Carolyn Christa Cannuscio

University of Pennsylvania | UP · Department of Family Medicine and Community Health

Background: The opioid overdose crisis claimed over 80,000 American lives in 2019, with opioids implicated in the majority of these deaths. The COVID-19 pandemic has exacerbated the crisis, with challenges arising from the increased use of fentanyl, synthetic opioids, and combined opioid-stimulant substances. Urgent strategies are required to mitig...

Introduction: Calorie labeling of standard menu items has been implemented at large restaurant chains across the United States since 2018. The objective of this study was to evaluate the cost-effectiveness of calorie labeling at large U.S. fast-food chains. Methods: This study evaluated the national implementation of calorie labeling at large fa...

Public libraries in the United States (U.S.) are important sources of health information. Immigrants comprise a large portion of the U.S. population, and research suggests that public libraries help immigrants adjust to life in a new country. Public libraries help immigrants access information directly related to health and provide programs that ha...

Background: To determine the impact of personalized risk communication and opioid prescribing on nonprescribed opioid use, we conducted a secondary analysis of RCT participants followed prospectively for 90 days after an E.D. visit for acute back or kidney stone pain. Methods: One thousand three hundred-one individuals were randomized during an...

OBJECTIVE We sought to evaluate the use of behavioral economics approaches to promote the carrying of epinephrine auto-injectors (EAIs) among adolescents with food allergies. We hypothesized that adolescents who receive frequent text message nudges (Intervention 1) or frequent text message nudges plus modest financial incentives (Intervention 2) wo...

Introduction: The study objective was to elucidate the relationship between social vulnerability and COVID-19 impacts in Philadelphia between June 2020 and December 2022. Methods: Using publicly available COVID-19 case, test, hospitalization, and mortality data for Philadelphia (June 7, 2020-December 31, 2022) and area-level social vulnerability da...

Vaccination remains key to reducing the risk of COVID-19-related severe illness and death. Because of historic medical exclusion and barriers to access, Black communities have had lower rates of COVID-19 vaccination than White communities. We describe the efforts of an academic medical institution to implement community-based COVID-19 vaccine clini...

Importance The COVID-19 pandemic has claimed nearly 6 million lives globally as of February 2022. While pandemic control efforts, including contact tracing, have traditionally been the purview of state and local health departments, the COVID-19 pandemic outpaced health department capacity, necessitating actions by private health systems to investig...

Importance Opioid overdose rates continue to increase, and extant literature suggests that many individuals who use heroin were first introduced to opioids through a medical prescription. Objective To explore patient experiences related to decisions regarding analgesia after an emergency department visit within the context of a randomized clinical...

Introduction: The study objective was to evaluate a contact tracing training program, and the role of contact tracing on volunteers’ professional development. Methods: A COVID-19 contact tracing program was conducted at an urban academic medical center, in collaboration with the local health department, between March 2020 - May 2021. Contact tracer...

In the U.S., overdoses have become a health crisis in both public and private places. We describe the impact of the overdose crisis in public libraries across five U.S. states, and the front-line response of public library workers. We conducted a cross-sectional survey, inviting one worker to respond at each public library in five randomly selected...

Objectives. To compare the effectiveness of 3 approaches for communicating opioid risk during an emergency department visit for a common painful condition. Methods. This parallel, multicenter randomized controlled trial was conducted at 6 geographically disparate emergency department sites in the United States. Participants included adult patients...

Importance: Consumers routinely generate digital information that reflects on their health. Objective: To evaluate the factors associated with consumers' willingness to share their digital health information for research, health care, and commercial uses. Design, setting, and participants: This national survey with an embedded conjoint experim...

Importance: Although racial disparities in acute pain control are well established, the role of patient analgesic preference and the factors associated with these disparities remain unclear. Objective: To characterize racial disparities in opioid prescribing for acute pain after accounting for patient preference and to test the hypothesis that r...

Background In 2020, the number of internet users surpassed 4.6 billion. Individuals who create and share digital data can leave a trail of information about their habits and preferences that collectively generate a digital footprint. Studies have shown that digital footprints can reveal important information regarding an individual’s health status,...

BACKGROUND In 2020, the number of internet users surpassed 4.6 billion. Individuals who create and share digital data can leave a trail of information about their habits and preferences that collectively generate a digital footprint. Studies have shown that digital footprints can reveal important information regarding an individual’s health status,...

Background Improving linkage to opioid use disorder (OUD) treatment and services is a public health priority. Public libraries, a community resource for health information, may be well positioned to support and guide people who use drugs, as well as their families and friends. In this study, we sought to evaluate the availability and types of resou...

