Public Health Commons^™

The Need For Culturally-Tailored Smartphone Applications For Weight Control, Stephen S. Coughlin, Dale Hardy, Lee S. Caplan

Journal of the Georgia Public Health Association

Background: Approximately 35% of U.S. adults are obese, and this rate is expected to increase by almost 50% by 2030. New media such as smartphone applications (apps) provide a useful and low-cost way to disseminate weight control information. For many culturally distinctive population subgroups, however, there is currently an absence of research-tested smartphone apps for weight control.

Methods: In this commentary, we highlight the need for culturally tailored smartphone apps for weight control and offer recommendations for further research by providing two specific examples: 1) the characteristic dietary patterns and absence of smartphone apps for weight loss for Hispanic Americans, …

Gender Disparities In Weight Gain Among Offenders Who Are Obese Upon Entering Correctional Facilities, Madison L. Gates, Nancy C. Webb, Rebecca Stone, Darra Ballance, Wonsuk Yoo

Journal of the Georgia Public Health Association

Background: Obesity is a significant health issue for offenders, who have a higher prevalence of obesity-related conditions, such as diabetes, compared to non-incarcerated populations. Within incarcerated populations, there are obesity disparities in terms of race, gender, and age, as well as excess weight gain during incarceration.

Methods: This longitudinal study was conducted for 2005 – 2010 in collaboration with a Department of Corrections in the east south central region of the United States. From electronic health records of 10,841 offenders, weight, height, and demographic data were extracted. As determined from these data, 2,622 offenders met the inclusion criteria (two or …

Evaluation Of A Diabetes Prevention Program For Rural Citizens, Barbara B. Kawulich, Diana Mindrila, Gina Brandenburg

Journal of the Georgia Public Health Association

Background: Georgia has one of the highest rates of diabetes in the US. Obesity and inactivity contribute to the onset of this disease. Tanner Health System addressed the obesity epidemic in three rural counties of Georgia through a 16-week diabetes prevention program (DPP) for 176 residents. This study evaluated the effectiveness of the DPP.

Methods: The multiple methods design of this project used pre- and post-surveys from January/February, 2014, classes to determine diabetes-related lifestyle factors, 11 mid-point telephone interviews, and focus groups with 17 members to identify lifestyle changes that were implemented. Additionally, initial and final measurements of body mass …

The Relationship Between Food Deserts, Farmers’ Markets And Food Assistance In Georgia Census Tracts, Andrea M. Brace, Todd L. Matthews, Bobbi Finkelstein, Daniela Beall

Journal of the Georgia Public Health Association

Background: Due to inadequate resources and limited access to healthy foods, residents of food deserts struggle to maintain a well-balanced, nutritious diet. These factors increase the risk of developing obesity and diet-related chronic diseases. Local farmers’ markets serve as community-level interventions, bringing healthy food to food deserts. Over the past two decades, farmers’ markets have been growing in numbers nationally. The present study explores the relationship between food deserts, placement of farmers’ markets, and availability of food assistance programs in Georgia.

Methods: Data are from the 2014 USDA Food Desert Atlas and the USDA Farmers’ Market Directory. Farmers’ market addresses …

Factors Associated With Body Mass Index Among African American Breast Cancer Survivors, Selina A. Smith, Mechelle D. Claridy, Mary S. Whitehead, Joyce Q. Sheats, Wonsuk Yoo, Ernest Alema-Mensah, Benjamin E. Ansa, Ronald L. Braithwaite

Journal of the Georgia Public Health Association

Background: Weight gain after diagnosis and treatment is common among breast cancer survivors (BCSs). Little information exists regarding associations between body mass index (BMI) and lifestyle factors and health-related quality of life (HR-QoL) among African American (AA) BCSs. The present study sought to determine associations between BMI, dietary intake, and physical activity as lifestyle modification strategies and HR-QoL among AA BCSs.

Methods: For this cross-sectional study, a lifestyle assessment tool was administered to 195 AA BCSs. Possible predictor variables included socio-demographic and medical characteristics, dietary intake and physical activity patterns, and physical health. The outcome variable was BMI.

