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Virginia Resources

Virginia's Licensed Clinical Social Worker Workforce: 2019
An overview of the licensed clinical social workers (LCSW) workforce in Virginia based on data from the 2019 Licensed Clinical Social Worker Workforce Survey. Features statistics including the number of LCSWs in rural Virginia and how many grew up in rural areas.
Date: 07/2019
Type: Document
Sponsoring organization: Virginia Department of Health Professions
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Selected Rural Healthcare Facilities in Virginia
Shows the state's Critical Access Hospitals (CAHs) and Rural Health Clinics (RHCs), as well as Federally Qualified Health Center (FQHC) sites located outside of urbanized areas.
Date: 07/2019
Type: Map/Mapping System
Sponsoring organization: Rural Health Information Hub
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The Appalachian Region: A Data Overview from the 2013-2017 American Community Survey Chartbook
Presents data form the American Community Survey for Appalachia from 2013-2017. Details data pertaining to health insurance coverage, transportation, and internet access, among other measures.
Author(s): Kelvin Pollard, Linda A. Jacobsen
Date: 05/2019
Type: Document
Sponsoring organization: Appalachian Regional Commission
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Virginia's Occupational Therapy Assistant Workforce: 2018
An overview of the occupational therapy assistant (OTA) workforce in Virginia based on data from the 2018 Occupational Therapy Assistant Workforce Survey. Features statistics including the number of OTAs in rural Virginia and how many grew up in rural areas.
Date: 03/2019
Type: Document
Sponsoring organization: Virginia Department of Health Professions
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Virginia's Occupational Therapy Workforce: 2018
An overview of the occupational therapist (OT) workforce in Virginia based on data from the 2018 Occupational Therapy Workforce Survey. Features statistics including the number of OTs in rural Virginia and how many grew up in rural areas.
Date: 03/2019
Type: Document
Sponsoring organization: Virginia Department of Health Professions
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Virginia's Physical Therapist Assistant Workforce: 2018
An overview of the physical therapist assistant (PTA) workforce in Virginia based on data from the 2018 Physical Therapist Assistant Workforce Survey. Features statistics including the number of PTAs in rural Virginia and how many grew up in rural areas.
Date: 03/2019
Type: Document
Sponsoring organization: Virginia Department of Health Professions
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Virginia's Physical Therapist Workforce: 2018
An overview of the physical therapist (PT) workforce in Virginia based on data from the 2018 Physical Therapist Workforce Survey. Features statistics including the number of PTs in rural Virginia and how many grew up in rural areas.
Date: 03/2019
Type: Document
Sponsoring organization: Virginia Department of Health Professions
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Virginia's Pharmacist Workforce: 2018
An overview of the pharmacist workforce in Virginia based on data from the 2018 Pharmacist Workforce Survey. Features statistics including the number of pharmacists in rural Virginia and how many grew up in rural areas.
Date: 02/2019
Type: Document
Sponsoring organization: Virginia Department of Health Professions
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Virginia's Pharmacy Technician Workforce: 2018
An overview of the pharmacy technician workforce in Virginia based on data from the 2018 Pharmacy Technician Workforce Survey. Features statistics including the number of pharmacy technicians in rural Virginia and how many grew up in rural areas.
Date: 01/2019
Type: Document
Sponsoring organization: Virginia Department of Health Professions
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Virginia's Physician Workforce: 2018
Details a breakdown of Virginia's physician workforce. Highlights rates of physicians from rural, urban, and suburban areas who are now serving in metro and nonmetro locations.
Date: 01/2019
Type: Document
Sponsoring organization: Virginia Department of Health Professions
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Identifying Priority and "Bright-Spot" Counties for Diabetes Preventive Care in Appalachia: An Exploratory Analysis
Details a study of type 2 diabetes prevalence and mortality in rural Appalachian counties and compares rates with non-Appalachian counties.
Author(s): Peter J. Mallow, Michael Topmiller, Jennifer Rankin, Jene Grandmont, David Grolling
Citation: Journal of Appalachian Health, 1(1), 27-33
Date: 2019
Type: Document
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Serum Cotinine Versus Parent Reported Measures of Secondhand Smoke Exposure in Rural Appalachian Children
Highlights a study of secondhand smoke exposure in Appalachian children. Features data collected from children aged 7-9 and compares rates to national and Appalachian-state rates.
