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What’s the Overdose Death Rate in Your County?

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Opioid Overdose Rate | Deaths per 100,000 population ages 15-64 by county from 2012 to 2016. (Source: NORC, University of Chicago.)

A new interactive map shows the county-by-county impact of opioid drug overdoses. A researcher describes some of the challenges of reporting overdoses in rural areas and what researchers did to address them.

If you’ve got a couple minutes, Michael Meit has a favor to ask. He’ll try not to take up too much of your time. 

“What I want is for people to go to the online tool, click on their county, pull up that 8 ½-by-11 fact sheet, and send it to all their local elected officials, health department staff, medical personnel, and others,” Meit said.  

And? 

“Start a community dialog about drug overdose deaths in their community,” Meit said. 

Meit, co-director of the Walsh Center for Rural Health Analysis, is part of an initiative launched last week that provides a county-by-county look at the impact of opioid deaths across the country. A press release calls the project the “first ever interactive data visualization of national county-level opioid overdose mortality rates.” 

The project is collaboration of the Walsh Center (part of NORC at the University of Chicago) and USDA Rural Development. 

Despite years of public discussion and news coverage, many communities don’t understand the extent of their opioid-abuse problem, Meit said. “People by and large still have no idea how bad things are in their communities,” he said. 

The tool gives the rate of drug-overdose deaths for about three quarters of all counties in the United States. A fact sheet for each of those counties compares local data to state and national figures. 

By the afternoon that the data tool was released, a handful of news organizations with online presence had already published stories about their county’s overdose rate, lending credence to the idea that the overdose rate is still news.  

Meit said rural America needs to be part of the overdose discussion because the stakes are so high there. But rural research always presents unique challenges. 

About a quarter of the U.S. counties do not have overdose death data because the number is suppressed. One reason the CDC leaves out the number is to protect individuals’ confidentiality. When the number gets too small, it may be possible to identify the people represented by the statistics. 

Rural counties are especially susceptible to having their overdose deaths suppressed for this reason. To get the number of deaths over the confidentiality threshold, researchers aggregated overdose data over five-year periods. Even with that provision, the map lacks overdose data for about 25 percent of counties. 

That’s not necessarily bad news, Meit said. “One explanation [for suppressing the county’s data] is that there are so few people there,” he said. “The other is that there are so few deaths there, and that’s a good, good thing. I suspect it’s a little of both.” 

Using the five-year numbers also means that the current overdose rate is likely higher than the figure on the map, since overdose rates have been climbing quickly in recent years. 

The overdose data comes from the CDC. (The specifics are here.) While the numbers are the best available, they likely understate the scope of the overdose problem, perhaps by about a third, one recent study says. Meit said data reliability is always harder in rural areas. 

“When issues of under-reporting are involved, it always tends to be worse in rural areas than in urban ones,” he said. Medical examiners may have less training and resources to determine causes of death. And the smaller size of communities may make them more likely to protect families from the stigma of a drug death. 

The map also includes layers of other data such as race/ethnicity, age, education, and income. Those data let users see a visual connection between those factors and the overdose problem. That’s not to provide the “answer” to the overdose problem. “Again, that information is there help start the conversation,” Meit said.  

He said future versions of the map will include “solutions” layers such as the location of treatment centers and hospitals or access to grant sources. 

In a press release, USDA Assistant to the Secretary of Rural Development Anne Hazlett said USDA would work with rural communities to help them address the “monumental challenge” of drug deaths. 

“Local leaders in small towns across our country need access to user-friendly and relevant data to assist them in building grassroots solutions for prevention, treatment, and recovery,” she said.  

This article was originally published by Daily Yonder

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Air Pollution Continues to Decline, Smog Remains a Problem

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Mt. Storm Power Plant in West Virginia. Photo: Cecilia Mason/WVPB

A new report released this week by the American Lung Association finds fine particle, or soot, pollution continues to improve across West Virginia, but smog pollution remains a challenge.

