Conference on Geospatial Approaches to Cancer Control and Population Sciences

September 12-14, 2016
Natcher Conference Center, NIH Campus, Bethesda MD
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Cancer Epidemiology, Biomarkers & Prevention published a Focus issue in April 2017 to showcase recent, cutting-edge research in the development and application of novel geospatial approaches in cancer control and population sciences.

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Overview

Growing technological capacity in mapping and spatial technology along with increasing sophistication in spatial thinking related to health has resulted in the emergence of a growing research community using geospatial approaches on diverse aspects of cancer prevention and control.

The purpose of this conference, sponsored by NCI's Division of Cancer Control and Population Sciences (DCCPS), was to bring together a community of researchers across the cancer control continuum using geospatial tools, models and approaches to address cancer prevention and control in order to 1) support and build this research community, 2) accelerate the integration of state of the art tools and theories from spatial research into cancer control and population sciences, and 3) identify future directions for data, resource, training and research funding in cancer control. This conference addressed spatial and contextual aspects of cancer across the entire cancer control continuum including etiology, prevention, detection, diagnosis, treatment and survivorship.

Agenda

View agenda for Monday, September 12
Time Topic
8:00 a.m. - 9:00 a.m. Registration
9:00 a.m. - 9:30 a.m.

Welcome and Introduction to the Conference
Ruth L. Kirschstein Auditorium

David Berrigan, Ph.D., M.P.H.
National Cancer Institute (NCI)

Robert T. Croyle, Ph.D.
NCI

9:30 a.m. - 10:30 a.m.

Opening Plenary Session
Ruth L. Kirschstein Auditorium

Gary L. Ellison, Ph.D., M.P.H. (Moderator)
NCI

New Directions in Cancer Control and Population Sciences
Invited Speaker: Robert Hiatt, M.D., Ph.D., University of California, San Francisco

Cancer control research has become increasingly focused on population health in the United States. The notion of 'translational research' has extended past the development of new therapeutics to impact populations… where people live, work and play. Cancer control research is now challenged with finding the best ways to make use of new types of data from electronic health records to social media, new linkages of data sets including cancer registries, administrative data and digitalized health information, and new technologies such as geospatial methods. Increasingly sophisticated molecular techniques are providing new biomarkers to assess risk, while at the other end of the research continuum, there is growing interest in implementation science. How do we best translate effective interventions to reach sectors of society where they can make a difference? There may even be a slow crumbling of the traditional walls between the medical science focus on individual patients and population health sciences with transdisciplinary approaches to complex problems including persistent inequities in cancer outcomes. The challenge will be whether we can see measureable and attributable impacts on prevention and population health, while we also pursue treating cancers more precisely in individuals.

Connecting Population, Health and Place (With Geospatial Tools and Data)
Invited Speaker: John P. Wilson, Ph.D., University of Southern California

Much has been written about the spatial turn in health research in recent years, culminating in the recent Science article authored by Richardson and colleagues, and many of the sessions and talks which follow this one will explore one or more facets of this engagement in great detail. That said, this particular talk starts with a brief synopsis of past work. From there, the value proposition for pursuing geospatial approaches to cancer control given a world that is suddenly awash with geospatial tools and data is articulated. The talk will then describe the current status of geospatial tools and data along with some of the nascent trends that will help to shape the growth and evolution of geospatial technologies moving forward. These geospatial tools and data are then connected with health through a series of enduring challenges whose resolution is likely to have a large impact on the success (or not) of geospatial approaches to cancer control. The talk will conclude with a brief discussion of the research opportunities afforded by the collaborative and connected worlds in which many of us now live our lives, the importance of activity spaces (what I like to refer as personal geographies) in clarifying what is important about specific places and spaces, and the need for cross-training to build and sustain meaningful, collaborative, and interdisciplinary research programs linking cancer control and the spatial sciences in the years ahead.

10:30 a.m. - 10:45 a.m. Break
10:45 a.m. - 12:00 p.m.

Plenary Session
Ruth L. Kirschstein Auditorium

April Oh, Ph.D., M.P.H. (Moderator)
NCI

Segregation and the People's Health: Implications for Cancer Registries, Research, and Prevention
Invited Speaker: Nancy Krieger, Ph.D., Harvard University

The counting we do for cancer registries, and for public health more generally, is for accountability, for we create knowledge critical for altering who and what drives population health and health inequities. As far as health inequities are concerned, we don't simply live in unjust societies– we live in places, and no matter how much of our lives or livelihood may roam around in cyberspace, or be engaged with non-geographically defined communities or diverse interest groups, issues of residence, economics, power, and health are tightly bound. My presentation accordingly will address three topics: (1) the context, conceptually and empirically, for current work on spatial social polarization, both globally and nationally, and its implications for population health; (2) the Index of Concentration at the Extremes, a metric for monitoring health inequities, especially in relation to racialized economic segregation, which is likely promising for our work; and (3) the ongoing embodied legacy of Jim Crow as it pertains to risk of current cancer outcomes, specifically breast cancer estrogen receptor status, and to health more generally. In closing, I will discuss why our work in cancer control and public health must be cognizant of how it is we embody history – including our societal and ecological context – and what this means for how we can and must promote health equity.

Discussants
Mei-Po Kwan, Ph.D.
University of Illinois at Urbana-Champaign

Myles Cockburn, Ph.D.
University of Colorado Cancer Center

12:00 p.m. - 1:15 p.m. Lunch
Cafeteria on site
View agenda for Tuesday, September 13
Time Topic
8:00 a.m. - 8:45 a.m. Registration
8:45 a.m. - 9:00 a.m.

Welcome Back and Overview of Conference Day 2
Ruth L. Kirschstein Auditorium

David Berrigan, Ph.D., M.P.H.
NCI

9:00 a.m. – 10:00 a.m.

Plenary Session
Ruth L. Kirschstein Auditorium

Gary L. Ellison, Ph.D., M.P.H. (Moderator)
NCI

Genetic GIScience: Toward a Place-Based Synthesis of the Genome, Exposome, and Behavome
Invited Speaker: Geoffrey M. Jacquez, Ph.D., SUNY Buffalo and Biomedware Inc.

Understanding latency is critical when modeling dynamic geographic systems. This presentation describes compartmental models to estimate residence times in states defining disease progression. Two models are developed. The first models carcinogenesis based on the cascade of mutations and cellular changes that lead to metastatic cancer. The second models cancer stages defined by diagnostic criteria for cancer staging. The models are linked by mapping molecular and cellular characteristics of cancer cells to the stage at diagnosis.

These models provide:

  1. Empirically-based, biologically reasonable estimates of the distribution of residence times in cellular states and disease stages;
  2. Estimates and maps of the total burden of yet to be diagnosed disease;
  3. Criteria for achieving and maintaining cancer remission.

The approach may be used in disease surveillance and clustering to reveal where people lived when they were vulnerable to exposures that could have caused their disease. It also advances our understanding of disease latency, both for individuals as well as populations. Finally, it links our emerging knowledge of cancer genomics to cancer progression at the cellular level, to individuals and the stage of their cancer at diagnosis, and finally to population-level outcomes describing geographic distributions of cancer in extant populations. This provides the basis for a new synthesis in cancer control and surveillance: genetic geographic information science. An example illustrates application to PANIn pancreatic cancers in a population in southeastern Michigan. Research is needed to (1) apply the approach to different cancers, and (2) extend the models to incorporate our increasing knowledge of the cancer exposome.

Multilevel Approaches to Cancer Etiology and Control: Where Are We Now?
Invited Speaker: Timothy R. Rebbeck, Ph.D., Dana Farber Cancer Institute and Harvard University

Cancer is etiologically complex. Contextual factors including health system, neighborhood or community characteristics, have increasingly been linked to cancer incidence and mortality. In addition, social determinants and processes have been identified as cancer risk factors, including socioeconomic status or self-reported race. Environmental exposures at the level of the individual may be causally associated with CaP. Applied and fundamental investigations have identified a wide array of biologic factors mechanistically involved in carcinogenesis including those of the tumor microenvironment, metabolome, proteome, transcriptome, and genome. Hundreds of novel genetic susceptibility loci have been identified through candidate and genome-wide association studies (GWAS).

Studies of factors at a single level have provided a great deal of insight into cancer etiology. However, it is clear that genomics and risk factors reported to date do not fully explain cancer incidence or outcome. Risk factors studied in isolation and identified by standard approaches are unable to fully explain the complex, multifactorial causes of cancer. A multilevel approach may be required that simultaneously assesses the role of two or more etiological agents within hierarchical levels including the: contextual level (e.g., geocode-linked neighborhood features); individual level (e.g., behaviors, carcinogenic exposures, socioeconomic factors and psychological responses); biological level (e.g., cellular biomarkers, genomic ancestry, and inherited genetic susceptibility). For example, genomic factors may be associated with intermediate traits and contextual factors, which in turn may be associated with disease outcomes including case-control status or aggressive disease. Using this framework, it may be possible to better understand cancer etiology and outcomes, as well as identify population groups in which targeted interventions to reduce cancer incidence or poor outcomes can be focused.

10:00 a.m. – 10:15 a.m. Break
10:15 a.m. – 11:45 a.m.