The coronavirus disease 2019 (COVID-19) pandemic has upended every aspect of life in the United States and forced Americans to rethink their daily activities, including how they work, attend school, secure food, obtain health care, and maintain social connections. For vulnerable populations that were already facing significant barriers to health, s...

Importance Digital technology is part of everyday life. Digital interactions generate large amounts of data that can reveal information about the health of individual consumers (the digital health footprint). Objective Τo describe health privacy challenges associated with digital technology. Design, Setting, and Participants For this qualitative...

Lay abstract: Interventions for children with autism spectrum disorder are complex and often are not implemented successfully within schools. When new practices are introduced in schools, they often are layered on top of existing practices, with little attention paid to how introducing new practices affects the use of existing practices. This stud...

BACKGROUND Prescription opioid misuse in the United States is a devastating public health crisis, of which many chronic opioid users were originally prescribed this class of medication for acute pain. Video narrative enhanced risk communication may improve patient outcomes such as knowledge of opioid risk and opioid use behaviors after an episode o...

Background: Prescription opioid misuse in the United States is a devastating public health crisis; many chronic opioid users were originally prescribed this class of medication for acute pain. Video narrative-enhanced risk communication may improve patient outcomes, such as knowledge of opioid risk and opioid use behaviors after an episode of acut...

Background: In the context of the opioid overdose crisis, local health departments are on the front lines, coordinating programs and services and translating state and federal policies into community action. While media reports describe growth of Overdose Education and Naloxone Distribution (OEND) programs among local health departments, little is...

Background: Approximately 8% of schoolchildren in the United States experience potentially life-threatening food allergies. They must diligently avoid allergenic foods and have prompt access to epinephrine to treat anaphylaxis. These prevention strategies must be sustained without interruption, posing a range of challenges at school. Methods: We...

Background: Parent-mediated early interventions (EI) for children with autism spectrum disorder (ASD) can result in significant improvements in children's cognitive ability, social functioning, behavior, and adaptive skills, as well as improvements in parental self-efficacy and treatment engagement. The common component to efficacious parent-media...

Purpose This study aimed to increase the consumption of home-cooked meals among employees at a large urban worksite through a fully subsidized Community Supported Agriculture (CSA) program. Design Randomized trial. Setting Worksite in a large northeast city. Participants Employees were recruited through flyers, e-mail listservs, and outreach fro...

Lay abstract: Most autistic adults struggle with mental health problems, such as anxiety and depression. However, they often have trouble finding effective mental health treatment in their community. The goal of this study was to identify ways to improve community mental health services for autistic adults. We interviewed 22 autistic adults with m...

Purpose Understanding the climate of safety is a core initiative of the US fire service in its quest to reduce injuries, fatalities, and toxic exposures linked to occupational disease. The purpose of this study was to develop a fire service safety climate scale to support this goal. Method Survey development followed an exploratory sequential mixe...

Objectives: This study explored chronic disease self-management over the monthly benefit cycle among primary food shoppers from households receiving Supplemental Nutrition Assistance Program (SNAP) benefits in Philadelphia, Pennsylvania. Methods: In-depth interviews, participant observation and surveys were conducted with the primary food shoppe...

Objective The present study explored chronic disease management over the monthly benefit cycle among primary food shoppers from households receiving Supplemental Nutrition Assistance Program (SNAP) benefits in Philadelphia, PA, USA. Design In-depth interviews, participant observation and surveys were conducted with the primary food shopper of SNAP...

One in seven Americans participates in the Supplemental Nutrition Assistance Program (SNAP), making it the largest federally funded food assistance program. SNAP benefits are distributed once per month and both food spending and calorie consumption tend to decrease as time from benefit distribution increases. The monthly SNAP benefit cycle has seri...

Objectives: To illustrate the effects that minor social or environmental disruptions could have on the food access of low-income households in Philadelphia, Pennsylvania, and provide suggestions for how cities can better incorporate food into emergency planning. Methods: Using publicly available data and stakeholder interviews (n = 8) in 2017, w...

Objective We sought to understand perspectives on access to physical activity in a gentrifying neighborhood. Design This qualitative descriptive study used street intercept interviews and photo documentation. Sample Participants included members (n = 19) of a gentrifying neighborhood in a northeastern city. Results Participants held markedly dif...

Background: Prescription opioid abuse in the United States is a devastating public health crisis, of which many chronic opioid users were originally prescribed the medication for acute pain. Narrative enhanced risk communication may improve patient outcomes such as knowledge of opioid risk and opioid use behaviors in the setting of acute pain. Meth...

In Philadelphia, over 40% of youth are overweight or obese. The objective in this assessment was to learn about urban residents’ perspectives regarding the local food environment and its impact on eating behaviors. Using photo-elicitation, 20 adolescents reflected on their food environments through photographs and corresponding interviews. Without...

