scholarly journals 2433

2017 ◽  
Vol 1 (S1) ◽  
pp. 41-41
Author(s):  
Solomon Abiola ◽  
Olaoluwa Akinwale ◽  
Earl Dorsey ◽  
Henry Kautz
Keyword(s):  
Infectious Disease ◽  
Developing Countries ◽  
Chronic Disease ◽  
Real Time ◽  
Chronic Diseases ◽  
The United States ◽  
University Teaching ◽  
Sedentary Behaviors ◽  
Mobility Patterns ◽  
Study Population

OBJECTIVES/SPECIFIC AIMS: This study sought to develop a mHealth application which was capable of predicting the spread of infectious diseases during the height of the Ebola outbreak in Lagos, Nigeria. Following the success of this primary task, the research then sought to understand behavioral health issues which are indicative of chronic diseases, such as sedentary behaviors and where they occur at a geospatial level in real-time. The results of this study are now being used to develop a larger scale 500 person study in Rochester, NY, USA. METHODS/STUDY POPULATION: During a 3-month period individuals were asked to install a mobile health application known as Node onto the their android device. Consent was done remotely, individuals were recruited through the Lagos University Teaching Hospital, Nigeria Institute of Medical Research, and the University of Lagos. Participants were paid 50 USD/month for each month of study completion, while continuous location data was collected in addition to survey information about participants. RESULTS/ANTICIPATED RESULTS: During the study period 70 individuals enrolled, using this data we were able to create network based models which indicated that diseases were more likely to spread at the beginning of the week, and also indicated who would be most susceptible to being patient zero. In phase 2 we have started to look at behavioral patterns to determine the risk of chronic disease among our study population, by examining their human mobility patterns, since we can determine average sleep patterns, activity patterns using machine learning classifiers, and time spent in traffic—all of which we can visualize in a real-time geospatial manner with higher objectivity than traditional mechanisms for data collection. DISCUSSION/SIGNIFICANCE OF IMPACT: In developing countries, using Nigeria as our example most chronic disease and household studies only enroll a few thousand participants for a country numbering 150 million plus. Using our rapidly available application we were able within 1 week to enroll 70 participants on 1 year of funding, this creates a framework for larger scale public health studies which can be done in developing countries and also demonstrates the value in mHealth which can both answer questions of infectious disease and chronic diseases at the same time. Our results indicate that at an infectious disease level in city environments diseases may be prevented by targeting events early in the week. While at a chronic disease level the lack of reliable power results in less sedentary behavior as individuals seek locations to charge phones, while those with more stable western-like lifestyles have started to exhibit the conditions which cause such outcomes as obesity, which has begun to rise in developing countries. Ultimately, these results serve as a staging point to launch a more wide scale study both in the United States and Nigeria within the year, now that feasibility has been established.

scholarly journals Trends in dietary patterns of Latin American populations

2003 ◽  
Vol 19 (suppl 1) ◽  
pp. S87-S99 ◽  
Author(s):  
Odilia I. Bermudez ◽  
Katherine L. Tucker
Keyword(s):  
Infectious Disease ◽  
Chronic Disease ◽  
Chronic Diseases ◽  
Food Consumption ◽  
Latin American ◽  
Consumption Patterns ◽  
Animal Products ◽  
Developmental Transitions ◽  
Dietary Changes ◽  
Total Fat

It is important to characterize the level and magnitude of changes in food consumption patterns in Latin American populations as they undergo demographic and developmental transitions because of the effects of such changes on the development and progression of chronic diseases. This paper examines trends in food intake across regions in Latin America. Although trends in apparent food consumption differ in magnitude and timing, the overall patterns of change are remarkably consistent. Intakes of total fat, animal products, and sugar are increasing, even while there have been rapid declines in the intake of cereals, fruit, and some vegetables. The costs of the increased prevalence of chronic disease associated with these dietary changes are already affecting health systems still coping with malnutrition and infectious disease. Because this pattern of change is predictable, it is important to learn from the experiences gained in countries that are more advanced in the transition. Efforts to educate the population on the importance of a healthy diet and to issue policies to improve the availability of a healthy food supply can help to reduce the rapid escalation of obesity and chronic diseases.

scholarly journals Device-assessed physical activity and sedentary behaviors in Canadians with chronic disease(s): findings from the Canadian Health Measures Survey

