Cluster Analysis Methods to Support Population Health Improvement Among US Counties.

Context: Population health rankings can be a catalyst for the improvement of health by drawing attention to areas in need of relative improvement and summarizing complex information in a manner understood by almost everyone. However, ranks also have unintended consequences, such as being interpreted as "hard truths," where variations may not be significant. There is a need to improve communication about uncertainty in ranks, with accurate interpretation.

Keeping It Political and Powerful: Defining the Structural Determinants of Health.

Policy Points The structural determinants of health are 1) the written and unwritten rules that create, maintain, or eliminate durable and hierarchical patterns of advantage among socially constructed groups in the conditions that affect health, and 2) the manifestation of power relations in that people and groups with more power based on current social structures work-implicitly and explicitly-to maintain their advantage by reinforcing or modifying these rules. This theoretically grounded definition of structural determinants can support a shared analysis of the root causes of health inequities and an embrace of public health's role in shifting power relations and engaging politically, especially in its policy work. Shifting the balance of power relations between socially constructed groups differentiates interventions in the structural determinants of health from those in the social determinants of health.

Discounting Health Grades for Disparity: The 2021 Wisconsin Population Health and Equity Report Card.

We describe updates to the University of Wisconsin Population Health Institute's methodology for a state health report card, first described in Preventing Chronic Disease in 2010, and the considerations that were weighed in making those updates. These methods have been used since 2006 to issue a periodic report entitled Health of Wisconsin Report Card. The report highlights Wisconsin's standing among other states and serves as an example for others seeking to measure and improve their population's health.

Evidence Clearinghouses as Tools to Advance Health Equity: What We Know from a Systematic Scan.

Evidence clearinghouses evaluate and summarize literature to help decision-makers prioritize and invest in evidence-informed interventions. Clearinghouses and related practice-oriented tools are continuously evolving; however, it is unclear the extent to which these tools assess and summarize evidence describing an intervention's impact on health equity. We conducted a systematic scan to explore how clearinghouses communicated an intervention's equity impact and reviewed their underlying methods and how they defined and operationalized health equity.

Theory in Action: Public Health and Community Power Building for Health Equity.

Context: Within the field of public health, there is growing awareness of how complex social conditions shape health outcomes and the role that power plays in driving health inequities. Despite public health frameworks lifting up the need to tackle power imbalances to advance equity, there is little guidance on how to accomplish this as an integral part of health promotion.

Objective: This article addresses the need for public health professionals to better understand power and identifies opportunities for shifting power to achieve more equitable outcomes.

Trends in infants born at low birthweight and disparities by maternal race and education from 2003 to 2018 in the United States.

Background: Understanding current levels, as well as past and future trends, of the percentage of infants born at low birthweight (LBW) in the United States is imperative to improving the health of our nation. The purpose of this study, therefore, was to examine recent trends in percentage of LBW, both overall and by maternal race and education subgroups. Studying disparities in percentage of LBW by these subgroups can help to further understand the health needs of the population and can inform policies that can close race and class disparities in poor birth outcomes.

Comparative Methodologic and Practical Considerations for Life Expectancy as a Public Health Mortality Measure.

Introduction: Life expectancy is a public health metric used to assess mortality. We describe life expectancy calculations for US counties and present methodologic considerations compared with years of potential life lost before age 75 (YPLL-75) and premature age-adjusted mortality (PAAM), 2 commonly used length-of-life metrics.

Methods: We used death data from the National Center for Health Statistics for 2015-2017 and other health measures from the 2019 County Health Rankings & Roadmaps.

What Do We Know About the Drivers of Health and Equity? A Narrative Review of Graphic Representations.

Frameworks can be influential tools for advancing health and equity, guiding population health researchers and practitioners. We reviewed frameworks with graphic representations that address the drivers of both health and equity. Our purpose was to summarize and discuss graphic representations of population health and equity and their implications for research and practice.

Generating Subcounty Health Data Products: Methods and Recommendations From a Multistate Pilot Initiative.

Background: County Health Rankings & Roadmaps (CHR&R) makes data on health determinants and outcomes available at the county level, but health data at subcounty levels are needed. Three pilot projects in California, Missouri, and New York explored multiple approaches for defining measures and producing data at subcounty geographic and demographic levels based on the CHR&R model. This article summarizes the collective technical and implementation considerations from the projects, challenges inherent in analyzing subcounty health data, and lessons learned to inform future subcounty health data projects.

Deaths of Despair(ity) in Early 21st Century America: The Rise of Mortality and Racial/Ethnic Disparities.

Introduction: Recent media coverage and research have emphasized increasing mortality rates for middle-aged white Americans. A concern is that this has shifted focus away from the health burden of other population subgroups. This cross-sectional study compares the magnitude of racial/ethnic mortality disparities across age groups and investigates how changing mortality trends have affected these disparities.

How to Be an Informed Consumer of Evidence Ratings: It's in the Details.

What are evidence-based strategies and how can public health practitioners find evidence without conducting extensive literature reviews? We developed an inventory of clearinghouses and other resources that disseminate research on evidence of effectiveness. We examined differences in evidence classification among 6 evidence clearinghouses that rate the effectiveness of community-level strategies to address determinants of health. Most evidence clearinghouses clearly defined their scope, but only a few clearinghouses explicitly defined the types of strategies they assess (eg, programs, policies, practices).

Joinpoint Trend Analysis of Infant Mortality Disparities in Wisconsin, 1999-2016.

Objectives: To address shortcomings of previous research exploring trends in racial, educational, and race by educational disparities in infant mortality rates (IMRs) by using nonlinear methods to compare improvement within and between disparity domains.

Methods: We used joinpoint regression modeling to perform a cross-sectional analysis of IMR trends from linked birth and death certificates in Wisconsin between 1999 and 2016.

