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Increasingly hotter temperatures threaten the environment and pose serious risks to human health. From contending with damaged crops and loss of work due to extreme weather to working in life-threateningly hot and humid temperatures, agricultural farmworkers are on the front lines of this harsh reality., (©2020 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.)

Over the past century, anthropogenic activities have resulted in high levels of greenhouse gases in our environment, creating a warming effect on the Earth. As a result, global temperatures have risen, shifting climatic zones, influencing weather patterns, and intensifying storms. These changes include heavy precipitation, drought, wildfires, hurricanes, heat waves, and coastal flooding. The impacts from this climatic activity continue to contribute negatively to our environment while influencing human health.In this special issue of the North Carolina Medical Journal , authors from universities, governmental agencies, and not-for-profit organizations address how the global impacts of climate change are affecting the health of communities across our beautiful state. This issue offers our readers research and real-life stories that underscore the need for keeping the issue of climate change at the forefront of public health for North Carolina. The information provided in these articles gives policymakers and health care providers a deeper understanding of the public health implications and challenges of climate change while highlighting the health risks to our most susceptible populations.Because there are no direct clinical symptoms or signs, the effects of climate change are difficult to assess at the individual level. However, an abundance of peer-reviewed climate health research studies provides overwhelming scientific evidence that climate change is impacting population health with generalizable results. Mitigation and adaptability strategies are necessary for reducing carbon emissions and building climate-resilient communities. Policymakers and health care providers are in key positions for educating others, helping protect our planet, improving health outcomes, and moving North Carolina toward more sustainable solutions., (©2020 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.)

BACKGROUND Recognizing that health outcomes are associated with climate threats is important and requires increased attention by health care providers and policymakers. The primary goal of this report is to provide information related to the public health threats of climate change, while identifying climate-sensitive populations primarily in rural, Eastern North Carolina. METHODS Publicly available data was used to evaluate regional (eg, Eastern, Piedmont, and Western) and county level socio-vulnerability characteristics of population groups in North Carolina, including: percent of persons living in poverty, percent of non-white persons, percent of persons under 18 years living in poverty, percent of elderly people living in poverty, percent of persons with a disability, and number of primary care physicians. One-way ANOVA was used to calculate and compare mean value estimates of population socio-vulnerability variables in Eastern North Carolina with Piedmont and Western regions. RESULTS Across all regional categories, the eastern part of the state had considerably higher averages than the state for percent of persons living in poverty (17.2%), percent of non-white persons (13.3%), percent of persons under 18 years old living in poverty (24.9%), percent of elderly people living in poverty (10.0%), and percent of persons with a disability (13.3%). Overwhelmingly, more counties in Eastern North Carolina had fewer primary care physicians (per 10,000 persons) than the state average (8.6 per 10,000 persons). CONCLUSION Eastern North Carolina has a disproportionally higher percent of population groups that are vulnerable to the threats of climate change. The need for health care providers to understand and communicate the challenges faced by rural, vulnerable population groups is of great public health importance. Communicating these health risks to policy makers is of equal importance., (©2018 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.)

BACKGROUND The purpose of this study was to compare asthma-related emergency department (ED) visit rates across North Carolina. Results from this study can inform health planning while helping public health and health care professionals in identifying geographical areas and targeting age groups to reduce the asthma burden in North Carolina. METHODS This was a retrospective data analysis between 2010 and 2014 among North Carolina patients presenting to an ED with a first or second listed diagnosis code related to asthma (ICD-9-CM, 493.xx). Data was obtained from the North Carolina Disease Event Tracking and Epidemiology Collection Tool. Annual, age-adjusted rates were standardized to the 2000 US standard population using the direct method. Repeated measures ANOVA was conducted to compare differences between mean values of asthma-related ED visit rates in regions, urbanicity, and age groups across years. RESULTS Asthma ED rates were consistently higher in the east (85.1 per 10,000) compared with other regions. While most age group ED rates fluctuated over the study period, univariate test results indicated statistical increases in ED asthma visits among the groups aged 5 to 9 years ( P < .01), and 65 and over ( P < .03). CONCLUSION Public health officials should recognize the disproportionate burden of asthma-related ED visits, particularly among rural and impoverished counties in the eastern portion of North Carolina when prioritizing health concerns across North Carolina., (©2018 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.)

