.
WE HAVE TWO PRESENTERS, FROM
MARYNIA KOLAK AND DR. DEVIN
BANKS.
I AM GOING TO INTRODUCE THEM
BOTH AND THEN WE WILL HAVE EACH
PRESENT IN SEQUENCE.
AND THEN THEY WILL BE ABLE TO
ANSWER QUESTIONS AT THE END.
AS A REMINDER, USE THE Q&A BOX
TO POSE QUESTIONS TO THOSE
SPECIFIC PRESENTER.
FIRST OFF DR. MARYNIA KOLAK.
SHE IS AN ASSISTANT PROFESSOR AT
THE DEPARTMENT OF GEOGRAPHY
AND GI SCIENCE AT THE UNIVERSITY
OF ILLINOIS IN CHANNEL N
CHAMPAIGN.
A GI AND FELLOW OF THE DATA
SCIENCE FOR THE UNIVERSITY OF
CHICAGO.
D
KOLAK IS A BIOGRAPHER AND
HEALTH, SPATIAL DATA SCIENCE AND
HEALTH EQUITY.
HER PRIMARY AREA INTEREST IS
UNDERSTANDING HOW PLACE IMPACTS
HEALTH OUTCOMES IN DIFFERENT
WAYS FOR DIFFERENT PEOPLE WITHIN
OPIOID RISK ENVIRONMENTS.
DR. KOLAK PLACE AS STRONG
EMPHASIS ON SOCIAL SPATIAL
DETERMINANTS OF HEALTH AND
BUILDING COMMUNITIES OF PRACTICE
TO MOVE THE SCIENCE AND POLICIES
FORWARDSHE WILL SPEAK ON
MEASURING THE SPATIAL
AVAILABILITY OF MEDICATIONS FOR
OPIOID-RELATED ABUSE DISORDER.
AND DR. DEVIN BANKS ARE A
LICENSED CLINICAL SIGH KOLG AND
ASSISTANT DIRECTOR OF THE
DEPARTMENT OF PSYCHOLOGY.
DR. BANKS RESEARCH IS EQUITY
PRESIDENT RESEARCH AND TREATMENT
OF SUBSTANCE ABUSE AND BE
BEHAVIORAL HEALTH PARTICULARLY
AMONG BLACK AMERICANS.
EXAMINES THE IMPACT OF RACISM OF
SUBSTANCE ABUSE AT MULTIPLE
LEVELS AIMING AT MITIGATING A
SOCIAL DETERMINANCE OF
BEHAVIORAL HEALTH.
HER WORK USES MIXED KWA
QUALITATIVE AND QUANTITATIVE
METHODS AND COMMUNITY-ENGAGED
METHODS INTO RESEARCH DESIGN.
DR. BANKS WILL BE SPEAKING ON
INTEGRATING COMMUNITY ENGAGEMENT
AND GEOSPATIAL DATA FOR METHODS
TO ADDRESS EQUITIES.
AND LET ME KICK IT OFF TO DR. KO
WILL,AK.
>> THANK YOU VERY MUCH FOR
HAVING ME HERE.
AND GREAT TO HEAR THE OTHER
FOLKS AS WELL AND LOOKING
FORWARD WITH OTHER
CONVERSATIONS.
I WILL BE CHATTING ABOUT MESH
THE SPATIAL AVATE OF MEDICATIONS
FOR OPIOID USE DISORDERS.
NEXT SHIED.
WHILE WE KNOW THERE ARE MULTIPLE
EVIDENCE-BASED MEDICATIONS
AVAILABLE FOR PERSONS WITH
OPIOID USE DISORDER.
I WILL BE CALLING THAT OUD FOR A
BIT THROUGH THE REST OF THE
TALK.
ON AVERAGE, ONLY ABOUT 20% OF
PERSONS WITH OUD ARE ACTUALLY
ABLE TO ACCESS THAT -- IF THAT.
SO THERE IS ACTUALLY A HUGE
VARIABILITY IN THAT NUMBER AND
ONLY A SMALL PROPORTION OF
PATIENTS SUCCESSFULLY MAKE IT
THROUGH THE OPIOID TREATMENT
CASCADES TOWARD TREATMENT
RETENTION AND REMISSION.
SO THE THREE MEDICATIONS IN
PARTICULAR ARE METHADONE,
FULL AGONIST.
BUPRENORP HINE PARTIAL A
GO,ONISN AND NALTREXONE.
EFFICACY CAN VARY AND EACH
PERSON OF OUD WITH REFERENCE
THEIR MEDICATION OF PRESENCE
WHICH IS KIND OF THE GOLD
STANDA
STANDARD. ALL RIGHT.
NEXT SLIDE.
SO UNFORTUNATELY, THERE ARE
MULTIPLE BARRIERS TO ACCESSING
OUDS.
AND IT TURNS OUT THAT A LOT OF
RESEARCH HAS SHOWN THAT LOWER
BARRIER M.O.U.D.s INCREASE
ENROLLMENT OF HIGH RISK.
HIGH BARRIER M OUDS.
IN A REVIEW BY SHARMA ET AL IN
2020 GARRIERS THAT THEY
IDENTIFIED WERE SPECIFICALLY
REGULATORY, LOGISTICAL,
GEOGRAPHIC, FINANCIAL AND
ATTITUDINAL.
ANOTHER GREAT REVIEW BY
HUTCHINSON IN 2023 ON BUT
FINANCIAL BARRIERS ARE
CONSISTENT ACROSS ALL THREE
MEDICATIONS.
LOGISTICALLY -- OH, I AM GETTING
A MESSAGE HERE.
OH, OKAY.
I CAN ADVANCE THE -- OKAY.
I WILL DO THAT.
OKAY.
SORRY ABOUT THAT.
SO LOGISTICALLY AND
GEOGRAPHICALLY.
WHILE FINANCIAL BARRIERS ARE
KIND OF CONSISTENT ACROSS ALL
THREE MEDICATIONS, LOGISTICALLY
AND GEOGRAPHICALLY TO ACCESS
MEDICATION ON A DAILY, WEEKLY OR
MONTHLY BASES REQUIRES PRETTY
CONSISTENT TRANSPORTATION AND
AFFORDABLE AND CONVENIENT
TRANSPORTATION, RIGHT.
SO REGULATORY CHALLENGES TO
METHADONE, FOR EXAMPLE, HAVE
LONG CHALLENGED ACCESS AND THEY
ALSO ARE LINKED WITH STIGMA
AGAINST OUDS AS WELL AS
MEDICATIONS FOR OPIOID ABUSE
DISORDER, ESPECIALLY IN -- AS --
THE OTHER OPTION BEING
ABSTINENCE WHICH, UNFORTUNATELY,
HAS BEEN LINKED WITH HIGHER
MORTALITY IN MANY CASES.
SO WHILE SPATIAL AVAILABILITY OF
MEDICATION IS LINKED AS AGREE
GRAPHIC FACTOR IN A LOT OF
EXISTING RESEARCH, I ARGUE THAT,
ACTUALLY ALL OF THESE BARRIERS
HAVE A PRETTY STRONG SPATIAL
FOOTPRINT AND SPATIALLY SPECIFIC
DIMENSIONS.
THEY VARY THROUGHOUT REGIONS.
TRANSPORTATION, INFRASTRUCTURE,
ECONOMIC OPPORTUNITIES AND
SOCIAL PATTERNS EMERGE AT LOCAL
AND REGIONAL SCALES AND CAN BE
AND HAVE BEEN MEASURED BY GEE
A
GEE GEOGRAPHERS FOR DECADES.
OUR STUDY TEAM EXPLORE THIS
INTERSECTION ACROSS BARRIERS.
IN ONE STUDY ATTITUDINAL
PERSPECTIVES, SIGMA, WAS
CORRELATED ACROSS MANY DIFFERENT
SEGMENTS, PERSONAL,
INTERPERSONAL, EVEN
ORGANIZATIONAL, WITH THE
PRESENCE OF MOUDs NEARBY.
MORE RESOURCES WERE TOO LYLE
LINKED TO LESS STIGMA AGAINST
ALL THESE DIFFERENT SCALES WHICH
IS VERY INTERESTING AND RESEARCH
HE IS FOUND THAT STIGMA IS
LETHAL.
BEING TREATED POORLY AT HEALTH
PROVIDER MEDICAL SPACE LEADS TO
WORSE OUTCOMES.
SOMETIMES THIS OCCURS BECAUSE OF
LACK OF UNDERSTANDING OF MOUD ON
PROVIDER SETTINGS AND FOCUS ON
DRUG-FREE OUTCOMES.
SOME POPULATIONS AND SOCIAL
GROUPS HAVE HIGHER STIGMA
AGAINST OUDS ORMOUDs AND IN
CRIMINAL RESPONSE TO OUD VERSUS
PUBLIC HEALTH RESPONSES.
I CAN GO ON FOR STIGMA FOR DAYS,
BUT I WANTED TO HIGHLIGHT THIS
AS A VERY IMPORTANT TOPIC, AND
MAYBE NOT THE MAIN FOCUS THAT I
WILL TALK ABOUT TODAY, BUT
SOMETHING THAT WE WILL BE
LOOKING AT IN THE FUTURE.
SO WHILE REFINING OUR
UNDERSTANDING OF ALL THE
DIFFERENT BARRIERS OF MOUD IS
UNDER WAY ACROSS MULTIPLE
RESEARCH GROUP.
OUR TEAM WANTS TO FOCUS ON THE
GEOGRAPHIC FLOOR OF THIS WORK
BEFORE ADVANCING TO OTHER
DIMENSIONS.
CONFLICTING EVIDENCE OF HOW
SPATIAL ACCESS TO MOUDs IMPACT
FINDINGS.
BEFORE WE CAN TEST THAT IN A
QUASI EXPERIMENTAL WAY, WE NEED
TO SEE HOW WE ARE MEASURING
SPATIAL ACCESS IN ITSELF NOT
INTRODUCING BIAS TO THE STUDY.
SO MULTIPLE DIFFERENT APPROACHES
BEING USED, OFTEN DIVERGING
ACROSS CLINICAL AND GEOGRAPHIC
HEALTH RESEARCHES. CLINICAL
SPACES OF TRAVEL TIMES AND
RESOURCE DISTANCES BECAUSE ABLE
TO INTERPRET.
AND GRAVITY MODELS DOMINATE
THE GI SCIENCE WORK THAT COMES
OUT IN SCORES.
AND THAT SCORE MAY BE DIFFICULT
TO INTERPRET IN CLINICAL
SETTINGS.
SO TOM LOGAN OF CANTERBURY
UNIVERSITY LIKES TO SPECIFY
DISTIC
DISTINCTION WITH SPATIAL.
SPATIAL, TEMPORAL, THE DISTANCE
MEASURE YOU USE AS WELL AS THE
ACCESS MEASURES.
OUR TEAMS' WORK, WE FOUND THAT
BOUNDARY CONDITIONS AND THE
DEGREE OF URBANICITY CAN
INFLUENCE OUTCOMES.
FOR EXAMPLE, A JAIL
OFFERING MOUDs FOR THEIR INMATES
MAY NOT BE ABLE TO TRANSPORT
FOLKS ACROSS STATE BORDERS.
IN SOME CASES, THERE MAY BE
INSURANCE THAT CHALLENGES AND
THOSE TYPES OF THIS I THINK SO.
AN EXAMPLE OF BOUNDARY
CONDITION.
CHANGES ACROSS EACH OF THESE
FACTORS CAN INFLUENCE RESULTS.
SO TO SEE EVALUATE SPATIAL
ACCESS CONSISTENTLY WILL HOLD
SOME OF THESE MEASURES CONSTANT
FOR AN ENVIRONMENTAL SETTING.
SPECIFICALLY FOR THIS STUDY, WE
LOOKED AT SPATIAL ACCESS AT
CENSUS TRACT LEVELS, BOUNDARY
CONDITIONS AND WE TWEAK THE
DISTANCE AND ACCESS MEASURES AND
LOOK AT THE RESULTS ACROSS
DIFFERENT DEGREES OF URBAN IS
TEASE IN -- AND THE URBANICITY
IS PART IS IMPORTANT BECAUSE
DIFFERENT BEHAVIORS OF URBAN,
SUBURBAN AND RURAL REGIMES.
SO OUR STUDY OBJECTIVE IS TO
CALCULATE AND COMPARE
NEIGHBORHOOD LEVEL ASSOCIATIONS
OF SPATIAL AVAILABILITY METRICS,
AND CONTEXT WISE THAT WITH
ADDITIONAL DIMENSIONS OF ACCESS
AT COMMUNITY SCALE.
WE WILL LOOK AT ACCESS METRICS
LIKE TRAVEL TIME AND GRAVITY
MODELS, MULTIPLE TRANSIT MOVES,
AND EXPLORE THE RESULTS ACROSS
DIFFERENT MORALITIES.
AND, AGAIN, ACROSS DIFFERENT
TYPE OLTS OF THE SOCIAL
DETERMINANCE OF HEALTH TO BRING
THAT -- THOSE ADDITIONAL
DIMENSIONS OF ACCESS IN.
AND THEN FINALLY, BECAUSE WE ARE
INTERESTED IN REFINING A MEASURE
OR MEASURES FOR FUTURE ANALYSIS
AND EXPERIMENTS, IT WILL BE
REALLY IMPORTANT TO IDENTIFY AND
MEASURE THAT IS MEANINGFUL,
CONSISTENT, AND HAS SUFFICIENT
VARIABILITY ACROSS STATES. OKAY.
SO LET'S TALK ABOUT THOSE
METHODS.
WHO IS THE STUDY POPULATION?
SO WE ARE LOOKING AT ALL
POPULATED AREAS IN THE
CONTINENTAL CENSUS.
FOCUS ON CENSUS TRACKS AND
BECAUSE WE ARE INTERESTED IN
DYNAMICS ACROSS CENSUS TRACT
BORDERS AND STATE BORDER, IN
THIS KIND OF ANALYSIS FOCUSING
ON THE CONTINENTAL STATES,
HAWAII AND ALASKA BRING NEW
CHALLENGES AND WOULD BETTER WORK
AS A SEPARATE TYPE OF ANALYSIS
ALL TOGETHER. WE USED DATA THAT
OUR TEAM COLLECTED WITH THE
ENVIRONMENTAL POLICY SCAM
OR OEPS.
METHADONE WERE EXTRACTED
FROM SAMSHA.
AND BUPRENORP HINE.
AND VIVITROL WEB SCRAPING
FOR NALTREXONE.
WE DID THIS AT YALE, AND NOW
AT PITT.
WE ARE AWARE OF ALL THE EXISTING
LIMITATIONS AMONG ALL OF THESE
RESOURCES.
I KNOW.
BUPLENORP HINE WILL BE AN
OVERESTIMATED MANY CAN PRESCRIBE
IT BUT DON'T.
AND ARE NOT ACCEPTING NEW
PATIENTS, BUT A THE COMPLETE
LIST WHAT IS PUBLICLY ON VIEW IN
A SNAPSHOT IN TIME OF MOW
PENSION MOUD RESOURCES ON
GOVERNMENT WEB SITES.
AS FOLKS WILL TRAVEL TO
RESOURCES IN DIFFERENT WAYS, WE
NEED TO CAPTURE DIFFERENT
TRANSIT.
DRIVING, WALKING, BIKING, OPEN
STREET MAPS, ROAD NETWORKS.
DISTANCE FROM EACH CENSUS TRACT
TO ANOTHER CENTER USING ROAD
NETWORKS AND THE TRACK CENTER TO
TRACK CENTER IS NOT IDEA, BUT
FOR THE SCALE OF OUR.
WE ALSO HAVE PROPORTIONS OF
HOUSEHOLDS WITHOUT A VEHICLE AND
COMMUTERS USING TRANSIT AND
WALKING TIMES OR COMMUTERS USING
TRANSIT AND WALKING MODES AS
MADE AVAILABLE FROM THE CENSUS.
WE REALLY WANTED TO HAVE PUBLIC
TRANSIT METRICS FOR THE COUNTRY;
HOWEVER, AT THE TIME THAT THESE
OTHER
MATRICES WERE GENERATED WE
DIDN'T HAVE CLEAN FEEDS AT THE
COUNTRY LEVEL, 245 HAS CHANGED
IN THE PAST FEW MONTHS AND THAT
MAY CHANGE AS WELL FOR FUTURE
ANALYSIS.
TO MEASURE SPATIAL ACCESS, WE
CALCULATE SUPPLY ONLY MODELS.
MINIMUM DISTANCE.
IN OTHER WORDS, AS THE CROW
FLIES, RIGHT, FOR THE GISERS AND
EUCLIDIAN, POINT A TO POINT B.
WHAT IS THE NEAREST OR SHORTEST
LINE.
TRAVEL TIMES FOR EACH TRAVEL
MODE.
THERE IS A LOT, A LOT, A LOT IN
THE LITERATURE SPECIFICALLY FOES
CUSSING ON HOW TRAVEL IS TIME IS
SUPERIOR TO MINIMUM DISTANCE
ESPECIALLY IN URBAN SPACES.
TOM LOGAN'S WORK SHOWED YOU CAN
BE OFF BY A COUPLE OF MILES IF
YOU ARE NOT USING THE RIGHT
TRAVEL TIME APPROACH OR THAT
SORT OF THING.
NOTE THAT FOR OUR ANALYSIS, A
COUPLE OF MILES MIGHT BE A --
THAT MIGHT BE WITHIN OUR ERROR
OF SENTENCE ZONE AND LOOKING AT
THINGS ACROSS THE COUNTRY AND
YOU WILL SEE IN A LITTLE BIT THE
VARIATION IS SO SUBSTANTIAL --
THE LACK OF ACCESS MAY BE SO
SUBSTANTIAL THAT A COUPLE OF
MILES MAY NOT BE A DEAL BREAKER.
FINALLY ACCOUNTED RESOURCES
WITHIN 30-MINUTE TRAVEL TIME.
AND NEXT WE HAVE OUR SUPPLY
DEMAND MODEL. AND.
THIS THIS ANALYSIS, WE ARE USING
TOTAL POPULATION AS A BASIS OF
NEED NOT PERFECT, BUT A
REASONABLE ESTIMATE.
SOME OF OUR PREVIOUS WORK HAS
SHOWN THAT USING JUST TOTAL
POPULATION IS REASONABLE IN LIEU
OF HAVING THE ACTUAL ACTIVE
POPULATION WITH OUD.
AGAIN, BECAUSE WE ARE TRYING TO
TAKE A HUMAN-CENTER AID
APPROACH.
HUMAN LED CENTERED APPROACH TO
HAVE ACCESS IN A REASONABLE WAY.
WE FELT THAT THE PTOTAL
POPULATION WAS REASONABLE AND
PER CAPITA AS AN APPENDIX LEVEL
MEASURE, BUT MORE IMPORTANTLY,
WE HAVE THESE CLASSICAL GRAVITY
NOVELS, WELL LOVED BY THE GEO
SCIENCE COMMUNITY.
FLOATING CATCHMENT AREAS WILL
MEASURE THE RATIO OF CLIENTS TO
THE TRAVEL TIME.
ENHANCED VERSIONS ARE GOING TO
REFINE THIS FURTHER.
SO THE RATIONAL AGENT ACCESS
MODEL IS A NEWER VERSION OF
THESE GRAVITY MODELS THAT
ATTEMPTS TO EQUALIZE CONGESTION
AND MINIMIZE COST.
SO IF THERE IS RESEARCH FURTHER
AWAY WITH LESS CONGESTION, THAT
WOULD BE PREFERRED ESSENTIALLY.
BECAUSE WE KNOW THIS IS WHAT
PEOPLE DO, THIS WAS KIND OF AN
EXCITE SOMETHING MODEL TO TEST
AS WELL.
THE RAM OF THE COST TO TRAVEL
FOR EACH TRACT.
LOWER IS BETTER AND TH
THE FCA-BASED METHOD OF
POPULATION.
SO HIGHER IS BETTER.
