When performing a survey, there are often questions about what method to use when measuring groun... more When performing a survey, there are often questions about what method to use when measuring ground position. This article discusses the importance of comparing the error range of GPS readings to that of the bearing and distance (compass and tape) method. Both techniques will result in a measured ground position that includes a certain margin of error. When working over smaller distances, the bearing and distance technique on average will produce more accurate results than when a GPS is used. This is due to the fact that the maximum error using compass and tape is proportionate to the distance measured while the maximum error of a GPS is consistent, and additive, for every single point recorded. However, there is a threshold above which the accumulated errors of the bearing and distance technique are equal to or greater than those of a GPS. The following examples show how to calculate these errors and how to choose an appropriate technique or a combination of techniques for the most ...
T W E N T Y - F I V E Y E A R S A G O University of Kansas geography field course students invest... more T W E N T Y - F I V E Y E A R S A G O University of Kansas geography field course students investigating the viability of ranching in Garden Park, a small valley in central Colorado (left, 2001), discovered that changing economics were making it increasingly difficult to earn a living off the land. A reexamination of the valley in 2001 revealed a shift from a commodity producing landscape to one focused on aesthetics and recreation, a transformation pandemic throughout the West.
ABSTRACT Background: This study was conducted through the Public Health Activities and Services (... more ABSTRACT Background: This study was conducted through the Public Health Activities and Services (PHAST) study associated with the system of state-level Public Health Practice-based Research Networks. We examined the effectiveness of using existing service statistics data gathered through local and state health departments for representing changes and variation in the output of a specific local health department (LHD) servicethe Supplemental Nutrition Program for Women, Infants, and Children (WIC). Methods: Unpublished WIC-related service data representing 148 LHDs were obtained from state WIC offices in 3 U.S. states and adapted into comparable measures of number of unduplicated WIC clients served by each LHD for each of 5 years from 2005-2009. Other state-specific data included the annual number of Medicaid births per county and the availability of WIC services from local non-LHD providers. Number of Medicaid births was used as a proxy for local need. Data were linked at the county level along with rural, small urban, and urban population size classifications. Results: LHDs providing WIC services appear to meet local demand rather consistently and relative to consistent federal guidelines directing WIC eligibility and service delivery. As a variable representing local need, the number of annual Medicaid births per county was a strong measure, accounting for major increases over time and county differences for number of WIC clients served by LHDs. This average change in WIC clients served per unit change in Medicaid births increased each year. Within each year, this association was largest among large urban regions and smallest among rural regions. Conclusions: Variation exists in LHD service delivery and it varies, in part, relative to jurisdiction population size, with rural LHDs seemingly less able to keep up with demand. Results also suggest that LHD service statistics can serve as useful data sources for measuring change and variation in volume of service.
ABSTRACT Background: As a part of the Public Health Activities and Service Tracking (PHAST) study... more ABSTRACT Background: As a part of the Public Health Activities and Service Tracking (PHAST) study and in collaboration with partners in 2 Public Health Practice-based Research Networks (PBRN), we examined local health department (LHD) expenditure data related to maternal/child health (MCH) services in order to investigate the relationship between LHD expenditures related to specific MCH services and apparent local need. Methods: Retrospective expenditure data from LHDs and for 3 MCH services over 6 years represented annual financial investments in WIC, Family Planning, and a composite of Maternal/Infant/Child/Adolescent service. We used a multivariate pooled-time series design to statistically estimate the ecologic associations between these MCH expenditures and related measures of local need over a six year period from 2005 to 2010 and while controlling for other factors. Results: MCH, as a share of a LHD's total expenditures, decreased over the study period in our sample, even as Medicaid births and numbers of children in poverty had increased in the same areas. Findings indicate that the MCH expenditures examined were strongly associated with local need in these LHD jurisdictions from 2005-2010 but that these associations are sometimes negative. WIC expenditures appear to have most consistently maintained a positive association with need. Conclusions: Findings suggest that budget cuts to MCH services may be undermining a positive association between MCH expenditures and local needparticularly in the areas of Family Planning and more general Maternal, Infant, Child, and Adolescent services. Annual expenditure data compiled through PHAST provide the potential for timely additional practice-based research.
