Melody Goodman

Goodman, Melody
Melody Goodman

Associate Professor of Biostatistics

Professional overview

Dr. Melody Goodman’s efforts seek to understand the social risk factors that contribute to health disparities in urban areas, with the goal of developing culturally competent, region-specific, and evidence-based solutions through collaborative activities with community members, community-based organizations, faith-based organizations, and other community health stakeholders. The purpose of her work is the development of solutions for improving health in minority and medically underserved communities.  

Dr. Goodman conducts applied biostatistical and survey research for community-based interventions and health disparities research with a strong focus on measurement. Additionally, through academic-community collaborations, she implements, evaluates, and enhances the infrastructure of community-engaged research, in order to mitigate health disparities. As such, Dr. Goodman is the Principal Investigator of a Patient-Centered Outcomes Research Institute (PCORI) grant that aims to validate and implement a quantitative survey measure to assess the level of community engagement in patient-centered outcomes research (PCOR) and clinical effectiveness research (CER) studies from the community stakeholder perspective.

Previously, Dr. Goodman has been subcontracted by the National Human Genome Research Institute/NIH to analyze patterns of beliefs about the genetic causation of health conditions and health behaviors among community health center patients. She was the Principal Investigator on a NIH Partners in Research grant entitled Community Alliance for Research Empowering Social change (CARES). With numerous funders supporting her work, she has published over 70 peer-reviewed journal articles.

Education

BS, Economics and Applied Mathematics & Statistics, State University of New York at Stony Brook, Stony Brook, NY
MS, Biostatistics, Harvard University, Cambridge, MA
PhD, Biostatistics (Minors: Social Determinants of Health Disparities and Theoretical Statistics), Harvard University, Cambridge, MA

Honors and awards

Siteman Cancer Center “Rock Doc” (2013)
Satcher Health Leadership Institute - Morehouse School of Medicine, Community Health Leadership Institute Intensive Cohort II (2013)
Women of the Year - Health, National Coalition of 100 Black Women, Inc. - Suffolk Chapter (2010)
President’s Award for Teaching Excellence - Stony Brook University (2009)
President’s Award for Excellence in Team Achievement - Stony Brook University (2008)

Areas of research and study

Biostatistics
Community Health
Community-based Participatory Research
Dissemination and Implementation of Evidence-based Programs
Health Disparities
Health Equity
Minorities
Minority Health
Quantitative Research

Publications

Publications

Screening for colorectal cancer: Using data to set prevention priorities

Colditz, G. A., McGowan, L. D., James, A. S., Bohlke, K., & Goodman, M. S.

Publication year

2014

Journal title

Cancer Causes and Control

Volume

25

Issue

1

Page(s)

93-98
Abstract
Introduction: Adherence to colorectal cancer screening recommendations is known to vary by state, but less information is available about within-state variability. In the current study, we assess county-level screening rates for Missouri, with the goal of better targeting public health efforts to increase screening. Methods: Prevalence of colorectal cancer screening among Missouri adults between the ages of 50 and 74 was obtained from 2008 and 2010 Behavioral Risk Factor Surveillance System data. We used multilevel logistic regression to generate county-specific estimates. After excluding 77 counties with fewer than 30 respondents, information was available about 3,739 individuals in 37 counties, representing 78.5 % of the state population. Results: Across counties, the prevalence of being up-to-date with recommended colorectal cancer screening ranged from 25 to 70 %. Conclusion: State-level information about colorectal cancer screening masks substantial within-state variability. Assessing and monitoring county-level disparities in screening can guide public health efforts to increase screening and reduce colorectal cancer mortality. More complete population survey data will make such analysis possible.

Urological chronic pelvic pain syndrome symptom flares: Characterisation of the full range of flares at two sites in the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network

Sutcliffe, S., Colditz, G. A., Goodman, M. S., Pakpahan, R., Vetter, J., Ness, T. J., Andriole, G. L., & Lai, H. H.

