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Background: Research has demonstrated that common chronic conditions, especially those related to cardiovascular health, are important risk factors for severe COVID-19 symptoms or hospitalization. Population prevalence rates of such conditions have not previously been examined in relation to COVID-19 case fatality rates in the Central Appalachian region. Purpose: This study examined prevalence rates of selected chronic conditions and COVID-19 case fatality rates to determine whether the relationship between them is consistent across Appalachian and non-Appalachian regions of Kentucky. Methods: Data from Kentucky’s Behavioral Risk Factor Survey (KyBRFS) were used to calculate prevalence rates of asthma, diabetes, influenza vaccination, hypertension, obesity, having a personal doctor, physical inactivity, and cigarette smoking. Publicly available COVID-19 case and death counts by county were used to calculate incidence and case fatality rates. Units of analysis were 41 single- and multi-county areas developed to visualize KyBRFS prevalence rates. Analysis included t-tests to compare Appalachian and non-Appalachian regions, and correlations characterizing associations between COVID-19 case fatality and rates of chronic conditions and behaviors. Results: Incidence and case fatality rates for COVID-19 were slightly lower in the Appalachian region, but not significantly. Significant correlations between COVID-19 case fatality and the prevalence of chronic conditions and behaviors were more common in the non-Appalachian region. Implications: Case fatality rates in Appalachia appear lower than expected, given the high prevalence of important chronic conditions and behaviors known to be associated with poor COVID-19 outcomes. This phenomenon merits further research and should be considered by public health researchers when examining COVID-19 outcomes in Kentucky and neighboring states., Copyright © 2021 W. Jay Christian

Across the United States, physicians are prescribing patients nature. These "Nature Rx" programs promote outdoor activity as a measure to combat health epidemics stemming from sedentary lifestyles. Despite the apparent novelty of nature prescription programs, they are not new. Rather, they are a reemergence of nature-based therapeutics that characterized children's health programs in the late 19th and early 20th centuries. These historic programs were popular among working-class urban families, physicians, and public health officials. By contrast, adherence is a challenge for contemporary programs, especially in socially disadvantaged areas. Although there are differences in nature prescription programs and social context, historical antecedents provide important lessons about the need to provide accessible resources and build on existing social networks. They also show that nature-and its related health benefits-does not easily yield itself to precise scientific measurements or outcomes. Recognizing these constraints may be critical to nature prescription programs' continued success and support from the medical profession.

This paper examines a pivotal moment in the history of the built environment in America. At the beginning of the twentieth century, factions within the American paint industry fought in state and federal legislatures over the definition of paint: What was pure paint? Were new paint formulations to be encouraged, or labeled “adulterated”? Was the known toxicity of lead to be a consideration? Despite some opponents' recourse to a rhetoric of toxicity and public health, all sides agreed that the best paints contained a significant quantity of lead, and that government should stay out of setting industry standards. This accord all but assured that Americans would apply tons of lead paint on the walls of their homes.

aLate in 1935, Alice Hamilton, who a generation earlier had done more than any other government-sponsored researcher to expose and ameliorate industrial lead poisoning, wrote to Martha May Eliot, assistant chief of the U.S. Children’s Bureau. 1 A young friend of Hamilton’s, a new mother married to a third-year medical student at Harvard, had asked Hamilton how to be sure that paint on baby furniture was lead-free. Although Hamilton had always assumed “that furniture and toys were painted with enamel paint, lead-free,” the Bureau of Standards informed her that in fact many enamel paints contained lead. Hamilton’s purpose in writing Eliot, then, was to urge “that tests would have to be made of furniture paints and toy paints,” and to suggest who should take on this task: “Do not you think that it is an important question and that it lies within the field of the Children’s Bureau?” No such investigation was ever undertaken by the Children’s Bureau, the federal agency charged with advocating for “the welfare of children and child life among all classes of our people.” 2