Author(s): Samrat Yeramaneni, Kimberly Yolton, Kurunthachalam Kannan, Kim N. Dietrich, Erin N. Haynes
Citation: Journal of Appalachian Health, 1(1), 15-26
Date: 2019
Type: Document
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The Social Determinants of Health and the Decline in U.S. Life Expectancy: Implications for Appalachia
Study explores life expectancy in the U.S. and compares these trends to those in Appalachia. Looks at social determinants of health such as substance use, injuries, and suicide, among others, as possible contributing factors.
Author(s): Steven H. Woolf, Heidi Schoomaker, Latoya Hill, Christine M. Orndahl
Citation: Journal of Appalachian Health, 1(1), 6-14
Date: 2019
Type: Document
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Network Spotlight: Strength in Peers
Highlights an interview with Nicky Fadley, who is the Network Director of Strength in Peers, a coalition of nonprofit and public organizations that provides behavioral health services in two rural counties in Virginia. Provides an overview of the network's work and goals. Covers network accomplishments, advice for those developing a rural health network, and network initiatives to strengthen community engagement.
Date: 12/2018
Type: Document
Sponsoring organization: National Rural Health Resource Center
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Virginia's Licensed Nurse Practitioner Workforce: Comparison by Specialty
Results of the 2017 and 2018 surveys of 6,234 Virginia Licensed Nurse Practitioners (NPs). Features statistics including percentages of Virginia NPs who grew up in rural areas and who are currently practicing in a nonmetro location.
Date: 11/2018
Type: Document
Sponsoring organization: Virginia Department of Health Professions
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Virginia's Certified Nurse Aide Workforce: 2018
An overview of the certified nurse aide (CNA) workforce in Virginia based on data from the 2018 Certified Nurse Aide Workforce Survey. Features statistics including the number of CNAs in rural Virginia and how many grew up in rural areas of Virginia.
Date: 11/2018
Type: Document
Sponsoring organization: Virginia Department of Health Professions
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Virginia's Licensed Nurse Practitioner Workforce: 2018
Features a breakdown of Virginia's Nurse Practitioner workforce. Details rates of nurse practitioners from rural, urban, and suburban areas that are now serving in metro and nonmetro locations.
Date: 11/2018
Type: Document
Sponsoring organization: Virginia Department of Health Professions
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Virginia's Licensed Practical Nurse Workforce: 2018
An overview of the licensed practical nurse (LPN) workforce in Virginia based on data from the 2018 Licensed Practical Nurse Workforce Survey. Features statistics including the number of LPNs in rural Virginia and how many grew up in rural areas of Virginia.
Date: 10/2018
Type: Document
Sponsoring organization: Virginia Department of Health Professions
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Virginia's Registered Nurse Workforce: 2018
An overview of the registered nurse (RN) workforce in Virginia based on data from the 2018 Registered Nurse Workforce Survey. Features statistics including the number of RNs in rural Virginia and how many grew up in rural areas.
Date: 10/2018
Type: Document
Sponsoring organization: Virginia Department of Health Professions
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Rising Rates of Injection Drug Use Associated Infective Endocarditis in Virginia with Missed Opportunities for Addiction Treatment Referral: A Retrospective Cohort Study
Describes the geographic, clinical trends and characteristics of infective endocarditis related to injection drug use (IDU-IE). Study site serves a large rural area in West Virginia and Virginia. Counties of residence for patient admissions with IDU-IE were identified as rural or urban. Discusses opportunities for improved quality of care for people who inject drugs.
Author(s): Megan E. Gray, Elizabeth T. Rogawski McQuade, W. Michael Scheld, Rebecca A. Dillingham
Citation: BMC Infectious Disease, 18, 532
Date: 10/2018
Type: Document
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Factors Affecting the Development of Medicaid Hospital Payment Policies: Findings from Structured Interviews in Five States
Study examining Medicaid hospital payment policies with a focus on factors affecting payment mix and structure, the impact of state policies and financing methods, how states target hospital services or types such as rural hospitals, barriers to and drivers of change to payment methods, and more. Focuses on five states that made or are making significant hospital policy changes: Arizona, Louisiana, Michigan, Mississippi, and Virginia. Appendix B includes state profiles.