In the past decade, large scale mobile phone data have become available for the study of human mo... more In the past decade, large scale mobile phone data have become available for the study of human movement patterns. These data hold an immense promise for understanding human behavior on a vast scale, and with a precision and accuracy never before possible with censuses, surveys or other existing data collection techniques. There is already a significant body of literature that has made key inroads into understanding human mobility using this exciting new data source, and there have been several different measures of mobility used. However, existing mobile phone based mobility measures are inconsistent, inaccurate, and confounded with social characteristics of local context. New measures would best be developed immediately as they will influence future studies of mobility using mobile phone data. In this article, we do exactly this. We discuss problems with existing mobile phone based measures of mobility and describe new methods for measuring mobility that address these concerns. Our measures of mobility, which incorporate both mobile phone records and detailed GIS data, are designed to address the spatial nature of human mobility, to remain independent of social characteristics of context, and to be comparable across geographic regions and time. We also contribute a discussion of the variety of uses for these new measures in developing a better understanding of how human mobility influences micro-level human behaviors and well-being, and macro-level social organization and change.
RESEARCH OBJECTIVE. A dearth of evidence regarding the distribution and reach of local health dep... more RESEARCH OBJECTIVE. A dearth of evidence regarding the distribution and reach of local health department (LHD) services is due, in part, to a lack of detailed data measuring and monitoring LHD service delivery temporally and across states and jurisdictions. Our Public Health Activities and Services Tracking Study harmonized LHD administrative data across multiple states to examine changes and variation in LHD service-specific expenditures. METHODS. Unpublished LHD expenditure data specific to Maternal and Child Health (MCH), Environmental Health (EH), and Communicable Disease (CD) Control were obtained from five states for over 300 LHDs. Data representing up to 12 years of service-specific expenditures (2000-2011) in each of MCH, EH, and CD service domains were harmonized into categories, based on the level of detail present in the state-wide expenditure codes for their LHDs. Descriptive and spatial analyses were conducted to examine trends and relationships. RESULTS. Inflation-adju...
Background: This study was conducted through the Public Health Activities and Services (PHAST) st... more Background: This study was conducted through the Public Health Activities and Services (PHAST) study associated with the system of state-level Public Health Practice-based Research Networks. We examined the effectiveness of using existing service statistics data gathered through local and state health departments for representing changes and variation in the output of a specific local health department (LHD) servicethe Supplemental Nutrition Program for Women, Infants, and Children (WIC). Methods: Unpublished WIC-related service data representing 148 LHDs were obtained from state WIC offices in 3 U.S. states and adapted into comparable measures of number of unduplicated WIC clients served by each LHD for each of 5 years from 2005-2009. Other state-specific data included the annual number of Medicaid births per county and the availability of WIC services from local non-LHD providers. Number of Medicaid births was used as a proxy for local need. Data were linked at the county level al...
Background: As a part of the Public Health Activities and Service Tracking (PHAST) study and in c... more Background: As a part of the Public Health Activities and Service Tracking (PHAST) study and in collaboration with partners in 2 Public Health Practice-based Research Networks (PBRN), we examined local health department (LHD) expenditure data related to maternal/child health (MCH) services in order to investigate the relationship between LHD expenditures related to specific MCH services and apparent local need. Methods: Retrospective expenditure data from LHDs and for 3 MCH services over 6 years represented annual financial investments in WIC, Family Planning, and a composite of Maternal/Infant/Child/Adolescent service. We used a multivariate pooled-time series design to statistically estimate the ecologic associations between these MCH expenditures and related measures of local need over a six year period from 2005 to 2010 and while controlling for other factors. Results: MCH, as a share of a LHD's total expenditures, decreased over the study period in our sample, even as Medic...
Local health department (LHD) leaders and their community stakeholders have different philosophie... more Local health department (LHD) leaders and their community stakeholders have different philosophies on the role of the public health departments in their communities. This contributes to variation in the portfolio of services offered by an LHD. Using national data sets and LHD data compiled from Public Health Practice-Based Research Network states participating in the Public Health Activities and Services Tracking (PHAST) study, this research is focused on developing and validating a method for identifying the underlying service philosophy of LHDs and is based on available data and practitioner input. Data on the types of services offered by LHDs in the 48 states represented in the 2008 NACCHO Profile were used. Cluster analysis identified clusters of LHD services, revealing three groups of services. These clusters were used in a latent class analysis to identify classes of LHDs based on their service offerings. Input from practice experts from four PHAST study states is helping to e...
