Public Health Commons^™

Can Mini Grant Programs Address Community Health Improvement Plans In Rural Areas? A Local Evaluation, Kelley Ditzel, Cameron Watts

Journal of the Georgia Public Health Association

Background: In the rural community of Hancock County, Georgia, it became apparent in the summer of 2017 that outside help was necessary to address the failing health and education problems plaguing this area. The North Central Health District received Healthcare Georgia Foundation grant leading to the creation of the Hancock Health Improvement Partnership (HHIP) composed of 11 community leaders who developed the Community Health Improvement Plan to positively impact their county.

Methods: This evaluation was conducted to report the efficacy of the mini grant program developed by the HHIP, particularly how grants could best improve organizational capacity, incentivize community collaborations, …

Barriers And Facilitators To Conducting Physical Activity Interventions In Children's Camps, Silvia Q. Giraudo, Jordan Merideth, Barbara M. Grossman

Journal of the Georgia Public Health Association

Background: Previous research has sought to uncover various behavior factors that contribute to childhood physical activity, but have primarily relied on quantitative methods or within the context of schools. Summer day camps offered potential for increasing activity of youth, but research is required to determine how best to convert camp activity into outreach interventions.

Methods: The University of Georgia Institutional Review Board (IRB) approved all methods and procedures prior to the start of the study (STUDY00004692, MOD00005513). A total of 112 campers ages 9-13 participated in the data collection. This research used semi-structured interviews, surveys, and observations to …

Perception Of Health Care Access In Rural Georgia: Findings From A Community Health Needs Assessment Survey, Elisa M. Childs, Tiffany R. Washington

Journal of the Georgia Public Health Association

Background: Limited access to health care services has been cited as a barrier to care for individuals who live in rural areas, contributing to significant health disparities in this population. While perception of services has been cited as a determinant of utilization of health services, it is unknown how perception of services influences health care access in rural areas. The paucity of studies specific to areas in the United States that are medically underserved, necessitated this study and its quantification of the issues that are relevant to individuals living in rural Georgia.

Methods: This study examined the perception of health …

Selective Participation In Syphilis Partner Services And Implications For Control Efforts, Fulton County, Georgia, 2013-2015, Sarah Hamid, Udodirim N. Onwubiko, David P. Holland, Allison T. Chamberlain

Journal of the Georgia Public Health Association

Background. Partner services is an important component of syphilis control, but not all persons with syphilis participate, limiting the strategy’s potential effectiveness and possibly introducing selection biases into analyses of risk factors for reinfection. This study aimed to describe demographic and clinical differences between partner-services participants and non-participants in Fulton County, Georgia, and to assess the association between participation and syphilis re-diagnosis.

Methods. Using surveillance data, we identified primary and secondary syphilis cases in Fulton County with a first diagnosis in 2013-2015. We compared the distributions of demographic and clinical characteristics between participants and non-participants using chi-squared tests. …

Elderly Educated Blacks And The Influence Of Exercise Identity, Self-Determination, And Social Determinants Of Health On Physical Activity, George Leonard Shaw Jr., Miles Anthony Irving

Journal of the Georgia Public Health Association

ABSTRACT:

Background: This study examined the influence of socio-economic status (SES), exercise self-definition, and self-determination variables on physical activity participation among African American retirees.

Methods: Both African American men and women, of at least 60 years of age, were surveyed. All participants lived independently. The data collected included demographic, Godin Leisure-Time Physical Activity Questionnaire (LTPA), Exercise Self-Definition Questionnaire (ESD), Behavioral Regulations Exercise Questionnaire-2 (BREQ-2), and Basic Psychological Needs Satisfaction in Exercise Scale (BPNES). The findings and analysis were conducted using data from149 participants.

Results: Only gender was a statistically significant predictor of physical activity participation in the study. Based on …

Impact Of Public Health Nurse Training On Their Perception To Provide Hypertension And Diabetes Care To Patients In Their Communities., Stephen Goggans, Jean O'Connor, Elena A. Wood, Elizabeth Sacksteder Laclair, Kathryn Martin, Paul Wallach

Journal of the Georgia Public Health Association

To evaluate the impact of protocol training by a medical school and public health department on nurses’ perceptions to deliver care to patients with hypertension and diabetes.

