Supporting Health Equity Through Data-Driven Decision-Making: A Local Health Department Response to COVID-19.

COVID-19 highlights preexisting inequities that affect health outcomes and access to care for Black and Brown Americans. The Marion County Public Health Department in Indiana sought to address inequities in COVID-19 testing by using surveillance data to place community testing sites in areas with the highest incidence of disease. Testing site demographic data indicated that targeted testing reached populations with the highest disease burden, suggesting that local health departments can effectively use surveillance data as a tool to address inequities. (Am J Public Health. 2021;111(S3):S197-S200. https://doi.org/10.2105/AJPH.2021.306421).

Infant Mortality Lessons Learned from a Fetal and Infant Mortality Review Program.

Objective To review fetal and infant deaths from women enrolled in Indianapolis Healthy Start using the National Fetal and Infant Mortality Review (FIMR) methods to provide strategies for prevention. METHODS: Marion County Public Health Department (MCPHD) FIMR staff identified and reviewed 22 fetal and infant deaths to Indianapolis Healthy Start program participants between 2005 and 2012. Trained FIMR nurses completed 13 of 20 maternal interviews and compiled case summaries of all deaths from the MCPHD FIMR database.. Results Case review teams identified a total of 349 family strengths, 219 contributing factors, and made 220 recommendations for future pregnancies. FIMR deliberation values for Healthy Start program participant deaths were similar to other infant deaths in Marion County during the same time period. Common themes that emerged from the reviews included lack of social support, absence of paternal involvement, substance abuse, non-compliance, and poor health behaviors leading to chronic health conditions that complicated many pregnancies. Conclusions A number of the infant deaths in this review could have been prevented with preconception and inter-conception education and by improving the quality and content of prenatal care.

Rewards and Lessons Learned From Implementation of a Healthy Homes Research Project in a Midwestern Public Health Department.

Marion County Public Health Department (MCPHD) in Indianapolis, Indiana, was awarded funding in 2009 from the U.S. Department of Housing and Urban Development through the Healthy Homes Demonstration Grant Program as a part of the American Recovery and Reinvestment Act. This funding is currently supporting activities addressing health and safety hazards in homes of low- and very low-income residents living in an urban community within Marion County with an extensive history of heavy industry and lead smelting. One portion of this grant is being used to fund IRB-approved research conducted by MCPHD for the period of the grant. Development and implementation of this study has provided both unique challenges and positive opportunities for study participants, MCPHD, and community stakeholders. The following commentary provides insight into the benefits and rewards of implementing a successful study process, as well as challenges in implementing a community-based research study for the first time in a preexisting Healthy Homes Demonstration Grant Program health department.

The impact of prenatal education on behavioral changes toward breast feeding and smoking cessation in a healthy start population.

PURPOSE: To evaluate the impact of prenatal education by case managers on 2 social determinants of health behaviors-breast feeding and smoking cessation-among participants enrolled in Indianapolis Healthy Start (IHS). METHOD: Birth and death data up to 1 year for IHS clients were collected from Marion County vital records for births 20 weeks or greater. Case managers provide education on the health benefits for mothers and infants on breast feeding and smoking cessation to all clients. Data were analyzed for differences between the IHS participants and other Marion County births. RESULTS: Most participants (63%) were non-Hispanic blacks aged less than 25 years (56%), without a high school diploma or general education development (53%), and enrolled in Medicaid (91%). Program participants were more likely to initiate breast feeding than nonparticipants (OR, 1.33; 95% CI, 1.10-1.61), and 22% continued to breast feed for 6 months. Hispanic women were more likely to breast feed for at least 6 months (OR, 4.71; 95% CI, 2.32-9.58). Women with advanced education were more likely to have quit smoking, as were women who were breast feeding at hospital discharge. After controlling for education, IHS clients tended to be less likely to continue to smoke during the third trimester (OR, 0.76, 95% CI, 0.49-1.16), as were those with a first pregnancy (OR, 0.32; 95% CI, 0.10, 0.98) and no other smokers in the home (OR, 0.25; 95% CI, 0.08, 0.74). CONCLUSION: Breast feeding and smoking cessation are modifiable risk factors that were impacted by behavioral interventions through case management education.

Petroleum scarcity and public health: considerations for local health departments.

Recognition of petroleum as a finite global resource has spurred increasing interest in the intersection between petroleum scarcity and public health. Local health departments represent a critical yet highly vulnerable component of the public health infrastructure. These frontline agencies currently face daunting resource constraints and rely heavily on petroleum for vital population-based health services. Against this backdrop, petroleum scarcity may necessitate reconfiguring local public health service approaches. We describe the anticipated impacts of petroleum scarcity on local health departments, recommend the use of the 10 Essential Public Health Services as a framework for examining attendant operational challenges and potential responses to them, and describe approaches that local health departments and their stakeholders could consider as part of timely planning efforts.

Dietary behaviors associated with fruit and vegetable consumption, Marion County, Indiana, 2005.

INTRODUCTION: Eating inadequate amounts of fruits and vegetables is associated with diminished health, and most Americans fall short of the Centers for Disease Control and Prevention's recommendation to eat at least 2 servings of fruit and 3 servings of vegetables each day. This study assessed behaviors associated with fruit and vegetable consumption in adults. METHODS: A cross-sectional, random-digit-dialed telephone survey of 4,784 adults living in Marion County (Indianapolis), Indiana, measured demographic characteristics, personal health data, food consumption, food label use, and other eating habits. Multivariate logistic regressions were used to assess the association between selected dietary behaviors and fruit and vegetable consumption, controlling for demographic characteristics. RESULTS: Behaviors associated with adequate versus inadequate consumption of fruits and vegetables were frequent snacking on healthy foods (odds ratio [OR], 2.54), eating meals at home (OR, 2.09), using nutrition labels when making purchases (OR, 1.52), and using "heart healthy" symbols and other food information labels when ordering from restaurants (OR, 1.41). Frequent red meat consumption was negatively associated with adequate consumption of fruits and vegetables (OR, 0.64). CONCLUSION: Healthful snacking, food label use, and eating meals prepared at home may improve dietary quality. Our measure of adequacy may also be useful in future studies assessing dietary behavior and diet composition.

Impact of the life skills training curriculum on middle school students tobacco use in Marion County, Indiana, 1997-2000.

Evaluation of school-based tobacco prevention and control programs have yielded mixed results. This study assessed the impact of the Life Skills Training curriculum on Marion County, Ind., middle school students' knowledge, attitudes, and ability to make good lifestyle decisions. From 1997 to 2000, students in grades six to eight in the study schools received the Life Skills Training curriculum. Survey data (n = 1,598) were used to compare tobacco use behavior, attitudes, and knowledge of those exposed with those not exposed to the program. Of the students surveyed, 12.5% were currently smoking. There were significantly fewer current smokers, and more students exposed to the program indicated they intended to stay smoke-free. Fewer of those participating in the program "hung out" with smokers and more said they could easily refuse a cigarette if offered one. Students completing the Life Skills Training curriculum were more knowledgeable about the health effects of smoking. Program effects were different for male and female students as well as for White and Black students.