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BACKGROUND: This study aimed to identify the most common types of nontraumatic dental conditions (NTDCs) before and during the COVID-19 pandemic and assess the variations in the most common NTDCs by patient age groups and rural or urban locations and the impact of COVID-19 on emergency department (ED) visits for NTDCs in North Carolina. METHODS: The authors conducted a retrospective data analysis of ED data from the North Carolina Disease Event Tracking and Epidemiology Collection Tool. The authors estimated the proportions of NTDCs of all ED visits in 2019 and 2021 and ranked the proportions of the major categories of NTDCs by age groups and rural or urban locations. They used a multiple logistic regression model to assess the impact of COVID-19 on NTDCs. RESULTS: By the first diagnosis, the proportion of NTDCs dropped from 1.1% in 2019 to 0.99% in 2021 (P < .001). Caries was specified as the third most common NTDC. Oral infection was the top NTDC among young (≤ 17 years) and older patients (≥ 65 years). No significant differences were found in NTDCs between rural and urban areas (P = .68). Children younger than 2 years (adjusted odds ratio, 4.36) and adults aged 18 through 44 years (adjusted odds ratio, 4.54) were more likely to visit the ED for NTDCs than those 75 years and older. CONCLUSIONS: The proportion of NTDCs seen at the ED was lower during the COVID-19 pandemic in 2021 than in 2019. The common NTDCs varied by age group but were similar in rural and urban areas. The most common NTDCs were related to toothache, oral infection, and caries. PRACTICAL IMPLICATIONS: More efforts are needed to reduce ED visits for NTDCs.

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PURPOSE: This study aimed to report recent trends in self-reported diabetes self-management education (DSME) participation rates among adults in North Carolina and to compare these rates between rural and urban residents. METHODS: Data for this analysis were obtained from the NC Behavioral Risk Factor Surveillance System (BRFSS) for the years 2012, 2013, 2015, and 2017, when the survey included the diabetes module. Respondents were classified as having participated in DSME if they answered "Yes" to the question, "Have you ever taken a course or class in how to manage your diabetes yourself?" We used the Rural Urban Continuum Code to classify urban and rural residence. The study sample included 4368 adults 18 years or older with self-reported diabetes. We assessed the changes in DSME participation from 2012 to 2017. We used multiple logistic regression modeling to assess the association between rural residence and DSME participation. All analyses were conducted in Stata 14 and accounted for the survey design of the BRFSS. Statistical significance was set at P < .01. RESULTS: Overall, the DSME participation rates decreased slightly in the study period, from 55.8% in 2012 to 55.6% in 2013 to 56.5% in 2015 to 52.1% in 2017. By rural-urban residence, the rates were 52.3% versus 57.8% in 2012, 54.0% versus 56.5% in 2013, 48.8% versus 62.0% in 2015, and 46.7% versus 56.1% in 2017. The multiple logistic regression model results showed that rural residents were less likely to have participated in DSME (adjusted odds ratio = 0.78; 95% confidence interval, 0.64-0.94) than urban residents. Adults with higher income and education levels were also more likely to have participated in DSME (P < .01). CONCLUSIONS: The recent BRFSS data showed that the DSME participation rate declined slightly in North Carolina. There were persistent rural-urban disparities in DSME participation, with rural residents showing lower rates, and the gaps seemed to be widening. IMPLICATIONS FOR POLICY OR PRACTICE: Continuous efforts are needed to bring more American Diabetes Association/American Association of Diabetes Educators programs to rural communities and assist persons with diabetes to participate in DSME training to reduce the burden of diabetes. Furthermore, those in rural areas may need additional support.

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Low health literacy (HL) is associated with poorer health outcomes. We examined HL among adults with multiple chronic conditions (CCs), using 2016 Behavioral Risk Factor Surveillance System data. Health literacy was measured by 3 subjective questions about difficulty with the following tasks: (1) obtaining health information or advice; (2) understanding spoken health information; and (3) understanding written health information. We estimated the prevalence of low HL (difficulty with ≥1 HL tasks) and used multiple logistic regression analysis to examine associations between HL and number of CCs. The prevalence of low HL was 13.8% overall and increased with the number of CCs from 10.6% among those with no CC to 24.7% among those with 3 or more CCs, with the latter having more than twice the adjusted odds of low HL compared with the former (adjusted odds ratio = 2.65; 95% confidence interval, 2.36-2.97). Efforts to improve HL in this population are needed.

