Community Health Assessment Research Articles

Scoping Review of Indices to Measure a Community's Health Status.

Composite health indicators are valuable tools to assess population health over time and identify areas for intervention. This scoping review (ScR) aimed to map the literature describing comprehensive health-related metrics used to assess community health. The Arksey and O'Malley framework was used to conduct the ScR, using the following steps: identifying the research question, identifying relevant studies, charting the data, collating and reporting results. United States-based studies that developed/utilized a composite health index using geographic information system (GIS) mapping capabilities to assess community health at the county level or more granular were identified through literature searches conducted in PubMed and EMBASE databases. Literature searches identified 5112 articles; of these, 8 studies describing composite health indices were included. The number of indicators used in each index ranged from 4 to 75 (median: 22). Health outcomes, health behaviors, education, and economics were incorporated into most indices. High school graduation rate (n = 6 indices), health insurance status (n = 5), commute time, median household income, unemployment, and obesity rates (n = 4 each) were the most common indicators across indices. All indicators were derived from publicly available data sources, such as the American Community Survey and US Census Bureau. Although a limited number of community health indices were identified in the ScR, the indices included a broad range of indicators covering both health outcomes and factors contributing to health vulnerabilities. The public data sources and GIS integration of the indices provide potential for broad, insightful applications to various contexts across the United States.

Mothers to Babies & Art of Creation: Canadian stakeholder engagement during intervention development

Abstract Background The 2021 British Medical Research Council framework, outline that effective development of interventions requires engagement of diverse stakeholders. In practice, however, engaging stakeholders in health intervention development often receives insufficient investment. The Mothers to Babies (M2B) Study and its linked Art of Creation (AoC) Intervention Project comprise a joint case study in prioritizing stakeholder engagement. Methods From 2016 to 2019, our M2B team dedicated its financial and personnel resources to assessing community health priorities for preventing non-communicable diseases (NCDs) in Hamilton, Canada. Motivated by a “first 1000 days” approach (i.e. health environments through pregnancy and infancy have outsized impacts on NCD risks across a child’s life), we worked with stakeholders to identify acceptable, feasible complex intervention strategies supportive of health behaviours among pregnant Hamiltonians. To this end, we surveyed 434 pregnant people of diverse backgrounds and ran focus groups, interviews, and meetings with 69 stakeholders with diverse orientations to pregnancy and family health provision. Results M2B’s work indicated two areas actionable through a complex, behavioural intervention: 1) lack of knowledge about the first 1000 days, and 2) need for platforms for peer support and empowerment. These themes were centred in the development and the stakeholder-engaged implementation/evaluation of the ongoing AoC intervention study. AoC uses outreach through local cultural institutions and arts-based workshops to facilitate understanding of the first 1000 days. AoC increases participants’ knowledge of the first 1000 days, supports social relationships among participants and is enjoyable and empowering. Conclusions Investing three years and dedicated personnel to stakeholder engagement by M2B yielded the development of AoC, a complex health promotion intervention that fits the diverse priorities of Hamilton communities.

Applying an Evaluation Framework of Hospital CHA/CHIP Quality and Heterogeneity to Accredited Local Health Departments in Kentucky, 2015-2022.

This study aimed to assess the quality of community health assessments (CHA) and community health improvement plans conducted by Public Health Accreditation Board (PHAB)-accredited local health departments (LHDs) in Kentucky. Quality assessment of CHAs and community health improvement plan documents using criteria adapted from Pennel et al (2015). PHAB-accredited LHDs in Kentucky. Seventeen CHAs and community health improvement plan documents from PHAB-accredited LHD. Quality scores based on 17 evaluation criteria, including stakeholder involvement, data examination, plan feasibility, and LHD-hospital collaboration. The study found significant variation in the quality of CHAs and community health improvement plan documents. The highest scores were for partner involvement, data examination, and plan feasibility. The lowest scores were for LHD-hospital collaboration, use of evidence-based strategies, and plan evaluation. No community variables significantly predicted overall report scores. The quality of CHAs and community health improvement plan documents varies among Kentucky LHDs, highlighting the need for more robust guidance and standardized criteria. Strengthening hospital-LHD collaboration and focusing on evidence-based strategies can improve public health outcomes. Enhancing CHAs and community health improvement plan processes through legislative changes, better guidance, and improved collaboration between hospitals and LHD can lead to more effective public health interventions and outcomes.