Results: Many …

Growing Fit: Georgia’S Model For Engaging Early Care Environments In Preventing Childhood Obesity, Kelsey Mcdavid, Catalina Piedrahita, Emily A. Vall, Christi Kay, Jean O’Connor

Journal of the Georgia Public Health Association

Background: In the United States, one in three children is overweight or obese by their fifth birthday. In Georgia, 35 percent of children are overweight or obese. Contrary to popular belief, children who are overweight or obese are unlikely to outgrow their weight status as adults, making early childhood an essential time to address weight status. An estimated 380,000 Georgia children attend early care and education environments, such as licensed child care centers, Head Start, and pre-kindergarten programs, which provide an opportunity to reach large numbers of children, including those at risk for obesity and overweight.

Methods: To address this …

The Association Between Obesity, Depression, And Anxiety: Evidence From A Community Health Needs Assessment Survey, Grace B. Adams, Angela Murcia

Journal of the Georgia Public Health Association

Background: The obesity epidemic has garnered much attention as a public health crisis. In order to make progress, it is necessary to understand the factors associated with obesity. One area of research needing more development is the link between obesity and other chronic health conditions. The objective of the present study was to further understand the relationship between obesity and the prevalence of anxiety and depression in Athens-Clarke County in northeast Georgia.

Methods: Data from the 2015 Athens-Clarke County Community Health Needs Assessment (n=1234) were used to assess the relationship between obesity and the prevalence of anxiety and depression among …

A Quantile Regression Approach To Measuring The Educational Effect On Body Mass Index, Dakshina G. De Silva, Bradley T. Ewing, Catherine P. Slade, Mark A. Thompson

Journal of the Georgia Public Health Association

Background: By use of a publically available database, the effects of education and geography on obesity as measured by body mass index (BMI) were evaluated with a quantile regression approach. The focus of the analysis was on the practical interpretation of the regression results to inform health policy decision makers about the importance of educational attainment for the growing public health issue of obesity in the US, particularly in the Southeast.

Methods: With data from the 2007 Behavioral Risk Factor Surveillance System (BRFSS), quantile regressions were employed to estimate the educational effect on BMI while controlling for relevant lifestyle, socioeconomic, …

Weight Status And Satisfaction With Healthcare Received In The U.S. And Georgia, Saswat Panda, Koichiro Otani, Janani R. Thapa

Journal of the Georgia Public Health Association

Background: Two-thirds of the U.S. population is overweight or obese, and, in Georgia, adult obesity rates are among the highest. Obesity is a risk factor for diabetes, heart disease, stroke, and some types of cancer, and adherence to treatment of such disease conditions is affected by patients’ perception of healthcare received. The present study examined the association between weight status and satisfaction with healthcare received in the U.S. and in Georgia.

Methods: The association between weight status and satisfaction with healthcare received in the U.S. and Georgia was examined using multiple logistic regression analyses, controlling for demographic and other healthcare-related …

The Two Georgias: Disparities In Rural Health And Healthcare, Gary D. Nelson

Journal of the Georgia Public Health Association

The Two Georgias: Disparities in Rural Health and Healthcare

Georgia’S Rural Hospital Closures: The Common-Good Approach To Ethical Decision-Making, Randi G. Bastian, Marcus Garner, John S. Barron, Emmanuel A. Akowuah, William A. Mase

Journal of the Georgia Public Health Association

Background: Critical access hospitals provide several essential services to local communities. Along with the functions associated with providing necessary medical care, they also offer employment opportunities and other economic benefits to the communities they serve. Since 2010, the number of rural hospitals closures has steadily increased. The common-good approach to ethical decision-making provides a framework that aids in evaluation of the effects that hospital closures have on rural residents and communities.

