Louisville Metro Research Articles

A Descriptive Analysis of Childhood Lead Poisoning in Jefferson County, Kentucky – Louisville’s Silent Epidemic

Introduction In this study we provide an epidemiological description of Elevated Blood Lead Levels (EBLLs) in the pediatric population of Jefferson County, KY. To provide a more thorough epidemiological description of this issue, we put together the largest known pediatric blood lead dataset for Jefferson County and evaluated the data using the Center for Disease Control and Prevention’s current Blood Lead Referent Value (BLRV) of > 3.5 mcg/dL. Methods We collected 111,065 rows of pediatric blood lead data from the Louisville Metro Department of Public Health and Wellness. Descriptive and inferential statistics were used to explore the magnitude of this issue. Unadjusted Risk Ratios (RR) were also calculated by specific demographics. Geographic cluster analysis was produced by the Kulldorff spatial scan statistic. Results There are 74,014 unique children in the blood lead dataset, of which 9,823 had at least one blood lead test > 3.5 mcg/dL. Black children had a 77% increased risk for an EBLL compared to white children (Unadjusted Risk Ratio: 1.77; 95% CI: 1.61, 1.95). Additionally, children who live in the northwest corner of Jefferson County, have an estimated 9.37-fold increased risk for an EBLL compared to children who live elsewhere in the county. Discussion The non-random distribution of EBLLs in Jefferson County is likely due to the distribution of Pre-1950 housing which is a known risk factor for remnant environmental lead. This issue may be a consequence of the systematic financial disinvestment of these neighborhoods via redlining during the 20th century. Childhood lead poisoning remains a critical public health issue in Jefferson County, KY.

Who Do Our Methods Serve and Protect? Pedagogical and Meta-Ethical Challenges in Teaching Breonna Taylor

Abstract: Introductory courses in Christian ethics ordinarily survey deontological, teleological, and virtue ethics, testing each against case studies. In spring 2021, this author followed the customary approach, but our case was a claim made by Sgt. John Mattingly of Louisville Metro Police Department, who was involved in the killing of Breonna Taylor. In an e-mail to over 1,000 LMPD colleagues, Mattingly claimed, "I know we did the legal, moral and ethical thing that night." Mattingly's striking assertion raises epistemological and meta-ethical questions. In what sense was killing Ms. Taylor the right thing to do? Was this action virtuous? Did it proceed from a worthy intention toward a valid goal? Was it done in accordance with duty/ies? Did it produce good consequences? Was it conducive toward liberation? While the methods are necessary, none is fully adequate; the article argues that they should be supplemented by responsibilist ethical lenses adapted from Darryl Trimiew and Iris Marion Young.

Testing for COVID-19 Using a Mobile Clinic Approach: A Collaborative Approach Focused on Underserved and At-Risk Populations in Louisville Kentucky

Testing for COVID-19 is an essential component of pandemic response, but equitable access across the communities has been a challenge due to failure of federally-funded programs to reach areas of greatest need. A partnership between the Louisville Metro Department of Public Health and Wellness, the Kentucky Nurses Association, and community leaders helped enable and facilitate a novel, community-based approach. Using a core of trained nurses and a larger group of volunteers, a mobile testing clinic process was developed and implemented in Louisville, Kentucky. From November 11, 2020 through June 30, 2022, 187 mobile testing clinics were held at 26 unique sites with 9337 tests performed. Sites focused on areas of Louisville where poverty density is the greatest, where recognized outbreaks occurred, and where community partners requested testing access. Fourteen nurse team leaders and more than 750 volunteers supported these efforts which were largely funded by existing resources. Standard Operating Procedures were developed to enable standardized training and activities across all clinics. The result is a process that has continued and has formed the basis for mobile vaccination clinics using many of the same processes.

