Visualizing an Intervention for Tobacco Control

Submitted by Jennifer Rewolinski

Dr. Heckman, an assistant professor of psychiatry and behavioral sciences at the Medical University of South Carolina (MUSC) in Charleston, used Community Health Maps (CHM) tools in his research on tobacco control. Smoking is the leading preventable cause of death worldwide and costs the US $130 billion in direct medical costs annually. Smoking is still a major public health issue that influences mortality, morbidity, healthcare costs, the environment, and quality of life.

Dr. Bryan Heckman

The outcome of Dr. Heckman’s precision medicine project will be a mobile app that aids smokers who recently quit by alerting them of proximity to stores which sell cigarettes or alternative nicotine products. Studies show that greater tobacco retailer density is associated with greater incidence of relapse; Dr. Heckman believes that mapping provides a new approach to visualizing environmental factors. A CHM training event at MUSC spurred his decision to integrate mapping into his own work using the CHM labs as a guide. These labs provide step-by-step instructions for implementing the CHM workflow. He used the data collection app Fulcrum on an iPhone to collect information on retailers: GPS coordinates, type, type of tobacco products sold, e-cigarette advertising, and photos. His team also used a high-powered Trimble GPS device to test accuracy of phone GPS, and the accuracy of phone GPS was adequate and more cost effective than more expensive GPS devices.

Figure 1. Dr. Heckman’s in progress map shows higher numbers of tobacco retailers are associated with  Census Tracts that have both higher poverty and a higher percentage of minority populations.

Dr. Heckman integrated his Fulcrum data into QGIS software. He added national datasets from the American Community Survey and Behavior Risk Factor Surveillance System for Census tract data, and Synar for retailer data to check the validity of the Fulcrum data; field data collection with Fulcrum revealed a more accurate list of current retailers than the national secondary datasets provided. Dr. Heckman believes QGIS is a powerful tool with many features; he was not only able to use QGIS to monitor and visualize his research questions but also to guide his project decisions and hypotheses. His results will guide policy recommendations, improve access to care, and deliver novel interventions.

Figure 2. Dr. Heckman’s in progress map shows higher numbers of tobacco retailers are associated with Census Tracts with higher percentages of minority populations

For those attempting to undertake a health GIS project on their own, Dr. Heckman emphasized that all the tools needed are provided on the CHM blog; only time and patience are required. He also recommends asking for help and reaching out to other CHM users who have experience. Dr. Heckman’s project has the potential to affect behavior change and reduce health disparities via a mobile intervention app which identifies nearby tobacco retailers and prompts and provides an intervention and awareness of a health issue. Dr. Heckman’s experience is an example of how the CHM blog and tools might be used.

Dr. Heckman would like to thank Kurt Menke and the CHM team, Dr. Williamson from MUSC, and his mentors for inspiration and growth. He would also like to acknowledge the Hollings Cancer Center and American Cancer Society Institutional Research Grant that helps support his work, and Alex Hirsch for his help coordinating the project.

The CHM team would like to extend their own gratitude to Dr. Heckman as they sincerely appreciate his time and his support of the CHM blog.

Community Health Maps Conducts a Training in the South Carolina Lowcountry

Recently Kurt Menke headed to Charleston, South Carolina to train several groups how to map their communities. This region is also known as the 'lowcountry' due to the flat, low elevation geography. The training was hosted by the Medical University of South Carolina (MUSC) and included people from Communities in Schools - Charleston (CISC) and the MUSC College of Nursing.First everyone learned how collect GPS field data with iPads. For this we used a new app named iForm. This app was used in lieu of EPI Collect, which no longer supported on iOS. (The next blog post will cover iForm in more detail.) iForm is an app very similar to the Android app ODK Collect, allowing a custom data collection form to be developed. To practice we collected bike rack locations  and seating areas around the MUSC campus. The afternoon was spent working with everyone's  data. GPS data points were brought into QGIS and shown against some local Charleston GIS data layers.The points were also uploaded to CartoDB. CartoDB is another new component of the Community Health Mapping workflow. It has become more intuitive than GIS Cloud and worked really well. (Note: There will be a post on using CartoDB soon too.)The following day I visited CISC's Derek Toth and three of his students at St. John's High School on John's Island, SC. Over a working lunch Mr. Toth showed students how easy it is to collect GPS points with their iPhones. We collecting several points while walking around the campus.Afterwards we went back inside and showed them how to upload the points into CartoDB and make a map. The figure below shows the results of 45 minutes worth of work! Click on the map to open the live version.This spring these three juniors will be leading the charge to map their island!  They will be presenting their work to the National Library of Medicine later this spring. I look forward to seeing their work!