Community Health Needs Assessment of Primary Healthcare in Saudi Arabia: A Cross-Sectional Study.

Continuous assessment of community health needs is essential to predict, recognize, and act on healthcare issues. Conducting community health needs assessments (CHNAs) in Saudi Arabia has become a priority to overcome the current healthcare challenges and keep pace with the Saudi Arabia 2030 vision. Studies reporting community health needs in Saudi Arabia regions are limited despite the high incidence of chronic diseases. This study aims to understand the community's health problems and the range of healthy behaviors and determine the priority health problems. We conducted a cross-sectional study based on the adults in Primary Health Care Centers in Hail, Northern Saudi Arabia, by using the CHNA standard questionnaire. In addition to the demographic information, the questionnaire collects data on personal health status, the health status of adults and children, health facilities access information, receiving of healthcare procedures, traveling for healthcare, source of medical information, safety measures and behaviors, health problems, childcare (special needs), and perceived community problems. In all, 336 individuals were approached to participate in this study; 303 agreed to participate (response rate: 90%). The analysis comprised 276 individuals after eliminating 27 who did not fulfill the age inclusion criteria or had missing gender data. Of these, 107 (38.8%) were men and 169 (61.2%) were women. Our data revealed that almost half of the participants, 135 (52.9%) constantly or 107 (42%) occasionally, were able to visit the doctors when needed. Our findings reported positive health behaviors and good accessibility to healthcare services when needed. However, the study findings also revealed healthcare challenges that required urgent action from Hail healthcare leaders. Developing healthcare strategies, screening/prevention programs, and changing healthcare policies in the Hail region are needed to control and prevent health problems and improve the population's health.

Characteristics, enablers, and barriers to the community health and well-being assessment component of the health promotion practice cycle: a scoping review protocol.

The proposed review will describe the characteristics, enablers, and barriers to the community health and well-being assessment (CHWA) component of the health promotion practice cycle. CHWA guides health promotion action in communities and populations. A "critical" approach to CHWA can be adopted, which addresses the social, political, cultural, economic, commercial, and environmental determinants of health and well-being to enhance health equity for priority communities and populations. Although tools exist to guide such a critical approach, little is known about the extent to which these tools are being used or the barriers and enablers to applying best practice CHWA. Such evidence is needed to inform future health promotion CHWA and research. This review will consider literature that describes CHWA conducted in health promotion practice, focusing on an organizational, social, or geographical community or population. Literature that focuses on clinical practice or a specific health condition will be excluded. Scopus, PubMed, Web of Science, and CINAHL (EBSCOhost) will be searched to identify peer-reviewed articles. Google Scholar and Google, as well as Public Health, Health and Medical, and Nursing and Allied Health (ProQuest) databases will be searched for gray literature. Articles will be screened and data extracted by 2 or more independent reviewers. The data extraction tool will be developed by the reviewers based on the JBI template and a critical health promotion approach to CHWA. Data will be analyzed and presented as frequency tables and narrative summaries of the characteristics, enablers, and barriers to CHWA. Open Science Framework osf.io/jq8th/.

Addressing Geographical Inequities and Barriers in Access to Mental Health Care among Youth in a Rural Western Kentucky County.

A Community Health Assessment (CHA) was conducted among community members in a rural Western Kentucky county in 2022-2023 identified mental health as one of the top health issues in the county. The purpose of a CHA is to identify key health needs and issues through data and develop strategies for action. One of the objectives was to identify barriers to accessing mental health care, especially among youth. Secondary data analyses were performed from survey results conducted by the local health department and local public schools. Quantitative data were analyzed using SPSS software. Qualitative data were analyzed using a two-cycle coding process. Access to mental healthcare is an area of great need in this rural Western Kentucky county. Recommendations include working with healthcare providers, especially specialists, to accept Medicaid and it is recommended to cross-train other professionals to address mental health needs in this region.