Publication year

2014

Journal title

BJU International

Volume

114

Issue

6

Page(s)

916-925
Abstract
Objectives To describe the full range of symptom exacerbations defined by people with interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome as 'flares', and to investigate their associated healthcare utilization and bother at two sites of the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Epidemiology and Phenotyping study. Subjects and Methods Participants completed a flare survey that asked them: 1) whether they had ever had flares ('symptoms that are much worse than usual') that lasted <1 h, >1 h and <1 day, and >1 day; and 2) for each duration of flare, to report: their average length and frequency; their typical levels of urological and pelvic pain symptoms; and their levels of healthcare utilization and bother. We compared participants' responses to their non-flare MAPP values and by duration of flare using generalized linear mixed models. Results Of 85 participants, 76 (89.4%) completed the flare survey, 72 (94.7%) of whom reported experiencing flares. Flares varied widely in terms of their duration (seconds to months), frequency (several times per day to once per year or less), and intensity and type of symptoms (e.g. pelvic pain vs urological symptoms). Flares of all durations were associated with greater pelvic pain, urological symptoms, disruption to participants' activities and bother, with increasing severity of each of these factors as the duration of flares increased. Days-long flares were also associated with greater healthcare utilization. In addition to duration, symptoms (pelvic pain, in particular) were also significant determinants of flare-related bother. Conclusions Our findings suggest that flares are common and associated with greater symptoms, healthcare utilization, disruption and bother. Our findings also show the characteristics of flares most bothersome to patients (i.e. increased pelvic pain and duration), and thus of greatest importance to consider in future research on flare prevention and treatment.

An institutional strategy to increase minority recruitment to therapeutic trials

Anwuri, V. V., Hall, L. E., Mathews, K., Springer, B. C., Tappenden, J. R., Farria, D. M., Jackson, S., Goodman, M. S., Eberlein, T. J., & Colditz, G. A.

Publication year

2013

Journal title

Cancer Causes and Control

Volume

24

Issue

10

Page(s)

1797-1809
Abstract
Purpose: Participation in therapeutic clinical trials rarely reflects the race and ethnic composition of the patient population. To meet National Institutes of Health-mandated goals, strategies to increase participation are required. We present a framework for institutional enhancement of minority clinical trial accrual. Methods: We implemented structural changes on four levels to induce and sustain minority accrual to clinical trials: (1) leadership support; (2) center-wide policy change; (3) infrastructural process control, data analysis, and reporting; and (4) follow-up with clinical investigators. A Protocol Review and Monitoring Committee reviews studies and monitors accrual, and the Program for the Elimination Cancer Disparities leads efforts for proportional accrual, supporting the system through data tracking, Web tools, and feedback to investigators. Results: Following implementation in 2005, minority accrual to therapeutic trials increased from 12.0 % in 2005 to 14.0 % in 2010. The "rolling average" minority cancer incidence at the institution during this timeframe was 17.5 %. In addition to therapeutic trial accrual rates, we note significant increase in the number of minorities participating in all trials (therapeutic and nontherapeutic) from 2005 to 2010 (346-552, 60 % increase, p < 0.05) compared to a 52 % increase for Caucasians. Conclusions: Implementing a system to aid investigators in planning and establishing targets for accrual, while requiring this component as a part of annual protocol review and monitoring of accrual, offers a successful strategy that can be replicated in other cancer centers, an approach that may extend to other clinical and translational research centers.

Availability of and Ease of Access to Calorie Information on Restaurant Websites

Bennett, G. G., Steinberg, D. M., Lanpher, M. G., Askew, S., Lane, I. B., Levine, E. L., Goodman, M. S., & Foley, P. B.

Publication year

2013

Journal title

PLoS One

Volume

8

Issue

8
Abstract
Objective:Offering calories on restaurant websites might be particularly important for consumer meal planning, but the availability of and ease of accessing this information are unknown.Methods:We assessed websites for the top 100 U.S. chain restaurants to determine the availability of and ease of access to calorie information as well as website design characteristics. We also examined potential predictors of calorie availability and ease of access.Results:Eighty-two percent of restaurants provided calorie information on their websites; 25% presented calories on a mobile-formatted website. On average, calories could be accessed in 2.35±0.99 clicks. About half of sites (51.2%) linked to calorie information via the homepage. Fewer than half had a separate section identifying healthful options (46.3%), or utilized interactive meal planning tools (35.4%). Quick service/fast casual, larger restaurants, and those with less expensive entrées and lower revenue were more likely to make calorie information available. There were no predictors of ease of access.Conclusion:Calorie information is both available and largely accessible on the websites of America's leading restaurants. It is unclear whether consumer behavior is affected by the variability in the presentation of calorie information.