WE FLIPPED THE COLOR OF THE MAPS
LATER ON JUST -- FOR THESE TWO
SO THAT ACCESSION IS BETTER --
LOWER ACCESS IN THE SAME
DIRECTION.
BUT IN SOME OF THE SUMMARY
STATISTICS, WE OBVIOUSLY DON'T
DO THAT AND TAKES JUST KNOWING
THAT ENDS UP BEING IMPORTANT.
AND SO WE DID A PRETTY MASSIVE
COMPUTATIONAL FRAMEWORK TO
ACCOMPLISH ALL OF THIS.
WE USED PRECOMPUTED TRAVEL
TIME MATRICES AND PRIOR
RESEARCH.
THIS IS ALSO AVAILABLE FOR
OTHERS TO USE.
ALSO AVAILABLE ON THAT OEPS
WEBSITE.
WE HAVE -- FOR ALL THE DIFFERENT
CALCULATIONS, THEY WERE EITHER
DONE IN OUR PYTHON.
AND WE HAVE OUR R OR PYTHON CODE
MADE AVAILABLE TO OTHERS MADE
AVAILABLE SO OTHERS CAN DO THIS.
OENZ ENVIRONMENT TOOL KIT THAT
CLAIMS RESEARCH.
AND WE HAVE A GOOGLE PYTHON
NETWORKING TO CALCULATE TRAVEL
TIME WITH THE TRAVEL TIM
TIME MATRICES.
THE GRAVITY MODELS WITH THE RAM
MODEL USING 90-MINUTE THRESHOLDS
WAS QUITE A COMPUTATIONALLY
INTENSIVE AND WOULDN'T WORK IN A
CLASSIC SETTING AND A HIGH
PERFORMANCE COMPUTING
ENVIRONMENT FOR THAT WHICH WAS
MADE AVAILABLE AT U OF I.
I KNOW THAT IS NOT A
STRAIGHTFORWARD THING FOR
EVERYONE AND CURRENTLY LOOKING
FOR A GROUP AT THE U OF I TO
MAKE THAT AVAILABLE AS
COMPUTATIONAL NETWORKING TO
ACCESS THE SAME COMPUTING
ENVIRONMENT. OKAY. AND SO LET'S
TALK MORE ABOUT NEEDS.
THERE IS POPULATION, BUT HERE IT
IS LIKE DEFINING NEED IN THE
WORLD OF LOOKING AT THE
DIFFERENT DIMENSIONS OF ACCESS.
WHAT ARE THOSE FACTOR.
SO WE DEFINED URBAN, SUBURBAN
AND RURAL AREAS USING DIFFERENT
CATEGORIES OF THE RURAL, URBAN
COMMUTING OR RURAL, URBAN
CONTINUUM CODES.
AND YOU CAN CHECK OUT OUR
RESEARCH BRIEF FOR MORE DETAILS
HERE, BUT ESSENTIALLY WE USE
COMMUTING FLOWS FOR URBAN,
SUBURBAN AND RURAL AND VIR PHI
USING EXTENSIVE EXPLORATORY DATA
ANALYSIS, A LOT OF MAPPING,
DISCUSSIONS, AND VERIFY AREAS
WITH POPULATION DENSITY
SUMMARIES TO MAKE THEIR THAT WAS
CONSISTENT.
OKAY, TO DEFINE VARYING NEED AND
APPROXIMATE THOSE DIMENSIONS OF
ACCESS IN A STANDARDIZED WAY, WE
USE PRE-EXISTING CLUSTERS OR
TYPOLOGIES.
THE SOCIAL DETERMINANT, HEALTH
OUTCOMES AND INTERSECTING
COMMUNITY CONTEXTS AT VARIABLE
SCALES.
OUR WORK PREVIOUSLY IDENTIFIED
FOUR DISTINCT INDICES AND THOSE
FOUR INDICES THEN WERE USED AS
INPUT TO GENERATE SEVEN DISTINCT
CLUSTERS CHARACTERIZING SDOH.
IS MOVING BEYOND THE CLASSICAL
SOCIO ECONOMIC LEVEL ALONE.
SOCIOECONOMIC ADVANTAGE, THE
FIRST COMPONENT IS STRONGLY
COORDINATED WITH THE AVI AND
THE SBI AND THE MEASURE IN
RELATED RESEARCH.
WE ALSO IDENTIFIED ADDITIONAL
MEASURES IN THIS CASE WOULD BE
IMPORTANT TO CAPTURING
DIMENSIONS OF THE OPIOID RISK
ENVIRONMENT FOR THIS ANALYSIS.
SOME LIKE AIR OF HIGH MOBILITY
AND PERSONS AND FAMILIES, FOR
EXAMPLE.
OF NOTE IN THE ANALYSIS, SO
SPECIFICALLY -- BECAUSE IT IS A
VERY -- THE TALK TODAY, I AM NOT
GOING TO BE ABLE TO GO THROUGH
ALL THE RESULTS, BUT HIGHLIGHT
THE SUBURBAN AFFLUENT GROUP AND
EXTREME POVERTY GROUP.
THESE ARE -- THEY HAVE VERY, YOU
KNOW, STRONGLY DIVERGING
ADVANTAGES AS WELL AS
VULNERABILITIES.
SO EXTREME POVERTY HAS VERY HIGH
SOCIOECONOMIC DISADVANTAGES, AND
SUBAFFLUENT GROUP HAS EXTENSIVE
ADVANTAGE ACROSS ALL THOSE
DIFFERENT CATEGORIES.
FOR HERE FOR MORE DETAILS.
DATA DRIVING THE MODELS AND SDOH
CLUSTERS.
AND WE ARE ALWAYS TRYING TO COME
BACK TO THAT IN SOME WAYS. OKAY.
SO WHAT DO WE DO WITH ALL THAT?
SO SOME GEOSPATIAL DATA SCIENCE.
WE CREATED CORRELATION MATRICES
USING SPEARMAN RANKED
CORRELATION.
MEASURES ARE SKEWED AND
NONLINEAR SO WE NEEDED TO U
USE THERAN FOR THIS FOR OVERALL
SPATIAL, ACCESSIBILITY MEASURES
TO EACH TREATMENT TIME FOR ALL
THE CENSUS TRACTS WITHIN EACH
URBAN, RURAL CATEGORY.
TO FURTHER UNDERSTAND THE
SPATIAL ACCESS, WE CREATED BOX
BLOCKS AND MAPPED SPATIAL
ACCESS.
BOX PLOTS TO MEASURE
APPLES-TO-APPLES AND RANGES AND
OUTLIERS BETWEEN EACH MEASURE.
AND WE USED SUMMARY STATISTICS
OF THE CO-VARIATE DATA AND
ACCESS METRICS STRATIFIED BY ALL
THESE DIFFERENCE ASPECTS.
I DON'T HAVE A CHANCE TO SHOW
ALL THE PIECES TODAY, BUT JUST
SOME OF THE HIGHLIGHTS
APPROXIMATELY.
AND THEN FINALLY, IT WAS VERY
IMPORTANT THAT WE IDENTIFIED
PARTS OF THE COUNTRY WITH BETTER
CONSISTENCY OR LESS CONSISTENCY.
MEASURING INTERNAL CONSISTENCY.
WE REPEATED STANDARD DEVIATIONS
AMONG THE SPATIAL ACCESS AMONG
EACH TREATMENT TYPE.
CENSUS TRACT WITH HIGH INTERNAL
CONSISTENCY SHOW LOW VARIANCE.
THAT IS A GOOD THING.
WE WANT CONSISTENT MEASURES.
ON THE OTHER HAND -- WELL, I
GUESS IT DEPEND.
CONSISTENT MEASURE IT IS DOESN'T
MATTER WHICH MEASURE YOU USE.
FROM THAT PERSPECTIVE, YOU ARE
-- YOU KNOW, THAT MIGHT BE A
GOOD THING.
ON THE OTHER HAND, ONES OF LOW
CONSISTENCY SHOW HIGH VARIANCE.
WE MAP IT OUT BECAUSE ONE OF THE
GOALS IS TO SEE, AGAIN, WHERE
SELECTING THE RIGHT SPATIAL IS
NECESSARY FOR POLICYMAKERS AND
THAT SORT OF THING.
LET'S GET TO SOME OF THE
RESULTS.
TRAVEL TIME TO NEAREST RESOURCE.
HERE WE SEE THAT FOR ALL THREE
MEDICATIONS.
VARIES ACROSS MEDICATION TYPE.
THIS IS CONSISTENT WITH OUR
PRIOR WORK, OTHER FOLKS' PRIOR
WORK.
MANY OF THE FOLKS ARE EITHER
TALKING HERE TODAY OR IN THE
AUDIENCE.
NOTE THAT THE LACK OF RESOURCES
FOR METHADONE AND RURAL AREAS,
AS WELL AS ACROSS OTHER PARTS OF
THE U.S., YOU KNOW, IT'S REALLY
NOT JUSTIFIED, ESPECIALLY
COMPARED TO THE WEALTH OF
POTENTIAL RESOURCES OF
OF BUPRENORP HINE AND
METHADONE.
AND NALTREXONE IN PREVENTING
OVERDOSES AND THE HIGHEST POLICY
ROAD BLOCKS AS WELL AS STIGMA.
SO THE LACK OF METHADONE
RESEARCH SPECIFICALLY MAY A
SIGNIFICANC
SIGNAL FOR OTHER BARRIERS LIKE
ATTITUDINAL AND, ETC.
ALL RIGHT, LET'S LOOK AT ONE
MEASURE LOOKING AT MULTIPLE
DIFFERENT METHODS.
WE LOOK AT A BOX PLOT CATEGORY
TO CHARACTERIZE ALL DIFFERENT
APPROACHES.
RED IS ESSENTIALLY AN OUTLIER.
AND SO THE APPROACH WILL DEPEND
ON WHICH -- WHICH METRIC YOU ARE
LOOKING AT. SO RED TO OUTLIERS.
BLYTHE BLUE TO PEACH OF THE CORE
TELL RANGE AND TOP THREE
RESOURCES ARE SIMILAR MAINLY
BECAUSE OF THE ACCUMULATION OF
RESOURCES AND POPULATION-LOADED
SUBURBS AND CITY CENTER.
HOWEVER, POPULATION IS NOT THE
ONLY THING.
BOTTOM THREE WHEN YOU TAKE INTO
ACCOUNT POPULATION IN OTHER WAYS
AGAINST THE BOTTOM RIGHT TWO,
THAT THE RAM MODEL, FOR EXAMPLE,
EVEN THOUGH THE TWO-STEP
FLOATING CATCHMENT AREA AND THE
RAM MODEL BOTH USE SUPPLY AND
DEMAND, THERE IS VERY CLEARLY
DIFFERENT VARIABILITY DEPENDING
ON THE TYPE OF MEASURE THAT YOU
USE.
TEXAS AND THE ROCKIES HAVE
DRAMATICALLY LESS ACCESS IN THAT
EXAMPLE.
HERE WE ARE LOOKING AT SPATIAL
ORLATION.
AND BASICALLY IF TWO THINGS ARE
STRONGLY CORRELATED WITH EACH
OTHER, IT MIGHT NOT MATTER WHICH
ONE YOU USE.
WHILE A LOT OF THE -- US
RESEARCHERS HAVE BEEN DEBATING
ON IS -- YOU KNOW, NEAREST
DISTANCE OR TRAVEL TIME BETTER
OR WORSE WHEN YOU ARE LOOKING AT
THIS AT A NATIONAL SCALE.
AND SOME CASES, THAT -- THOSE --
THOSE -- THAT DEBATE BECOMES
LESS IMPORTANT.
ESPECIALLY IS A HUGE VARIETY IN
WHAT YOU ARE LOOKING AT.
SPATIAL MATTERS ARE DISTINCT.
EXAMINE THE TO SEE LIGHTER
COMBARS.
BUPONORP HINE AND THEY PERFORM
SIMILAR TO EACH OTHER WITH HIGH
CORRELATIONS.
FOR EXAMPLE, IN THIS CAS
CASE, BUPRENORP HINE I WOULD
RECOMMEND USING A GRAVITY MODEL
AND WILL ACCOUNT FOR THE
POPULATION IN A DISTINCTLY
DIFFERENT WAY DOESN'T MATTER
WHICH GRAVITY MODEL AND DOESN'T
MATTER ACROSS THE URBAN,
SUBURBAN RURAL AREAS.
IN CONTRAST.
LET'S LOOK AT METHADONE.
WHILE URBAN AREAS HAVE LESS
CORRELATION BECAUSE WE SEE A
LITTLE BIT MORE OF THOSE LIGHT
AREAS.
SEVERAL ACCESS METRICS IN
SUBURBAN AND ESPECIALLY RURAL
AREAS ARE STRONGLY CORRELATED
WITH EACH OTHER.
DRIVING TIME AND NEAREST
RESOURCE IS ALMOST
INDISTINGUISHABLE.
THE LACK -- AND SO HERE -- WHY
IS THIS HAPPENING?
WELL, A HUGE LACK OF RESOURCES
AND VERY DIFFICULT TO HAVE
VARLGS IN ALMOST ZERO ACCESS.
I CONTEND THIS IS WHY WE
SOMETIMES SEE THAT METHADONE
SPATIAL ACCESS IS NOT A
SIGNIFICANT VARIABLE IN
DIFFERENT ANALYSES BECAUSE THERE
IS VERY -- IF YOU DON'T HAVE
SPECIFIC VARIATION, YOU ARE
MISSING THAT.
SO HERE TO KIND OF MAKE IT MORE
COMPLEX, WE ARE ONLY SHOWING
AREAS THAT WERE WITHIN 90-MINUTE
DRIVING TIME OF METHADONE AND
EVEN WHOLE OTHER SWATHS OF THE
COUNTRY THAT HAVE ZERO ACCESS
CONSISTEN
CONSISTENTLY WE ARE RECALLING
ANY MINUTES REASONABLE.
AND HIGHLIGHT THE VERY DRAMATIC
CHANGE OF URBAN, SUBURBAN AND
RURAL AREAS AND VERY IMPORTANT
TO STRATIFY BY URBANICITY IN
DOING THIS KIND OF WORK.
ANOTHER WAY TO LOOK AT THIS IS
LOOKING AT BOX PLOTS AS A WAY OF
KIND OF AGAIN -- THE BOX PLOTS
IS HOW WE ARE MAPPING IT BUT
LOOKING AT THE BOX PLOT ON A
TRADITIONAL WAY AND SO ON AND SO
FORTH.
SO I AM GOING TO JUMP TO THE
LAST SCREEN HERE.
ESSENTIALLY WHEN WE PUT THIS ALL
TOGETHER WHICH METRIC WAS FAST,
THE RAM MODEL HAD SUFFICIENT
VARIABILITY AND VERY EFFICIENT;
HOWEVER, IT ACTUALLY DIDN'T
MATTER FOR METHADONE.
METHADONE -- WE ACTUALLY FOUND
THAT FOR RESOURCES THAT ARE V
VERY SCARCE LIKE METHADONE,
MINIMUM DISTANCE MAY BE
CONSISTENT.
THAT IS A BIG SAY, BUT A BIG
FINDING.
THESE ARE SOME OF THE HIGH
MODELS.
WE FOUND THAT THE CONSISTENCY
BETWEEN SPATIAL -- MEASUREMENTS
WERE HETEROGENEOUS.
RESOURCES HAVE LESS CONSISTENCY
IN SUBURBAN AND RURAL AREA.
MATTERS WHAT YOU USE MEASURING
IN THOSE PLACES.
HOW POPULATION IS ACCOUNTED FOR
OR NOT CAN GENERATE INCONSISTENT
VIS.
IN THE END, RECOMMEND USING RAM
AND MINIMUM DISTANCE OR TRAVEL
TIME JUST TO BETTER COMMUNICATE
YOUR FINDINGS.
AND I ALSO MENTIONED SOME OF THE
COMPUTATIONAL NOTEBOOKS AND
THINGS BEING MADE AVAILABLE SO
OTHERS CAN DO THIS AS WELL.
THANK YOU, GUYS.
I THINK THE FIRST FEW MINUTES
THREW ME UP.
I POLL SIZE FOR RUNNING A MINUTE
OR TWO OVER.
>> THANK YOU SO MUCH FOR THAT
GREAT PRESENTATION.
I LOVED HEARING ALL THE NUANCE
ABOUT THE DIFFERENT MEASUREMENT
APPROACHES AND HOW THAT CAN
IMPACT -- IMPACT THE ABILITY TO
HAVE INSIGHTS.
THAT WAS GREAT.
JUST A REMINDER TO FOLKS WHILE
THE NEXT PRESENTATION IS GOING,
IF YOU HAVE QUESTIONS FOR
MARYNIA, PUT THEM IN THE Q AND A
AND WE WILL GET TO THEM AT THE
END OF THE SESSION.
HAND IT OVER TO DR. BANK.
>> THANK YOU.
OKAY.
I CAN'T SEE MYSELF BUT I ASSUME
YOU SHALL MARILY.
DEVIN BANKS, AND MY SESSION IS
INTEGRATING COMMUNITY ENGAGEMENT
AND GEO SPATIAL METHODS TO
ADDRESS RACIAL INEQUITIES.
SWITCH GEARS FROM ANALYTIC
METHODS AND COMMUNITY ENGAGEMENT
AS MENTIONED BY MY COLLEAGUE DR.
STOPKA EARLIER WITH THE GOAL OF
GETTING AT SOME OF THOSE USER
APPLICATIONS THAT -- THAT D
DR. BLANCO TALKED ABOUT IN THE
VERY -- IN HIS OPENING REMARKS.
AND ESPECIALLY AS THEY RELATE TO
RACIAL INEQUITIES.
I WOULD LIKE TO START WITH THE
PROBLEM SO WE ALL START FROM THE
SAME PLACE.
SINCE THE MID 2010s, FATAL DRUG
OVERDOSES HAVE INCREASED
DRASTICALLY OF PEOPLE
FROM MINORITY AND RACIAL AND
ETHNIC GROUPS ACROSS THE UNITED
STATES MANUFACTURE OF FENTANYL
IN THE DRUG SUPPLY AND
DISPROPORTION ALLEY IMPACTED
BLACK MEN IN PARTICULAR THATCH
-- KINDS OF THE SHARPEST SLOPE
OF INCREASE THERE FROM 2015 TO
20
2020 THIS LED A LOT OF
STAKEHOLDER INCLUDING NIDA THAT
PREVENTION AND TREATMENT EFFORTS
WERE NOT BENEFITING RACIAL
ETHNIC GROUPS.
EVEN RECENTLY, THE DATA SUGGESTS
THAT -- EVEN MORE RECENTLY AND
INTO THIS DECADE, THE CURRENT
DECADE, SUGGESTS THAT ALL KNOW
DEATHS ARE FALLING, THEY
CERTAINLY ARE NOT FALLING
EQUALLY AMONG RACIAL GROUPS.
WHILE RATES HAVE STABILIZED AND
TOTAL DEATHSES HAVE FALLEN
SIGNIFICANTLY AMONG WHITE
INDIVIDUALS, THAT IS NOT
NECESSARILY THE CASE THAT YOU
CAN SEE AMONG OTHER RACIAL ETHIC
GROUPS IN THE UNITED STATES.
SO IT IS WELL ESTABLISHED THAT
THIS HAS NOTHING TO DO WITH RACE
WITH YOU WITH SOCIAL
DETERMINANTS OF HEALTH THAT WE
HEARD A LOT ABOUT ALREADY TODAY.
FOR EXAMPLE, NO 022, INCOME
INEQUALITY WAS ASSOCIATED WITH
DRUG OVERDOSE.
BUT PARTICULARLY AMONG BLACK
AMERICANS, SUCH AS THE HIGHEST
PER TILE OF INCOME INEQUALITY
WAS ASSOCIATED WITH FATAL
OVERDOSE TWO TIMES AS HIGH AS
THE LOWEST.