Findings of a Community Health Needs Assessment Survey in Al Najaf Governorate Iraq: A Snapshot of Al Marashda's Health Status.

Community health assessment (CHA) is a well-known method for identifying and analyzing community health needs. This CHA survey aimed to identify and analyze community health needs and assets to prioritize these needs and to plan and act upon significant unmet community health needs. The CHA was planned based on the suggested standard of the North Carolina Guide including eight phases from July to December 2023. The CHA survey was performed among Al-Marashda region residents in the Al-Manathera district. The sample size of our study was 184 interviews of 12536 population. The primary data, which included demographic information, quality of life statements, and community improvement, were collected from the community using a questionnaire through opinion surveys and focus groups, while the secondary data which included the social, health, and economic status of Al-Marashda region residents were obtained from district and governorate sources. Analysis of whole data sources allowed 10 areas of community concern to be identified. Findings from the CHA survey showed that diabetes and high blood pressure, poverty and unemployment, and air pollution were the most common public health problems as priorities. The high-priority problems of Al-Marashda are in common with the noncommunicable diseases (NCDs) priority in Al Najaf. However, poverty and air pollution are specific to the Al-Marashda region. Public health authorities and the city governorate are advised to consider, support, and develop community diagnosis documents to implement appropriate interventions.

Ohio Presents Opportunities For Understanding Hospital Alignment With Public Health Agencies On Community Health Assessments.

Multisector collaboration is critical for improving population health. Improving alignment between nonprofit hospitals and local health departments is one promising approach to achieving health improvement, and a number of states are exploring policies to facilitate such collaboration. Using public documents, we evaluated the alignment between Ohio nonprofit hospitals and local health departments in the community health needs they identify and those they prioritize. The top three needs identified by hospitals and health departments were mental health, substance use, and obesity. Alignment across organizations was high among the top needs, but it varied more among less commonly identified needs. Alignment related to social determinants of health was low, with health departments being more responsive to social determinants than hospitals. Given the different strengths and capacities of hospitals and health departments, this divergence may be in the best interests of the communities they serve. Community benefit policies should consider how to promote collaboration between hospitals and health departments while also encouraging organizations to use their own expertise to meet community needs.

The evolution of symptoms of nervous system dysfunction in a First Nation community with a history of mercury exposure: a longitudinal study

BackgroundSince the 1960’s, mercury (Hg) contamination of the aquatic environment of Asubpeeschoseewagong Anishinabek (Grassy Narrows First Nation) territories has impacted the community members’ traditions, culture, livelihood, diet and health. Despite decreasing Hg exposure over time, a recent study suggested that long-term exposure contributed to later-life symptom clusters of nervous system dysfunction. Here, the objective was to evaluate, 5 years later, the prevalence and progression of these symptoms and examine the contribution of long-term, past Hg exposure.MethodsThe symptom questionnaire, applied in the 2016/17 Grassy Narrows Community Health Assessment (GN-CHA) (Time 1), was re-administered in the 2021/22 Niibin study (Time 2). A total of 85 adults (median age: 47y; range: 29-75y) responded at both times. Paired statistics were used to test the differences (Time 2 – Time 1) in self-reported symptom frequencies. The symptom clustering algorithm, derived from the entire study group of the GN-CHA (n = 391), which had yielded 6 clusters, was applied at Time 1 and 2. Equivalent hair Hg measurements (HHg) between 1970 and 1997 were used in Longitudinal Mixed Effects Models (LMEM), with a sub-group with ≥ 10 repeated HHg mesurements (age > 40y), to examine its associations with symptom cluster scores and their progression.ResultsFor most symptoms, paired analyses (Time 2 – Time 1) showed a significant increase in persons reporting “ very often” or “all the time”, and in the mean Likert scores for younger and older participants (< and ≥ 50y). The increase in cluster scores was not associated with age or sex, except for sensory impairment where a greater increase in symptom frequency was observed for younger persons. LMEM showed that, for the sub-group, long-term past Hg exposure was associated with most cluster scores at both times, and importantly, for all clusters, with their rate of increase over time (Time 2 – Time 1).ConclusionsThe persistence of reported symptoms and their increase in frequency over the short 5-year period underline the need for adequate health care services. Results of the sub-group of persons > 40y, whose HHg reflects exposure over the 28-year sampling period, suggest that there may be a progressive impact of Hg on nervous system dysfunction.

