An Emerging Model for Community Health Worker-Based Chronic Care Management for Patients With High Health Care Costs in Rural Appalachia.

Community health workers (CHWs) can improve patients' health by providing them with ongoing behavioral support during the health care experience, and they help decrease health care costs, especially among patients whose starting costs are high and among underserved and minority populations. We developed a CHW-based care model with the aim of improving outcomes and lowering costs for high-risk diabetes patients in rural Appalachia. Enrolled patients experienced a mean decrease in HbA1c of 2.4 percentage points, and 60% or more of patients with diabetes lowered their blood glucose between baseline and 6 to 12 months after enrollment. As health care providers and patients became familiar with this model of care management, enrollment in the program accelerated.

Challenges and Lessons Learned From a Prevention Research Center Partnership.

For more than a decade, the West Virginia Prevention Research Center, Mid-Ohio Valley Health Department, and the Wood County Schools have built and sustained a partnership to reduce health disparities and promote population health. Specifically, this partnership has contributed significantly to the peer-reviewed literature on children's physical activity, fitness, and academic achievement, as well as identifying possible areas for physical activity interventions (within the school and community settings) that would improve health and academic outcomes. This case study describes the partnership among a University Prevention Research Center, a local health department, and a local school system. In the description of the partnership, this paper sequentially explores characteristics of the partnership that were advantageous or challenging over time. It details the interface among state and local partner interest, resources, and goals all directed toward enhancing children's physical activity, fitness, cardiovascular risk, and academic improvement. The paper concludes with lessons learned that may contribute to the science and practice of multilevel collaborations in child health.

Childhood exposure to manganese and postural instability in children living near a ferromanganese refinery in Southeastern Ohio.

Airborne manganese (Mn) exposure can result in neurotoxicity and postural instability in occupationally exposed workers, yet few studies have explored the association ambient exposure to Mn in children and postural stability. The goal of this study was to determine the association between Mn and lead (Pb) exposure, as measured by blood Pb, blood and hair Mn and time weighted distance (TWD) from a ferromanganese refinery, and postural stability in children. A subset of children ages 7-9 years enrolled in the Marietta Community Actively Researching Exposure Study (CARES) were invited to participate. Postural balance was conducted on 55 children residing in Marietta, Ohio and the surrounding area. Samples of blood were collected and analyzed for Mn and Pb, and samples of hair were analyzed for Mn. Neuromotor performance was assessed using postural balance testing with a computer force platform system. Pearson correlations were calculated to identify key covariates. Associations between postural balance testing conditions and Mn and Pb exposure were estimated with linear regression analyses adjusting for gender, age, parent IQ, and parent age. Mean blood Mn was 10 µg/L (SEM=0.36), mean blood Pb was 0.85 µg/dL (SEM=0.05), and mean hair Mn was 0.76 µg/g (SEM=0.16). Mean residential distance from the refinery was 11.5 km (SEM=0.46). All three measures of Mn exposure were significantly associated with poor postural balance. In addition, low-level blood Pb was also negatively associated with balance outcomes. We conclude that Mn exposure and low-level blood Pb are significantly associated with poor postural balance.

Observing anthropometric and acanthosis nigrican changes among children over time.

This study assessed the anthropometrics and acanthosis nigricans (AN) in a sample of 7,337 children at two assessments. Four groups of children were identified based on the presence of AN at both time points: those who never had the marker, those who gained the marker, those who lost the marker, and those who maintained the marker. Group differences in height, weight, body composition, and the amount of change in these variables over time were explored. Our findings demonstrated that children who maintain or gain the AN marker had the greatest height, weight, and body composition changes over time. It is apparent that the AN marker does disappear in some children and that this is associated with lower weight gain and body composition loss. If interventions can be developed targeting children who present with the marker, it is likely that their risk of developing type 2 diabetes could be reduced.

Children's aerobic fitness and academic achievement: a longitudinal examination of students during their fifth and seventh grade years.