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The COVID-19 pandemic has disproportionately affected racial and ethnic minority groups in the U.S. Over a 7-week period in late 2020, with funding from the NC Office of Minority Health and Health Disparities, the West Greenville Health Council (WGHC), a community-academic, non-profit partnership, engaged and activated a 27-member organizational partnership network for COVID-19 health communication and personal protective equipment (PPE) distribution in African American communities in Eastern North Carolina. Outreach included: local production and dissemination of 10 culturally relevant safety videos, 10 risk, prevention, and safety postcard messages, 3 virtual forums, and PPE kit distribution via the network and their distribution venues. Communication mediums included social media posts (i.e., Facebook and YouTube), network email distribution lists, and postcards distributed along with PPE kits. Outreach activities were evaluated via an online survey, reach of social media posts, and PPE distribution. Working through the organizational network, the WGHC reached a combined total of 30,310 community members with educational materials. Forty-four outreach events were held during this period and over 8000 PPE kits were distributed. The online survey, distributed through the network, yielded more than 400 completed questionnaires. This tool was used to gain insights on community perceptions of COVID-19 safety barriers and media messages. The activation of the network as an approach for rapid response to an emerging public health crisis greatly expanded the reach of the WGHC. The WGHC is working to institutionalize the network to address future emerging health threats, as well as the dissemination of health information more generally.

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OBJECTIVE: Low health literacy has been associated with unfavorable health outcomes. We examined diabetes self- and clinical care measures among adults with diabetes by 3 dimensions of health literacy. DESIGN/SETTING: Questions about health literacy were available for optional use in the 2016 Behavioral Risk Factor Surveillance System. We analyzed 2016 Behavioral Risk Factor Surveillance System data from 4 states and the District of Columbia that had included both the Health Literacy and Diabetes optional modules. PARTICIPANTS: Respondents who participated in the 2016 Behavioral Risk Factor Surveillance System in Alabama, Louisiana, Mississippi, Virginia, and Washington, District of Columbia, and completed both modules (n = 4397). MAIN OUTCOME MEASURES: Health literacy was measured by level of difficulty (easy, difficult) with 3 health literacy tasks: getting health advice or information, understanding health information delivered orally by health professionals, and understanding written health information. Diabetes care measures included physical activity, self-monitoring blood glucose, self-checking feet, hemoglobin A1c testing, professional foot examination, flu vaccination, professional eye examination, dental visits, and diabetes self-management education. RESULTS: Among those with self-reported diabetes, 5.9% found it difficult to get health advice or information, 10.7% found it difficult to understand information health professionals told them, and 12.0% found it difficult to understand written health information. Those who found it difficult to get health advice or information had 44% to 56% lower adjusted odds of A1c testing, professional foot examinations, and dental visits; those who found it difficult to understand written health information had lower odds of self-monitoring glucose and self-checking feet. Difficulty understanding both oral and written health information was associated with never having taken a diabetes self-management class. CONCLUSIONS: Our results suggest that problems with health literacy may be a barrier to good disease management among adults with diabetes and that health care providers should be attentive to the needs of patients with low health literacy, especially for diabetes-specific specialty care.

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BACKGROUND Low health literacy is a recognized contributor to health disparities. Significant proportions of the adult population, especially the underserved, have low health literacy. The purpose of this study was to examine health literacy and its associations with health status and chronic health conditions among North Carolina adults.METHODS The 2016 North Carolina Behavioral Risk Factor Surveillance System included health literacy questions that focused on accessing and understanding health information. Using these self-reported data, we estimated the prevalence of low health literacy and assessed its associations with general health status and chronic health conditions after adjusting for sociodemographic characteristics and health care access.RESULTS Overall, 4.8% of adults reported having difficulty getting health information or advice, 7.5% understanding oral information from health professionals, and 8.3% understanding written health information; 14.8% reported having difficulty with at least one of these tasks. The adjusted odds of low health literacy were moderately higher for those who had been diagnosed with the following conditions compared to those not diagnosed: heart attack, coronary heart disease, or stroke (AOR = 1.81, 95% CI=1.33, 2.47); COPD (AOR = 1.67, 95% CI = 1.19, 2.34); arthritis (AOR = 1.68, 95% CI = 1.32, 2.15); depression (AOR = 1.95, 95% CI=1.52, 2.50); and kidney disease (AOR = 1.62, 95% CI = 1.02, 2.60).LIMITATIONS All data were self-reported.CONCLUSIONS A notable segment of the North Carolina adult population has low health literacy, and those who do are particularly vulnerable to adverse health status. Targeted efforts are needed to identify strategies to improve health literacy and decrease health disparities.