Community Health Assessment to Identify and Prioritize Health Problems

Background: Community health assessment is a process in which researchers achieve a proper understanding of the community health status through the community active participation. The present study was conducted aiming to identify and prioritize health problems of Meshkin Tappeh village with people’s direct involvement. Methods: This study was conducted using the community assessment method in Meshkin Tappeh village in the city of Bueen Zahra, Iran, based on the North Carolina model. One person was selected from each household, and a total of 271 people were entered into the study. The community health assessment process was performed in 8 stages and problem prioritizing was also carried out using Hanlon’s scoring matrix method. Results: At the village level, 32 problems were identified in 6 areas, including problems related to health area (31.2%), municipal services area (21.8%), educational and cultural area (15.6%), economic and employment area (12.5%), social and citizenship rights area (12.5%), and security area (6.4%). Based on the matrix table scoring criteria, the problem of drug peddlers (15 points), poverty and low income (14 points), dropping out of school (13 points), emergency preparedness in unexpected events (12 points), and non-financial support for many health costs (12 points) were identified as 5 main problems at the village level. Conclusion: In this research, a broad spectrum of social, cultural, economic, and health problems were identified. Although the selected priority for further assessment was allocated to the problem of drug peddlers, solving all these problems requires the consultation and cooperation of all public institutions and organizations and the people.

Systematic literature review: Assessing community health hazards arising from food safety concerns in the food market

Food safety concerns have an immediate impact on public health. The food market is an important node for investigating possible risks due to its central role in the delivery of food goods to communities. Health concerns are internationalized as food supply chains span many countries. Therefore, we undertook this literature study to uncover widespread threats to public health from inadequate food safety measures. The online databases were examined for any quantitative, qualitative or mixed-method studies that had been published and they were in the process of publishing. Prisma table analysis was used to determine the level of methodological quality in the included research. Using a qualitative analysis strategy, we classified the ideas in the full-text articles into overarching categories that share commonalities but are not mutually exclusive. After identifying commonalities in the articles' discussions and final thoughts, we synthesized each subject. After a thorough and methodical reading, recurring motifs were uncovered. During analysis, we got better at categorizing and analyzing the data. The examination of 7 full-text papers resulted in common public health issues linked with food safety in the food industry. The expiration dates on these products were demonstrated to pose a serious risk to healthcare in the food sector. The food industry faces several public health issues discovered in this evaluation of the relevant research. As a result, robust national risk-based food surveillance systems are necessary to guarantee the public's safety. Foods entering global trade must be guaranteed to be safe and of high quality as well as imported foods must meet domestic standards. Regulatory bodies, players in the food sector and consumers need to work together to find effective solutions to these problems. By addressing these issues, we can work toward making the food market a place where everyone can feel secure and healthy.

Using Photovoice to Improve Engagement in Community Health Assessments Addressing Behavioral Health.