Results: In the race and education domains, IMR decreased by 1.

Separate and Sick: Residential Segregation and the Health of Children and Youth in Metropolitan Statistical Areas.

The purpose of this study was to better understand residential segregation and child/youth health by examining the relationship between a measure of Black-White residential segregation, the index of dissimilarity, and a suite of child and youth health measures in 235 U.S. metropolitan statistical areas (MSAs).

Shiftwork, Sleep Habits, and Metabolic Disparities: Results from the Survey of the Health of Wisconsin.

Background: With the expanding demand for a 24-hour society, the prevalence of sleep deprivation and other sleep-related health problems is increasing. Shiftwork is an occupational health risk of growing significance because of its high prevalence and because of its potential role as a determinant of socioeconomic-related health disparities.

Aims: The aim of this study was to examine the associations of shiftwork with overweight status and type 2 diabetes, and explore whether a history of sleep problems mediates or modifies these associations.

The association between neighborhood economic hardship, the retail food environment, fast food intake, and obesity: findings from the Survey of the Health of Wisconsin.

Background: Neighborhood-level characteristics such as economic hardship and the retail food environment are assumed to be correlated and to influence consumers' dietary behavior and health status, but few studies have investigated these different relationships comprehensively in a single study. This work aims to investigate the association between neighborhood-level economic hardship, the retail food environment, fast food consumption, and obesity prevalence.

Methods: Linking data from the population-based Survey of the Health of Wisconsin (SHOW, n = 1,570, 2008-10) and a commercially available business database, the Wisconsin Retail Food Environment Index (WRFEI) was defined as the mean distance from each participating household to the three closest supermarkets divided by the mean distance to the three closest convenience stores or fast food restaurants.

Advancing efforts to achieve health equity: equity metrics for health impact assessment practice.

Equity is a core value of Health Impact Assessment (HIA). Many compelling moral, economic, and health arguments exist for prioritizing and incorporating equity considerations in HIA practice. Decision-makers, stakeholders, and HIA practitioners see the value of HIAs in uncovering the impacts of policy and planning decisions on various population subgroups, developing and prioritizing specific actions that promote or protect health equity, and using the process to empower marginalized communities.

Primary care practitioners survey of non-alcoholic fatty liver disease.

Background: The rising incidence of non alcoholic fatty liver disease (NAFLD) mirrors the epidemics of obesity and metabolic syndrome. Primary care practitioners (PCPs) are central to management of patients with NAFLD, but data on knowledge and attitudes of PCPs towards NAFLD are lacking.

Material And Methods: We conducted a statewide, stratified survey of 250 PCPs to examine knowledge, practices and attitudes regarding NAFLD and the barriers to providing care for this condition.

Maternal exposure to polybrominated and polychlorinated biphenyls: infant birth weight and gestational age.

Understanding the influence of maternal exposures on gestational age and birth weight is essential given that pre-term and/or low birth weight infants are at risk for increased mortality and morbidity. We performed a retrospective analysis of a cohort exposed to polybrominated biphenyls (PBB) through accidental contamination of cattle feed and polychlorinated biphenyls (PCB) through residual contamination in the geographic region. Our study population consisted of 444 mothers and their 899 infants born between 1975 and 1997.

Estimating dietary consumption patterns among children: a comparison between cross-sectional and longitudinal study designs.

Estimating dietary intake for children is an essential component of conducting pesticide exposure assessments given the fact that children are predominantly exposed to certain pesticides, such as organophosphorus pesticide, through dietary intake. Different study designs and their respective sampling methodology utilized to estimate food consumption patterns can significantly alter the parameter estimates and the variability in the values obtained. This study investigated the impacts of study design on overall estimates of dietary intake by applying the temporal sampling characteristics used in cross-sectional approaches, as in The Continuing Survey of Food for Intakes by Individuals (CSFII), to food consumption data collected in a longitudinal manner via a bootstrap sampling technique.

The Groucho-related gene family regulates the gonadotropin-releasing hormone gene through interaction with the homeodomain proteins MSX1 and OCT1.

Gonadotropin-releasing hormone (GnRH) is exclusively expressed in a unique population of hypothalamic neurons that controls reproductive function. GnRH gene expression is highly dynamic. Its transcriptional activity is regulated in a complex spatiotemporal manner during embryonic development and postnatal life.

Developmental regulation of gonadotropin-releasing hormone gene expression by the MSX and DLX homeodomain protein families.

Gonadotropin-releasing hormone (GnRH) is the central regulator of the hypothalamic-pituitary-gonadal axis, controlling sexual maturation and fertility in diverse species from fish to humans. GnRH gene expression is limited to a discrete population of neurons that migrate through the nasal region into the hypothalamus during embryonic development. The GnRH regulatory region contains four conserved homeodomain binding sites (ATTA) that are essential for basal promoter activity and cell-specific expression of the GnRH gene.

Phylogenetic footprinting reveals evolutionarily conserved regions of the gonadotropin-releasing hormone gene that enhance cell-specific expression.

Reproductive function is controlled by the hypothalamic neuropeptide, GnRH, which serves as the central regulator of the hypothalamic-pituitary-gonadal axis. GnRH expression is limited to a small population of neurons in the hypothalamus. Targeting this minute population of neurons (as few as 800 in the mouse) requires regulatory elements upstream of the GnRH gene that remain to be fully characterized.

TALE homeodomain proteins regulate gonadotropin-releasing hormone gene expression independently and via interactions with Oct-1.

Gonadotropin-releasing hormone (GnRH) is the central regulator of reproductive function. Expression of the GnRH gene is confined to a rare population of neurons scattered throughout the hypothalamus. Restricted expression of the rat GnRH gene is driven by a multicomponent enhancer and an evolutionarily conserved promoter.