The Impact of Social Determinants of Health on Technology Access, Health Behaviors, and Health Status in Southern Arizona

Meghan B. Skiba, PhD, MS, MPH, RDN, Assistant Professor, College of Nursing, University of Arizona
Carlie M. Felion, MSN, APRN, FNP-BC, PMHNP-BC, BC-ADM, Doctoral Student, College of Nursing, University of Arizona
Christopher Krupnik, BA, MS, GIST Graduate Student, School of Geography, Development & Environment, University of Arizona

Pinpoint Shadow  The Role of Social Determinants of Health in Tucson, Arizona MSA

The ability to respond to health threats and support health-promoting behaviors is essential for local, state, and federal stakeholders. Chronic diseases, such as diabetes, cardiovascular disease, cancers, lung diseases, and depression are prevalent in southern Arizona. The unique population characteristics and geographic disparities in this region, such as inadequate healthcare resources, lack of access to healthy foods, and lower median household incomes are contributing factors for chronic disease.

Social determinants of health are the environmental conditions in which people are born, live, learn, work, play, worship, and age. These conditions impact a person's overall health, functioning, and quality of life. Approximately 50% of a person's health status is related to social and environmental factors, and 34% is related to individual health behaviors, such as eating a healthy diet, being physically active, avoiding tobacco, risky alcohol and substance use, getting adequate sleep, and obtaining the recommended immunizations and health screenings. Healthcare organizations rarely collect socially relevant variables on individuals, leaving a gap in our understanding of the community-level social determinants of health data that can enable stakeholders to ascertain factors that expose individuals or groups in a specific region to risks.

Mobile health (mHealth), the practice of medicine and public health that is supported by mobile devices, is increasing in its availability and application in modern society. mHealth provides infrastructure for engaging diverse populations, increasing knowledge, and allowing individuals to monitor, track, and transmit health metrics to improve access to healthcare or promote health behavior changes. mHealth can be used outside of clinical settings, making it ideal for use in areas where healthcare services are lacking. Access to technology in southern Arizona may play a key role in bridging the divide between social determinants of health and health outcomes.

This project, funded by a Making Action Possible Grant from the University of Arizona Eller College of Management, used epidemiological data and geospatial analysis to identify communities in southern Arizona that have health-protective attributes. To characterize the social determinants of health in southern Arizona, the researchers developed and validated the Community Connectedness Classification and an interactive map that shows community-level data.

The Community Connectedness Classification uses publicly available ACS data representing positive social determinants of health factors merged by ZIP code tabulation area. The ZIP code tabulation area system was created by the US Census Bureau and built from Census Blocks and ZIP Codes to address potential spatiotemporal mismatches; in the majority of cases, ZIP code tabulation area and ZIP Codes are the same for an address. ZIP code tabulation areas are larger and more diverse than Census Tracts, providing the ability to more reliably estimate social determinants of health's influence in more rural communities and across places. Principal components analysis of Census ZIP code tabulation area data from four southwestern US states: Arizona, Colorado, Utah, and New Mexico were used to develop Community Connectedness Classification using established methods.

Key Findings

This research resulted in three key findings. More connected communities in southern Arizona, determined by the Community Connectedness Classification, have

  • Greater access to technology
  • Engaged in less high-risk health behaviors
  • Higher perceptions of physical, mental, and overall health.

The development and practical application of the novel Community Connectedness Classification to represent factors related to social determinants of health in relation to health risk behaviors allows local non-profits, researchers, policymakers, and other change leaders in southern Arizona to develop targeted interventions, initiatives, and policies that systemically improve the health of residents and their communities, ultimately reducing the economic burden of chronic disease in southern Arizona and beyond.

This interactive map details Community Connectedness Classification in southern Arizona by ZIP code tabulation area. Zip code tabulation areas shaded in darker blue, have higher Community Connectedness Classification values (more connected) while ZIP code tabulation areas in the lightest blue have the lowest Community Connectedness Classification values (more isolated). Note: For ZIP code tabulation areas with unavailable data, they are shaded with diagonal lines. Zip code tabulation areas shaded in solid gray represent central and northern Arizona areas that were not included in the analysis.


For an interactive version of the map that provides more detail click here. The interactive map allows searchability, details the Community Connectedness Classification in southern Arizona by ZIP code tabulation area, and illustrates technology access with red dots that represent population density of technology access with dark red representing tablets, light red representing smartphones, and bright red representing desktop or laptops. On this map, you will be able to search for a specific zip code tabulation area. When searching or selecting a ZIP code tabulation area, a window will appear providing values for the Community Connectedness Classification for that area and population estimates for technology access and health behaviors.

Recommendations from this report include

  • Continuing to expand access to broadband internet and other technologies that allow southern Arizona residents to take advantage of the existing mHealth infrastructure 
  • Apply the Community Connectedness Classification in future analyses and utilize the interactive web map to inform the development of interventions, programs, and policies that improve the health and quality of life of southern Arizona residents and reduce economic burden.


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