WE DIDN'T SEE THAT DRASTIC OF A
DOSE RESPONSE RATE AMONG OTHER
GROUPS.
AS YOU MITE IMAGINE SOCIAL
DETERMINANTS OF HEALTH VARY BY
REGION AND SO DO INEQUITIES.
THIS IS THE RATE OF OVERDOSE
AMONG BLACK INDIVIDUALS IN THE
UNITED STATES.
WHERE I LIVE IN MISSOURI.
THE DARK BLUE SPOT IN THE MIDDLE
LOWEST RATE OF BLACK OVERDOSES
IN THE COUNTRY BETWEEN 2019 AND
202
2022 AND WHAT WE SEE IN MISSOURI
IS REFLECTING A LOT OF THE
TRENDS WE ARE SEEING NATIONALLY
AS WELL IN PARTICULAR HIGH RATE
BELONG BLACK MEN.
THE HIGH RATE AMONG BLACK MEN IN
MISSOURI IS DRIVEN LARGELY BY
THE ST. LOUIS METROPOLITAN AREA
WHICH ACCOUNTS FOR 45% OF STATE
DRUG INVOLVED DEATHS AND 75% OF
STATE -- STATE INVOLVED DEATH.
AND VERY SUB EPIDEMIC BLACK
RESIDENTS.
LIKE I SAID, THIS IS NOT DRIVEN
NECESSARILY BY RACE BY
RACIALIZED DETERMINANCE OF
HEALTH.
THIS -- THIS ENVIRONMENTAL
EXPOSURE DRIVES RACIAL
INEQUITIES.
IN ST. LOUIS, THE IMPACT OF
SOCIAL DETERMINANTS HAVE BEEN
DEMONSTRATED THROUGH DATA
VISUALIZATION AND GIS.
THESE ARE JUST MAPS THAT SHOW
THE CONCENTRATION OF AFRICAN
AMERICAN POPULATION, POVERTY,
RELATIVE TO THE CAUSE OF HEART
DISEASE AND CANCER.
THESE WERE ALL THE WAY BACK IN
2013.
AND THIS IS ST. LOUIS CITY.
AND ST. LOUIS COUNTY.
AND WHAT THEY ARE TRYING TO
DEMONSTRATE OR HOP CREATED THESE
MATCHES WERE TRYING TO
DEMONSTRATE POVERTY AND THE
PERCENTAGE OF AFRICAN AMERICAN
WAS ASSOCIATED WITH HEALTH
INEQUITIES. SO CERTAINLY RACE
AND POVERTY IS RELATED TO
OVERDOSE, BUT WE DO KNOW THIS IS
MORE COMPLEX BECAUSE IN THE
COMPLEX OF THE FENTANYL ERA,
ENVIRONMENTAL EXPOSURES ARE MORE
PROMINENT.
BLURRIER THAN IT LOOKED ON MY
COMPUTER.
I APOLOGIZE FOR THAT.
BUT THIS WAS SOME WORK WE DID A
COUPLE OF YEARS AGO.
BASE AND WORKING THAT
ELIZABETH NESOF DID AND OTHERS
THAT SHOWED THAT IN THE FENTANYL
ERA, FENTANYL INVOLVED DEATHS
CLUSTER MORE DENSELY THAN OTHER
TYPES OF DRUG-INVOLVED -- OR
OVERDOSE DEATHS.
IN ST. LOUIS, WE FOUND THAT DRUG
OVERDOSE CLUSTERED NOT ONLY MORE
DENSELY IN THE FENTANYL AREA BUT
CLUSTERED MORE DENSELY IN NORTH
CITY ST. LOUIS.
THIS THE READ AIR AREA IN THE
TOP LEFT-HAND SIDE.
BLACK NEIGHBORHOOD THAT HAVE
BEEN DIVESTED IN.
AND THAT WAS EXPECTED AMONG THE
BLACK DECEDENENTS.
WHITE RESIDENTS WERE MORE
CLUSTERED IN THOSE PREDOMINANTLY
BLACK NEIGHBORHOODS.
SO THAT LED US, YOU KNOW, TO THE
QUESTION, WHAT ARE THE SPECIFIC
SOCIAL DETERMINANTS DRIVING
OVERDOSE IN THESE AREAS?
IT IS NOT JUST RACE. ONE OF THE
THINGS THAT HAVE BEEN POINTED TO
IS ACCESS TO TREATMENT.
I SHOWED THIS MAP TO DEMOCRAT
STRAIGHT AS AN EXAMPLE THAT GIS
IS NOT ONLY EASILY TRANSLETABLE
TO COMMUNITY SETTINGS BUT ALSO
SOMETHING THAT WE FOUND THAT
COMMUNITIES ARE INTERESTED IN.
AT THIS TIME, IN 2021, OUR
COMMUNITY PARTNERS WERE
INTERESTED IN MAPPING, TREATMENT
ACCESS AND OTHER DETERMINANTS OF
HEALTH AND SOMETHING THAT ONE OF
OUR PARTNERS PUT TOGETHER AS A
RUDIMENTARY ATTEMPT AT GIS.
SO THIS TOLD ME THAT GIS HAD
SIGNIFICANT POTENTIAL FOR
TRANSLATION TO COMMUNITY
SETTINGS.
BUT AS FAR AS I COULD TELL, IT
WASN'T REALLY BEING APPLIED OR
TRANSLATED TO THE COMMUNITY IN
OUR REGION DESPITE THE INTEREST
AND EASE OF INTERPRETATION.
AND THAT IS A SHAME, BECAUSE A
LOT OF GIS RESEARCH HAS BEEN
APPLIED TO OVERDOSE.
THIS IS A PAPER PUSH IN 2022
THAT FOUND THAT OVER 231
ARTICLES ARE -- THAT 231
ARTICLES USING GIS 2
CHARACTERIZED OPIOID OVERDOSE
SPECIFIC LOW AND OVER 3/4 OF
THOSE WERE PUBLISHED IN THE LAST
FIVE YEARS SINCE 2017.
MOST OCCURRED AT THE LOCAL LEVEL
DEMONSTRATING THAT POTENTIAL FOR
ENGAGEMENT WITH THE LOCAL
COMMUNITY. BUT WHAT -- WHAT TYPE
OF COMMUNITY?
WELL FOR ME, I WAS PARTICULARLY
INTERESTED IN -- IN -- MY WORK
IN RACIAL INEQUITIES.
THE DETERMINANCE OF HEALTH AND
ACCESS TO TREATMENT IN
PREDOMINANTLY BLACK
NEIGHBORHOODS, SOME MOBILE
APPROACHES HAVE POPPED UP.
I KNOW IT POPPED UP IN OUR CITY
IN ST. LOUIS, BUT ALL OVER THE
COUNTRY.
IT CAN LOOK LIKE GRASS-ROOTS
ORGANIZATIONS THAT RETROFIT
MOBILE VEHICLES.
IT CAN LOOK LIKE BRICK AND
MORTAR ORGANIZATIONS THAT SEND
OUTREACH WORKERS.
IT CAN LOOK LIKE PEERS -- PEER
OUTREACH PROGRAMS.
BUT BASICALLY PEOPLE ARE
DISPATCHING -- LAY HEALTH
WORKERS, PEERS, COMMUNITY WORK
ARES TO UNDERSERVED COMMUNITIES
TO MITIGATE SOCIAL DETERMINANTS.
WE KNOW OUTREACH THAT CAN
IMPROVE TRUST AND ACCESS IF
PEOPLE KEEP SHOWING UP TO
NEIGHBORHOODS AND PROVIDING
SERVICES WHERE THERE WERE NOT
PREVIOUSLY SERVICED.
SERVICES RANGE FROM BASIC NEEDS
NO NALOXONE TO WOUND CARE TO
EVEN BUPRENORP HINE PRODUCTION
AND RELIANCE ON CONVENIENCE OR
ARBITRARY METHODS LIKE WORD OF
MOUTH, FUNDING, AGENCY POLICY,
AND THEN, OF COURSE, SIGMA, WHO
WILL ALLOW YOU TO PARK THEIR
MOBILE VAN IN THEIR PARKING LOT,
FOR EXAMPLE.
SO MY QUESTION IS, CAN DATA
DRIVEN OUTREACH, CAN WE USE GIS
AND MAPS TO IMPROVE SERVICE
IMPACT AND ENVELOPE
INTERVENTION?
BASICALLY RAPIDLY TRANSLATE
OPIOID OVERDOSE SURVEILLANCE TO
MOBILE OUTREACH.
BUT GIVEN WE ARE TALKING OF
COMMUNITIES THAT HAVE BEEN
INVESTED IN.
THE QUESTION END SPIRALED BY
COMMUNITIES THEMSELVES.
I COULDN'T BEGIN TO ANSWER THEIR
QUESTION INPUT.
WE DID A FOCUS GROUP.
WE ENGAGED -- BASICALLY EXISTING
PARTNERS THAT WE KNEW WE WERE
DOING OUTREACH IN BLACK
NEIGHBORHOODS IN NORTH ST.
LOUIS.
THEY REPRESENTED ORGANIZATIONS
FROM GRASS-ROOTS NONPROFITS TO
LARGE TREATMENT AND SERVICE
AGENCIES.
THEY ALL HAD OPERATIONAL AND
SUPERVISING ROLE.
MEANING THEY -- THEY EITHER WERE
GOING OUT ON -- ON OUTREACH
EVERY DAY.
AND THAT WAS THEIR MAIN JOB.
SO THEY DECIDED WHERE THEY WERE
GOING.
OR MAYBE THEY RAN AN OUTREACH
TEAM OF PEERS OR THE ONLY PERSON
AT THEIR ORGANIZATION WHO WAS
RESPONSIBLE FOR OUTREACH.
THEY WORKED FOR THE BRICK AND
MORTAR AND THEY WERE THE
COMMUNITY OUTREACH COORDINATOR.
SO DURING THE FOCUS GROUP,
PARTICIPANTS WERE ASKED OF THEIR
CURRENT OUTREACH EFFORTS AND
THEIR ATTITUDE TOWARD MAPPING
EFFORTS IN ST. LOUIS THAT WERE
ALREADY GOING ON.
WE CREATED SOME BASIC MAPS IN
OUR GIS, DEMONSTRATING OVERDOSE
LIKE IN A HEAT MAP, OVERLAID
WITH SUBSTANCE ABUSE TREATMENT
AND SERVICES THAT EXIST WHICH
YOU CAN SEE KIND OF ON THE
LEFT-HAND SIDE, AND THEN WE --
WE SHOWED THEM SOME POINT MAPS
AND HOW THE FILTERS WORK.
AND SO ON THE RIGHT HAND JOB,
THERE IS A MAP FILTER BY YEAR
AND RACE.
BUT MOSTLY, WE WERE INTERESTED
ON ACCESSIBILITY OF MAPS LIKE
THIS.
AND PREADOPTION AND
IMPLEMENTATION QUESTIONS.
THESE ARE THE THEMES WE
EXTRACTED FROM THE DATA. I WILL
GO WITH EACH OF THEM
INDIVIDUALLY.
THE FIRST ONE IS IMPORTANCE OF
CONSIDERING BROADER COMMUNITY
CONTEXT.
SO OUR INTENT WAS TO DISCUSS THE
MAPPING TOOL AND IMPLEMENTATION
QUESTIONS AND QUESTIONS OF THE
SIZE OF THE CONTEXT UNDERLYING
RACIAL SOCIAL DETERMINANCE.
THEY ARE FOCUSED OUT CURRENT AND
HISTORICAL POLICIES WERE
IMPACTING BLACK COMMUNITIES
LEADING TO BASICALLY REALLY
VISIBILITY BLACK, WHITE
DISPARITIES IN OUR COMMUNITY.
AND THIS DERIVED -- PART FROM MY
PREVIOUS CONCERNS ABOUT WITH
INITIATIVES THAT USE MAPPING TO
MAP THINGS LIKE HIV AND STI
DISPARITIES THAT INSTALLED
LIMITED IMPACT AND IT NO SOCIAL
DETERMINANTS WERE REALLY
ADDRESSED IT.
OR THE SOCIAL DETERMINANCE
BARRIERS WERE MADE HARDER TO
IMPLEMENT.
AND APPEAR MAPPING TOOL WILL NOT
ONLY SHOW OVERDOSE BUT SHOW THE
SOCIAL DETERMINANTS OF HEALTH
THAT HAVE TO IT BE MITIGATED IN
ORDER TO EFFECTIVELY REDRESS
OVERD
OVERDOSE I AM JUST LEAVING THIS
UP FOR YOU FOR A SECOND TO READ
THE QUOTE. THE SECOND THEME WAS
DATA MANIPULATION AND VALIDITY
CONCERNS.
SO NOT UNEXPECTEDLY PARTICIPANTS
WERE APPREHENSIVE OF THE
VALIDITY OF THE OVERDOSE DATA
THAT THE TOOL WOULD DISPLAY THAT
WE GET FROM THE MEDICAL
EXAMINER'S OFFICE OF ST. LOUIS
CITY AND COUNTY.
THEY DOUBTED WHETHER THE DATA
COULD ACCURATELY REPRESENT THE
PEOPLE WHO USE DRUGS THAT THEY
WORK WITH MANY OF WHOM WERE
UNHOUSED AND FACED STRUCTURAL
BARRIERS THAT LED THEM, QUOTE,
"INVISIBLE TO THE SYSTEM."
AND THAT HAS BEEN SPOKEN ABOUT
QUITE A BIT.
AND IT IS A FAIR CRITICISM BUT
WE KNOW THERE ARE RACIAL
DISPARITIES IN HOW THESE DATA
ARE PROCESSED AND COLLECTED.
NOT ONLY ABOUT BASIC DATA
VALIDITY BUT ALSO MANIPULATION
CONCERNS.
SKEPTICISM OF HOW THE DATA WILL
BE USED AND WHO IT WILL ATTRACT.
IN PARTICULAR BAD ACTORS.
PARTICIPANTS WERE CONCERNED THAT
A MAP HIGHLIGHTING MAJORITY
BLACK AREA AS HIGH CRIME, HIGH
OVERDOSE COULD LEAD TO FURTHER
DISINVESTMENT OF THOSE
NEIGHBORHOODS, INCREASED LAW
ENFORCEMENT PRESENCE, AND CAN BE
USED TO JUSTIFY AND ENCOURAGE
GENTRIFICATION AND DISPLACEMENT
OF BLACK RESIDENTS RATHER THAN
IMPROVING THEIR CIRCUMSTANCES.
THIS FIRST CODE KIND OF CITES A
PREVIOUS INSTANCE THAT
PARTICIPANTS COULD REMEMBER THAT
HAPPENING IN THEIR OWN LIFETIME.
>> THE THIRD -- I WILL SAY
DESPITE THAT, THERE WERE SOME
BENEFITS WITHIN THE DATA HAVE I
LID CONCERNS.
A QUOTE FROM A PARTICIPANT WHO
TALKED ABOUT HOW HE ALREADY USED
THE DATA THAT WERE AVAILABLE BY
ZIP CODE TO CHECK OUT SPECIFIC
NEIGHBORHOODS.
AND HE DIDN'T TAKE IT FOR FACE
VALUE, BUT, YOU KNOW, HE USED IT
AS ONE DATA POINT. THE NEXT INTO
EMWAS POTENTIAL FOR AWARENESS,
ENGAGEMENT AND COMMUNITY
COLLABORATION.
DESPITE CONCERNS, PARTICIPATE
TONIGHTS ENDORSED THE
COMPATIBILITY OF AN OVERDOSE
VISUALIZATION TOOL WITH CURRENT
SERVICE AND COMMUNITY NEEDS.
THEY TALKED OF HOW A MAP WILL
HELP THEM WITH OUTREACH AND
SPECIFIC TARGET RESOURCES.
FOR EXAMPLE FOR PEOPLE WHO USE
STIMULANTS, WHO WERE -- WHO WERE
FACING -- PEOPLE THAT THOUGHT
THEY WERE ONLY USING STIMULANTS
WHO THEY FELT COULD BE AT
SPECIFIC RISKS AND WEREN'T
GETTING THE RESOURCES THEY NEED.
SO, HOWEVER, PARTICIPANTS MOST
STRONGLY VIEWED A TOOL LIKE THIS
AS AN ADVOCACY TOOL.
AT THE INDIVIDUAL LEVEL, THEY
TALKED OF WHO YOU IT WILL
INCREASE GENERAL AWARENESS OF
OVERDOSE IN THE NEIGHBORHOODS
THEY WORK WITH AND REDUCE STIGMA
TO HAVE SOMETHING ON A PHONE OR
AN iPAD, AND TALK OF THE
OVERDOSES THAT HAPPEN IN THIS
NEIGHBORHOOD OR THIS COMMUNITY
TO INCREASE AWARENESS TO
ENCOURAGE RESIDENTS TO CAR
CARRY NALOXONE, THINGS LIKE
THAT.
AND COLLABORATION AND REFERRAL
ACROSS ORGANIZATIONS.
AND CAN SEE ORGANIZATIONS DOING
THIS WORK ON THE MAP.
AND THEN AT THE POLICY LEVEL,
THEY THOUGHT IT COULD BE A GREAT
STRATEGY TO ADVOCATE FOR
INCREASED FUNDING AND ENGAGEMENT
WITHIN THEIR COMMUNITIES AND FOR
THEIR ORGANIZATIONS
SPECIFICA
SPECIFICALLY.
FINAL THEME WAS ENSURE DATA
RELEVANCE TO THE AFFECTED
COMMUNITY.
PARTICIPANTS STRESS THE
IMPORTANCE OF PEOPLE WITH LIVED
EXPERIENCE WITH THE DEVELOPMENT
OF ANY OVERDOSE MAPPING TOOL.
THEY -- ALTHOUGH THEY VALUED
SPATIAL DATA, THEY BELIEVED IT
SHOULD BE PAIRED WITH DATA AND
NARRATIVE AND STORYTELLING AND
VITAL FOR FRAMING THE MAPS SO
THEY DIDN'T CONTINUE TO
PERPETUATE STIGMA FOR PEOPLE WHO
USE DRUGS OR BAD ACTORS TO
FURTHER DISINVEST IN BLACK
MAJORITY AREAS WITH HIGH
OVERDOSE RATES. AND THEN I WILL
SEND WITH THIS QUOTE JUST TO
HIGHLIGHT TOWARD THE END OF THE
FOCUS GROUP.
DEFENSE STATION OF THE OVERDOSE
CRISIS IN BLACK COMMUNITIES WAS
SO SEVERE THAT BETTER TO USE THE
DATA IN HOPES OF ATTRACTING MORE
AWARENESS AND RESOURCES AND TO
IMPROVE THEIR WORK.
THE POTENTIAL BARRIERS AND
CONCERNS ABOUT IT. SO WE HAVE
THESE FOUR THEMES.
AND WE HAVE THESE FOUR THEMES,
VALIDITY, COMPLEX, POTENTIAL AND
COMMUNITY RELEVANCE.
AND WE HAD THIS DATA.
WE HAVE DATA THAT WE -- LOCATION
OF INJURY THAT WE CAREFUL LY
GEOCODED FROM THE MEDICAL
EXAMINER'S OFFICE.
AND I REALLY WAS HAVE HAD --
INTERESTED IN HOW TO GET THIS
DATA ON THE STREETS WITH THE
OVERDOSE PREVENTION AND TO HELP
THEIR WORK.
FROM THAT FOCUS GROUP, PROJECT
MOST WAS BORN.
WHICH IS WHAT WE CALL MY CAREER
DEVELOPMENT AWARD PROJECT FR
FROM NIDA.
IT IS NOT THE NAME -- NOT THE
NAME OF THE PROJECT, BUT I FOUND
THAT IN COMMUNITY ENGAGEMENT
WORK.
YOU NEED A CATCHY TITLE SO
PEOPLE CAN IDENTIFY WHAT YOU ARE
DOING. AND THE IDEA FOR AT
PROJECT "MOST" IS TO CREATE A
COMMUNITY-INFORMED INDEX.