Frontiers in public health services & systems research, 2012
Great variation exists in the nature of LHD service delivery and it varies, in part, relative to ... more Great variation exists in the nature of LHD service delivery and it varies, in part, relative to jurisdiction population size. Larger LHD jurisdictions may achieve an economy of scale in WIC service delivery that is not matched in smaller areas. Overall, we found that WIC service provision appears relatively consistent across study states and in the presence of increasing need, with greater responsiveness to need in urban areas. As demand for some preventive services increases LHDs in rural areas may need greater support than LHDs in large jurisdictions for meeting local demand. Unlike WIC, LHD-provided services that have less consistently maintained service-delivery guidelines may have a harder time responding to increasing need. The relative consistency of a federally-funded program such as WIC may serve as a good baseline for further study of less consistently delivered programs among LHDs. LHD service statistics can serve as useful data sources in measuring volume of service del...
Background: Major local health department (LHD) cuts, in relation to the economic crisis, have oc... more Background: Major local health department (LHD) cuts, in relation to the economic crisis, have occurred in the area of maternal and child health (MCH). Little evidence exists, however, regarding the outcomes associated with these services and how changes in MCH investments impact health. In connection with the Public Health Activities and Service Tracking (PHAST) study and in collaboration with 2 Public Health Practice-Based Research Networks (PBRN), we examined relationships between MCH-related investments of LHDs and health outcomes for women and children. Methods: We used a multivariate panel time series design to estimate ecologic associations between annual MCH expenditures and related county-level outcomes, while controlling for other factorsincluding the availability of those services via alternative providers. Our sample included 102 LHDs and covered 11 years (2000 to 2010). Health outcomes examined included rates of no/late prenatal care, teenage births, low birth weight, a...
Research Objective Data limitations and the complex ecological relationships involved in examinat... more Research Objective Data limitations and the complex ecological relationships involved in examinations of the health outcomes associated with targeted local health department (LHD) investments in specific service areas have hampered studies that could direct and support policy and practice in the delivery of local public health services. Our study used unique and detailed LHD expenditure data specific to Communicable Disease (CD) Control services to examine ecological relationships between these local-level data depicting a level of service expenditures and related health outcomes. Methods Uniquely detailed, unpublished annual local-level CD Control expenditure data were obtained from state health departments in three states representing 2005-2010 expenditures and including 144 LHD jurisdictions. We used county-level rates of communicable diseases that could reasonably be associated with variations in LHD spending related to CD Control activities to statistically estimate ecologic re...
RESEARCH OBJECTIVE. Public health practice-level decisions regarding the distribution of public h... more RESEARCH OBJECTIVE. Public health practice-level decisions regarding the distribution of public health services and system investments have largely been based on “conventional wisdom or expert opinion.” The Institute of Medicine (IOM) attributes the failure to make informed decisions based on evidence, in part, to a lack of accessible data that measure the volume and reach of services provided by public health agencies. In connection with the Public Health Activities and Service Tracking (PHAST) Study, our research objective was to investigate relationships between local-level Food Safety and Sanitation expenditures and health outcomes. METHODs. Uniquely detailed, unpublished annual local-level Food Safety and Sanitation expenditure data were obtained from state health departments in Washington (WA) and New York (NY). Through engagement with practice partners across the states, data were matched across 93 LHDs and over 2000-2010. We used a multivariate panel time-series design to ex...
We explored service variation among local health departments (LHDs) nationally to allow systemati... more We explored service variation among local health departments (LHDs) nationally to allow systematic characterization of LHDs by patterns in the constellation of services they deliver. We conducted latent class analysis by using categorical variables derived from LHD service data collected in 2008 for the National Profile of Local Health Departments Survey and before service changes resulting from the national financial crisis. A 3-class solution produced the best fit for this data set of 2294 LHDs. The 3 configurations of LHD services depicted an interrelated set of narrow or limited service provision (limited), a comprehensive (core) set of key services provided, and a third class of core and expanded services (core plus), which often included rare services. The classes demonstrated high geographic variability and were weakly associated with expenditure quintile and urban or rural location. This empirically derived view of how LHDs organize their array of services is a unique approa...