Plenary Session
Ruth L. Kirschstein Auditorium

Zaria Tatalovich, Ph.D. (Moderator)
NCI

Geovisualization/Geovisual Analytics: Addressing the Cancer Burden
Invited Speaker: Alan MacEachren, Ph.D., Pennsylvania State University

This presentation will focus on advances in Geovisulization and Geovisual Analytics that have the potential to help researchers and practitioners address the cancer burden from multiple perspectives. It will begin with an overview of the related domains of Geovisualization/Geovisual Analytics research and practice, providing selected examples of their application to public health challenges (particularly related to the cancer burden), with attention to research and practice with application in epidemiology, behavioral sciences, health services, surveillance, and cancer survivorship. Then, some Geovisualization and Geovisual Analytics research challenges for the future will be outlined, with an emphasis on big data, heterogeneous information, and reasoning with uncertainty.

Discussants
David Stinchcomb, M.S., M.A.
Westat, Inc.

Kevin A. Henry, Ph.D.
Temple University

11:45 a.m. - 1:00 p.m. Lunch
Cafeteria On Site
1:00 p.m. – 2:30 p.m.

Concurrent Sessions 9 - 11

Session 9: Geo-Visualization of Cancer Burden
Balcony A

Session Chair: Dave Stinchcomb, M.S., M.A., Westat Inc.

Opening Remarks from Session Chair
Time: 1:00 - 1:10 p.m.

Submitted Presentations: Visualizing the Diffusion of Digital Mammography in New York State, 2004-2012
Presenting Author: Francis Boscoe, Ph.D., New York State Cancer Registry

Time: 1:10 - 1:25 p.m.
Co-Author: Xiuling Zhang, Ph.D., New York State Cancer Registry

Innovations in cancer detection and treatment are introduced in an uneven fashion, typically originating in research and teaching hospitals and eventually diffusing to smaller community hospitals. One such major innovation was the replacement of film mammography with digital mammography in the early 2000s. We quantify the diffusion of digital mammography within the state of New York from 2004, when approximately 10% of all mammogram images were digital, to 2012, when the figure was over 90%, using Medicare claims data from a sample of over 100,000 cancer-free women for whom the zip code of residence was known. The percentage of mammograms that were digital was calculated for each zip code for each 12-month trailing period in the study. The data were smoothed using a flexible spatial filter to capture a minimum of at least 100 mammograms centered on each zip code. Viewing the resulting smoothed percentages as a series of sequential maps reveals the times, locations, and rates at which digital mammography was adopted. Early adopters tended to be in areas with younger, upscale populations and communities with teaching hospitals, but there were individual exceptions; for example, the small Binghamton market was years ahead of other upstate areas. This type of analysis can help us better understand the persistence of disparities in cancer, as differential access to technology can translate into differences in incidence and survival. The process is now being repeated with the introduction of 3-D digital tomography. Health care providers are likely interested in seeing where they fall on the innovation spectrum; maps like these could help accelerate future innovation.

Place Matters: Identifying Communities with Unequal Risk for Prostate Cancer
Presenting Author: Anne-Marie Meyer, Ph.D., University of North Carolina at Chapel Hill

Time: 1:25 - 1:40 p.m.
Co-Authors: Tzy-Mey Kuo, Ph.D., M.P.H., University of North Carolina at Chapel Hill; Angela Smith, M.D., M.S., University of North Carolina at Chapel Hill; Matthew Nielsen, M.D., M.S., University of North Carolina at Chapel Hill

The epidemiology of prostate cancer (CaP) in the US is influenced by patient demographics, community, and provider characteristics which vary geographically. We explore this variation using incidence rates (IR) to identify areas of highest risk and deconstruct the relative influence of community and provider characteristics in the state of North Carolina (NC). Methods: We examine age-adjusted IR data from the NC cancer registry and county-level data (number of primary care & urology physicians per capita, race, education/insurance/employment) from the Area Resource File to describe disease risk in NC. Spatial clustering analysis methods were applied to evaluate spatial autocorrelation and identify clusters with significant high (HH) and low (LL) incidence relative to the surrounding area. Analyses were used to compare defining characteristics between clusters. Results: The geographic distribution of CaP Incidence in NC is not random (p < .001). Local Indicator of Spatial Association (LISA) analysis identified 12 HH clusters and 11 LL clusters. The HH clusters had a significantly larger proportion of black residents, fewer urologists and primary care physicians per capita, and lower SES than LL clusters. Conclusion and Impact: This study suggests that county-level socioeconomic and racial variables, as well as access to primary and specialty care, are associated with geographic disparities in prostate cancer. These observations support additional work with spatial regression to further characterize factors affecting disparities in incidence and outcomes to better identify targets for intervention.

Evaluating Regional Variation in Lung and Bronchus Cancer Survival in the US using Mortality-to-Incidence Ratios
Presenting Author: Cassie Odahowski, M.P.H., University of South Carolina

Time: 1:40 - 1:55 p.m.
Co-Authors: James Hebert, Sc.D., University of South Carolina; Jan Eberth, Ph.D., University of South Carolina

Regional disparities exist in rates of lung and bronchus cancer within the United States. Underlying reasons may include access to care, screening utilization, quality of treatment, socioeconomic, or cultural (including lifestyle) characteristics, or some combination of these. The mortality-to-incidence ratio (MIR) provides a relative measure of cancer survival and a means for identifying regional disparities that is easily derived from traditional cancer incidence and mortality data. Mortality and incidence rates for lung and bronchus cancer for 49 states (i.e., excluding Nevada) and the District of Columbia (D.C.) were obtained from the National Cancer Institute State Cancer Profiles. Rates were given as 5-year averages for the years 2008-2012. MIRs were calculated by dividing the age-adjusted mortality rate by the age-adjusted incidence rate per 100,000 for a given state. States were ranked by ascending MIR and divided into deciles. These categories were mapped using ArcGIS software in order to highlight the geographic variation in lung and bronchus cancer survival. A mean MIR of 0.75 was observed for the 49 states and D.C. MIRs ranged from 0.65 to 0.83. The five states with the lowest relative survival from lung and bronchus cancer, as measured by the highest MIRs, were all in the South: Arkansas, Oklahoma, Tennessee, Alabama, and Louisiana. The states with the lowest MIR, indicating the highest relative survival, were mostly in the Northeast: Connecticut, New York, Massachusetts, New Jersey, and Hawaii. The calculation and mapping of state level MIRs for lung and bronchus cancer revealed that many southern states have the lowest relative lung and bronchus cancer survival. Future research should focus on identifying the underlying risk factors for poor lung and bronchus cancer outcomes. This may entail exploring variation at smaller scales (e.g., counties).

An Interactive Web Mapping Tool for Visualizing Cancer Disparities with Socioeconomic Variables
Presenting Author: Ming-Hsiang Tsou, Ph.D., San Diego State University

Time: 1:55 - 2:10 p.m.
Co-Authors: Su Yeon Han, M.S., San Diego State University; Atsushi Nara, Ph.D., San Diego State University; Joseph Gibbons, Ph.D., San Diego State University; Caroline A. Thompson, Ph.D., San Diego State University

We developed an interactive web mapping tool for visualizing San Diego County cancer rates with socioeconomic data at the sub-regional area (SRA) level. This tool will be extended to provide dynamic choropleth mapping and spatial analysis functions for areas beyond San Diego using California Cancer Registry data. This dynamic web GIS/mapping tool was created with an open-source JavaScript library, Leaflet, and free web authoring tools (bootstrap, jquery, and Google Chart) to provide user-friendly maps and data mining functions, including multiple classification methods, correlation analysis, data export, and side-by-side map displays. Data obtained from San Diego County Health & Human Services Agency includes age-adjusted rates of death and hospitalization for 19 different cancer sites. Contextual data were compiled from the 2009-2013 wave of the American Community Survey, including variables on race/ethnicity and other demographic factors. The web tool is currently available in beta testing and undergoing a usability review by public health staff and cancer researchers. Conclusion: Different from existing web mapping tools for cancer data, our tool can provide a side-by-side visual comparison between cancer data and socioeconomic data to facilitate hypothesis testing for cancer population health research. Version-2 will add advanced GIS analysis functionality including multivariate analysis capabilities using Geographically Weighted Regression (GWR) models, Principle Component Analysis for covariate control, and correction for spatial autocorrelation. This free web map tool can be re-created by other researchers easily to help cancer researchers and policymakers visualize and analyze the spatial correlation between cancer outcomes and socioeconomic variables.

Discussion
Time: 2:10 - 2:30 p.m.


Session 10: Geo-Surveillance of Cancer
Balcony B

Emerging Topics in Geospatial Cancer Control and Surveillance: Project Us and Geospatial Cryptography
Invited Speaker and Session Chair: Geoffrey M. Jacquez, Ph.D., SUNY Buffalo and Biomedware Inc.

Time: 1:00 - 1:30 p.m.

This presentation will (1) explore the use of wearable environmental sensors to reduce cancers in vulnerable populations such as infants and children; and (2) describe a research collaboration with NAACCR that seeks to develop novel methods (geospatial cryptography) that will enhance sharing and analysis of geospatial cancer data among disease registries and researchers.