OBJECTIVES: We assessed children's potential differences in academic achievement based on aerobic fitness over a 2-year period. METHODS: The longitudinal study sample included 3 cohorts of students (n = 1725; 50.1% male) enrolled in a West Virginia public school system. Students received baseline fitness and academic assessments as fifth graders and at a 2-year follow-up assessment. We used FitnessGram to assess fitness in aerobic capacity and WESTEST, a criterion-based assessment, for academic performance. RESULTS: Students who stayed in the healthy fitness zone (HFZ) had significantly higher WESTEST scores than did students who stayed in the needs improvement zone (NIZ). Students who moved into or out of the HFZ occasionally had significantly higher WESTEST scores than did students who stayed in the NIZ, but they were rarely significantly lower than those of students who stayed in the HFZ. CONCLUSIONS: Students' aerobic capacity is associated with greater academic achievement as defined by standardized test scores. This advantage appears to be maintained over time, especially if the student stays in the HFZ.

Developing a bidirectional academic-community partnership with an Appalachian-American community for environmental health research and risk communication.

BACKGROUND: Marietta, Ohio, is an Appalachian-American community whose residents have long struggled with understanding their exposure to airborne manganese (Mn). Although community engagement in research is strongly endorsed by the National Institutes of Health and the National Institute of Environmental Health Sciences in particular, little has been documented demonstrating how an academic-community partnership that implements the community-based participatory research (CBPR) principles can be created and mobilized for research. OBJECTIVES: We created a bidirectional, academic-community partnership with an Appalachian-American community to a) identify the community's thoughts and perceptions about local air quality, its effect on health, and the perception of risk communication sources and b) jointly develop and conduct environmental health research. METHODS: We formed a community advisory board (CAB), jointly conducted pilot research studies, and used the results to develop a community-driven research agenda. RESULTS: Persons in the community were "very concerned" to "concerned" about local air quality (91%) and perceived the air quality to have a direct impact on their health and on their children's health (93% and 94%, respectively). The CAB identified the primary research question: "Does Mn affect the cognition and behavior of children?" Although the community members perceived research scientists as the most trusted and knowledgeable regarding risks from industrial emissions, they received very little risk information from research scientists. CONCLUSIONS: Engaging a community in environmental health research from its onset enhanced the quality and relevance of the research investigation. The CBPR principles were a useful framework in building a strong academic-community partnership. Because of the current disconnect between communities and research scientists, academic researchers should consider working collaboratively with community-based risk communication sources.

L.I.F.E.: a school-based heart-health screening and intervention program.

This article describes the development and growth of Lifestyle Improvements in the Family Environment (L.I.F.E.), a school-based heart-health screening and intervention program. The primary goals of L.I.F.E. through three rounds of grant funding remained constant: (a) to identify cardiovascular risk factors in students and their families and (b) to provide counseling, education, and opportunities to change lifestyle routines that contribute to those risk factors. The program began with direct ties to a university-based research program and grew with evidence-based successes and development of community partnerships. Waves of growth were influenced by capacity-building efforts, partnership development, and resource availability. School nurses managed the screening component and partnered with appropriate others in the intervention programming. School nurses are appropriately positioned to assist families as well as school and community partners in decreasing the incidence of obesity and promoting healthy lifestyle behaviors.

The extended relationship between child cardiovascular risks and academic performance measures.

OBJECTIVE: To examine the relationship between children's overweight status and other cardiovascular risk fitness factors and academic performance among fifth-grade students. RESEARCH METHODS AND PROCEDURES: Using a sample of 968 fifth-grade students (50.7% boys; mean age = 10.6 years), children's cardiovascular risks (BMI, blood pressure, acanthosis nigricans) and fitness measures were compared with their mean group performance scores across four subscales (mathematics, reading/language arts, science, and social studies) of a statewide standardized academic performance test. RESULTS: Of this sample, 39% were either at risk for being overweight or were already overweight; slightly over one half were of normal weight. Initial findings revealed a significant relationship between children's weight category and their reading/language arts, mathematics, and science test scores even after controlling for a proxy of socioeconomic status. When additional cardiovascular risk and fitness measures were included in the model, however, children's BMI status had no association. Instead, a composite fitness index, children's blood pressure, sex, and proxy of socioeconomic status were significantly associated with children's academic test scores. DISCUSSION: This study expanded our understanding of the connection between children's overweight risks and academic performance by examining the impact of other cardiovascular risk factors such as high blood pressure and measures of fitness. These findings support the development and implementation of childhood cardiovascular risk surveillance programs that evaluate not only children's overweight risks but also their fitness, risk for type 2 diabetes, and/or high blood pressure by showing a relationship between some of these risks and children's academic test performance.