Methods: This analysis includes results of a systematic overview of peer-reviewed literature to address the following research questions: 1) How have state policies and the adoption of Medicaid expansion …

A Systematic Review Of Lifestyle Interventions For Chronic Diseases In Rural Communities, Selina A. Smith, Benjamin Ansa

Journal of the Georgia Public Health Association

Background: Rural Americans suffer disproportionately from lifestyle-related chronic diseases (e.g., obesity, diabetes, hypertension, cardiovascular disease, and breast cancer). Interventions that consider the distinctive characteristics of rural communities (e.g., access to healthcare, income, and education) are needed. As an initial step in planning future research, we completed a systematic review of dietary intake and physical activity interventions targeting rural populations.

Methods: Manuscripts focused on dietary intake and physical activity and published through March 15, 2016, were identified by use of PubMed and CINAHL databases and MeSH terms and keyword searches.

Results: A total of 18 studies met the inclusion criteria. Six …

Georgia Latino Enrollment In The Affordable Care Act: A Qualitative, Key Informant Analysis, Audrey Mcculloch, Dabney P. Evans

Journal of the Georgia Public Health Association

Background: Prior to implementation of the Affordable Care Act (ACA) in 2010, one in three Latinos in the United States were uninsured. In Georgia, a state that established a federal Marketplace, nearly half of Latinos lacked health insurance coverage going into the initial enrollment period of October 1, 2013 to April 15, 2014. The ACA provided an opportunity for these uninsured Latinos to gain health insurance coverage, thus increasing their access to necessary medical services. The purpose of this qualitative study was to explore, from the perspective of key informants, knowledge of Georgia Latinos about the ACA and perceived barriers …

Demographic And Socioeconomic Factors Associated With Hpv Vaccination In Georgia’S South Central Health District, Sydney Ekeledo, Candace Best, Stephanie Norman, Jodi Bazemore, Jessica Smith Schwind

Journal of the Georgia Public Health Association

Background: Human Papillomavirus (HPV) subtypes are the primary cause of cervical cancer. Despite introduction of the HPV vaccine in 2006, vaccination percentages remain low across Georgia counties. The primary objective of this research was to conduct a descriptive epidemiological study of HPV vaccination coverage among individuals in the South Central Health District (SCHD) to provide guidance for targeted vaccination campaigns aimed at adolescents residing in rural communities.

Methods: Data from the Georgia Registry of Immunization Transactions and Services and AEGIS.net, Inc. were used to analyze demographic and socioeconomic factors associated with HPV vaccine uptake among individuals visiting county health departments …

Characteristics Of Rural Users Of Emergency Medical Services In Georgia: A Population-Based Study, Nannette Turner, Huey Chen, Liliana Morosanu

Journal of the Georgia Public Health Association

Background: Emergency medical services (EMS) are an essential part of health care. Appropriate information about EMS usage in rural areas will allow effective utilization of EMS resources for their intended purpose, and at the state level, drive the adoption of better EMS policies to ensure and maintain equitable access to these health services in rural areas.

Methods: The present study, performed by analyzing data from the Georgia Emergency Medical Services Information System (GEMSIS), describes the population using EMS in rural Georgia. Distributions of rural EMS transports are reported, along with usage for selected population groups based on race, gender, age …

Human Papillomavirus-Associated Cancers In Georgia, 2008-2012, Irene Solomon, Chrissy Mcnamara, A. Rana Bayakly

Journal of the Georgia Public Health Association

Background: High-risk human papillomaviruses (HPV) cause most anal, vaginal, vulvar, penile, and oropharyngeal cancers, and virtually all cervical cancers. In 2014, in Georgia (GA), fewer than half of adolescent females and males aged 13-17 years received the three doses of the HPV vaccine. Increasing vaccination coverage among this age group, education of adolescents in regard to HPV risks, and cervical cancer screening of adults can prevent HPV-associated cancers.