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Diabetes is a significant public health problem in eastern North Carolina, and completion of formal diabetes self-management education (DSME) is low. To seek methods to increase DSME completion, patients with diabetes in an eastern North Carolina regional health care system who had not completed DSME (n = 58) were surveyed during wellness visits to examine attitudes toward the use of vouchers (eg, coupons that purchase healthy food, exercise classes, gym memberships). There was an extremely low awareness (19%) of and referral (5%) to DSME. Most respondents (77%) said they would or might be more likely to complete DSME if they received a voucher at the end. Vouchers for healthy food venues such as farmers' markets were most preferred, and 6 months or less was found to be an acceptable time frame to use the voucher. This study offers some evidence for DSME providers to explore vouchers as one approach to increase program completion.

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All local health departments in North Carolina are mandated to provide a defined set of environmental health services, yet few have the tools to understand the costs incurred in delivering these services. The objectives of this study were to (1) derive cost estimates for 2 commonly provided environmental health services-food and lodging inspections and on-site water services-and (2) explore factors that drive variations in costs, focusing on the roles of economies of scale and scope. Using data from 15 local health departments in North Carolina, we found that costs varied substantially. A bivariate analysis found evidence of economies of scale: higher volumes of services were associated with lower costs per service. Providing a greater scope of services, however, was not consistently associated with reduced costs. In-depth cost data provide public health officials with key information when deciding how to best serve their communities.

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With real-world relevance and translatability as important goals, applied methodological approaches have arisen along the participatory continuum that value context and empower stakeholders to partner actively with academics throughout the research process. Community-based participatory research (CBPR) provides the gold standard for equitable, partnered research in traditional communities. Practice-based research networks (PBRNs) also have developed, coalescing communities of practice and of academics to identify, study, and answer practice-relevant questions. To optimize PBRN potential for expanding scientific knowledge, while bridging divides across knowledge production, dissemination, and implementation, we elucidate how PBRN partnerships can be strengthened by applying CBPR principles to build and maintain research collaboratives that empower practice partners. Examining the applicability of CBPR partnership principles to public health (PH) PBRNs, we conclude that PH-PBRNs can serve as authentic, sustainable CBPR partnerships, ensuring the co-production of new knowledge, while also improving and expanding the implementation and impact of research findings in real-world settings.

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OBJECTIVES: To describe levels of partnership between local health departments (LHDs) and other community organizations in maternal and child health (MCH), communicable disease prevention, and chronic disease control and to assess LHD organizational characteristics and community factors that contribute to partnerships. DATA SOURCES: Data were drawn from the National Association of County & City Health Officials' 2013 National Profile Study (Profile Study) and the Area Health Resources File. LHDs that received module 1 of the Profile Study were asked to describe the level of partnership in MCH, communicable disease prevention, and chronic disease control. Levels of partnership included "not involved," "networking," "coordinating," "cooperating," and "collaborating," with "collaborating" as the highest level of partnership. Covariates included both LHD organizational and community factors. Data analyses were conducted using Stata 13 SVY procedures to account for the Profile Study's survey design. RESULTS: About 82%, 92%, and 80% of LHDs partnered with other organizations in MCH, communicable disease prevention, and chronic disease control programs, respectively. LHDs having a public health physician on staff were more likely to partner in chronic disease control programs (adjusted odds ratio [AOR] = 2.33; 95% confidence interval [CI], 1.03-5.25). Larger per capita expenditure was also associated with partnerships in MCH (AOR = 2.43; 95% CI, 1.22-4.86) and chronic disease prevention programs (AOR = 1.76; 95% CI, 1.09-2.86). Completion of a community health assessment was associated with partnership in MCH (AOR = 7.26; 95% CI, 2.90-18.18), and chronic disease prevention (AOR = 5.10; 95% CI, 2.28-11.39). CONCLUSION: About 1 in 5 LHDs did not have any partnerships in chronic disease control. LHD partnerships should be promoted to improve care coordination and utilization of limited health care resources. Factors that might promote LHDs' partnerships include having a public health physician on staff, higher per capita expenditure, and completion of a community health assessment. Community context likely influences types and levels of partnerships. A better understanding of these contextual factors may lead to more complete and effective LHD partnerships.

