• Characterizing discrepancies in school recovery after disasters

      Shah, Hazel; Georgia State University (Georgia Public Health Association, 2019-01-30)
      Background: Academic institutions provide consistency and routine to children. When disasters damage schools, students often suffer in a variety of ways, and racial minority students are often impacted disproportionately. However, minimal research exists exploring these discrepancies. This presentation examines racial disparities in school systems affected by Hurricane Ike (2008). Methods: This study, funded by the National Science Foundation, uses publicly available Texas Education Agency data from approximately 600 schools affected by Hurricane Ike. Schools were included in the study based on two criteria: if they were declared “disaster areas” by FEMA and if they were closed for at least 10 school days after Hurricane Ike. Results: Descriptive analyses were conducted comparing school characteristics and pass rates for all students in grades 3-11 on the Texas Assessment of Knowledge and Skills (TAKS) standardized test during pre- and post-hurricane school years (i.e., 2003 – 2011). Mean pass rates on the TAKS varied greatly by race/ethnicity and other factors. Of African American students, 60.7% (SD=17.4) passed the TAKS in 2004 compared to 69.9% in 2011 (SD=15.0); 68.0% (SD=15.7) of Hispanic students passed in 2004 as opposed to 76.23% (SD=12.2) in 2011; 78.8% (SD=14.8) of White students passed in 2004 versus 83.1% in 2011. Further analyses will explore various other determinants influencing academic performance. Conclusions: Preliminary findings show discrepancies at baseline in academic outcomes between racial/ethnic groups. These discrepancies persisted post-hurricane, though all groups saw an increase in pass-rates. Further research utilizing advanced statistical approaches and geographic information system (GIS) analysis could yield insights on variation of academic performance between schools and school districts, as well as physical exposure and risk factors. These insights can inform strategies for improving schools’ academic trajectories after disasters and optimizing community recovery as a whole.
    • Surveillance, Epidemiology, and End Results (SEER) data for monitoring cancer trends

      Yoo, Wonsuk; Coughlin, Steven S; Augusta University (Georgia Public Health Association, 2019)
      Background: Monitoring cancer trends allows evaluation of the effectiveness of cancer screening or detection methods and determination of priorities in cancer control programs. Government officials and policy makers also use information on cancer trends to allocate resources for cancer research and prevention. Although data from the Surveillance, Epidemiology, and End results (SEER)-affiliated cancer registry are accessible to the public, there is a shortage of published research describing cancer incidence rates for White, Black, and other residents in Georgia. The objective of this research is to provide an overview of how to use SEER data through analysis of the incidence rate for cervical cancer. Methods: Cervical cancer cases (ICD-O-3/WHO 2008 =’Cervix Uteri’, corresponding to C530-C539) were obtained from the SEER18 database. It includes the largest geographic coverage compared to SEER 9 and SEER 13 data. The incidence and incidence rates for cervical cancer were obtained, stratified by year (2000-2012), sex, race/ethnic groups, and region (Georgia and US). Age-adjusted incidence and incidence rates (to the 2000 US standard population) were calculated using SEER*Stat software, which is available, free of charge, on the SEER Web site: http://seer.cancer.gov. Results: Age-adjusted incidences and incidence rates in Georgia and the US from SEER 18 data were created by SEER*Stat. The incidence rates were stratified by age variable (5-year category), sex, race/ethnicity, and other socio-demographic variables. Annual percent changes (APC) and 95% CI were also obtained to characterize trends in cancer rates over time. The trends for age-adjusted incidence rates for regions (Georgia and the US) and race (white, black, others) were compared using APC. Furthermore, age-specific incidence and incidence rates for cervical cancer for Georgia and US for recent five years (2008-2012) were reported. Conclusions: The Surveillance, Epidemiology, and End results (SEER) program provides cancer researchers a convenient and intuitive system for viewing individual cancer records and producing statistics useful in studying the impact of cancer on a population.
    • Arsenal: Volume 2, Issue 1: Table of Contents and Editorial

      Walton, Amberly; Venugopal, Natasha; White, Adam; Layton, James; Alexander, Khadijah; Anosike, Kingsley (Augusta University Libraries, 2018-07-25)
    • Civilizing with a Krag: U.S. Counter-Insurgency in Vietnam and Iraq

      Ritchie, George (Augusta University Libraries, 2018-04)
    • Arsenal Volume 2, Issue 1

      Walton, Amberly; Venugopal, Natasha; White, Adam; Layton, James; Alexander, Khadijah; Anosike, Kingsley (Augusta University Libraries, 2018-04)
    • Techniques Used to Establish the First Person Narrator and Perspective in Double Indemnity and Murder, My Sweet