Brief for Amicus Curiae The Kentucky Commission on Human Rights, Nelson v. Louisville Metro (Sixth Circuit Court of Appeals, Nos 22-5884/22-5912)

Brief for Amicus Curiae The Kentucky Commission on Human Rights, Nelson v. Louisville Metro (Sixth Circuit Court of Appeals, Nos 22-5884/22-5912)

Mapping gestational diabetes in the louisville metro area

Mapping gestational diabetes in the louisville metro area

A new pandemic and an old epidemic: The impact of COVID-19 and gun violence as measured by years of potential life lost in a US city

BackgroundThe COVID-19 pandemic has altered daily life on a global scale and has resulted in significant mortality with >985,000 lives lost in the United States alone. Superimposed on the COVID-19 pandemic has been a concurrent worsening of longstanding urban gun violence. We sought to evaluate the impact attributable to these 2 major public health issues on the greater Louisville region as determined by years of potential life lost. MethodsUsing the Collaborative Jefferson County Firearm Injury Database, all firearm injuries from January 1, 2011 to December 31, 2021 were examined. The COVID-19 data was compiled from the Louisville Metro Department of Public Health and Wellness. Pre-COVID (March 1, 2019–February 29, 2020) and COVID (March 1, 2020–February 28, 2021) time intervals were examined. The demographics, outcomes data, and years of potential life lost were determined for the groups, and injury locations were geocoded. ResultsFrom 2011 to 2021, there were 6,043 firearm injuries in Jefferson County, Kentucky. During the COVID time interval, there were 4,574 years of potential life lost due to the SARS-CoV-2 virus and 9,722 years of potential life lost due to all-cause gun violence. In the pre-COVID time interval, there were 5,723 years of potential life lost due to all-cause gun violence. ConclusionIn Louisville, greater years of potential life lost were attributable to firearm fatalities than the SARS-CoV-2 virus. Given the impact of COVID-19, the robust response has been proportionate and appropriate. The lack of response to firearm injury and fatality is striking in comparison. Additional resources to combat the sequelae of gun violence are needed.

Clustering Patterns and Hot Spots of Opioid Overdoses in Louisville, Kentucky

Using data obtained from the Louisville Metro Emergency Medical Services, this article examined the spatial and temporal patterns of opioid overdoses in Louisville, Kentucky. We aggregated opioid overdoses to street segments and applied the optimized hot spot analysis to identify areas with significant high overdose rates. Multiple spatial regression models were used to explore the ecological risk factors potentially associated with the spatial variations of the epidemic. The results suggest an overall clustered pattern of opioid overdoses with all overdose incidents concentrated in less than 8% of all the street segments. The consecutive hot spots largely overlapped with the most disadvantaged inner-city neighborhoods in Louisville. Regression results provided statistical evidence regarding the effects of socioeconomic correlates including uninsured, vacancy rates, and criminal activity. The spatial discrepancy between the overdose hot spots and lack of medical facilities or hospitals in the disadvantaged neighborhoods points to the critical issue of health inequity.

Assessing the impact of de‐escalation training on police behavior: Reducing police use of force in the Louisville, KY Metro Police Department

AbstractResearch summaryChanging police use of force policies and training to incorporate de‐escalation tactics is one of the most routinely recommended police reform measures. Despite widespread promotion and proliferation of de‐escalation trainings, to date, no research has empirically demonstrated that these trainings reduce use of force in the field (Engel, R. S., McManus, H. D., & Herold, T. D., 2020). Therefore, it is unknown if de‐escalation trainings actually reduce force, have no impact, or have unintended consequences that possibly increase injuries to officers or citizens. We collaborated with the Louisville Metro Police Department (LMPD) in 2019 to evaluate the impact of the Integrating Communications, Assessment, and Tactics (ICAT) de‐escalation training developed by the Police Executive Research Forum. Using a stepped‐wedge randomized controlled trial research design, the panel regression results demonstrated statistically significant reductions in use of force incidents (−28.1%), citizen injuries (−26.3%), and officer injuries (−36.0%) in the post‐training period. These significant reductions were larger than any changes in LMPD arrest patterns during the same period. Other possible time‐based confounders were also considered; the combined analyses show robust, consistent, and immediate impacts on use of force counts after training.Policy implicationsOur findings suggest that agencies should continue to implement and evaluate de‐escalation trainings and adopt other resiliency‐based approaches to police training. To facilitate long‐term changes in police behavior, a holistic approach is recommended that supports training tenets with complementary policies, supervisory oversight, managerial support, and community involvement in reform efforts. Finally, researchers must continue to support police executives willing to open their agencies for evaluation and oversight. Due to the LMPD's partnership with researchers, evidence now exists that de‐escalation training can make police encounters with the public safer for all. Continuing to implement and evaluate innovative police trainings is our best opportunity for meaningful changes in policing.