Submitted Presentations: A Spatiotemporal Cluster Detection Analysis of Invasive Cervical Cancer Incidence, By County In The State Of Maryland
Presenting Author: Sally Peprah, M.S.P.H., Johns Hopkins University

Time: 1:30 - 1:45 p.m.
Co-Authors: Shalini Pahrek, M.P.H., Maryland Department of Health and Mental Hygiene, Center for Cancer Prevention and Control; Jennifer Hayes, M.Ed., M.P.H., Maryland Department of Health and Mental Hygiene, Center for Cancer Prevention and Control; Kimberly Stern, M.H.A., C.T.R., Maryland Department of Health and Mental Hygiene, Center for Cancer Prevention and Control; Frank Curriero, Ph.D., Johns Hopkins University; Amber D'Souza, Ph.D., Johns Hopkins University

Invasive cervical cancer (ICC) is a highly preventable cancer; yet some women in the state of Maryland, like in other parts of the United Sates, continue to develop the disease. We hypothesized that there is space-time variation in ICC incidence. Methods: Data on all 2172 ICC cases reported by the Maryland Cancer Registry between 2003 and 2012 was utilized. Our analysis involved a retrospective space-time cluster detection analysis (SaTScan), searching for clusters of both high and low rates. All analyses were conducted at the county level, using 2-year aggregates of time and adjustments were made for age distribution and race using census data as well as percentage of females per county receiving Pap test using Behavioral Risk Factor Surveillance Data. Results: Median age of cases was 50 years (IQR: 40-63.5) and at diagnosis, cases had mainly grade 2 or 3 cancers (83%) with no metastasis (88%). After adjustments, four significant clusters were identified. A cluster of higher than expected rates comprising 3 counties (Baltimore city, Anne Arundel and Howard); RR 1.52, p=0.011 was observed for the period 2011-2012. In addition three significant clusters of lower than expected rates were observed for the period 2003-2004 in Cecil county (RR 0.21, p=0.011), 2005-2008 in Somerset county (RR 0.063, p <0.001) and 2011-2012 in Fredrick county (RR 0.25, p<0.001). Conclusion and Impact: Overtime some counties have experienced significantly lower than expected rates of disease. However there is a more recent cluster of disease that is not explained by age distribution, racial composition or the percentage of females screened for cervical cancer and this cluster may require targeted efforts to decrease disease rates.

Detecting Linear and Ring-Shaped Spatial Clusters for Geo-Surveillance of Cancer: An Abstract
Presenting Author: Shashi Shekhar, Ph.D., University of Minnesota

Time: 1:45 - 2:00 p.m.
Co-Authors: Emre Eftelioglu, M.C.S., University of Minnesota; Xun Tang, Ph.D., University of Minnesota

Finding spatial clusters, i.e., places with unusually high disease rate, is an important task for the geo-surveillance of cancer. Many current tools (e.g., NCI GeoViewer) use spatial auto-correlation map-visualizations for manual searching of spatial clusters. Since manual searches are expensive for large datasets, other tools (e.g., SaTScan) use algorithms to automatically identify statistically significant spatial clusters with simple footprints (e.g., circles) to reduce manual labor. However, SaTScan fails to detect many interesting spatial clusters. For example, towers (or chimneys) emitting carcinogenic material may lead to a ring-shaped cluster surrounding the source. In addition, related lung-cancer clusters related to vehicular emissions may lead to linear footprints along high-traffic transportation corridors (e.g., roads, rivers, etc.). We recently proposed new algorithms for detecting (statistically significant) clusters with ring-shaped footprints. The proposed algorithms outperformed SaTScan in a case study with dataset describing the legionnaire's disease outbreak in New York in 2015, where a cooling tower that was determined to the source the outbreak by public health officials. Our algorithm identified a statistically significant ring containing the location of the source. However, the source was not contained in any cluster identified by SaTScan. We have also proposed new algorithms for detecting (statistically significant) clusters with linear footprints. In case studies with pedestrian fatality datasets, our algorithms identified several statistically significant spatial clusters with linear footprints. However, SaTScan missed all but one statistically significant cluster with linear footprints. We acknowledge support from the USDOD, the NSF and the University of Minnesota.

Detecting Localized Clusters of Colorectal Cancer Incidence in New York City: Application of Spatial Scan Statistics
Presenting Author: Kosuke Tamura, Ph.D., New York University

Time: 2:00 - 2:15 p.m.
Co-Authors: Dustin T. Duncan, Sc.D., New York University; Jessica K. Athens, Ph.D, New York University; Brian Elbel, Ph.D., M.P.H., New York University

Colorectal cancer is one of the most prevalent cancers in the United States. Cluster detection methods have been applied to colorectal cancer previously but rarely done in New York City (NYC). These analyses may yield a better understanding of how cancer incidence concentrates in certain areas and insight into key environmental determinants. The objective of this study was to detect geospatial clusters of colorectal cancer incidence in NYC. We used data on gender-specific colorectal cancer incidence of five NYC boroughs at the zip-code level from the NY State Cancer Registry in 2005-2009. A spatial scan statistic based on the unadjusted discrete Poisson model was used to identify statistically significant (p <0.05) in NYC, individuals had 19-21% greater risks compared to outside the cluster. Of two low-risk clusters (p<0.05), individuals had 20-25% lower-risks, compared to outside the cluster. For women, of three high-risk clusters, individuals had 13-92% greater risks than individuals outside the cluster. In one low-risk cluster, individuals had a 17% lower-risk, relative to outside cluster. For both gender, high risk clusters appeared in Bronx and Brooklyn, whereas low risk clusters emerged in Manhattan and a few areas in Queens. Colorectal cancer incidence spatially clustered at the zip-code level in NYC. Future research should examine the geographic stability of identified colorectal cancer clusters over time.

Spatial-Temporal Survival Analysis on Prostate Cancer in PA
Presenting Author: Ming Wang, Ph.D., Penn State

Time: 2:15 - 3:30 p.m.
Co-Authors: Zheng Li, Ph.D., Penn State; Stephen A. Matthews, Ph.D., Penn State; Vern Chinchilli, Ph.D., Penn State

Prostate cancer is one of the most common cancers diagnosed among males, and is an important public health issue in Pennsylvania. The incidence rate and mortality vary substantially across geographical regions (counties) and over time (years). The widely-used Cox Proportional Hazard (PH) model does not apply due to the violation of PH assumption. In this work, we propose to use Bayesian accelerated failure time (AFT) models to analyze prostate cancer survivorship by incorporating random effects with multivariate conditional autoregressive (MCAR) priors for taking spatial temporal variation into account. The models are fitted based on Monte Carlo Markov Chain (MCMC) technique under the Bayesian framework. Extensive simulations are performed to examine and compare the performances of various Bayesian AFT models with MCAR priors. The criteria for model selection via the deviance information criterion (DIC) is also evaluated in the simulation study. Finally, we implement our method to the prostate cancer data obtained from the Pennsylvania Cancer Registry which includes all reported prostate cancer diagnosed and death cases by county from years 2000-2011.


Session 11: Geo-Statistical Methods and Models for Cancer Control
Balcony C

Geospatial Modeling for Cancer Prevention and Control
Invited Speaker and Session Chair: Andrew Lawson, Ph.D., Medical University of South Carolina

Time: 1:00 - 1:30 p.m.

Cancer prevention and control is founded on inferential tools that should highlight important etiological and behavioral patterns in the variation of the disease. To this end it can be fundamentally important to consider a model-based approach to such disease analysis. A model-based approach is the most flexible tool in the inferential box. It allows the inclusion of multiple observed effects within the inference framework, something that testing-based paradigms do not provide. In addition, it can adjust for unobserved effects (confounding). Within a modeling framework, geospatial information can play a significant role in highlighting risk effects not observable in time based studies (cohort or longitudinal studies).

Bayesian disease mapping addresses these issues by focusing on hierarchical modeling of disease risk effects (e.g. clusters, hot spots, ecological relations) from a spatial view point while allowing sensible inference to be made. Confounding can easily be included within these models via predictor adjustment and random effects. These latter effects can be spatially correlated or uncorrelated and can be seen as latent effects underlying the risk. An example of the analysis of multiple cancer outcomes where between-disease shared effects are modelled and an optimal model selection strategy is pursued.

Submitted Presentations:

Exposure Modeling of Erythemal Ultraviolet Radiation: Spatiotemporal Downscaling Using Geostatistics
Presenting Author: Trang VoPham, Ph.D., Brigham and Women's Hospital/Harvard University

Time: 1:30 - 1:45 p.m.
Co-Authors: Jaime E. Hart, Sc.D., Brigham and Women's Hospital/Harvard University; Kimberly A. Bertrand, Sc.D., Boston University; Zhibin Sun, Ph.D., Colorado State University and U.S. Department of Agriculture UV-B Monitoring and Research Program; Rulla M. Tamimi, Sc.D., Harvard University; Francine Laden, Sc.D., Harvard University

Ultraviolet B (UV-B) radiation, the primary source of vitamin D for most humans, is associated with cancers. Current U.S. UV exposure models are limited in spectral, spatial, and/or temporal resolution. Area-to-point (ATP) residual kriging is a geostatistical method that can be used to create a spatiotemporal exposure model. A stratified ATP residual kriging approach was used to predict average July noon-time erythemal UV (UVEry) (mW/m2) from 1998-2012 by downscaling National Aeronautics and Space Administration (NASA) Total Ozone Mapping Spectrometer and Ozone Monitoring Instrument remote sensing images to a 1 km spatial resolution and incorporating ancillary data (aerosol optical depth [AOD], surface albedo, cloud cover, dew point, elevation, latitude, ozone, surface incoming shortwave flux, year, and/or interactions [e.g., year and AOD]). Modeling was performed separately within nine U.S. regions. Cross-validation was used to compare ATP models and NASA grids to UV-B Monitoring and Research Program (UVMRP) measurements (gold standard) by calculating mean absolute errors (MAEs) and root mean square errors (RMSEs). From 1998-2012, ATP models more accurately estimated UVEry at UVMRP stations on average compared to NASA grids in the Northeast (average MAE for ATP, NASA: 13.9, 17.4; average RMSE 16.5, 19.2), Mid-Atlantic (MAE 14.8, 14.9; RMSE 15.8, 16.4), and Southeast (MAE 25.3, 36.9; RMSE 30.6, 43.3). Preliminary results indicate ATP residual kriging can provide accurate fine-scale UVEry estimates. This spatially and temporally varying exposure model will be applied to epidemiologic studies to elucidate the role UVEry may play in cancer risk.