2018 ◽  
Author(s):  
Gabriel Hains-Monfette ◽  
Sarah Atoui ◽  
Kelsey Needham Dancause ◽  
Paquito Bernard
Keyword(s):  
Physical Activity ◽  
Chronic Disease ◽  
Sedentary Behavior ◽  
Chronic Diseases ◽  
Self Report ◽  
Sedentary Behaviors ◽  
Targeted Interventions ◽  
Canadian Health ◽  
Objectively Measured ◽  
Objectively Measured Physical Activity

Background: Physical activity and sedentary behaviors are major determinants of quality of life in adults with one or more chronic disease(s). However, there are no Canadian representative population-based studies investigating objectively measured physical activity and sedentary behaviors in adults with and without chronic disease(s).Objective: To compare objectively measured physical activity and sedentary behaviors in a representative sample of Canadian adults with and without chronic disease(s). Methods: Data were obtained from the Canadian Health Measure Survey (CHMS) (2007-2013). Physical activity and sedentary behaviors were measured using accelerometry in Canadians aged between 35 and 79 years. Data are characterized as daily mean time spent in moderate to vigorous physical activity (MVPA), light physical activity (LPA), and sedentary behavior, as well as steps accumulated per day. Chronic diseases (chronic obstructive pulmonary disease, diabetes, heart diseases, cancer) were assessed via self-report diagnostic or laboratory data. Four weighted multivariable analyses of covariance comparing physical activity and sedentary behavior variables among adults without and with one or more chronic diseases were conducted.Results: In the total, 6270 CHMS participants were included. Analyses indicated that 23.9%, 4.9% and 0.5% had one, two, and three or more chronic diseases. Adults with two or three and more chronic diseases had significantly lower daily duration of MVPA and LPA, lower daily step counts, and higher daily duration of sedentary behavior compared to adults with no chronic diseases, with low effect sizes.Conclusions: Canadian multimorbid adults might benefit from targeted interventions to increase physical activity and reduce sedentary behaviors.

scholarly journals Healthcare cost of patients with multiple chronic diseases in Singapore public primary care setting

2021 ◽  
Vol 50 (11) ◽  
pp. 809-817
Author(s):  
Shu Yun Tan ◽  
Kaiwei Jeremy Lew ◽  
Ying Xie ◽  
Poay Sian Sabrina Lee ◽  
Hui Li Koh ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Chronic Diseases ◽  
Healthcare Cost ◽  
Demographic Data ◽  
Healthcare Utilisation ◽  
Public Health Issue ◽  
Study Population ◽  
Per Capita ◽  
Multiple Chronic Diseases

ABSTRACT Introduction: The rising prevalence of multiple chronic diseases is an important public health issue as it is associated with increased healthcare utilisation. This paper aimed to explore the annual per capita healthcare cost in primary care for patients with multiple chronic diseases (multimorbidity). Methods: This was a retrospective cohort study conducted in a cluster of public primary care clinics in Singapore. De-identified data from electronic medical records were extracted from July 2015 to June 2017. Only patients with at least 1 chronic disease were included in the study. Basic demographic data and healthcare cost were extracted. A list of 20 chronic diseases was considered for multimorbidity. Results: There were 254,377 patients in our study population, of whom 52.8% were female. The prevalence of multimorbidity was 62.4%. The median annual healthcare cost per capita for patients with multimorbidity was about twice the amount compared to those without multimorbidity (SGD683 versus SGD344). The greatest percentage increment in cost was when the number of chronic diseases increased from 2 to 3 (43.0%). Conclusion: Multimorbidity is associated with higher healthcare cost in primary care. Since evidence for the optimal management of multimorbidity is still elusive, prevention or delay in the onset of multimorbidity in the general population is paramount. Keywords: Chronic disease, healthcare cost, multimorbidity, primary care

scholarly journals Automated Real-Time Collection of Pathogen-Specific Diagnostic Data: Syndromic Infectious Disease Epidemiology (Preprint)

2018 ◽  
Author(s):  
Lindsay Meyers ◽  
Christine C Ginocchio ◽  
Aimie N Faucett ◽  
Frederick S Nolte ◽  
Per H Gesteland ◽  
...  
Keyword(s):  
Infectious Disease ◽  
United States ◽  
Real Time ◽  
Large Scale ◽  
The United States ◽  
Molecular Diagnostic ◽  
Respiratory Pathogens ◽  
Test Results ◽  
Patient Privacy ◽  
Clinical Laboratories