Behavioral health disorders are well-known to have close links with the social determinants of health, yet little is known about how impacted communities perceive these links. Qualitative participatory methods can not only provide insight into how communities conceptualize these relationships but also empower those with lived experience to contextualize their perspectives and formulate calls to action. This study used Photovoice as a participatory method to supplement the Clark County Health Department Community Health Assessment and determine priority facilitators and barriers contributing to the behavioral health of Clark County, KY, residents. A secondary aim was to gain a greater understanding of how the Photovoice methodology impacts community engagement efforts in Community Health Assessments. Twenty-three Clark County residents participated in four Photovoice groups involving five weekly sessions, which included photograph "show and tell," critical group dialogue, participatory analysis, and planning for dissemination. Secondary analysis of Photovoice focus group discussions revealed behavioral health facilitators and barriers were most influenced by (1) public sector unresponsiveness, (2) strong partnerships formed between community and grassroots organizations, and (3) the siloed division of responsibility between agencies and across sectors. The authors also found the Photovoice method successfully enhanced engagement and empowered those with lived experience to frame their perspectives of the behavioral health landscape. This project has implications for enhancing community engagement and empowerment in behavioral health-focused public health assessments and shaping policy to promote multi-sector collaboration.

Mixed-methods community assessment of drowning and water safety knowledge and behaviours on Lake Victoria

BackgroundDrowning is a major cause of death in Uganda, especially among young adults with water-based occupations and livelihoods. Information about drowning and other water-related deaths and injuries is limited. To...

Examination of Pediatric Burn Incidence and the Impact of Social Determinants of Health in Florida.

Introduction Burn injuries are a major mechanism of trauma worldwide, caused by friction, cold, heat, radiation, chemical, or electric sources. Most often, burn injuries occur due to heat contact from hot liquids, solids, or fire, termed scald burns and flame burns, respectively. These types of injuries are complex and carry major injury and mortality risks, especially in pediatric populations. Burn trauma prevention has been a major focus in the US, with initiatives to increase public health outreach and safety measures. Unfortunately, children in socioeconomically disadvantaged situations may face these types of injuries at disproportionately higher rates, and we aim to highlight these disparities, if any, within our Florida community. Materials and methods This study was designed as a retrospective observational analysis using publicly available data from the Florida Health Community Health Assessment Resource Tool Set (CHARTS). Data was extracted for nonfatal burn injuries resulting in ED visits in the years 2018-2020. This data was limited to those ranging from 0 to 19 years old and converted to rates of burn injuries per 100,000. Sociodemographic details for each county were recorded from County Health Rankings & Roadmaps and compared with burn data in each respective county. Frequencies were generated for categorical data, and statistical analyses for burn rates and sociodemographic details were performed with a generalized linear model using a Poisson distribution and bivariate correlation for a p < 0.05. Results In Florida, the median annual burn rate per 100,000 was 136 (IQR: 96-179), with Jackson county holding the highest rate of 323 and Glades, Hardee, and Lafayette each holding a rate of 0. Of the 18 socioeconomic factors examined, a total of five were found to have no statistically significant effect on nonfatal burn injury ED visits: severe housing problems, percentage of Asians, teen births, percentage of children (<18 years) in poverty, and severe housing cost burden. The two most important factors to be found in nonfatal burn ED visits of pediatric patients were the percentage of those younger than 19 years old without health insurance and the average grade level performance of third-grader reading scores. When adjusting for the small sample size using Firth's bias-adjusted estimates and overdispersion, both reading scores and those without insurance play a significant role in pediatric burn injuries. For each increase in a single point in reading scores, the incidence rate ratio decreases by 97.1% (95% CI). For every percentage increase in children insured, there is a 28.8% decrease in pediatric burn injuries (95% CI). Conclusions This analysis highlights increased pediatric burn rates across multiple social determinants of health (SDOH) in all 67 Florida counties. The findings here demonstrate that there may continue to be a disproportionate distribution of burn rates among lower and higher sociodemographic areas. This study further highlights this trend within the Florida community, and continued research will be necessary to meet the needs of lower sociodemographic areas to improve burn rates in vulnerable populations, such as children, who are at increased risk of injury.

Electronic Health Records for Population Health Management: Comparison of Electronic Health Record-Derived Hypertension Prevalence Measures Against Established Survey Data.

