Digital Commons Network^™

Use Of The County Health Rankings By Local Health Departments In Florida, 2010 - 2011, Nancy L. Winterbauer, Bonita Sorensen, James B. Tidwell

Frontiers in Public Health Services and Systems Research

This paper describes how local health departments (LHDs) in Florida used the County Health Rankings over the first two years of their release (2010 – 2011). We surveyed LHD leadership to describe if, how and to what extent the Rankings were used by Florida’s 67 LHDs to improve the health of their communities and describe changes in use from the 2010 to the 2011 release. Our results indicate substantial use of the Rankings by Florida’s LHDs, particularly as applied to community health assessments, staff education, as a starting point for examining other indicators and databases, and in grant applications. From …

Effectiveness And Challenges For Implementing Quality Improvement Activities In Nebraska’S Local Health Departments, Li-Wu Chen, Anh Nguyen, Janelle J. Jacobson, Diptee Ojha, David Palm

Frontiers in Public Health Services and Systems Research

What is already known on this topic? Although the implementation strategies and effectiveness of quality improvement (QI) activities have been examined extensively for many industries, including the health care sector, very few studies have focused on QI activities in the public health context.

What is added by this report? The study results indicated that Nebraska’s LHDs still face significant barriers for QI implementation, including low capacity, knowledge gaps, inadequate resources, and low institutional QI maturity.

What are the implications for public health practice/policy/research? Policy makers and LHDs should provide QI training and external QI expertise to LHD staff and better …

Building Capacity To Support And Study Qi In Local Georgia Public Health Systems, William C. Livingood, Nandi Marshall, Angela Peden, Ketty Gonzales, Gulzar H. Shah, Russ Toal, Kellie Penix, Dayna Alexander, Kay Davis, Sylvester Nixon, Purity Cummings, William Riley, Lynn Woodhouse

Frontiers in Public Health Services and Systems Research

The study of quality improvement within Georgia’s local public health systems provides important insight into the use of regional bodies as quality improvement (QI) collaboratives and multijurisdictional entities. This report describes QI initiatives following a RWJF funded quick strike research grant to assess health district capacity to conduct QI in Georgia’s local public health systems. These QI initiatives use QI to improve public health outcomes including: Adolescent pregnancy and Sexually Transmitted Infection prevention, HIV prevention and control, and HIV Management.

Tax Levy Financing For Local Public Health: Relationships Between Fiscal Allocation, Fiscal Effort And Fiscal Capacity, William Riley, Kim J. Gearin, Carmen D. Parrotta, Jill Briggs, M. Elizabeth Gyllstrom

Frontiers in Public Health Services and Systems Research

This study examines property tax levy (local tax levy) as a source of local health department (LHD) funding during a five year period (2006-2010) in all Minnesota counties by assessing fiscal effort, fiscal allocation and fiscal capacity. Local health departments rely on pluralistic funding from local, state, federal and private sources. However, local tax levy funding is unexplored and little is known regarding the extent of fiscal allocation (tax levy used for LHD), fiscal effort (potential amount of tax levy available for LHD), and fiscal capacity (wealth of community). More important it is not known to what extent variation between …

Mandated Activities And Limited Decision-Making Authority Among Local Public Health Officials, Betty Bekemeier, Anthony L-T Chen, Nami Kawakyu

Frontiers in Public Health Services and Systems Research

Local public health department leaders face difficult decisions regarding the allocation of increasingly scarce resources, yet existing evidence for public health decision making, while still limited, is underutilized by public health officials. Participants in this study described processes regarding resource allocation in response to local budget cuts as based largely on legally mandated activities and categorical funding and perceived these factors as limiting much of their agency-level decision making to a relatively small portion of flexible funding. In the limited areas in which they perceived themselves to have flexibility, they generally considered their agencies to have very little capacity for …

Evidence-Based Decision Making In Local Health Departments, Linda Weiss, Collette Sosnowy, Christopher M. Maylahn, Nancy J. Katagiri, Sylvia Pirani

Frontiers in Public Health Services and Systems Research

Evidence-based decision making (EBDM) represents an important strategy to increase efficacy and efficiency of public health programs and practice. There is insufficient information on the application of EBDM among local health departments (LHDs). This qualitative study examined use of EBDM in New York State (NYS) LHDs and factors facilitating and impeding its adoption through interviews and focus groups with 47 LHD commissioners, health directors, and other upper-level staff. Findings suggest variability in application of EBDM in NYS LHDs. A number of internal factors (e.g., staff capacity, organizational culture) and external factors (e.g., policy environment, appropriate and …

