• Childhood cancer incidence in Georgia: Descriptive epidemiology, geographic trends, and disparities in insurance coverage and health care access

      Kanu, Florence; Robb, Wagner Sara; Corriero, Rosemary; University of Georgia (Georgia Public Health Association, 2015)
      Background: Limited research has been conducted concerning childhood cancer (CC) incidence in Georgia, which is a leading cause of death for children in the US. The purpose of this study was to determine if county-level CC incidence rates differed by geography or race and if health care access disparities exist. Methods: Incidence data were obtained from the Georgia Comprehensive Cancer Registry for 2000-2011. Age-adjusted incidence rates per 100,000 were analyzed by sex, race, and county. Hotspots and coldspots of CC incidence were analyzed using the Getis-Ord GI* statistic. Health care access data for children under 19 were obtained using US Census Bureau’s Small Area Health Insurance Estimates for 2011. Georgia’s three children’s oncology group (COG) treatment facilities with 40-mile buffer zones were geographically overlaid with CC incidence rate maps and health insurance maps using Geographic Information Systems (GIS). Results: For leukemia and central nervous system cancers, incidence rates were significantly different between Whites [7.8, 95% confidence interval (CI) (7.4, 8.2)] and Blacks [5.2, 95% CI (4.8, 5.6)]. Statistical hotspots of CC were observed in north Georgia. A lower percentage of insurance coverage among children was observed in southeast GA. Approximately 25% of Georgia counties that were not within a COG buffer had a higher percentage of children who were uninsured (mean ± SD: 10.28% ± 1.86%). Conclusion: Higher CC incidence rates and disparities in access to care were evident in north Georgia. Future research is needed in these geographies to investigate potential risk factors associated with CC incidence patterns and racial differences in Georgia.
    • Coastal septic tank inventory: data resources for future wastewater management planning

      Alcorn, Jessica; University of Georiga (Georgia Public Health Association, 2017)
      Background: The US Environmental Protection Agency estimates that more than one in five homes are served by decentralized wastewater treatment systems—commonly known as septic tanks. In coastal areas where it is impossible to extend sewer service due to either financial or hydrogeological constraints, septic tanks are an integral part of wastewater treatment. When maintained adequately and installed under appropriate conditions, septic tanks remove excess nutrients and dangerous pathogens from wastewater. As coastal infrastructure is increasingly threatened by recurrent flooding, extreme weather events, and future sea level rise, coastal communities will need to assess the adequacy of their wastewater management systems and plan for future changes. Methods: Through funding from the Coastal Resource Division of the Department of Natural Resources, UGA’s Marine Extension has completed digitization of historic septic tank records into the Digital Health Department database in five coastal counties. This presentation will discuss how septic tank records have been linked to unique parcel identification numbers; the methodology for identification of potential undocumented septic tanks; and online, interactive GIS mapping features to allow expanded access and applications of the data. The septic tank inventory offers two primary benefits. First, digitization of septic tank records increases the efficiency of local public health departments in fulfilling information requests. Second, mapping the septic tank data allows for identification of areas in the county where septic tanks might be at the highest risk of failure or where targeted water sampling might be beneficial. Results and Conclusions: This presentation will focus on enhancing awareness of the data resource that has been created and potential uses in local wastewater management planning that incorporates climate considerations. This presentation will also demonstrate how other relevant GIS datasets can be integrated with the septic tank inventory.
    • Effect of Medicaid status on up–to-date vaccination rates among two-year-old children in Georgia, 2015

      Machado, Fabio; Tuttle, Jessica; Drenzek, Cherie; Georgia Department of Health (Georgia Public Health Association, 2017)
      Background: The annual Georgia Immunization Study (GIS) employs a retrospective cohort design to determine the up-to-date (UTD) immunization rate of 24-month-old children in Georgia. Previous results have shown lower vaccination rates in the second year of life, particularly for DTaP. We sought to determine if a discontinuation of Medicaid coverage after the infant year contributed to lower immunization rates in the second year. Methods: A stratified random sample of 2,002 Georgia children born in January 2013 was drawn from electronic birth records. Immunization history and Medicaid status were obtained from the Georgia Registry of Immunization Transactions and Services (GRITS). Parents and providers of children inadequately immunized according to the Advisory Committee on Immunization Practices’ (ACIP) immunization schedule were contacted for additional information. UTD immunization rates were compared among participants based on Medicaid status (Medicaid both years, first year only, second year only, never on Medicaid). The relationship between Medicaid status and specific immunizations was also explored. Reasons for loss of Medicaid among children who were not UTD were sought via parent interview. Significance testing was performed using Chi-Square tests in SAS version 9.4. Results: Children covered by Medicaid both years or never covered by Medicaid were more likely to be UTD by 24 months (90.4% and 84.5%, respectively) than children no longer covered by Medicaid in their second year of life (49.2%). These children also demonstrated a significantly lower immunization rate for the 4th DTaP dose (p<0.0001). Conclusions: A discontinuation of Medicaid coverage after the first year of life was associated with a lower UTD immunization rate among 24 month old children, particularly the 4th DTaP dose. Although reasons for discontinuation of Medicaid were beyond the scope of this study, lower vaccination levels among this group may reflect a lack of understanding of vaccine support services, and deserves further examination.
    • Use of geographical information systems to identify counties in Georgia with high risk for childhood lead poisoning

      Rustin, R Christopher; Kuriantnyk, Christy; Lobsinger, Byron; Charles, Simone; Georgia Department of Public Health; Michigan University (Journal of the Georgia Public Health Association, 2015)
      Background: For children in Georgia, lead poisoning is a substantial public health problem. Primary risk factors include low socioeconomic status and poor-quality housing built prior to 1978. The Environmental Health Team of the Georgia Department of Public Health (DPH) utilized geographical information system (GIS) technology and census housing data to identify counties in which children have high risk for lead poisoning. The purpose of this research was to update and refine previous maps developed with older technology and on a different geographic scale so that targeted public health interventions can be developed. Methods: Data related to stratified and median housing age data were derived from the 2013 5-year American Community Survey. With ESRI ArcMap 10.2 geographic information software, the data were geospatially linked to the state’s county shapefile for development of spatial maps. Results: A series of spatial maps were developed utilizing housing risk factors of age and occupancy status. Refined spatial maps were developed for: 1) the percentage of homes built prior to 1978 and prior to 1950 per county; 2) owner- and renter-occupied housing stratified by age and color-coded per county; and 3) counties in which children were at high risk for lead poisoning. Conclusions: The data from this research provides information for the DPH Lead and Healthy Homes program of areas in the state where targeted interventions are needed. The updated maps can be used to educate policy makers, healthcare providers, and community leaders in regard to prevention of lead poisoning.