This document summarizes resources for conducting research on rural populations in Virginia. It identifies several key public data sources for studying chronic disease in central Appalachia, including the Appalachian Regional Commission, Centers for Disease Control and Prevention, and various state-level sources. It also describes a case study using Virginia College of Osteopathic Medicine's study of chronic health conditions in central Appalachia as an example. This involved collecting both primary data through medical record reviews and secondary data from sources like the U.S. Energy Information Administration and Virginia Department of Health. It concludes by discussing future directions for continuing this research.

1. Finding Research Data Sources for
Populations in Rural Virginia
Rural Resident Research Symposium
UVA-Wise, April 28, 2015
Susan L. Meacham, PhD, RDN
Professor of Nutrition
Discipline of Family Medicine, Preventive Medicine and Public Health

2. “The Question”
Where do I find data on rural populations
to answer hypothesis driven
research questions?
Appalachia, VA
Lewisburg, WV

3. Public Data Sources for Chronic Disease Study in Central Appalachia, Virginia
Appalachian Regional Commission, http://www.arc.gov/
Centers for Disease Control and Prevention, http://www.cdc.gov/
County Health Rankings and Road Maps, http://www.countyhealthrankings.org/
National Center for Health Statistics, http://www.cdc.gov/nchs/
U.S. Energy Information Administration, http://www.eia.gov/,
Virginia Cooperative Extension, http://www.ext.vt.edu/
Virginia Department of Health, http://www.vdh.state.va.us/
Virginia Diabetes Council, http://www.virginiadiabetes.org/
Virginia Rural Health Association, http://vrha.org/
Virginia Tobacco Indemnification and Community Revitalization Commission,
http://www.tic.virginia.gov/

4. Presentation learning objectives
 Identify primary and secondary sources of data
 Recognize the procedures needed to obtain approvals to
use personal record information in research
 Locate common sources of county, district and state
level data for rural populations
“Case study” - VCOM’s Study of Chronic Health Conditions
in Central Appalachia
Funding source: “This study is sponsored by Initiative for Environmental Science
(ARIES). ARIES is an industrial affiliates program at Virginia Tech, supported by members that
include companies in the energy sector. The research under ARIES is conducted by independent
researchers in accordance with the policies on scientific integrity of their institutions. The views,
opinions and recommendations expressed herein are solely those of the authors and do not
imply any endorsement by ARIES employees, other ARIES-affiliated researchers or industrial
members. Information about ARIES can be found at http://www.energy.vt.edu/ARIES.”

5. Quick review of human research process*
I. Literature Review (thorough)
1. PubMed, BioMed, Central (free),Clinical trials.gov
2. CINAHL (Cumulative Index to Nursing and Allied Health)
II. Type of research
1. Meta-analysis, Case study or
2. Hypothesis driven vs descriptive report
1. Clinical or Basic science
2. Qualitative (ex: oral histories) or quantitative
3. Plan for statistical evaluation, i.e., power analysis
*Research, def. = “careful or diligent search”, is not necessarily
slow – but deliberate! Encourage team to be patient…

6. Quick review of human research process
III. Approvals (research is published, adds to body of
knowledge; other communications ‘reports’)
1. Certification of training in the protection of human
subjects* (NIH, CITI) for personnel
2. Institutional Review Board (IRB) approval for protocol
3. Possibly also:
a. Joint or reliance agreement IRBs with partners,
- HIPAA privacy compliant if medical record reviews
b. Business and regulatory agreements, etc.
*subjects vs patients vs clients
IV. Network

7. Network - access local offices, knowledgeable persons

8. VCOM ARIES Study
I. Primary sources of data:
A. Data collected, are original and collected for the first
time by the researcher –
a. Ex: surveys, record reviews, measurements
b. Limitations – approvals, costs, time/labor, field
visits
II. Secondary sources of data:
A. Data collected by someone else for their purposes
a. Ex: Cancer, Heart, Diabetes organizations, Health
Dept., Appalachian Regional Commission, etc.
b. Limitation – may not capture everything you want

9. VCOM Study Information Extracted
I. Outputs – from primary and secondary
A. Demographic data
a. Gender, age (> 18 adults only)
b. Geographic – state, health districts, county, zip codes,
distressed areas, latitude/longitude of residence
c. Temporal - Longitudinal (over 50 yrs, 1960-2012)
Cross sectional (point in time, 2011/2012)
d. IDC codes for conditions of interest
e. Personal/Family histories
f. Lifestyle-smoking, physical activity, alcohol, drug use
g. Environment – coal, air, water, soil, fast food, access to care

10. 1980
1980
2008
VA total
Buchanan County
Wise County
(Taber VCOM OMS II, AOF Nominee)
Source: U.S. Energy Information Administration, Government
Coal production in Southwest VA, 1980 - 2008

11. 1980
Tobacco production trends in VA, 1980 - 2008
Gordon Groover, PhD, Virginia Cooperative Extension,
Department of Agricultural and Applied Economics, 2012

12. Geographic areas in VA
Regional Data
Poverty
Percentage (%)Diabetes Obesity
Southwest (SW), Southside (SS), Eastern VA
Source: Virginia Rural Health Association,
Data Portal, 2012 (discontinued)

13. Environmental/Economy data –
1999-2012 - Tobacco commission gave $458.5 million to farmers;
Communities given $131 mil for agribusiness,
education, economic development,
added research and development.
VA counties in Appalachian Regional Commission,1963 (left)

14. All cause age-adjusted mortality rates for males and
females in SW and SS VA plotted for each decade,
1960-2012 (95% CI)(VCOM, VDH, UPITT).
Results: County Data, Aggregated by decade
Males
Females
What went ‘right’ in tobacco counties?