Hypertension is the most prevalent risk factor for mortality globally. Uncontrolled hypertension is associated with excess morbidity and mortality, and nearly one-half of individuals with hypertension do not have the condition under control. Data from electronic health record (EHR) systems may be useful for community hypertension surveillance, filling a gap in local public health departments' community health assessments and supporting the public health data modernization initiatives currently underway. To identify patients with hypertension, computable phenotypes are required. These phenotypes leverage available data elements-such as vitals measurements and medications-to identify patients diagnosed with hypertension. However, there are multiple methodologies for creating a phenotype, and the identification of which method most accurately reflects real-world prevalence rates is needed to support data modernization initiatives. This study sought to assess the comparability of 6 different EHR-based hypertension prevalence estimates with estimates from a national survey. Each of the prevalence estimates was created using a different computable phenotype. The overarching goal is to identify which phenotypes most closely align with nationally accepted estimations. Using the 6 different EHR-based computable phenotypes, we calculated hypertension prevalence estimates for Marion County, Indiana, for the period from 2014 to 2015. We extracted hypertension rates from the Behavioral Risk Factor Surveillance System (BRFSS) for the same period. We used the two 1-sided t test (TOST) to test equivalence between BRFSS- and EHR-based prevalence estimates. The TOST was performed at the overall level as well as stratified by age, gender, and race. Using both 80% and 90% CIs, the TOST analysis resulted in 2 computable phenotypes demonstrating rough equivalence to BRFSS estimates. Variation in performance was noted across phenotypes as well as demographics. TOST with 80% CIs demonstrated that the phenotypes had less variance compared to BRFSS estimates within subpopulations, particularly those related to racial categories. Overall, less variance occurred on phenotypes that included vitals measurements. This study demonstrates that certain EHR-derived prevalence estimates may serve as rough substitutes for population-based survey estimates. These outcomes demonstrate the importance of critically assessing which data elements to include in EHR-based computer phenotypes. Using comprehensive data sources, containing complete clinical data as well as data representative of the population, are crucial to producing robust estimates of chronic disease. As public health departments look toward data modernization activities, the EHR may serve to assist in more timely, locally representative estimates for chronic disease prevalence.

Developing wastewater-based surveillance schemes for multiple pathogens: The WastPan project in Finland

Wastewater comprises multiple pathogens and offers a potential for wastewater-based surveillance (WBS) to track the prevalence of communicable diseases. The Finnish WastPan project aimed to establish wastewater-based pandemic preparedness for multiple pathogens (viruses, bacteria, parasites, fungi), including antimicrobial resistance (AMR). This article outlines WastPan's experiences in this project, including the criteria for target selection, sampling locations, frequency, analysis methods, and results communication. Target selection relied on epidemiological and microbiological evidence and practical feasibility. Within the WastPan framework, wastewater samples were collected between 2021 and 2023 from 10 wastewater treatment plants (WWTPs) covering 40 % of Finland's population. WWTP selection was validated for reported cases of Extended Spectrum Beta-lactamase-producing bacterial pathogens (Escherichia coli and Klebsiella pneumoniae) from the National Infectious Disease Register. The workflow included 24-h composite influent samples, with one fraction for culture-based analysis (bacteria and fungi) and the rest of the sample was reserved for molecular analysis (viruses, bacteria, antibiotic resistance genes, and parasites). The reproducibility of the monitoring workflow was assessed for SARS-CoV-2 through inter-laboratory comparisons using the N2 and N1 assays. Identical protocols were applied to same-day samples, yielding similar positivity trends in the two laboratories, but the N2 assay achieved a significantly higher detection rate (Laboratory 1: 91.5 %; Laboratory 2: 87.4 %) than the N1 assay (76.6 %) monitored only in Laboratory 2 (McNemar, p < 0.001 Lab 1, = 0.006 Lab 2). This result indicates that the selection of monitoring primers and assays may impact monitoring sensitivity in WBS. Overall, the current study recommends that the selection of sampling frequencies and population coverage of the monitoring should be based on pathogen-specific epidemiological characteristics. For example, pathogens that are stable over time may need less frequent annual sampling, while those that are occurring across regions may require reduced sample coverage. Here, WastPan successfully piloted WBS for monitoring multiple pathogens, highlighting the significance of one-litre community composite wastewater samples for assessing community health. The infrastructure established for COVID-19 WBS is valuable for monitoring various pathogens. The prioritization of the monitoring targets optimizes resource utilization. In the future legislative support in target selection, coverage determination, and sustained funding for WBS is recomended.