De-Escalation Training Receptivity and First-Line Police Supervision: Findings from the Louisville Metro Police Study

Despite calls for police reform that include changes to use of force training and field supervision, evidence regarding their impact is sorely lacking. This study examines survey data collected from first-line supervisors in the Louisville (KY) Metro Police Department after department-wide de-escalation training. Presented as part of a larger randomized controlled trial study, descriptive results from this survey demonstrate that, despite high levels of reported confidence in supervisory ability, supervisors infrequently engage in the activities that support and reinforce subordinates’ use of de-escalation skills. Results from multivariate ordinary least squares (OLS) linear regression models further show that only supervisors’ receptivity to de-escalation training is a significant predictor of engaging in activities that support the training tenets for subordinates. Combined with previous findings, the emerging research and policy implications suggest that training receptivity is critical, and further, that field supervision continues to be an under-utilized mechanism to reduce police use of force.

Review: The (Un)Known Project. Louisville, Kentucky

Review: <i>The (Un)Known Project</i>. Louisville, Kentucky

Lessons from Modeling and Running the World’s Largest Drive-Through Mass Vaccination Clinic

We provide an overview of the design and analysis of a simulation model that was used in designing, refining, planning, and implementing the world’s largest drive-through mass vaccination clinic in Louisville, Kentucky. The Louisville Metro Public Health and Wellness department provided the H1N1 vaccine to 19,318 residents via a drive-through and a walk-up clinic over 1.5 days. Almost two-thirds of the people vaccinated used the drive-through clinic. The simulation model and its results helped advise the project commissioners about the feasibility of the drive-through vaccination. It also allowed them to determine the proper layout and levels of staffing for efficient dispensing of the vaccines. General observations made at the actual clinic and a comparison of those with the simulation model are presented. Recommendations and shortcomings are discussed for improving the flow of the drive-through and the effectiveness of the data gathering, which could be helpful in future efforts. With the entire world having to react to the COVID-19 pandemic and plan for protecting citizens against the novel coronavirus, the models we developed and the experience we gained could be helpful in administering COVID-19 tests to large swaths of the population quickly or dispense vaccines, when the latter becomes available.

George Rogers Clark and William Croghan: A Story of the Revolution, Settlement, and Early Life at Locust Grove by Gwynne Tuell Potts

