COVID-19 Media Exposure and Mental Health

By Alison Davis, CEDIK Executive Director

For those that know me, I am an extroverted introvert. I can confidently stand in front of a large group of people and talk and talk and talk some more. But, when the presentation is over, I run for solitude. So not surprisingly, the COVID-19 social distancing has not been a terribly difficult time for me to navigate. I sit in my new makeshift office and get to work and jump on Zoom calls for several hours a day (and still get exhausted by these interactions).

What has been interesting to me is witnessing two things:

  • My extroverted CEDIK family who have been deeply impacted by being constrained to their home. They are not able to maintain their daily connections with friends, family, and strangers (although extroverts know no strangers). They look lonely and lost and are desperately trying to figure out how extrovert themselves during this time.
  • My introverted husband, who really only needs interaction with our dogs, has been obsessed with watching the news. If he could, I think he would watch from 7am until 8pm. And I can see him visibly getting agitated when he listens to interviews that don’t conform with his perspective.

I recently came across this data snapshot (that updates daily) highlighting global panic, hype, and media coverage by country. This was quite telling to me but it clearly illustrates why some of my staff and my husband are responding differently to COVID-19 than I am. The fact that there is a source that is measuring the amount of panic, hype, fake news, global sentiment and contagion media in an index suggests that we need to set some real boundaries and proactively plan for how we mentally respond to this pandemic.

Data Source:

I have asked my husband and my staff to consider the following recommendations:

  • Limit your exposure to the news and other media designed to create hype about COVID-19. Pick your trusted source of information, tune in for when a daily update occurs, and then turn it off. In Kentucky, our Governor gives us one update a day at 5pm on Facebook live, where he discusses the number of new state cases and policies. This is when I tune in. I then read a trusted news source after the President speaks to see if there are any new federal policies implemented. That’s it for me each day.
  • Reach out to your coworkers and friends, even if it is just a text, to see how they are doing. Pick up the phone, or Zoom/Skype, and call relatives, particularly those that are older. This is an even scarier time for them.
  • Set a schedule, just as if you were at work. Checking off “to-do” items is just as meaningful (if not more) during this time.
  • Be kind(er). Be patient. Be generous.

These are not overly sophisticated recommendations but I find that these have helped me navigate these challenging times. With the extension of social distancing through the end of April, we need to be deliberate about our intentions moving forward.

Improving Access to Healthy Foods in Kentucky

By Daniel Kahl, CEDIK Associate Director and Jayoung Koo, CEDIK Community Design Specialist

You can’t get that here!

At the beginning of a new year many people make resolutions to improve their diet by eating healthier. But eating healthier is not always as easy as making a resolution to do so.  In a recent study,  Survey of SNAP Food Providers in Eight Kentucky Counties: Store Access and Availability of Food Types the barriers of access to healthy foods became evident.

A survey was conducted of stores accepting SNAP electronic benefit transfer (EBT) cards in the Kentucky counties of Bourbon, Boyle, Breathitt, Jackson, Knott, Lincoln, Madison, and Owsley.  The survey was a component of research conducted by CEDIK at the University of Kentucky, in conjunction with the Kentucky Grocers and Convenience Store Association to gain a better understanding of local food environments and to learn more about grocery store policies and practices. While survey response numbers were small, this study revealed multiple barriers to healthy food access to consumers in the study area.

Access Impediments

Stores responding to the survey acknowledged that transportation can be an issue for customers. Lack of reliable personal transportation, restricted public transportation, and cost of travel all contribute to challenges of EBT card users when wanting to access stores. In addition, distances of travel in rural areas can often add to the challenge of access to groceries.


Restricted Hours of Store Operation

Like many businesses, some stores operate on a regular business time schedule. SNAP food service providers who responded to the 2018 Grocer’s Survey in Central and Eastern Kentucky have hours of operation that overlap with a typical work day. This can create an accessibility issue for people working a typical 8am-5pm job. On average, consumers in Eastern Kentucky experience 49% fewer hours of access to food per week than consumers in Central Kentucky counties.

Limited Food Types

The types of foods available to customers in the study differed depending on the store’s main function. In particular, convenience stores were the most frequent respondents to the survey in the eight counties and had the most limited fresh or healthy food options. Availability of foods offered in the store were assessed by the percent of floor space dedicated to food type.  In a graphic comparison between Grocery and Convenience store type between Eastern and Central Kentucky regions, it is easy to see that food access in Eastern Kentucky is distinctly different than in the more populated counties in Central Kentucky.

Key Insights

While the number of businesses participating in this survey make it difficult to generalize broadly, the results did indicate challenges related to healthy food access for EBT Card users. Ultimately, the consumption of fresh, healthy foods is a two-part process that must be embraced by all parties involved to achieve the desired goal. Residents must be willing and purposeful to seek out and consume healthy foods, while food providers need to better supply stores with healthy food options and adjust business operations to accommodate their customers. Healthier eating is a resolution that needs to be supported by the entire community!  Want to learn more? See the full series of reports on Food Access on the CEDIK website.

Daniel Kahl is the Associate Director of CEDIK and an Assistant Professor in Community and Leadership Development at the University of Kentucky.