From The Frontier: Translating Research To Practice, Paul C. Erwin

Frontiers in Public Health Services and Systems Research

The purpose of this invited article is to describe the process of translating research into public health practice. An example is provided, showing how questions arose in the practice setting, a researcher was identified to help answer the questions, and findings from the research were applied in the practice setting. In this example, Dr. Lea LaFave (Community Health Institute/JSI in New Hampshire) worked with Dr. Danielle Varda (Assistant Professor at the University of Colorado/ Denver, School of Public Affairs) to use social network analysis to better understand a network of coalitions focused on underage substance abuse. The social network analysis …

Stimulating Public Health Improvement In Complex And Constrained Delivery Systems: Findings From The Public Health Pbrns, Glen P. Mays

Frontiers in Public Health Services and Systems Research

The Robert Wood Johnson Foundation’s Public Health Practice-Based Research Networks Program sponsored a series of studies to examine how public health decision-makers are responding to accreditation, quality improvement, and public reporting initiatives amid the ongoing fiscal pressures. Overall, the evidence to date indicates that these initiatives represent promising strategies for strengthening evidence-based decision-making and expanding the delivery of evidence-tested programs and policies in local public health settings. Continued, comparative research and evaluation activities are needed to provide more definitive evidence about which combination of strategies work best, for which population groups, in which community and organizational settings, and why.

Elevated Cardiovascular Risk Among Adults With Obstructive And Restrictive Airway Functioning In The United States: A Cross-Sectional Study Of The National Health And Nutrition Examination Survey From 2007 - 2010, Earl S. Ford, Ann G. Wheaton, David M. Mannino, Latitia Presley-Cantrell, Chaoyang Li, Janet B. Croft

David M. Mannino

Background

Reasons for the excess risk for cardiovascular disease among people with chronic obstructive pulmonary disease remain unclear. Our objective was to examine the cardiovascular risk profile for adults with obstructive and restrictive impairments of lung functioning in a representative sample of adults from the United States.

Methods

We used data from adults aged 20–79 years who participated in the National Health and Nutrition Examination Survey from 2007 to 2010 and had a pulmonary function test. The severity of obstructive impairment was defined by adapting the Global Initiative for Chronic Obstructive Lung Disease criteria.

Results

Among 7249 participants, 80.9% had …

Elevated Cardiovascular Risk Among Adults With Obstructive And Restrictive Airway Functioning In The United States: A Cross-Sectional Study Of The National Health And Nutrition Examination Survey From 2007-2010, Earl S. Ford, Anne G. Wheaton, David M. Mannino, Letitia Presley-Cantrell, Chaoyang Li, Janet B. Croft

Preventive Medicine and Environmental Health Faculty Publications

BACKGROUND: Reasons for the excess risk for cardiovascular disease among people with chronic obstructive pulmonary disease remain unclear. Our objective was to examine the cardiovascular risk profile for adults with obstructive and restrictive impairments of lung functioning in a representative sample of adults from the United States.

METHODS: We used data from adults aged 20-79 years who participated in the National Health and Nutrition Examination Survey from 2007 to 2010 and had a pulmonary function test. The severity of obstructive impairment was defined by adapting the Global Initiative for Chronic Obstructive Lung Disease criteria.

RESULTS: Among 7249 participants, 80.9% had …

Public Health Return On Investment: Making The Case, Glen P. Mays

Health Management and Policy Presentations

Fiscal pressures and policy imperatives have created a need for rigorous economic analyses of public health programs and policies. ROI analyses can reveal whether the benefits of public health strategies justify their costs, who realizes these benefits and costs, and under what circumstances.

Comparative Effectiveness Research And Patient Centered Outcomes Research In Public Health Settings: Design, Analysis, And Funding Considerations, Glen P. Mays

Health Management and Policy Presentations

The principles and methods of CER and PCOR have developed primarily with therapeutics in mind, but they must also be applied to the study of public health programs, policies, and delivery systems. This session surveys the emerging field, and provides examples of CER/PCOR methods applied in public health settings using practice-based research networks (PBRNs).

Understanding And Treating Smoking Among Individuals With A Mental Illness, Chizimuzo T.C. Okoli

Nursing Presentations

• Background and significance

• Reasons for smoking among individuals living with a mental illness

• Smoking cessation treatment for individuals living with a mental illness

Occupational Chronic Obstructive Pulmonary Disease: An Update, Enrique Diaz-Guzman, David M. Mannino, Shambhu Aryal

David M. Mannino

Chronic obstructive pulmonary disease represents a major cause of morbidity and mortality in industrialized and nonindustrialized countries. Although tobacco use remains the main factor associated with development of the disease, occupational risk factors represent an important and preventable cause. The most common occupationally related factors include exposure to organic dusts, metallic fumes, and a variety of other mineral gases and/or vapors. This article summarizes the literature on the subject and provides an update of the most recent advances in the field.

