Improving the environmental quality component of the County Health Rankings model.

Objectives: We examined the association between environmental quality measures and health outcomes by using the County Health Rankings data, and tested whether a revised environmental quality measure for 1 state could improve the models.

Methods: We conducted state-by-state, county-level linear regression analyses to determine how often the model's 4 health determinants (social and economic factors, health behaviors, clinical care, and physical environment) were associated with mortality and morbidity outcomes. We then developed a revised measure of environmental quality for West Virginia, and tested whether the revised measure was superior to the original measure.

Effects of a cost-sharing policy on disenrollment from a state health insurance program.

Subsidized public health insurance programs face financial difficulties and are increasingly implementing policies to pass on greater costs to low-income enrollees. Results of a stratified, random sample of 1,153 enrollees and disenrollees of a state program after introduction of increased cost sharing revealed three main reasons for disenrollment, which varied by enrollee income: finding other coverage, becoming financially ineligible, or dropping coverage as too expensive. Seventeen percent of disenrollees cited cost sharing as a reason for disenrollment.

Adult tooth loss for residents of US coal mining and Appalachian counties.

Objectives: The authors compared rates of tooth loss between adult residents of Appalachian coal-mining areas and other areas of the nation before and after control for covariate risks.

Methods: The authors conducted a cross-sectional secondary data analysis that merged 2006 national Behavioral Risk Factor Surveillance System data (BRFSS) (N = 242 184) with county coal-mining data and other county characteristics. The hypothesis tested was that adult tooth loss would be greater in Appalachian mining areas after control for other risks.

A national study of the association between food environments and county-level health outcomes.

Purpose: This national, county-level study examines the relationship between food availability and access, and health outcomes (mortality, diabetes, and obesity rates) in both metro and non-metro areas.

Methods: This is a secondary, cross-sectional analysis using Food Environment Atlas and CDC data. Linear regression models estimate relationships between food availability and access variables (direct-to-consumer farm sales, per capita grocery stores, full-service restaurants, fast food restaurants, and convenience stores) with health outcomes.

The association between mountaintop mining and birth defects among live births in central Appalachia, 1996-2003.

Birth defects are examined in mountaintop coal mining areas compared to other coal mining areas and non-mining areas of central Appalachia. The study hypothesis is that higher birth-defect rates are present in mountaintop mining areas. National Center for Health Statistics natality files were used to analyze 1996-2003 live births in four Central Appalachian states (N=1,889,071).

Full cost accounting for the life cycle of coal.

Each stage in the life cycle of coal-extraction, transport, processing, and combustion-generates a waste stream and carries multiple hazards for health and the environment. These costs are external to the coal industry and are thus often considered "externalities." We estimate that the life cycle effects of coal and the waste stream generated are costing the U.

Residence in coal-mining areas and low-birth-weight outcomes.

The objective of this study was to estimate the association between residence in coal mining environments and low birth weight. We conducted a cross-sectional, retrospective analysis of the association between low birth weight and mother's residence in coal mining areas in West Virginia. Birth data were obtained from the West Virginia Birthscore Dataset, 2005-2007 (n = 42,770).

Mortality in Appalachian coal mining regions: the value of statistical life lost.

Objectives: We examined elevated mortality rates in Appalachian coal mining areas for 1979-2005, and estimated the corresponding value of statistical life (VSL) lost relative to the economic benefits of the coal mining industry.

Methods: We compared age-adjusted mortality rates and socioeconomic conditions across four county groups: Appalachia with high levels of coal mining, Appalachia with lower mining levels, Appalachia without coal mining, and other counties in the nation. We converted mortality estimates to VSL estimates and compared the results with the economic contribution of coal mining.

Community participation and the emergence of late-life depressive symptoms: differences between women and men.

Objective: To understand the role of community participation in prevention of first lifetime depressive episode in older women and men.

Methods: We used data from the Wisconsin Longitudinal Study to identify variables that predicted risk for the emergence of depressive symptoms and tested a hypothesis that community participation would protect women from depression more than it would protect men. The sample was drawn from Wisconsin high school graduates who were approximately 64-66 years of age in the 2003-2005 data collection period (n = 2546 with complete data meeting inclusion criteria.