When performing a survey, there are often questions about what method to use when measuring groun... more When performing a survey, there are often questions about what method to use when measuring ground position. This article discusses the importance of comparing the error range of GPS readings to that of the bearing and distance (compass and tape) method. Both techniques will result in a measured ground position that includes a certain margin of error. When working over smaller distances, the bearing and distance technique on average will produce more accurate results than when a GPS is used. This is due to the fact that the maximum error using compass and tape is proportionate to the distance measured while the maximum error of a GPS is consistent, and additive, for every single point recorded. However, there is a threshold above which the accumulated errors of the bearing and distance technique are equal to or greater than those of a GPS. The following examples show how to calculate these errors and how to choose an appropriate technique or a combination of techniques for the most ...
T W E N T Y - F I V E Y E A R S A G O University of Kansas geography field course students invest... more T W E N T Y - F I V E Y E A R S A G O University of Kansas geography field course students investigating the viability of ranching in Garden Park, a small valley in central Colorado (left, 2001), discovered that changing economics were making it increasingly difficult to earn a living off the land. A reexamination of the valley in 2001 revealed a shift from a commodity producing landscape to one focused on aesthetics and recreation, a transformation pandemic throughout the West.
ABSTRACT Background: This study was conducted through the Public Health Activities and Services (... more ABSTRACT Background: This study was conducted through the Public Health Activities and Services (PHAST) study associated with the system of state-level Public Health Practice-based Research Networks. We examined the effectiveness of using existing service statistics data gathered through local and state health departments for representing changes and variation in the output of a specific local health department (LHD) servicethe Supplemental Nutrition Program for Women, Infants, and Children (WIC). Methods: Unpublished WIC-related service data representing 148 LHDs were obtained from state WIC offices in 3 U.S. states and adapted into comparable measures of number of unduplicated WIC clients served by each LHD for each of 5 years from 2005-2009. Other state-specific data included the annual number of Medicaid births per county and the availability of WIC services from local non-LHD providers. Number of Medicaid births was used as a proxy for local need. Data were linked at the county level along with rural, small urban, and urban population size classifications. Results: LHDs providing WIC services appear to meet local demand rather consistently and relative to consistent federal guidelines directing WIC eligibility and service delivery. As a variable representing local need, the number of annual Medicaid births per county was a strong measure, accounting for major increases over time and county differences for number of WIC clients served by LHDs. This average change in WIC clients served per unit change in Medicaid births increased each year. Within each year, this association was largest among large urban regions and smallest among rural regions. Conclusions: Variation exists in LHD service delivery and it varies, in part, relative to jurisdiction population size, with rural LHDs seemingly less able to keep up with demand. Results also suggest that LHD service statistics can serve as useful data sources for measuring change and variation in volume of service.
ABSTRACT Background: As a part of the Public Health Activities and Service Tracking (PHAST) study... more ABSTRACT Background: As a part of the Public Health Activities and Service Tracking (PHAST) study and in collaboration with partners in 2 Public Health Practice-based Research Networks (PBRN), we examined local health department (LHD) expenditure data related to maternal/child health (MCH) services in order to investigate the relationship between LHD expenditures related to specific MCH services and apparent local need. Methods: Retrospective expenditure data from LHDs and for 3 MCH services over 6 years represented annual financial investments in WIC, Family Planning, and a composite of Maternal/Infant/Child/Adolescent service. We used a multivariate pooled-time series design to statistically estimate the ecologic associations between these MCH expenditures and related measures of local need over a six year period from 2005 to 2010 and while controlling for other factors. Results: MCH, as a share of a LHD's total expenditures, decreased over the study period in our sample, even as Medicaid births and numbers of children in poverty had increased in the same areas. Findings indicate that the MCH expenditures examined were strongly associated with local need in these LHD jurisdictions from 2005-2010 but that these associations are sometimes negative. WIC expenditures appear to have most consistently maintained a positive association with need. Conclusions: Findings suggest that budget cuts to MCH services may be undermining a positive association between MCH expenditures and local needparticularly in the areas of Family Planning and more general Maternal, Infant, Child, and Adolescent services. Annual expenditure data compiled through PHAST provide the potential for timely additional practice-based research.
