Earlier this month, the University of Arkansas was awarded more than $777,000 from Arkansas' Rural Health Transformation Program to expand research and data into care gaps across the state. Michael Niño is an associate professor of sociology at the University of Arkansas and the principal investigator on the Arkansas Health Survey. He says last year, in year one, they surveyed almost 10,000 adults across the state.
Niño: And as part of that, we built out prevalence estimates at the county level and also at the census tract level and put them on a publicly available dashboard. So you can go on to this dashboard and learn a lot about health throughout the state. So if you wanted to know about hypertension at the county level, it would tell you that. But beyond that, we have 823 census tracts, which function like neighborhoods. And so if you wanted to look within a county, if you wanted to look within Washington County and begin to understand what does hypertension look like within that given county, the dashboard can tell you that.
And so we designed the Arkansas Health Survey as a way to track health outcomes over time. And so what we were applying for is, one, to administer the survey again, to expand it, to focus on some other areas that are really important to Arkansas: things on mental health, suicide, also maternal health, nutritional literacy, etc. And two, to expand the dashboard. So outside of providing prevalence estimates at the county and tract level, to help people begin to understand where services exist and they don't.
So when you think about Arkansas as a state, almost half of the state is rural. And when you look within these rural counties and these rural neighborhoods, we know that they have fewer access to resources. And what I mean by resources are providers. So physical health providers, behavioral health providers like counselors and therapists, but also community resources like where are food banks? Where food pantries? Where are pharmacies? Where are the resources that people can access in the state and where are they not?
So that's basically what the project is about, is administering year two of the survey and then two, expanding the dashboard to include all of those resources.
So as part of this, once the dashboard expansion goes live, so as part of this project, that will go live sometime in December, if somebody wanted to learn more about depression in a given rural area, they could go to the dashboard, look in their particular county and then they could also click on where the counselors, where the psychiatrists, where the psychologists and it will show them on a map where they are.
It'll tell them information about those different types of providers, and it'll also give them a radius, like within a 10-mile radius, how many are in a given area, within a 20-, 30-mile radius, so that we can begin to, one, understand where need is and where it's not, but also for organizations on the ground doing this work. If they wanted to refer somebody, this could be a one-stop shop for them. They don't have to go to several different websites to figure out, where's a food bank? Where's a pharmacy? Where's a provider? They can look at all of that in one space. So that's at the crux of the project.
Moore: First time you did the survey, thinking about the second time you'll do the survey, what lessons have you learned? What ways have you thought about ways that you can improve this work to get better quantitative data, but also maybe better qualitative data too?
Niño: Sure. So the way that we did this is we sent out 70,000 invitations across the state the first time, and we learned a lot about the desire for people to know more about health more generally across the state. Our response rate was really high. It was 14% in comparison to other similar surveys. It's usually around 8 to 10%. So Arkansans want to talk about their health. They want to help each other and try and figure out what are ways to improve or reduce disparities in health in the state.
For this particular round, we've decided to increase the sampling frame from 70,000 to 100,000 and significantly oversample in rural areas. We did the first time, but we're actually going to increase the oversample in rural areas. And two, oversample women between the ages of 18 to 44.
So the second round of the survey has an expanded maternal health module. And so we'll learn a lot more about women's health, but also maternal health in this particular iteration of the survey, and focus particularly on both women prior to giving birth and then obviously after giving birth and then everything kind of in between.
Moore: For me, when I hear the term oversampling, I think of political polling, and I think about this idea that you have to think about kind of making it even across the board. It sounds like this is probably a different idea here, that it's OK to oversample in rural areas and with women who could potentially be mothers, because this is really the places where you're trying to improve resources and understanding of.
Niño: Yeah. We want to make sure that we have really strong responses in these areas. And it's a great question, because once we've finished data collection, what we'll do is we'll go back in and weight the responses to the adult population within a given county and also a census tract. So when you look at data on the dashboard, which is called AR-COMPASS, what you're looking at is both reliable and representative data at the county and tract level. So they're anchored within population demographics within a given county or tract. But we want to make sure that we're oversampling, so we have enough power to reliably provide estimates to the state on any given health or social condition.
We're talking a lot about health, but what we know is that there are several really important drivers of health disparities in the state, including things like food insecurity and poverty or a particular group within the state. They're called ALICE family. So these are asset-limited, income-constrained, employed family. So these are families who live above poverty thresholds but are still unable to meet their material needs.