A Spatiotemporal Industrial-Activity Model for Investigating the Intensity of Oil and Gas Activities
Presenting Author: William Allshouse, Ph.D., B.S.P.H., Colorado School of Public Health

Time: 1:45 - 2:00 p.m.
Co-Author: Lisa McKenzie, Ph.D., M.P.H., Colorado School of Public Health

Preliminary studies indicate that populations living near oil and gas (O&G) wells have a higher risk of childhood leukemia and other adverse health outcomes compared to populations living without O&G wells. While these studies used GIS methods to determine inverse distance weighted well counts around homes, they have not accounted for changes in intensity. Our objective is to use GIS methods to build an industrial-activity model to estimate the intensity of O&G activities surrounding homes over relevant exposure periods. We obtained dates for O&G activities such as drilling, fracturing, and production for each O&G well in Colorado. Additionally, we acquired monthly production data and other variables relevant to air emissions. This information was used to build a GIS model that estimates the wind-adjusted intensity of O&G activities for any given month. By categorizing wells into activity phases, we can produce the high degree of spatial and temporal heterogeneity in intensities expected around these sites. Our model allows us to evolve from a spatial model to a spatiotemporal one where we can assign time-varying exposure scores due to O&G development. Changes in activities, pollutants, and wind direction can have a large impact on the environmental exposure one receives from a particular source. This is particularly important when investigating associations with health outcomes such as childhood cancers where the exposure window for developing cancer may be fairly specific and relatively short. Our space/time GIS model should allow us to advance research investigating the association between decentralized sources of air toxics, such as O&G development, and childhood cancers.

Estimating Geographic Variation in Age-Period-Cohort Model Parameters with Multivariate Conditionally Auto-Regressive Random Effects
Presenting Author: Pavel Chernyavskiy, Ph.D., National Cancer Institute

Time: 2:00 - 2:15 p.m.
Co-Authors: Van Tran, Ph.D., National Cancer Institute; Mark P. Little, D.Phil, National Cancer Institute; Philip S. Rosenberg, Ph.D., National Cancer Institute

Age-period-cohort (APC) models are frequently used to study population trends in vital rates. However, tools for a comprehensive evaluation of geographic heterogeneity of model parameters are not well developed. We outline a general and scalable method for modeling rates in geographically-organized regions. We apply our approach to state-level variation in all-cause mortality trends for white non-Hispanic women under age 50; recent studies have noted an overall rise in mortality for this group in the United States. Thus, state-level estimates may provide new insights into this emerging public health issue. We allow region-specific parameters to be correlated spatially (e.g., among neighboring states), and to one another (e.g., allowing for correlations between state-specific mean rate and birth cohort trends (net drift)), via a random-effects formulation using a generalized multivariate conditionally auto-regressive model. This allows parameters to vary spatially, while retaining interpretability. Estimation is carried out using Bayesian methods in JAGS. Longitudinal age trend (LAT) (i.e., trend with age) exhibited significant geographic clustering with 95% posterior CI for spatial auto-correlation parameter of (0.19, 0.85). LAT varied between 5% per year in northern mountain states, and 9% per year in East North Central states. Birth cohort trend (net drift) was not significantly clustered and it varied between -0.7% per year (-0.9%, -0.5%) in New York, and 3.0% per year (2.6%, 3.5%) in West Virginia. National APC analyses that do not account for spatial heterogeneity in model parameters can over-generalize findings. Our model provides more nuanced estimates, aiding in performing reliable inference.

An Innovative Small Area Estimation Approach for Estimating County-Level Tobacco Use and Exposure
Presenting Author: Alexander McLain, University of South Carolina

Time: 2:15 - 2:30 p.m.
Co-Authors: Erica Sercy, M.S.P.H., University of South Carolina; Abdoulaye Diedhiou, M.D., Ph.D., University of South Carolina; Daniel Kilpatrick, Ph.D., University of South Carolina; Jan Eberth, Ph.D., University of South Carolina

Local health behavior and outcome data are important for program planning and evaluation, resource allocation, and policy-making. Although interest in local-level data is growing, surveys powered to make national or state-level inferences are rarely adequate to support direct estimation for small areas such as counties. Model-based small area estimation techniques have shown to be a viable solution. Using data from the 2014-2015 SC Adult Tobacco Survey, we examined several tobacco-related outcomes at the county level using a spatial multilevel, post-stratification approach. Specifically, we used a 2-level, random-intercept multilevel model and a spatially intrinsic ICAR model. Stratum-specific (race, age and sex) estimates for each county were created and then averaged based on stratum-specific population estimates obtained from the U.S. Census. The estimated prevalence of current smoking among SC adults ranged from 9-36%, and was lowest in Lee and Edgefield counties, both rural counties with a high proportion of African-Americans. The percentage of adults reporting ever trying an e-cigarette ranged from 4-29%, and was highest in Colleton County, a rural and majority-white county. Among smokers, 22-88% reported being advised to quit, and 36-92% reported a desire to quit. Data from the SC Adult Tobacco Survey was used to develop county-level estimates of >20 tobacco-related outcomes using a spatial multilevel, post-stratification approach. The results showed heterogeneity in smoking behaviors across the state along with marked spatial correlation. Our approach could be adapted to other states to produce accurate small area estimates for tobacco use and other health behaviors.

2:30 p.m. – 2:45 p.m. Break
2:45 p.m. – 4:15 p.m.

Concurrent Sessions 12 - 14

Session 12: Spatial Analyses Using Surveillance and Health Systems Data
Balcony A

Linkage of Community and Environmental Data with Electronic Health Records to Study Social, Built Environmental, Community, and Contextual Factors in Relation to Health
Invited Speaker and Session Chair: Brian S. Schwartz, M.D., M.S., Johns Hopkins University

Time: 2:45 - 3:15 p.m.

The Environmental Health Institute at the Geisinger Health System has been engaged in epidemiologic research using electronic health records since 2007. Geisinger has > 6 hospitals and > 40 community outpatient clinics in over 40 counties in central and northeastern Pennsylvania; its EHR began in 2001; its >450,000 primary care patients represent the general population in the region; and the 40 counties have a range of communities from urban to rural with a wide range of built and social environments. Each of these features facilitates epidemiologic research. This presentation will show how EHR data can be used to identify health outcomes and give examples of how environmental and community conditions can be measured at the individual or contextual level, assigned to individuals, and evaluated in relation to health. EHR data will be contrasted with what can be learned from claims data, which are available from the Geisinger Health Plan for approximately one-third of primary care patients. Environmental and community conditions that will be discussed include unconventional natural gas development (aka "fracking"); food environments; land use environments relevant to physical activity; community socioeconomic deprivation; animal feeding operations; building radon levels; and abandoned coal mine lands. Health conditions that will be discussed include childhood obesity, methicillin-resistant Staphylococcus aureus, type 2 diabetes, and asthma exacerbations. These were selected to show the range of health conditions that can be measured with EHR data, including the use of diagnoses, laboratory tests, medications, and procedures. EHR-based epidemiologic research can be enriched with primary data collection, including to measure health-related behaviors or to obtain samples for genetic or epigenetic studies, and examples will be presented.

Submitted Presentations: Space-Time Analysis of Late Stage Breast Cancer Incidence in Michigan
Presenting Author: Pierre Goovaerts, Ph.D., BioMedware Inc.

Time: 3:15 - 3:30 p.m.

The major difficulty in the analysis of health outcomes is that the patterns observed reflect the influence of a complex constellation of demographic, social, economic, cultural and environmental factors that likely change through time and space, and interact with the different types and scales of places where people live. A suite of techniques is introduced for the visualization and spatial analysis of time series of health data, including 3D display in a combined time and geography space, binomial kriging for noise filtering, joinpoint regression to model temporal trends, and cluster analysis to group geographical units with similar temporal trends. These techniques are used to explore spatio-temporal disparities in the incidence of breast cancer late-stage diagnosis for counties of Michigan Lower Peninsula over the period 1985-2007. Overall the proportion of late-stage diagnosis declined significantly at a rate of 3 to 5.3% per year until 1999 when it started rising again at a significant rate of 2.38% per year. Temporal trends greatly vary among counties and such discrepancies peaked in the early 1990s when the number of mammography clinics in operation started increasing steadily. The first significant decline in proportion of late-stage diagnosis started much later on the Eastern border of the State along Lake Huron, in particular in the Thumb area where late-stage diagnosis has been more prevalent over the years and both access to screening and socio-economic status are less favourable.