Introduction: Public libraries are free and accessible to all and are centers of community engagement and education, making them logical choices as partners for improving population health. Library staff members routinely assist patrons with unmet health and social needs. Methods: We used a 100-question, self-administered web survey sent to all...

Social media and emerging mobile technologies have sparked radical shifts in human behavior, with people worldwide spending an average of 2 hours and 15 minutes daily on social networks. Facebook, Instagram, and Twitter have more than 2 billion users globally. Social networking site use has risen dramatically by all age groups, with the highest use...

Public libraries are free and open to all—and accessed at high rates by vulnerable populations—which positions them to be key public health allies. However, library staff themselves often feel ill-equipped to address the health and social concerns of their patrons. To fill this gap, we developed a case-based training curriculum to help library staf...

Opioid use and addiction have reached epidemic proportions in Philadelphia, making drug overdose involving opioids a leading cause of death. Both pharmaceutical and illicit opioids contribute to this crisis. Opioid sales in Philadelphia more than doubled between 2000 and 2012, and health care providers continue to prescribe opioid pain medication i...

For years Bob worried something was wrong with his memory. He expressed this worry to his family physician, who told him memory loss is a normal part of aging. "All these years that I've known that something was going on in my brain, I can see a curve," said Bob. "It's always been a pretty steady curve going slowly downhill." (Am J Public Health. P...

Background The number of children diagnosed with autism has rapidly outpaced the capacities of many public school systems to serve them, especially under-resourced, urban school districts. The intensive nature of evidence-based autism interventions, which rely heavily on one-to-one delivery, has caused schools to turn to computer-assisted intervent...

Public libraries are not usually included in discussions about improving population health. They are, however, well positioned to be partners in building a culture of health through programming that addresses the social determinants of health. The Healthy Library Initiative, a partnership between the University of Pennsylvania and the Free Library...

Understanding how new Medicaid enrollees are approaching their own health and health care in the shifting health care landscape of the Affordable Care Act has implications for future outreach and enrollment efforts, as well as service planning for this population. The objective of this study was to explore the health care experiences and expectatio...

Introduction Urban corner store interventions have been implemented to improve access to and promote purchase of healthy foods. However, the perspectives of store owners and managers, who deliver and shape these interventions in collaboration with nonprofit, government, and academic partners, have been largely overlooked. We sought to explore the v...

Background The significant lifelong impairments associated with autism spectrum disorder (ASD), combined with the growing number of children diagnosed with ASD, have created urgency in improving school-based quality of care. Although many interventions have shown efficacy in university-based research, few have been effectively implemented and susta...

The goal of this study was to understand safety climate in the United States (U.S.) fire service, which responded to more than 31 million calls to the 9-1-1 emergency response system in 2013. The majority of those calls (68 %) were for medical assistance, while only 4 % of calls were fire-related, highlighting that the 9-1-1 system serves as a crit...

As more patients enroll in health insurance with high out-of-pocket costs, provider-patient cost discussions are of growing importance. Little is known about how patients want providers to engage in cost conversations. We surveyed 842 chronically ill adults seeking financial help to examine preferences around treatment trade-offs in 3 areas-conveni...

Fifteen million Americans suffer from potentially life-threatening food allergies and must strictly avoid allergenic foods. Behavioral errors are common. Each year there are 90,000 emergency department visits for food-induced anaphylaxis. Food service establishments are an important target for prevention, given that Americans consume half of their...

Brandon Stokes has a disarming smile. He asks thoughtful questions and leans in to hear the answers. The conversation is easy, but don't mistake Brandon for easygoing. Brandon's got grit-which may be one reason he is on such a promising path at age 26, even though he was born into a homeless shelter rather than a home. There are at least 1.2 millio...

Adolescents and young adults with food allergies are at increased risk of adverse events, including death from anaphylaxis. Epinephrine is the cornerstone of emergency response, yet few individuals with serious food allergies consistently carry their emergency medication. Behavioral economics offers promising, previously untapped opportunities for...

Assessments of access to healthful food frequently use GIS to measure the distance and concentration of food outlets relative to where residents live. These descriptive approaches do not account for food shopping behavior, which may vary based on the attributes of food shoppers and their activity space-places where they live, work, access resources...

To respond to the high prevalence of obesity and its associated health consequences, recent food research and policy have focused on neighborhood food environments, especially the links between health and retail mix, proximity of food outlets, and types of foods available. In addition, the social environment exerts important influences on food-rela...

Given that many patients with chronic diseases face cost-related barriers to care, we evaluated patients’ views on which providers (both physicians and nonphysicians) to involve and which methods to use to screen for those barriers. We also examined patients’ preferences for how physicians consider cost-efficacy trade-offs in decisions. A national...

