Graceann Palmarella, Colleen McGrath, Sara Solomon, Roxanne Dupuis, and Carolyn Cannuscio
Social media and emerging mobile technologies have sparked radical shifts in human behavior, with people worldwide spending an average of 2 hours and 15 minutes daily on social networks. Facebook, Instagram, and Twitter have more than 2 billion users globally. Social networking site use has risen dramatically by all age groups, with the highest use among 18-29 year olds (see Figure below).
Every second, Twitter users send 6,000 tweets, amounting to 500 million tweets per day. Instagram users post approximately 95 million photos, generating 4.2 billion likes, each day. A newer platform, Snapchat, has 178 million daily users, 60% of whom are under 25 years of age. They share an average of 3 billion snaps, or rapidly vanishing photos, every day. Researchers at Penn are turning these Tweets, posts, and snaps into innovative data sources that hold vital clues about behaviors, emotions, preferences, opinions, and social networks—all with potential implications for population health. Through the analysis of keywords, images, phrases, emoticons, likes, and hashtags, Penn teams are turning troves of digital information into human-centered health interventions and educational initiatives.
Ruth Shefner, Colleen McGrath, Meghana Sharma, Evan Anderson, and Benjamin Cocchiaro
Injection drug use once accounted for half of the new HIV cases each year in Philadelphia. Today, it accounts for less than 6%. This achievement is the result, in large part, of increased access to sterile syringes through needle exchange at Prevention Point Philadelphia. But while tremendous strides have been made in reducing the HIV risk for people who inject drugs (PWID), the story with respect to skin and soft tissue infection (SSTI) and overdose is grim. SSTIs are life-threatening, painful, and remain common among PWID. Rates of fatal overdose, meanwhile, have skyrocketed in recent years, resulting in 907 deaths in 2016 and over 1200 in 2017. Trends for injection-related HIV and injection-related infection and overdose have taken different trajectories because access to sterile injection materials only addresses a portion of the risk environment for injection drug use. Avoiding SSTIs is hard, even with a sterile syringe, when injecting in poorly lit, cold, dirty or otherwise unhygienic spaces.
Reversing an overdose is possible with naloxone, but there has to be someone to administer it, and PWID often inject in secluded spaces. Some evidence also suggests that overdose is more likely when PWID inject hurriedly – from fear of assault or arrest – and without the opportunity to taste and control dosing.
Colleen McGrath, Graceann Palmarella, Sara Solomon, and Roxanne Dupuis
A new trend, “Precision Prevention,” is emerging in public health. This term is borrowed from “Precision Medicine,” a concept in medicine that allows for individualized treatments for patients. Precision prevention utilizes “biologic, behavioral, socioeconomic, and epidemiologic data to devise and implement strategies” tailored to specific individuals or populations. The goal of precision prevention is to target the “right intervention to the right population at the right time.” Much of precision prevention accounts for one’s social determinants of health, tailoring interventions based on a set of individual factors related to where we live, learn, work, and play that impact our health. Precision prevention works to move away from universal approaches to illness and injury prevention.
Flaura Koplin Winston, MD, MPH, Chair of the Science and Medical Advisory Committee for Entrepreneurship and Innovation at The Children’s Hospital of Philadelphia (CHOP), applies a precision prevention framework, using a “tiered risk model” (see figure 1) for the Violence Prevention Initiative at CHOP. In the tiered risk model, there are three types of interventions focused around the needs of universal, selected, and indicated populations. At each level, interventions range from meeting the universal needs of the general population, to the select needs of populations at increased or different risk, and finally to interventions tailored for populations with adverse or indicated needs. For example, within the Violence Prevention Initiative, selected interventions that integrate appropriate community support services are tailored to children at greater risk for violence, and indicated interventions tailor the most intensive, direct support to child victims of violence.
Ruth Shefner, Evan Anderson, and Derek Riker
Reducing incarceration is an important public health priority. There is now widespread recognition that criminal justice systems are a significant source of public health harm. They sometimes penalize individuals without improving community health, or create improvements that are offset by the considerable individual and communal harms associated with incarceration and with the collateral consequences of criminal convictions.
Philadelphia has become a leader in implementing criminal justice reforms. In 2010, the District Attorney’s Office initiated changes to reduce overcharging. In the last seven years, the First Judicial District has created nine specialized diversion programs, with seven specifically aimed at addressing the underlying causes of criminal activity. These programs vary in design but share key features. All attempt to prevent future criminal activity by diverting offenders away from incarceration and into community supervision. Programs also provide access to appropriate social and health services, and utilize a more collaborative approach between prosecutors, defense attorneys, judges and social services staff. This more efficient use of resources allows greater attention to more serious and violent crimes in Philadelphia.
Caroline Stark, Sara Solomon, Carolyn Cannuscio, Jeffrey Hom, and Zachary Meisel
Opioid use and addiction have reached epidemic proportions in Philadelphia, making drug overdose involving opioids a leading cause of death. Both pharmaceutical and illicit opioids contribute to this crisis. Opioid sales in Philadelphia more than doubled between 2000 and 2012, and health care providers continue to prescribe opioid pain medication in greater quantities than medically appropriate. The peak age group for overdoses is 45-54, an older age group than previously seen. Over-prescribing of opioids contributes to the recruitment of adults into drug dependence. While use of opioid pain medications usually does not lead to opioid use disorder, four out of five heroin users nationwide transitioned from original use of prescription medications. Heroin is easy to obtain, potent and cheap compared to prescription pain medications. There are estimated to be at least 70,000 heroin users in Philadelphia.
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