Investigating the impact of the diseases of despair in Appalachia

Introduction: Appalachia is one of the regions most significantly impacted by the opioid crisis. This study investigated mortality due to diseases of despair within the Appalachian Region, with an additional focus on deaths attributable to opioid overdose. Methods: Diseases of despair include: alcohol, prescription drug and illegal drug overdose, suicide, and alcoholic liver disease/cirrhosis of the liver. Mortality data from the National Center for Health Statistics (NCHS) National Vital Statistics System (NVSS) Multiple Cause of Death database were analyzed for this study, focusing on individuals aged 15–64. Results: Over the past two decades, the mortality rate due to diseases of despair has been increasing across the United States, but the gap has widened between the Appalachian Region and the rest of the nation. In 2017, the combined diseases of despair mortality rate was 45% higher in the Appalachian Region than the non-Appalachian United States. When looking at just overdose mortality, this disparity grows to 65% higher in the Appalachian Region. Within the Appalachian region disparities are most notable in the Central and North Central Appalachian subregions, among males, and among individuals age 45 to 54. Discussion: These findings document the scale and scope of the problem in Appalachia and highlight the need for additional research and discussion in terms of effective interventions, policies, and strategies to address these diseases of despair. Over the past two decades, mortality from overdose, suicide, and alcoholic liver diseases/cirrhosis has increased across the United States, but the disparity between Appalachia and the non-Appalachian U.S. continues to grow

Tracking the Impact of Diseases of Despair in Appalachia—2015 to 2018

Introduction: This study provides an update on mortality due to diseases of despair within the Appalachian Region, comparing 2015 to 2018. Methods: Diseases of despair include: alcohol, prescription drug and illegal drug overdose, suicide, and alcoholic liver disease/cirrhosis of the liver. Analyses are based on National Vital Statistics System (NVSS) mortality data for individuals aged 15-64. Results: Between 2015 and 2017, the diseases of despair mortality rate increased in both Appalachia and the non-Appalachian U.S., and the disparity grew between Appalachia and the rest of the county. In 2018, the disease of despair mortality rate declined by 8 percent in Appalachia, marking the first decline for the Region since 2012. Diseases of despair continue to impact the working-age population, and while males experience a higher burden of mortality due to diseases of despair, the disparity between Appalachia and the rest of the United States is greater for females. Overdose mortality rates in Appalachia increased between 2015 and 2017, followed by a decline in 2018. During this same time frame, suicide also increased notably within the Appalachian region, and the disparity between Appalachia and the non-Appalachian U.S. increased by 50 percent. Implications: These findings document that the diseases of despair continue to have a greater impact in the Appalachian Region than in the rest of the United States. While the declining trends between 2017 and 2018 are promising, data has shown that these rates are likely to increase again, particularly as a result of the COVID-19 pandemic

Firearm Safety, Gun Violence and Chicago Families: Voices of Child Health in Chicago Report

Chicago has seen continuing firearm violence, with over 2,000 shooting victims so far in 2021. The epidemic of firearm violence impacts children across the state, as it remains the number one cause of death in children and youth across Illinois. In some of our previous reports, Chicago parents identified gun violence as their top social concern for kids in the city, and in recent years, they reported it was the main social problem getting worse the fastest for Chicago youth. In this month's Voices of Child Health in Chicago Report, we focus on the importance of firearm safety and parents' concerns about gun violence in the city. We asked 1,505 Chicago parents from all 77 community areas in the city about their experiences with firearm safety as well as other gun violence prevention and concern-related questions.

Continental-scale homogenization of residential lawn plant communities

© The Author(s), 2017. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Landscape and Urban Planning 165 (2017): 54-63, doi:10.1016/j.landurbplan.2017.05.004.Residential lawns are highly managed ecosystems that occur in urbanized landscapes across the United States. Because they are ubiquitous, lawns are good systems in which to study the potential homogenizing effects of urban land use and management together with the continental-scale effects of climate on ecosystem structure and functioning. We hypothesized that similar homeowner preferences and management in residential areas across the United States would lead to low plant species diversity in lawns and relatively homogeneous vegetation across broad geographical regions. We also hypothesized that lawn plant species richness would increase with regional temperature and precipitation due to the presence of spontaneous, weedy vegetation, but would decrease with household income and fertilizer use. To test these predictions, we compared plant species composition and richness in residential lawns in seven U.S. metropolitan regions. We also compared species composition in lawns with understory vegetation in minimally-managed reference areas in each city. As expected, the composition of cultivated turfgrasses was more similar among lawns than among reference areas, but this pattern also held among spontaneous species. Plant species richness and diversity varied more among lawns than among reference areas, and more diverse lawns occurred in metropolitan areas with higher precipitation. Native forb diversity increased with precipitation and decreased with income, driving overall lawn diversity trends with these predictors as well. Our results showed that both management and regional climate shaped lawn species composition, but the overall homogeneity of species regardless of regional context strongly suggested that management was a more important driver.This research was supported by the Macrosystems Biology Program in the Emerging Frontiers Division of the Biological Sciences Directorate at the National Science Foundation (NSF) under grants EF-1065548, 1065737, 1065740, 1065741, 1065772, 1065785, 1065831, and 121238320

Climate and lawn management interact to control C4 plant distribution in residential lawns across seven U.S. cities.

