1. Using GIS to Evaluate the Social Determinants of Health Michael Dulin

2. Disclosures I have no relationships to disclose. I will not discuss off label use and/or investigational use in my presentation. Funding from: – NIH (R01 MD006127) – The Robert Wood Johnson Foundation – NIH (R24 MD004930)

3. Background

4. Goal Examine the relationship between social determinants and health outcomes Design and validate GIS models that can identify areas within our community in need of health resources Implement community-based interventions to improve appropriate healthcare utilization

5. Community-Based Participatory Research Community Advisory Board (CAB) CAB Research Team Latino Community Healthcare Providers

6. Community Advisory Board (CAB) Healthcare System (Providers, Administrators) School Board City/County Management Parks Department Law Enforcement Community Academic (Social Sciences, Statistical Support, GIS) Health Department

7. Variables Race / Ethnicity Income Access to Grocery Stores Distance to Green Space Access to Public Transportation Access to Healthcare Social Network Hospitalizations ED Visits Primary Care Treatable ED Visits Utilization of Primary Care Quality of Life

8. Variable Selection Process Key Actors CAB Research Team Latino Community & Healthcare Providers Survey

9. Themes Identified / Data Elements Selected Education – Hispanic Population Speaking Spanish at Home and Not Proficient in English Economic Status - Hispanic/Latino Families below the Poverty Line Acculturation - Time of Arrival/Latin American-born Population who Entered U.S. in 2000 or Later and are Not U.S. Citizens Safety - Violent Crime Rate

10. Percent Hispanic (2010)

11. Access to Public Transportation

12. Violent Crime Rate

13. Emergency Department for Primary Care

14. Latin American Born Population who Entered the US after 2000 and not US Citizens

15. Hispanic Renter-Occupied Housing

16. Hispanic Hospitalization Rate

17. Median Household Income

18. Hispanic Children Speaking Spanish at Home - Not Proficient in English

19. Hispanic Families below the Poverty Line

20. Hispanic Patients Using a Safety Net Clinic

21. Hispanic Families

22. Hispanic High School Graduation Rate

23. Hispanic Population that Moved from Abroad in the Past Year

24. Hispanic Single Mother Families

25. Hispanic Unemployment Rate

26. Latin American-Born Population

27. Latin American-Born Population that Entered the U.S. in 2000 or Later

28. Latin American-Born Population who are not U.S. Citizens

29. Combining Variables Variables Identified are Normalized CAB asked to Weigh Each Variable Variables are combined CAB Adds Exclusion Criteria Composite Map Created Dulin MF, et. al. Geographic Information Systems (GIS) demonstrating primary care needs for a transitioning Hispanic community. J Am Board Fam Med. 2010 Jan-Feb;23(1):109-20. Dulin MF, et. al. Using Geographic Information Systems (GIS) to understand a community’s primary care needs. J Am Board Fam Med. 2010 Jan-Feb;23(1):13-21

30. Composite Map

31. Neighborhood Evaluation / Ground Truthing Drill Down to the Neighborhood Level Validation Process Started Qualitative / Photovoice Quantitative Begin to Build Intervention Team