Multistate Study Research Articles

Sources of moral distress among obstetrician-gynecologists after Dobbs: A qualitative, multi-state study

Since the US Supreme Court's 2022 decision in Dobbs v Jackson Women's Health Organization, 18 states have enacted functional bans on abortion, yet little is known about how these laws contribute to workplace stress and its sequelae among clinicians. The purpose of this study was to characterize sources of moral distress—which occurs when a clinician knows the right course of clinical action but is barred from taking that action by external constraints—among obstetrician-gynecologists (OB-GYNs) in states with abortion bans. We conducted qualitative, semi-structured interviews with 54 OB-GYNs practicing in 13 of 14 states where abortion was illegal as of March 2023. Using a qualitative descriptive coding approach, we identified four types of clinical situations leading to moral distress: delaying treatment for patients with obstetric complications, conflict with other clinicians, denying care they would have provided locally prior to Dobbs, and restrictions on clinical counseling. These situations provoked feelings of anger, frustration, helplessness, and emotional exhaustion. Participants attributed moral distress to the cumulative toll of routinely being unable to provide evidence-based healthcare, in addition to the acute burden of managing obstetric emergencies in legal gray areas, which was relatively rarer. The findings demonstrate a previously unreported source of moral distress: the everyday chipping away of professional integrity that occurs when OB-GYNs cannot care for patients in the way that patients need. Next steps include developing institutional-level policies and programs to support clinicians and enable them to practice ethical medicine in abortion-restrictive policy environments.

Suicide Prevention Effects of Extreme Risk Protection Order Laws in Four States.

More than half of suicide deaths in the United States result from self-inflicted firearm injuries. Extreme risk protection order (ERPO) laws in 21 states and the District of Columbia temporarily limit access to firearms for individuals found in a civil court process to pose an imminent risk of harm to themselves or others. Research with large multistate study populations has been lacking to determine effectiveness of these laws. This study assembled records pertaining to 4,583 ERPO respondents in California, Connecticut, Maryland, and Washington. Matched records identified suicide decedents and self-injury method. Researchers applied case fatality rates for each suicide method to estimate nonfatal suicide attempts corresponding to observed deaths. Comparison of counterfactual to observed data patterns yielded estimates of the number of lives saved and number of ERPOs needed to avert one suicide. Estimates varied depending on the assumed probability that a gun owner who attempts suicide will use a gun. Two evidence-based approaches yielded estimates of 17 and 23 ERPOs needed to prevent one suicide. For the subset of 2,850 ERPO respondents with documented suicide concern, comparable estimates were 13 and 18, respectively. This study's findings add to growing evidence that ERPOs can be an effective and important suicide prevention tool.

Assessing the Mental Model State of Emergency Responders in the Context of Radiological Dispersal Device (RDD) Incidents: A Multi-state Study.

Hazardous Materials (HAZMAT) Technicians' notions of mental model, or cognitive representations of their understanding and beliefs regarding Radiological Dispersal Devices (RDDs) incidents, have not been previously explored. A prior study developed an Expected Mental Model State (EMMS) framework specific to RDD incident response for HAZMAT technicians. The work herein presents the development of a derivative of this framework, the EMMS Diagnostic Matrix, to evaluate the actual Mental Model State (MMS) of HAZMAT technicians in the context of RDD incidents. The EMMS Diagnostic Matrix was administered via a survey and simulation activity in four U.S. states representing the Northeast, West, South, and Midwest regions. Data were collected and coded using grounded theory methodology. Reflexive thematic analysis was employed to identify themes across related areas where the notions of mental model for the HAZMAT technician responders' actual MMS differed from the EMMS. The analysis of the collected data revealed four significant themes representing incomplete notions of the mental model spanning various EMMS conceptual domains: Overestimation of Radiation Dose and Health Effects, indicating misunderstandings about the health impacts of radiation exposure, Acute Radiation Syndrome (ARS), particularly in the lower range of radiation doses; Overreliance on Responder Protection [personal protective equipment (PPE)/self-contained breathing apparatus (SCBA)], highlighting gaps in understanding radiation principles and radioactive material dispersal properties from a radiological dispersal device; Misunderstanding Radiation Detection and Units, signifying confusion about radiation units and differentiation between dose rate and accumulated dose; and Incomplete Understanding of Radiation Characteristics and Dispersal Properties, outlining a limited grasp of inhalation risks from radiation and the dispersal traits of a radiological dispersal device. The interconnectedness of these technical misunderstandings can guide the development of a strategic plan to evaluate and modify existing training, aiming at these specific themes to improve the efficiency of HAZMAT technicians in emergency situations and to identify areas for further research.

