Digital Commons Network^™

A Preliminary Examination Of Elevated Blood Lead Levels In A Rural Georgia County, R. Christopher Rustin, Yu Sun, Chris Calhoun, Christy Kuriatnyk

Environmental Health Sciences Faculty Publications

Background: Rural areas are often viewed as lower risk for lead poisoning and toxic exposures seriously impacting development of the brain and central nervous system; this report examines the prevalence of elevated blood lead levels for children <6 years of age in rural Ben Hill County, GA.

Methods: Lead surveillance data from the Georgia Department of Public Health (DPH) were analyzed using SAS®v-9.3 to calculate the prevalence of elevated blood lead levels (≥5ug/dL) among those children in Ben Hill County who had been tested for lead; the results were compared to Georgia and national data.

Results: A preliminary analysis of 2010-2015 screening data for Ben Hill County indicates that 8.73% …

Velamentous Cord: A Dangerous Case Complicated By A Rural Population, Adam Franks, Md, Carolyn Curtis, Md, Shawndra Barker, Md

Carolyn A. Curtis, MD

A velamentous cord insertion occurs when the umbilical cord’s Wharton jelly fails to reach the placenta, due to early placental atrophy around the insertion site, leaving a segment of unprotected vessels running through the thin membranes of the amniotic sac. This area of weakness exposes a threat to the well-being of the fetus through acute hemorrhage and both acute and chronic restriction of nutrition. With advances in technology, resolution capabilities of ultrasounds allow for antenatal diagnosis, when previously this was impossible. With this knowledge, considerations for screening and management of this pathology are essential when dealing with a rural population …

Access To Health Care Services For Adults In Maine [Report], Erika C. Ziller Phd

Access / Insurance

On October 17, 2016, the Maine Health Access Foundation (MeHAF) released a new research brief developed with the University of Southern Maine that found significant inequality in the ability of people in Maine to access quality health care. The authors, Barbara Leonard from MeHAF and Erika Ziller from the USM Muskie School, found that income, age and education are all closely associated with Maine people’s ability to receive appropriate and timely health care. Specifically, they found that among Maine adults 18 and older, those with family incomes less than $25,000 a year, young adults, racial and ethnic minorities, and people …

Health Insurance Co-Ops: Product Availability And Premiums In Rural Counties, Erika C. Ziller Phd, Zachariah T. Croll Ba, Andrew F. Coburn Phd

Access / Insurance

Created by the Affordable Care Act (ACA), Consumer Operated and Oriented Plans (CO-OPs) are private, non-profit health insurers that were designed to increase insurance plan choice and lower premiums in the Health Insurance Marketplaces. Early analyses of the ACA suggested that CO-OPs may be particularly beneficial for rural communities, where fewer individual and small group health insurance options have traditionally been available.

This Research and Policy Brief, authored by research staff at the Maine Rural Health Research Center, explores the early availability and role of CO-OPs in rural and urban counties. We describe the regional distribution and market prevalence of …

A Preliminary Examination Of Elevated Blood Lead Levels In A Rural Georgia County, R. Christopher Rustin, Yu Sun, Chris Calhoun, Christy Kuriantnyk

Journal of the Georgia Public Health Association

Background: Rural areas are often viewed as lower risk for lead poisoning and toxic exposures seriously impacting development of the brain and central nervous system; this report examines the prevalence of elevated blood lead levels for childrenCounty, GA.

Methods: Lead surveillance data from the Georgia Department of Public Health (DPH) were analyzed using SAS®v-9.3 to calculate the prevalence of elevated blood lead levels (≥5ug/dL) among those children in Ben Hill County who had been tested for lead; the results were compared to Georgia and national data.

Results: A preliminary analysis of 2010-2015 screening data for Ben Hill County indicates that …

Health Policy & Management News, Georgia Southern University

Health Policy & Management Department News (2011-2018)

• Georgia Southern Examines Rural Hospital Closures

A Randomized Controlled Trial Of A Faith-Placed, Lay Health Advisor Delivered Smoking Cessation Intervention For Rural Residents, Nancy E. Schoenberg, Christina R. Studts, Brent J. Shelton, Meng Liu, Richard Clayton, Jordan Baeker Bispo, Nell Fields, Mark Dignan, Thomas Cooper

Behavioral Science Faculty Publications

Introduction. Rural US residents smoke at higher rates than urban or suburban residents. We report results from a community-based smoking cessation intervention in Appalachian Kentucky.

Study design. Single-blind, group-randomized trial with outcome measurements at baseline, 17 weeks and 43 weeks.

Setting/participants. This faith-placed CBPR project was located in six counties of rural Appalachian Kentucky. A total of 590 individual participants clustered in 28 churches were enrolled in the study.