Sugar-sweetened beverages contribute substantial calories to children’s diets. Aggressive marketing and promotion strategies, particularly deep discounts, may increase children’s consumption, which has been associated with unhealthy weight gain. For sugar-sweetened beverages as for tobacco, price may be an important and malleable driver of consumpt...

Pennsylvania sits atop the Marcellus Shale, a reservoir of natural gas that was untapped until the 2004 introduction of unconventional natural gas drilling operations (UNGDO) in the state. Colloquially known as fracking, UNGDO is a controversial process that employs large volumes of water to fracture the shale and capture gas; it has become a multi...

Photo-elicitation is a qualitative interviewing technique that has gained popularity in recent years. It is the foundation for photovoice projects and is a tool well-suited for community-based participatory research. Photo-elicitation yields rich data, and interview participants say these interviews encourage community awareness and engagement. Thi...

There is limited research documenting the shopping behaviors of urban residents with regard to where they shop for fruits and vegetables. This study sought to: (1) describe characteristics of consumers who shop for produce at supermarkets, alternative fresh food outlets, and farmers' markets; and (2) identify correlates of farmers' market shopping...

Study objective Patient handoffs are known as high-risk events for medical error but little is known about the professional, structural, and interpersonal factors that can affect the patient transition from emergency medical services (EMS) care to the emergency department (ED). We study EMS providers’ perspectives to generate hypotheses to inform a...

Background Previous research has shown differences in adult physical activity (PA) levels by race/ethnicity, sex and age. We aimed to determine whether those differences existed within urban population, in what types of activities they participated, and where they were active. Methods: A sample of 514 urban Philadelphia adult residents was surveyed...

Food environments may promote or undermine healthy behaviors, but questions remain regarding how individuals interact with their local food environments. This study incorporated an urban food environment audit as well as an examination of residents' food shopping behaviors within that context. In 2010, the research team audited the variety and heal...

Informed by a largely secondary and quantitative literature, efforts to improve care and outcomes for complex patients with high levels of emergency and hospital-based health care utilization have offered mixed results. This qualitative study identifies psychosocial factors and life experiences described by these patients that may be important to t...

Objective: To describe the methodology used to develop a community-campus partnership to recruit and engage control participants in a childhood obesity project targeting Mexican origin communities. Description: Overview of the Community Based Partici-patory Research (CBPR) methodology utilized in NSFS to develop activities for the participants in t...

Overweight, obesity, and tobacco use are major preventable causes of disability, disease, and death. In 2010, 25% of Philadelphia adults smoked, and 66% were overweight or obese. To address these health threats, the Philadelphia Department of Public Health launched Get Healthy Philly, an initiative to improve the city's nutrition, physical activity...

Research on the impact of the built environment on obesity and access to healthful foods often fails to incorporate information about how individuals interact with their environment. A sample of 198 low-income WIC recipients from two urban neighborhoods were interviewed about where they do their food shopping and surveys were conducted of food stor...

Background: The quality of end-of-life (EOL) care at Veterans Affairs Medical Centers (VAMC) has improved. To date, however, the quality and outcomes of end-of-life care delivered to women veterans have not been examined. Objective: The goal of this study was to evaluate gender differences in the quality of EOL care received by patients in VAMCs...

Consultation is an effective implementation strategy to improve uptake of evidence-based practices for youth. However, little is known about what makes consultation effective. The present study used qualitative methods to explore therapists perspectives about consultation. We interviewed 50 therapists who had been trained 2 years prior in cognitive...

Purpose: Physicians prescribing new medications often do not convey important medication-related information. This study tests an intervention to improve physician-patient communication about newly prescribed medications. Methods: We conducted a controlled clinical trial of patients in 3 primary care practices, combining data from patient survey...

Vacant land is a significant economic problem for many cities, but also may affect the health and safety of residents. In order for community-based solutions to vacant land to be accepted by target populations, community members should be engaged in identifying local health impacts and generating solutions. We conducted 50 in-depth semi-structured...

Introduction: Required research methods courses are often a dreaded part of public health, social work and other professional graduate degree curricula. In this presentation we discuss how we turned the members of a qualitative methods class into members of a research team in order to excite students about research and explore participant perspecti...

INTRODUCTION: In 2010, 25.2% of Philadelphians smokedthe highest rate in any of the ten largest American citiesand 66.3% were overweight or obese. To address these health threats, the Philadelphia Department of Public Health and the Centers for Disease Control and Prevention launched Get Healthy Philly, an initiative focused on improving the city's...

This paper argues that door-to-door surveys are a valuable tool for collecting information about health and the environment in urban areas in a manner consistent with community-based participatory research principles. We describe in detail how a door-to-door survey on food shopping and physical activity was conducted with the primary food shopper i...