Training was delivered using the Georgia Diabetes and Hypertension Nurse protocols for public health nurses. A survey was developed and distributed post training to participants. The training included lectures, workshops, case discussions, simulation, and physical examination practice on standardized patients. Participants were asked about perceptions, both before and after training completion regarding frequency in changing practice and confidence in treating hypertension and diabetes for six items.

Perceived levels of confidence for all questionnaire …

Addressing Maternal Mental Health Among Black Perinatal Women In Atlanta, Georgia: A Cbpr Approach, Natalie Hernandez, Sherilyn Francis, Brielle Evans, Andrea G. Parker, Jemea Dorsey, Danette Mclaurin Glass, Mica Whitfield, Elise Blasingame, Pamela Braxton, Rasheeta Chandler

Journal of the Georgia Public Health Association

Background: Perinatal mood and anxiety disorders (PMADs) are the most common complication of pregnancy, affecting up to 1 in 5 childbearing women, with higher rates among low-income minority women. One in seven women suffer from perinatal depression. This study aimed to (1) assess the mental and emotional health challenges of underserved Black perinatal women in Atlanta, Georgia (GA) and (2) examine local priorities and sources of care for mental health among underserved women in Atlanta, GA.

Methods: A community-based participatory research partnership between Morehouse School of Medicine (MSM) and the Center for Black Women’s Wellness (CBWW)’s Atlanta Healthy Start Community …

Barriers To Hiv Related Services Among Men Who Have Sex With Men (Msm) In Rural Georgia, Jordan D. Helms, Alvin Tran, Neal Carnes, Eric J. Nehl

Journal of the Georgia Public Health Association

Background: Gay, bisexual, and men who have sex with men (MSM) living in the Southeastern United States are at high risk of contracting HIV, and those in rural communities experience challenges in accessing HIV prevention and treatment.

Methods: Seven health care workers and 17 MSM in rural health care districts participated in semi-structured interviews. A theory-informed thematic analysis approach was used to summarize and compare perspectives between health care workers and MSM participants.

Results: Stigma, insufficient resources, and social structures of rural life emerged as barriers to accessing HIV-related services

Conclusions: Overcoming these barriers are necessary to reduce HIV infection …

Cyberbullying In Middle School Students: An Intervention Using An Educational Mobile Application For Caregivers: A Pilot Study, Gregory C. Claxton

Journal of the Georgia Public Health Association

Cyberbullying among middle school students is a growing problem that is shown to affect psychological development in middle school youth which can result in self-harm and suicide. Evidence suggests more frequent communication between children and their caregivers is a protective factor against cyberbullying. The KnowBullying app is designed to increase caregiver and student communication to prevent bullying. This study examines the effectiveness of the KnowBullying app regarding enhanced caregiver and child communication and cyberbullying experience reduction in middle school students. Five students and nine caregivers were given surveys before and after the caregivers downloaded and used the KnowBullying app. The …

Air Pollutant Levels And Asthma Emergency Room Visits In A Highly Populous Us Urban County During 2018-19, Osaremhen Ikhile, Jingjing Yin, Atin Adhikari

Journal of the Georgia Public Health Association

Objective: Air pollutants are linked to asthma exacerbation. The study purpose was to demonstrate an association between air pollutants levels and asthma emergency room (ER) visit trends in a highly populated US urban county in Georgia during 2018-2019.

Methods: Time series analyses were conducted for the variations in daily numbers of children and adult asthma emergency room visits and changes in daily mean PM_2.5, daily mean PM₁₀ concentrations, daily max 1-hour SO₂ concentrations, daily max 1-hour NO₂ concentrations, daily max 8-hour ozone concentrations, and airborne pollen loads for 2018 to 2019 and potential trends were …

Widening Health Disparities: Increasing Cholangiocarcinoma Incidence In An Underserved Population, Disha Kumar, Varun Bansal, Syed A Raza, Aaron P Thrift, Hoda M Malaty, Robert J Sealock

Faculty, Staff and Students Publications

BACKGROUND AND AIMS: Cholangiocarcinoma is a relatively rare malignancy with high mortality. In the U.S., incidence rates of cholangiocarcinoma have increased, particularly affecting younger age groups and Hispanic and Asian individuals. We investigated the incidence of cholangiocarcinoma in a largely under-represented, minority population.