BACKGROUND Health care and public health professionals rely on accurate, real-time monitoring of infectious diseases for outbreak preparedness and response. Early detection of outbreaks is improved by systems that are comprehensive and specific with respect to the pathogen but are rapid in reporting the data. It has proven difficult to implement these requirements on a large scale while maintaining patient privacy. OBJECTIVE The aim of this study was to demonstrate the automated export, aggregation, and analysis of infectious disease diagnostic test results from clinical laboratories across the United States in a manner that protects patient confidentiality. We hypothesized that such a system could aid in monitoring the seasonal occurrence of respiratory pathogens and may have advantages with regard to scope and ease of reporting compared with existing surveillance systems. METHODS We describe a system, BioFire Syndromic Trends, for rapid disease reporting that is syndrome-based but pathogen-specific. Deidentified patient test results from the BioFire FilmArray multiplex molecular diagnostic system are sent directly to a cloud database. Summaries of these data are displayed in near real time on the Syndromic Trends public website. We studied this dataset for the prevalence, seasonality, and coinfections of the 20 respiratory pathogens detected in over 362,000 patient samples acquired as a standard-of-care testing over the last 4 years from 20 clinical laboratories in the United States. RESULTS The majority of pathogens show influenza-like seasonality, rhinovirus has fall and spring peaks, and adenovirus and the bacterial pathogens show constant detection over the year. The dataset can also be considered in an ecological framework; the viruses and bacteria detected by this test are parasites of a host (the human patient). Interestingly, the rate of pathogen codetections, on average 7.94% (28,741/362,101), matches predictions based on the relative abundance of organisms present. CONCLUSIONS Syndromic Trends preserves patient privacy by removing or obfuscating patient identifiers while still collecting much useful information about the bacterial and viral pathogens that they harbor. Test results are uploaded to the database within a few hours of completion compared with delays of up to 10 days for other diagnostic-based reporting systems. This work shows that the barriers to establishing epidemiology systems are no longer scientific and technical but rather administrative, involving questions of patient privacy and data ownership. We have demonstrated here that these barriers can be overcome. This first look at the resulting data stream suggests that Syndromic Trends will be able to provide high-resolution analysis of circulating respiratory pathogens and may aid in the detection of new outbreaks.

scholarly journals Prioritized Research for the Prevention, Treatment, and Reversal of Chronic Disease: Recommendations From the Lifestyle Medicine Research Summit

2020 ◽  
Vol 7 ◽  
Author(s):  
Yoram Vodovotz ◽  
Neal Barnard ◽  
Frank B. Hu ◽  
John Jakicic ◽  
Liana Lianov ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Chronic Diseases ◽  
Underserved Populations ◽  
The United States ◽  
Current Status ◽  
Future Research ◽  
Biomedical Knowledge ◽  
Research Methodologies ◽  
Lifestyle Medicine ◽  
Medicine Research

Declining life expectancy and increasing all-cause mortality in the United States have been associated with unhealthy behaviors, socioecological factors, and preventable disease. A growing body of basic science, clinical research, and population health evidence points to the benefits of healthy behaviors, environments and policies to maintain health and prevent, treat, and reverse the root causes of common chronic diseases. Similarly, innovations in research methodologies, standards of evidence, emergence of unique study cohorts, and breakthroughs in data analytics and modeling create new possibilities for producing biomedical knowledge and clinical translation. To understand these advances and inform future directions research, The Lifestyle Medicine Research Summit was convened at the University of Pittsburgh on December 4–5, 2019. The Summit's goal was to review current status and define research priorities in the six core areas of lifestyle medicine: plant-predominant nutrition, physical activity, sleep, stress, addictive behaviors, and positive psychology/social connection. Forty invited subject matter experts (1) reviewed existing knowledge and gaps relating lifestyle behaviors to common chronic diseases, such as cardiovascular disease, diabetes, many cancers, inflammatory- and immune-related disorders and other conditions; and (2) discussed the potential for applying cutting-edge molecular, cellular, epigenetic and emerging science knowledge and computational methodologies, research designs, and study cohorts to accelerate clinical applications across all six domains of lifestyle medicine. Notably, federal health agencies, such as the Department of Defense and Veterans Administration have begun to adopt “whole-person health and performance” models that address these lifestyle and environmental root causes of chronic disease and associated morbidity, mortality, and cost. Recommendations strongly support leveraging emerging research methodologies, systems biology, and computational modeling in order to accelerate effective clinical and population solutions to improve health and reduce societal costs. New and alternative hierarchies of evidence are also be needed in order to assess the quality of evidence and develop evidence-based guidelines on lifestyle medicine. Children and underserved populations were identified as prioritized groups to study. The COVID-19 pandemic, which disproportionately impacts people with chronic diseases that are amenable to effective lifestyle medicine interventions, makes the Summit's findings and recommendations for future research particularly timely and relevant.