THAT TRANSLATES DATA TO OUTREACH
PREVENTION SERVICES WHILE -- TO
ACHIEVE THE AWARENESS AND
ENGAGEMENT POTENTIAL THAT THE
COMMUNITY SAW THROUGH SOCIAL
DETERMINANTS OF HEALTH AND DATA
RELEVANCE TO THE COMMUNITY FROM
COMMUNITY PARTNERS.
I HAVE SEVEN CONSULTANTS AND
ENGAGED IN PARTICIPATORY PROCESS
WITH SCIENCE AND GEOGRAPHY AND
APPLYING IT TO HEALTH.
THE IDEA IS THAT THEY BRAINSTORM
AND RANK SOCIAL DETERMINANTS OF
HEALTH VARIABLES IN AN
ANALYTICAL HIERARCHY PROCESS
TOWARD THIS COMMUNITY ARRIVED
SPATIAL INDEX. I HAVE TO SAY I
DID NOT COME UP WITH THIS.
THIS HAS MORE RECENTLY STARTED
TO BE APPLIED TO THE HEALTH
SCIENCES RICHARD SADDLER AND
COLLEAGUES IN MICHIGAN HAVE USED
THIS PROCESS AND AN EXAMPLE OF
WHAT AN POLITICAL HIERARCHY
PROCESS MIGHT LOOK LIKE.
TO USING A -- SEVERAL COMMUNITY
STAKESHOULDERS WITH DIFFERENT
ROLES THE FLINT GEOSPATIAL
HEALTH INDEX.
AND THIS PAPER IS FROM 2019, BUT
MORE RECENTLY A VALIDATION OF
THEIR INDEX AND FOUND THAT THEIR
COMMUNITY DERIVED HELPFUL SCORES
IS RELATED TO THINGS LIKE BLOOD
PRESSURE.
NOT CONDITIONS OR SPECIFIC, SO
WE ARE TRYING TO REPLICATE THIS
AND MAKE IT CONDITION SPECIFIC.
AND FRANKLY, INEQUITY LOOKING AT
RACIAL DETERMINANCE OF HEALTH
AND THE IDEA THAT THAT INDEX CAN
BE USED FOR ADVOCACY AND STIGMA
AND INTERVENTION AS WELL AS
SERVICE PRIORITIZATION FOR LAY
HEALTH CARE WORKERS AND MODEL
REP POLICE THE CA-- REPLICATED
OTHER AREAS WITH HAY SHALL SUB
EPIDEMICS.
SO I HAVE JUST A LITTLE BIT OF
DATA TO SHOW YOU.
SO I WILL SAY THIS.
THIS PARTICIPATORY GIS PROCESS,
THE STAGES ARE CONVENING,
DELIBERATION AND OUTCOMES.
CONVENING IS THE BRAINSTORMING,
ANALYTICAL HIERARCHY AND
OUTCOMES YOU DO THE VALIDATION.
SO IN CONVENING OUR CONSULTANTS
WERE INTRODUCED TO PROJECT
GOALS.
SUSTAINED MEMORANDUMS OF
AGREEMENT.
AND INTRODUCTION ON GIS AND SOME
TRAINING ON IT.
LITERATURE REVIEW THAT WE SHOWED
GEOSPATIALLY BASED ON THE
LITERATURE.
AND BASED ON THEIR LIVED
EXPERIENCE AND THEY BRAINSTORMED
THEY FELT WERE MOST RELEVANT TO
BLACK OVERDOSE IN ST. LOUIS. AND
YOU WILL SEE A LOT OF THE THINGS
THAT CONSULTANTS CAME UNDER WITH
MATCHED UP WITH THE LITERATURE
REVIEW AND ADDED A FEW AND TOOK
AWAY A FEW.
AND A LOT OF THEM HAVE ASTERISKS
BY THEM AND ADDED A LOT MORE
COLOR.
THEN WHAT IS -- THEN OUR
PREVIOUS DEFINITIONS. ARE YOU
ABLE TO ADVANCE THE SLIDES FOR
ME?
THEY STOPPED ADVANCING.
FORECAST, HOUSING QUALITY AND
STABILITY, THAT IS GREAT, BUT
ALSO CAN WE PRESSURE
GENTRIFICATION AND DISPLACEMENT.
PREDATORY LENDING.
EXCLUSIONARY ZONING PRACTICES
THAT ONLY ALLOW CERTAIN TYPES OF
BUILDINGS.
FOR EXAMPLE, THEY HIGHLIGHTED
NOT ONLY INSURANCE STATUS AND
TYPE, BUT ALSO INSURANCE
UTILIZATION. NEXT SLIDE.
OVER TWO THIRD OF DETERMINANCE
WERE NEW AND NOT IN THE
LITERATURE THAT HIGHLIGHTS THE
BENEFITS OF PARTICIPATORY
MAPPING HERE.
NEXT SLIDE. AREA OF THE
DEPRAVATION INDEX AND THE DOME
INDEX AND THEY ARE VARIABLES
JUST TO SHOW -- NEXT SLIDE,
PLEASE -- THESE ARE THE DOMAINS
THAT OUR CONSULTANTS HAVE COME
UP WITH THAT WE ARE WORKING ON
GETTING THE INDIVIDUAL VARIABLES
INTO EACH OF THOSE DOMAINS.
YOU CAN SEE HOW DIFFERENT THEY
ARE THAN SOMETHING LIKE A AHTRA
ELNASHAR DI-- A TRADITIONALLY
DERIVED INDEX.
GIS HAS MATERIALS OF THE BLACK
COMMUNITY AND UNDERRESOURCED
INCLUDING INFORMING
LOCATION-BASED TARGET.
APPROVING AWARENESS AND STIGMA
AND COLLABORATION.
DESPITE BENEFIT, WE HAVE TO
RECOGNIZE THE CHALLENGES AND
SKEPTICISM REMAIN DUE TO
INEQUITIES IN DATA VALIDITY AND
DATA USE.
COMMUNITY-EN GAMED GEOSPATIAL
REQUIREMENTS CAN MITIGATE
CHALLENGES AND ILLUMINATE NO
SOCIAL DETERMINANCE OF OVERDOSE
TO ADVANCE THE SCIENCE OF HEALTH
EQUITY.
THAT'S ALL I HAVE FOR YOU.
THANK YOU.
>> THANK YOU, DR. BANKS FOR THAT
GREAT PRESENTATION.
AND HIGHLIGHTING THE IMPORTANCE
OF ENGAGING PARTNERS TO
INTERPRET DATA, AS WELL AS EVEN
IDENTIFY WHAT DATA ARE THE MOST
IMPORTANT TO BE CONSIDERING IN
THE FIRST PLACE.
THANK YOU FOR THAT.
I NOTICED ONE QUESTION THAT CAME
IN THROUGH THE Q ANDA AND SHE
ANSWER IT RELATED TO RESOURCES
OF CONGESTION DATA.
AND THERE IS A LINK IN THERE TO
ACCESS WITH A NOTE THAT THERE
WILL BE SOME NOTEBOOKS COMING
OUT SOON AND THERE WILL BE MORE
DETAILS FOR INDIVIDUALS
INTERESTED IN THAT.
I DIDN'T SEE ANY OTHER QUESTIONS
COME IN.
I DO HAVE A COUPLE THAT I CAN
START WITH WHILE WE WAIT FOR
OTHERS.
SO DR. BANKS, I WILL JUST START
WITH YOU.
YOU TALKED OF THE IMPORTANCE OF
TRUST IN DATA AND HOW THAT TRUST
HAVEN'T BEEN BY RESEARCHERS OR
COMMUNITY LEADERS.
AND SOME POINT, PEOPLE HAVE
BROKEN TRUST.
AND MANY IN THE COMMUNITY MAY
NOT SEE THEMSELVES REFLECTED IN
THE DATA OR HELPED WITH DATA
USE.
I AM JUST WONDER WHAT KIND OF
CAPACITY BUILDING OR TRAINING
YOU THINK MIGHT BE NEEDED FOR
THE RESEARCH COMMUNITY TO BETTER
SUPPORT THIS MEANINGFUL
ENGAGEMENT IN THE RELATIONSHIPS
WITH THE APPROACHES YOU ARE
MODELING OF TRUST AND DATA BY
THE COMMUNITY AND CAN BE USED
FOR BENEFITS.
ARE THERE SPECIFIC TYPES OF
RESOURCES REFUNDED OR SUPPORTED
TO HELP THE FIELD?
>> YEAH, YOU KNOW, I THINK IT IS
BEST FOR RESEARCHERS TO HEAR
DIRECTLY FROM COMMUNITY PARSERS
IN.
THAT IS WHERE I LEARN THE BEST.
SO ANYTHING THAT IS EMPOWERING
OR EMBOLDENING COMMUNITY MEMBERS
WHO HAVE GOTTEN ENGAGED IN A
MEANINGFUL WAY WITH A COMMUNITY
ADVISORY BOARD OR CONSULTANT TO
SHARE THEIR EXPERIENCE AND
LEARNINGS AND RESOURCES FOR
RESEARCHERS, RIGHT.
THEY HAVE GOTTEN INVOLVED IN
RESEARCH AND LEARNED OF THE
RESEARCH PROCESS AND TAKEN IT
BACK WHO WANTED TO ENGAGE MORE
IN COMMUNITY.
HEARING WHAT WE THINK
COMMUNITIES WILL BE INTERESTED.
I LEARNED THIS EVERY TWO WEEKS
WHEN I HAVE MEETING WITH
CONSULTANTS THAT THING THEY WILL
BE INTERESTED IN EVEN THOUGH
DEVELOPED RELATIONSHIPS WITH
THEM OF WHAT THEY ARE ACTUALLY
ARE INTERESTED IN ARE ALWAYS
VERY DIFFERENT.
I GIVE TALKS ALL THE TIME AND
HAPPY TO TELL PEOPLE WHAT I
LEARNED AND HEARING FROM
COMMUNITY MEMBERS TO HAVE BEEN
ENGAGED IN THIS RESEARCH AND
WHAT THEIR CONCERNS ARE THE MOST
IMPACTF
IMPACTFUL.
>> ANOTHER QUESTION CAME IN
THROUGH Q&A.
AND MEASUREMENT OF TREATMENT
ACCESS.
WE KNOW THERE IS DIFFERENCE IN
DOSING FOR BUPRENORP HINE AND
ACCESSIBLE.
AND I AM WONDERING HOW THAT WILL
BE INCLUDED IN MEASURES OF
ACCESS.
NOT JUST ACCESS OF THE
MEDICATION BUT HIGHER DOSE WHERE
IS IT IS NEEDEDED WITH
PREDOMINANCE OF FENTANYL, FOR
EXAMPLE.
WONDER IF YOU CAN SPEAK TO THAT.
>> I THINK CHALLENGE THERE IS
DATA THAT EXISTS FOR THE WHOLE
COUNTRY AT SCALE.
OFTENTIMES, THAT IS NOT THE
CASE.
AND OUR APPROACH HAS BEEN WHAT
WE FIGURE OUT AT SCALE FOR THE
COUNTRY AND THAT IS THE INITIAL
VIEW AND WORK WITH THE COMMUNITY
AND A LOT OF OUR COLLABORATORS
ON THIS -- ON THIS SERIES OF
PROJECTS ARE ACROSS THE COUNTRY.
SO A BIG PART OF IT IS --
ACTUALLY WHAT DR. BANKS SAID AS
WELL.
GOING TO THOSE AREAS IN
COMMUNITIES AND KIND OF
CONNECTING ON THAT LEVEL TO SEE
WHAT -- NOT JUST TO SEE WHAT IS
AVAILABLE, BUT WHAT HIGHEST
TOPICS OF CONCERNS ARE IN THOSE
AREAS.
FOR EXAMPLE, MEDICATION DOSES.
HIPPA SPECIFIC -- HIPPA SPECIFIC
TOPIC.
AND THIS WILL BE KIND OF LIKE A
SUB NATIONAL ANALYSIS, TO
VALIDATE A COMPONENT OF IT.
THAT IS WITH A LOT OF THE WORK
WE DO, WE ARE TRYING TO UNDER
BETTER UNDERSTAND HOW THESE
PROCESSES WORK.
AND WE ARE TRYING TO ADVANCE
ANALYSIS, AND MAKE AN IMPACT
RIGHT NOW.
CONSTANT TENSION WHAT WE CAN --
WHAT CAN WE DO WITH ALL THE
LIMITATIONS THAT WE HAVE AND
WHAT CAN WE PROVIDE TO
POLICYMAKERS, COMMUNITY GROUPS,
RESEARCHERS TO IMPACT THINGS.
I THINK THAT IS MAYBE A
NONANSWER.
JUST DEPENDS.
>> GREAT, THANKS.
I DIDN'T SEE ANYTHING ELSE COME
IN, SO I HAVE ANOTHER ONE.
I THINK -- DR. KOLAK.
YOU TALK A LOT OF FACTORS THAT
INFLUENCE SPATIAL FACTORS,
DISTANCE, BORDERS, URBANICITY,
AS THEY RELATE TO LOCATION OF
SERVICES.
I AM WONDERING HOW WE MIGHT
AFFECT OTHER FACTORS SPATIALLY.
EARLIER IN YOUR PRESENTATION YOU
STALKED OF STIGMA AND INTERESTED
IN LEARNING THAT.
I THINK OF COMMUNICATION AROUND
RESOU
RESOURCE AVAILABILITY.
IN MY COMMUNITY, WE HAVE A
PROGRAM THAT THE POLICE
DEPARTMENT IS FOCUSING ON
REFERRING DIRECTLY TO TREATMENT
AND TRYING TO AVOID ENTRY INTO
THE JUSTICE SYSTEM.
AND THEY TALK A LOT ABOUT IT IN
COMMUNITY NEWSLETTERS AND
PROMOTE IT.
A GOOD SOURCE OF PRIDE.
EVERYBODY IN THE COMMUNITY KNOWS
OF THIS ACCESS TO THIS PROGRAM,
RIGHT.
BUT THAT MAY NOT BE THE CASE IN
A LOT OF AREAS, AND EVEN IF A
PROGRAM IS AVAILABLE PEOPLE MAY
NOT KNOW ABOUT IT.
WONDERING HOW WE MIGHT MAP THESE
OTHER KIND OF SOFTER ACCESS
MEASURES AND MAYBE YOU CAN
SPEAK.
AND DR. BANKS, YOU MOO IT HAVE
INSIDES ON THIS TOO.
>>.
>> WELL, I WILL SAY AT THIS
PARTICULAR STUDY -- ONE OF THE
FINDINGS THAT I WASN'T ABLE TO
TALK ABOUT IN TOO MUCH DETAIL
IS, FOR EXAMPLE, I MOAN, THERE
ARE SOME AREAS THAT CLEARLY HAVE
POOR ACCESS.
RURAL -- CERTAIN TYPES OF RULES
AREAS, SPARSE AREAS NEAR
NATIONAL PARKS AND THAT KIND OF
THING.
GOT IT.
ANOTHER INTERESTING THING CAME
OUT WHEN WE STRATIFIED BY THE
SOCIAL DETERMINANT HEALTH
CLUSTERS, AS WELL AS THOSE
DIFFERENT, LIKE, CENSUS-BASED,
LIKE, PUBLIC TRANSPORTATION,
COMMUTING MEASURES .SO WE FOUND
THAT SUBURBAN AFFLUENT PLACES
AND PLACES EXTREME POVERTY
ACTUALLY HAD SIMILAR SPATIAL
ACCESS TO RESOURCES.
AND THAT ACTUALLY MAKES -- YOU
KNOW, A LOT OF PLACES OF THIS --
LIKE EXTREME POVERTY WOULD EXIST
IN URBAN ENVIRONMENTS AND
RESOURCES NEARBY.
HOWEVER, THE NUMBERS ARE ALMOST
INDISTINGUISHABLE AND SDOH AND A
COMPLETELY DIFFERENT STORY.
FOLKS ARE WALKING FOLKS ARE
WALKING TO WORK.
USING PUBLIC TRANSPORTATION TO
WORK.
THEY DON'T HAVE ACCESS TO
VEHICLES EVEN THOUGH NUMBERS ARE
THE SAME, A DIFFERENT EXPERIENCE
AND DIFFERENT BARRIERS THAT
DIDN'T EXIST BEFORE AND LOOKING
AT ONE DIMENSION AND YOU CAN
FOLD IN ALL THE OTHER -- SORT
OF SDOH AND STRUCTURAL DRIVERS
THAT GO WITH THAT.
SO, YEAH, I THINK I WILL GIVE
THAT AS A SHORT ANSWER, BUT,
AGAIN, WE CAN TALK FOR ANOTHER
HOUR ABOUT THIS.
>>ALL RIGHT, LOOKS LIKE WE ARE
AT TIME THEN.
SO THANK YOU VERY MUCH FOR YOUR
PRESENTATIONS.
THEY WERE VERY
VERY INSIGHT.
MOVE TO EPIDEMIOLOGY RESEARCH
AND TAKE IT BACK TO JANET.
>> THANK YOU SO MUCH, TAMARA AND
THE VERY INFORM SIEVE SESSION OF
TREATMENT RESEARCH.
IT IS MY PLEASURE TO MODERATE
THE LAST SESSION OF TODAY'S
WORKSHOP ON EPIDEMIOLOGY
RESEARCH.
AND IT IS MY PLEASURE TO
INTRODUCE TWO OF OUR LAST
SPEAKERS, DR. JOHANNES
EICHSTAEDT IS AN ASSISTANT
PROFESSOR IN STANFORD, AND OF
HUMAN CENTERED AI WHERE HE
FOCUSES ON RESEARCH THAT HAS A
POSITIVE SOCIETAL IMPACT ONLINE
TEXT DATA FOR PSYCHOLOGY, HEALTH
AND WELL BEING FOR INDIVIDUALS
IN THE COMMUNITY, HELPING MENTAL
HEALTH WITH LARGE LANGUAGE
MODELS.
KWO FOUNDED A PROJECT, A
CONSORTIUM OF PSYCHOLOGY AND
COMPUTER SCIENCE LABS ACROSS
FIVE UNIVERSITIES.
TRAINED AS A PHYSICIST.
Ph.d. OF CLINICAL TRAINING AT
THE UNIVERSITY OF PENNSYLVANIA.
AND DR. JOHANNES EICHSTAEDT WAS
ELECTED A RISING STAR BY THREE
ORGANIZATIONS AND PUBLISH
$85-PLUS ARTICLES AND EXPERT FOR
THE UNITED NATIONS AND FEDERAL
GOVERNMENT.
FOLLOWING DR. JOHANNES
EICHSTAEDT.
WE HAVE DR. CHERYL SEE SHOVER
AT UCLA DIRECTS THE EPIDEMIOLOGY
AND POLICY LAB DATA ANALYSIS
WITH PARTICIPATORY OF RESEARCH
AND INFECTIOUS DISEASES AND
HOMELESSNESS.
HAVE SLOFR COMPETED HER
EPIDEMIOLOGY AND POST DOCTORAL
OF PSYCHIATRY AND BEHAVIORAL
SCIENCE AT STANFORD UNIVERSITY
SCHOOL OF MEDICINE.
DR. SHOVER'S WORK.
AND OPERATES A PROGRAM AND
SYRINGE SERVICES PROGRAMS.
CO-AUTHOR OF A REPORT PUBLISHED
2022 AS A MEMBER OF THE NORTH
AMERICAN OVERDOSE CRISIS.
AND IN 2023, SHE WAS INVITED TO
JOIN A WORKING GROUP OF THE
UNITED KINGDOM ADVISORY COUNCIL
ON THE MISUSE OF DRUGS TO C IBT
TO A REPORT MAKING
RECOMMENDATIONS TO PREVENT
PUBLIC HEALTH HARMS ASSOCIATED
WITH IT. WITHOUT FURTHER ADO,
DR. JOHANNES EICHSTAEDT.