AB016. Understanding drowning and water safety interventions in Uganda: results of a youth-led community health assessment in rural lakeside communities

AB016. Understanding drowning and water safety interventions in Uganda: results of a youth-led community health assessment in rural lakeside communities

Patterns in Benthic Polychaete Community and Benthic Health Assessment at Longline and Bottom Culture Shellfish Farms in Gangjin Bay, Namhae, Korea

Patterns in Benthic Polychaete Community and Benthic Health Assessment at Longline and Bottom Culture Shellfish Farms in Gangjin Bay, Namhae, Korea

Determining the connectivity of tribal communities to wastewater treatment facilities for use in environmental contamination and exposure assessments by wastewater-based surveillance.

Limited information is available on the connectivity of Tribal communities to wastewater treatment facilities (WWTFs). This is important for understanding current sanitation infrastructure which drives public health and community construction, knowledge of potential routes of exposure through lack of infrastructure and/or discharging facilities, and opportunities to assess community health through wastewater-based surveillance (WBS). The objective of this work was to assess current wastewater infrastructure for 574 Federally Recognized Indian Tribes (FRITs) in the United States (US) to determine the number and location of facilities on or adjacent to Tribal reservations and Off-Reservation Trust Lands, with the goal of determining the feasibility of employing wastewater-based surveillance within these communities and to identify areas with inadequate sanitation infrastructure. Here, we identified available National Pollutant Discharge Elimination System (NPDES) wastewater discharge permits in the Environmental Protection Agency's Environmental Compliance History Online database to assess proximity to and within spatial boundaries of Tribal lands. These data were coupled to race data and tribal spatial boundary information from the US Census Bureau. 94 FRITs have registered NPDES permits within Tribal boundaries including a total of 522 facilities. 210 of these are American Indian (AI)-serving (>50% AI) with the ability to reach 135,000 AI-people through the wastewater network to provide community health assessments via WBS. Of the remaining facilities, 153 predominantly serve non-Tribal populations raising concerns about infrastructure placement and indigenous sovereignty. 523 FRITs were identified as without permitted discharging WWTFs, which may suggest inadequate or alternative infrastructure. Here, multiple data sources including permit information from the Environmental Protection Agency's National Pollution Discharge Elimination System and US Census Bureau data were used to determine the number of wastewater treatment facilities on or adjacent to Tribal lands and how many community members were connected to those municipal systems. This information was used to assess which Tribal communities may be a viable option for wastewater public health surveillance techniques and were used to answer supplemental questions related to basic sanitation and environmental justice concerns.

Longitudinal Trends in Insurer Participation in Multisector Population Health Activities.

Healthcare organizations increasingly engage in activities to identify and address social determinants of health (SDOH) among their patients to improve health outcomes and reduce costs. While several studies to date have focused on the evolving role of hospitals and physicians in these types of population health activities, much less is known about the role health insurers may play. We used data from the National Longitudinal Survey of Public Health Systems for the period 2006 to 2018 to examine trends in health insurer participation in population health activities and in the multi-sector collaborative networks that support these activities. We also used a difference-in-differences approach to examine the impact of Medicaid expansion on insurer participation in population health networks. Insurer participation increased in our study period both in the delivery of population health activities and in the integration into collaborative networks that support these activities. Insurers were most likely to participate in activities focusing on community health assessment and policy development. Results from our adjusted difference-in-differences models showed variation in association between insurer participation in population health networks and Medicaid expansion (Table 2). Population health networks in expansion states experienced significant increases insurer participation in assessment (4.48 percentage points, P < .05) and policy and planning (7.66 percentage points, P < .05) activities. Encouraging insurance coverage gains through policy mechanisms like Medicaid expansion may not only improve access to healthcare services but can also act as a driver of insurer integration into population health networks.