Methods: The incidence of HPV-associated cancers for 2008-2012 in GA was obtained from GA Comprehensive Cancer Registry data. Case definitions for HPV-associated cancers were based on standard definitions of the Centers for …

A Comparison Of Hospital Utilization In Urban And Rural Areas Of South Carolina, Vivian G. Dicks

Journal of the Georgia Public Health Association

Background: Previous studies have described health care utilization based on insurance status and ethnicity. Few investigations, however, have looked at rural populations in relation to distance in securing health care.

Methods: The 2008 to 2009 Healthcare Cost and Utilization Project (HCUP) State Inpatient Database (SID) for South Carolina was used to assess the relationship of living in rural versus urban communities and the demographic variables related to insurance coverage. By use of bivariate and multivariate analyses, patient socio-demographic characteristics were explored for working-aged groups in relation to their income and for payer status (Medicaid or uninsured) relative to those privately …

Implementation And Evaluation Of The Carrera Program For Delaying Teen Sex In Georgia, Tressa Tucker, Mary Langley

Journal of the Georgia Public Health Association

Background: In three geographic areas in Georgia, rural, micropolitan, and urban, Morehouse School of Medicine (MSM) implemented the evidence-based Children’s Aid Society Carrera Program at community organizations with Boys and Girls Clubs (BGCs) as the comparison group. This study attempted to replicate the findings of reduced teen pregnancy and birth found for the New York Carrera Program.

Methods: For this longitudinal study with a quasi-experimental design, the sample included 400 youth who were in 6th or 7th grade. A total of 220 were enrolled in the intervention group and 180 in the comparison group. The study was performed in the …

Using The Exercise Is Medicine® On Campus Platform To Assess College Students’ Practice Of Physical Activity In A Rural Setting, Bridget Melton, Jazmin A. Williamson, Helen Bland, Jian Zhang

Journal of the Georgia Public Health Association

Background: The college setting offers public health educators and exercise scientists a favorable environment to implement wide-spread change in levels of physical activities. With over two-thirds of all adults in the U.S. now categorized as obese or overweight (CDC, 2015), it has become necessary to increase physical activity levels on college campuses. Exercise is Medicine® on Campus (EIM®-OC) is a national initiative to increase physical activity on college campuses by creating an environment to change the subjective norm of diminished exercise movement and fitness among adults. The purpose of the present study was to use the EIM®-OC platform to assess …

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 …

Engaging Rural Georgians In Internal Revenue Service (Irs)-Mandated Community Health Needs Assessments, Raymona H. Lawrence, Dziyana Nazaruk, Marie Denis-Luque, Stuart Tedders

Journal of the Georgia Public Health Association

Background: On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law. The law became effective on March 23, 2012. The ACA stipulates that non-profit hospitals must demonstrate benefit to their communities through the process of community health needs assessments (CHNAs). Failure to comply with this law may result in loss of non-profit status or large fines. This report describes strategies for engaging rural communities in Internal Revenue Service (IRS)-mandated CHNAs.

Methods: Public health practitioners from Georgia Southern University’s Jiann Ping Hsu College of Public Health collaborated with 18 rural, non-profit hospitals to …

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 …

Racial And Socioeconomic Disparities In Melanoma Incidence Rates In Georgia: 2000-2011, Marybeth Culp, Sara W. Robb, A. R. Bayakly, John E. Vena

Journal of the Georgia Public Health Association

Background: The objective of this research was to investigate melanoma incidence rates and health outcomes in Georgia over time and by race, socio-economic status (SES), and gender.

Methods: Age-adjusted melanoma incidence rates were obtained from the Georgia Comprehensive Cancer Registry SEER*Stat Database (2000-2011). To compare incidence rates across counties, and public health districts and by race, SES and gender, maps were generated using Geographic Information Systems (GIS). A cluster analysis was performed by use of SaTScan, and maps were created to visualize clusters of melanoma cases.

Results: In Georgia, from 2000-2011, age-adjusted incidence rates for melanoma were higher among Whites …

Promoting Colorectal Cancer Screening Among Haitian Americans, Steven S. Coughlin, Erica I. Lubetkin, Jennifer L. Hay, Renald Raphael, Selina A. Smith

Journal of the Georgia Public Health Association

Background: Few studies have examined colorectal cancer screening among Haitian Americans, although striking disparities in colorectal cancer screening and mortality are well-documented among U.S. Blacks. Race, socioeconomic status, and place of birth are factors associated with colorectal cancer incidence and mortality patterns.