Defoliation level and timing affect popcorn yield traits in the Midwestern United States

Popcorn [Zea mays (L.) var. Everta] is an important field crop in the Midwestern United States. However, hailstorms are a major threat to ensuring high yield because of their effects on leaf photosynthesis, pollination, and stalk lodging. A multi-state study spanning six site-years (2020–2023) was conducted in two locations (Ohio and Nebraska) to determine how defoliation intensity at different stages affects yield loss in popcorn and compare these losses with current values in the National Crop Insurance Service (NCIS) Corn Loss Instructions. At each location the study was conducted in a randomized complete block design with four replicates. The treatments consisted of the combination of four levels of leaf loss (25, 50, 75 and 100 % leaf blade area removal) imposed at five developmental stages: V8 (10-leaf), V13 (15-leaf), VT, R2, and R4. The evaluated traits were plant population, grain yield, stalk lodging, and 100-kernel weight. All evaluated traits were affected by defoliation, except plant population. The treatments 100 % defoliation at VT and R2 stages were the most damaging in terms of grain yield reduction, number of ears per plant and 100-kernel weight for both locations. In Ohio, the greatest stalk lodging was observed at 100 %-R2 and in Nebraska, at 75 %-VT. For both locations, the actual yield losses in the defoliated treatments were lower than values currently listed in the NCIS Popcorn Leaf Loss Chart. These results indicate leaf loss chart values should be updated to accurately reflect yield losses from popcorn defoliation events. This evaluation did not impose damage to stalks (e.g., bruising) or to plant whorls as may be expected in natural events. Future research should incorporate other forms of plant damage such as those described to provide a better emulation of hail damage.

MOLECULAR IDENTIFICATION OF HCV GENOTYPES AMONG INJECTING DRUG USERS HAVING HCV and HIV CO-INFECTION

Co-infection with hepatitis C virus (HCV) and Human immunodeficiency virus (HIV) is common in Injecting drug users (IDUs). The aim of this study was the molecular identification of HCV genotypes in IDUs having HC/HIV co-infection in Peshawar. A cohort cross-sectional study was conducted in Nai Zindagi NGO from 2020 to 2022. A sample of 350 IDUs including 309 males, 23 females, 09 children, and 09 transgender were enrolled. Suspected age was 34 years. Screening of HIV and HCV infection was performed through ICT and RT-PCR. For genotype determination, a specific SACACE real-time PCR kit was used. Out of a total of 350 patients, 204 were HCV/HIV co-infected. According to bivariate analysis, there is statistically moderate positive r=522 between viral load and HCV/HIV co-infection (p=0.000). It is concluded that the prevalence of HCV/HIV co-infection was 44.28% in IDUs with the prevalent genotype 3a (51.1%). Viral load of males was higher than females. To overcome the burden of HCV/HIV co-infection large-scale, multicentre, and multistate studies should be conducted across Pakistan and preventive measures should be taken to reduce the use of syringes, razors, tattooing, sex workers, and blood transfusion.

Using policy codesign to achieve multi-sector alignment in adolescent behavioral health: a study protocol

BackgroundPolicymaking is quickly gaining focus in the field of implementation science as a potential opportunity for aligning cross-sector systems and introducing incentives to promote population health, including substance use disorders (SUD) and their prevention in adolescents. Policymakers are seen as holding the necessary levers for realigning service infrastructure to more rapidly and effectively address adolescent behavioral health across the continuum of need (prevention through crisis care, mental health, and SUD) and in multiple locations (schools, primary care, community settings). The difficulty of aligning policy intent, policy design, and successful policy implementation is a well-known challenge in the broader public policy and public administration literature that also affects local behavioral health policymaking. This study will examine a blended approach of coproduction and codesign (i.e., Policy Codesign), iteratively developed over multiple years to address problems in policy formation that often lead to poor implementation outcomes. The current study evaluates this scalable approach using reproducible measures to grow the knowledge base in this field of study.MethodsThis is a single-arm, longitudinal, staggered implementation study to examine the acceptability and short-term impacts of Policy Codesign in resolving critical challenges in behavioral health policy formation. The aims are to (1) examine the acceptability, feasibility, and reach of Policy Codesign within two geographically distinct counties in Washington state, USA; (2) examine the impact of Policy Codesign on multisector policy development within these counties using social network analysis; and (3) assess the perceived replicability of Policy Codesign among leaders and other staff of policy-oriented state behavioral health intermediary organizations across the USA.DiscussionThis study will assess the feasibility of a specific approach to collaborative policy development, Policy Codesign, in two diverse regions. Results will inform a subsequent multi-state study measuring the impact and effectiveness of this approach for achieving multi-sector and evidence informed policy development in adolescent SUD prevention and treatment.