Author(s): Thomas Marks, Kathy Gifford, Steven Perlin, Melisa Byrd, Timothy Beger
Date: 10/2018
Type: Document
Sponsoring organization: Medicaid and CHIP Payment and Access Commission
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Virginia's Licensed Clinical Psychologist Workforce: 2018
Presents an overview of the licensed clinical psychologist (LCP) workforce for 2018. Highlights the percentage of LCP workforce from a rural area and the percent currently working in a rural area, among other measures.
Date: 08/2018
Type: Document
Sponsoring organization: Virginia Department of Health Professions
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Kids SIPsmartER: A Feasibility Study to Reduce Sugar-Sweetened Beverage Consumption among Middle School Youth in Central Appalachia
Reports on a study examining a school-based intervention, Kids SIPsmartER, aimed at decreasing sugar-sweetened beverage consumption among middle school students in rural Appalachian Virginia. Includes student demographic data, such as weight, physical activity, sugar-sweetened beverage consumption, and other health factors.
Author(s): Hannah Lane, Kathleen J. Porter, Erin Hecht, et al.
Citation: American Journal of Heath Promotion, 32(6), 1386-1401
Date: 07/2018
Type: Document
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Virginia's Licensed Professional Counselor Workforce: 2018
An overview of the licensed professional counselor (LPC) workforce in Virginia based on data from the 2018 Licensed Professional Counselor Survey. Features statistics including the number of LPCs in rural Virginia and how many grew up in rural areas.
Date: 07/2018
Type: Document
Sponsoring organization: Virginia Department of Health Professions
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Virginia's Assisted Living Facility Administrator Workforce: 2018
An overview of the assisted living facility administrator (ALFA) workforce in Virginia based on data from the March 2018 Assisted Living Facility Administrator Workforce Survey. Features statistics including the number of ALFAs in rural Virginia and how many grew up in rural areas.
Date: 05/2018
Type: Document
Sponsoring organization: Virginia Department of Health Professions
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Virginia's Nursing Home Administrator Workforce: 2018
An overview of the nursing home administrator (NHA) workforce in Virginia based on data from the March 2018 Nursing Home Administrator Workforce Survey. Features statistics including the number of NHAs in rural Virginia and how many grew up in rural areas.
Date: 05/2018
Type: Document
Sponsoring organization: Virginia Department of Health Professions
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Virginia's Dentistry Workforce: 2018
An overview of the dentistry workforce in Virginia based on data from the 2018 Dentist Survey. Features statistics including the number of dentists in rural Virginia and how many grew up in rural areas.
Date: 04/2018
Type: Document
Sponsoring organization: Virginia Department of Health Professions
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Virginia's Radiologic Technologist Workforce: 2017
An overview of the radiologic technologist (RT) workforce in Virginia based on data from the 2017 Radiologic Technologist Workforce Survey. Features statistics including the number of RTs in rural Virginia and how many grew up in rural areas.
Date: 03/2018
Type: Document
Sponsoring organization: Virginia Department of Health Professions
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Virginia's Respiratory Therapist Workforce: 2017
An overview of the respiratory therapist (RT) workforce in Virginia based on data from the 2017 Respiratory Therapist Workforce Survey. Features statistics including the number of RTs in rural Virginia and how many grew up in rural areas.
Date: 03/2018
Type: Document
Sponsoring organization: Virginia Department of Health Professions
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Virginia's Optometrist Workforce: 2017
An overview of the optometrist workforce in Virginia based on data from the 2017 Optometrist Workforce Survey. Features statistics including the number of optometrists in rural Virginia and how many grew up in rural areas.
Date: 03/2018
Type: Document
Sponsoring organization: Virginia Department of Health Professions
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The Appalachian Region: A Data Overview from the 2012-2016 American Community Survey
Provides state and county-level information on population, age, race and ethnicity, housing occupancy, education, labor force, employment, income, health insurance coverage, disability, and veteran status, for the 13 states with Appalachian regions. Includes breakdowns by five levels of urban or rural county types.
Author(s): Kelvin Pollard, Linda A. Jacobsen
Date: 03/2018
Type: Document
Sponsoring organization: Appalachian Regional Commission
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Virginia's Speech-Language Pathology Workforce: 2017
An overview of the speech-language pathologist (SLP) workforce in Virginia based on data from the 2017 Speech-Language Pathologist Workforce Survey. Features statistics including the number of SLPs in rural Virginia and how many grew up in rural areas.