Examining infant and neonatal mortality by community health center concentration

Barnes, P. A., Goodman, M., Mathis, A., Shah, G. H., & Oka, M.

Publication year

2013

Journal title

European Journal of Scientific Research

Page(s)

547

Family Health History Communication Networks of Older Adults: Importance of Social Relationships and Disease Perceptions

Ashida, S., Kaphingst, K. A., Goodman, M., & Schafer, E. J.

Publication year

2013

Journal title

Health Education and Behavior

Volume

40

Issue

5

Page(s)

612-619
Abstract
Older individuals play a critical role in disseminating family health history (FHH) information that can facilitate disease prevention among younger family members. This study evaluated the characteristics of older adults and their familial networks associated with two types of communication (have shared and intend to share new FHH information with family members) to inform public health efforts to facilitate FHH dissemination. Information on 970 social network members enumerated by 99 seniors (aged 57 years and older) at 3 senior centers in Memphis, Tennessee, through face-to-face interviews was analyzed. Participants shared FHH information with 27.5% of the network members; 54.7% of children and 24.4% of siblings. Two-level logistic regression models showed that participants had shared FHH with those to whom they provided emotional support (odds ratio [OR] = 1.836) and felt close to (OR = 1.757). Network-members were more likely to have received FHH from participants with a cancer diagnosis (OR = 2.617) and higher familiarity with (OR = 1.380) and importance of sharing FHH with family (OR = 1.474). Participants intended to share new FHH with those who provide tangible support to (OR = 1.804) and were very close to them (OR = 2.112). Members with whom participants intend to share new FHH were more likely to belong to the network of participants with higher perceived severity if family members encountered heart disease (OR = 1.329). Many first-degree relatives were not informed of FHH. Perceptions about FHH and disease risk as well as quality of social relationships may play roles in whether seniors communicate FHH with their families. Future studies may consider influencing these perceptions and relationships.

Spatial and Racial Patterning of Real Estate Broker Listings in New York City

Kwate, N. O., Goodman, M. S., Jackson, J., & Harris, J.

Publication year

2013

Journal title

Review of Black Political Economy

Volume

40

Issue

4

Page(s)

401-424
Abstract
It has been well documented that Black homeseekers face discrimination in the housing market in the form of racial steering and other institutional policies and practices that are critical in limiting housing access. Less is known about the mechanisms that operate on the other side of real estate transactions to perpetuate racially segregated neighborhoods. We investigated whether White and Black brokers face segregation in the housing market. That is, to what extent do White and Black brokers differentially market property listings in neighborhoods of varying racial composition? Using real estate listings extracted from the websites of two of the largest New York City real estate brokerages, we examined whether Black and White brokers market properties primarily in Black and White neighborhoods, respectively; and whether, controlling for gender and experience level, Black brokers had a lower average price per square foot than White brokers. Results showed that Black brokers overwhelmingly marketed properties in Black neighborhoods, with fewer listings in White areas. Black brokers also marketed properties with an average price per square foot that was $197 lower than White brokers. Black brokers who worked in offices in Black neighborhoods had the lowest asking price of all brokers. Taken together, Black and White real estate brokers control a bifurcated market in NYC, perpetuating residential segregation and Black-White income and wealth disparities.

Using small-area analysis to estimate county-level racial disparities in obesity demonstrating the necessity of targeted interventions

D’Agostino-McGowan, L., Gennarelli, R. L., Lyons, S. A., & Goodman, M. S.

Publication year

2013

Journal title

International Journal of Environmental Research and Public Health

Volume

11

Issue

1

Page(s)

418-428
Abstract
Data on the national and state levels is often used to inform policy decisions and strategies designed to reduce racial disparities in obesity. Obesity-related health outcomes are realized on the individual level, and policies based on state and national-level data may be inappropriate due to the variations in health outcomes within and between states. To examine county-level variation of obesity within states, we use a small-area analysis technique to fill the void for county-level obesity data by race. Five years of Behavioral Risk Factor Surveillance System data are used to estimate the prevalence of obesity by county, both overall and race-stratified. A modified weighting system is used based on demographics at the county level using 2010 census data. We fit a multilevel reweighted regression model to obtain county-level prevalence estimates by race. We compare the distribution of prevalence estimates of non-Hispanic Blacks to non-Hispanic Whites. For 25 of the 26 states included in our analysis there is a statistically significant difference between within-state county-level average obesity prevalence rates for non-Hispanic Whites and non-Hispanic Blacks. This study provides information needed to target disparities interventions and resources to the local areas with greatest need; it also identifies the necessity of doing so.