Exploring Parents’ Perceptions of Early Intervention Services: A Multi-State Study

Exploring Parents’ Perceptions of Early Intervention Services: A Multi-State Study

Work Attendance with Acute Respiratory Illness Before and During COVID-19 Pandemic, United States, 2018-2022.

Both SARS-CoV-2 and influenza virus can be transmitted by asymptomatic, presymptomatic, or symptomatic infected persons. We assessed effects on work attendance while ill before and during the COVID-19 pandemic in the United States by analyzing data collected prospectively from persons with acute respiratory illnesses enrolled in a multistate study during 2018-2022. Persons with previous hybrid work experience were significantly less likely to work onsite on the day before through the first 3 days of illness than those without that experience, an effect more pronounced during the COVID-19 pandemic than during prepandemic influenza seasons. Persons with influenza or COVID-19 were significantly less likely to work onsite than persons with other acute respiratory illnesses. Among persons with positive COVID-19 test results available by the second or third day of illness, few worked onsite. Hybrid and remote work policies might reduce workplace exposures and help reduce spread of respiratory viruses.

Drivers of vaccine hesitancy among vulnerable populations in India: a cross-sectional multi-state study.

India's Covid-19 vaccination campaign engaged frontline workers (FLWs) to encourage vaccination among vulnerable segments of society. The FLWs report encountering a variety of barriers to vaccination and are often unsuccessful despite multiple visits to the same person. This cross-sectional study aims to pinpoint which of these barriers drive vaccine hesitancy among these segments, to help streamline vaccine communication, including FLW training, to better safeguard the population. Trained field enumerators contacted 893 individuals from five states across India and collected self-reported assessments of fifteen vaccination barriers (identified through discussions with FLWs), current vaccination status and future vaccination intentions, and covariates (demographics/comorbidities). Factor analysis of the fifteen barriers yielded two factors, one relating to fear of vaccine adverse effects and a second focused on peripheral concerns regarding the vaccine. The covariates significantly associated with current vaccination status were combined under a latent class regime to yield three cluster types (health access, financial strength, and demographics). The primary analysis examined the effect of the two barrier factors, the covariate clusters, and comorbidity, on current vaccination status and future vaccine intentions. Fear of vaccine adverse effects was the primary driver of vaccine hesitancy; peripheral concerns frequently mentioned by the FLWs had no impact. Although cluster membership and the presence of comorbidities predicted vaccine uptake, neither of them materially altered the effect of fear of vaccine adverse effects with the following exception: fear of adverse effects was not associated with vaccination status among young Muslim men. Subject to limitations, these results indicate that interventions to decrease vaccine hesitancy should focus primarily on fear associated with vaccines rather than spend resources trying to address peripheral concerns.

Refractory Helicobacter pylori infection in Australia: updated multicentre antimicrobial resistance.

Helicobacter pylori infection is responsible for considerable morbidity and mortality worldwide and eradication rates are falling globally because of increasing antimicrobial resistance. However, there is a paucity of local data to guide the choice of eradication therapy in Australia. This study aimed to evaluate current Australian rates of H. pylori antibiotic resistance in patients who had failed prior eradication therapy. A retrospective analysis of routine culture and antibiotic susceptibility data from two pathology laboratories servicing multiple tertiary referral hospitals in Western Australia (WA) and South Australia (SA), between 2018 and 2022, was performed. Rates of antimicrobial resistance and prevalence of multiresistant isolates in both SA and WA were calculated and comparison of temporal trends and differences between the two states was conducted. A total of 796 H. pylori isolates revealed a clarithromycin resistance rate of 82%, metronidazole 68%, amoxicillin 4.4% and tetracycline 0.5%. Resistance to levofloxacin was observed in 22% and rifampicin 14%. Rates of resistance to clarithromycin were lower in SA compared with WA (incidence rate ratio [IRR]: 0.69, P = 0.0001). Multiresistant isolates were discovered in 63% of patients, with lower rates in SA compared with WA (IRR: 0.74, P = 0.002). This first multicentre, multistate study of H. pylori resistance in Australian patients exposed to prior therapy demonstrated high rates of antimicrobial resistance, including levofloxacin (>20%). This raises concern about recommending levofloxacin in empirical second-line therapies. Increased monitoring and awareness of current H. pylori resistance rates in Australia are needed to guide local eradication practices.