15. Diabetes Trends US, VA and Appalachian VA
http://www.cdc.gov/diabetes/statistics/prev/national/figageadult.htm
A. Snyder, OMS III, VCOM Summer Research Award, 2012; AOF Nominee
7.6
20.9
VA Adult (%) Diagnosed Diabetes,
1994 – 2011, CDC
US Adults (%) Diagnosed Diabetes,
1980–2011, CDC
Virginia Diabetes Association, State Plan for Diabetes Management 2008=2017

16. VDH Vital Statistics
Birth Defects Data
1998
http://www.vdh.virginia.gov/HealthStats/stats.htm
Similar data, different outcomes presented

17. County Data, secondary
Coal
(N=8)
Mean + SD
Tobacco
(N=12)
Mean + SD
Compare
(N=12)
Mean + SD
VA
total
Air Quality 12.7 + 0.3 12.7 + 0.3 12.9 + 0.2
12.7
Water
Violations
6.4 + 15.4 4.0 + 11.5 + 18.9
6
Poor Mental
Health Days
4.0 + 1.1 4.4 + 4.5 + 1.2 3.1
Mental Health
Provider Ratio
5005 + 2093 93297 + 4298 + 6277
1027
Motor Vehicle
Crashes
26.6 + 9.3 23.6 + 6.7 21.3 + 4.7 11
VCOM Environmental Factor Results –
note variability and large standard deviations

18. Facility #1 Coal – Dependent Community Hospital
Chronic Disease < 99%
Male/Female 52%/47%
Caucasian 99%
Coal Miner 31%
Individual Data, primary
VCOM Phase III Preliminary Results
Electronic Medical Record Review (EMR)
N = 200 records from 2012 admissions, systematic randomization

19. Diagnosis Confirmed bySelected Clinical Condition
Numbers of Records
Phys’
Note
ICD #
Lab
Results
Clinical
Exam
Diabetes Mellitus (ICD9, 250) 62 62 62 61
Other Metabolic and Immunity
Disorders (ICD9, 270-279)
111 110 111 108
Mental Disorders (ICD9, 300-316) 96 92 64 92
Ischemic Hrt Dis (ICD9, 410-414) 66 65 66 65
Chronic Bronchitis (ICD9, 491) 86 85 83 85
Other ICD 9 Codes… 155 153 151 149
VCOM EMR Diagnosis Confirmation
Individual Data

20. EMR review will provide individual level data and location
information with improved geographic specificity, to
provide for improved future health care programming.
VCOM Phase III Outcome expected
Visualization of data

21. I. Visualization and data display
a.Figures/Tables
b.Maps
c. Video
(from D. Meisha, VCOM, Research Statistician)
http://www.bing.com/videos/search?q=TED%20TALK%20DATA%20VISUALIZAITION%20OF%20COUNTRY%20POPULATION%20CHA
NGE&qs=n&form=QBVR&pq=ted%20talk%20data%20visualizaition%20of%20country%20population%20change&sc=0-29&sp=-
1&sk=#view=detail&mid=1D351C9B4D1BE67595361D351C9B4D1BE6759536

22. Summary of Future Directions for VCOM
Phase III complete continuing medical record reviews with:
- established relationships in hospital facilities
- geographic, rural, economic comparable disparate health
areas of southern and eastern VA
- further study of VA – WV prevalence rates of chronic
disease, i.e. income comparisons
- expand study of physical environment factors; focus on
air, soil and water quality and links to biochemical
mechanisms
- continue focus on VDH birth data proposal
- continue focus on mental health

23. Conclusions/Discussion
Our current data confirms inadequate evidence to
support previous publication results on MTM effects on
chronic conditions
Need for multidisciplinary, collaborative approaches to
study mechanisms of cause – effect relationships
Need to know what’s ‘right’ in positive trends in health
disparities

24. - Medical facilities administration and staff!
- VCOM Students
- VCOM OMS III 2015 – A. Snyder, Elective Summer Research
- VCOM OMS II 2016 – T. Taber, A. Whitener, D. Metzger
- VCOM OMS I 2017 – Katie Kennedy, Kristy Atkinson
- Western Illinois University – C. Goessl, Public Health Intern, VT PH - C. Hall
- VCOM Staff – Calvin, Kelly, Angie, Annette….etc…
- Development/Outreach – D. J. Sutphin, M. Harris, L. Liechtner, M. Breeding, K. Yancy
- Office of Research – K. Nicewander, G. Reaves, D. Bennett,
- NCAHD – A. Peton, S. Richards , K. Price
- VRHA – B. O’Connor
- OMNEE staff – W. Stevens, T. Maddy, J. Lucas
- VCOM Faculty (DO/MD/PhD/DVM/DDS)
- S. Sukpraprut, R. Hendershot, S. Olgun, H. Misra, J. Mahaney, D. Meisha
- VCOM Administration, D. Tooke-Rawlins, J. Mahaney, D. Sutphin
- ARIES, VA Center for Coal /Energy Research, M. Karmis, J. Craynon
- Virginia Department of Health – D. Woolard, C. Reynolds, J. Rainey
- University of Pittsburgh, J. Buchanich, E. Talbott, A. Potter
Acknowledgements
Thanks to all !