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Hospital Assessment and Response to Environmental Pollution as a Population Health Need: Identifying Prevalence and Predictors in Community Benefit Practices

Hospitals have a growing role in improving population health. Environmental pollution is an important determinant of health with disproportionate effects on Communities of Color. This warrants hospital action. To advance such action, it is important to take stock of current hospital engagement with environmental pollution and to identify factors associated with such engagement. I investigated the following. To what extent do New York State (NYS) non-profit hospitals assess, identify, and respond to environmental pollutants as part of community benefit practices? Do factors previously reported as associated with hospital engagement of social determinants predict engagement with environmental pollution as a community health need? For this retrospective non-experimental design, a sample of 53 NYS hospitals was drawn by stratified geographical probability sampling. Hospital data were abstracted from hospital community benefit documents and IRS reporting using a priori coding in a structured categorical approach. County level data for predictive factors were gathered from demographic and epidemiological sources. Of hospitals sampled, 60.4%, 95%CI[.46,.74] included environmental pollution in community health needs assessment, 18.9%, 95%CI[.09,.32] identified a type of environmental pollution as a stated community health need. No hospital acted on a point source, industrial or transportation related pollutant. Two hospitals, 3.8%, 95%CI [.01,.13], conceptualized outdoor cigarette smoke as an environmental pollutant and went on to plan and initiate action on this community health need. Significant positive factors in models predicting hospital assessment and/or identification of environmental pollution as a community health need include: social justice in hospital mission; accountable care organization status; PM 2.5 level, and county population percentage of Persons of Color (with Hispanic). Paradoxically, collaboration on strategic planning and presence of collective impact criteria emerged as negative predictors. The findings of this study establish contextual knowledge upon which nurses, and others, may premise upstream environmental health research and development of community benefit related policy agendas and pathways to address environmental pollution as a health determinant.