Social observatories and historic neighborhood exposures: Implications for cancer prevention and control
Presenting Author: Amy Hughes, Ph.D., University of Texas Health Science Center and University of Texas Southwestern Medical Center

Time: 3:30 - 3:45 p.m.
Co-Authors: Sandi Pruitt, Ph.D., University of Texas Southwestern Medical Center; Tammy Leonard, Ph.D., University of Texas at Dallas

Social observatories comprise longitudinal, linked multi-sector datasets of individuals within their local geospatial context. These datasets uniquely facilitate assessment of residential mobility and historic neighborhood exposures, thus presenting scalable, flexible platforms for longitudinal geospatial cancer prevention and control research. We link three administrative and clinical datasets tracking low-income families across the charitable food, housing, and medical sectors to evaluate potential for differential measurement of historic neighborhood exposures. Household members recorded in a food bank administrative database were matched to a safety-net healthcare system electronic medical record (EMR). Two years of food bank address histories and all associated EMR addresses were linked to housing parcel data using a hierarchical geocoding scheme. We assessed address congruence in space-time using descriptive statistics, and individual and housing correlates of congruence using logistic regression models. In all, 3,696 households and 23,192 addresses (6,289 food bank; 16,903 EMR) were included. Of 6,289 food bank addresses, 4,103 (65.2%) overlapped temporally with EMR addresses. Congruence in space-time was low (2,293 addresses; 36.5%). Congruence was more likely for older, married, Medicare/Medicaid- or un-insured and residentially-zoned households. Congruence was less likely for males and if the household moved. Multi-sector datasets measure markedly different historic neighborhood exposures. Congruence across component datasets in our social observatory is associated with household characteristics (e.g., uninsured) and behaviors (e.g., mobility), and independent of social safety-net system engagement. Social observatory datasets facilitate assessment of geospatial influences on cancer prevention and control behaviors. Future research is needed to characterize geospatial measurement error.

Does the Geographic Pattern of Late-Stage Colorectal Cancer (CRC) Predict the Pattern of CRC Mortality? An Example using Iowa Cancer Registry Data, 1999-2010
Presenting Author: Kevin Matthews, M.S., Centers for Disease Control and Prevention

Time: 3:45 - 4:00 p.m.

Colorectal cancer (CRC) mortality is higher among persons diagnosed with late-stage CRC; therefore it is likely that areas with high CRC mortality rates will also have high rates of late-stage CRC. We tested whether the proportion of late-stage CRC cases among all CRC cases was a better predictor of CRC mortality than was the rate of late-state cases among the population at risk for CRC. We matched individual-level cancer incidence data from the Iowa Cancer Registry to mortality data from the Iowa Department of Health, for Iowans aged 50 years and older. In this population from 1999 – 2010 there were 21,756 persons diagnosed with CRC, of whom 14,435 were late-stage, and 7,950 deaths from CRC. Incidence, mortality and population data for ZIP Code tabulation areas were aggregated to 3,423 small areas, which each contained at least 30 expected deaths. Indirectly age-sex adjusted measures, reported as standardized ratios, were calculated for each area. Adjusted R-squares from ordinary least squares regression quantified the correlation between these measures. In Iowa, between 1999 and 2010, the late-stage incidence rates per 100,000 person-years ranged from 114.9 to 243.6, the late-stage proportions per 100 diagnosed cases ranged from 52.9 to 77.1, and the mortality rates per 100,000 person-years ranged from 41.6 to 96.5. The correlation between late-stage incidence rates and mortality rates (r2 = 0.411, p < 0.001) was nearly 400 times higher than the correlation between the proportion of cases that were late and mortality rates (r2 = 0.003, p < 0.001). The late-stage incidence rate is a better predictor of CRC mortality in Iowa than the proportion of late-stage cases. Impact: State CRC prevention programs should consider using the late-stage incidence rate as a surveillance measure and for program planning. Disclaimer: The findings and conclusions in the report are those of the author and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Estimating Hospitals Cancer Care Market Share and its Variation by Patient and Clinical Factors
Presenting Author: Joel Segel, Ph.D., Penn State University

Time: 4:00 - 4:15 p.m.
Co-Author: Eugene Lengerich, V.M.D., M.S., Penn State University

While many cancer studies have examined how distance to the nearest facility may affect cancer treatment decisions and outcomes, little research has been undertaken on what factors affect the actual distance patients travel and what this means in terms of the types of patients different cancer facilities see. We use 2010-2014 Pennsylvania Cancer Registry data and a Stata user-provided open-source routing machine program to first calculate patients' driving time to the hospital where they receive treatment as well as the driving time to the nearest hospital. We then examine patient (age, sex, race, and insurance type, disease (primary site, stage), and facility characteristics that are associated with distance traveled to the treating hospital. For all analyses we estimate linear regression models with standard errors clustered at the county level. Preliminary results suggest that younger age, being insured, VA/Tricare insurance, a higher US News hospital quality score, hospital volume, and distance to nearest hospital were significantly associated with greater travel time. In addition, we found significantly greater travel times for prostate, cervical/uterine, and ovarian cancers but significantly shorter times for colorectal, breast, and lung cancers as well as cancers at a distant stage. Patient, hospital, and disease characteristics are all associated with significant differences in cancer care travel times. Understanding what factors are associated with patient cancer care location choices is critical as policymakers and payers attempt to encourage patients to seek care at higher quality facilities and will be particularly critical to understanding the potential future impact of alternative care model, particularly in oncology.


Session 13: Geoinformatics
Balcony B

Reconsidering Geocode Accuracy in Health Research
Invited Speaker and Session Chair: Daniel W. Goldberg, Ph.D., Texas A&M University

Time: 2:45 - 3:15 p.m.

It is well known that the accuracy of input data used for scientific investigations can affect the results generated from experiments, as well as the validity and power of the conclusions that can be drawn from them. These facts are particularly relevant when considering the spatial accuracy of data used in health research. For many years, qualitative metrics have been used to define the accuracy of geocoded data, which have in turn been used to judge the appropriateness of input data for epidemiological and disease surveillance and control purposes in public health. The existing measures used to indicate the spatial accuracy of geocoded data in health research are inadequate, sometimes misleading to research end-users, and are difficult to integrate into accuracy assessments in meaningful ways. Given prior results from large national-scale health investigations, it is possible to predict in advance what level of spatial accuracy can be obtained for different localities. Further, these same approaches can be used to re-assess the spatial accuracy of the data which underlie prior investigations to evaluate if inaccuracies impacted the validity of findings. This talk will examine the sources, magnitudes, and implications of error sources in the geocoding process, as well propose alternative spatial accuracy assessments that could and should be used in place of qualitative measures and hierarchical coding schemes that may imply false precision. Geocoding is an important first step in the health research process. It usually works well, but when it does not – it matters – and researchers must be provided with understandable and actionable measures to evaluate just how poorly it went.

Submitted Presentations: Better Practices for Spatial Energetics Data Processing
Presenting Author: Philip Hurvitz, Ph.D., University of Washington

Time: 3:15 - 3:30 p.m.
Co-Authors: Anne Moudon, Ph.D., University of Washington; Jason Y. Scully, M.U.P., University of Washington; Eric J. Howard, M.U.P., University of Washington; Brian E. Saelens, Ph.D., University of Washington

Spatial energetics research relies on processing of large amounts of sensor and GIS data. Correct data handling and processing is critical. The Transportation and Community Study (TRAC), focusing on longitudinal effects of the new light rail system in Seattle, WA, collected global positioning systems (GPS; Qstarz BTQ1000XT), accelerometry (Actigraph GT3X), and travel diary data from hundreds of adults for one week over three measurement waves. In the course of data processing and analysis we identified several technical problems induced by the device vendors' proprietary software (QTravel, Actilife), as well as commonly used analytic software (MS Excel and Access). We also identified issues surrounding the use of geographic information systems (GIS) software (ArcGIS) for geocoding and network routing. We present errors in time stamp handling related to time zones and daylight savings time in common software used for handling device data spatial energetics research. We also present some problems encountered integrating instrument data with GIS data. Furthermore, we present solutions to these problems. Results: Incorrectly accounting for standard/daylight savings time can induce time shifts of plus or minus one hour in GPS and accelerometry data. This can affect time synchronization among time stamped data tables, which can have downstream effects in estimating when and where physical activity takes place. Such locational problems may affect measurement of the built environment characteristics of physical activity bout locations. Likewise, problems with GIS data, software, and processing during geocoding and network routing can induce similar errors affecting estimation of built environment variable values at geocoded locations, and of the distances required to travel between known points. The large amount of data required for spatial energetics research precludes detailed review of all data, thus unforeseen errors may arise without analysts' knowledge. Data and software used in spatial energetics research may contain errors or omissions that compromise analysis and findings. More attention needs to be paid to these issues, with researchers sharing information and website and refereed journals reporting on the limitations of both data and software used. Solutions to identified problems may help other researchers in improving data processing and analysis.