      Walton, Breana; Department of English and Foreign Languages (Augusta University Libraries, 2017-05-11)
      Directed by Billy Wilder and Edward Dmytryk respectively, the films noir Double Indemnity (1944) and Murder, My Sweet (1944) each have a storyline that unfolds from a first person perspective as told by a narrator. The techniques used in the films establish this first person perspective through which the films are understood. Both films include voice over as a technique, which determines who the narrator is and the amount of information withheld or disclosed to the audience. Establishing the visual perspective of the narrator is portrayed through differently for each film. While, Double Indemnity utilizes camera angle, Murder, My Sweet uses camera filters and special effects. Lastly, to achieve the first person narration, the character narrating in each film must be present in every scene or give explanation of events that occur in his absence. The various techniques used in each film function cohesively to establish the narrator and achieve his perspective through which the plot is understood by the audience.
    • Studying Gene Expression in Whole Embryos by in situ Hybridization: A Peer-to-Peer Laboratory Guide

      Kalra, Aarushi; Xia, Di; Department of Biological Sciences (Augusta University Libraries, 2017-05-11)
      The extracellular matrix (ECM) plays an important role in cell to cell signaling pathways. Our goal is to provide a full laboratory guide for students to study gene expression in zebrafish embryos by in situ hybridization. Prior to our study, the laboratory had observed disorganized and shortened cilia in cells that are important for cell signaling in the pronephric duct and neural tube floor plate of the zebrafish embryo. Ciliogenesis depends on a master transcriptional regulator, foxj1a, whose mRNA expression can be monitored through in situ hybridization and microscopic imaging. Knockdown morpholino-injected, control mismatched morpholino-injected, and uninjected embryos were fixed to determine if foxj1a transcription is qualitatively affected by ECM gene knockdown. Our results showed that the knockdown embryos portrayed an inconsistent foxj1a signal strength along the length of the pronephric duct, when compared to analysis of control mismatched and wild-type uninjected embryos. We created this manuscript for other students to observe how ECM gene knockdown can affect foxj1a mRNA expression, but also to give them a guide to the tools they would need to explore their own genes of interest, in zebrafish or in many other organisms and tissues.
    • Social networks as predictors of colorectal cancer screening in African Americans

      Alema-Mensah, Ernest; Smith, Selina; Claridy, Mechelle D; Ede, Victor; Ansa, Benjamin E.; Blumenthal, Daniel S.; Morehouse School of Medicine, Augusta University (Georgia Public Health Association, 2017)
      Background: Early detection can reduce colorectal cancer (CRC) mortality by 15%–33%, and screening is widely recommended for average-risk adults beginning at age 50 years. Colorectal cancer mortality rates are higher in African Americans than in whites, while screening rates are somewhat lower. Individual social networks can reduce emotional and/or logistical barriers to health-promoting but distasteful procedures such as CRC screening. The aim of this study was to examine social network interactions, and their impact on CRC screening among African Americans. We hypothesized a positive association between social network index (SNI) scores and CRC screening. Methods: In a community intervention trial with four arms, we previously demonstrated the efficacy of a small group educational intervention to promote CRC screening among African Americans. This intervention outperformed a one-on-one educational intervention, a reduced out-of-pocket expense intervention, and a control condition. In the present analysis, we compared the SNI scores for participants in the small group intervention cohort with a comparison group comprised of the other three cohorts. Social networks were assessed using the Social Network Index developed by Cohen. Results: Small group participants had a significantly higher network diversity score (Mean difference 0.71; 95% CI, 0.12-1.31; p=0.0017) than the comparison group. In the second component of the SNI score - -the number of people talked to over a two week period -- the small group intervention cohort also scored significantly higher than the comparison group. (Mean difference, 9.29; 95% CI, 3.963-14.6266; p=0.0004). Conclusions: The findings suggest that social interaction and support was at least partially responsible for the relatively high post-intervention screening rate in the small group intervention participants. Education in small groups could foster strong social networks. Strong and positive network diversity and a large number of people in social networks may enhance CRC screening rates among African Americans.
    • The association between dental coverage and self-reported health in older adults