In the past decade, large scale mobile phone data have become available for the study of human mo... more In the past decade, large scale mobile phone data have become available for the study of human movement patterns. These data hold an immense promise for understanding human behavior on a vast scale, and with a precision and accuracy never before possible with censuses, surveys or other existing data collection techniques. There is already a significant body of literature that has made key inroads into understanding human mobility using this exciting new data source, and there have been several different measures of mobility used. However, existing mobile phone based mobility measures are inconsistent, inaccurate, and confounded with social characteristics of local context. New measures would best be developed immediately as they will influence future studies of mobility using mobile phone data. In this article, we do exactly this. We discuss problems with existing mobile phone based measures of mobility and describe new methods for measuring mobility that address these concerns. Our measures of mobility, which incorporate both mobile phone records and detailed GIS data, are designed to address the spatial nature of human mobility, to remain independent of social characteristics of context, and to be comparable across geographic regions and time. We also contribute a discussion of the variety of uses for these new measures in developing a better understanding of how human mobility influences micro-level human behaviors and well-being, and macro-level social organization and change.
RESEARCH OBJECTIVE. A dearth of evidence regarding the distribution and reach of local health dep... more RESEARCH OBJECTIVE. A dearth of evidence regarding the distribution and reach of local health department (LHD) services is due, in part, to a lack of detailed data measuring and monitoring LHD service delivery temporally and across states and jurisdictions. Our Public Health Activities and Services Tracking Study harmonized LHD administrative data across multiple states to examine changes and variation in LHD service-specific expenditures. METHODS. Unpublished LHD expenditure data specific to Maternal and Child Health (MCH), Environmental Health (EH), and Communicable Disease (CD) Control were obtained from five states for over 300 LHDs. Data representing up to 12 years of service-specific expenditures (2000-2011) in each of MCH, EH, and CD service domains were harmonized into categories, based on the level of detail present in the state-wide expenditure codes for their LHDs. Descriptive and spatial analyses were conducted to examine trends and relationships. RESULTS. Inflation-adju...
Background: This study was conducted through the Public Health Activities and Services (PHAST) st... more Background: This study was conducted through the Public Health Activities and Services (PHAST) study associated with the system of state-level Public Health Practice-based Research Networks. We examined the effectiveness of using existing service statistics data gathered through local and state health departments for representing changes and variation in the output of a specific local health department (LHD) servicethe Supplemental Nutrition Program for Women, Infants, and Children (WIC). Methods: Unpublished WIC-related service data representing 148 LHDs were obtained from state WIC offices in 3 U.S. states and adapted into comparable measures of number of unduplicated WIC clients served by each LHD for each of 5 years from 2005-2009. Other state-specific data included the annual number of Medicaid births per county and the availability of WIC services from local non-LHD providers. Number of Medicaid births was used as a proxy for local need. Data were linked at the county level al...
Background: As a part of the Public Health Activities and Service Tracking (PHAST) study and in c... more Background: As a part of the Public Health Activities and Service Tracking (PHAST) study and in collaboration with partners in 2 Public Health Practice-based Research Networks (PBRN), we examined local health department (LHD) expenditure data related to maternal/child health (MCH) services in order to investigate the relationship between LHD expenditures related to specific MCH services and apparent local need. Methods: Retrospective expenditure data from LHDs and for 3 MCH services over 6 years represented annual financial investments in WIC, Family Planning, and a composite of Maternal/Infant/Child/Adolescent service. We used a multivariate pooled-time series design to statistically estimate the ecologic associations between these MCH expenditures and related measures of local need over a six year period from 2005 to 2010 and while controlling for other factors. Results: MCH, as a share of a LHD's total expenditures, decreased over the study period in our sample, even as Medic...
Local health department (LHD) leaders and their community stakeholders have different philosophie... more Local health department (LHD) leaders and their community stakeholders have different philosophies on the role of the public health departments in their communities. This contributes to variation in the portfolio of services offered by an LHD. Using national data sets and LHD data compiled from Public Health Practice-Based Research Network states participating in the Public Health Activities and Services Tracking (PHAST) study, this research is focused on developing and validating a method for identifying the underlying service philosophy of LHDs and is based on available data and practitioner input. Data on the types of services offered by LHDs in the 48 states represented in the 2008 NACCHO Profile were used. Cluster analysis identified clusters of LHD services, revealing three groups of services. These clusters were used in a latent class analysis to identify classes of LHDs based on their service offerings. Input from practice experts from four PHAST study states is helping to e...
