Presenter Profile
Maura Powell, MPH, MBA
The Possibilities Project
The Children's Hospital of Philadelphia
powellma@chop.edu
Maura Powell is the Senior Manager of The Possibilities Project (TPP), an exciting initiative to reimagine and reengineer primary care at The Children’s Hospital of Philadelphia. In her role she is charged with overseeing the development and implementation of innovative solutions across the primary care network. Prior to her role with TPP, Maura worked in the Center for Healthcare Quality and Analytics at The Children's Hospital of Philadelphia as a Senior Improvement Advisor, where she combined improvement science and clinical data analysis to facilitate clinical improvement projects across the enterprise. She has a background in global public health, research and quality improvement.
Presentations
Adolescent Driving Intentions and Licensure by Neighborhood Opportunity
Maura Powell, MPH, MBA
Gabrielle DiFiore, MPH
Stephanie Mayne, PhD
Hannah Martin, BS
Nicole Koepke, MSN, CRNP
Elizabeth Walshe, PhD
Anthony Luberti, MD
Brian Jenssen, MD, MSCE
Angela M. Rapposelli, BA
Flaura Winston, MD, PhD
Alexander Fiks, MD, MSCE
Low-income teens are more likely to delay driver licensing to 18 or older. It is not known whether this delay reflects disparities in intentions to drive or barriers to licensure. The Childhood Opportunity Index (COI) is a multi-dimensional indicator of neighborhood opportunity conducive to healthy child development that may be associated with driving intention and licensure. Little is known on the intersection of COI and these outcomes.
We conducted a cross-sectional analysis of electronic health data for adolescents aged 15-18 years seen within a large 31-site Primary Care Network from February 2022-October 2023. Adolescents were included if they completed their annual Adolescent Health Questionnaire (AHQ). The AHQ assesses health risks, including self-reported driving intention and licensure status. Neighborhood opportunity was measured using score quintiles of the Childhood Opportunity Index (COI) based on adolescents’ addresses. Mixed effects logistic regression separately estimated the association between neighborhood COI and driving intention for 15-year-olds and licensure status of 17-18-year-olds. Regression models were adjusted for adolescent sex, race/ethnicity, health insurance payor, and urbanicity.
Adolescents (n=17,622) were 51% Non-Hispanic White, 70% privately insured, and 65% lived in neighborhoods with “high” or “very high” COI. 77% of 15-year-olds from “low” or “very low” COI neighborhoods planned to learn to drive within the next year, compared to 83% from “high” or “very high” COI neighborhoods. 38% of 17-18-year-olds from “low” or “very low” COI neighborhoods reported having a permit or license, compared to 84% in “high” or “very high” COI neighborhoods. In adjusted models, being in the lowest two vs the highest two COI quintile neighborhoods was not significantly associated with intention to start driving in 15-year-olds (OR: 0.85, 95% CI: 0.62, 1.16), but was associated with 58% lower odds of 17-18-year-olds having their permit or license (OR: 0.42, 95% CI: 0.34, 0.51).
Although driving intentions are similar in 15-year-olds from neighborhoods with lower vs higher COI, our findings indicate a large disparity in licensure at age 17-18. Future studies should examine barriers that limit progress from driving intention to licensure in order to develop approaches to address this disparity.
1. Describe the disparity in self-reported driving intentions among adolescents by neighborhood opportunity
2. Describe the disparity in self-reported licensure status among adolescents by neighborhood opportunity
3. Demonstrate a method for collecting adolescent driving intention and licensure status in a preventive care visit workflow