BACKGROUND Inmates face challenges upon release from prison, including increased risk of death. We examine mortality among former inmates in North Carolina, including both violent and nonviolent deaths. METHODS A retrospective cohort study among former North Carolina inmates released between 2008 and 2010 were linked with North Carolina mortality data to determine cause of death. Inmates were followed through December 31, 2012. Mortality rates among former inmates were compared with deaths among North Carolina residents using standardized mortality ratios (SMRs). RESULTS Among former inmates (N = 41,495), there were 926 deaths during the study period. Compared to the North Carolina general population, SMRs were higher for all-cause mortality for total deaths (SMR = 2.10, 95% CI: 1.97-2.24), heart disease (SMR = 4.45, 95% CI: 3.64-5.34), cancer (SMR = 3.92, 95% CI: 3.34-4.62), suicide (SMR = 14.46, 95% CI: 10.28-19.76), and homicide (SMR = 7.98, 95% CI: 6.34-10.03). DISCUSSION The death rate among former North Carolina inmates is significantly higher than that of other North Carolina residents. Although more research is needed, identifying areas for interventions is essential for reducing the risk of death among this population., (©2017 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.)

Background: Agriculture is a hazardous, stressful occupation that can adversely affect farmers' health. Identifying stressors among farmers may help health professionals improve health outcomes by developing targeted intervention strategies and services., Methods: Over a 4-month period, we conducted a cross-sectional study of 128 farmers in an economically disadvantaged, 29-county region of Eastern North Carolina. We used a modified version of the Farm Ranch Stress Inventory to measure farmers' self-reported reactions to potential stressors., Results: The majority of farmers surveyed were aged 40-59 years, had farmed for more than 20 years, and worked more than 40 hours per week on the farm. Large proportions of respondents identified the following factors as 'very stressful': concern about the weather (60.2%), concern over the future of the farm (29.7%), outsiders not understanding the nature of farming (25.2%), problems with machinery (23.4%), market prices for crops/livestock (45.3%), taxes (38.3%), health care costs (32.5%), and not having enough time to spend with family in recreation (13.3%). Experiencing 8 or more factors as "very stressful" was found to be positively associated with working more than 40 hours per week on the farm (P = .008) and with being a farm manager or a farm worker who does not operate equipment (P = .001)., Conclusions: Information about perceived stressors among farmers may help health professionals develop targeted interventions for reducing stress. More research is needed to better evaluate health outcomes, to reduce farm-related injuries, and to improve psychosocial well-being.

Objective: Our objective was to characterize nonfatal injuries, by age groups, that were seen in emergency departments (EDs) in 29 selected counties in Eastern North Carolina following Hurricane Irene., Methods: A descriptive evaluation using data from the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) was performed to identify the numbers and types of nonfatal injuries among individuals who sought treatment at hospital EDs. Percentages of reported ED visits related to external injuries in the 7 most severely impacted counties were compared with results in the entire 29-county region and with data from a reference period in 2010., Results: The total number of individuals who sought treatment at an ED for an external cause of injury was 22.3% greater during the week following Hurricane Irene than during the 2010 reference week. In the 29-county region, the increases were primarily due to falls; in the 7-county region, they were primarily due to cutting and piercing incidents. Following the storm, injuries related to falls, adverse effects of health care, or being struck by an object accounted for higher proportions of injury-related ED visits in the 7-county disaster region than in the 29-county region., Limitations: The inability to identify the patient's home address and the county where treatment was sought was a spatial limitation. Furthermore, data for urgent care visits, primary care doctor visits, and injuries treated at home were not included. Additionally, cautious inference should be made to distinguish between injuries that occurred as a direct result of the storm and those that occurred incidentally., Conclusion: Data from NC DETECT can be used to estimate the most common types of injuries seen in EDs following a natural disaster.