Frontiers in public health services & systems research, 2012
Great variation exists in the nature of LHD service delivery and it varies, in part, relative to ... more Great variation exists in the nature of LHD service delivery and it varies, in part, relative to jurisdiction population size. Larger LHD jurisdictions may achieve an economy of scale in WIC service delivery that is not matched in smaller areas. Overall, we found that WIC service provision appears relatively consistent across study states and in the presence of increasing need, with greater responsiveness to need in urban areas. As demand for some preventive services increases LHDs in rural areas may need greater support than LHDs in large jurisdictions for meeting local demand. Unlike WIC, LHD-provided services that have less consistently maintained service-delivery guidelines may have a harder time responding to increasing need. The relative consistency of a federally-funded program such as WIC may serve as a good baseline for further study of less consistently delivered programs among LHDs. LHD service statistics can serve as useful data sources in measuring volume of service del...
Background: Major local health department (LHD) cuts, in relation to the economic crisis, have oc... more Background: Major local health department (LHD) cuts, in relation to the economic crisis, have occurred in the area of maternal and child health (MCH). Little evidence exists, however, regarding the outcomes associated with these services and how changes in MCH investments impact health. In connection with the Public Health Activities and Service Tracking (PHAST) study and in collaboration with 2 Public Health Practice-Based Research Networks (PBRN), we examined relationships between MCH-related investments of LHDs and health outcomes for women and children. Methods: We used a multivariate panel time series design to estimate ecologic associations between annual MCH expenditures and related county-level outcomes, while controlling for other factorsincluding the availability of those services via alternative providers. Our sample included 102 LHDs and covered 11 years (2000 to 2010). Health outcomes examined included rates of no/late prenatal care, teenage births, low birth weight, a...
Research Objective Data limitations and the complex ecological relationships involved in examinat... more Research Objective Data limitations and the complex ecological relationships involved in examinations of the health outcomes associated with targeted local health department (LHD) investments in specific service areas have hampered studies that could direct and support policy and practice in the delivery of local public health services. Our study used unique and detailed LHD expenditure data specific to Communicable Disease (CD) Control services to examine ecological relationships between these local-level data depicting a level of service expenditures and related health outcomes. Methods Uniquely detailed, unpublished annual local-level CD Control expenditure data were obtained from state health departments in three states representing 2005-2010 expenditures and including 144 LHD jurisdictions. We used county-level rates of communicable diseases that could reasonably be associated with variations in LHD spending related to CD Control activities to statistically estimate ecologic re...
RESEARCH OBJECTIVE. Public health practice-level decisions regarding the distribution of public h... more RESEARCH OBJECTIVE. Public health practice-level decisions regarding the distribution of public health services and system investments have largely been based on “conventional wisdom or expert opinion.” The Institute of Medicine (IOM) attributes the failure to make informed decisions based on evidence, in part, to a lack of accessible data that measure the volume and reach of services provided by public health agencies. In connection with the Public Health Activities and Service Tracking (PHAST) Study, our research objective was to investigate relationships between local-level Food Safety and Sanitation expenditures and health outcomes. METHODs. Uniquely detailed, unpublished annual local-level Food Safety and Sanitation expenditure data were obtained from state health departments in Washington (WA) and New York (NY). Through engagement with practice partners across the states, data were matched across 93 LHDs and over 2000-2010. We used a multivariate panel time-series design to ex...
We explored service variation among local health departments (LHDs) nationally to allow systemati... more We explored service variation among local health departments (LHDs) nationally to allow systematic characterization of LHDs by patterns in the constellation of services they deliver. We conducted latent class analysis by using categorical variables derived from LHD service data collected in 2008 for the National Profile of Local Health Departments Survey and before service changes resulting from the national financial crisis. A 3-class solution produced the best fit for this data set of 2294 LHDs. The 3 configurations of LHD services depicted an interrelated set of narrow or limited service provision (limited), a comprehensive (core) set of key services provided, and a third class of core and expanded services (core plus), which often included rare services. The classes demonstrated high geographic variability and were weakly associated with expenditure quintile and urban or rural location. This empirically derived view of how LHDs organize their array of services is a unique approa...
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Papers by Matthew Dunbar