Date: 03/2018
Type: Document
Sponsoring organization: Virginia Department of Health Professions
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Virginia's Physician Assistant Workforce: 2017
An overview of the physician assistant (PA) workforce in Virginia based on data from the 2017 Physician Assistant Workforce Survey. Features statistics including the number of PAs in rural Virginia and how many grew up in rural areas.
Date: 01/2018
Type: Document
Sponsoring organization: Virginia Department of Health Professions
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Virginia's Audiologist Workforce: 2017
An overview of the audiologist workforce in Virginia based on data from the 2017 Audiologist Workforce Survey. Features statistics including the number of audiologists in rural Virginia and how many grew up in rural areas.
Date: 01/2018
Type: Document
Sponsoring organization: Virginia Department of Health Professions
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Mental Health Disparities: Appalachian People
Breaks down the mental health disparities across Appalachia. Looks at behavioral health indicators, such as rates of depression, excessive drinking, and suicide, among others, as well as social determinants indicators, such as median household income, poverty, and education, among others.
Date: 2018
Type: Document
Sponsoring organization: American Psychiatric Association
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Robert Pack & Maggie Elehwany: VRHA Keynoters--and VRHA Board President Summer Sage
Recording from the 2017 Virginia Rural Health Association (VRHA)'s Rural Health Providers Conference. Discussion of new rural healthcare-related education initiatives and resources, grant funding to help combat the Virginia opioid crisis, and rural health policy developments on the federal level and their impact on rural areas.
Date: 11/2017
Type: Audio
Sponsoring organizations: Center for Rural Affairs, National Rural Education Association
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Health Disparities in Appalachia
Measures population health in Appalachia and explores disparities within the region and between Appalachia and the country as a whole. Features statistics on mortality, morbidity, behavioral health, child health, community characteristics, lifestyle, healthcare systems, quality of care, and social determinants, with breakdowns between urban and rural areas.
Author(s): Julie L. Marshall, Logan Thomas, Nancy M. Lane, et al.
Date: 08/2017
Type: Document
Sponsoring organizations: Appalachian Regional Commission, PDA, Inc., The Cecil G. Sheps Center for Health Services Research
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Virginia's Dental Hygienist Workforce: 2017
An overview of the Virginia dental hygienist workforce. Features statistics on the number of dental hygienists working in rural Virginia as well as how many grew up in rural areas of Virginia.
Date: 05/2017
Type: Document
Sponsoring organization: Virginia Department of Health Professions
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Promising Practice: Virginia SORH Taking Aim at Opioid Overdose
Illustrates how the Virginia State Office of Rural Health (VA SORH) and its partners are focusing their attention on the opioid epidemic in rural areas of the state by expanding treatment, and training lay rescuers to recognize and respond to an opioid overdose and administer naloxone when necessary.
Author(s): Beth Blevins
Date: 04/2017
Type: Document
Sponsoring organization: National Organization of State Offices of Rural Health
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Tobacco Use and Health Insurance Literacy Among Vulnerable Populations: Implications for Health Reform
Results of a study examining health insurance literacy among tobacco users, with data collected from 631 lower-income, predominantly minority residents of rural Virginia. Features statistics on insurance choice and cost, age, race, education, and tobacco use.
Author(s): Robert T. Braun, Yaniv Hanoch, Andrew J. Barnes
Citation: BMC Health Services Research, 17, 729
Date: 2017
Type: Document
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Child Care Deserts
Analyzes child care centers by zip code in eight states, with a specific focus on how limited or complete lack of access disproportionately affects rural areas. Includes a discussion of what constitutes a child care desert and what may prevent families from finding needed care, such as prohibitive cost based on income ratio.
Date: 10/2016
Type: Document
Sponsoring organization: Center for American Progress
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Pathways to BSN: A Look at Virginia's Registered Nurse Workforce
Provides information about the registered nurse workforce in Virginia including how registered nurses advance in the profession, their educational debt and their income. Provides rural, suburban, and urban data.
Date: 07/2016
Type: Document
Sponsoring organization: Virginia Department of Health Professions
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Food for Every Child: The Need for Healthy Food Financing in Virginia
Describes the extent and implications of food deserts in rural and urban Virginia and outlines a solution by financing the construction of grocery stores in underserved areas.
