Rural and suburban population surge following detonation of an improvised nuclear device: A new model to estimate impact

Background: The objective of the study was to model urban evacuation into surrounding communities after the detonation of an improvised nuclear device (IND) to assist rural and suburban planners in understanding and effectively planning to address the effects of population surges. Methods: Researchers developed parameters for how far evacuees would travel to escape disasters and factors that would influence choice of destination from studies of historical evacuations, surveys of citizens' evacuation intentions in hypothetical disasters, and semistructured interviews with key informants and emergency preparedness experts. Those parameters became the inputs to a "push-pull" model of how many people would flee in the 4 scenarios and where they would go. Results: The expanded model predicted significant population movements from the New York City borough of Manhattan and counties within 20 km of Manhattan to counties within a 150-mi radius of the assumed IND detonation. It also predicted that even in some communities located far from Manhattan, arriving evacuees would increase the population needing services by 50% to 150%. Conclusions: The results suggest that suburban and rural communities could be overwhelmed by evacuees from their center city following an IND detonation. They also highlight the urgency of educating and communicating with the public about radiation hazards to mitigate panic and hysteria, anticipating the ways in which a mass exodus may disrupt or even cripple rescue and response efforts, and devising creative ways to exercise and drill for an event about which there is great denial and fatalism

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

Rural Appalachia Battling the Intersection of Two Crises: COVID-19 and Substance Use Disorders

During the COVID-19 pandemic, rural Appalachia is at great risk of unforeseen side effects including increased mortality from substance use disorders (SUDs). People living with SUDs are at increased risk for both exposure to and poor outcomes from COVID infection. The economic impacts of COVID-19 must also be considered. As rural Appalachia combats the substance use crisis amidst the COVID-19 pandemic, the geographic economic, health and social inequities within our region must be considered. As a national recovery is sought, we should reimagine federal policies that center the economic and public health of rural Appalachia addressing the two crises

The double disparity facing rural local health departments: A short report

Rural residents in the U.S. face significant health challenges, including higher rates of risky health behaviors and worse health outcomes than many other groups. Rural communities are also typically served by local health departments (LHDs) that have fewer human and financial resources than their suburban and urban peers. As a result of history and need, rural LHDs are more likely than urban LHDs to provide direct health services, which may result in limited resources for population-based activities. This review examines the double disparity facing rural LHDs and their constituents: pervasively poorer health behaviors and outcomes and a historical lack of investment by local, state, and federal public health entities

Clinical Service Delivery along the Urban/Rural Continuum

Background: Engagement in the core public health functions and ten essential services remains the standard for measuring local health department (LHD) performance; their role as providers of clinical services remains uncertain, particularly in rural and underserved communities. Purpose: To examine the role of LHDs as clinical service providers and how this role varies among rural and nonrural communities. Methods: The 2013 National Association of County and City Health Officials (NACCHO) Profile was used to examine the geographic distribution of clinical service provision among LHDs. LHDs were coded as urban, large rural, or small rural based on Rural/Urban Commuting Area codes. Bivariate analysis for clinical services was conducted by rural/urban status. For each service, the proportions of LHDs that directly performed the service, contracted with other organizations to provide the service, or reported provision of the service by independent organizations in the community was compared. Results: Analyses show significant differences in patterns of clinical services offered, contracted, or provided by others, based on rurality. LHDs serving rural communities, especially large rural LHDs, tend to provide more direct services than urban LHDs. Among rural LHDs, larger rural LHDs provided a broader array of services and reported more community capacity for delivery than small rural LHDs- particularly maternal and child health services. Implications: There are capacity differences between large and small rural LHDs. Limited capacity within small rural LHDs may result in providing less services, regardless of the availability of other providers within their communities. These findings provide valuable information on clinical service provision among LHDs, particularly in rural and underserved communities

Local Health Department Clinical Service Delivery along the Urban/Rural Continuum

Background: Engagement in the core public health functions and ten essential services remains the standard for measuring local health department (LHD) performance; their role as providers of clinical services remains uncertain, particularly in rural and underserved communities. Purpose: To examine the role of LHDs as clinical service providers and how this role varies among rural and nonrural communities. Methods: The 2013 National Association of County and City Health Officials (NACCHO) Profile was used to examine the geographic distribution of clinical service provision among LHDs. LHDs were coded as urban, large rural, or small rural based on Rural/Urban Commuting Area codes. Bivariate analysis for clinical services was conducted by rural/urban status. For each service, the proportions of LHDs that directly performed the service, contracted with other organizations to provide the service, or reported provision of the service by independent organizations in the community was compared. Results: Analyses show significant differences in patterns of clinical services offered, contracted, or provided by others, based on rurality. LHDs serving rural communities, especially large rural LHDs, tend to provide more direct services than urban LHDs. Among rural LHDs, larger rural LHDs provided a broader array of services and reported more community capacity for delivery than small rural LHDs- particularly maternal and child health services. Implications: There are capacity differences between large and small rural LHDs. Limited capacity within small rural LHDs may result in providing less services, regardless of the availability of other providers within their communities. These findings provide valuable information on clinical service provision among LHDs, particularly in rural and underserved communities

Changes in Adolescent Birth Rates within Appalachian Subregions and Non-Appalachian Counties in the United States, 2012–2018

Background: Adolescent births are associated with numerous challenges. While adolescent birth rates have declined across the U.S., disparities persist and little is known about the extent to which broader declines are seen within Appalachia. Purpose: The purpose of this study was to examine the extent to which adolescent birth rates have declined across the subregions of Appalachia relative to non-Appalachia. Methods: We conducted a retrospective study of adolescent birth rates between 2012 and 2018 using county-level vital records data. Differences were examined across the subregions of Appalachia and among non-Appalachian counties. Multiple regression models were used to examine changes in the rate of decline over time, adjusting for additional covariates of relevance. Results: About 13.4% of all counties in the U.S. are within the Appalachian region. The rate of adolescent births decreased by 12.6 adolescent births per 1,000 females between 2012 and 2018 across the U.S. While all regions experienced declines in the rate of adolescent births, Central Appalachia had the largest reduction in adolescent births (18.5 per 1,000 females), which was also noted in the adjusted models when compared to the counties of non-Appalachia (b= –5.78, CI: –9.58, –1.97). Rates of adolescent birth were markedly higher in counties considered among the most socially and economically vulnerable. Implications: This study demonstrates that the rates of adolescent births vary across the subregions of Appalachia but have declined proportional to rates in non-Appalachia. While adolescent birth rates remain higher in select subregions of Appalachia compared to non-Appalachia, the gap has narrowed considerably

The Double Disparity Facing Rural Local Health Departments

Residents of rural jurisdictions face significant health challenges, including some of the highest rates of risky health behaviors and worst health outcomes of any group in the country. Rural communities are served by smaller local health departments (LHDs) that are more understaffed and underfunded than their suburban and urban peers. As a result of history and current need, rural LHDs are more likely than their urban peers to be providers of direct health services, leading to relatively lower levels of population-focused activities. This review examines the double disparity faced by rural LHDs and their constituents: pervasively poorer health behaviors and outcomes and a historical lack of investment by local, state, and federal public health entities

A Profile of Tribal Health Departments

This study uses data to analyze the impacts of Tribal health departments in improving health status and reducing health disparities.