Objectives. We identified the levels of joint action that led to collaboration between hospitals and local health departments (LHDs) using the hospital’s community health needs assessments (CHNAs). Methods. In 2014, we conducted a content analysis of Missouri nonprofit hospitals (n = 34) CHNAs, and identified hospitals based on previously reported collaboration with LHDs. We coded the content according to the level of joint action. A comparison sample (n = 50) of Missouri nonprofit hospitals provided the basic comparative information on hospital characteristics. Results. Among the hospitals identified by LHDs, 20.6% were “networking,” 20.6% were “coordinating,” 38.2% were “cooperating,” and 2.9% were “collaborating.” Almost 18% of study hospitals had no identifiable level of joint action with LHDs based on their CHNAs. In addition, comparison hospitals were more often part of a larger system (74%) compared with study hospitals (52.9%). Conclusions. The results of our study helped develop a better understanding of levels of joint action from a hospital perspective. Our results might assist hospitals and LHDs in making more informed decisions about efficient deployment of resources for assessment processes and implementation plans.

Book Summary: JPHMP's 21 Public Health Case Studies on Policy & Administration , compiled by the founding editor and current editor-in-chief of the Journal of Public Health Management and Practice, provides you with real-life examples of how to strategize and execute policies and practices when confronted with issues such as disease containment, emergency preparedness, and organizational, management, and administrative problems.Feautures: Each case is co-written by a professional writer and tells a “story,” using characters, conflicts, and plot twists designed to compel you to keep reading. Case elements include the core problem, stakeholders, steps taken, challenges, results, conclusions, and discussion questions for analysis. More than 60 contributors—experts in public policy, clinical medicine, pediatrics, social work, pharmacy, bioethics, and healthcare management. Ideal for public health practitioners as well as students in graduate and undergraduate public health and medical education programs. Tracks 2016 CEPH (Council on Education for Public Health) accreditation criteria. These cases can be used as tools to develop competencies designated in the new CEPH (Council on Education for Public Health) accreditation criteria.

Throughout the Appalachian Region, smoking is a common health risk that contributes to significantly higher rates of tobacco-related disease and lower life expectancy compared to the rest of the United States. Drawing on the research presented in the health disparities and Bright Spot reports, this brief focuses on promising practices, intervention strategies, and policies aimed at reducing health disparities related to smoking. This brief: ■ summarizes statistics on smoking and related diseases in Appalachian communities, ■ discusses key strategies and resources for reducing tobacco use, and ■ provides recommendations for community leaders, funders, and policymakers. This brief discusses four recommendations in detail: 1. Prevent smoking initiation among youth. 2. Increase access to tobacco cessation interventions. 3. Launch anti-tobacco communication campaigns. 4. Reduce exposure to secondhand smoke.

The Appalachian Region continues to experience higher rates of opioid misuse and overdose deaths than other parts of the country. While the impact of the burgeoning epidemic is being felt nationwide, states and counties within the Appalachian Region are particularly hard hit, with opioid overdose rates more than double national averages. Drawing on the research presented in the health disparities and Bright Spot reports, this brief: ■ summarizes statistics on opioid misuse and overdose deaths in Appalachian communities, ■ discusses key strategies and resources for addressing opioid misuse and overdose deaths, and ■ provides recommendations for community leaders, funders, and policymakers. This brief features promising practices, intervention strategies, and policy development and implementation ideas to reduce health disparities related to opioid misuse and overdose deaths. This brief discusses five recommendations in detail: 1. Prevent opioid misuse. 2. Increase access to treatment for opioid use disorder. 3. Implement harm reduction strategies to reduce the consequences of opioid use disorder. 4. Support long-term recovery of opioid use disorder. 5. Implement community-based solutions to prevent substance misuse.

Obesity, which is both a chronic disease and a risk factor for other chronic diseases, contributes to higher rates of premature mortality in Appalachia. Drawing on research presented in the health disparities and Bright Spot reports, this brief focuses on promising practices, intervention strategies, and policies aimed at reducing health disparities related to obesity. This brief: ■ summarizes statistics on obesity and related disease in Appalachian communities, ■ discusses key strategies and resources for preventing and reducing obesity, and ■ provides recommendations for community leaders, funders, and policymakers. This brief discusses four recommendations in detail: 1. Establish healthy behaviors among children and youth to prevent childhood obesity. 2. Increase the availability of affordable healthy foods and beverages in communities. 3. Create safe communities that support physical activity. 4. Increase physical activity and healthy eating among adults.

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Local health departments (LHD) serve a critical role in leveraging internal and community assets to improve health and equity in their communities; however, geography is an important factor when understanding LHD capacity and perspective. LHDs serve a critical role in leveraging internal and community assets to improve health and equity in their communities; however, geography is an important factor when understanding LHD capacity and perspective. Data were obtained from the NACCHO 2013 National Profile of Local Health Departments Study. LHDs were coded as “urban”, “micropolitan”, or “rural” based on Rural/Urban Commuting Area codes. Results demonstrate that rural LHDs differed from their urban counterparts. Specifically, rural LHDs relied more heavily on state and federal resources and have less access to local resources making them more sensitive to budget cuts. Rural LHDs also rely more heavily on clinical services as a revenue source. Larger rural LHDs provide more clinical services while urban health departments work more closely with community partners to provide important safety net services. Small rural LHDs have less partners and are unable to provide as many direct services due to their lack of human and financial resources. LHDs residing in urban communities were 16.6 times (95% confidence interval [CI], 5.3-52.3) and micropolitan LHDs were 3.4 times (95% CI, 1.1-11.3) more likely to seek PHAB accreditation than rural LHDs.

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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.