Author(s): Risa Waldoks, Brian Lang
Date: 07/2015
Type: Document
Sponsoring organization: The Food Trust
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Increases in Hepatitis C Virus Infection Related to Injection Drug Use Among Persons Aged ≤30 Years - Kentucky, Tennessee, Virginia, and West Virginia, 2006-2012
Discusses opioid abuse, drug injecting, and hepatitis C virus (HCV) infection in central Appalachia, with data on HCV infection rates for four states. Includes data for rural and urban areas by gender and race/ethnicity.
Author(s): Jon E. Zibbell, Kashif Iqbal, Rajiv C. Patel, Anil Suryaprasad, Kathy J. Sanders, Loretta Moore-Moravian, Jamie Serrecchia, et al.
Citation: MMWR (Morbidity and Mortality Weekly Report), 64(17), 453-458
Date: 05/2015
Type: Document
Sponsoring organization: Centers for Disease Control and Prevention
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Community Health Center Growth & Sustainability: State Profiles From the Northeastern and Mid-Atlantic United States
Provides health and economic data, and Medicaid policy information regarding community health centers (CHCs) in rural and urban areas, from 13 Northeastern and Mid-Atlantic states (Connecticut, Delaware, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia and West Virginia) and the District of Columbia.
Author(s): Dan Lowenstein, Nancy Lager, Tom Manning, et al.
Date: 12/2014
Type: Website
Sponsoring organizations: Primary Care Development Corporation, RCHN Community Health Foundation
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Disparities in Obesity Among Rural and Urban Residents in a Health Disparate Region
Reports on a community-based study to measure and compare the current levels of obesity and associated lifestyle behaviors of physical activity and diets of fruits and vegetables among rural and urban residents in south central Virginia and north central North Carolina.
Author(s): Jennie L Hill, Wen You, Jamie M Zoellner
Citation: BMC Public Health, 2014(14), 1051
Date: 10/2014
Type: Document
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No Margin for Error: Virginia's Rural Hospitals at a Crossroads
Documents the importance of Virginia's 37 rural hospitals and highlights the impact they have on local communities. Also explains the financial and workforce-related issues they are facing.
Author(s): Jay Andrews, Barbara Brown, Sheila Gray, et al.
Date: 10/2014
Type: Document
Sponsoring organization: Virginia Hospital & Healthcare Association
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The Virginia Health Care Landscape
Provides an overview of Virginia's demographics, state economy, population health, insurance coverage, Medicaid beneficiaries, and safety net providers, including Critical Access Hospitals. Includes some discussion of rural healthcare issues.
Date: 05/2014
Type: Document
Sponsoring organization: Kaiser Family Foundation
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Description of Healthcare Needs at an Episodic Clinic in Rural Southwest Virginia
Describes the population served at an episodic clinic in Southwest Virginia to better understand patient needs at a yearly episodic Remote Area Medical (RAM) clinic providing free healthcare services. Includes demographic information collected from RAM patient records, including age, sex, primary care physician access, tobacco use, and more.
Author(s): Audrey Snyder, Gwyneth Milbrath
Citation: Rural and Remote Health, 13(4), 2557
Date: 12/2013
Type: Document
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Virginia's State Rural Health Plan: Supporting Rural Health Through Community Engagement and Action
Identifies the key objectives and priorities for rural health in Virginia including those related to health outcomes, healthy communities, access to healthcare, individual empowerment, workforce development, and advocacy.
Date: 10/2013
Type: Document
Sponsoring organization: Virginia State Office of Rural Health
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Qualitative Needs Assessment: Healthcare Experiences of Underserved Populations in Montgomery County, Virginia
Describes a study that was conducted as part of a comprehensive community assessment to determine the feasibility of developing a Federally Qualified Health Center (FQHC) in a medically underserved area (MUA) of Virginia.
Author(s): Kelly Pieh, Cathy Callahan, Pat Young
Citation: Rural and Remote Health, 12(3), 1816
Date: 06/2012
Type: Document
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Delivering Free Healthcare to Rural Central Appalachia Population: The Case of the Health Wagon
Describes the Health Wagon, a full mobile medical clinic delivering free healthcare to those in rural Southwest Virginia in Central Appalachia.