METHODS: We performed a retrospective cohort study from 2005 to 2017 among adults in a county-funded healthcare system in Harris County, Texas. Incidence rate ratios were computed to compare age-standardized rates using U.S. standard population between 2 time periods: 2005-2011 and 2012-2017.

RESULTS: We identified 139 cholangiocarcinoma cases (64% intrahepatic, 36% extrahepatic). The median age at diagnosis …

Sarscov-2 Serostatus Amongst Vaccinated Employees At A Pediatric Hospital System, Sridevi Devaraj, Izmarie Poventud-Fuentes, Matthew Girotto, Jermaine Monroe, Julie Boom, George Delclos, James Versalovic

Faculty, Staff and Students Publications

To gain insights on the heterogeneity of immune responses to vaccination against SARS-CoV-2 and to identify factors that could make individuals vulnerable to infection due to lack of response to vaccination, our hospital started offering free voluntary post-antibody testing against the spike protein IgG for all fully vaccinated employees.

Post-vaccination response against SARS-CoV-2 was assessed using the FDA-EUA approved VITROS anti-SARS-CoV-2 IgG immunometric assay specific to the spike protein.

Out of a total of 3266 antibody tests performed in fully vaccinated Texas Children’s, 99.4% had a positive antibody response to the spike protein. From the 21 employees (0.6%) that had …

Endometriosis-Associated Angiogenesis And Anti-Angiogenic Therapy For Endometriosis, Monica S Chung, Sang Jun Han

Faculty, Staff and Students Publications

Endometriosis is a known estrogen-dependent inflammatory disease affecting reproductive-aged women. Common symptoms include pelvic pain, dysmenorrhea, dyspareunia, heavy menstrual bleeding, and infertility. The exact etiology of endometriosis is largely unknown, and, thus, the diagnosis and treatment of endometriosis are challenging. A complex interplay of many molecular mechanisms is thought to aid in the progression of endometriosis, most notably angiogenesis. This mini-review examines our current knowledge of the molecular etiology of endometriosis-associated angiogenesis and discusses anti-angiogenic therapy, in the blockade of endometriosis-associated angiogenesis, as potential non-hormonal therapy for the treatment of endometriosis.

Whole Lung Lavage: Treating Pulmonary Alveolar Proteinosis At The Time Of Covid Pandemic, Katherine Jean Powers, Vasanthi Avadhanula, Purvesh R Patel, Pralay Kumar Sarkar, Pedro Piedra, Neda Zarrin-Khameh

Faculty, Staff and Students Publications

Pulmonary alveolar proteinosis (PAP) is a rare syndrome due to increased production or decreased clearance of surfactant in alveoli and terminal bronchi that cause hypoxemic respiratory insufficiency. Here we present a patient with PAP whose disease was exacerbated by superimposed COVID-19 pneumonia. He underwent whole lung lavage (WLL). Evaluation of the viral count of the first and the last lavage of the left lung showed viral load in the alveolar space dropped by approximately 10-folds, however the magnitude of the viral load was substantial in both lavage samples. Whole pulmonary lavage may be used as a treatment option on patients …

Cross-Sectional Survey Of Smoking Patterns During The Covid-19 Pandemic In A Tobacco Cessation And Lung Cancer Screening Program, Maria C Mejia, Roger Zoorob, Robert S Levine, Xiaofan Huang, Charles H Hennekens

Faculty, Staff and Students Publications

Background: Coronavirus disease 2019 (COVID-19) produces a wide array of deleterious consequences, some of which are unintended. Data are sparse on whether, and if so, how, current cigarette smoking habits are affected by COVID-19. We describe changes to smoking habits and their correlates during the COVID-19 pandemic among participants in a tobacco cessation and lung cancer screening program.