Intervention. Local lay health advisors delivered the 12-week Cooper/Clayton Method to Stop Smoking program, leveraging sociocultural factors to improve the cultural salience of the program for Appalachian smokers. Participants met with …

Are Rural Older Adults Benefitting From Increased State Spending On Medicaid Home And Community-Based Services?, Andrew F. Coburn Phd, Eileen Griffin Jd, Deborah Thayer Mba, Zachariah T. Croll Mph, Erika C. Ziller Phd

Long Term Services and Supports

In a shift away from institutional long term services and supports (LTSS), the federal government and states have pursued an array of strategies for expanding access to home and community-based services (HCBS) over the past few decades. Yet, little is known about variations in the availability or use of Medicaid HCBS within states, across rural and urban areas. This study used the national Medicaid Analytical Extract claims data file (2008) to examine differences in HCBS use and expenditures among rural and urban older adult Medicaid beneficiaries receiving LTSS. The study found that rural Medicaid LTSS users were less likely to …

Cancer Perceptions And Health Behaviors In Tazewell County, Virginia, Sarah E. Waddle

Senior Honors Projects, 2010-2019

Tazewell County is a community the citizens feel is plagued by cancer. This concern was so great the county officials requested a study be done by a local university, Virginia Polytechnic Institute and State University (Virginia Tech), to explore potential external factors causing these perceived high rates of cancer within the community. The results of the Virginia Tech study found the rates of cancer were no higher in Tazewell County than elsewhere in the state of Virginia. The purpose of the current study was to explore the idea of perceptions and the effect they may have on the health behaviors …

Using Homeland Security Exercise Evaluation Program To Execute A Mass Prophylaxis Exercise In A Rural Community., Brian K. Smith

Theses & Dissertations

This project explores the execution of point of distribution exercises in a rural community. Harrison County Iowa is a rural county with a population over 15,000 located approximately 45 minutes north of the Omaha metro area. The project explored the existing point of distribution plans and inventory for the Harrison County Home and Public Health Department. Prior to this project, many staff at Harrison County Home and Public Health Department had no experience with table top or full scale exercises. The mass prophylaxis point of distribution plan had not been updated, and staff had not received training on the point …

Factors And Outcomes Associated With Potentially Inappropriate Medication Use In Rural Community-Dwelling Older Adults, Marcia Y. Shade

Theses & Dissertations

Potentially inappropriate medications (PIMs) use in older adults is a significant public health concern. The use of PIMs to avoid may lead to negative outcomes such as adverse drug events. Prior conceptual analysis of PIMs use and observation of health-related factors in rural adults led to the design of this dissertation study. A sample was recruited from a population of rural community-dwelling older adults to examine the following specific aims: 1) Describe the use of PIMs to avoid, 2) Explore individual demographic characteristics (age, gender, income, education, and rural home location), health experience (comorbidity, number of medications and health providers), …

Health Information Exchange: A Strategy For Improving Access For Rural Veterans In The Maine Flex Rural Veterans Health Access, Karen B. Pearson Mlis, Ma, Amanda Burgess Mppm, John A. Gale Ms, Andrew F. Coburn Phd, Anush Yousefian Hansen Ms, Ma

Access / Insurance

This paper reports on the design and implementation of a first-in-the nation project to expand rural veterans’ access to healthcare by establishing a bi-directional connection between Maine’s statewide health information exchange (HIE) and Veterans Administration facilities and centers. The paper reviews key factors that have contributed to implementation challenges and successes and lessons relevant to efforts to create interoperable health IT systems across multiple, complex organizational settings.

Effect Of Air Flow Rates In Versatrap Slit Impactor Cassettes On The Collection Of Atmospheric Mold Spores In A Rural Community, Bushra Shah, Tedd Gandy, Oreoluwa Adeyinka, Galela Shebani, Atin Adhikari

GS4 Georgia Southern Student Scholars Symposium

Exposure to mold allergens including mold spores and hyphal fragments are associated with allergic sensitization which is a risk factor for asthma in a community. Smaller aerodynamic size of spores (åµm) allows them to penetrate and settle in the lower airways and produce damaging byproducts (allergens, glucans, mycotoxins, and other immunomodulators). Usually mold spores in ambient atmosphere are collected by impactors in air monitoring stations and in most cases these impactors are operated in a single standard air flow rate. However, sampling efficiency of an impactor can change in different air flow rates and since spore aerodynamic sizes vary a …

Adapting A Physical Activity Intervention For Youth In A Rural Area: A Case Study, Moya L. Alfonso, Gavin Golquitt, Ashley Walker, Akrati Gupta

Journal of the Georgia Public Health Association

Background: Physical activity offers children and youth many well-documented positive effects on health. The present study adapted a community-based prevention marketing campaign (CBPM), VERBTM Summer Scorecard (VSS) to promote physical activity among minority youth in rural, southeast Georgia. The purpose of this paper is to describe the adaptation process, emphasizing methods used and lessons learned.