Author(s): Teresa Gardner, Paul Gavaza, Paula Meade, Donna Adkins
Citation: Rural and Remote Health, 12(1), 2035
Date: 03/2012
Type: Document
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Journal of Appalachian Health
Highlights issues relating to the health and wellness of rural Appalachian communities. Features peer-reviewed, open access research on health outcomes in Appalachia.
Type: Journal/Newsletter
Sponsoring organization: University of Kentucky College of Public Health
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The Rural Health Voice
Podcast discusses various issues pertaining to rural healthcare in Virginia. Features interviews with state, local, and national leaders in rural health care.
Type: Audio
Sponsoring organization: Virginia Rural Health Association
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Virginia Health Opportunity Index
Allows the user to examine health opportunities and challenges at the census tract level, by county, or by independent city for the state of Virginia. Utilizes 13 indicators addressing the social determinants of health. These indicators are grouped into four profiles or measures focused on the natural and social environment, consumer resources, economic opportunities, and access to health services.
Type: Website
Sponsoring organization: Virginia Department of Health: Office of Health Equity
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Rural Syringe Services Program
Features links for resources related to syringe services, including recommendations and reasons for establishing a syringe service program, types of programs, and examples of successful programs. Includes information on state laws in Kentucky, North Carolina, West Virginia, Tennessee, and Virginia allowing the establishment of syringe services programs.
Type: Website
Sponsoring organization: Harm Reduction Coalition
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Creating a Culture of Health in Appalachia: Disparities and Bright Spots
An initiative focused on health outcomes in Appalachian communities. Provides access to health disparities data on health status, healthcare delivery, and social determinants of health indicators for counties within the rural Appalachian region. Also identifies and provides case studies of "Bright Spots", counties in the region with better-than-expected health outcomes.
Type: Website
Sponsoring organizations: Appalachian Regional Commission, Foundation for a Healthy Kentucky, Robert Wood Johnson Foundation
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Virginia Shortage Designations and Maps
Maps and data for shortage designations in the state of Virginia. Includes maps for mental health professional shortage areas (HPSAs), dental health HPSAs, and primary care HPSAs. Also provides information for finding HPSAs and Medically Underserved Areas (MUAs) by address and locality.
Type: Website
Sponsoring organization: Virginia Department of Health
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Virginia Health Data Portal
Interactive tool that provides health related data for the state of Virginia. Includes information about cancer, chronic disease, communicable disease, demographics, drinking water, heath behavior, injury and violence, maternal and child health, opioid addiction, sexually transmitted infection, and social determinants of health.
Type: Website
Sponsoring organization: Virginia Department of Health
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Healthcare Workforce Data Findings
Provides a collection of health workforce reports for a wide range of professions in Virginia. Includes provider demographics, geographic distribution, income, and more.
Type: Website
Sponsoring organization: Virginia Department of Health Professions
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ERS State Fact Sheet: Virginia
State-level data on population, poverty, food security, educational attainment, employment, and income. Includes data for rural areas, urban areas, and the state as a whole.
Type: Website
Sponsoring organization: USDA Economic Research Service
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Virginia KIDS COUNT Data Center
Provides data on child well-being for the state. Covers demographics, economic well-being, education, family and community, health, and safety and risky behaviors. Some data available by county.
Type: Website
Sponsoring organization: Annie E. Casey Foundation
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Virginia QuickFacts
State-level data on demographics, housing, income, and other social determinants of health, with the option to add data for counties and cities and towns with a population of 5,000 or more. Includes information from multiple U.S. Census Bureau censuses, surveys, and programs.
Type: Website
Sponsoring organization: U.S. Census Bureau
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Virginia State Health Facts
State-level data on demographics, health status, healthcare costs and access, healthcare providers, and more.
Type: Database
Sponsoring organization: Kaiser Family Foundation
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Virginia Rural Health Association Weekly Updates
Provides news updates on rural health topics from the Virginia Rural Health Association.
Type: Journal/Newsletter
Sponsoring organization: Virginia Rural Health Association
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Virginia - Office of Health Equity Newsletter
Newsletter focused on inequities related to socioeconomic status, race/ethnicity, geography and living environment, and access to health care in Virginia.
Type: Journal/Newsletter
Sponsoring organization: Virginia Department of Health: Office of Health Equity
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Additional resources are available. See a full list of Virginia Resources.


Last Updated: 11/11/2019