Methods: Between June and October 2020, we conducted a cross-sectional survey of a convenience sample of 150 participants in a lung cancer screening and tobacco cessation program. The survey consisted of 3 parts: (1) changes in tobacco use, (2) impact and coping …

A Survey On Self-Medication For The Prevention Or Treatment Of Covid-19 And Distrust In Healthcare Of Veterans In A Primary Care Setting In The United States, Eva Amenta, Larissa Grigoryan, Laura Dillon, Casey Hines-Munson, John Van, Barbara Trautner

Faculty, Staff and Students Publications

BACKGROUND: The SARS-CoV-2 (COVID-19) pandemic brought the public overwhelming and conflicting information. Rates of trust in healthcare professionals have been declining among laypersons over the past five decades. In this setting, we sought to evaluate the use of medications, both with or without a prescription, to prevent and treat SARS-CoV-2 as well as trust in healthcare among patients in a primary care clinic.

DESIGN: We surveyed 150 veterans in primary care clinic waiting rooms at a large southwestern tertiary care Veterans Affairs hospital. This survey was performed in March-November 2021.

METHODS: The survey asked about respondents' demographics, use of medications, …

Racial/Ethnic Variations In Alcohol And Cigarette Use By Pregnancy Status Among 20- To 44-Year-Old Women, Nhanes 2001–2018, Jacqueline M Hirth, Catherine Valadez, Sandra Gonzalez, Alicia Kowalchuk, Judith A Gutierrez, Roger Zoorob

Faculty, Staff and Students Publications

OBJECTIVES: This study examines alcohol consumption and smoking behaviors by pregnancy status and race/ethnicity in order to inform improved interventions designed to assist women of all races to avoid alcohol and tobacco use during pregnancy for their health and to prevent potential fetal exposure.

METHODS: This retrospective secondary data analysis utilized nationally representative National Health and Nutrition Examination Survey data between 2001 and 2018. Smoking and alcohol use were evaluated by race/ethnicity and pregnancy risk. Sexual behavior, reproductive health, and prescription drug use determined pregnancy risk, categorized as low pregnancy risk, at risk of becoming pregnant, and pregnant. Binary and …

Health Disparities In Children And Adolescents Living In Lmic During Covid-19 Pandemic, Diane Nguyen, Satid Thammasitboon, Anna M Mandalakas

Faculty, Staff and Students Publications

PURPOSE OF REVIEW: The purpose of this editorial is to introduce the pediatric global health issue focusing on health disparities emerging from the COVID-19 pandemic on children and adolescents living in low- and middle-income countries (LMIC).

RECENT FINDINGS: As the COVID-19 pandemic ensues, children and adolescents living in LMIC have been disproportionately affected by socio-economic and mitigation practices, leading to widening disparities in health and the social determinants of health that influence their well-being.

SUMMARY: This pediatric global health issue brings to bare the extent, range, and nature of these health disparities, integrated with expert viewpoints, to prompt critical dialogue …

Covid-19 Impact On Disparity In Childhood Immunization In Low- And Middle-Income Countries Through The Lens Of Historical Pandemics, Harriet Itiakorit, Abhilash Sathyamoorthi, Brigid E O'Brien, Diane Nguyen

Faculty, Staff and Students Publications

PURPOSE OF REVIEW: The COVID-19 pandemic, since 2020, has affected health care services and access globally. Although the entire impact of COVID-19 pandemic on existing global public health is yet to be fully seen, the impact of COVID-19 pandemic on global childhood immunization programs is of particular importance.

RECENT FINDINGS: Disruptions to service delivery due to lockdowns, challenges in vaccination programs, vaccine misinformation and hesitancy, and political and social economic inequalities all posed a threat to existing childhood immunization programs. These potential threats were especially critical in LMIC where childhood immunization programs tend to experience suboptimal implementation.

SUMMARY: This review …

Disparities In Accessing Sexual And Reproductive Health Services And Rights Among Adolescents And Young People During Covid-19 Pandemic: Culture, Economic, And Gender Perspectives, Rogers N Ssebunya, Mafusi Boopa, Diane Nguyen, Lee Ligon

Faculty, Staff and Students Publications

PURPOSE OF REVIEW: As the world grapples with the health systems' challenges during the COVID-19 pandemic, addressing the needs of the already vulnerable adolescents and young people is vital. This narrative synthesis is aimed to highlight the current gender, cultural, and socioeconomic dynamics fueling inequalities to accessing sexual, reproductive health and rights (SRHR) services among adolescents and young people in low- and middle-income countries (LMIC).