Reviewed by: George Rogers Clark and William Croghan: A Story of the Revolution, Settlement, and Early Life at Locust Grove by Gwynne Tuell Potts R. Douglas Hurt George Rogers Clark and William Croghan: A Story of the Revolution, Settlement, and Early Life at Locust Grove. By Gwynne Tuell Potts. (Lexington: University Press of Kentucky, 2020. Pp. viii, 306. $40.00, ISBN 978-0-8131-7867-7.) The name George Rogers Clark often brings to mind Indian-white warfare in the trans-Appalachian West. Although Clark’s military exploits in Kentucky, the Ohio River Valley, and the Illinois Country in behalf of Virginia and the national government from the American Revolution through the War of 1812 are familiar to anyone knowledgeable about this period, his later years are less well known. Even fewer people know much about William Croghan, the Irishborn veteran of the Virginia Line of the Continental army and western businessperson. It is in these respects regarding Clark and Croghan that this new book by Gwynne Tuell Potts, former executive director and president of Historic Locust Grove, contributes to historical knowledge. Clark met Croghan during the Revolution, and they became friends for life. After the war, Clark, as principal surveyor, hired Croghan to help lay out Virginia’s military bounty lands, and Croghan stood by Clark in his efforts to secure lands in Kentucky and the Illinois Country by both peace and warfare. After the American Revolution, Virginia wanted a leader who could suppress Native American resistance and ensure its land claims west of the Appalachians. Clark had a reputation for military skill and ruthlessness. Potts goes beyond this well-told story by pursuing Clark after his military years when his grievances festered because Virginia and the federal government declined to pay for his military expenses, at least until near the end of his life. To do so, Potts follows Clark’s efforts to raise a western army to help France overthrow the Spanish regime at New Orleans and establish a colony of Virginians on the west bank of the Mississippi River. Along the way, she notes the intrigues of James Wilkinson and Aaron Burr in the West. Potts also traces the life of William Croghan who, in 1790, purchased 387 acres near Louisville and built a house known as Locust Grove. Croghan’s residence soon became a place of visitation for many western leaders, such as William Clark (George Rogers Clark’s brother), Meriwether Lewis, and Andrew Jackson, among others. William Croghan married the Clarks’ sister, Lucy, thereby strengthening the interfamily relationship. In 1818, George Rogers Clark, ill, penniless, and embittered, died at Locust Grove under the care of his prosperous friend. Potts acknowledges the often dysfunctional relationships of the Croghan family and the sales of Locust Grove to various nonfamily buyers. In 1961, Jefferson County and the commonwealth of Kentucky purchased Locust Grove and its remaining fifty-five acres. Locust Grove became a National Historic Landmark by virtue of the many well-known people who passed through its doors. Louisville metro government now owns it. Overall, Potts provides a succinct survey of the interconnected lives of George Rogers Clark and William Croghan. Her portrayal of Clark’s life after the War of 1812 is a story of heartbreak and decline, and his relationship with Croghan is a testament to friendship and loyalty during good and bad times. Both men lived “socially traditional” lives for the age regarding slavery, Native [End Page 119] Americans, and national expansion (p. 2). The latter part of the book provides ample genealogical information that can be tedious to follow. Potts bases her work on primary research to consider Clark’s later years when his military exploits largely had been forgotten, but when his friendship with Croghan remained unwavering. In the end, Clark contributed to securing Kentucky and the Illinois Country for the United States, while William Croghan’s Locust Grove became a physical legacy to a little-known period in American history. R. Douglas Hurt Purdue University Copyright © 2021 The Southern Historical Association

The Impact of Return-to-Field and Targeted Trap-Neuter-Return on Feline Intake and Euthanasia at a Municipal Animal Shelter in Jefferson County, Kentucky.

Simple SummaryNearly three-quarters of a million cats and dogs were euthanized at animal shelters in the United States in 2018. This total represents a decline of more than 90% in such deaths at USA shelters since the early 1970s. The majority of animals euthanized in shelters today are free-roaming feral and stray cats. Two new approaches to the management of free-roaming cats—return-to-field (RTF) and targeted trap-neuter-return (TNR)—have grown in use over the past decade and have recently been associated with significant reductions in shelter euthanasia and intake. RTF programs are similar to TNR programs in that they entail the sterilization, vaccination, and return of cats; however, RTF programs are shelter based rather than community based. RTF programs provide live outcomes for community cats otherwise at high risk of euthanasia after shelter admission. The purpose of the present study was to examine changes in feline euthanasia and intake, as well as additional shelter metrics, at a municipal animal shelter in Jefferson County, KY, USA, after an RTF program was added to an ongoing community-based TNR program. The euthanasia of cats at Louisville Metro Animal Services (LMAS) declined by 94.1% and feline admissions dropped by 42.8% after a combined total of 24,697 cats were trapped, sterilized, vaccinated and returned over an eight-year period. The results of the present study are consistent with previous research and illustrate the amenability of RTF and TNR programs to customization based upon the needs and resources of a given community.The number of cats and dogs impounded and euthanized at animal shelters in the USA has declined dramatically in recent decades. The Humane Society of the United States reported that in 1973 an estimated 13.5 million cats and dogs were euthanized nationwide; according to Best Friends Animal Society, in 2018 that number had been reduced to approximately 733,000. A disproportionate number of animals euthanized at shelters today are free-roaming feral and stray cats, who most often face euthanasia due to their temperament or a lack of shelter space. Over the past decade, two new management tactics—return-to-field (RTF) and targeted trap-neuter-return (TNR)—have exhibited the capacity to contribute to significant reductions in feline euthanasia and intake. The present study examines changes in feline euthanasia and intake, as well as impacts on additional metrics, at a municipal animal shelter in Jefferson County, KY, USA, after an RTF program was added to an ongoing community-based TNR program. A combined total of 24,697 cats were trapped, sterilized, vaccinated, and returned over 8 years as part of the concurrent RTF and TNR programs. Feline euthanasia at Louisville Metro Animal Services (LMAS) declined by 94.1% and feline intake dropped by 42.8%; the live-release rate (LRR) increased by 147.6% due primarily to reductions in both intake and euthanasia. The results of the present study corroborate prior research on the effectiveness of combining RTF and TNR and exemplify the flexibility available to communities in configuring such programs to align with their particular needs and resources.