scholarly journals Device-Assessed Physical Activity and Sedentary Behaviors in Canadians with Chronic Disease(s): Findings from the Canadian Health Measures Survey

Sports ◽  
2019 ◽  
Vol 7 (5) ◽  
pp. 113 ◽  
Author(s):  
Gabriel Hains-Monfette ◽  
Sarah Atoui ◽  
Kelsey Needham Dancause ◽  
Paquito Bernard
Keyword(s):  
Physical Activity ◽  
Chronic Disease ◽  
Chronic Diseases ◽  
Vigorous Physical Activity ◽  
Laboratory Data ◽  
Self Report ◽  
Sedentary Behaviors ◽  
Health Measures ◽  
Canadian Health ◽  
Canadian Health Measures Survey

Physical activity and sedentary behaviors (SB) are major determinants of quality of life in adults with one or more chronic disease(s). The aim of this study is to compare objectively measured physical activity and SB in a representative sample of Canadian adults with and without chronic disease(s). The Canadian Health Measures Survey (CHMS) (2007–2013) was used in this study. Daily time spent in physical activities and sedentary behaviors were assessed by an accelerometer in Canadians aged 35–79 years. Data are characterized as daily mean time spent in moderate-to-vigorous physical activity (MVPA), light physical activity (LPA), steps accumulated per day and SB. Chronic diseases (chronic obstructive pulmonary disease, diabetes, heart diseases, cancer) were assessed via self-report diagnostic or laboratory data. Weighted multivariable analyses of covariance comparing physical activity and SB variables among adults without and with chronic disease(s) were conducted; 6270 participants were included. Analyses indicated that 23.9%, 4.9% and 0.5% had one, two, and three or more chronic diseases. Adults with two and more chronic diseases had significantly lower daily duration of MVPA and LPA, daily step counts, and higher daily duration of SB compared to adults without chronic diseases. Interventions targeting physical activity improvement and SB reduction might be beneficial for Canadian multimorbid adults.

scholarly journals Near Real-time Surveillance of Disease during 2016-17 Influenza Season in the U.S.

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Sushruth K. Reddy ◽  
Jhobe Steadman ◽  
John Tamerius
Keyword(s):  
Public Health ◽  
Infectious Disease ◽  
Real Time ◽  
Influenza A ◽  
Influenza Season ◽  
The United States ◽  
Influenza B ◽  
Test Results ◽  
Influenza Activity ◽  
The U.S