Spatial Uncertainty of GIS Exposure Estimates
Presenting Author: Thomas Kirchner, Ph.D., M.S., New York University

Time: 3:30 - 3:45 p.m.
Co-Authors: Hong Gao, M.P.P., New York University; Andrew Anasetti-Rothermel, Ph.D., Truth Initiative

There is a great deal of interest in the way exposure to risk and protective factors within neighborhoods affects the health of people who traverse their streets. Real-time exposure estimates derived from actual mobility patterns are inherently more specific than residential approximations, but empirical methods for contrasting the predictive power of residential versus real-time exposure estimates are not well established. A nationwide density surface of convenience and related retail outlet locations was generated using kernel density estimation (KDE). This surface was linked to participants' (N=363) residential location, as well as their real-time geographic locations, recorded every 10-minutes over 180-days. Hourly mobility (N=1,567,156 total hours) was characterized by radius of gyration and associated contact with the retail density surface. Overall, 61.3% of real-time, hourly exposures were of relatively low intensity, and after controlling for temporal and seasonal variation, 72.8% of these low-level exposures was accounted for by residence in one of the two lowest residential density quintiles. Residence in the two highest residential density quintiles accounted for approximately 50% of extreme exposure levels, but extreme levels of exposure were rare, constituting about 1% of the data. Altogether 55.2% of real-time exposures were not explained by participants' residential density level, and of the unexplained exposures, 38.5% fell in the central, moderate range of the distribution. Results document the degree that residential exposure estimates may lead to misclassification, suggesting that a substantial proportion of real-time exposures will be misleadingly ignored, especially among people residing in areas characterized by moderate levels of residential density. This paper describes the development of an analytic framework for direct comparison of estimates based on residential versus real-time exposure to the landscape of retail outlets across the US, an industry vector for distribution of products known to heavily influence a range of health-related behaviors and clinical outcomes.

Complementary Exposure Methods to Evaluate Long-Term Effects of Traffic-Related Air Pollutants on Breast Cancer Incidence: The Multiethnic Cohort
Presenting Author: Iona Cheng, Ph.D., M.P.H., Cancer Prevention Institute of California

Time: 3:45 - 4:00 p.m.
Co-Authors: Juan Yang, Ph.D., M.P.H., Cancer Prevention Institute of California; Chiuchen Tseng, M.S., University of Southern California; Shannon Conroy, Ph.D., M.P.H., Cancer Prevention Institute of California; Lianfa Li, Ph.D., University of Southern California; Jun Wu, Ph.D., University of California, Irvine; Daniel O. Stram, Ph.D., University of Southern California

Vehicle exhaust contains a mixture of gases and particulate matter with known mutagenic and carcinogenic effects. Using three complementary exposure methods, we examined the association between NOx, a marker of traffic-related air pollutants, and breast cancer risk among female Multiethnic Cohort participants, residing predominately in Los Angeles County. We estimated average NOx exposure for 57,530 females, using 93,148 residential addresses over a 17 year period of follow-up by: 1) temporally adjusted land use regression (LUR; high spatial and high temporal resolution); 2) California line source dispersion model, version 4 (CALINE4; high spatial and moderate temporal resolution); 3) Bayesian kriging interpolation of routine monitoring station data (low spatial and high temporal resolution). Cox proportional hazard regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Stratified analyses were conducted by race/ethnicity, moving status, and distance to monitoring stations. Breast cancer risk was significantly associated with an increase in the interquartile range in NOx exposure in African Americans (LUR: HR=1.24; 95% CI: 1.01-1.53) and Japanese Americans (LUR: HR=1.39; 95% CI: 1.05-1.83 and CALINE4: HR=1.13; 95% CI: 1.00-1.27). For the LUR model, stronger significant associations were observed in African Americans and Japanese Americans among non-movers (single residential address) and those living closer to monitoring stations ( < median distance=5 miles). No significant associations were identified by kriging interpolation. Exposure assessment with high spatial and high/moderate temporal resolutions identified long-term effects of NOx on breast cancer risk. Future analyses will examine associations by neighborhood- and individual-level factors.

National Dataset and Tools to Estimate Health Impacts of Land Use and Transportation
Presenting Author: Lawrence Frank, Ph.D., University of British Columbia; Urban Design 4 Health, Inc.

Time: 4:00 - 4:15 p.m.
Co-Authors: James E. Chapman, M.S. C.E., Urban Design 4 Health, Inc.; Eric H. Fox, M.Sc.P., Urban Design 4 Health, Inc.; Jessica Schoner, Ph.D., Urban Design 4 Health, Inc.

Planners and public health officials seek to prioritize built environment investments which contribute to health behaviors important for chronic disease and cancer prevention. Despite this relevance, there is no widely available, nationally applicable decision-support planning tool to quantify health impacts at fine-grained geographies. This study creates resources to measure and optimize health impacts of transport and land use investments: 1) a national, consistent built, natural and social environment database at the Census block group level, and 2) a web-based health module to enhance the functionality of multiple existing scenario planning software tools. The health module contains statistical models of health behaviors and outcomes developed using participant address level data from the California's Health Interview and Household Travel Surveys. The models show sensitivity of health behaviors and outcomes to several useful environment variables, such as residential density and tree canopy. Using the health module, communities can estimate health behaviors and outcomes using the national database (existing conditions) and custom scenarios that reflect their land use and transport planning investment decisions. Successful health interventions may be implemented through strategies using the health module to enhance scenario planning tools' functionality to estimate health outcomes, including cancer risk factors. These data, models and tools allow more jurisdictions, even those which are challenged by insufficient data, staff and resources, to more easily include health impacts in planning decisions.


Session 14: Confidentiality and Defining Place Without Compromising Confidentiality
Balcony C

Session Chair: Douglas Richardson, Ph.D., American Association of Geographers

Opening Remarks from Session Chair Time: 2:45 - 3:00 p.m.

Submitted Presentations: An Adaptive Geomasking Method for Health Data Dissemination
Presenting Author: Xun Shi, Ph.D., Dartmouth College

Time: 3:00 - 3:15 p.m.

To protect patients' confidentiality, the data provider often employs the geomasking technique to de-identify individuals. Geomasking moves a point from its original location to a random location that is within a certain spatial extent. The main concern in geomasking is the balance between de-identifying individuals and preserving the spatial pattern determined by the individual locations. So far there is a lack of method for the data provider to evaluate this balance, and often geomasking in practice is performed in a subjective or even arbitrary way. Based on the understanding that as long as the de-identification can be achieved, the moving distance should always be minimized, an adaptive geomaksing process is proposed, which adjusts the moving distance according to the local population density. To achieve this adaption, instead of specifying a geographic distance as the maximum moving distance, a safe size of population is specified, which eventually has more explicit statistical and epidemiological meanings than a subjectively chosen distance. Furthermore, when choosing a random location, a location that has a population density similar to that of the original location has a greater chance to be selected. An experiment with a simulated dataset demonstrates that the adaptive geomasking is more advantageous in both preserving the original spatial pattern and evaluating (and thus controlling) the balance between confidentiality and fidelity. The adaptive geomasking improves the conventional geomasking that is based on specified geographic distances. The process should be able to facilitate dissemination of health data for research purposes.

Did You Mean to Give Your Patient's Address to Hooli.com? Privacy Concerns When Using Online Spatial Tools for Research
Presenting Author: Andrew Rundle, Dr.P.H., Columbia University

Time: 3:15 - 3:30 p.m.
Co-Authors: Stephen Mooney, Ph.D., Columbia University; Michael D.M. Bader, Ph.D., American University

Physical activity prevents several cancers, yet less that 50% of U.S. adults meet physical activity recommendations. There is a growing interest in using urban design to foster physical activity. These analyses investigate the associations between physical activity among residents of NYC and residential neighborhood walkability and access to green space. Sociodemographic information and data on physical activity measured by accelerometers were collected from 803 residents of NYC between November 2010 and November 2011. Physical activity was measured as minutes of moderate intensity equivalent activity per week ((minutes of moderate activity + (2 x minutes of vigorous activity)). The residential neighborhood was defined as a 1km radial buffer around the home. Neighborhood walkability was measured using a scale that combines data on residential density, land use mix, intersection density, retail space configuration and subway stop count. Access to green space was measured as the proportion of residential neighborhood covered with large parks spaces (park areas>6 acres) and small park spaces and the number of street trees per km of neighborhood area. After adjustment for individual and neighborhood sociodemographic characteristics, total weekly minutes of moderate intensity equivalent physical activity were significantly associated with neighborhood walkability (+26% across the interquartile range (IQR) of walkability, p<0.01), access to small and large park spaces (+12%, P<0.05, +11%, p=0.09 respectively, across the IQR of park access) and street tree density (+15% across the IQR of tree density, p<0.05). Physical activity among NYC residents is associated with neighborhood walkability and some measures of green space access.