Jayoung Koo is a CEDIK Community Design Specialist and an Associate Professor in Landscape Architecture at the University of Kentucky.

Ambulance Services: How Does Kentucky Compare to the U.S.?

By SuZanne Troske, CEDIK Research Associate

At CEDIK, we have three studies of ambulance services in the U.S.:

Our goals in researching ambulance services are:

  • To understand quality and costs of ambulance services and how to deliver effective emergency services for the lowest cost,
  • To discover the characteristics of patients who use ambulance services and how usage varies across the U.S. and between rural and urban areas,
  • To understand emergency healthcare – especially in rural areas – more specifically, how emergency services change if a hospital closes in a community.

After learning more about ambulance service operations across the U.S., we now wanted to see how Kentucky compared to the national average in ambulance service characteristics. For ownership types Kentucky has, on a percentage basis, fewer ambulance services managed through fire departments and more through community non-profit organizations (Figure 1). From conversations with EMS managers, there is no “typical” mix of ownership types in the states. Each state is unique.

Figure 1. Kentucky and U.S. EMS Agencies by Ownership Type (Percentage).

We summarized data from the Kentucky Board of EMS which reports the average call times of all ambulance calls for the state. Unfortunately, the latest data are from 2017 which do not include calls from Louisville. Louisville started reporting in 2018. The times in Kentucky are very similar in the time it takes to arrive at a scene (time to scene) and time at the scene (scene time) as the national average (Figure 2). The time traveling from the scene to the hospital emergency room is longer in Kentucky. One reason may be because Louisville data are missing which would presumably have shorter transport times as it is more urban.

Figure 2. Ambulance Call Times (in Minutes), Kentucky and U.S.

The last comparison we want to make is about how much Medicare beneficiaries are using ambulance services. Based on Medicare claims, on average more Medicare beneficiaries are transported to a hospital in a year (15.9%) in Kentucky than the average state (12.2%). Those beneficiaries who use the ambulance service travel more miles per trip (15.5 miles) than average (12.5 miles) and use the service more often (2.0 days per year) than the average (1.8 days per year).figure_3

Regional Differences in Ambulance Service Ownership and Management

By Su Troske and Sookti Chaudhary

Emergency care for an individual often begins when Emergency Medical Technicians (EMTs) and/or Paramedics arrive in an ambulance. Communities must find a way to provide this essential service to their residents. Federal legislation has allowed communities flexibility in determining who provides ambulance services. We define 5 models, or ownership types of ambulance services among U.S. communities:

Fire Department: Non-profit, Fire Department-based EMS Service.

Community, Non-Profit: Owned by a “Community”, not-for-profit meaning patients likely pay for the services through taxes, like fire protection and ambulance tax districts.

Governmental, Non-Fire: Owned by a “Community” and only offers EMS services, not fire service.  Community-owned ambulance companies are included in this type.

Hospital:  This is a service managed by a hospital. Ownership type of the hospital can vary such as non-profit or for-profit.

Private, Non-Hospital: Privately owned (for-profit) and not owned by a hospital.  Examples are Gold Cross or AMR companies.

CEDIK has access to the National EMS Information System (NEMSIS) data for year 2010-2015, which provides the most comprehensive data available on 9-1-1 ambulance calls. Below are a few preliminary findings from the NEMSIS data on the different ownership types of ambulance services and regional variations in usage.  It is important to note that we focused on 9-1-1 calls with an ambulance transport to a hospital for Medicare-aged patients.

From 2010-2015, the calls serviced by ownership types have remained fairly consistent. Figure 1 shows the percent of total calls in a year serviced by different ownership types. For example, 27% percent of 2010 calls were serviced by Fire Departments. In most years, Fire Departments provided the most 9-1-1 call transports.  In 2015, while Fire Departments covered almost 30% of the calls, calls serviced by Private companies represented 25% of the calls. The fewest calls were handled by Hospital-based services at 12%.2010-15_911_calls_by_ownership type

After understanding which services were most frequently used in 9-1-1 call transports, we looked next at regional differences in the NEMSIS data. Figure 2 below shows the difference in call volume by ownership type for the East South Central Census division, compared to the rest of the United States. In the East South Central division (which includes Kentucky), 64% of its calls were serviced by Private, non-hospital ambulance services. The states that make up the East South Central region are Alabama, Kentucky, Mississippi, and Tennessee. These four states rely more on private ambulance companies for service.


The Kentucky Board of Emergency Medical Services (KBEMS) confirms that for Kentucky, much of the state relies on the private, non-hospital ambulance services in recent years. The national conversation on healthcare has not been talking much about reimbursement for ambulance services. Given the regional differences in ambulance service ownership and management, if changes are made to the reimbursement structure at the federal level, there will be regions that are impacted more than others.

In future work, we are continuing to analyze the NEMSIS data to understand patient, ambulance service and incident characteristics which affect ambulance call times by ownership type. Ultimately, we wish to explore how the ownership models affect health outcomes among community residents.

We thank John H. Schnatter Institute for the Study of Free Enterprise for financial support.  The opinions expressed reflect the views of the authors and may not represent the opinions of the Schnatter Institute or the University of Kentucky.