RECENT FINDINGS: The COVID-19 pandemic has in most countries exacerbated already existing inequalities due to economic, gender, cultural, and legal aspects. Strategies implemented by most governments to mitigate the spread of the virus have also …

Cervical Cancer In Northern Tanzania–What Do Women Living With Hiv Know, Dorah Mrema, James Samwel Ngocho, Alex Mremi, Maryam Amour, Rogathe Machange, Benjamin C Shayo, Julius P Alloyce, Evaline Ndosi, Beatus T Shirima, Device Fande, Rahma Shehoza, Emmanuel Balandya, Bruno Sunguya, Stephen E Mshana, Alfred K Mteta, Eligius Lyamuya, John Bartlett, Blandina T Mmbaga

Faculty, Staff and Students Publications

BACKGROUND: Cervical cancer (CC) is more prevalent in women living with human immunodeficiency virus (HIV) infection compared to the general population. The magnitude is high among all countries burdened with HIV-Tanzania is no exception. Despite the unprecedented risk, women living with HIV (WLHIV) may not be aware of the risk and might have unfounded beliefs thereof. This study aimed to determine the knowledge, awareness, and beliefs on CC screening among WLHIV attending a clinic at the Kilimanjaro Christian Medical Centre (KCMC) in Northern Tanzania.

METHODS: This hospital-based cross-sectional study was conducted among 327 WLHIV attending care and treatment clinic (CTC) …

“I Have Nothing More To Give”: Disparities In Burnout And The Protective Role Of Immigrant Status During The Covid-19 Pandemic, Gene Chibuchim Otuonye, Nancy Shenoi, Tianshi David Wu, Kalpalatha Guntupalli, Nidal Moukaddam

Faculty, Staff and Students Publications

Burnout is an epidemic, with deleterious effects on individuals, patient care, and healthcare systems. The Coronavirus Disease 2019 (COVID-19) pandemic may be exacerbating this problem. We aimed to explore socio-cultural and gender norms that modulate burnout development in physicians during the pandemic and analyze any disparities associated with gender, marital and immigration status and work-life balance. We conducted an online cross-sectional survey of physicians (August-November, 2021): The Maslach Burnout Inventory-Human Services Survey (MBI-HSS) was used to measure burnout, combined with a validated survey assessing work-life balance. Demographic data was obtained for each participant. MBI-HSS subscales were measured, along with work …

Factors Influencing Human Papillomavirus Vaccination Among Hispanic Youth In Bexar County, Texas, Timothy Edward Wallum

Walden Dissertations and Doctoral Studies

A high number of Hispanic youth in Bexar County, Texas, face morbidity and mortality related to human papillomavirus (HPV) infection due to inadequate vaccination coverage youth. A better understanding of the factors that influence vaccination might help public health authorities to increase coverage. The aim of this quantitative, cross-sectional study, which was based on the socioecological model and involved analysis of weighted survey data from the 2016 to 2018 National Immunization Survey-Teen, was to better understand the multilevel factors influencing HPV vaccine use among Hispanic youth. The weighted sample was representative of the study population in terms of survey characteristics …

The Double Burden Of Intra-Household Malnutrition Among Mother–Child Dyads In South Africa, Puveshni Crozier

Walden Dissertations and Doctoral Studies

Household-level double burden of malnutrition (HL-DBM) challenges traditional South African vertical malnutrition programs. Research has associated a household with an overweight/obese mother of reproductive age and her under 5-year-old child with signs of undernutrition (wasting, stunting, or thinness) with socioeconomic levels, maternal characteristics, features of the household, and child’s demographics. Grounded in the social determinants of health conceptual framework, this study aimed to investigate the determinants of HL-DBM in South Africa across the reproductive-child health continuum. Using the representative 2017 Wave 5 South African National Income Dynamics Study survey secondary data, a total sample of 314 homes met this non-experimental …

Analysis Of Recurrent Urinary Tract Infection Management In Women Seen In Outpatient Settings Reveals Opportunities For Antibiotic Stewardship Interventions, Marissa A Valentine-King, Barbara W Trautner, Roger J Zoorob, George Germanos, Michael Hansen, Jason L Salemi, Kalpana Gupta, Larissa Grigoryan

Faculty, Staff and Students Publications

OBJECTIVES: We characterized antibiotic prescribing patterns and management practices among recurrent urinary tract infection (rUTI) patients, and we identified factors associated with lack of guideline adherence to antibiotic choice, duration of treatment, and urine cultures obtained. We hypothesized that prior resistance to nitrofurantoin or trimethoprim-sulfamethoxazole (TMP-SMX), shorter intervals between rUTIs, and more frequent rUTIs would be associated with fluoroquinolone or β-lactam prescribing, or longer duration of therapy.