Methods: In this article, we summarize published studies on colorectal cancer screening among Haitian Americans, identified through bibliographic searches in PubMed and CINAHL through August 2015, and offer recommendations for further research.

Results: Only one qualitative study and three quantitative surveys have examined colorectal cancer screening among Haitian Americans. A qualitative study found important differences in perceptions of …

Missed Opportunities For Diagnosing Hiv Via Routine Screening In An Inner- City Primary Care Clinic, Abigail Hankin, Sara Turbow, Jennifer Spicer, Heather Freiman, Bijal Shah, Natasha Travis

Journal of the Georgia Public Health Association

Background: Although routine, opt-out HIV screening has been recommended for nearly a decade, clinical practice has not kept pace. Here, we examine missed opportunities for HIV screening among patients newly diagnosed with HIV via a routine non-targeted opt-out HIV screening program in a primary care clinic at an inner-city safety-net hospital.

Methods: Select demographic and clinical data were analyzed for all persons with a new HIV diagnosis between July 9, 2013 and August 31, 2015. Retrospective reviews of medical records were performed to identify missed opportunities for HIV screening in the year prior to HIV diagnosis.

Results: Among 6,582 patients …

Social And Behavioral Implications Of National Collegiate Athletic Association Sickle Cell Trait Screening: The Athletes’ Perspective, Raymona H. Lawrence, Alison Scott, Carlton Haywood Jr., Kayin Robinson, Mondi Mason

Journal of the Georgia Public Health Association

Background: In August 2010, the National Collegiate Athletic Association (NCAA) implemented a policy mandating sickle cell trait (SCT) testing for all Division I collegiate athletes. Subsequently, all Division II-III athletes were also compelled to undergo SCT testing. This decision has met with controversy among healthcare providers, researchers, and sickle cell advocates. However, there is little information concerning the athletes’ perspective of this policy. The purpose of this paper is to report the findings of a qualitative study that explored college athletes’ perceptions of sickle cell trait SCT, NCAA policies on SCT testing, and potential implications of SCT screening.

Methods: The …

Differences In Health Literacy Knowledge And Experiences Among Senior Nursing Students, Sharon S. Williamson, Joanne Chopak-Foss

Journal of the Georgia Public Health Association

Background: Low health literacy has been identified as a significant public health problem. Also, higher expenditures due to longer hospital stays have been reported for persons with low health literacy. Nurses can assist patients with low health literacy to reduce their hospital stays and increase compliance with discharge instructions.

Methods: A quantitative, descriptive research design was employed to assess knowledge and experiences of 192 senior nursing students. These students were administered the Health Literacy Knowledge and Experiences Survey (HL-KES), a 2-part survey that included assessment of knowledge about health literacy and experience in working with populations of low health literacy. …

Sexual Health Education In Georgia: A Role For Reducing Sexually Transmitted Infections Among Adolescents, Madison L. Gates, Veronica Walker, Nancy C. Webb

Journal of the Georgia Public Health Association

Background: In Georgia, sexually transmitted infections (STIs) are a substantial health issue, particularly among young adults in vulnerable and minority populations. The United States Preventive Services Task Force recommends that sexually active adolescents and at-risk adults receive behavioral counseling and education in primary care settings, community organizations, departments of health, and schools.

Methods: The present approach used in Georgia for educating adolescents at high risk for STIs about these diseases was assessed. The data collected included standards for sexual health education, survey results from educators and students, and observations from a pilot study with adolescents detained by the juvenile justice …

Dealing With West Nile Virus: Evaluate, Re-Evaluate, Respond, Rosmarie Kelly

Journal of the Georgia Public Health Association

Dealing With West Nile Virus: Evaluate, Re-Evaluate, Respond