The American Lung Association’s 20th annual “State of the Air” report analyzed air quality data collected by federal, state and local air monitoring devices between 2015 and 2017, the most recent data available. Data is collected in just 10 of West Virginia’s 55 counties.

The Lung Association’s 2019 report found fine particle pollution continued to improve across the state. All counties with data earned an “A” grade.

Soot pollution is expelled from sources like exhaust pipes or industrial plants. It’s the fine, microscopic dust sometimes small enough to pass directly into the blood streams through the lungs. Not only can it exacerbate respiratory health problems, but fine particle pollution is also linked to heart problems.

Cabell and Kanawha counties had zero unhealthy days of short-term spikes in particle pollution for at least the fifth consecutive year, listing them among the nation’s cleanest counties for soot pollution, the report stated. The area ranked 89 worst in the country.

It was a different story, however, for ozone pollution. Ozone is a powerful lung irritant that exacerbate asthma attacks and negatively impact those with other lung diseases. The new report showed West Virignia counties had similar levels of unhealthy days of high ozone as last year’s report.

Cabell, Kanawha, Ohio and Wood counties all earned “C” grades and had four or more days with unhealthy ozone levels.

The American Lung Association said a warming climate may help explain the boost in unhealthy ozone pollution levels. Ozone levels increased in most cities around the country during the three-year period, which were also some of the warmest on record.

The report also highlighted a series of federal environmental laws that have been rolled back — from methane standards for oil and gas wells to car pollution standards — that may be negatively affecting air quality.

Nationally, the report found ozone and short-term particle pollution worsened in many cities. More than four in 10 Americans, or about 43 percent of the population, live in counties that have monitored unhealthy ozone and/or particle pollution.

This article was originally published by West Virginia Public Broadcasting.

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Serving Survivors: In Rural States, Telemedicine Brings Treatment For Sexual Abuse

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“Open plains and lots of antelope,” Matt Gray describes the Wyoming landscape. Photo: Mary Meehan, Ohio Valley ReSource

Gillette, Wyoming, isn’t the kind of place you just happen to come across.

“It’s about a four hour drive through vast, unimpacted, wide, sweeping plains,” said Matt Gray, a professor at University of Wyoming in Laramie, explaining the trek from his office to his clients.

Plains, he said, “and lots and lots of antelope.”

For the last decade, Gray and graduate students have bridged the space across the high plains with a digital connection in order to serve survivors of domestic violence and sexual abuse.

The university town of Laramie connects with the boom and bust energy town of Gillette near the South Dakota border providing specialized trauma counseling. Without that link no such service would be available.

Graphic: Alexandra Kanik, Ohio Valley ReSource

AMargie McWilliams is director of what is officially called the Gillette Abuse Refuge Foundation and unofficially called GARF. In her estimation the therapy program has been invaluable.

“Honestly, it has saved a lot of lives.”

Since the #MeToo movement started a national conversation about sexual violence, the scope of the discussion continues to grow from exposing the issue to exploring how to best help survivors. Those include rural women who are often underserved and overlooked. Each place is different but many rural communities, including those in the Ohio Valley, share the challenge of providing services when there are lots of miles between people and providers.

Underserved, Overlooked

Historically, much of the research on domestic violence and sexual assault has centered on urban areas. But a study published in the Journal of Women’s Health shows that women in rural areas suffered a higher rate of intimate partner violence than their urban counterparts.

Not only is there more violence, it is less frequently reported. A 2016 report from the Justice Department noted that in rural areas only 41 percent of violent crime and 47 percent of serious violent crimes (defined as rape or sexual assault, robbery, and aggravated assault) are reported to the police.

An earlier study explored reasons that people did not report these crimes: it was considered a personal matter; such an assault was not considered important enough to report; victims felt the police would not or could not help; and victims fear of reprisal or getting the offender into trouble.

These findings are not news to McWilliams or Gray, who between them have nearly 50 years of experience in dealing with domestic violence and sexual assault in rural communities.