Factors affecting frequency of communication about family health history with family members and doctors in a medically underserved population

Kaphingst, K. A., Goodman, M., Pandya, C., Garg, P., Stafford, J., & Lachance, C.

Publication year

2012

Journal title

Patient Education and Counseling

Volume

88

Issue

2

Page(s)

291-297
Abstract
Objective: Family history contributes to risk for many common chronic diseases. Little research has investigated patient factors affecting communication of this information. Methods: 1061 adult community health center patients were surveyed. We examined factors related to frequency of discussions about family health history (FHH) with family members and doctors. Results: Patients who talked frequently with family members about FHH were more likely to report a family history of cancer (p=.012) and heart disease (p<.001), seek health information frequently in newspapers (p<.001) and in general (p<.001), and be female (p<.001). Patients who talked frequently with doctors about FHH were more likely to report a family history of heart disease (p=.011), meet physical activity recommendations (p=.022), seek health information frequently in newspapers (p<.001) and in general (p<.001), be female (p<.001), and not have experienced racial discrimination in healthcare (p<.001). Conclusion: Patients with a family history of some diseases, those not meeting physical activity recommendations, and those who do not frequently seek health information may not have ongoing FHH discussions. Practice implications: Interventions are needed to encourage providers to update patients' family histories systematically and assist patients in initiating FHH conversations in order to use this information for disease prevention and control.

Nonparametric diagnostic test for conditional logistic regression

Goodman, M., & Li, Y.

Publication year

2012

Journal title

Journal of Biometrics and Biostatistics

Perceived familiarity with and importance of family health history among a medically underserved population

Ashida, S., Goodman, M. S., Stafford, J., Lachance, C., & Kaphingst, K. A.

Publication year

2012

Journal title

Journal of Community Genetics

Volume

3

Issue

4

Page(s)

285-295
Abstract
Inadequate knowledge of family health history (FHH) continues to be a major obstacle limiting its usefulness in public health and clinical practice; strategies to facilitate FHH dissemination are needed. Data (N0 1,334) were obtained through waiting-room surveys completed by a diverse sample of patients attending three community health centers. Perceptions about the importance of genetic information (β00.13, p<0.001; β00.11, p<0.001) and higher genetic self-efficacy (β00.14, p<0.001; β00.23, p<0.001) were significantly associated with higher levels of perceived familiarity with and importance of FHH, respectively. Furthermore, beliefs about genetic causation of illnesses (β00.12, p<0.001) and a wider reach of health communication within one's family (β00.15, p<0.001) were associated with higher levels of perceived familiarity with one's FHH. Participants in the oldest group (>50 years) reported higher familiarity than those in the youngest (18-25 years). Those with higher familiarity were significantly less likely to answer "don't know" when reporting diabetes and heart disease diagnoses among immediate (OR00.35 and OR00.29, respectively) and extended (OR00.50 and OR00.46, respectively) family members. Having a wider health communication reach within a family may be beneficial in increasing familiarity with FHH; however, the reported levels of communication reach were limited among most participants. Women, older-generation family members, and those who believe in the importance of genetics in health or feel confident about using genetic information may be particularly important as targets of public health interventions to facilitate FHH dissemination within families.

Quantitative assessment of participant knowledge and evaluation of participant satisfaction in the CARES training program

Goodman, M. S., Si, X., Stafford, J. D., Obasohan, A., & Mchunguzi, C.