ObjectiveDemonstrate performance of the Virena Global Wireless Surveillance System, an automated platform utilized in conjunction with the Sofia FIA Analyzer, for near real-time transmission of infectious disease test results to public health and other healthcare organizations.IntroductionPublic health agencies worldwide all enjoy the same mission—providing healthcare warnings, guidance, and support to the public and healthcare professionals they represent. A critical element in achieving this mission is accessing timely and comprehensive surveillance information about disease in their regions of responsibility. Advances in diagnostic technologies for infectious disease and in the wireless conveyance of information hold great promise for advancing the quality of surveillance information and in facilitating the delivery of timely, accurate, and impactful public health information. Quidel Corporation has developed a cloud–based, wireless communications system that is fully integrated with its Sofia fluorescence immunoassay (FIA) platform for rapid, point-of-care diagnosis of infectious disease. The system, called the Virena Global Wireless Surveillance System (hereinafter, Virena) provides test results to public health organizations and other appropriate entities in near-real time. Currently, more than 4,000 Sofia instruments are transmitting results automatically by Virena. This presentation describes the use of Virena in surveilling influenza in the U.S. in the 2016-2017 influenza season, when over 700,000 influenza-like-illness (ILI) patient results were transmitted. The methods employed, results, and the promise of this innovative system will be discussed.MethodsThe Sofia Fluorescent Immunoassay Analyzer (FIA) is a small FDA-cleared, CLIA-waived bench top device that uses immunofluorescence-based, lateral-flow technology for rapid analyte detection within 15 minutes for influenza. With Sofia2, a recent upgrade, positive influenza test results can be obtained in as few as 3 minutes, depending on virus levels. The results are encrypted, and automatically transmitted by Virena--often within 5 seconds--to a dual cloud system for further encryption and formatting. The test results (also including location, date, and patient age) are subsequently pushed to participating public health and healthcare organizations for daily collection and analysis. Healthcare providers utilizing the Virena system may also access their own data and facility-de-identified regional and national data, using a password-enabled internet application called MyVirena.com.ResultsBetween August 1, 2016 and October 6, 2017, 706,654 ILI patient results were transmitted by Virena from over 3,000 clinical sites in the United States. The influenza positivity rate (influenza A and B combined) peaked on February 9th at 33% and maintained this level for two weeks (Figure 1). During this period, as many as 7,048 results were transmitted by Virena per day. Influenza A activity peaked on the same day at 26%, and influenza B peaked at 18% nearly 6.5 weeks later. In the six months from December 15th to June 15th, the influenza positivity rate for patients with ILI was 10% or greater in the United States. Data analysis for individual states revealed significant differences in time of onset of influenza and in the peak positivity rates. For example, the state of Arizona experienced peak positivity rates for influenza activity (42%) as late as mid-May, driven largely by influenza B. In California, influenza A peaked at 43% on January 16th and maintained a positivity rate greater than 15% for nearly three months, while influenza B averaged below 4% for the entire period. Age-specific analysis showed that children in the 2 to 18 year old group had the highest positivity rate (44%, n=251,756) and the longest incidence period. Virena data demonstrated similar influenza activity trends on national and regional levels as that depicted by the clinical laboratory and NREVSS data collected by the CDC; however, the Virena data were collected and reported sooner (Figure 2).ConclusionsThe Virena system represents a major stride for disease surveillance, providing clinical testing data in near real-time time, with local, national, and global scope. This first substantial evaluation of the Virena system, with over 4,000 transmitting Sofia Analyzers, demonstrates capabilities for near real-time assessment of disease onset, regionally varying positivity rates, durations of outbreaks, differential assessment of influenza A and B prevalence, and dynamic mapping throughout the year. With expanding regional and metropolitan coverage, the Virena system holds promise as both a powerful surveillance tool, and as a valuable resource for healthcare quality initiatives, epidemiological research, and the development of new mathematical models for influenza forecasting .

scholarly journals Remote Health Coaching Text-based Walking Program in Ethnic Minority Primary Care Patients who are Overweight and Obese: A Feasibility and Acceptability Pilot (Preprint)

2021 ◽  
Author(s):  
Mary H. Smart ◽  
Nadia A. Nabulsi ◽  
Ben S. Gerber ◽  
Itika Grupta ◽  
Barbara Di Eugenio ◽  
...  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Chronic Disease ◽  
Ethnic Minority ◽  
Chronic Diseases ◽  
Text Messaging ◽  
The United States ◽  
Overweight And Obesity ◽  
Summative Evaluation ◽  
Walking Program