So we plan on capturing more important information about these particular families who are working several jobs. They have child care, but they're still food insecure. Or they still have trouble with transportation. We're capturing really important information on these ALICE families. So one, we can assess whether or not they are asset-limited, income-constrained and employed. And two, we're also asking really important questions around the types of material hardships that they're experiencing. So whether or not they can pay their electric bill or their rent or their mortgage.
But then beyond that, we're also working with the Arkansas Foodbank and with the Arkansas Hunger Relief Alliance on expanding the food insecurity module. So in the first year, we focused on food insecurity generally, in what large population health surveys do. In year two, what we're doing is capturing chronic food insecurity. So if this is happening often, and then when this is happening, if there's an exposure, what are the reasons as to why? Did you lose a job? Or is this kind of the first thing you decide to forgo as an adult in order to feed your children, etc.? Or was it a medical emergency? What are the reasons behind it?
And then on top of that is, are you receiving other kinds of services? Are you on Medicaid? Are you using SNAP? Are these benefits enough in order to provide the types of support necessary for folks to live a full and meaningful life in this state?
Moore: $777,351. That's a lot of money.
Niño: Sure.
Moore: But it sounds like you'll make good use of it quickly.
Niño: Absolutely. So what that enables us to do is send out 100,000 invitations several different times, provide $10 incentives to those who complete the survey. And then what it also enables us to do is to significantly expand the dashboard. So that first expansion will go live sometime in December. And then because of the generous award that we received from the state, we're going to be able to update the dashboard every quarter on all of those really important resources.
Another thing that I forgot to mention is that in this new iteration of the dashboard, we'll be providing legislative estimates at the House and the Senate level. So if folks wanted to know about, within my district, what does food insecurity look like? What does hypertension look like? What does diabetes look like? So that we can begin to think beyond counties and beyond neighborhoods, in terms of my legislative district, both Senate and House. What does that look like across the state?
So this is really a platform where we think about action-oriented work, how organizations can use it, legislators can use it, but then folks just in the community. If I'm trying to advocate for folks in a given community, I can tell you where resources are, where they're not. Organizations can use this to write grants or just advocate for resources with their lawmakers.
Moore: The work that's happening here is not advocating for certain policies necessarily. It's just really just laying out the information here. But it sounds like you do hope that people who have power to make policy utilize this data as information and power to make better policies for the state.
Niño: Absolutely. So we know that organizations are already using it. We've been working very closely with the Arkansas Foodbank and providing these data snapshots to different counties to help them understand the prevalence of food insecurity across different census tracts, where resources exist. And these data shots have been shared with legislators and with leaders in a given community.
And what we're doing now, the next step is the action-oriented part. We're actually working with these groups. How can we support the work that they're already doing on the ground? And how can we learn from them as part of this award?
What's so exciting about this is once data collection is completed and the dashboard expansion is live, we will start traveling across the state. I'm already doing some of that work already, but we will do it much more. So we're going to go to every single region of the state several times to show people how they can use these data, how the dashboard works and then offer our support. So this won't be, here it is, use it. It will be going on the ground, talking to folks in the community and thinking about what's next.
Moore: Often when we think about grants like this, and especially big number grants like this, for every dollar put in, we hope to see a better ROI on that. Do you have any idea what that could be? Do you have any sort of goal? What success look like for you?
Niño: Success for me personally is to see significant reductions in disparities in health. As an example, we have one of the highest premature death rates in the country. In Phillips County alone, over 20,000 years of potential life lost, or are lost, every single year in that given county. What would it look like if we were to be able to significantly reduce premature death in the state by 10%?
To me, that's years of life back that we're giving to families with their loved ones. It's years of life back that we're giving to people to contribute meaningfully to their communities. So it's not just about reducing premature death, but also ensuring that folks are living meaningful lives.
And so to me, that's what these data can help us do, is organize and build coalitions around goals. We have a better understanding of food insecurity. Now we have a better understanding of disparities in health and things around poverty, etc. What would it look like to meaningfully reduce these social conditions, disparities in health and the returns on investment from those significant reductions? To me, that's really at the heart of what we're trying to do.
Michael Niño is an associate professor of sociology at the University of Arkansas and the principal investigator on the Arkansas Health Survey. He joined me late last week in the Bruce and Ann Applegate News Studio Two.
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