Publication year

2012

Journal title

Progress in Community Health Partnerships: Research, Education, and Action

Volume

6

Issue

3

Page(s)

361-368
Abstract
Background: The purpose of the Community Alliance for Research Empowering Social change (CARES) training program was to (1) train community members on evidencebased public health, (2) increase their scientific literacy, and (3) develop the infrastructure for community-based participatory research (CBPR). Objectives: We assessed participant knowledge and evaluated participant satisfaction of the CARES training program to identify learning needs, obtain valuable feedback about the training, and ensure learning objectives were met through mutually beneficial CBPR approaches. Methods: A baseline assessment was administered before the first training session and a follow-up assessment and evaluation was administered after the final training session. At each training session a pretest was administered before the session and a posttest and evaluation were administered at the end of the session. After training session six, a midtraining evaluation was administered. We analyze results from quantitative questions on the assessments, pre- and post-tests, and evaluations. Results: CARES fellows knowledge increased at follow-up (75% of questions were answered correctly on average) compared with baseline (38% of questions were answered correctly on average) assessment; post-test scores were higher than pre-test scores in 9 out of 11 sessions. Fellows enjoyed the training and rated all sessions well on the evaluations. Conclusions: The CARES fellows training program was successful in participant satisfaction and increasing community knowledge of public health, CBPR, and research methodology. Engaging and training community members in evidence-based public health research can develop an infrastructure for community-academic research partnerships.

Relationship between perceived racial composition and health literacy among community health center patients

Kaphingst, K. A., Goodman, M., Pyke, O., Stafford, J. D., & Lachance, C.

Publication year

2012

Journal title

Health Education and Behavior

Page(s)

35

Relationship between self-reported racial composition of high school and health literacy among community health center patients

Kaphingst, K. A., Goodman, M., Pyke, O., Stafford, J., & Lachance, C.

Publication year

2012

Journal title

Health Education and Behavior

Volume

39

Issue

1

Page(s)

35-44
Abstract
Intervention and policy approaches targeting the societal factors that affect health literacy (e.g., educational systems) could have promise to improve health outcomes, but little research has investigated these factors. This study examined the associations between self-reported racial composition of prior educational and neighborhood contexts and health literacy among 1,061 English-and Spanish-speaking adult community health center patients. The authors found that self-reported racial composition of high school was a significant predictor of health literacy among those who received schooling in the United States, controlling for race/ethnicity, education, age, country of birth, and survey language. Black and Hispanic patients had significantly lower health literacy than White patients within educational strata among those schooled in the United States. The findings revealed substantial disparities in health literacy. Self-reported racial composition of school context was a significant predictor of health literacy. Transdisciplinary, multilevel intervention approaches are likely to be needed to address the health literacy needs of this population.

Self-reported segregation experience throughout the life course and its association with adequate health literacy

Goodman, M. S., Gaskin, D. J., Si, X., Stafford, J. D., Lachance, C., & Kaphingst, K. A.

Publication year

2012

Journal title

Health and Place

Volume

18

Issue

5

Page(s)

1115-1121
Abstract
Residential segregation has been shown to be associated with health outcomes and health care utilization. We examined the association between racial composition of five physical environments throughout the life course and adequate health literacy among 836 community health center patients in Suffolk County, NY. Respondents who attended a mostly White junior high school or currently lived in a mostly White neighborhood were more likely to have adequate health literacy compared to those educated or living in predominantly minority or diverse environments. This association was independent of the respondent's race, ethnicity, age, education, and country of birth.

Validation of self-reported measures in health disparities research

Hidalgo, B., & Goodman, M.

Publication year

2012

Journal title

Journal of Biometrics and Biostatistics

Weight perceptions and perceived risk for diabetes and heart disease among overweight and obese women, Suffolk County, New York, 2008

Darlow, S., Goodman, M. S., Stafford, J. D., Lachance, C. R., & Kaphingst, K. A.

Publication year

2012

Journal title

Preventing chronic disease

Volume

9

Issue

4
Abstract
Introduction: Many Americans fail to accurately identify themselves as overweight and underestimate their risk for obesity-related diseases. The purpose of this study was to investigate associations between weight perceptions and perceived risk for diabetes and heart disease among overweight or obese women. Methods: We examined survey responses from 397 overweight or obese female health center patients on disease risk perceptions and weight perceptions. We derived odds ratios (ORs) and 95% confidence intervals (CIs) from multivariable logistic regression analyses to examine predictors of perceived risk for diabetes and heart disease. We further stratified results by health literacy. Results: Perceiving oneself as overweight (OR, 2.78; 95% CI, 1.16-6.66), believing that being overweight is a personal health problem (OR, 2.46; 95% CI, 1.26-4.80), and family history of diabetes (OR, 3.22; 95% CI, 1.53-6.78) were associated with greater perceived risk for diabetes. Perceiving oneself as overweight (OR, 4.33; 95% CI, 1.26-14.86) and family history of heart disease (OR, 2.25; 95% CI, 1.08-4.69) were associated with greater perceived risk for heart disease. Among respondents with higher health literacy, believing that being overweight was a personal health problem was associated with greater perceived risk for diabetes (OR, 4.91; 95% CI, 1.68-14.35). Among respondents with lower health literacy, perceiving oneself as overweight was associated with greater perceived risk for heart disease (OR, 4.69; 95% CI, 1.02-21.62). Conclusion: Our findings indicate an association between accurate weight perceptions and perceived risk for diabetes and heart disease in overweight or obese women. This study adds to research on disease risk perceptions in at-risk populations.