Relations between health indicators and residential proximity to coal mining in West Virginia.

We used data from a survey of 16493 West Virginians merged with county-level coal production and other covariates to investigate the relations between health indicators and residential proximity to coal mining. Results of hierarchical analyses indicated that high levels of coal production were associated with worse adjusted health status and with higher rates of cardiopulmonary disease, chronic obstructive pulmonary disease, hypertension, lung disease, and kidney disease. Research is recommended to ascertain the mechanisms, magnitude, and consequences of a community coal-mining exposure effect.

Avoidable hospitalizations for diabetes: comorbidity risks.

This study examined the risk for avoidable diabetes hospitalizations associated with comorbid conditions and other risk variables. A retrospective analysis was conducted of hospitalizations with a primary diagnosis of diabetes in a 2004 sample of short stay general hospitals in the United States (N = 97,526.) Data were drawn from the Health Care Utilization Project National Inpatient Sample.

Hospitalization patterns associated with Appalachian coal mining.

The goal of this study was to test whether the volume of coal mining was related to population hospitalization risk for diseases postulated to be sensitive or insensitive to coal mining by-products. The study was a retrospective analysis of 2001 adult hospitalization data (n = 93,952) for West Virginia, Kentucky, and Pennsylvania, merged with county-level coal production figures. Hospitalization data were obtained from the Health Care Utilization Project National Inpatient Sample.

Anesthesia staffing and anesthetic complications during cesarean delivery: a retrospective analysis.

Background: Obstetrical anesthesia services may be provided by Certified Registered Nurse Anesthetists (CRNAs), anesthesiologists, or a combination of the two providers. Research is needed to assist hospitals and anesthesia groups in making cost-effective staffing choices.

Objectives: To identify differences in the rates of anesthetic complications in hospitals whose obstetrical anesthesia is provided solely by CRNAs compared to hospitals with only anesthesiologists.

Social capital and risk for chronic illnesses.

Objectives: This study used an ecological model of social capital to examine the relationship between social capital and chronic illness. The model hypothesizes that personal social support and collective social capital are related to risk for chronic illnesses.

Methods: Data were taken from the American Changing Lives public use database.

Physician orders for life-sustaining treatment form: honoring end-of-life directives for nursing home residents.

Physician Orders for Life-Sustaining Treatment (POLST) form provides choices about end-of-life care and gives these choices the power of physician orders. The POLST form assures end-of-life choices can be implemented in all settings, from the home through the health-care continuum. The use of the POLST form was evaluated in a pilot study in nursing homes in two eastern Washington counties.

Improved clinical outcomes for fee-for-service physician practices participating in a diabetes care collaborative.

Background: The Rockwood Clinic in Spokane, Washington, participated in the Washington State Diabetes Collaborative, which promoted spread of the Chronic Care Model. Eleven participating providers managed care for 698 patients with diabetes, while 19 non-participating providers had 1,300 patients. IMPLEMENTING THE CHRONIC CARE MODEL: Rockwood upgraded its clinical information system to allow for creation of a patient registry to track clinical measures and generate performance reports.

Social capital and trust in providers.

Trust in providers has been in decline in recent decades. This study attempts to identify sources of trust in characteristics of health care systems and the wider community. The design is cross-sectional.

Isolation and characterisation of a novel bacteriocin produced by Bacillus thuringiensis strain B439.

Bacillus thuringiensis strain B439 produces a bacteriocin-like inhibitory substance in its growth medium. This antimicrobial peptide, referred to as thuricin 439, acts as a bacteriocidal peptide and exhibits an apparent narrow range of inhibitory activity, essentially only affecting growth of Bacillus cereus and B. thuringiensis strains.

Access to health care and community social capital.

Objective: To test the hypothesis that variation in reported access to health care is positively related to the level of social capital present in a community.

Data Sources: The 1996 Household Survey of the Community Tracking Study, drawn from 22 metropolitan statistical areas across the United States (n = 19,672). Additional data for the 22 communities are from a 1996 multicity broadcast media marketing database, including key social capital indicators, the 1997 National Profile of Local Health Departments survey, and Interstudy, American Hospital Association, and American Medical Association sources.