Ambulatory Orbital Fracture Repair: An Analysis of ER Visits After Surgery From a Multistate Study.

To determine the 30-day postoperative emergency room (ER) visit rate following ambulatory orbital fracture repair with same-day discharge, and the causes and risk factors associated with ER visit. Database study. State Ambulatory Surgery and Services Database (SASD) and State Emergency Department Database (SEDD) for California, New York, and Florida for 2011. We identified orbital fracture repair procedures among adults from the SASD, which was linked to the SEDD to identify the incidence and causes of ER visits within 30 days. Univariate and multivariable logistic regression models were used to determine the factors associated with ER visit. Among 762 patients, the 30-day postoperative ER visit rate was 4.5%. Most ER visits (58.9%) occurred during the first week after surgery. The most common reasons for ER visits were related to pain, swelling, headache, dizziness, and fatigue (29.4%), followed by ophthalmologic etiologies including visual disturbances and infection of the eye (14.7%). There was no case of retrobulbar hematoma. In the multivariate analysis, patients living in Florida were at a significantly higher risk for ER visit compared to those in California (odds ratio: 4.48 [1.43-14.10], p = .010). Ambulatory orbital fracture repair appears to be safe. Common reasons for ER visit included pain, swelling, and ophthalmic symptoms. An increased risk for ER visit was seen with certain geographic regions but not with medical comorbidities or concurrent facial fractures or procedures.

Evaluating changes in the emergency medical services workforce: A preliminary multistate study.

There is growing concern with the strength and stability of the emergency medical services (EMS) workforce with reports of workforce challenges in many communities in the United States. Our objective was to estimate changes in the EMS workforce by evaluating the number of clinicians who enter, stay, and leave. A 4-year retrospective cohort evaluation of all certified EMS clinicians at the emergency medical technician (EMT) level or higher was conducted for 9 states that require national EMS certification to obtain and maintain EMS licensure. The study spanned 2 recertification cycles (2017-2021) for 2 workforce populations: the certified workforce (all EMS clinicians certified to practice) and the patient care workforce (the subset who reported providing patient care). Descriptive statistics were calculated and classified into 1 of 3 categories: EMS clinicians who entered, stayed in, or left each respective workforce population. There were 62,061 certified EMS clinicians in the 9 included states during the study period, and 52,269 reported providing patient care. For the certified workforce, 80%-82% stayed in and 18%-20% entered the workforce. For the patient care workforce, 74%-77% stayed and 29%-30% entered. State-level rates of leaving each workforce ranged from 16% to 19% (certified) and 19% to 33% (patient care). From 2017 to 2020, there was a net growth of both the certified (8.8%) and patient care workforces (7.6%). This was a comprehensive evaluation of both the certified and patient care EMS workforce dynamics in 9 states. This population-level evaluation serves as the first step for more detailed analyses to better understand workforce dynamics in EMS.

Use of residential opioid use disorder treatment among Medicaid enrollees in nine states

IntroductionResidential treatment is a key component of the opioid use disorder care continuum, but research has not measured well the differences in its use across states at the enrollee level. MethodsThis cross-sectional observational study used Medicaid claims data from nine states to document the prevalence of residential treatment for opioid use disorder and to describe the characteristics of patients receiving care. For each patient characteristic, chi-square and t-tests tested for differences in the distribution between individuals who did and did not receive residential care. ResultsAmong 491,071 Medicaid enrollees with opioid use disorder, 7.5 % were treated in residential facilities in 2019, though this number ranged widely (0.3–14.6 %) across states. Residential patients were more likely to be younger, non-Hispanic White, male, and living in an urban area. Although residential patients were less likely than those without residential care to be eligible for Medicaid through disability, diagnoses for comorbid conditions were more frequently observed among residential patients. ConclusionsResults from this large, multi-state study add context to the ongoing national conversation around opioid use disorder treatment and policy, providing a baseline for future work.