Methods: A qualitative study design was used to identify social marketing concepts that informed program adaptation, including two focus groups with 12 children and two focus groups with 14 parents. Qualitative thematic data analysis was used to analyze formative research. The adapted program was implemented …

Leveraging University-Community Partnerships In Rural Georgia: A Community Health Needs Assessment Template For Hospitals, Ayanna Robinson, Sabrina T. Cherry, Michelle Elliott, Marsha Davis, Grace Bagwell

Journal of the Georgia Public Health Association

Background: Under the Affordable Care Act, nonprofit hospitals are required to conduct a Community Health Needs Assessment (CHNA) every three years. Using recommendations proposed by Georgia Watch, students and faculty members from the University of Georgia (UGA) conducted a CHNA for a hospital in a rural county in Georgia. The purpose of the CHNA was to identify community health problems and needs, as well as community assets and resources. The aim of this report is to describe the process for conducting the CHNA, the findings, and the lessons learned.

Methods: The CHNA team consisted of students and faculty members from …

Capital And Technical Assistance Needs Of Georgia’S Health-Related Nonprofits: An Exploratory Study, Jerry B. Daniel, Cherysh Green-Caldwell

Journal of the Georgia Public Health Association

Background: Nonprofit organizations, particularly those related to health and human services, are involved in addressing needs of the American population. They provide an array of services in small and large communities throughout the United States. Compared to for-profit organizations, health-related nonprofits are increasing in number. Despite having a substantial share of the health care market, nonprofit organizations face difficulties delivering services to those in need. The difficulties faced by rural nonprofits may be greater than those for their urban counterparts. The impetus for this study came from Healthcare Georgia Foundation’s goal of strengthening nonprofits to address the burgeoning health inequities …

Improving Rural Access To Care: Recommendations For Georgia’S Health Care Safety Net, Karen Minyard, Chris Parker, John Butts

Journal of the Georgia Public Health Association

Background: In Georgia, the safety net provides health care services to vulnerable populations scattered across 74 urban and 85 rural counties. In rural communities, the safety net is challenged with longstanding gaps in service provision and persistent difficulty in making services accessible. The rural safety net in Georgia is vulnerable.

Methods: An environmental scan was conducted of the Georgia rural safety net to assess who it serves, its providers, and how care is accessed in light of the Affordable Care Act (ACA). The scan included analysis of population-based census and health databases and a literature review to inform recommendations.

Results: …

Quality Rated Childcare Programs And Social Determinants Of Health In Rural And Non-Rural Georgia, Nancy C. Webb, Madison L. Gates

Journal of the Georgia Public Health Association

Background: Early childhood is linked to school readiness and early school achievement. Through its Quality Rated (QR) program, which was designed to improve the quality of care in early childhood programs, the state of Georgia has been a trailblazer in funding universal preschool and in improving the quality of childcare programs. We have assessed differences in the availability of QR childcare programs in Georgia to learn if, in rural versus non-rural counties, there is a relationship between QR childcare programs and health-related outcomes.

Methods: This cross-sectional study evaluated county-level data to evaluate the relationship between QR childcare programs and social …

Colorectal Cancer Prevention: Perspectives Of Key Players From Social Networks In A Low-Income Rural Us Region, Nancy E. Schoenberg, Kathryn Eddens, Adam Jonas, Claire Snell-Rood, Christina R. Studts, Benjamin Broder-Oldach, Mira L. Katz

Behavioral Science Faculty Publications

Social networks influence health behavior and health status. Within social networks, “key players” often influence those around them, particularly in traditionally underserved areas like the Appalachian region in the USA. From a total sample of 787 Appalachian residents, we identified and interviewed 10 key players in complex networks, asking them what comprises a key player, their role in their network and community, and ideas to overcome and increase colorectal cancer (CRC) screening. Key players emphasized their communication skills, resourcefulness, and special occupational and educational status in the community. Barriers to CRC screening included negative perceptions of the colonoscopy screening procedure, …

Local Health Department Clinical Service Delivery Along The Urban/Rural Continuum, Kate E. Beatty, Nathan Hale, Michael Meit, Paula Masters, Amal Khoury

Frontiers in Public Health Services and Systems Research

Background: Engagement in the core public health functions and ten essential services remains the standard for measuring local health department (LHD) performance; their role as providers of clinical services remains uncertain, particularly in rural and underserved communities.

Purpose: To examine the role of LHDs as clinical service providers and how this role varies among rural and nonrural communities.