Facilitating Analysis of Censored Geospatial Data: A Primer on Restricted Data Using the Kullback-Leibler Divergence Approach
Presenting Author: Tse-Chuan Yang, Ph.D., State University of New York at Albany

Time: 3:30 - 3:45 p.m.
Co-Authors: Stephen A. Matthews, Ph.D., Penn State; Daniel Kifer, Ph.D., Penn State

Due to concerns about confidentiality, cancer patients' information is censored and any residential information is typically replaced by reference to coarse areal units (e.g., ZIP code). Censoring does not necessarily preserve the relative spatial associations in the data, leading to an empirical question of whether researchers can obtain meaningful statistical inference with censored geospatial data. We develop an approach based on Kullback-Leibler (KL) divergence (NSF, 1228669) to address this problem. We compute a distribution of areas where respondents may reside and sample from this distribution to generate an imputed dataset. To obtain this distribution, we combine hierarchical Census data with censored geospatial data to estimate a probability distribution over areas with multiple imputation. We offer the KL primer by applying the method to a large dataset (over 700,000 geocoded observations) to the study of housing in Arkansas, and discuss extensions in cancer research. Our approach facilitates the use of spatial analytic tools to censored geospatial data. Geographically weighted regression was used on the imputed data and we found that coefficient estimates fall within the 95% confidence intervals of the true parameters (drawn from the geocoded data). The same patterns hold for other spatial clustering measures (e.g., Moran's I). The results indicate that our approach can help researchers make meaningful statistical inference with censored geospatial data. Our approach serves as a primer on handling restricted cancer patient data as it allows researchers to obtain preliminary findings about the spatial associations with public data, facilitating the decision to apply for restricted data.

New Methods for Describing and Measuring Spatial-Temporal Exposure to Multiple Places: Developments from the Activity Space and Contextual Measures of Environmental Exposures (ASCMEE) Study
Presenting Author: Stephen A. Matthews, Ph.D., Penn State

Time: 3:45 - 4:00 p.m.
Co-Authors: Shannon N. Zenk, Ph.D., M.P.H., R.N., University of Illinois at Chicago; Zhenhui Li, Ph.D., Penn State; Aster Xiang, M.A., University of Illinois at Chicago; Amber Kraft, University of Illinois at Chicago; Kirby McKinnon, M.P.H., University of Illinois at Chicago

Activity Space (AS) research offers a promising approach to understanding environmental influences on cancer-risk behaviors and outcomes. An objective of the ASCMEE measurement grant (5R21CA195543) is to develop tools to examine the joint spatial and temporal stability of AS. ASCMEE included the collection of 28-day GPS data (97 adults, Chicago); generating a geospatial database of 3+ million data points. We focus on the application of a new, flexible data aggregation tool to describe and synthesize the spatiotemporal patterns generated from GPS data. We introduce general and conditioned AS profile graphs to both represent accumulated exposure to places across time and to identify places where participants spend most time. We compare data for different sequences and durations of days across the 28-day period; and demonstrate the robustness of results through sensitivity analysis and the examination of specific cases. Results demonstrate heterogeneity in the size and complexity of individual AS over time, reveal different subgroups (rapid vs. slow accumulators) and the role of specific days or journeys in accumulated exposure. This method development scratches the surface of what is possible in AS research. The new ASCMEE tools are fast and efficient (do not require GIS), parameters options control spatial and temporal metrics and output can easily generate AS profile graphs. These methods/results have conceptual and substantive implications for the design of AS studies vis-à-vis the duration of data collection. This new tool can provide more accurate measures of spatiotemporal environmental exposures and ultimately a better understanding of environmental contributions to cancer risk behaviors.

Discussion
Time: 4:00 - 4:15 p.m.

4:15 p.m. – 5:30 p.m. Poster Session
Atrium
  1. Impacts of Locational Error on Local Spatial Autocorrelation Indices: A Cancer Data Case Study. Yongwan Chun, Monghyeon Lee.
  2. Local Weighted Quantile Sum Regression: A Method for Modeling Spatially Varying Effects of Chemical Mixtures. Jenna Czarnota, David C. Wheeler, Chris Gennings.
  3. A Research Framework Exploring the Influence of Neighborhood Chronic Toxic Stress Exposure on Genomic Change and Mortality of Inner City U.S. Blacks. Pam DeGuzman, Donna Schminkey.
  4. Selecting Spatial Scale of Area-Level Covariates in Regression Models. David Wheeler, Lauren Grant.
  5. Statistical Models for Cancer Center Catchment Area Analysis. David Wheeler, Aobo Wang.
  6. Spatial Scan Statistics in Practice: Complications with Cluster Detection Due to Late-Stage Case Definition. Laura Hayes, Lou Gonsalves, Cathryn Phillips, Lloyd Mueller.
  7. Small Area Estimation of Being Current with Colorectal Cancer Test Use. Zahava Berkowitz, Aman Chauhan, Lowell Anthony, Eric Durbin, Rachel Stewart, Virginia Valentin, Kimberly Absher, Nathan Vanderford, Susanne Arnold.
  8. Geographic Location and Breast Cancer Risk in Wisconsin. Ronald Gangnon, Amy Trentham-Dietz, Pat Remington, Jane McElroy, Polly Newcomb, Stephanie Robert, John Hampton.
  9. Characterizing the Locations and Social Characteristics of Hotspots of Oral and Pharyngeal Cancer Incidence in Florida. Jaclyn Hall, Yi Guo, Ramzi Salloum, Elizabeth Shenkman.
  10. Spatial Analysis of Socioeconomic Factors and Lung Cancer Mortality in China, 1973-2013. Xiaoping Shen, Limin Wang.
  11. Tracking Progress, Improving Health: ASTHO's Tracking Fellowship Program. Samantha Williams.
  12. A Population-Based Study of Sociodemographic and Geographic Variation in Human Papillomavirus (HPV) Vaccine Series Initiation in Primary Care Practices. Patrick M. Wilson, Lila J. Finney Rutten, Jennifer L. St. Sauver, Michaela E. McGree, Robert M. Jacobson.
  13. Spatio-Temporal Analysis of Large Cell Neuroendocrine Lung Cancer in Kentucky, 1995-2012. Jay Christian.
  14. Change in Lifespace in Breast Cancer Survivors from a Weight Loss Intervention. Jacqueline Kerr, Kristin Meseck, Suni Godbole, Marta Jankowska, Loki Natarajan.
  15. Safe Routes to Play? Pedestrian and Bicyclist Crashes Near Parks in Los Angeles. Michael Jerrett, Jason Su, Kara MacLeod, Cooper Hanning, Doug Houston, Jennifer Wolch.
  16. Effects of Buffer Size and Shape on the Association of Neighborhood SES and Adult Fruit and Vegetable Consumption. Minal Patel, April Oh, Heather D'Angelo, Linda Nebeling.
  17. Physical Activity and Neighborhood Walkability and Green Space Access in New York City (NYC). Andrew Rundle, Daniel M Sheehan, James W Quinn, Katherine Bartley, Michael M. D. Bader, Gina Lovasi, Kathryn M. Neckerman.
  18. Associations between Geographic Information Systems (GIS)-Based Walk Score®, Transit Score®, Bike Score®, Crime Score® and Google Street View-based Audits: A Comparison of Neighborhood Built Environment Quality Measures. Joel Adu-Brimpong, Nathan Coffey, Colby Ayers, David Berrigan, Alnesha Banks, Leah Yingling, Samantha Thomas.
  19. Investigating the Spatial Dimension of Local Food Access. Jackie Yenerall, Jennie Hill, Wen You.
  20. Development of Neighborhood Obesogenic Factors and its Applicability to Obesity-Related Studies in Diverse Populations: the Multiethnic Cohort Study. Salma Shariff-Marco, Juan Yang, Alison J. Canchola, Yurii B. Shvetsov, Shannon M. Conroy, Andrew Hertz, Cheryl Albright.
  21. Patient to Hospital Distance and Racial Differences in Access to Care and Outcome: Effects on Lung Cancer Surgical Treatment. Wil Lieberman-Cribbin, Bian Liu, Emanuele Leoncini, Raja Flores, Emanuela Taioli.
  22. Pediatric Cancer Late Effects Clinic Patients in Utah: Potential Barriers to Care. Judy Ou, Rochelle R. Smits-Seemann, Jennifer Wright, Anne Kirchhoff.
  23. Lung Cancer Incidence, Smoking Status and Socioeconomic Environment- Understanding the Causal Pathway. David Tabano, Debra Ritzwoller, Lori Sakoda, Robert Greenlee, Mara Epstein, Lawrence H. Kushi.
  24. Environmental Radon and Breast Cancer Risk in the Nurses' Health Study II. Trang VoPham, Natalie DuPre, Rulla M. Tamimi, Peter James, Kimberly A. Bertrand, Veronica Vieira, Francine Laden.
  25. Spatial and temporal variations of cancer screening. Xue Feng, Jongwha Chang, Xi Tan.
5:30 p.m. Adjourn
View agenda for Wednesday, September 14
Time Topic
8:00 a.m. - 8:15 a.m. Registration
8:15 a.m. – 8:30 a.m.

Welcome Back and Overview of Conference Day 3
Ruth L. Kirschstein Auditorium

David Berrigan, Ph.D., M.P.H.
NCI

8:30 a.m. – 9:30 a.m.