LOOKING FORWARD TO YOUR
PRESENTATION.
THANK YOU FOR JOINING US.
>> HELLO, EVERYONE, AND THANK
YOU TO ALL OF THE PARTICIPANTS
AND ORGANIZERS.
I KNOW WE ARE ALL VERY BUSY AND
TO PUT SOMETHING LIKE THIS ON IS
A BIG CONTRIBUTION FOR EVERYONE.
THANK YOU FOR YOUR ATTENTION.
I AM GOING TO TRY TO MAKE THIS
AS PAINLESS AS I POSSIBLY -- AS
I POSSIBLY CAN DO.
OKAY.
SO SUPER HIGH LEVEL.
I AM GOING TO TALK A LITTLE BIT
HOW WE USE SOCIAL MEDIA IN THE
OPIOID EPIDEMIC.
THERE YOU GO.
AND I -- MORE THAN ANYTHING, I
WANT TO ORIENT, AND I WANT TO
GIVE YOU MENTAL MODELS TO MAKE
ACCEPTS OF THE SPACE.
I WANT TO TALK A LITTLE BIT OF
DATA SOURCES.
ONCE YOU HAVE TWEETS OR REDDIT
POSTS, HOW DO YOU DETERMINE THAT
INTO ESTIMATES.
AND I WILL WALK YOU THROUGH A
FEW EXAMPLE RESULTS AND TALK
ABOUT SOME OUR COLLABORATIONS
THAT TRY TO USE THE SOCIAL MEDIA
DATA FEED AS PART OF EXISTING
SURVEILLANCE PLATFORM IN
KENTUCKY.
AND I WILL ALSO FOREGROUND SOME
TOPICS AROUND DATA LINKAGE AND
ETHICS STUFF.
SO -- SO WITH THAT -- SO WE JUT
HAD A LOOK -- OUR RESEARCH TEAM
AT STANFORD HAD A LOOK AT
DIFFERENT TYPES OF SOCIAL MEDIA
PLATFORMS USE FOR OPIOID
SURVEILLANCE.
AND A BIG CONCERN OR BIG
CONSTRAINT ON USING THESE
DIFFERENT PLATFORMS ARE TWO
THINGS.
DOES IT CONTAIN LANGUAGE ABOUT
OPIOID USE AND DRUG USE?
AND CAN YOU GEOLOCATE IT.
SO THAT IS ACTUALLY QUITE HARD A
LOT OF THESE PLATFORMS.
THE BEST PLATFORM TO GEO-LOCATE
IS TWITTER, BUT BY ELON MUSK,
USED TO BE TWITTER.
AND YOU HAVE GPS TAGS YOU CAN
USE AND PROFILING INFORMATION
THAT INCLUDES THE LOCATION FIELD
THAT WE HAVE USED TO GEO-LOCATE
A FEW MILLION TWITTER USERS WE
ARE NOW FOLLOWING OVER TIME.
THERE ARE OTHER GEO-LOCATION
METHOD AT OTHER PLATFORMS.
SAY ON REDDIT, EXPLOIT THE FACT
SOMEBODY MAY POST IN A SUB
REDDIT BUT ALSO IN THE
PHILADELPHIA SUB REDDIT AND YOU
MAKE INFERENCES THAT THIS PERSON
IS FROM PHILADELPHIA.
WHERE TWIPT TT /* TWITTER AT TH
COUNTY LEVEL, WITH REDDIT STATE
LEVEL.
AND EXPLORED OTHER LOCATIONS.
WITH THE OTHER FORMS, DATA
ACCESS IS A CONSTRAINT.
TWITTER AT LEAST HISTORICALLY
YOU CAN COLLECT TO THE ORDER OF
BILLION OF TWEETS PER YEAR AND
HAVE BECOME MORE DIFFICULT NOW.
AND THERE IS NOTHING LIKE IT,
SAY, ON FACEBOOK WHERE YOU USED
TO BE ABLE TO COLLECT FACEBOOK
WITH INDIVIDUAL LEVEL AND
INFORMED CONSENT FROM PEOPLE BUT
LATE LAST YEAR, FACEBOOK HAS
STOPPED THAT OPPORTUNITY TO
COLLECT DATA WITH RESEARCH APPS
FOR LARGER POLITICAL REASONS
THAT ARE ABOVE MY ACADEMIC PAY
GRADE.
OKAY, SO LET'S ASSUME WE HAVE
LANGUAGE DATA.
LET'S ASSUME WE COLLECTED
TWEETS, REDDIT POSTS THAT I WILL
FOCUS ON AND NOW WE NEED TO MAKE
SOME SORT OF CHOICE OF HOW TO
TURN INTO THAT ESTIMATES ABOUT
DRUG USE.
SO THIS IS WHERE NATURAL
LANGUAGE PROCESSING METHODS COME
IN.
TWO DIFFERENT OPTIONS AT A HIGH
LEVEL.
SUPER SIMPLE THING WHERE WE
COUNT KEY WORDS, SO THIS IS THE
GENERALIZED ASSUMPTION THAT
PEOPLE WANTED -- ARE MORE LIKELY
TO USE DRUGS IN AN AREA THAN
USING FENTANYL OR FENTY OR ALL
THESE SORT OF SLANG WORDS.
THAT WORKS TO SOME EXTENT.
SEEMS TO WORK ON REDDIT.
DOES NOT WORK ON TWITTER.
SIMPLE AYE APPROACH TO DO THIS
KIND OF INFERENCE.
WE HAVE LEARNED IN PRIOR WORKS
AND SOME OF WHICH WE WILL SHOW
NEW A SECOND THAT YOU DON'T
ACTUALLY WANT TO DO THIS FOR
PUBLIC HEALTH APPLICATIONS.
YOU WANT TO PROBABLY INGEST THE
ENTIRE VOCABULARY AND CREATE
THIS OVERALL SMITH ODD THIS OF
PAIN AND ASSOCIATED WITH THESE
MORTALITY END POINTS OR USE END
POINTS.
WE BUILT THIS ON TWITTER AN
BENCHMARK THIS ON TWITTER.
SO YOU EITHER LEARN THE LANGUAGE
PATTERNS DIRECTLY FROM THE DATA.
LET'S SAY YOU HAVE COUNTY
MORTALITY AND THE LANGUAGE
STATISTICS AND TOLD THE MACHINE
LEARNING FIND THE LANGUAGE THAT
PREDICTS THE MORTALITY
STATISTICS ACROSS COUNTIES OR
YOU GO TO SUPERVISED SMALLER
INDIVIDUAL LEVEL TRAINING DATA
SETS.
A SET OF LANGUAGE DATA FROM
SOCIAL MEDIA AND THEY HAVE ALL
TAKEN A SURVEY OF PSYCHOLOGICAL
DISTRESS, AND YOU CAN EXPLOIT
CO-VARIANCE TO MAP THE LANGUAGE
TO THE DISTRESS.
ONCE YOU BUILD THAT MODEL, YOU
CAN APPLY IT TO SCALE OF THE
GEO-AGGREGATED TWEETS.
RUN YOU THROUGH AN EXAMPLE HERE.
WE HAVE GEO-LOCATED -- OKAY, SO
I AM A LITTLE BIT OUT OF SYNC,
GEO-LOCATED TWITTER OF GPS
TEXTS.
REDDIT.
I ALREADY TALKED ABOUT.
AND PARTICULATE HAS A
RESEARCH API, BUT IT IS ACTUALLY
QUITE TRICKY TO INTERACT WITH.
AND IT IS NOT CLEAR ALSO HOW
MUCH DATA YOU CAN ACTUALLY GET
WITH THE RESEARCH API.
LEAPT ME TALK ABOUT TWITTER.
THIS IS -- THIS TOOK TEN YEARS
AND OUR CONSORTIUM AND DOING
THAT ACROSS.
WE HAVE RESEARCHERS, GEORGIE
AT NIDA.
WE HAVE A GROUP AT PENN AND MY
LAB AT STANFORD.
WE HAVE COMPUTER CHESTERS
TOGETHER AND WHAT THE PIPELINES
LOOK LIKE.
YOU GET THESE TWEETS.
FEE YO-LOCATE TWEETS.
THROW OUT RETWEETS AND REPLIES.
YOU ARE TRYING TO GET TO THE
MOST DIRECT SELF-DISCLOSURE THAT
GIVES YOU A QUARTER OF THE DATA
SET.
WE GO THROUGH THESE PIPELINES
AND NEST WITHIN USERS THAT TURNS
OUT TO BE A VERY, VERY IMPORTANT
PROCESSING STEP BECAUSE IT
PROTECTS AGAINST BOTS AND OTHER
ACCOUNTS THAT POST A LOT OF
LANGUAGE TO SKEW YOUR LANGUAGE
MODEL.
ANDING A G-- AND AGGREGATE ACROS
THESE AREAS AND LINGUISTIC
PATTERNS WITH LANGUAGE
PROCESSING.
WE COUNT THE FREQUENCY OF WORDS
OR SOMETHING A LITTLE BIT MORE
INTELLIGENT A TODAY USE THESE
SORT OF TOPIC MODELS WHICH IS A
TYPE OF DIMENSION AT REDUCTION
IN THE LANGUAGE FACE.
AND ONCE YOU HAVE -- LET'S HE
SAY YOU HAVE 1,000 COUNTIES.
AND NOW YOU HAVE 2,000
DIMENSIONAL VECTOR THAT
DESCRIBES THE LANGUAGE, NOW YOU
CAN USE THAT AS INPUT AND
MACHINE LEARNING MODEL.
AND IN THIS CASE, WE HAVE A
PRETRAINED MODEL AT THE
INDIVIDUAL LEVEL.
WE ESTIMATE DEPRESSION AND
ANXIETY.
AND WE GO TO THE PIPELINE WHERE
FOR EVERY GIVEN PERSON, SO IN
OUR DATA SETS NOW, OVER '21,
'22, FIVE MILLION AMERICANS
OUIJA
OUIJA -- WE HAVE GEO-LOCATED
OVER TIME AND WE ESTIMATE THEIR
AGE, GENDER, EDUCATION AND
INCOME AND COMPARE THAT AGAINST
CENSUS STATISTICS AND
POST-STRATIFY THE EXAMPLE WHAT
YOU WOULD DO IN A REPRESENTATIVE
PHONE SURVEY.
WE ASSIGN WEIGHTS TO PEOPLE TO
BIAS THE DISTRIBUTION TOWARD THE
-- THE UNDERLYING DISTRIBUTIONS
AND THE POPULATIONS.
WE FOLLOW THESE PEOPLE OVER
TIME, AND NOW WE HAVE THESE POST
STRATIFIED DEMOGRAPHICALLY
CONTROLLED PERSON-LEVEL WEIGHTED
T
TEMPO
TEMPORAL ESTIMATES OVER TIME.
WE ARE PRODUCING ALL THAT DATA
AS A COMMON GOOD.
THE ONES THAT FUND US, IT IS OUR
GOAL TO PUT ALL OF THIS IN THE
PUBLIC DES MOINES AND THE
RESEARCH DOMAIN.
OUTDATING IT AT THE COUNTY WEEKS
AND MONTH LEVEL AND OUTPUTTING
UNDER AGGREGATION.
NOT INDIVIDUAL LEVEL PEOPLE, BUT
COUNTY LEVELS SCORE THA
THAT ANNOMIZE AWAY FROM THE
INDIVIDUALS AND MAKES IT
UNPROBLEMATIC TO SHARE.
JUST TO GIVE YOU A SENSE THIS IS
LANGUAGE-BASED MENTAL HEALTH
ASSESSMENT, DEPRESSION, ANXIETY
MODELS OF COUNTIES.
AT THE TOP THERE, YOU CAN SEE
SORT OF THEIR RANGE OF HOW MUCH
WE CAN THRESHOLD ACROSS
DIFFERENT UNITS OF ANALYSIS.
AND AT THE BOTTOM, YOU SEE WHAT
YOU CAN DO WITH SURVEYS -- WITH
2.1 MILLION SURVEY RESPONSES.
AND THE HIGH LEVEL -- NEVER MIND
THE DETAILS, THE HIGH-LEVEL
TAKEAWAY IS THE KIND OF DATA YOU
GET FROM SOCIAL MEDIA DOMINATES
EVEN THE LARGEST POPULATION
HEALTH INSURANCE EFFORTS LIKE
THE BRFSS OR GALLOP OR WHATEVER
IT IS.
WE THINK THAT THE SWEET SPOT AT
THE COUNTY LEVEL.
AND DATA AGGREGATION.
SPATIAL VERSUS TEMPORAL.
YOU HAVE TO LUMP THEM.
INTO DAILY TOWNSHIPS,
RELIABILITY TANKS.
SO LET ME GIVE YOU AN EXAMPLE
WHAT IT LOOKS LIKE TO GIVE YOU
AN INTUITION.
IN THE BOTTOM SADNESS OVER TIME
OF THE GALLOP SURVEY OF SAY.
PART OF THE COVID SURVEY.
THE PEAK IS THE MURDER OF GEORGE
FLOYD.
THE MOST STRONGEST NEGATIVE
AFFECT OR SOCIAL MEDIA DATA.
AT THE TOP YOU SEE OUR ESTIMATES
OF NATIONAL DEPRESSION BASE AND
TWIPT TWIT.
YOU CAN SEE THEY HAVE BECOME
VERY STABLE BECAUSE WE ARE
FOLLOWING THE SAME PEOPLE OVER
TIME.
SOME WE ARE BUILDING A DIGITAL
PANEL SURVEY IF YOU WILL.
WE ARE TAKING RANDOM SLICES
TWITTER HOPING THEY LINE UP.
SO HERE IS THE SET-UP.
RIGHT.
WE HAVE COUNTIES FROM THE
COUNTIES.
OPIOID MORTALITIES AND THE
TWEETS.
X POSTS.
FUTURE EXTRACTION.
I TALKED OF IT LIKE A DIMENSION
AT.
THINK OF IT AS A CLUSTER
ANALYSIS IN THE LANGUAGE SPACE.
FACTOR ANALYSIS IS A LITTLE
DIFFERENT BECAUSE STATISTICS ARE
A LITTLE BIT DIFFERENT.
WITH THE DISTRIBUTION OF ROUTES
AND FREQUENCIES, TRAIN A MACHINE
LEARNING MODEL THAT PREDICTS THE
OPIOID MORTALITY AND USE SIMPLE
AGGRESSION.
AND JUST TO BENCHMARK IT ACROSS
600, 700 COUNTIES, YOU SEE HOW
WELL DIFFERENT CO-VARIATES OF
THE COUNTY LEVEL PREDICT OPIOID
MORTALITY.
WELL BEING ARE THOSE GALLOP
RESPONSES INDICATING STRESS,
PAIN, ALL THESE DIFFERENT THINGS
AND DEPRESSION AS WELL FROM
GALLOP.
A SORT OF STANDARD MODEL THAT
COMBINES EVERY ECONOMIC AND
DEMOGRAPHIC AND SURVEY ASSESSED
VARIABLE THAT WE CAN FIND AND
HOW WELL TWITTER DOES OF
PREDICTING OPIOID MORTALITY.
THE WAY WE THINK OF TWITTER,
CAPTURES OTHER VARIABLES, SOCIAL
ECONOMIC AND BEHAVIORS AND ADD A
SLIVER OF UNIQUELY PSYCHOLOGICAL
SIGNAL THAT YOU CAN ONLY REALLY
SEEM TO GET THROUGH THE SOCIAL
MEDIA OF SOCIAL MEDIA EFFORTS.
WE ARE WORKING WITH AN EFFORTS
OUT OF THE UNIVERSITY OF
KENTUCKY CALLED "REDORKY."
WHICH IS BASICALLY A
BENCHMARKING OF DIFFERENT DATA
FEEDS TO PREDICT OPIOID HOT
SPOTS.
HOSPITAL REPORTS, CORONER
REPORTS COME WITH DIFFERENT
LEGS.
AND THE HOPE OF SOCHI THAT YOU
CAN IN PRINCIPLE GET A END-TIME
INDICATE THEIR CAN FRONT SOME OF
THOSE OTHER INDICATORS.
WHAT WE ARE DOING FOR THE FIRST
TIME AND HANDING OVER A DATA
PRODUCT TO THIS CONSORTIUM AND
SAY HERE IS OUR BEST ESTIMATE OF
MONTHLY COUNTY LEVEL, LEVELS OF
DISTRESS ON THE POPULATION.
DOES IT ADD PREDICTIVE
INCREMENTAL VALUE TO YOUR
PREDICTION MODELS?
SO HERE -- JUST TO GIVE YOU A
SENSE WHAT THIS LOOKS LIKE, LIKE
ALL DISTRIBUTION THIS WAS KIND,
POWER LAW DISTRIBUTIONS WHERE
YOU HAVE THE COUNTIES THAT HAVE
THE CITIES HAVE, AND MOST OF THE
POPULATION, EVERYTHING ELSE
PETERS OUT AFTER THAT.
20 1-2022.
AN ORDER OF MAGNITUDE IDEA, WE
ARE LOOKING JUST AT KENTUCKY.
WHICH -- IT IS ONE OF OUR LEAST
SAMPLED STATE IN THE U.S. IN
TERMS OF TWITTER USERS.
IN 2021, WE HAD 20,000 -- 21,000
GEO-LOCATED TWITTER USERS IN
KENTUCKY.
PRODUCED SEVEN MILLION TWEETS OF
WHICH THREE MILLION OR SO WERE
RELEVANT.
AS ALWAYS, YOU HAVE THIS HUGE
DISTRIBUTION WHERE -- WHERE SOME
PEOPLE POST A LOT AND MOST
PEOPLE JUST POST ONCE OR TWICE.
BUT TO BE INCLUDED IN OUR DATA
SET, THEY HAVE ACTUALLY BEEN
SHORT LIFTED AND POSTED AT LEAST
30 TIMES THIS YEAR AND SO FORTH.
THERE IS REFERENCES IN THE BACK
IF YOU CARE ABOUT THE GNARLY
DETAILS.
THEN IN 2022, SIMILAR SIZED DATA
SET.
THAT IS VERY FRESH.
THAT HAVEN'T BEEN EVALUATED.
THAT IS WHAT WE JUST HANDED
OVER.
THIS GIVES YOU A SENSE, I HOPE,
OF THE POWER OF THE TWITTER
METHODS JUST TO RECAP, THEY USE
THE WHOLE VOCABULARY.
THEY USE MACHINE LEARNING TO
DEFINE PATTERNS AND
DISTRIBUTIONS AND THOUSANDS OF
WORDS SAID LESS OR MORE THAT
INDEX TO OPIOID MORTALITY.
SO WE ARE NOT COUNTING KEY
WORDS.
IN -- IN THIS WORK HERE, IN THIS
REDDIT WORK, EARLIER WORK, WE
ARE DOING KEY WORDS.
THIS WORK IS UNDER REVIEW, AND
SO HERE WE ARE EXPLOITING WHAT I
ALREADY TOLD YOU A LITTLE BIT
ABOUT WHERE SOMEBODY POINTS IN
THE LOS ANGELES SUB REDDIT THIS
PERSON IT FROM LOS ANGELES.
IF THEY POSTED IN MULTIPLE
CITIES, WE DISREGARD HIM.
VERY CRUDE WAY OF GEO-LOCATING.
IT DOVETAILS ROUGHLY TO THE
STATE POPULATION OF THE STATE
REDDIT USER POPULATION ACROSS
THE DIFFERENT STATES.
SEEM TO GO TOGETHER SOMEWHAT,
AND THIS IS SORT OF A HIGH LEVEL
VIEW OF THE DATA.
YOU CAN SEE THE DIFFERENT PHASES
IF NOT ELSE, YOU CAN SEE THE
DIFFERENT PHASES OF THE OPIOID
EPIDEMIC.
YOU SEE HEROIN AND THE -- THE
GROWTH OF SYNTHETIC OPIOID ALL
THE WAY NOW TO FENTANYL WHICH
HAS BEEN STRIKING AS YOU SEE
THERE ON THE RIGHT.