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OBJECTIVE: Examine overall level of and variation in local health department (LHD) use and perceived impact of the County Health Rankings report (Rankings) in Florida (2010, 2011) and North Carolina (2010-2012, 2013). DESIGN: Two cross-sectional surveys among LHDs. PARTICIPANTS: Local health directors and relevant staff. MAIN OUTCOME MEASURES: Use of the Rankings was measured by asking respondents if their LHD had used the Rankings in any of 10 ways and through assessment of community engagement. Perceived impact was measured by amount of attention the Rankings received from various stakeholders and whether they had already produced or would likely produce any of 7 possible results. RESULTS: Overall, LHDs used the Rankings most often to educate staff in Florida (78%) and North Carolina (56%). Engagement with community groups around the Rankings was variable. Media engagement, through press releases (41%; 40%) or interviews (51%; 36%) in Florida and North Carolina, was moderate. Florida LHDs used the Rankings in more ways and significantly more frequently than North Carolina LHDs. There were few significant differences in perceived impact by state. At least a moderate amount of attention was received from media in Florida (52%) and North Carolina (46%). Twenty-percent of LHDs reported the Rankings received at least moderate attention from the general public in both states and 38% (Florida) and 33% (North Carolina) from policy makers. Tangible benefits to communities from the Rankings, such as having already influenced adoption of new policies, were modest in Florida (3%) and North Carolina (11%). CONCLUSIONS: Results suggest that tangible benefits to communities from use of the Rankings have yet to be fully realized but are encouraging. More effective media engagement could produce the community awareness necessary to maximize the Rankings' potential to mobilize communities for health improvement. State variation in Rankings use suggests that more support to LHDs may be helpful.

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Descriptions of barriers and facilitators to adoption of evidence-based interventions in local health departments (LHDs) are limited. This study was conducted by the North Carolina Public Health Practice-Based Research Network to identify factors associated with adoption of an evidence-based human papillomavirus video intervention, "1-2-3 Pap NC," in North Carolina LHDs. A sequential mixed-method study design was used. Data from the 2013 National Profile of Local Health Departments were used to test associations between LHD characteristics and adoption of the intervention. Qualitative, key stakeholder interviews with LHD directors provided the context for quantitative data. Data collection and analysis continued from March 3, 2014, to September 15, 2014. Overall, 28% of North Carolina health jurisdictions (33 of 100 counties) implemented the intervention. Of the three channels used to deliver the intervention to clients, most LHDs opted to show the video in the exam room (42%), followed by website/other social media (36%) and video loop in the lobby/waiting room (22%). In logistic regression, gender of the director (female) was significantly and positively associated with adoption of the intervention (AOR=4.44, p<0.05). Being a first-time director was marginally significant (AOR=0.28, p=0.074), suggesting first-time directors were less likely to adopt. Qualitative results suggested that aspects of communication (awareness and positive attitudes) and agency directors' evaluation of resources, balanced against intervention complexity and flexibility, competing priorities, and mandates, influenced adoption. Adoption of evidence-based interventions by LHDs is critical to improve population health. Practice-based research can contribute to understanding facilitators and modifying barriers to this process.

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The purpose of this paper is to describe a process and technical requirements for the development of a video and related communications strategy that CBPR partnerships can use to recruit policymakers to participatory research. Policymakers play a critical role in social change agendas, yet are often difficult to engage for a variety of reasons, including limited availability and multiple, competing demands and constituencies. This paper draws on the experience of the Healthy Jacksonville Childhood Obesity Prevention Coalition, a 10-year-old partnership with a large membership and strong community roots in Duval County, Florida. The objectives of the communications strategy were to engage local and state policymakers in policy change that would positively affect childhood obesity prevention; educate policymakers about the social determinants of health, particularly those related to childhood obesity; and to do so in a way that elicited champions for the coalition's goals.

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Correctional health care is of interest to public health practitioners due to the highly vulnerable social and health characteristics of inmates, ex-offenders, and their communities, as well as the access to health care provided to them through the criminal justice system. The public health model for correctional health care has evolved from one concerned primarily with infectious disease control within the facility to a model of comprehensive health care that additionally recognizes the importance of providing continuity of care as inmates transition into free-living communities. The Ten Essential Public Health Services is proposed as a conceptual framework for a public health approach to correctional health care and is illustrated by application to a health care program for a large jail system in Jacksonville, FL.

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The Medical Home model for providing services to children with special healthcare needs has strong philosophical foundations, but the science supporting this theoretical model is not as well developed. The use of logic models and mixed method design provide systematic and rigorous approaches to observation while retaining the complexity, which tends to be lost with research designs intended to control and reduce the number of variables impacting a desired outcome, such as randomized controlled trials. This application provides a historical basis for applying logic models of evaluation and illustrates the utility of logic models.

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