“Does daylight matter”? An examination of racial bias in traffic stops by police

PurposeThe purpose of this paper is to draw a better understanding of the potential impact of daylight in officer decision making. In order to this, the authors test the veil of darkness hypothesis, which theorizes that racial bias in traffic stops can be tested by controlling for the impact of daylight, while operating under the assumption that driver patterns remain constant across race.Design/methodology/approachPublicly available traffic-stop records from the Louisville Metro Police Department for January 2010–2019. The analysis includes both propensity score matching to examine the impact of daylight in similarly situated stops and coefficients testing to analyze how VOD may vary in citation-specific models.FindingsThe results show that using PSM following the VOD hypothesis does show evidence of racial bias, with Black drivers more likely to be stopped. Moreover, the effects of daylight significantly varied across citation-specific models.Research limitations/implicationsThe data are self-reported from the officer and do not contain information on the vehicle make or model.Practical implicationsThis paper shows that utilizing PSM and coefficients testing provides for a better analysis following the VOD hypothesis and does a better job of understanding the impact of daylight and the officer decision-making on traffic stops.Social implicationsBased on the quality of the data, the findings show that the use of VOD allows for the performance of more rigorous analyses of traffic stop data – giving police departments a better way to examine if racial profiling is evident.Originality/valueThis is the first study (to the researchers' knowledge) that applies the statistical analyses of PSM to the confines of the veil of darkness hypothesis.

The influence of body-worn cameras, minority threat, and place on police activity.

Police practices evolve and are often shaped by technological innovation, such as the adoption of body-worn cameras (BWCs). While initial research on their impact is evergrowing, researchers have neglected to examine if their use is influenced by neighborhood characteristics. This study examines the influence of a BWC implementation on police activity and enforcement practices across neighborhoods, using minority threat hypothesis and place theory to explain the relationship. We used pre- and postimplementation enforcement data to examine the influence of BWCs and community characteristics on the actions taken by Louisville Metro Police Department officers. Ten ordinary least squares models were used to analyze the enforcement changes including self-initiated activity, total enforcement, felony arrests, low-level arrests, and low-level citations. Our findings indicate BWCs implementation was associated with a decrease in low-level citations; however, self-initiated activity and felony and low-level arrests were unaffected. Also, concentrated disadvantage was associated with a decrease in self-initiated activity. We also examined the moderating effects between BWCs and neighborhood characteristics and found BWCs were correlated with a decrease in low-level citations. The implications of the findings are discussed.

Examining Social-Ecological Factors in Developing the Louisville Metro Department of Public Health and Wellness Syringe Exchange Program.

Amid an opioid epidemic and increasing HIV and hepatitis C virus (HCV) concerns, the Louisville Metro Department of Public Health and Wellness developed syringe exchange programming (SEP) to reduce HIV and HCV transmission, increase linkage to health care, and provide health education to clients in Louisville, Kentucky. We describe organizational, community, and policy factors contributing to SEP development. Approximately 8000 clients received SEP services from June 2015 to December 2016. Coalition building, timely advocacy, and media engagement are integral to successful SEP development and uptake.

AIR Louisville: Addressing Asthma With Technology, Crowdsourcing, Cross-Sector Collaboration, And Policy.