Author Posting. © Ecological Society of America, 2019. This article is posted here by permission of Ecological Society of America for personal use, not for redistribution. The definitive version was published in Trammell, T. L. E., Pataki, D. E., Still, C. J., Ehleringer, J. R., Avolio, M. L., Bettez, N., Cavender-Bares, J., Groffman, P. M., Grove, M., Hall, S. J., Heffernan, J., Hobbie, S. E., Larson, K. L., Morse, J. L., Neill, C., Nelson, K. C., O'Neil-Dunne, J., Pearse, W. D., Chowdhury, R. R., Steele, M., & Wheeler, M. M. Climate and lawn management interact to control C4 plant distribution in residential lawns across seven U.S. cities. Ecological Applications, 29(4), (2019): e01884, doi: 10.1002/eap.1884.In natural grasslands, C4 plant dominance increases with growing season temperatures and reflects distinct differences in plant growth rates and water use efficiencies of C3 vs. C4 photosynthetic pathways. However, in lawns, management decisions influence interactions between planted turfgrass and weed species, leading to some uncertainty about the degree of human vs. climatic controls on lawn species distributions. We measured herbaceous plant carbon isotope ratios (δ13C, index of C3/C4 relative abundance) and C4 cover in residential lawns across seven U.S. cities to determine how climate, lawn plant management, or interactions between climate and plant management influenced C4 lawn cover. We also calculated theoretical C4 carbon gain predicted by a plant physiological model as an index of expected C4 cover due to growing season climatic conditions in each city. Contrary to theoretical predictions, plant δ13C and C4 cover in urban lawns were more strongly related to mean annual temperature than to growing season temperature. Wintertime temperatures influenced the distribution of C4 lawn turf plants, contrary to natural ecosystems where growing season temperatures primarily drive C4 distributions. C4 cover in lawns was greatest in the three warmest cities, due to an interaction between climate and homeowner plant management (e.g., planting C4 turf species) in these cities. The proportion of C4 lawn species was similar to the proportion of C4 species in the regional grass flora. However, the majority of C4 species were nonnative turf grasses, and not of regional origin. While temperature was a strong control on lawn species composition across the United States, cities differed as to whether these patterns were driven by cultivated lawn grasses vs. weedy species. In some cities, biotic interactions with weedy plants appeared to dominate, while in other cities, C4 plants were predominantly imported and cultivated. Elevated CO2 and temperature in cities can influence C3/C4 competitive outcomes; however, this study provides evidence that climate and plant management dynamics influence biogeography and ecology of C3/C4 plants in lawns. Their differing water and nutrient use efficiency may have substantial impacts on carbon, water, energy, and nutrient budgets across cities.This research was funded by a series of collaborative grants from the U.S. National Science Foundation Macrosystems Biology Program (EF‐1065548, 1065737, 1065740, 1065741, 1065772, 1065785, 1065831, 121238320). The authors thank La'Shaye Ervin, William Borrowman, Moumita Kundu, and Barbara Uhl for field and laboratory assistance

Climate and Lawn Management Interact to Control C\u3csub\u3e4\u3c/sub\u3e Plant Distribution in Residential Lawns Across Seven U.S. Cities

In natural grasslands, C4 plant dominance increases with growing season temperatures and reflects distinct differences in plant growth rates and water use efficiencies of C3 vs. C4 photosynthetic pathways. However, in lawns, management decisions influence interactions between planted turfgrass and weed species, leading to some uncertainty about the degree of human vs. climatic controls on lawn species distributions. We measured herbaceous plant carbon isotope ratios (δ13C, index of C3/C4 relative abundance) and C4 cover in residential lawns across seven U.S. cities to determine how climate, lawn plant management, or interactions between climate and plant management influenced C4 lawn cover. We also calculated theoretical C4carbon gain predicted by a plant physiological model as an index of expected C4 cover due to growing season climatic conditions in each city. Contrary to theoretical predictions, plant δ13C and C4 cover in urban lawns were more strongly related to mean annual temperature than to growing season temperature. Wintertime temperatures influenced the distribution of C4 lawn turf plants, contrary to natural ecosystems where growing season temperatures primarily drive C4 distributions. C4 cover in lawns was greatest in the three warmest cities, due to an interaction between climate and homeowner plant management (e.g., planting C4 turf species) in these cities. The proportion of C4 lawn species was similar to the proportion of C4 species in the regional grass flora. However, the majority of C4 species were nonnative turf grasses, and not of regional origin. While temperature was a strong control on lawn species composition across the United States, cities differed as to whether these patterns were driven by cultivated lawn grasses vs. weedy species. In some cities, biotic interactions with weedy plants appeared to dominate, while in other cities, C4 plants were predominantly imported and cultivated. Elevated CO2 and temperature in cities can influence C3/C4competitive outcomes; however, this study provides evidence that climate and plant management dynamics influence biogeography and ecology of C3/C4plants in lawns. Their differing water and nutrient use efficiency may have substantial impacts on carbon, water, energy, and nutrient budgets across cities