Age differences in genetic knowledge, health literacy and causal beliefs for health conditions

Ashida, S., Goodman, M., Pandya, C., Koehly, L. M., Lachance, C., Stafford, J., & Kaphingst, K. A.

Publication year

2011

Journal title

Public Health Genomics

Volume

14

Issue

4

Page(s)

307-316
Abstract
Objectives: This study examined the levels of genetic knowledge, health literacy and beliefs about causation of health conditions among individuals in different age groups. Methods: Individuals (n = 971) recruited through 8 community health centers in Suffolk County, New York, completed a one-time survey. Results: Levels of genetic knowledge were lower among individuals in older age groups (26-35, p = 0.011; 36-49, p = 0.002; 50 years and older, p<0.001) compared to those in the youngest age group (18-25). Participants in the oldest age group also had lower health literacy than those in the youngest group (p <0.001). Those in the oldest group were more likely to endorse genetic (OR = 1.87, p = 0.008) and less likely to endorse behavioral factors like diet, exercise and smoking (OR = 0.55, p = 0.010) as causes of a person's body weight than those in the youngest group. Higher levels of genetic knowledge were associated with higher likelihood of behavioral attribution for body weight (OR = 1.25, p <0.001). Conclusions: Providing additional information that compensates for their lower genetic knowledge may help individuals in older age groups benefit from rapidly emerging genetic health information more fully. Increasing the levels of genetic knowledge about common complex diseases may help motivate individuals to engage in health promoting behaviors to maintain healthy weight through increases in behavioral causal attributions.

Detecting multiple change points in piecewise constant hazard functions

Goodman, M. S., Li, Y., & Tiwari, R. C.

Publication year

2011

Journal title

Journal of Applied Statistics

Volume

38

Issue

11

Page(s)

2523-2532
Abstract
The National Cancer Institute (NCI) suggests a sudden reduction in prostate cancer mortality rates, likely due to highly successful treatments and screening methods for early diagnosis. We are interested in understanding the impact of medical breakthroughs, treatments, or interventions, on the survival experience for a population. For this purpose, estimating the underlying hazard function, with possible time change points, would be of substantial interest, as it will provide a general picture of the survival trend and when this trend is disrupted. Increasing attention has been given to testing the assumption of a constant failure rate against a failure rate that changes at a single point in time. We expand the set of alternatives to allow for the consideration of multiple change-points, and propose a model selection algorithm using sequential testing for the piecewise constant hazard model. These methods are data driven and allow us to estimate not only the number of change points in the hazard function but where those changes occur. Such an analysis allows for better understanding of how changing medical practice affects the survival experience for a patient population. We test for change points in prostate cancer mortality rates using the NCI Surveillance, Epidemiology, and End Results dataset.

Survey study of anesthesiologists' and surgeons' ordering of unnecessary preoperative laboratory tests.

Katz, R. I., Dexter, F., Rosenfeld, K., Wolfe, L., Redmond, V., Agarwal, D., Salik, I., Goldsteen, K., Goodman, M., & Glass, P. S.

Publication year

2011

Journal title

Anesthesia and Analgesia

Volume

112

Issue

1

Page(s)