Rural Similarities

Eileen Recktenwald is executive director of the Kentucky Association of Sexual Assault Programs. She said access to quality care has been an issue for the 35 years she has been an advocate. She said she could see a telehealth program working in the Ohio Valley.

Already, she said, younger people, especially ages 18 to 24, are seeking services in a different way. “They are much more electronically inclined and access services via chat or the internet,” she said.

Eileen Recktenwald of the Kentucky Association of Sexual Assault Programs. Photo: Mary Meehan, Ohio Valley ReSource

Rural communities don’t all look the same. Wyoming’s wide open spaces, as people there like to say with some pride, make it one of only two states determined to be not only rural but uber-rural, or “frontier.”  (The other frontier state being Alaska.)

But there are similarities between the plains in the west and rural parts of Kentucky, West Virginia, and Ohio.

Recktenwald said most rural parts of America share some common traits. They also have similar barriers to mental health care because they lack services and providers, face transportation barriers, and have cultural factors that can cause social stigma to be amplified.

Graphic: Alexandra Kanik, Ohio Valley ReSource

Telemedicine, as a whole, is becoming a routine part of healthcare. According to a recent report from the American Hospital Association, 76 percent of hospitals offer some kind of telehealth service. Last year, the Veterans Association launched a telehealth initiative for service members with PTSD.

But as Gray points out, the best ways to approach rural women and combat veterans are not the same. And, he said, there are other things to consider.

Why Wyoming

Gray went to college to be a dentist but soon found a passion for psychology and has specialized in sexual abuse and domestic violence for more than 20 years. With a dark beard and an easy smile, he’s the kind of guy who frequently says, “that’s a great question,” yet manages to always sound sincere.

Matt Gray, a professor at the University of Wyoming in Laramie. Photo: Mary Meehan, Ohio Valley ReSource

The university’s information technology department first brought the idea for a telehealth clinic to him. They had received grant money for telehealth but couldn’t find the right focus.

Gray said he was a little worried at first that he wasn’t tech savvy enough to oversee a digital operation. Now he rolls with the lingo.

“It was a matter of having them help set up a polycom unit that is secured and encrypted video conferencing at the distal site,” he said.

Translated, that means there is a secure computer in one place that connects to the same in the other. Those computers can only talk to each other and no one else can listen. Securing privacy is a key element given the subject of the conversations that will take place on these links.

The first clinic was in Rawlins, a town of just under 9,000 people. Rawlins already offered domestic abuse services but not therapy. Gray said only one or two clients in Rawlins access telehealth each year. Some clients come from the state’s biggest city, Cheyenne, but most come from Gillette.

Gray said he had some reservations in the beginning as to whether the person-to-person experience of counseling could be replicated in a remote and mediated setting. His research shows the clients are often more satisfied with their experience than are the therapists.

“The baseline is different because the client isn’t comparing the telehealth experience to previous counseling,” he said. For them, he said, “it’s how does this compare to getting nothing at all, which would be the only alternative.”

Student Help

Another important piece is the graduate students who make up the therapy team.

Two current team members are Kendal Binion from Georgia and Stephanie Amaya from Los Angeles.

Kendal Binion, part of the graduate student therapy team. Photo: Mary Meehan, Ohio Valley ReSource

After working together closely for two years, they frequently laugh in unison and finish each other’s sentences. It is a bound forged, they said, in doing the difficult work of providing therapy to rural survivors of sexual assault and domestic violence.

Binion said she applied to the program while working as a hospital advocate where she helped connect clients to services but didn’t provide therapy.

“What I saw was a lot of victim-blaming from not only medical providers and police officers, but from family and friends,” she said. “And I really wanted to reach out and go beyond advocacy.”

Binion gets tears in her eyes as she talks about one Wyoming client who made a lasting impression. The woman had kept the secret of her assault to herself for decades, telling no one.