THIS IS JUST THE PURE OCCURRENCE
OF KEY WORDS THAT INDEXES
DIFFERENT CONSTRUCTS.
ONE THING WE HAVE DONE.
WE HAVE USED EMBEDDINGS WHICH IS
SORT OF THE CLEVER WAY OF
MAPPING LANGUAGE INTO NUMERICAL
SPACES AND SEEING WHICH OTHER
WORDS MAP TO AREAS.
SO THIS WAS AN EARLY NEURO
NETWORK WAY OF THINKING OF
LANGUAGE AND USING THE SYNTHETIC
MODELS TO FIND ALL THE WORDS
THAT MEAN HEROIN BUT ARE SOME
SORT OF SLANG.
AND WE ALSO HAD GOOD SUCCESS
USING CHAT GPT 3 AND 4 TO DITCH
NARY EXTENSIONS, AS THEY ARE
CALLED.
EVEN IF YOU USE KEYWORDS, CLEVER
WAYS TO DO THAT TO GIVE YOU AN
EASIER WAY TO EXTEND YOUR KEY
WORDS TO GET THE SPEAK.
AND THIS SORT OF SLANG.
OKAY.
SO IF YOU GROUP THIS INTO --
INTO DIFFERENT CATEGORIES, YOU
SEE SORT OF A SIMILAR PATTERN
HERE.
THEN AT THE TOP HERE, YOU SEE
THE CDC DEATHS PER 1,000.
AS REPORTED PROBABLY THE
UNDERLYING CAUSE OF DEATH BY CDC
WONDER AND AT BOTTOM, YOU SEE
THE REDDIT RATES.
TAMPA ROUGHLY DOVETAILS.
NOT A PERFECT FIT.
NOT A PERFECT FIT DOING COVID-19
WHERE THE POSTING BEHAVIOR
ONLINE REALLY CHANGED AS DID THE
OPIOID MORTALITY IN THE REAL
WORLD.
WE TESTED DIFFERENT OFFSETS, YOU
SEE ON THE RIGHT AND WE GOT THE
SENSE THAT IF YOU OVERLIE THE
TIME SERIES EXACTLY, YOU GET THE
HIGHEST TIME SERIES COURSE.
>> SO DENSE.
IF YOU WERE TO SHIFT IT BY JUST
A MONTH OR TWO THAT CORRELATION
WOULD DECAY AND GIVES US
ADDITIONAL INFORMATION THAT
THESE THINGS MAY BE TRACKING.
SO THIS IS THE COURSE.
>> SO DENSE WITH THE CDC.
WE USE THE DIFFERENT DRUG
REPORTING, THE LABORATORY
INFORMATION SYSTEM.
AND YOU CAN SEE WE SEE SIMILAR
COURSE.
>> SO DENSE FOR FENTANYL ACROSS
DIFFERENT AREAS OF THE U.S.
AND THEN WE WANTED TO BE MORE
PRINCIPLED AND TESTED THIS IN AN
ARENA, SO AN AUTO REGRESSIVE
MODEL.
AND WE LOOKED AT HOW THE
PREDICTION ERA CHANGES AS A
FUNCTION OF PRECLUDING REALTIME
SOCIAL MEDIA IN IF THE
CO-VARIANCE.
AND NORMALLY THIS HAS LAG CDC
DATA.
AND HAS SIX-MONTH -- SIX-MONTH
LAG.
AND THIS -- WE FIND STATISTICAL
SIGNIFICANCE AT LEAST SHOWING
THERE IS I BELIEVE CEMENTAL
PREDICTIVE VALUE USING CREW
ALLEGATIONS STRATEGIES.
SO CERTAINLY VERY PROMISE.
THANK YOU FOR YOUR ATTENTION AND
HERE ARE THE REFERENCES IF YOU
ARE INTERESTED.
>> THANK YOU VERY MUCH, DJOHANNS
EICHSTAEDT.
USE OF NONTRADITIONAL DATA
SOURCES IN RESEARCH THROUGH
SOCIAL MEDIA PLATFORM DATA.
REALLY APPRECIATE THAT
INFORMATION.
NEXT WE HAVE DR. CHELSEA STOVER
WHO WILL BE SPEAKING OF THE HARM
RESEARCH.
>> THANK YOU SO MUCH.
HI, EVERYBODY.
HAPPY TO BE HERE.
AND ALWAYS FUN TO TALK OF SOCIAL
MEDIA AND REALIZE THAT THE ONLY
SOCIAL MEDIA PLATFORM I AM
REFERENCING ON MINE IS NOT ON
THAT LIST YET.
NEW AREAS FOR THE TEAM TO STUDY
AS SO MANY SCIENTISTS MOVE OVER
TO BLUE SKY.
ANYWAY, TODAY I WILL BE TALKING
ABOUT A PROJECT THAT GROWS OUT
YOU HAVE AN RO 1 AND MPI.
IT IS FOCUSED ON MAPPING
OVERDOSE IN TERMS OF FATAL AND
NONFATAL OVERDOSE IN LOS ANGELES
COUNTY AS IT RELATES OF HOW WE
MIGHT BETTER ALLOCATE TREATMENT
AND HARM REDUCTION SERVICES.
SORRY.
LET ME ADVANCE -- DO I CONTROL
MY SLIDE?
YES, I DO.
GREAT.
OKAY.
I WANT TO START BY THANKING ALL
THE PEOPLE THAT REALLY DID THIS
WORK.
MY MPI IS DR. GOODMAN-MESA, THE
RARE COMBINATION OF ADDICTION
MEDICINE AND DISEASE PHYSICIAN
MEDICINE AND EXPERTISE IN
NATURAL LANGUAGE PROCESSING AND
OTHER MACHINE LEARNING, AND
REALLY IS KIND OF THE DRIVING
FORCE BETWEEN -- BEHIND A LOT OF
THE DATA SCIENCE ASPECTS OF OUR
WORK.
DR. MICHAEL SCIN, A PROFESSOR IN
THE GEOGRAPHY DEPARTMENT AND OUR
GEOSPATIAL EXPERT.
HE IS MAKING ALL THESE MAPS.
I SAY CAN YOU MAKE A MAP THAT
DOES THIS.
HE TELLS ME WHY IT IS NOT METH
LOGICALLY RIGOROUS OR WHAT KIND
OF ASSUMPTIONS WE ARE BAKING IN
AND THE QUIRKS OF LOS ANGELES
THAT I WILL TALK ABOUT AS I GO
THROUGH THIS PRESENTATION.
TUCKER AVRA, A CURRENT MEDICAL
STUDENT AND ALSO A VETERINARIAN
WHO HAS BEEN WORKING ON OUR
PROJECT AND HIS IDEA ACTUALLY TO
LOOK AT THIS CONCEPT OF SYRINGE
SERVICE DESERTS.
AND LASTLY OUR PROJECT DIRECTOR
RUBY ROMERO KEEPING US ALL ON
TRACK TRYING TO KEEP DOING THIS.
WE WORK VERY CLOSELY WITH A
NUMBER OF PARTNERS HERE IN LOS
ANGELES AS FAR AS OUR COUNTY
GOVERNMENT AND COMMUNITY-BASED
ORGANIZATIONS.
AND THAT'S KIND OF WHAT -- YOU
KNOW, THAT SORT OF -- I GUESS
STORYTELLING TIME.
THAT IS KIND OF WHY WE ARE DOING
THIS PROJECT. YOU KNOW, DAVID
AND I KNOWN EACH OTHER FOR A
LONG TIME AND STARTED TALKING OF
THIS RO-1 WHEN WE WERE DOING
FIELD-BASED WORK IN LOS ANGELES.
OUR IDEALIZED PICTURE OF LOS
ANGELES.
AT THE TIME WRITING THIS GRANT
FROM EARLY 2021 AND EARLY 2022.
I WAS RUNNING A PROGRAM THAT WAS
DOING COVID-19-VACCINE EVENTS
PEOPLE EXPERIENCING HOMELESSNESS
AND LIVING IN ENCAMPMENTS.
TAKING TEAMS FROM THE COUNTY G
AROUND TO DIFFERENT PLACE TO
FIND WHERE PEOPLE MAY BE LIVING
AND GIVE THE COVID VACCINE.
PEOPLE LIVING IN THE ENCAMPMENT
AS COMMUNITY PEER AMBASSADORS.
WE WERE LOOKING AT WHY WHETHER
PEOPLE MIGHT BE MISSED BY OTHER
ASPECTS OF THE HEALTH CARE
SYSTEM.
AT THE SAME TIME, DAVID BECAME
SITE PRINCIPAL INVESTIGATOR OF A
BIG NIH-FUNDED CLINICAL TRIAL
ABOUT DELIVERING BUPRENORP HINE
WITH CLEAR NAVIGATION AN WE WERE
TEXTING -- BECAUSE WE WERE
FRIENDS WITH AND CO-FACULTY AND
TEXTING.
HEY, I WAS JUST BY THIS ONE
LIBRARY AT THIS ONE
INTERSECTION.
A LOT OF NEEDLES ON THE GROUND.
YOU SHOULD PROBABLY PARK YOUR
BUS BECAUSE THERE MAY BE PEOPLE
WHO WILL QUALIFY FOR YOUR
STEADY.
HE WOULD TELL ME, HEY, WE HAD
THE BUS OUT AT THIS PLACE.
AND ASK ABOUT THE COVID VACCINE.
AND SO THEN, WE SAID, WOW, LOS
ANGELES IS SO BIG.
SOME THIS IS OUR LITTLE
IDEALIZED VERSION OF WHAT WE --
YOU KNOW, IF YOU DON'T LIVE
IN L.A. YOU MIGHT IMAGINE
WHAT L.A. IS LIKE.
YOU MIGHT IMAGINE THIS WHICH IS
WHAT L.A. IS LIKE SALIENT AND
RELEVANT TO ANY GEOSPATIAL WORK.
ONE OF THE EARLIER TALKS HOW DO
YOU DEAL WITH PEOPLE WALKING
VERSUS DRIVING.
AND SPOILER, THAT IS A MAJOR
PART OF THE TYPE OF APPLIED WORK
WE ARE DOING. BUT ANYWAY, LOS
ANGELES.
FOR THOSE OF HOW HAVEN'T SPENT
TEN YEAR OBSESSIONED WITH TH
THE DEMOGRAPHY AND THE
POPULATION AND VARIOUS THINGS
THAT MAKE L.A. A SPECIAL PLACE.
POPULATION OVERVIEW.
POPULATION IN 2023 WAS 9.7
MILLION.
IF IT WAS A STATE, IT WOULD BE
THE 11th LARGEST STATE BY
POPULATION.
LAND AREA IS OVER 4,000 SQUARE
MILES.
TO BE RHODE ISLAND AND DELAWARE,
THE AREA AS LOS ANGELES.
ONE OF MY FAVORITE EXPERIENCES
WHEN I FIRST MOVED HERE --
BECAUSE I GREW UP ON THE EAST
COAST IN A VERY SMALL TOWN.
I MOVED TO LA AND I SAW A SIGN
FOR ONE OF THE METROBUS SYSTEMS.
TAMPA SAID, HEY, THIS CARD IS
GREAT BECAUSE WORKS ON 55
DIFFERENT TRANSIT SYSTEMS
WITHIN L.A. COUNTY.
I SAID THAT IS NOT GOOD.
IT IS NOT GOOD WE HAVE 55
DIFFERENT TRANSIT SYSTEMS IN ONE
COUNTY.
THAT IS ABSURD.
88 CITIES AND IN MANY UNINCORPS
RATED AREA.
IT AFFECTED THE LARGE POPULATION
AND THE FACT WE GOT FENTANYL
LATE, BUT ALSO HIT US VERY HARD
IN TERMS OF TAKING OVER OUR
ILLICIT DRUG SUPPLY AND NOT ONLY
REPLACING BUT DISPLACING
EXPANDING THE POPULATION OF
FOLKS USING ILLICIT OPIOIDS.
WE LEAD THE COUNTRY IN PEOPLE
DYING FROM OVERDOSE DEATHS IN
THE LAST FEW YEARS.
AND, YES, YOU KNOW, POPULATION
IN THE COUNTRY, COUNTY -- THE
COUNTY AND THE COUNTRY WHERE THE
LARGEST POPULATION.
SO OUR POPULATION RATE IS A
LITTLE BIT BELOW AVERAGE, BUT
THE ACTUAL NUMBERS, YOU KNOW, IT
IS MULTIPLE THOUSANDS OF PEOPLE
EVERY YEAR SO WHEN I THINK ABOUT
IT, WE HAVE A HUGE PROJECT AHEAD
OF US.
IF WE CAN FIGURE IT OUT HERE, WE
CAN FIGURE IT OUT IN LOTS OF
OTHER PLACES. SO, OKAY, SO OUR
MOTIVATING QUESTION FOR THIS
PARTICULAR ANALYSIS WAS, WELL,
WHERE ARE HARM REDUCTION SERVICE
DESERTS IN LOS ANGELES?
SO IF YOU HAVE A PASSING
FAMILIARITY WITH L.A., YOU
PROBABLY HEARD OF SKID ROW.
THAT IS LIKE THE OPPOSITE OF A
HARM REDUCTION DESERT.
IT IS VERY SERVICE-DENSE PLACE
WHERE THERE IS A LOT OF
OVERDOSE.
BUT WHAT I KNOW, BECAUSE I -- I
LIVED IN A DIFFERENT PART AND I
HAVE SPENT ON THIS STUDY I WAS
TALKING ABOUT GOING ALL OVER THE
PLACE.
KNOW THAT THERE ARE LOTS OF
SPOTS THAT ARE -- YOU KNOW, THAT
SEEM TO BE BASE ON THE MAPS HE
WERE MAKING OF OVERDOSE
MORTALITY AND LATER OF NONFATAL
OVERDOSES MEASURED BY NALOXONE
BY EMS.
THERE SEEMS TO BE A HOT SPOT OF
OVERDOSE HERE, BUT WE ARE NOT
REALLY SURE HOW MUCH COVERAGE
THERE ACTUALLY IS IN TERMS OF
HARM REDUCTION RESOURCES. SO,
YOU KNOW, TUCKER CAME TO US AND
STARTED SAYING, WE SHOULD DO A
PROJECT ABOUT HARM REDUCTION
SERVICE DESERTS.
SAID, OKAY, WHAT DOES THAT MEAN?
HOW DO YOU DEFINE A HARM
REDUCTION SERVICE DESERT.
BROUGHT IN MICHAEL, OUR G
GEOGRA
GEOGRAPHER.
AND WE SAID THERE IS A LOT OF
LITERATURE ON FOOD DESERTS AND
PHARMACY DESERTS.
A LOT OF DIFFERENT DESERTS.
PEOPLE HAVE LESS ACCESS TO
SERVICES.
WHAT DOES THAT MEAN FOR HARM
REDUCTION?
THAT IS THE QUESTION FOR THE
MAIN THING.
WE ESSENTIALLY WANTED TO KNOW
WHAT PARTS OF LOS ANGELES HAD
OVERDOSE MORTALITY AND NOT
ENOUGH SERVICES.
WE HAVE A SENSE -- YOU KNOW,
JUST FROM WORKING HERE WHERE HAS
A LOT OF OVERDOSES AND A LOT OF
SERVICES AND SINCE -- WE HAVE A
SENSE OF -- WE SORT OF HAVE A
SENSE OF -- WHERE THERE ANY
OVERDOSES AND NOT MANY SERVICES
BECAUSE A LOT OF L.A. SHOCKINGLY
IS LIKE FORESTS AND PARKS.
AND THAT, YOU KNOW -- WE ARE
TRYING TO GET THAT IN BETWEEN
THAT AND UNDERSTAND AREAS WHERE
THERE IS NEED AND THOSE NEEDS
ARE NOT NECESSARILY BEING MEANT.
THIS GETS MORE COMPLICATED
THOUGH AS MORE QUESTIONS -- AS
MANY RESEARCHES PROCESS DO. THEY
GENERATE MORE QUESTIONS.
THE FIRST IS WHERE ARE HARM
REDUCTION SERVICES?
HARM REDUCTION IS SOMETHING THAT
HAS BEEN PRACTICED FOR A VERY
LONG TIME. I THINK WHAT WE
COMMONLY CALL "HARM REDUCTION."
IT GREW OUT OF THE HIV-AIDS ACT
HIPS MOVEMENT AND CLEAN NEEDLES,
SYRINGE AND NEEDLE EXCHANGE HAVE
BEEN A PART OF IT.
THAT IS WHERE WE STARTED.
OKAY, NOW THERE IS -- WHAT
PEOPLE CONSIDER HARM REDUCTION
IS PROBABLY A BIGGER TENT, BUT
LET'S KEEP IT FOCUSSED ON SORT
OF THE ORIGINAL OF WHERE IS
SYRINGE EXCHANGE HAPPENING.
OKAY, THERE IS -- LET'S SEE.
WE WORK CLOSELY WITH THE COUNTY
GOVERNMENT AND A LIST OF WATCH
IS FUNDED BY THE COUNTY
GOVERNMENT.
I THINK WE STARTED WITH 8.
ANOTHER WAS ADDED AND IT WAS 9.
MOST OF THEM HAVE MOBILE
COMPONENTS.
AND SO -- LOOK, OKAY, WHERE IS
THAT -- FOR MAPPING, WHERE --
YOU KNOW, I -- IT SEEMED CLEAR
TO ALL OF US CONCEPTUALLY, LIKE
THIS EXAMPLE.
ONE COUNTY SYRINGE EXCHANGE
PROGRAMS I WORK WITH DRUG
CHECKING.
IN PHYSICAL BUILDING OBVIOUSLY
THAT IS A LOCATION WHERE HARM
REDUCTION SERVICES ARE.
BUT SO IS THIS VAN.
HOW DO YOU ACCOUNT FOR THIS VAN
WHEN YOU ARE MAPPING?
SO THAT IS -- THAT IS OUR ONE
QUESTION.
OKAY.
SO TO TRY TO FIGURE THAT OUT, WE
HAD TO DO A SURVEY -- BASICALLY
WHAT I THINK OF AS A SURVEY OF
SERVICE.
AND RUBY TOOK THIS ON -- I MEAN
TUCKER, AS WELL, FIGURING OUT --
HOW TO ACTUALLY MAP IT.
PART OF IT, WELL, WE KNOW FROM
LOCAL KNOWLEDGE THAT THERE IS
SOME AREAS OF LOS ANGELES WHERE
NEEDLES ARE NOT ALLOWED TO BE
DISTRIBUTED AND OTHER TYPES OF
HARM REDUCTION LIKE NALOXONE.
WE SYSTEMATICALLY WENT TO COUNTY
SYRINGE PROGRAMS AND SURVEY --
SEMI STRUCTURED INTERVIEW
BASICALLY.
WHAT DO OFFER, WHERE DO YOU
OFFER IT AND WHEN?
WE WERE INTERESTED IN THE BROAD
RANGE INCLUDING, OF COURSE,
INJECTING SUPPLIES.
BUT AS -- AS THE FENTANYL USE IN
THE WEST COAST AND INCREASINGLY
MORE OF THE COUNTRY HAS SHIFTED
TO SMOKING, IT WAS LIKE, OH,
SAFER INJECTION EQUIPMENT IS
IMPORTANT.
IN LOS ANGELES, PEOPLE EN JECT
METH AND SMOKE THEIR FENTANYL.
WE WANT TO KNOW ABOUT SAFER
SMOKING KITS.
NALOXONE.
DIFFERENTIATE OF NASAL SPRAY AND
INJECTABLE.
HIV PREVENTION LIKE PREP,
CONDOMS AND SOME ON AND GET A
SORT OF BROAD RANGE.
WHAT I WAS PERSONALLY INTERESTED
IN IS THE WHERE AND WHEN THIS
TERMS OF HOW IT IS MAPPED OUT.
ANIMATED CHATS.