207-212
Abstract
Nearly 20 years ago it was shown that patients are exposed to unnecessary preoperative testing that is both costly and has associated morbidity. To determine whether such unnecessary testing persists, we performed internal and external surveys to quantify the incidence of unnecessary preoperative testing and to identify strategies for reduction. The medical records of 1000 consecutive patients scheduled for surgery at our institution were examined for testing outside of our approved guidelines. Subsequently, 4 scenarios were constructed to solicit physician views of appropriate testing: a 45-year-old woman for a laparoscopic ovarian cystectomy, a 23-year-old woman for right inguinal herniorrhaphy, a 50-year-old man for a hemithyroidectomy, and a 50-year-old man for a total hip replacement. One or more of these scenarios were sent to directors of preoperative clinics (all), United States anesthesiologists (all), gynecologists (cystectomy), general surgeons (herniorrhaphy), otolaryngologists (thyroidectomy), and orthopedists (hip replacement). Potential predictors of ordering and demographic information were collected. More than half of our patients had at least 1 unnecessary test based on our testing guidelines (95% lower confidence limit = 52%). The 17 responding preoperative directors were unanimous for 36 of the 72 combinations of test or consult (henceforth "test") and scenario as being unnecessary. Among the 175 anesthesiologists responding to the survey, 46% ordered 1 or more of the tests unanimously considered unnecessary by the preoperative directors for the given scenario. Among 17 potential predictors of anesthesiologists' unnecessary ordering, only training completed before 1980 significantly increased the risk of ordering at least 1 unnecessary test (by 48%, 95% confidence limits >29%). Anesthesiologists were 53% less likely to order at least 1 unnecessary test relative to gynecologists for the cystectomy scenario, 64% less likely than general surgeons for the herniorrhaphy scenario, 66% less likely than otolaryngologists for the thyroidectomy scenario, and 67% less likely than orthopedists for the hip replacement scenario. The 95% lower confidence limits were all >40%. The percentage of patients with at least 1 unnecessary test is a suitable end point for monitoring providers' ordering. The incidence can be high despite efforts at improvement, but may be reduced if anesthesiologists rather than surgeons order presurgical tests and consults. However, anesthesia groups should be cognizant of potential heterogeneity among them based on time since training.

Comparison of small-area analysis techniques for estimating prevalence by race

Goodman, M. S.

Publication year

2010

Journal title

Preventing chronic disease

Volume

7

Issue

2
Abstract
Introduction: The Behavioral Risk Factor Surveillance System (BRFSS) is commonly used for estimating the prevalence of chronic disease. One limitation of the BRFSS is that valid estimates can only be obtained for states and larger geographic regions. Limited health data are available on the county level and, thus, many have used small-area analysis techniques to estimate the prevalence of disease on the county level using BRFSS data. Methods: This study compared the validity and precision of 4 small-area analysis techniques for estimating the prevalence of 3 chronic diseases (asthma, diabetes, and hypertension) by race on the county level. County-level reference estimates obtained through local data collection were compared with prevalence estimates produced by direct estimation, synthetic estimation, spatial data smoothing, and regression. Discrepancy statistics used were Pearson and Spearman correlation coefficients, mean square error, mean absolute difference, mean relative absolute difference, and rank statistics. Results: The regression method produced estimates of the prevalence of chronic disease by race on the county level that had the smallest discrepancies for a large number of counties. Conclusion: Regression is the preferable method when applying small-area analysis techniques to obtain county-level prevalence estimates of chronic disease by race using a single year of BRFSS data.

Hepatitis B vaccination of male neonates and autism diagnosis, NHIS 1997-2002

Gallagher, C. M., & Goodman, M. S.

Publication year

2010

Journal title

Journal of Toxicology and Environmental Health - Part A: Current Issues

Volume

73

Issue

24

Page(s)

1665-1677
Abstract
Universal hepatitis B vaccination was recommended for U.S. newborns in 1991; however, safety findings are mixed. The association between hepatitis B vaccination of male neonates and parental report of autism diagnosis was determined. This cross-sectional study used weighted probability samples obtained from National Health Interview Survey 1997-2002 data sets. Vaccination status was determined from the vaccination record. Logistic regression was used to estimate the odds for autism diagnosis associated with neonatal hepatitis B vaccination among boys age 3-17 years, born before 1999, adjusted for race, maternal education, and two-parent household. Boys vaccinated as neonates had threefold greater odds for autism diagnosis compared to boys never vaccinated or vaccinated after the first month of life. Non-Hispanic white boys were 64% less likely to have autism diagnosis relative to nonwhite boys. Findings suggest that U.S. male neonates vaccinated with the hepatitis B vaccine prior to 1999 (from vaccination record) had a threefold higher risk for parental report of autism diagnosis compared to boys not vaccinated as neonates during that same time period. Nonwhite boys bore a greater risk.