Plenary Session
Ruth L. Kirschstein Auditorium

Zaria Tatalovich, Ph.D. (Moderator)
NCI

Spatial Turn in Health Research and its Implications for Cancer Control
Invited Speaker: Douglas Richardson, Ph.D., Association of American Geographers

Advances in real-time spatiotemporal data generation technologies, mobile sensors, and analytical methods have created a rapidly evolving landscape of new health research opportunities and challenges. This presentation draws on three inter-related American Association of Geographers (AAG) research initiatives which explore key elements of this new health and cancer research landscape: 1) the AAG Initiative for an NIH-wide Geospatial Infrastructure (funded by NIH and AAG); 2) Geospatial Frontiers of Health and Social Environments (funded by NIH); and 3) Addressing Challenges For Geospatial Data-Intensive Research Communities: Research on Unique Confidentiality Risks & Geospatial Data Sharing within a Virtual Data Enclave (funded by NSF). These AAG initiatives present linked and interactive health and geospatial data research agendas in the domains of spatial technologies, spatiotemporal data infrastructure, and health research methods relevant to cancer control. They also are creating an increased awareness by health and biomedical researchers of the core role that geography, GIScience, and spatial analysis play in addressing cancer research and treatment needs. Technical and institutional obstacles to implementing geospatial approaches to cancer control, such as standards, interoperability, common terminology, and data confidentiality are also identified and addressed, and future research directions for advancing this field are proposed.

Emerging Technologies to Measure Neighborhood Conditions in Cancer Research
Invited Speaker: Mario Schootman, Ph.D., Saint Louis University

Contributing Authors: Erik Nelson, Ph.D., Saint Louis University; Kimberly Werner, Ph.D., Washington University in St. Louis; Enbal Shacham, Ph.D., Saint Louis University; Michael Elliott, Ph.D., Saint Louis University; Kendra Ratnapradipa, M.S.W., Saint Louis University; Min Lian, M.D., Ph.D., Washington University School of Medicine; Allese McVay, M.P.H., Saint Louis University

Adverse neighborhood conditions play an important role beyond individual characteristics. There is increasing interest in identifying specific characteristics of the social and built environments adversely affecting cancer risk and outcomes. To-date, most studies have been limited by: 1) a focus on residence only when most people spend one third of their time elsewhere; 2) failure to consider cumulative exposures over time (e.g., residential history); and 3) use of arbitrary administrative units (county, census tract, or zip code) to infer neighborhood risks. This study describes the utility, validity and reliability of selected emerging technologies (Google Street View, webcams, crowdsourcing, remote sensing, social media, and lifespace) to measure neighborhood conditions in cancer research. It also describes next steps for future research and opportunities for location-based interventions. Emerging technologies such as Google Street View, social media, webcams, and crowdsourcing may serve as effective and inexpensive tools to measure the ever-changing environment. Georeferenced social media responses may help identify where to target intervention activities, but also to passively evaluate their effectiveness. Future studies should measure exposure across key time points during the life-course as part of the exposome paradigm and integrate different types of data sources to measure neighborhood contexts. By harnessing these technologies, cancer research can not only monitor exposure of populations to the environment and move from place-based to people-based exposure, but also intervene using novel strategies to improve cancer-related outcomes.

9:30 a.m. – 10:30 a.m.

Plenary Session
Ruth L. Kirschstein Auditorium

Stephen Taplin, M.D., M.P.H. (Moderator)
NCI

Charting a Path Toward Improved Data Collection and Methods for Measuring Geographic Accessibility to Cancer Prevention and Care
Invited Speaker: Kevin A. Henry, Ph.D., Fox Chase Cancer Center and Temple University

Access to health care is multifaceted, including availability, acceptability, and financial and geographic accessibility of services. Geographic accessibility measures how physically accessible resources are for the population, while availability reflects what resources are available and in what amount to meet the demand. Barriers such as a deficit or maldistribution of health services or inadequate transportation often results in long travel distances or times. In the past decade, there has been an increase in the number of studies that have focused on geographical access to health services, only made possible through the widespread availability and affordability of software and data for geocoding and calculating travel distance/time; and advancements in the methods to measure geographic accessibility. In this presentation I will briefly describe the most popular approaches and methods used to measure geographic accessibility to health services and their limitations. I will follow with a description of a research agenda, offering suggestions of how to advance research on geographic accessibility to cancer prevention and care services. This research agenda focuses on absolute and relative measures of travel time/distance based on multiple transportation modes, time constraints based variations in time-use and mobility patterns, and improving our understanding of how geographical accessibility to health care is experienced by different populations. I will discuss short-term solutions such as leveraging underutilized datasets; and, long-term solutions involving the collection of new data from surveys and improving the collection of relevant data from cancer registries.

Cancer Control and Populations from a Geospatial Perspective: A Focus on NCI-Cancer Center Catchments Invited Speaker: Tracy Onega, Ph.D., M.A., M.S. Dartmouth College

Contributing Author: Fahui Wang, Ph.D., Dartmouth College

NCI-designated Cancer Centers have a charge to serve the cancer control needs of their catchment areas. Refined approaches to measure catchments, align services with needs, and assess population impact, are needed to best serve that mission. Over the past decade, NCI-Cancer Centers have expanded their presence within regions through satellite facilities intended to reach particular communities and/or provide specific services other than at the parent location. There has been no assessment of how satellite facilities change the geographic footprints of NCI-Cancer Centers, or how further geographic 'reach' of NCI-Cancer Centers may impact cancer control efforts, particularly for vulnerable populations.

NCI-designated Cancer Centers (N=62) in 2014 were geocoded and defined as "parent" or "satellite", based on web searches and phone interviews. We ascertained 76 and 211 geographically-unique parent and satellite facilities, respectively. Closest facility was calculated between block group centroids and facilities, measured as travel time (minutes). Population attributes for census tracts (age, race/ethnicity, median income, rurality, and education), were summarized by median for travel time. Travel time savings by adding satellites were quantified.

For the total U.S. population of 279,540,000, median travel time savings was 72 min.(IQR;27-172). Savings (median;IQR in minutes) were greatest for Native American (155;62-308), followed by White and Hispanic (86;33-174 and 86;23-229), Black (69;16-193), and least for Asian populations (28;15-66). Rural gradient showed expected savings, ranging from 57 minutes in urban areas to 180 in small town/isolated rural. Greatest savings by income was found in the lowest quartile (141;24-256 min.). Travel time savings across education levels were not notable. Mapping of NCI Cancer Center catchments based on travel time, reveals a range of increase in spatial footprint when considering satellite locations; more urban cancer centers did not expand their geographic extent much, while those in less urban areas did.

Satellite facilities improve geographic access to NCI Cancer Centers, with impacts on reduced travel time greatest for vulnerable populations. Regional expansion of NCI Cancer Center footprints may improve access and utilization of specialized cancer care. This work provides a 'first step' in measurement of catchments, but must be followed with strategies to fully characterize heterogeneous populations within the catchment in terms of prevention, treatment, and survivorship needs, resources, and outcomes.

10:30 a.m. – 10:45 a.m. Break
10:45 a.m. – 11:45 a.m.

Closing Panel Session
Ruth L. Kirschstein Auditorium

David Berrigan, Ph.D., M.P.H. (Moderator)
NCI

Geospatial and Contextual Approaches to Cancer Control and Population Sciences: Next Steps
Electra D. Paskett, Ph.D.
The Ohio State University

Linda W. Pickle, Ph.D.
Statnet Consulting, LLC

Kathy J. Helzlsouer, M.D., M.H.S.
NCI

11:45 a.m. – 12:00 p.m. Closing Remarks and Next Steps
Gary L. Ellison, Ph.D., M.P.H.
NCI
12:00 p.m. Adjourn

View Biosketches of Speakers and Conference Organizers

Steering Committee

  • David Berrigan, Ph.D., M.P.H., Program Director, Health Behaviors Research Branch, Behavioral Research Program, DCCPS, NCI
  • Gary L. Ellison, Ph.D., M.P.H., Chief, Environmental Epidemiology Branch, Epidemiology and Genomics Research Program, DCCPS, NCI
  • Scarlett Lin Gomez, Ph.D., Research Scientist III, Cancer Prevention Institute of California and Consulting Associate Professor, Department of Health Research and Policy, Stanford University School of Medicine
  • Kevin A. Henry, Ph.D.External Web Site Policy, Assistant Professor, Geography and Urban Studies and Fox Chase Cancer Center, Temple University
  • April Oh, Ph.D., M.P.H., Program Director, Health Communication and Informatics Research Branch, Behavioral Research Program, DCCPS, NCI
  • Timothy R. Rebbeck, Ph.D.External Web Site Policy, Professor of Cancer Epidemiology, Harvard TH Chan School of Public Health and Dana Farber Cancer Institute
  • Mario Schootman, Ph.D., Associate Dean for Research, James R. Kimmey Endowed Chair in Public Health, Professor of Epidemiology and of Health Services Research and of Medicine, and co-Director of Doctoral Program, Saint Louis University
  • Stephen Taplin, M.D., M.P.H., Deputy Associate Director, Healthcare Delivery Research Program, DCCPS, NCI
  • Zaria Tatalovich, Ph.D., Program Director, Statistical Research and Application Branch, Surveillance Research Program, DCCPS, NCI

Related Resources

Geographic Information Systems and Science for Cancer Control
This resource center allows cancer researchers, cancer control planners, cancer advocacy groups and public health officials to interactively map, explore and download geographically-based cancer related information.

Contact

Have questions about conference logistics?

Contact Rob Watson