Epidemiology Of Comorbidities In Chronic Obstructive Pulmonary Disease: Clusters, Phenotypes And Outcomes, Shambhu Aryal, Enrique Diaz-Guzman, David M. Mannino

David M. Mannino

COPD is a complex multisystem disease often accompanied by multiple co-morbidities that contribute to symptoms, exacerbations, hospital admissions and mortality. Individual comorbidities can be grouped into clusters of common human pathology: inflammation/immune response (e.g., ischemic heart disease, metabolic syndrome), thrombosis/hemorrhage (e.g., cerebrovascular diseases, pulmonary embolism), fibrosis/cell proliferation (e.g., lung cancer and other malignancies) and apoptosis/necrosis (e.g., osteoporosis, skeletal muscle dysfunction). While the prevalence of the co-morbidities has been described in a number of observational studies, there is considerable variability in results; moreover characterization of cluster of co-morbidities with the most clinical significance in terms of morbidity and mortality is still …

Drug Overdose Morbidity And Mortality In Kentucky, 2000-2010: An Examination Of Statewide Data, Including The Rising Impact Of Prescription Drug Overdose On Fatality Rates, And The Parallel Rise In Associated Medical Costs, Terry Bunn, Svetla Slavova

Kentucky Injury Prevention and Research Center Special Report

From Foreword:

Kentucky has seen an explosion in fatal poisonings, particularly prescription drug related fatalities, in the last decade. In 2009, Kentucky had the 5^th highest drug overdose rate in the US, increased from the 6^th highest drug overdose fatality rate determined in 2008 (CDC WONDER). Kentucky also had the 5^th highest nonmedical use of opioid pain relievers, and 11^th highest for opioid pain reliever sales in the nation (CDC, MMWR Report November 4, 2011). These drug overdose mortality statistics are extremely startling and only begin to reveal the devastating mental, emotional, and economic toll and …

Smoking On The Margins: An Equity Analysis Of The Outcomes Of An Outdoor Smoke-Free Policy, Chizimuzo T.C. Okoli, Ann Pederson

Nursing Presentations

• Purpose: To analyze the health and health equity impact of the newly implemented smoke-free policy for Vancouver’s parks and beaches

• CIHR Operating Grant: Population Health Intervention Research – designed to study an intervention in action not controlled by the investigators

• End date of funding, March 31, 2013 (with potential 12-month extension)

Expanding Delivery System Research In Public Health Settings: Lessons From Practice-Based Research Networks, Glen P. Mays, Rachel A. Hogg

Health and Clinical Sciences Faculty Publications

BACKGROUND: Delivery system research to identify how best to organize, finance, and implement health improvement strategies has focused heavily on clinical practice settings, with relatively little attention paid to public health settings-where research is made more difficult by wide heterogeneity in settings and limited sources of existing data and measures. This study examines the approaches used by public health practice-based research networks (PBRNs) to expand delivery system research and evidence-based practice in public health settings.

METHODS: Practice-based research networks employ quasi-experimental research designs, natural experiments, and mixed-method analytic techniques to evaluate how community partnerships, economic shocks, and policy changes impact …

Suicides And Suicide Attempts In Kentucky, 2001–2011, Kayla Pope, Svetla Slavova

Kentucky Injury Prevention and Research Center Special Report

From Executive Summary:

1. There were 605 suicides among Kentucky residents in the year 2010, up 7% from the 567 recorded in the year 2009.

2. The Kentucky resident age-adjusted suicide rate increased from 12.8 per 100,000 population in 2009 to 13.5 per 100,000 population in 2010, a 5.5% increase.

3. Firearms were the primary means of completed suicide from 2001-2010.

4. Kentucky residents aged 45-54 were the age group that completed suicide most frequently in 2010.

5. The age-adjusted rate for Kentucky self-harm-related hospitalizations increased 7.6% from 2010-2011 (52.5 hospitalizations per 100,000 population in 2010 to 56.5 hospitalizations in …

Estimating Scale And Scope Effects In Public Health Delivery: Implications For Regionalization, Glen P. Mays, Rachel A. Hogg, Rick Ingram, Kristina Rabarison

Health Management and Policy Presentations

OBJECTIVES: The nation's public health delivery system comprises nearly 3000 local public health agencies that vary widely in capabilities. Economic pressures, workforce shortages, and new national accreditation standards are leading these agencies to explore mechanisms for pooling resources to enhance delivery and improve population health.