The Impact of Realistic Age Structure in Simple Models of Tuberculosis Transmission

Background : Mathematical models of tuberculosis (TB) transmission have been used to characterize disease dynamics, investigate the potential effects of public health interventions, and prioritize control measures. While previous work has addressed the mathematical description of TB natural history, the impact of demography on the behaviour of TB models has not been assessed. Methods : A simple model of TB transmission, with alternative assumptions about survivorship, is used to explore the effect of age structure on the prevalence of infection, disease, basic reproductive ratio and the projected impact of control interventions. We focus our analytic arguments on the differences between constant and exponentially distributed lifespans and use an individual-based model to investigate the range of behaviour arising from realistic distributions of survivorship. Results : The choice of age structure and natural (non-disease related) mortality strongly affects steady-state dynamics, parameter estimation and predictions about the effectiveness of control interventions. Since most individuals infected with TB develop an asymptomatic latent infection and never progress to active disease, we find that assuming a constant mortality rate results in a larger reproductive ratio and an overestimation of the effort required for disease control in comparison to using more realistic age-specific mortality rates. Conclusions : Demographic modelling assumptions should be considered in the interpretation of models of chronic infectious diseases such as TB. For simple models, we find that assuming constant lifetimes, rather than exponential lifetimes, produces dynamics more representative of models with realistic age structure

World-Wide FINGERS Network: A global approach to risk reduction and prevention of dementia

© 2020 The Authors. Alzheimer\u27s & Dementia published by Wiley Periodicals, Inc. on behalf of Alzheimer\u27s Association Reducing the risk of dementia can halt the worldwide increase of affected people. The multifactorial and heterogeneous nature of late-onset dementia, including Alzheimer\u27s disease (AD), indicates a potential impact of multidomain lifestyle interventions on risk reduction. The positive results of the landmark multidomain Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) support such an approach. The World-Wide FINGERS (WW-FINGERS), launched in 2017 and including over 25 countries, is the first global network of multidomain lifestyle intervention trials for dementia risk reduction and prevention. WW-FINGERS aims to adapt, test, and optimize the FINGER model to reduce risk across the spectrum of cognitive decline—from at-risk asymptomatic states to early symptomatic stages—in different geographical, cultural, and economic settings. WW-FINGERS aims to harmonize and adapt multidomain interventions across various countries and settings, to facilitate data sharing and analysis across studies, and to promote international joint initiatives to identify globally implementable and effective preventive strategies

Documenting and Mapping Health Disparities in Central Appalachia: Obesity and Chronic Disease Mortality

East Tennessee State University and NORC at the University of Chicago (on behalf of the Appalachia Funders Network) documented the current burden of obesity, diabetes, and chronic disease mortality in central Appalachia. We conducted an analysis of county-level data to provide a comprehensive picture of the health condition of the region and explore urban/rural disparities. More than two-thirds (68.6%) of the 234 counties in central Appalachia have an adult obesity prevalence above the national median of 30.9% (defined as BMI over 30). Over 85% of the counties in central Appalachia have a percentage of physically inactive adults higher than the national median of 26.4% (defined as not participating in physical activity or exercise in the past 30 days). When analyzing the combined chronic disease mortality for heart disease, stroke, diabetes and chronic lower respiratory disease, the combined national mortality rate is 93.0 deaths per 100,000 population. Nearly 90% of central Appalachian counties have a higher combined morality rate. The disparity is more pronounced in rural communities. The combined mortality rate for these four diseases is 74% higher in rural central Appalachia than urban counties nationally. Compared to the rest of the country, people in central Appalachia are more likely to experience and prematurely die from obesity-related chronic disease, including diabetes and heart disease. Residents of rural central Appalachia face even more significant disparities as compared to urban residents within the region and nationally. We will present study methods and findings, including maps and graphs that document these disparities