TO YOU DO YOU DEFINE HARM
REDUCTION SERVICE DESERT?
IN THE OTHER TYPES OF DESERTS
THEY THINK ABOUT IN PUBLIC
HEALTH, THERE ARE SORT OF
STANDARD DEFINITIONS.
BUT WE WEREN'T ABLE TO FIND ONE
FOR HARM REDUCTION SERVICES.
AND NOT THAT I THINK IT IS A NEW
IDEA THAT WE THOUGHT OF, JUST
THIS ISN'T SOMETHING THAT IS
ROBUSTLY DOCUMENTED IN THE
SCIENTIFIC LITERATURE.
SO WE USED A COUPLE OF DIFFERENT
POSSIBLE DEFINITIONS.
ESSENTIALLY, YOU KNOW, WE
THOUGHT LIKE A VERY -- LIKE VERY
NARROW WOULD BE LIKE WITHIN ONE
MILE.
THINKING OF IT BOTH IN TERMS OF
DRY TIME AND WALKING TIMES.
LOS ANGELES IS SUPER CAR-BASED
AND TWO, A LOT OF PEOPLE WHO ARE
ACCESSING SYRINGE SERVICES
PROG
PROGRAMS DON'T HAVE CARS.
AREN'T DRIVING ARE NOT USING
PUBLIC SIT OR WALKING AND
BIKING.
SO WE HAD TO KIND INCLUDE BOTH.
WHAT DO THE MAPS LOOK LIKE?
I APOLOGIZE SHOWING YOU OLD
OVERDOSE DATA.
WHEN WE STARTED DOING THIS
PROCESS -- WE STARTED TO DOING
IN 2022.
WE WANTED TO LOOK BACK AT THE
MOST RECENT COMPLETE YEAR OF
WHEN WE HAD DATA AS A WAY TO
LOOK AT THIS IN TERMS OF WHERE
THE SERVICES WORK. AND SO THIS
IS LOS ANGELES COUNTY.
IT IS -- IT IS BASICALLY A HEAT
MAP.
ALL THE LITTLE DOTS REPRESENT A
OVERDOSE DEATH.
THE PURPLE REPRESENTS A WARMER
CONCENTRATION AND KIND OF MOVES
ON THE INGREDIENT FROM PURPLE TO
ORANGE.
AND IN THIS DOWNTOWN L.A. AREA
WITH SKID ROW AND DOWNTOWN.
AND THEN THE LIGHTER PURPLE, YOU
CAN GET IN YOUR HOLLYWOOD, YOUR
SOUTH L.A. AND COUPLE OTHER HOT
SPOTS LIKE UP IN THE SAN
FERNANDO VALLEY AND DOWN IN LONG
BEACH.
SOME THAT'S PRETTY -- THIS IS
ACROSS ALL KINDS OF DRUGS.
WE ARE WORKING ON WRITING IT UP,
YOU KNOW, AS IT DIFFERS BY TYPE
OF DRUG IMPLICATED.
I THINK THE OTHER THING THAT IS
WORTH MENTIONS THAT LOS ANGELES
HAD HISTORICALLY HAD SUCH A HUGE
METH PROBLEM IN THAT UNTIL JUST
A -- JUST A -- JUST TWO OR THREE
YEARS AGO, MORE
METHAMPHETAMINE-RELATED DEATHS
THAN OPIOID-RELATED DEATHS.
THIS IS JUST DRUG-RELATED
DEATHS, SORRY, NOT SPECIFICALLY
OVERDOSES.
DRUG-RELATED DEATHS THAT WE
DEFINE DRUGS IN THE HAD CAUSE
AND CONTRIBUTING FACT ARE OF THE
DEATHER IS TESTIFY CAT.
IT DOESN'T JUST MEAN THAT DRUGS
WERE FOUND ONLY BOARD, BUT MEANS
THAT THE MEDICAL EXAMINER DURING
THIS PERIOD WAS THE PERIOD WE
ARE LOOKED AFFIDAVIT THIS.
YOU KNOW THIS MAP IS ONLY 2021,
BUT WE WERE LOOKING AT IT
STARTING IN 2012, THE SAME
MEDICAL EXAMINER FOR A LONG TIME
OPERATING ON THE SAME GENERAL
FRAMEWORK IN TERMS OF MAKING
THOSE DETERMINATIONS. OKAY.
SO TAKING THOSE -- TAKING THAT
MAP OF OVERDOSE MORTALITY AND
ADDING IN THE BE 5 AND 15-MINUTE
DRIVE TIMES TO SYRINGE SERVICES
PROGRAMS.
IN VERSION OF IT, THE BRIGHT
PURPLE DOTS ARE THE SSPs, WHICH
INCLUDE FIXED SITES AS WELL AS
MOBILE SITES.
I WILL GET INTO WHY THAT IS A
LITTLE COMPLICATED AND RED DOTS
IN HERE ARE THE OVERDOSE DEATHS.
THE, LIKE, FAINT PURPLY LINE IS
SUPPOSEDLY A TVOF A FIVE-MINUTE
AND THE OTHER ONE SEASON A
30-MINUTE DRIVE.
THAT IS MOST OF L.A.
MAYBE NOT SERVICE DESERTS.
SOMEBODY SHOWED ME THAT MAP, BUT
WHAT ABOUT TRAFFIC?
NO RURAL -- DISTANCE JUMPING
BACK FOR A SECOND, THE TIME TO
GET FROM -- THOSE CENTER POINTS
TO THE OUTER EDGE OF THE LITTLE
-- THE LITTLE SURROUNDING FOR
EACH POINT IS FIVE MINUTES.
LIKE, YEAH, MAYBE IN THE MIDDLE
OF THE NIGHT OR SOMETHING LIKE
THAT.
THAT IS NOT HOW IT IS MOST OF
THE TIME.
SOME HOW DO WE ACTUALLY ACCOUNT
FOR THAT?
THAT IS SORT OF WHERE I GET TO A
SPOILER OF OURS THAT WICK NOT
FIRST DEGREE THIS OUT OF HOW TO
DO THIS YET.
ONE THING -- ONE THING YOU CAN
TAKE BE AWAY FROM THIS.
LOS ANGELES HAS A LOT OF THE
SERVICES.
WE DON'T REALLY HAVE THAT MUCH
OF A DESERT.
WHICH, YOU KNOW, MAYBE.
WALKING VERSUS DRIVING WHERE THE
SOLID LINES ARE FIVE-MINUTE
WALKING AND 15-MINUTE WALKING.
THAT I ACTUALLY FEEL GOOD OF
BEING PRETTY ACCURATE IN TERMS
OF -- YOU KNOW, WALKING IS GOING
TO PROBABLY TAKE ABOUT THE SAME
AMOUNT OF TIME MOST OF THE TIME.
IT IS A SHORT ENOUGH DISTANCE
THAT WOULD EVEN EXPECT YOUR
PUBLIC TRANSIT ESTIMATES TO BE
PRESENTEE EXTRAIBLE OF ACROSS
TIME OF DAY.
AND THE DRIVING IS RECOMMENDED
FROM THE LANES THAT ARE THE
THINNER LINES, THE GREEN, THE
YELLOW AND RED.
AND SO IF YOU WERE RESTRICTED TO
WALKING, YOU WOULD BE LIKE, WOW,
THERE IS A LOT OF DESERTS.
THIS IS WHERE WE SORT OF RUN
INTO THE LIMITS OF WHAT CAN WE
DO THAT FITS SQUARELY WITHIN THE
PUBLISHED LITERATURE ON DESERTS
IN THE SENSE THAT IT IS VERY
COMPLICATED TO SAY, WELL, HOW
ARE WE GOING TO SAY WHAT IS TOO
FAR.
AND SO I -- YOU KNOW, I AS WE
ARE MOVING THIS PROJECT FORWARD,
WE WILL HAVE TO DO A LOT OF
SENSITIVITY ACT MALL IN CEASE
WHICH IS HELPFUL BECAUSE I AM AN
EPIDEMIOLOGIST.
AND BUT PRESENTING IT TO
COMMUNITY PARTNERS WE WORK WITH.
THEY ARE LIKE, WELL, IF YOU
ASSUME EVERYONE WALKS OF PLACES
LEFT OUT.
YOU ASSUME SOMEONE DRIVES AND.
NO TRAFFIC, WE ARE DOING VERY
WELL.
NONE OF THOSE ARE REASONABLE
ASSUMPTION SO WE HAVE TO THINK
LITTLE BIT BEYOND THAT.
SO, RIGHT.
THAT IS MY QUESTION THAT WE CAME
DOWN TO.
DOING WELL AND AREN'T SERVICE
DECISIONERS.
THE REASON WE HAVE SEEN THIS
GOING UP IS SOMETHING ELSE.
I MEAN, I THINK THERE ARE
SERVICE DESERTS, FIRST OF ALL.
BUT -- BUT THEY ARE NOT ABLE TO
BE CAPTURED IN THIS WAY.
AND I AM ABOUT TO SHOW YOU, YOU
KNOW, WHAT HI THINK MAKES THE
STRONG EPPS CASE FOR THAT WHICH
IS -- AND THAT'S WHY I AM GLAD
WE DID THIS SURVEY -- WHAT IS
OFFERED AND WHEN IS IT TO
OFFERED?
I WILL SHOW YOU THE DAY-BY-DAY
-- DAYS OF THE WEEK.
WHERE SSPs ARE OPERATING.
THIS IS A FIVE-MINUTE TO
TEN-MINUTE DRIVE TIME.
THIS IS, AGAIN, ASSUME NOTHING
PROBLEM.
UNREASONABLE ASSUMPTION.
I THINK THE IMPORTANT THING TO
REMEMBER THAT MOST PEOPLE
IN L.A. WHO DRIVE HAVE A
TOLERANCE FOR DRIVING LONGER
THAN FIVE TO TEN MINUTES.
WE EXPLICITLY INCLUDED THOSE AS
SHORT TIMES TO KIND OF SPLIT THE
DISTANCE FOR WHAT PEOPLE MIGHT
ACTUALLY DO.
THERE ARE A LOT OF SYRINGE
SERVICE PROGRAMS.
THE LITTLE GREEN DOTS ARE ALL
THE DIFFERENT SSPs THANK ARE
OPERATING AND THESE ARE
INCLUDED.
-- SOME OF THEME ARE OPEN FOR
TWO HOURS ON MONDAY.
SOME OF THEM ARE OPEN ALL DAY.
SOME ARE OPEN ALL DAY, EVERY
DAY, THE WEEKDAY.
SOME ARE OPEN AT NIGHT.
ALL OVER THE PLACE.
AND, YOU KNOW, URGENTING AN IDEA
THAT THERE IS REASONABLE
COVERAGE AROUND ON MONDAY.
HOW IS TUESDAY LOOK?
TUESDAY, LITTLE LESS.
NOT AS MUCH HAPPENING ON
TUESDAY.
IF YOU WANT TO GO GENT YOUR
STERILE SYRINGES ON TUESDAY, YOU
WON'T HAVE AS MANY CHOICES.
WEDNESDAY, YOU SEA THIS BIG ONE
OUT PAMONA WHICH IS IMPORTANT
BECAUSE THE NEIGHBORING COUNTY
DOES NOT CURRENTLY ALLOW FOR
SYRINGE EXCHANGE AND PEOPLE
DRIVE FROM ORANGE COUNTY TO GET
SUPPLIES.
THURSDAY, SAME DEAL.
AND -- LIKE, YOU KNOW, IF I WERE
WAVING A MAGIC WAND.
AND LOTS OF PEOPLE TO DO ALL OUR
TIME AND AGNOSTIC AND PEOPLE
THAT PICK UP BEFORE WEEK
JENNIFER AS WE THINK OF PEOPLE
USING DRUGS IN DIFFERENT WAYS
LIKE DAILY VERSUS EVENT-BASED OR
FOR PARTYING.
I WOULD WANT TO HAVE MORE
COVERAGE ON WEEKENDS.
ALSO, IT IS HARD TO GET PEOPLE
TO WORK THAT TIME.
UH-OH, SATURDAY, NOT GREAT.
SORRY, I FORGOT THE IMPORTANT
NOTE.
THE GREEN DOTS ARE WHERE
THE SSPs ARE.
THE ONES WITH NO RADIUS AROUND,
THEY ARE NOT OPEN ON THAT DAY.
SOME SATURDAY, NOT A WHOLE LOT
GOING OBJECT.
AND SUNDAY, ALSO NOT A LOT GOING
ON, BUT AT LEAST SOMETHING IN
LONG BEACH.
AND I KNOW R SOME MOBILE SITES.
ALL THESE DISORDERS SAYS IT NOT
JUST GEOSPATIAL ANALYSIS HERE.
ONE OF THE EARLIER SPEAKERS WITH
AS TALKING ABOUT, IT IS NOT JUST
-- YOU KNOW WE HAVE TO THINK
ABOUT -- NOT JUST THE SPAESHZ
EVER SPATIAL PART WITH THE
MAPPING.
IT IS ALSO -- IT IS ALSO THE
TIME HERE.
SO IF -- I HAVE BEEN VERY
CURIOUS OF ANY ATTENDEES THAT
HAVE MORE EXPERTISE IN THE
GEOGRAPHY ON THE MAPPING PART OF
THIS HAVE AN IDEA HOW TO HANDLE
THIS WHERE THERE IS TIME VARYING
AVAILABILITY OF SERVICES.
YOU KNOW WE HAVE BEEN TALKING OF
DIFFERENT THINGS SIN WE HAVE
SEEN THESE RESULTS HOW TO
PRESENT THIS IN A WAY THAT IS
USABLE TO OUR PARTNERS BEYOND --
BEYOND THE MAPS AND SHOWING,
HEY, IT IS HARD TO HAVE
DECISIONS ON SATURDAY.
COMMUNITY PARTIES KNOW THAT.
AND THEY ARE ALL WORKING AND
TAGS BIG -- BIG INTERCONNECTED
CONVERSATION, OF COURSE, WHICH
INCLUDE VALUING PEOPLE'S SKILLS
AND EXPERIENCES AND COMPENSATING
THE KIND OF ROLES LIKE PASSING
OUT CLEAN, STERILE SYRINGES THAT
IT IS -- YOU KNOW, HARDER TO GET
PEOPLE TO WORK ON WEEKS
WEEKENDS.
DOES YOU IT MAKE A DIFFERENCE?
WE ARE NOT SURE.
I FEEL LIKE I AM MOSTLY RAISING
QUESTIONS.
BUT ALSO SHOWING THAT --
THINKING ABOUT IT THIS WAY IS --
HAS BEEN HELPFUL FOR US IN SORT
OF MOVING BEYOND OUR ORIGINAL
THING -- WHERE ARE SERVICES NOT
BEING OFFERED.
AND IT IS NOT JUST -- OKAY,
WHERE IS THE BRICK AND MORTARS,
BUT WHERE ARE MOBILE UNITS
GOING.
AND I GUESS A POLICY THING THAT
MAKES IT MORE RELEVANT IN
CALIFORNIA.
IN THE LAST FEW YEARS AND
INSURANCE BE IN MEDICAID,
MEDICAL WILL BE TO REIMBURSEMENT
FOR MOBILE SERVICES.
A LOT MORE NEW PROVIDERS HAVE
ENTERED THIS AND THAT WAS PART
OF THE REASON FOR TRYING TO DO
THIS.
OKAY, WE DO AS MUCH AS WE CAN
AND I GUESS SERVICE AND TALK
ABOUT IT IN LCHDA. SKID ROW IS
SOMEWHERE THERE THERE IS AGREE
AMOUNT OF NEED AND SERVICES AND
WHEN PEOPLE -- WHEN NEW GROUPS
ARE COMING IN, THEY SAY WHERE DO
I GO.
I GO TO SKID ROW.
LOOK, A BIG HOT SPOT IN THE
VALLEY AND A BIG HOT SPOT IN
LONG BEACH WHERE THERE AREN'T AS
MANY SERVICES.
SO I THINK THAT AT THE RISK OF
GETTING TOO LOST IN THE LITTLE,
I GUESS, PROVENCIAL DETAILS OF
MAPS OF LOS ANGELES.
WHAT IT SORT OF SHOWS IS THAT,
YOU KNOW, ZOOMING IN AND ZOOMING
OUT, YOU GET A DIFFERENT PICTURE
OF WHAT THE DIFFERENT ACCESS
THINGS ARE.
WE HAVEN'T TOUCHED ON ALL THE
IMPORTANT QUALITATIVE THINGS
RELATED TO SERVICE ACCESS THAT
MIGHT MAKE SOMETHING OTHER
BARRIERS WITH RAW, GEOGRAPHIC
ASSISTANCE.
AND WHERE DO WE GO FROM HERE?
I SHOULD HAVE SHOWED THIS
QUESTION EARLIER BECAUSE I JUST
TRIED TO ANSWER THAT.
IN THE SENSE THAT WE ARE TRYING
TO FIGURE OUT HOW TO
SYSTEMATICALLY ACCOUNT FOR TIME
VARYING AVAILABILITIES, AS WELL
AS HOW DO WE PRESENT -- LIKE HOW
-- LIKE HOW MIGHT THIS
INFORMATION GUIDE POLICY LOCALLY
AND ALSO GUIDE HOW WE THINK
ABOUT IT IF WE ARE MACKING IN A
LARGER OTHER AREA.
THANK YOU, AGAIN, TO MY TEAM.
ESPECIALLY THE FOLKS I MENTIONED
EARLIER BY NAME AS WELL AS OUR
MUCH LARGER GROUP.
THERE IS MAY E-MAIL.
HAPPY TO TAKE QUESTIONS.
>> THANK YOU, DR. SLOVER, FOR A
VERY INFORMATIVE SESSION, AND
TALKING OF THE INTRICACIES AND
COMPLEXITY OF GEOGRAPHY, TIMING,
OPERATIONALIZATION OF WHAT
DESERT MEMBERS AND MANY OTHERS.
SO AT THIS TIME, WE UP FOR
DISCUSSION.
WE ARE AHEAD OF TIME, BUT WE
WILL -- WE WILL HAVE TEN MINUTES
OF DISCUSSION UNLESS THERE IS
MORE QUESTIONS COMING IN THROUGH
THE AUDIENCES.
SO -- I DO SEE ONE QUESTION HERE
OR TWO.
FIRST ONE THAT I SEE IS WHY WAYS
TO TRANSPORT STK.
THAT IS FOR DR. SHOVER.
>> FUNNY, NONREGULAR RUSS IDEAS
OF HOW TO DEAL WITH THIS, PICK A
RANDOM TIME OF DAY AND USE
GOOGLE MAPS AND SOME SORT OF APP
AND DO IT THAT WAY.
THAT IS DEFINITELY SOMETHING WE
ARE EXPLORING DURING -- DOING IT
THAT WAY.
WE NEED TO FIGURE OUT HOW TO
MAKE IT, LIKE PALATABLE TO
PEOPLE WHO HAVE THE GEOSPATIAL
MODELING EXPERTISE.
>> THANK YOU SO MUCH.
I SEE ANOTHER QUESTION ABOUT
VERY INTERESTING ANALYSIS.
DO YOU HAVE TIME OF DAY/NIGHT?
>> I DON'T HAVE THOSE MAPS
READY, BUT IT IS SOMETHING THAT
WE HAVE LOOKED AT.
SO, YES, I THINK THAT -- THANK
YOU FOR ASKING THAT QUESTION.
IT ADDS AMMUNITION TO MY POINT
THAT I THINK WE REALLY SHOULD BE
SHOWING THAT, EVEN IF IT IS A
LITTLE UNORTHODOX AS FAR AS
MAPPING GOES.
LIKE, HEY, IT IS 5:00.
WHERE CAN I GEL A STERILE
SYRINGE.
>> THANK YOU SO MUCH.
I DO HAVE A -- PERHAPS ONE FOR
YOU QUESTIONS AS WE WAIT TO SEE
IF THERE ARE OTHERS AS WELL.
DR. JOHANNES EICHSTAEDT.