BACKGROUND Over half of adults in the United States have at least one chronic disease including obesity. Although physical activity is an important component of chronic disease self-management, few reach the recommended goals for physical activity. Individuals who identify as racial and ethnic minorities are disproportionally impacted by chronic diseases and physical inactivity. Interventions utilizing consumer-based wearable devices have shown promise for increasing physical activity among patients with chronic diseases; however, populations with the most to gain such as minorities, have been poorly represented to date. OBJECTIVE To assess the feasibility, acceptability, and preliminary outcomes of an 8-week text-based coaching and Fitbit program aimed to increase steps among a predominantly ethnic minority population with overweight and obesity. METHODS Overweight (body mass index [BMI] >25 kg/m2) patients were recruited from an internal medicine clinic located within an inner-city academic medical center to participate. Fitbit devices were provided. Using 2-way text messaging, HCs guided patients to establish weekly step goals that were Specific, Measurable, Attainable, Realistic, and Time-bound (SMART). Texting and Fitbit activities were managed with a custom designed application. Program feasibility was assessed via the recruitment rate, retention rate (defined as the proportion of eligible participants completing the 8-week program) and patient engagement (based on number of weekly text message goals set with the HC across the 8-week period). Acceptability was assessed through a qualitative summative evaluation. Exploratory statistical analysis included evaluating the average weekly steps in week 1 compared to week 8 using a paired t-test and modeling daily steps over time using a linear mixed model. RESULTS Thirty (91%) of the thirty-three patients initially screened were enrolled. At baseline, the average BMI was 39.3 kg/m2 (SD = 9.3 kg/m2), with 23 (73%) of the participants presenting as obese. Nine (30%) self-rated their health as either "fair" or "poor.” Twenty-two patients (87%) set up ≥6 weekly goals across the 8-week program. Twenty-eight (93%) participants completed the qualitative summative evaluation. Ten themes emerged from the evaluation: (1) patient motivation, (2) convenient texting experience, (3) social support, (4) supportive accountability, (5) technology support, (6) self-determined goals, (7) achievable goals, (8) feedback from Fitbit, and (9) challenges, and (10) habit formation. There was no significant group change in the average weekly steps for week 1 compared to week 8 (mean difference: 7.26, p=0.99). However, five participants (17.9%) had a significant increase in their daily steps. CONCLUSIONS Overall, the results demonstrate the feasibility and acceptability for a remotely delivered walking study which included a HC, text messaging, wearable device (Fitbit), and SMART goals within a ethnic minority group of patients. These preliminary results of a walking program recruiting from primary care support further development and testing in larger samples to explore the efficacy. CLINICALTRIAL n/a

scholarly journals Drone Assisted Robust Emergency Service Management for Elderly Chronic Disease

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Shengqiang Jiang ◽  
Yong Jin ◽  
Kaijian Xia
Keyword(s):  
Chronic Disease ◽  
Real Time ◽  
Chronic Diseases ◽  
Emergency Service ◽  
Service Management ◽  
The Elderly ◽  
Time Cost ◽  
Early Screening ◽  
Time Service ◽  
Assisted Management

It is important to monitor the early screening of chronic diseases, predict the risk, and provide the comprehensive management of chronic diseases for the elderly. However, it is difficult to provide the robust and real-time emergency service for elderly chronic disease because of the complex social network and diversity of elderly chronic disease service. To address these issues, we design a new drone assisted robust emergency service system. We formulate the Drone assisted Management (DM) problem to minimize the total time cost of drone subject to all elderly chronic disease services which can be guaranteed exactly once by the drone under its energy constraint. Then, we propose the DRS algorithm to solve the DM problem. To provide the robust and real-time service, we further formulate the Charging driven Drone assisted Management (CDM) problem and present the CDRS algorithm to solve the CDM problem. Through the theoretical analysis and numerical simulation experiments, we demonstrate that DRS and CDRS can decrease the total time cost by 37.61% and increase the QoE by 112.80% through the designed system, respectively.

scholarly journals Place Effects and Chronic Disease Rates in a Rural State: Evidence from a Triangulation of Methods

2020 ◽  
Vol 17 (18) ◽  
pp. 6676
Author(s):  
Mohamed Shabani Kariburyo ◽  
Lauri Andress ◽  
Alan Collins ◽  
Paul Kinder
Keyword(s):  
Chronic Disease ◽  
Chronic Diseases ◽  
Low Income ◽  
Rural Areas ◽  
Hot Spots ◽  
Urban Areas ◽  
The United States ◽  
Disease Rates ◽  
Cold Spots ◽  
Access To Food

High rates of chronic diseases and increasing nutritional polarization between different income groups in the United States are issues of concern to policymakers and public health officials. Spatial differences in access to food are mainly blamed as the cause for these nutritional inequalities. This study first detected hot and cold spots of food providers in West Virginia and then used those places in a quasi-experimental method (entropy balancing) to study the effects of those places on diabetes and obesity rates. We found that although hot spots have lower rates of chronic diseases than non-hot spots and cold spots have higher rates of chronic diseases than non-cold spots—the situation is complicated. With the findings of income induced chronic disease rates in urban areas, where most hot spots are located, there is evidence of another case for "food swamps." However, in cold spots which are located mainly in rural areas, higher rates of chronic diseases are attributed to a combination of access to food providers along with lacking the means (i.e., income for low-income households) to form healthier habits.

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