Methods: The 2013 National Association of County and City Health Officials (NACCHO) Profile was used to examine the geographic distribution of clinical service provision among LHDs. LHDs were coded as urban, large rural, or small rural based on Rural/Urban Commuting …

Generational Differences In Practice Site Selection Criteria Amongst Primary Care Physicians., Christopher Duffrin Phd, Mches, Molly Cashion Mph, Doyle M. Cummings Pharmd, Lauren Whetstone Phd, Jonathon Firnhaber Md, Gary Levine Md, Ricky Watson Md, Msph, Aaron Lambert Md

Marshall Journal of Medicine

ABSTRACT

Background and Objectives: Generational differences are often viewed as shaping the overall attitudes and actions of different age cohorts. It is essential to understand the motivations and generational differences in primary care physicians for efforts to recruit, retain, and educate the future physician workforce. Determining what factors most influence different generations of primary care physicians when choosing a practice site is essential to build our future primary care system. This study examined generational differences in the factors that attracted primary care physicians to their current practice.

Methods: A survey instrument was mailed to all active members of the North …

Child Sexual Abuse And The Impact Of Rurality On Foster Care Outcomes: An Exploratory Analysis, Austin G. Griffiths, April L. Murphy, Whitney Harper

Social Work Faculty Publications

Given the cost of long-term foster care placement in both human and economic terms, few studies have specifically explored if any factors help to predict why this vulnerable population spends significantly more time in foster care. The overarching goal of this exploratory study was to use binary logistic regression to investigate whether any child demographic or environmental characteristics predicted the discharge of a child placed in Kentucky's foster care system for child sexual abuse. Results indicated that children in the most rural areas of the state were over 10 times more likely to be discharged from foster care during the …

Promoting Healthy Eating And Physical Activity: A Qualitative Examination Of Community-Based Obesity Interventions In Rural Kentucky, Brooke F. Butterworth

Theses and Dissertations--Nutrition and Food Systems

Rural Americans are medically underserved groups and are at greater risk of becoming obese than urban Americans. The purpose of this qualitative study was to determine the perceived causes of obesity in six counties of rural Kentucky and to determine how to customize strategies to reduce obesity in these areas. University of Kentucky Cooperative Extension Service Agents formed coalitions in each of the six counties to assess their communities’ needs and assets to inform plans for implementing evidence-based obesity interventions. Between February and August of 2015, the coalitions were convened for a total of 11 meetings. Each of the coalition …

Strengths And Challenges Of A Rural Ohio Public Health Department: Considerations For Effective Service Delivery And Emergency Preparedness, Cindy L. Harris Graessle

Master of Public Health Program Student Publications

The local public health department is the main entity in cities and counties established to ensure the safety, health, and well-being of its community members. In many cases, particularly in rural areas, the health department may be the community’s closest access to health care, providing not only clinical care, but preventive services as well. These rural health departments have additional challenges that may not be experienced in the larger, more populated metropolitan areas. These challenges include lack of resources and funding that impact daily operations, expanded registered sanitarian responsibilities, and emergency preparedness difficulties with resource allocation and communication. Despite these …

Are There Rural-Urban Differences In Dentist Supply?, Mutlaq Alotaibi

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

The purpose of this project was to examine the supply of dentists in the Commonwealth of Kentucky at the county level. Counties with shortages in dentist supply were determined and associated factors were examined.

Several county-level variables were analyzed. These included total number of dentists, total county population, dentist to population ratio, dentist supply shortage, median household income, median age, percent of Medicaid enrollees, rurality, oral cancer crude incidence and mortality rates per 100,000 and percent of adults missing six or more teeth.

This project showed that 42 of the 120 counties in Kentucky had shortages in dentist supply. Also, …

Characterizing Health Risks In Privately-Supplied Drinking Water Due To Agricultural Practices In Rural Western Kentucky, Karen Schroeder Card

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

At least 400,000 people in Kentucky rely on private water wells or springs for drinking water. 551 households that rely on private water wells for drinking water were surveyed in 2009 about adverse health outcomes, including selected cancer incidence, adverse birth outcomes, and yearly incidence of diarrheal illness. Survey recipients were drawn from a population of well owners in the Jackson Purchase Region of Kentucky whose wells were tested for nitrate-nitrogen (NO3-N), triazine pesticides, and E. coli or total coliforms, by Kentucky Geologic Survey within the previous 15 years. 214 questionnaires were returned and matched to water quality data for …

Clinical Service Delivery Along The Urban/Rural Continuum, Kate E. Beatty, Nathan Hale, Michael Meit, Paula Masters, Amal Khoury

ETSU Faculty Works

Background: Engagement in the core public health functions and ten essential services remains the standard for measuring local health department (LHD) performance; their role as providers of clinical services remains uncertain, particularly in rural and underserved communities.

Purpose: To examine the role of LHDs as clinical service providers and how this role varies among rural and nonrural communities.

Methods: The 2013 National Association of County and City Health Officials (NACCHO) Profile was used to examine the geographic distribution of clinical service provision among LHDs. LHDs were coded as urban, large rural, or small rural based on Rural/Urban Commuting …