      Yang, Frances M; Kao, Solon T; Lundeen, Joran S; Augusta University (Georgia Public Health Association, 2017)
      Background: For the older population of the United States, lack of dental insurance coverage is a substantial health problem. The purpose of the present study was to examine the longitudinal relationship between dental coverage and self-reported health among older adults. Methods: The Health and Retirement Study (HRS), a nationally representative biennial cohort study of community-dwelling individuals, includes 19,595 adults (aged 50 and older) living in the United States. For the 2010, 2012, and 2014 waves, the independent variable of dental coverage and the outcome of self-reported health were examined. Results: At each time point, dental coverage for older adults had a positive association with self-reported health (parameter estimate, β=0.340, standard error (SE)=0.039, p<0.0001), controlling for sociodemographic variables of age, sex, race/ethnicity, education, and the status of edentulism. There were no significant longitudinal effects for dental coverage associated with self-reported health. Conclusions: At each time point, the results show a positive association between having dental coverage and better self-reported health of older adults. This is relevant, because, in the United States, there is an increasing population of older people.
    • Dental students develop program addressing geriatric oral health at local nursing home

      Wilson, Nancy Lyn; Ciarrocca, Katharine; Chana, Monica; Augusta University, Georgia War Veterans Nursing Home (Georgia Public Health Association, 2017)
      Background: The elderly, especially those who reside in institutions and have a minority or low-income background, often have unmet oral health needs. As life expectancy increases, so will the need for oral health providers skilled in addressing the unique challenges presented by geriatric patients. Methods: Dentists for Della is a student organization at the Dental College of Georgia that aims to improve the oral health status of residents at the Georgia War Veterans Nursing Home (GWVNH) in Augusta, Georgia. The students conduct fundraising activities so that third and fourth year students can provide needed dental treatment at no cost to the residents. Students also regularly rotate at GWVNH in order to provide tooth brushing help, denture cleanings, and head and neck examinations, including oral cancer screenings. Results: Dentists for Della has funded approximately $40,000 worth of dental work since 2013. The program also provides an educational experience valued by students: the ability to interact with patients as early as their first semester of dental school. Conclusions: Dentists for Della is a vital program which not only provides educational opportunities in institutional public health dentistry and geriatrics for dental students, it also provides a much needed safety net for Georgia veterans with no ability to access other means of dental care
    • Arsenal: Volume 1, Issue 2

      Walton, Amberly; Venugopal, Natasha; White, Adam; Layton, James; Alexander, Khadijah; Anosike, Kingsley (Augusta University Libraries, 2017)
    • Zika virus communication preferences of pregnant women: Beyond the verbal

      Ellingston, Mallory; Chamberlain, Allson; Emory University (Georgia Public Health Association, 2017)
      Background: Pregnant women are frequently a priority group during public health emergencies, including the current Zika virus outbreak. These women turn to prenatal care providers for health information, but providers may not have the time for discussions with every patient. Knowing alternative ways to communicate key Zika-related information to pregnant women is important. Methods: To determine pregnant women’s preferences for obtaining Zika information from their prenatal providers, a 27-item survey was administered to 408 pregnant women at four prenatal care clinics in Atlanta between May 5th, 2016 and June 20th, 2016. The anonymous survey evaluated women’s preferences for receiving information about three topics: Zika virus, maternal vaccines and safe medications. Chi-square and Fisher’s exact tests were used to determine statistical significance of associations between these topics and selected patient characteristics. Significance was evaluated at α=0.05. Results: Educational brochures (63.8%), e-mails (55.2%) and their provider’s practice website (40.2%) were women’s most preferred modalities for receiving information about Zika virus beyond verbal communication. Most women (73.2%) use the CDC website as their primary source of information about Zika virus; only 19.2% seek that information on their provider’s website. Conclusions: Conveying Zika-related information to pregnant women is essential. As public health practitioners create and refine provider-to-patient communications, they can use these findings to ensure their messages align with how women want to receive information (e.g., brochures, emails, provider websites) and take advantage of existing modalities (e.g. their own websites) that providers may not be fully utilizing.
    • Letter to the Editor in response to “STD services delivery arrangements in Georgia county health departments”

      Moore, Kathryn; Terry, Latasha; Allen, Michelle (Georgia Public Health Association, 2017)
    • Leveraging partnerships in order to increase notifiable disease reporting

      Dekalb County Board of Health (Georgia Public Health Association, 2017)
      Background: Notifiable disease reporting, although required by law, does not always occur. For this reason, it is crucial for local public health agencies to leverage new partnerships for reporting of notifiable diseases. Schools represent sites within communities that experience relatively high numbers of cases of notifiable disease and clusters of illness. By leveraging partnerships with schools, an increase in disease reporting can occur within communities. Methods: DeKalb County Board of Health has developed an infectious disease protocol for the two major school systems in the county and one large private school: DeKalb County School District, City Schools of Decatur and the Waldorf School of Atlanta. This protocol was developed to outline each party’s responsibilities regarding disease reporting, surveillance and infection control within the schools. This protocol template was then used to develop an infectious disease protocol in partnership with two county school districts and a university within the North Central Health District and in a private school system in the DeKalb Health District. Results: Through education of notifiable disease reporting, the health district developed and implemented two protocols and has three pending protocols with schools. This has improved the relationships between the health district and the school systems through better communication and surveillance within the schools. Conclusions: Response to public health situations requires coordination across multiple sectors and effective use of existing resources within communities. It is essential for local public health agencies to build innovative partnerships that can then form the foundations for an increase in notifiable disease reporting and disease surveillance.
    • Chronic disease prevention as an adaptive leadership problem