Cross-sector partnerships benefit public health by leveraging ideas, resources, and expertise from a wide range of partners. In this study we documented the process and impact of AIR Louisville (a collaboration forged among the Louisville Metro Government, a nonprofit institute, and a technology company) in successfully tackling a complex public health challenge: asthma. We enrolled residents of Louisville, Kentucky, with asthma and used electronic inhaler sensors to monitor where and when they used medication. We found that the use of the digital health platform achieved positive clinical outcomes, including a 78percent reduction in rescue inhaler use and a 48percent improvement in symptom-free days. Moreover, the crowdsourced real-world data on inhaler use, combined with environmental data, led to policy recommendations including enhancing tree canopy, tree removal mitigation, zoning for air pollution emission buffers, recommended truck routes, and developing a community asthma notification system. AIR Louisville represents a model that can be replicated to address many public health challenges by simultaneously guiding individual, clinical, and policy decisions.

Influence of Built Environment Quality and Social Capital on Mental Health of Residents of Assisted Living Communities in Louisville, Kentucky.

Objectives: Prior research has shown social capital and built environment quality are associated with overall health status and the incidence of mental illness. This study explores the relationship between social capital, built environment, and quality of life specifically for assisted living residents, currently a gap in the literature. Method: A total of 76 assisted living residents were interviewed for the study using researcher-administered questionnaires. In addition, site audits were conducted to quantitatively evaluate the built environment surrounding 12 assisted living communities in the Louisville Metro region. Results: There was a moderate, positive correlation between social capital and mental health, r = .473, p < .001. Built environment quality for the neighborhood immediately surrounding the assisted living community was not significantly correlated with quality of life for assisted living residents. Other population characteristics, including demographic characteristics, self-rated health status, and instrumental activities of daily living were not significantly predictive of mental health scores. Conclusion: This study demonstrates that social capital is associated with happiness and self-rated quality of life. Specifically, increased social capital is associated with increased mental well-being for older adults residing in assisted living communities, with social capital explaining about 20% of the variation in quality of life scores.

Assessing Community Leadership: Understanding Community Capacity for Health Improvement.

The purpose of this study was to pilot a quantitative instrument to measure aspects of community leadership within an assessment framework. The instrument includes 14 Likert-type questions asking residents how they perceive leaders within 5 sectors: Louisville Metro Council/Mayor's Office, the faith community, education, business, and the civic sector. Louisville/Jefferson County, Kentucky, has a population of about 743 000 residents. Respondents were asked to examine leadership within West Louisville, an economically deprived area of the city made up of 9 contiguous neighborhoods. This area is predominantly African American (78% compared with 22% in Louisville Metro), with an overall poverty rate of 43% (compared with 18% in Louisville Metro), and unemployment rate of 23% (compared with 8% in Louisville Metro). Residents of West Louisville are looking to leadership to address many of the inequities. Twenty-seven participants representing 7 community sectors completed the survey, of whom 90% work in West Louisville. The instrument measured local perceptions of leadership strength, effectiveness, trust, communication, community building, and leadership development. The majority of respondents agree that strong leadership exists across the 5 sectors, with variation regarding perceptions of the quality of that leadership. City leadership within the Mayor's Office and Metro Council is largely viewed positively, while the growing tensions within the education sector were reflected in the survey results. The perception of community leadership is important to understanding local community capacity to improve health and also inclusivity of community voice in the assessment and community improvement processes. Results from such assessments can offer useful information for strengthening community capacity and sustaining relationships needed to enact progressive and equitable solutions to address local issues. Leaders in a variety of settings can utilize this instrument to improve their community as well as their practical approaches towards leadership and equity.

Partnering: A Metro Health Department and Community Hospital Collaboration. Implementation of an Outpatient Lactation Clinic

This project focused on an innovative collaboration between a metro health department and a community hospital to create a free outpatient lactation clinic for breastfeeding support. The Louisville Metro Health Department was awarded a 2-year, $7.9 million “Communities Putting Prevention to Work” grant from the U.S. Department of Health and Human Services. The project focused on policy, environmental, and systems changes to address risk factors for obesity by improving access to healthy foods and increasing access to physical activity.