CAN YOU SHARE WITH US THE
COMPLEXITY OF THE DATA PROCESSES
OF SOCIAL MEDIA.
AND I UNDERSTAND -- I'M CURIOUS
TO SEE HOW THE MORE REALTIME THE
DAY AT THAT COMES IN AND HOW
POTENTIALLY OPPORTUNITIES I
GUESS ON UNDERSTANDING THAT
MERGING LANDSCAPE, CHANGING
AMOUNT OF DRUGS USING SOCIAL
MEDIA DATA.
>> YEAH, SO I WILL SAY THAT, YOU
KNOW, IN PRINCIPLE REALTIME.
AND -- [ LAUGHTER ] -- AND
REALTIME IN THE REAL WORLD,
THERE ARE MORE COMMERCIAL GRADE
IMPLEMENTATIONS OF THIS.
WE ARE SCIENTISTS AND
BOOT-STRAPPING IT ON RELATIVELY
INEXPENSIVE HARDWARE.
ORDER OF MAGNITUDE ONE OF OUR
SERVICES COST $50,000.
CLUSTER COST $50,000.
IF WE WERE TO DO THIS IN A
COMMERCIAL WAY, YOU COULD DO
WHAT IS CALLED STREAMING
IMPLEMENTATION.
YOU GET THE DATA AND PROCESS THE
DATA AND PROCESS THE DATA OUT.
IN PRINCIPLE, THAT CAN RUN
NIGHTLY.
THERE IS NO REASON WHY YOU CAN'T
DO THIS WITH A DAY'S WORTH OF
DEFENSE LAY.
CONSTRAIN IS ACCESS TO DATA AT
THE MOMENT. SO -- SO BOTH REDDIT
AND TWIPT TWIT HAS SHUT DOWN
THE APIs FACE WHERE IS THE
COMPUTERS CONNECT TO GET THE
DATA.
REDDIT DATA YOU CAN OBTAIN ON
THE OPEN WEB AS OF AUGUST 2024.
THERE ARE SOURCE FOR THIS KIND
OF DATA THAT STILL WORKS AND
WITH TWITTER IT IS EVOLVING.
IN THE EUROPEAN UNION, LAWS HAVE
BEEN PASSED THAT RESEARCHERS
NEED ACCESS TO THIS KIND OF
DATA.
I THINK THAT IS A GREAT STEP
FORWARD AND MAYBE SOMETHING TO
PACK THE -- OKAY, THAT WAS DATA
REALTIME.
YOUR SECOND QUESTION.
YEAH, WE THINK THAT IS ACTUALLY
ONE OF THE MOST PROMISING
APPLICATIONS ARE SOCIAL MEDIA
THAT YOU CAN GET AN EARLY
WARNING SYSTEM FOR UPCOMING
SUBSTANCES.
SO WE -- WE SAW VERY GOOD
RESOLUTION, FOR EXAMPLE, F
FOR CRATUM.
IT WAS MEMEKING FOR A WHILE AND
WE GOT A LOT OF SIGNAL AND YOU
CAN MA'AM THAT NEAR REALTIME,
YOU CAN MINE PARTICULARLY
PARTICULATE HONESTLY AT THE
MOMENT FOR THIS KIND OF
INFORMATION.
-- TIK TOK HONESTLY AT THE
MOMENT FOR THIS INFORMATION.
>> I HAVE A QUESTION COMING IN.
WHAT IS THE BENEFIT USING TWEETS
OVER GOOGLE SEARCH FOR TRENDS?
>> WELL, ALSO -- A GOOD
QUESTION.
AND WE HAVE A PAPER BAKING OFF
TWEETS AGAINST GOOGLE SEARCH
DATA.
ONE THING TO KNOW OF GOOGLE
SEARCH DATA.
GOOGLE TRENDS AREA FROM THE DNA,
DESIGNATED MODEL AREA LIKE NSAs
AND QUIRKY AND PURELY MARKETING
-- MARKETING UNIT.
SO THAT PRESENTS A CHALLENGE.
SO IGNORING THAT SORT OF DATA
LINKAGE STUFF IS PROBABLY GOING
TO BE FAIRLY SIMILAR, HONESTLY.
MORE OF THE KEYWORD THAN THE
GENERAL DISTRESS ROUTE.
PROBABLY MORE GOOGLE TRENDS, AND
PARAPHERNALIA, SOME SUCH PLY
RATHER THAN -- RATHER THAN SORT
OF THE GENERALIZED POPULATION
DESPAIR THAT WE THINK TRANSLATES
INTO DRUG TAKING.
BUT WORTH EXPLORING.
HARD TO GET ACCESS TO THE DATA.
>> ALL RIGHT.
THANK YOU SO MUCH.
DEALERSHIP HAVE ONE QUESTION FOR
DR. SHOVER.
A COMMENT OF THE SENSITIVITY
ANALYSIS, BUT THEN PRESENTING
THOSE NUANCES TO THE
DECISIONMAKERS OF THE DATA.
AND THE CHALLENGE.
I WOULD LIKE TO SEE IF YOU HAVE
ANY FURTHER ELABORATION OF HOW
THE PROCESS WORKS OR IF THERE
ARE WAYS TO MAKE THE DATA KIND
OF MORE DIGESTIBLE TO THE PEOPLE
WHO ARE MAKING THE DECISIONS.
>> YEAH, THEIR IS A GREAT
QUESTION.
AND I SEE ANOTHER ONE IN THE
CHAT THAT IS OF A PIECE OF THIS,
I THINK IT IS FOR ME.
IT IS ABOUT -- SO -- YEAH, HOW
DO YOU MAKE -- HOW DO YOU MAKE
IT DIGESTIBLE?
WELL, I THINK -- YOU KNOW, I --
I THINK FOCUSED -- I THINK THERE
IS -- THERE IS A FEW DIFFERENT
WAYS THAT I THOUGHT ABOUT IT.
ONE WAY SERVICE BY SERVICE.
THE REASON I WANTED TO TO THE
SERVICE, WHEN WE SAY SRP, DOES
THAT EVEN IN THE SAME THING
ACROSS THE BOARD?
WITH THE EXCEPTION OF THE AREA
THAT SPECIFICALLY PROHIBIT -- AT
LEAST AT THE TIME PASSING OUT
SYRINGES AND INJECTING
EQUIPMENT.
IT WAS PRETTY CONSTANT FURTHER
INTO THAT MAKING IT MORE
COMPLICATED.
SOME OF THE SERVICES THEY OFFER.
WE DO HAD HIV TESTING BUT ONLY
THURSDAY NIGHT ONCE A MONTH.
REASONABLE AMOUNT OF HIV TESTING
TO BE DONE MAYBE, BUT PRETTY
DIFFERENT THAN IF IT WAS
AVAILABLE ALL THE TIME AND I GET
WHY IT IS NOT IN TERM OF USING
THE HIV TESTING COUNCIL THERE
AND NEED ALL THE THE RESOURCES.
SO SERVICE BY SERVICE IN TERMS
OF WHERE YOU CAN GET, SAY SAFER
SMOKING KITS.
STERILE SYRINGES.
WHY DO YOU DO RAPID START
WITH BUPRENOPRINE.
THINKING OF MAKING IT SERVICE BY
SERVICE IS A WAY TO MAKE IT
EASIER TO UNDERSTAND IN TERMS OF
-- YOU KNOW, WHAT ARE THE GAP
HERE.
AND THEN THE QUESTION ABOUT THE
GROWING POLITICAL ACT ABOUT HARM
REDUCTION SERVICES -- CONCERNS
OF MAKING THESE MAPS PUBLICLY
AVAILABLE FOR SSP LOCATIONS.
YES THEY ARE NOT PUBLICLY
AVAILABLE.
YOU HAVE SEEN THEM BUT THEY ARE
NOT OUTDATED.
YOU ARE CERTAIN ABOUT THAT.
THAT HAS BEEN A MAJOR --
SPECIFICALLY OF OVERDOSE DEATH
AND NONFATAL OVERDOSE HAS BEEN
TALK WITH THE DIFFERENT
COMMUNITY MEMBERS AND HARM
REDUCTION WORKERS AND GOVERNMENT
PUBLIC HEALTH PEOPLE.
LIKE NO ONE WANTS -- NOBODY
WANTS US TO PUT, HIKE, POI -- L
POINTS ON THE MAP THAT YOU CAN
ZOOM IN.
I DON'T THINK I NEED TO EXPLAIN
WHY NOBODY WANTS THAT.
DISAGREEMENT IS HOW MUCH ZOOMING
OUT WE NEED TO DO.
WE PROPOSED ZOOMING IT OUT TO
THE CENSUS TRACT.
I FEEL GOOD ABOUT THAT OF NOT
ABOUT IDENTIFIABLE.
BUT A LOT OF DATA IS ONLY AT
THIS LEVEL.
SO PROBABLY WHEN WE GET TO A
PLACE OF MAKING SOME OF THIS
PUBLIC, WE WILL HAVE MULTIPLE --
WE WILL TALK OF HAVING MULTIPLE
LAYERS WHERE, YOU KNOW, SERVICE
PROVIDERS MIGHT BE ABLE TO SEE,
OKAY, THIS IS EXACTLY WHERE YOU
CAN GET EXACTLY IN OR THAT.
THIS IS EXACTLY WHERE PARK THEIR
VAN WITH THE VERSION OF PUBLIC
TO SEE IT AT THE ZIP CODE LEVEL.
TWO SSPs THAT OFFER SERVICES IN
THE ZIP CODE OR ONE IN THE
ADJACENT ZIP CODE.
COLOR CODE IT THAT WAY.
NO, THAT IS REALLY IMPORTANT.
LUCKILY IN LOS ANGELES -- IT IS
ACTUALLY SHALL -- LOS ANGELES IS
SO BIG.
A TON OF HETEROGENIETY OF
WELCOME AND VERSUS ACTIVELY
DESTRUCTIVE.
LOCATION DEPENDENT EVEN IN L.A.
SOME PLACES THAT I ABSOLUTELY
DON'T SAY WHAT WE ARE DOING
WHERE WE ARE DOING IT.
OTHER PLACES WE PUT IT ON SOCIAL
MEDIA SAYING BRING YOUR DRUGS
HERE.
WE WILL CHECK THEM ON THIS TATE,
THIS TIME.
SO, YEAH.
>> GREAT.
THANK YOU SO MUCH FOR THE
RESPONSE TO THE QUESTION.
I THINK I SEE A LITTLE
BIT-RELATED IN TERMS OF
CALIFORNIA LEGISLATION INVOLVING
THE UNHOUSED POPULATION.
DO YOU HAVE ANY THOUGHTS OF HOW
THAT CAN BE INVOLVED IN
RESEARCH.
>> HOW IT MIGHT HAVE AFFECTED
RECENT RESEARCH?
>> HOW THIS MIGHT EFFECT THE
FUTURE OF YOUR RESEARCH AND
OTHER HARM REDUCTION EFFORTS?
>> YEAH, TOTALLY.
I MEAN, SO PEOPLE EXPERIENCING
HOMELESSNESS IN LOS ANGELES OVER
THE LAST FIVE YEARS ONE IN FOUR
TO ONE IN FIVE OPIOID-RELATED
DEATHS AND METHAMPHETAMINE
RELATED DEATHS IT IS ONE IN
THREE.
THAT MEANS THIS IS A REALLY,
REALLY IMPORTANT POPULATION TO
FOCUS ON.
IT ALSO MEANS THAT THE MAJORITY
OF PEOPLE DYING FROM FENTANYL
OVERDOSE ARE HOUSED.
AND THAT IS ACTUALLY A MUCH
HARDER POPULATION TO REACH.
THE THING ABOUT, YOU KNOW -- ONE
THING THAT I THEORIZE IS BEHIND
SOME OF THE LOCAL DECLINE.
YOU KNOW -- IT MITOGEN RALIZE
NATIONALLY WITH OVERDOSE WE ARE
SEEING.
EFFORTS TO GET NALOXONE IN THE
HAND OF PEOPLE WHO WITNESS
OVERDOSE IS SUCCESSFUL AND ALSO
PEOPLE EXPERIENCING HOMELESSNESS
TONIGHT HAVE A CHOICES TO USE IT
A LOT OF THE TIMES.
THEY ARE INHER TENTLY USING IT
IN A WAY.
NOW THAT THERE IS A TON O
OF NALOXONE ON THE STREETS.
MULTIPLE MOBILE OVERDOSE
RESPONSE TEAMS.
LOTS OF JUST BYSTANDER WHO HAVE
IT.
MORE THAN ANY GIVEN OVERDOSE
WILL BE WITNESS BY SOMEONE WHO
HAS NALOXONE.
THAT IS NOT TRUE FOR PEOPLE WHO
ARE HOUSED AND USING FENTANYL IN
THEIR HOME.
FOR WHOM THERE IS ALSO A MUCH
HIGHER BARRIER TO DISCLOSURE.
MORE STIGMATIZED.
IT IS ALMOST LIKE -- YOU KNOW,
TALKING TO PEOPLE IN THIS
SITUATION, MY SENSE IS THAT THE
MORE INSULATED YOU ARE FROM THE
-- THE SORT OF VISIBLE
CONSEQUENCES OF SEVERE OPIOID
USE DISORDER, THE HARDER IT IS
TO ENGAGE IN DIFFERENT KINDS OF
SERVICES AND PUTS PEOPLE AT
GREAT RISK.
SO IN SHORT, HOMELESSNESS IS
VERY IMPORTANT.
HOUSED PEOPLE ALSO REALLY
IMPORTANT.
AND HONESTLY, MORE CHALLENGING
THAN FOLKS WHO ARE LIVING OUT IN
THE OPEN OR IN CONGREGATE
SETTING WITH THE INITIAL ACCESS
PIECE.
UPTAKE IS A DIFFERENT THING.
THAT IS A SEPARATE QUESTION,
BUT, YEAH.
>> THANK YOU.
TWO MORE QUESTIONS THAT I SEE.
THEY ARE COMING IN.
ONE IS, DO YOU HAVE DATA ON
OVERDOSES OF DAYS/TIMES COMPARED
TO THE SYRINGE SERVICE PROVIDERS
ARE OPEN?
>> WE DO HAVE DATA.
WE NEED TO FORMALLY ANALYZE
THAT, STILL.
YES, ONE OF THE MANY IDEA WE
THROW OUT.
NICE TO HEAR ANOTHER VOTE FOR
THAT.
YEAH.
>> AND THE NEXT QUESTION --
>>SPEAKER: RECENT --
>>SPEAKER: YOU ANSWERED THIS ONE
ABOUT THE --
>>SPEAKER: OH, THE CHANGE IN
LEGISLATION.
LIKE -- OH, RIGHT.
YOU WERE ASKING -- I FORGOT,
YES.
I MEAN, ON THE ONE HAND, IF THIS
LAW LEADS TO MORE HOUSING AND
MORE PEOPLE GETTING INTO
HOUSING, I THINK THAT IS GOOD
ACROSS MANY DIFFERENT HEALTH
METRICS AND PROVIDE OPPORTUNITY
TO OFFER HARM REDUCTION AND
SUBSTANCE ABUSE TREATMENT
SERVICES.
IN PRACTICE, I AM DETERMINED IT
IS MOVING PEOPLE AROUND AND
FURTHER DISCONNECTING THEM FROM
EXISTING SERVICES.
THAT HAS BEEN -- THAT HAS BEEN
KIND OF WHAT WE HAVE SEEN
IN L.A. SINCE A SIMILAR LAW
STARTED BEING ENFORCED A FEW
YEARS AGO.
SO THAT'S WHAT I AM MOSTLY
CONCERNED ABOUT THERE. BUT, YOU
KNOW, I AM -- YEAH.
AND I SEE SOMEONE ALSO ASK, HOW
TO GET A INVENTORY FACILITY
FOR HIV EDUCATION TEST OR PREP.
I MEAN, I CAN THINK OF A FEW
DIFFERENCE WAYS .TO BE CLEAR,
THERE ARE MANY, MANY OTHER PLACE
INFORMS L.A. THAT YOU CAN GET
PREPPEDED THAT IS NOT ON THIS
MAP AND NOT IN ANY OF OUR MAPS.
WE DO NOT INCLUDE FEDERALLY
QUALIFIED HEALTH CENTERS THAT
ARE REQUIRED TO HAVE PREP IF
DON'T HAVE A SSP.
IF I WAS TRYING TO MAKE A MAP,
LOCAL LAWS WHERE IT IS REQUIRED
TO OFFER PREP AND COVER IT.
I WOULD PROBABLY JUST BE DOING,
LIKE, CALLING AROUND TO SOME OF
THE OTHER PLACES TO GET A SENSE.
BUT THEY DO A LOT OF MAPPING.
CURIOUS IF THEY HAD ALREADY DONE
THIS.
BUT I ALSO KNOW JUST FROM
WORKING IN THE FIELD THAT L.A.
HAS A HISTORY OF HIV MOBILE
VANS.
AND STREETS WHERE YOU KNOW YOU
WILL FIND A VAN TO HOP IN AND
GET A HIV TEST ON FRIDAY AND
SATURDAY NIGHT.
>> AND -- THANK YOU SO MUCH FOR
BOTH OF THE SPEAKERS FOR THE
EPIDEMIOLOGY SESSION.
I BELIEVE THOSE ARE ALL THE
QUESTIONS AND ANSWERS THAT I SEE
HERE.
SO I WOULD LIKE TO NOW CLOSE THE
-- THE MEETING WITH A FEW
CLOSING REMARKS.
>> WELL, FIRST OF ALL, I WOULD
LIKE TO THANK THE NIDA LEADER
PRESENTERS, THE TECHNICAL AND
SUPPORT STAFF FOR MAKING THIS
WORKSHOP POSSIBLE, AS WELL AS
THE PARTICIPANTS AVAILABLE FOR
THIS FOUR-HOUR VIRTUAL WORKSHOP.
WE APPRECIATE THE ACTIVE
ENGAGEMENT AND Q&A BOX.
WE APPRECIATE THE SPEAKERS ON
GEOSPATIAL DATA SCIENCE AND HOW
IT CAN USE FOR DRUG RESEARCH.
AND USING ANALYSIS, AND
INTERVENTIONS.
HOW OF THE PRIVATE GEOGRAPHIC
PRECISION.
HOW CAN WE LEVERAGE THESE TO
REALLY UNDERSTAND THE ACCESS TO
TREATMENT, AS WELL AS THE
INTRICACIES OF THE
TRANSPORTATION MODALITY, TIME OF
THE DAY AND USING THE SOCIAL
MEDIA DATA ON HOW IT WILL BE
LEVERAGED USING THE GEOSPATIAL
DATA THAT COMES FROM IT AS WELL.
LAST BUT NOT LEAST, ON HOW TO
REALLY CONDUCT VISUAL SPATIAL
WORK WITH COMMUNITY ENGAGEMENT
WITH PARTNERSHIP SO THE DATA
REACHES THE PEOPLE AND USEFUL
FOR HOSE WHO CAN BENEFIT THE
MOST.
SO WE REALLY APPRECIATE HEARING
FROM YOU AND TO HELP US FUTURE
WORKSHOPS.
QR CODE ON THE UPPER RIGHT.
I BELIEVE, SUSAN, THANK YOU SO
MUCH FOR PUTTING IN THE CHAT THE
LINK TO THE SURVEY AS WELL.
WE REALLY APPRECIATE HEARING
FROM YOU TO YOU HELP YOU CREATE
FUTURE WORKSHOPS.
AND AS A QUOTE SAYS, I HOPE THIS
WORKSHOP HAS INSPIRED YOU OF HOW
GEOSPATIAL DATA SCIENCE WILL
HELP YOU WITH NEW DISCOVERED
PATHWAYS.
AND THANK YOU SO MUCH FOR
ATTENDING AND ALL THE PRESENTERS
FOR THIS WORKSHOP.
NOW I WOULD LIKE TO ADJOURN THE
WORKSHOP.
THANK YOU.