“All of these cases are hard, but to have someone who had the added pain of no support,” Binion said, “it was also exceptionally hard to hear that it was for 40 years.”

Amaya said she’s been inspired by her clients. “They are the ones making those steps first,” she said.

Those first steps involve escaping the extensive control exerted by the partner. That can include, she said, the lack of access to money, the lack of the ability to leave the house, threats to take away children, and the very real possibility of additional physical or sexual violence.

The geographic isolation of a rural setting can compound those effects, she said.

“Part of that cycle of violence is isolation that the perpetrator tries to inflict on the victim, whether that be from family or from resources,” Amaya said. “And geographic isolation just really fits perfectly into that model.”

But she said therapy can work even if it is happening across a computer network instead of across the room.

“I found that human connection is transcendent,” she said. “It doesn’t depend on proximity. It depends on empathy, and a willingness to share and to open up and to support someone who needs that support.”

Finding Funding

Telehealth is not the perfect solution in rural areas, Gray said. First, there’s the question of funding.

“It goes without saying that in terms of getting dollars in resources for sexual assault and domestic violence, no matter what kind of service you’re trying to provide, that’s a really hard thing to do,” he said.

Matt Gray,
left, and trauma treatment students on a hiking field trip. Photo: Courtesy Univ. of Wyoming

Plus, he said, most available grant money is tied to innovative uses of technology for a limited number of years. There is less funding available to sustain the work of treating trauma.

There are plenty of other rural communities that would benefit from such a program, he said. But there is also a limited number of appropriate therapists-in-training. His program can serve about 20 to 25 clients at a time. Those clients receive, on average, 12 to 15 sessions.

What you don’t want to create, he said, is a service with a far reach but a long wait time.

He said that to tell a domestic violence or sexual assault victim “’we can get you but it is going to be two or three months’ is highly problematic.”

The goal of the current team is to contact a client within the first 48 hours after the first report and to have the first session with the client within 96 hours.

The need for more services, he said, is always there. “Unfortunately up until very recently mental health services has been deemed kind of a luxury,” he said.

Even the rate of sexual assault and domestic violence is not well understood in the broad community, Gray said.

He conducted a study of 2,000 University of Wyoming students on incidents of sexual misconduct, partner violence, domestic violence, sexual harassment, and stalking. The study found 27 percent of students had experienced sexual abuse. People outside of the field of study might find the results “eye popping,” he said, but “while they are tragic, they are not atypical.

“So, I do think we still have this disconnect between people who recognize how common this is — and that’s been replicated again, and again, and again — versus people who are just finding out about the magnitude of this problem for the first time,” he said.

Margie McWilliams,
left, and Shawna McDonald seen
on a telemedicine link. Photo: Mary Meeha, Ohio Valley ReSource

A #MeToo Effect

McWilliams has been at the Gillette Abuse Rescue Foundation for most of its three decades. Shawna McDonald has worked there for 15 years.

The two women are self-described left-leaning advocates in a deeply red community. They are carrying on work that began when “host families” took in victims of domestic violence in private homes back in the 1970s.

They said getting survivors into the building so they can use the telehealth service involves pushing back against cultural norms that encourage silence.

Gillette is a boom town dependent on the cyclical nature of the energy business. Because of that, the locals welcome outsiders out of economic necessity. But that has its limits, McWilliams said.

McDonald said the families that came to the region generations ago, called the “homesteaders,” still hold political sway.

“We always we call it the Good Ol’ Boy system here because, you know, men run our government.”

She said when a female GARF board member recently talked about running for a county office, one male elected official told her “we won’t be letting any little ladies” win elections.

But, they said, #MeToo is having an effect, even out on the high plains. McWilliams said they are seeing more young people seeking help.

There is something else, a cultural shift that is both quiet and broad. In January about 60 people turned out for a Women’s March in Gillette. McWilliams and McDonald said that kind of support matters.