Drivers of HIV self-testing among female sex workers: Findings from a multi-state study in Malaysia.

Although research on HIV self-testing (HIVST) has rapidly increased, few studies have explored HIVST uptake in female sex workers (FSW), and none in Malaysia. Therefore, we endeavored to assess the willingness to use HIVST in this at-risk, vulnerable population. A cross-sectional survey study was conducted among 113 HIV-negative Malaysian FSW in 2017. Participants were recruited using advertisements on social media, flyers, and direct referrals from community-based organizations. Data were collected using self-administered surveys. Multivariable logistic regression was used to identify correlates of willingness to use HIVST. Nearly a third of participants (30.1%) reported they would be willing to use HIVST. Multivariable analyses adjusting for Malay ethnicity, stable housing, living in Kuala Lumpur (KL), years in sex work, age of first sex work, childhood sexual assault, history of HIV testing, and previously in prison indicated that living in KL [adjusted odds ratio (aOR) = 5.214, p = 0.0137] was associated with a greater willingness to use HIVST. In contrast, having stable housing (aOR = 0.100, p = 0.0064) was negatively associated with willingness to use HIVST. Our results indicate that HIVST may potentially enhance the uptake of HIV testing among FSWs living in an urban environment and experiencing unstable housing, but an overall willingness to use HIVST is low. These findings highlight the need for efforts to increase awareness of HIVST among FSWs and additional research on the effective implementation of HIVST for FSW.

Caring through Crisis: Supporting African Immigrant Students and Educators during the COVID-19 Pandemic

All human beings need care, including professional caregivers such as educators. What happens when a global crisis places care providers; own care needs in conflict with their duty and desire to provide care? In this article, we apply care ethics to a school district's decisions regarding newcomer English learners (ELs) and their educators during the 2020-2021 academic year. Drawing on qualitative case study data from a larger multi-district, multi-state study, we examine how educators and administrators in a small urban school district in New England make sense of students' and educators' sometimes conflicting care needs during the COVID-19 pandemic. We argue that even school districts with clear commitments to equity and justice have their efforts severely limited by state and federal leadership's neglect of care/essential workers, youth, and marginalized groups. To end the ongoing pandemic and prevent future harm, we recommend that educational and political leaders prioritize human needs and relationships through a move towards "universal care" (Chatzidakis et al., 2020).

Factors associated with receptive injection equipment sharing among people who inject drugs: findings from a multistate study at the start of the COVID-19 pandemic

BackgroundReceptive injection equipment sharing (i.e., injecting with syringes, cookers, rinse water previously used by another person) plays a central role in the transmission of infectious diseases (e.g., HIV, viral hepatitis) among people who inject drugs. Better understanding these behaviors in the context of COVID-19 may afford insights about potential intervention opportunities in future health crises.ObjectiveThis study examines factors associated with receptive injection equipment sharing among people who inject drugs in the context of COVID-19.MethodsFrom August 2020 to January 2021, people who inject drugs were recruited from 22 substance use disorder treatment programs and harm reduction service providers in nine states and the District of Columbia to complete a survey that ascertained how the COVID-19 pandemic affected substance use behaviors. We used logistic regression to identify factors associated with people who inject drugs having recently engaged in receptive injection equipment sharing.ResultsOne in four people who inject drugs in our sample reported having engaged in receptive injection equipment sharing in the past month. Factors associated with greater odds of receptive injection equipment sharing included: having a high school education or equivalent (adjusted odds ratio [aOR] = 2.14, 95% confidence interval [95% CI] 1.24, 3.69), experiencing hunger at least weekly (aOR = 1.89, 95% CI 1.01, 3.56), and number of drugs injected (aOR = 1.15, 95% CI 1.02, 1.30). Older age (aOR = 0.97, 95% CI 0.94, 1.00) and living in a non-metropolitan area (aOR = 0.43, 95% CI 0.18, 1.02) were marginally associated with decreased odds of receptive injection equipment sharing.ConclusionsReceptive injection equipment sharing was relatively common among our sample during the early months of the COVID-19 pandemic. Our findings contribute to existing literature that examines receptive injection equipment sharing by demonstrating that this behavior was associated with factors identified in similar research that occurred before COVID. Eliminating high-risk injection practices among people who inject drugs requires investments in low-threshold and evidence-based services that ensure persons have access to sterile injection equipment.