METHODS: A longitudinal cohort design is used to analyze changes in the availability and perceived effectiveness of services delivered by local public health providers. A stratified random sample of the nation's 3000 local public health agencies (n=497) were surveyed in 1998 and again in 2006 and 2011 (70% response) to measure the availability of 20 …

Child Maltreatment Outpatient Visits To Kentucky Non-Federal Acute Care Hospitals, 2008-2010, Marjorie Stanek, Michael Singleton, Svetla Slavova, Terry Bunn

Kentucky Injury Prevention and Research Center Special Report

No abstract provided.

Reinventing The 21st Century Public Health Workforce: Innovation, Evaluation & Practice-Based Research, Glen P. Mays

Health Management and Policy Presentations

Compelling opportunities exist for incorporating practice-based research to into the design, implementation, and evaluation of public health workforce training and development programs. Public Health Training Centers (PHTCs) can collaborate with practice-based research networks (PBRNs) to discover and disseminate evidence-based strategies for workforce development.

Owner/Operator Hauling Asphalt Flux Dies After Driving Into A Ravine And Striking Trees, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Motor Vehicle

In the early morning of a late summer’s day, a 50 year old semi-truck driver was transporting a load of asphalt flux. He had been driving for approximately five hours and was getting ready to exit the interstate when for an unknown reason, the unit left the interstate, sideswiped a SUV parked on the shoulder, drove through a guardrail then proceeded into a ravine. A passing motorist called emergency services, who upon their arrival contacted the local coroner. The driver had been ejected from the cab and was pronounced dead at the scene.

To prevent future occurrences of similar incidents, …

Sensemaking In The Shadow Of A Superfund Site: Defining Atsdr Roles And Goals In An Agency-Saturated Community, Anna G. Hoover, Lindell Ormsbee, Stephanie W. Jenkins, Ashley M. Bush

Anna G. Hoover

By working directly in Superfund communities, the Agency for Toxic Substances and Disease Registry is embedded within a complex tapestry of federal and state agencies, local government entities, and other organizations that community stakeholders encounter regularly. The diversity of statutory obligations and expertise among these organizations, particularly as they relate to stakeholders’ health concerns, presents challenges for creating shared understanding between agencies and the communities they serve. Thus, addressing key elements of individual sensemaking during engagement activities is essential for those who work in communities.

Because sensemaking helps individuals determine the seriousness of a situation, decide how to react to …

College Drinking: A Call To Physicians, Shawn Sorrel, Hatim A. Omar

Pediatrics Faculty Publications

The aim of this paper was to review literature related to prevalence of drinking on college campuses and current prevention practices targeting this population. This paper focuses on current data surrounding alcohol use and misuse. It further discusses strategies which have been successful to prevent alcohol abuse. Finally, it discusses the need for further research to determine the role of the physician in alcohol prevention at university student health services.

Patterns Of Interaction Public Health Pbrns: Insight From Network Analysis, Rachel A. Hogg, Glen P. Mays

Health Management and Policy Reports

This report presents data from a network analysis survey conducted with public health practice-based research networks (PBRNs) to examine patterns of interaction among researchers and public health practitioners who participate in the networks. These data provide a baseline for tracking the types and frequencies of interaction that occur within networks, and reveal opportunities for promoting more productive patterns of engagement in applied public health research. Over time, these types of data can reveal how and under what circumstances PBRNs facilitate the production and application of research about public health services and delivery systems. The analysis includes data on more than …

Making The Case For Public Health: Estimating Roi And Value, Glen P. Mays

Health Management and Policy Presentations

This presentation describes recent progress and new directions for estimating the value of public health strategies and infrastructure.

Editorial Comment: Keeneland Conference Plenary Sessions: Thomas R. Frieden, Julia Costich

Frontiers in Public Health Services and Systems Research

No abstract provided.

Keeneland Conference Plenary Sessions: Thomas R. Frieden, Thomas R. Frieden

Frontiers in Public Health Services and Systems Research

One of the leading challenges in public health today is moving forward as one whether we are part of academia, a clinical health setting, or a public health department, in order to improve health outcomes. Right now in the United States, the leading causes of death are caused from diseases that are preventable. We also face a steady rise in health inequalities among those citizens with a lower socioeconomic status. Director of the CDC, Thomas Friedan addressed the Keeneland conference audience on the impact that public health initiatives have had on the health of our nation. Public health interventions have …

Editorial Comment: Keeneland Conference Plenary Sessions: Richard J. Umbdenstock, Part 2, Glen Mays

Frontiers in Public Health Services and Systems Research

No abstract provided.