“So to me that was a big thing that’s changed. We’ve never had that many people involved before. And of course, we got the trucks that drove by and you know flipping people off,” they recalled in unison. “But it was cool because nobody cared. We were just there for a reason and we have seen an increase in our services and sexual assault victims are coming in.”

People from more rural parts of the state came to the march. That included two moms who brought their daughters from the next town over, Sheridan. It’s 104 miles, one way.

Support for this story came from the Solutions Journalism Network. This article was originally published by Ohio Valley ReSource.

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West Virginia Coal Miners Rally For Black Lung Legislation

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Photo: Perry Bennett, WV Legislative Photography

Miners and advocates rallied Wednesday at the West Virginia Capitol in support of a series of bills aimed at preventing and treating severe black lung disease.

Five bills introduced by lawmakers would make it easier to make qualify for state benefits and provide benefits to miners who have early-stage black lung.

The bills come at a time when the Ohio Valley is facing a surge in cases of severe black lung disease, also called Progressive Massive Fibrosis.

“We’re here because so many of the people that’s worked years and years years, 30, 35 years in the mines, and been exposed to coal dust their whole life and they fall through the cracks,” said Terry Abbott, president of United Mine Workers of America Local 8843, which represents miners in West Virginia’s Fayette and Kanawha counties.

A miner is tested for lung function and signs of black lung disease. Photo: Coal Miners Respiratory Clinic

We’re here to support all the miners that should be receiving compensation for the the years they put in the mines.”

Black lung is caused by exposure to coal dust and the debilitating and progressive disease has no cure. The state and federal government both have benefits systems that allow miners to make a claim against their employer for medical expenses and a small stipend.

Advocates and miners argue access to health and financial benefits increases the likelihood sufferers can seek medical treatment.

Getting those benefits through federal or state programs can be challenging, and recent changes on the state level has  made it tougher for miners to qualify.

Obstacles To Benefits

Kentucky lawmakers last year eliminated radiologists from the process miners use to qualify for benefits. In West Virginia, a decision by the state Supreme Court made it harder for miners to file a claim.

Now, advocates for black lung victims are rallying behind new legislation in West Virginia which they say can help sick miners. Kentucky representatives have also proposed a bipartisan bill that would repeal the state’s 2018 law that limits which doctors can evaluate black lung workers compensation claims.

One bill in West Virginia with bipartisan support is Senate Bill 260. Co-sponsored by two doctors, it would change the law to allow miners to receive partial disability awards if they are diagnosed with the disease. Miners diagnosed with early-stage black lung would qualify for 20 weeks of benefits.

Members of the Southeastern Kentucky Black Lung Association light candles in memory of those lost to the disease. Photo: Benny Becker, Ohio Valley ReSource

Miners would only have to have X-rays that show the presence of severe black lung disease, not a diagnosis that the disease has yet impacted their health.

Supporters of the bill argue that because black lung is progressive, there is no doubt symptoms will worsen. Providing some benefits to miners early on may boost their ability to seek treatment or assist in re-training to allow early career miners to find other employment and limit coal dust exposure.

Benefits Boost

Another bill, Senate Bill 144, would create a state black lung program that would provide $300 in monthly benefits for West Virginia miners with at least 10 years of coal dust exposure.

“We want to simplify the black lung program here in West Virginia, so the state can take care of its own, give them what they’re due, what they’re entitled to and what they’ve worked for,” said Charles Dixon, with UMWA Local 1440 in Matewan, West Virginia.

He was one of dozens of miners who rallied at the Capitol Wednesday in support of the black lung bills.

A third bill, House Bill 2588, would challenge the recent West Virginia Supreme Court decision that made it harder for miners to file a state workers’ compensation case. It stipulates a person seeking an evaluation from the state Occupational Pneumoconiosis Board can do so at any time regardless of the time limits set to file a claim and that insurance carriers must pay for the exam.

The bills have not yet advanced to a floor vote.

Dave Mistich of ReSource partner station WVPB contributed to this story. This article was originally published by Ohio Valley ReSource.

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