      O'Connor, Jean; Georgia Department of Public Health (Georgia Public Health Association, 2017)
    • Characteristics of reported symptoms among confirmed and suspect cases of Zika virus in Georgia, 2016

      Thompson, Ashton; Georgia Department of Public Health (Georgia Public Health Association, 2017)
      Background: In May 2015, Zika virus was detected in Brazil. The virus has since spread through several countries in the Americas. Knowledge of the major symptoms of Zika virus infection was based on historic data from two previous outbreaks in the Pacific Islands. Currently-known Zika-specific symptoms include rash, conjunctivitis, arthralgia, and fever. Epidemiologists at the Georgia Department of Public Health (GDPH) began surveillance for travel-related Zika virus infections in January 2016. Surveillance data from GDPH contributes to better characterization of the current Zika clinical picture and more efficient triage of suspect cases for laboratory testing and prevention measures. Methods: For each patient approved for Zika testing, GDPH epidemiologists created an entry in the Zika Active Monitoring System (ZAMS) within the State Electronic Notifiable Disease Surveillance System (SendSS). Patients are categorized as “asymptomatic” or “symptomatic” and reported symptoms are noted. For symptomatic patients, clinical data are compared to determine differences in the distribution of symptoms in Zika negative and positive patients. Results: GDPH has approved testing for 383 symptomatic suspect Zika patients as of October 19, 2016; 88 (23%) were confirmed Zika infections. Among symptomatic positive patients, the most common Zika-specific symptom was maculopapular rash (95%); other common symptoms were headache and myalgia (27%). Among symptomatic Zika-negative patients, the most common Zika specific symptom was fever (62%), and the most common non-Zika specific symptom was headache (19%). Conclusions: Maculopapular rash is the most suggestive symptom of a true Zika virus infection, with 95% of symptomatic Zika positive patients in Georgia exhibiting the symptom. These data can be taken into consideration when updating the testing criteria for Zika virus. GDPH currently does not approve a patient for testing based on fever or non-Zika specific symptoms alone, and that guideline is reaffirmed by these results.
    • Injection drug use and hepatitis C: Interventions in behavioral health settings

      Sutton, Marie; Imagine Hope INC (Georgia Public Health Association, 2017)
      Background: Georgia is experiencing a crisis of injection drug use and hepatitis C virus (HCV) infection. From 2002 to 2014, the statewide drug overdose mortality rate increased, with nearly every county experiencing a significant increase in drug overdose mortality. Especially concerning is the rising HCV infection rate in people younger than 30, many of whom inject drugs. HCV incidence in young people increased over 200% in Georgia from 2006 to 2012. CDC officials have suggested “…Georgia is experiencing an expanding epidemic of heroin use that is driving an increase in injection drug use, putting many more at risk for the spread of HIV and HCV infection.” Methods: Now in its second year, Imagine Hope is a Georgia-wide project that includes 20 agencies (8 methadone clinics, 12 abstinence based agencies) serving substance-using populations. It offers free routine HCV testing and linkage to care. Nearly all individuals served inject drugs. The agencies have implemented a novel combination of embedding routine HCV testing into services; tandem testing for HCV and HIV; linking individuals to HCV care and treatment; and providing access to two support groups. Results: Over 18 months, 6,136 consumers received HCV antibody testing. Of those, 677 (11%) were HCV antibody positive (Ab+), with 83% of them born outside the baby-boomer cohort. To confirm HCV status, clinics conducted RNA tests, completing 464 such tests that yielded 381 (82.1%) confirmed cases of HCV. Currently, the project has linked 102 (36.8%) confirmed HCV+ clients to care and treatment services, with 12 (11.8%) clients experiencing total remission. Conclusions: Among intravenous drug users, HCV prevalence is high, while infection awareness is low. Navigators and support groups enhance linkage. Connecting a population of mostly uninsured behavioral health clients to care is feasible. Providing HCV RNA confirmatory testing in the behavioral health setting greatly enhances the linkage to care process.
    • Tailoring a hybrid program for reducing health and education disparities in Georgia communities: Outcomes of listening sessions