Increasing research literacy in minority communities: CARES fellows training program

Goodman, M. S., Dias, J. J., & Stafford, J. D.

Publication year

2010

Journal title

Journal of Empirical Research on Human Research Ethics

Volume

5

Issue

4

Page(s)

33-41
Abstract
THE COMMUNITY ALLIANCE FOR Research Empowering Social Change (CARES) is an academic-community research partnership designed to: (1) train community members about evidencebased public health, (2) increase community members' scientific literacy, and (3) develop the infrastructure for community-based participatory research so that local stakeholders can examine and address racial/ethnic health disparities in their communities. Nineteen community members enrolled in the CARES training. The training consisted of 11 didactic training sessions and 4 experiential workshops, taught by a multidisciplinary faculty from research institutions. Results suggest that the training increased research literacy, prepared community members for collaborative work with academic researchers, and empowered them to utilize scientific research methods to create social change in their communities.

Does "off-hours" admission affect burn patient outcome?

Taira, B. R., Meng, H., Goodman, M. S., & Singer, A. J.

Publication year

2009

Journal title

Burns

Volume

35

Issue

8

Page(s)

1092-1096
Abstract
Introduction: Previous critical care and cardiology studies find that critically ill patients have worse outcomes when admitted to the hospital during off-hours as compared to those admitted during weekdays. As severe burn is equally emergent we hypothesized that this disparity in outcomes would exist for burn patients as well. Study design: Secondary analysis of the National Trauma Data Bank (NTDB) version 7.1. The NTDB is a national registry of hospital admissions for traumatic injury administered by the American College of Surgeons. Setting: 700 trauma facilities nationwide contributing to the NTDB between 2002 and 2006. Subjects: All trauma patients included in the dataset with the injury mechanism of burn divided into "off-hours" admits (nights from 6 pm to 6 am and weekends) and weekday admits. Measures: Time and day of admission, demographics, ISS score, injury characteristics (±inhalational injury, TBSA, and full thickness injury), facility characteristics (number of burn beds, teaching status). Outcomes: Mortality as the primary outcome. Secondary outcomes include ICU length of stay (LOS), hospital length of stay. Data analysis: Descriptive statistics to summarize group characteristics, χ2 and Student's t tests for bivariate analysis, multivariable linear and logistic regressions. Results: Of the 25,572 burn patients, 17,625 (68.9%) arrived during off-hours. There was no difference in ICU length of stay (LOS) (p = 0.233), hospital LOS (p = 0.82), or mortality (p = 0.546) for those admitted during off-hours compared with weekday admits. In multivariate analysis when controlling for age, gender, burn characteristics (inhalation injury, full thickness injury, and TBSA >30%), and hospital type, off-hours admission was not predictive of mortality (OR = 1.06, 95% CI 0.91-1.23). Conclusions: Contrary to studies in other critically ill patient populations, off-hours admission is not predictive of worse outcomes in burn patients.

Psychosocial stress and 13-year BMI change among blacks: The pitt county study

Fowler-Brown, A. G., Bennett, G. G., Goodman, M. S., Wee, C. C., Corbie-Smith, G. M., & James, S. A.

Publication year

2009

Journal title

Obesity

Volume

17

Issue

11

Page(s)

2106-2109
Abstract
Adverse psychosocial exposures may partially drive the high rates of obesity among blacks. The objective of this study was to prospectively examine the relationship between perceived psychosocial stress and percent change in BMI among adult black men and women. We used data from 756 women and 416 men who were participants in the Pitt County Study, a community-based, prospective cohort study of blacks in eastern North Carolina. Participants were aged 25-50 years of age on entry into the study in 1988 and follow-up was obtained in 2001. Using multivariable linear regression, we calculated the adjusted mean percentage change in BMI over the follow-up period for each tertile of baseline measures of the Perceived Stress Scale (low, medium, and high), adjusted for potential confounders. For black women, higher levels of psychosocial stress at baseline predicted higher adjusted percentage increase in BMI over the 13-year follow-up: low stress 12.0% (95% CI 9.6-14.4), medium stress 16.3% (95% CI 13.7-18.9), and high stress 15.5% (95% CI 13.1-17.8). For black men, perceived stress was not associated with percent BMI change. These data suggest that interventions targeting obesity in black women should consider the potential impact of emotional stress on weight change.

Contact

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