Effects of Disease Resistance and Fungicide Application on Management of Tar Spot on Corn in the North Central United States

Tar spot, caused by Phyllachora maydis, is the most significant disease of corn in the North Central United States. Elucidating an integrated management approach to protect grain yield is a high priority. The integration of tillage, hybrid, and fungicide application on tar spot severity, canopy greenness, and grain yield was assessed in Indiana in 2019, 2020, and 2021. A split-plot arrangement of two tillage treatments as main plots with factorial arrangement of subplots with three hybrids (tar spot susceptible and two partially resistant) and fungicide application (propiconazole + benzovindiflupyr + azoxystrobin) were evaluated. Furthermore, a multistate study comparing two hybrids (susceptible and partially resistant) and fungicide application (propiconazole + benzovindiflupyr + azoxystrobin) was conducted in Indiana, Michigan, and Wisconsin in 2020. This research demonstrates that partially resistant hybrids with a standardized area under the disease progress curve of 2.5 and 3.0 had significantly less tar spot than a susceptible hybrid with a standardized area under the disease progress curve of 10.1 and increased canopy greenness ratings of 48.1 and 51.5%, which were significantly higher than the susceptible hybrid at 13.0% at maturity. Tar spot severity was further reduced and canopy greenness increased with a fungicide application in the susceptible hybrid. These results suggest that partial resistance alone may be used to manage tar spot. Yields did not differ significantly across hybrids with or without a fungicide application. However, a general trend of preserved yield potential was observed in the treatments with fungicide, indicating that knowledge of genetics and yield potential will be necessary to achieve the greatest benefit from partially resistant hybrids and judicious fungicide applications.

Prevalence of refractive errors among school-going children in a multistate study in India

AimMuch existing data on childhood refractive error prevalence in India were gathered in local studies, many now dated. The aim of this study was to estimate the prevalence, severity and...

A study of phase portraits, multistability and velocity profile of magneto-hydrodynamic Jeffery–Hamel flow nanofluid

Bifurcation analysis is studied for the first time in magneto-hydrodynamic (MHD) Jeffery–Hamel flow nanofluids. The dimensionless ordinary differential equations is formulated by using the similarity transformations. The phase portraits of the travelling wave solutions are examined using bifurcation theory on the dynamical system of the considered equation. Moreover, multistability and sensitivity analysis is used to examine quasi-periodic and periodic behavior for various initial conditions. The (MHD) Jeffery–Hamel flow solutions are derived analytically by applying the extended direct algebraic approach and the influence of the different physical parameters for velocity profiles, have been examined. It is found that the physical parameter i.e, Reynolds number and channel angle rising in convergent flow results in an increase in the velocity profiles, signifying that backflow is excluded, while an inverse behavior can be attributed to a diverging flow. • Magneto-hydrodynamic Jeffery–Hamel flow has been observed by bifurcation analysis. • All possible phase portraits are drawn. • The influence of the magnetic field and nanoparticles on the magneto-hydrodynamic Jeffery–Hamel flow has been studied. • The influence of the different physical parameters on the velocity profiles have been examined.

A Multistate Study on Housing Factors Influential to Heat-Related Illness in the United States.

As climate change increases the frequency and intensity of devastating and unpredictable extreme heat events, developments to the built environment should consider instigating practices that minimize the likelihood of indoor overheating during hot weather. Heatwaves are the leading cause of death among weather-related causes worldwide, including in developed and developing countries. In this empirical study, a four-step approach was used to collect, extract and analyze data from twenty-seven states in the United States. Three housing characteristic categories (i.e., general housing conditions, living conditions, and housing thermal inertia) and eight variables were extracted from the American Housing Survey database, ResStock database and CDC's National Environmental Public Health Tracking Network. Multivariable regression models were used to understand the influential variables, a multicollinearity test was used to determine the dependence of those variables, and then a logistic model was used to verify the results. Three variables-housing age (HA), housing crowding ratio (HCR), and roof condition (RC)-were found to be correlated with the risk of heat-related illness (HRI) indexes. Then, a logistic regression model was generated using the three variables to predict the risk of heat-related emergency department visits (EDV) and heat-related mortality (MORD) on a state level. The results indicate that the proposed logistic regression model correctly predicted 100% of the high-risk states for MORD for the eight states tested. Overall, this analysis provides additional evidence about the housing character variables that influence HRI. The outcomes also reinforce the concept of the built environment determined health and demonstrate that the built environment, especially housing, should be considered in techniques for mitigating climate change-exacerbated health conditions.