      Ejikeme, Chinwe; Georgia Department of Public Health (Georgia Public Health Association, 2017)
      Background: Minorities in Georgia experience increased rates of chronic disease and poor health and education outcomes. In the general population in 2013, about 35% of adolescents were either overweight or obese and approximately 13% of children 2-4 years old were obese, with minorities accounting for higher rates. In 2010, 23% of students from low-income families, comprising a higher proportion of minorities, scored at or above proficient level for reading at the end of third grade. Targeting children 0-5 years, Georgia Department of Public Health developed an integrated curriculum to train Early Childcare Educators (ECEs) to increase their knowledge and skills to model food, activity and language nutrition in their classrooms and to coach families. We conducted listening sessions to understand attitudes and knowledge around nutrition in 3 communities with significant racial and ethnic populations. Methods: Listening sessions with ECEs and families were conducted separately in each community. Participants engaged in guided one-hour discussions around food, activity and language nutrition and completed a post-listening session survey to assess their nutrition practices with the children in their care or homes. Results: 70 ECEs and families participated in the sessions and post session surveys. With an over 80% satisfaction rate with sessions, results showed that although baseline understanding of and challenges to modelling nutrition differed in different communities, many strategies used to support nutrition were common across communities. Participants also demonstrated a need for support in increasing access to resources to improve nutrition. Conclusions: This study suggested that multiple issues hinder optimal engagement of children 0-5 years in improved nutrition. Addressing the factors specific to targeted communities is essential to reducing disparities. Thus, integrating these findings in the development of the curriculum and training strategy has the potential to produce more knowledgeable and skilled ECEs as coaches for improving nutrition.
    • Community-based approaches to reduce chronic disease disparities in Georgia

      Rollins, Latrice; Akintobi, Tabia Henry; Hermstad, April; Cooper, Dexter; Goodin, Lisa; Beane, Jennifer; Spivey, Sedessie; Riedesel, Amy; Taylor, Olayiwola; Lyn, Rodney; et al. (Georgia Public Health Association, 2017)
      Background: Among underserved and racial/ethnic minority populations in Georgia, there are profound health disparities and a burden of chronic diseases. Such diseases, which are preventable, are influenced by risk factors, including poor nutrition, physical inactivity, lack of quality health care, and tobacco use and exposure. Awardees of the Racial and Ethnic Approaches to Community Health (REACH) and Partnerships to Improve Community Health (PICH) are implementing community-based initiatives using evidence-based, policy, systems, and environmental approaches to reduce racial and ethnic health disparities and the chronic disease burden in underserved urban and rural Georgia communities. Methods: Within the context of a social ecological framework, the REACH and PICH awardees selected interventions. Their impact in the areas of tobacco use and exposure, chronic disease prevention and management, and nutrition are described. Results: To date, the interventions of Georgia’s PICH and REACH awardees have reached approximately 805,000 Georgia residents. Conclusions: By implementing strategies for community-based policy, systems, and environmental improvement, Georgia’s PICH and REACH awardees are reducing tobacco use and exposure; increasing access to healthy foods; and providing chronic disease prevention, risk reduction, and management opportunities for underserved communities in urban and rural Georgia communities. Their efforts to address chronic disease risk factors at various social and ecological levels are contributing to a reduction in racial/ethnic health disparities and the chronic disease burden in Georgia.
    • Mock Me! A guide to developing a first rate training tool on a second rate budget

      Baxter, Galen; Georgia Department of Health (Georgia Public Health Association, 2017)
      Background: Working closely with county Environmental Health Specialists through the Standardization Process, a critical need was identified. Assistance was needed in prioritizing inspections based on risk levels identified in restaurant kitchens during inspections. Additionally, more training was needed to help them identify other areas in food service establishments that require further assessment. Methods: Tight budget constraints prevented the purchase of expensive training equipment; however, with a little creativity and team work, a mock kitchen made entirely out of cardboard, tape and a couple of aluminum pans was created as a portable, hands-on training tool that could be easily transported around the state. Results: Overwhelming positive feedback was received from the districts that experienced training using the tool. Environmental Health Specialists suddenly had an opportunity to practice and apply what they had learned within a controlled environment and increase their confidence in assessing and prioritizing during inspections. Conclusions: Solutions to problems can sometimes be found using a very simple approach. A little bit of creativity and a willingness to literally “think outside the box” can go a long way in providing viable, alternative solutions to common roadblocks in government. The key to creating an effective training tool is to accurately identify training gaps in the intended audience.