METHODS: This study was a retrospective database study of adult women with

RESULTS: Among 214 patients with 566 visits, 61.5% of prescriptions comprised first-line agents of nitrofurantoin (39.7%) and TMP-SMX (21.5%), followed by …

Perspectives Of Girls, Families, And Healthcare Workers On Accessing Services For Adolescents With Perinatal Hiv In Nigeria, Joseph Fabian Inyang

Walden Dissertations and Doctoral Studies

Adolescents living with Human Immunodeficiency Virus (HIV) include those who were infected from their mother perinatally (PHIV) and those who were infected through sexual behaviors or drug use. Nigeria contributes the largest burden of children born with HIV globally, due to poor implementation of its prevention of mother-to-child transmission program. With advances in antiretroviral therapy (ART), more children and adolescents with HIV survive into adulthood. However, there are challenges to ART including access, uptake, adherence, and risks of long-term exposure. Using the social ecological model and a phenomenological approach, this qualitative study was designed to understand the experiences of adolescent …

Experiences Of Individuals With Opioid Use Disorder In Medication Assisted Treatment Programs, Lynda M. Maxfield

Walden Dissertations and Doctoral Studies

AbstractOpioid use accounts for many deaths each day in the United States. Although research has shown that retention in medication assisted treatment (MAT) programs increases quality of life for those individuals with opioid use disorder (OUD) and decreases premature death, there has been limited research on the perspectives of individuals with OUD in MAT programs and why they remained in or left the programs. The purpose of this qualitative phenomenological study, guided by Merleau-Ponty’s theory of perception, was to explore the lived experiences of those with OUD treated in a MAT program. An algorithm type interview was conducted to ask …

Birthplace Decision Making Experiences Of The Ugep Women Of Southern Nigeria, Thomas Okoi Ofem

Walden Dissertations and Doctoral Studies

The purpose of this basic qualitative study was to explore and describe how behavioral, normative, and control beliefs shape women's birthplace decision-making experiences. The study sought to better understand how Ugep women of southern Nigeria decided where to give birth after attending antenatal care. Using the theory of planned behavior as a framework, a purposeful sample of nine women aged 25 to 35 years who attended antenatal clinic at least twice at the selected primary health facility but gave birth at home during the past year was recruited. Data collection was through face-to-face, semistructured interviews. Audio recordings of interviews were …

Role Of Hypertension In Low-Birth-Weight Racial Disparities Among Virginian Women, Ashli Owen

Walden Dissertations and Doctoral Studies

Low birth weight (LBW) is a leading cause of infant mortality globally, but it disproportionately burdens the Black community in the United States, with a rate twice that of White women. Further, hypertensive disorders of pregnancy (HDsP) increase LBW incidence. The purpose of the study was to assess the association between HDsP and LBW, maternal race and LBW, and the moderation effect of HDsP on race and LBW on Black and White women in Virginia. The theoretical framework for this study was based on the lifecourse health development model, which states that health should be viewed as an outcome of …

Sociodemographic And Behavioral Predictors Of Obesity Among Female Asian Indian Immigrants In The United States, Afiya Saleem

Walden Dissertations and Doctoral Studies

Individuals from low-income countries such as those in the Asian region migrate to high-income countries and adopt obesogenic behaviors like sedentary lifestyles and high fat and sugar intake. This results in increased susceptibility to obesity, diabetes mellitus, cardiovascular disease, and stroke. Previous research has demonstrated that migrants from South Asian countries are at an increased risk of developing obesity, type 2 diabetes, and hypertension; however, little is known about the factors that contribute to this phenomenon. This was a quantitative, cross-sectional study guided by the social-ecological model. This study used secondary data from the National Health Interview survey to investigate …