• Gender disparities in weight gain among offenders who are obese upon entering correctional facilities

      Gates, Madison, L.; Webb, Nancy C.; Stone, Rebecca; Ballance, Darra; Yoo, Wonsuk; Institute of Public & Preventive Health, Augusta University (Georgia Public Health Association, 2016)
      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 more valid weight and height measurements and length of incarceration > zero). Results: Women offenders who entered corrections as obese had a mean (and standard deviation) body mass index (BMI) of 36.2 (5.3) at baseline; the mean for men was 34.2 (4.4). For women who were obese at baseline, their BMI increased by 1.0 (3.3); for men their BMI decreased by 0.7 (3.1). Gender differences for changes in BMI among the obese population were significant (χ2 = 15.8, p < 0.001). Women and men also differed in regard to weight gain (χ2 = 34.0, p < 0.001). Further, those women and men who were not obese at baseline had an increase in BMI that was greater than the increase for the group that entered corrections as obese (p > 0.001). Conclusions: Women offenders, obese or not at baseline, had greater gains in weight in comparison to men. However, there were no significant differences in BMI changes for race or correlations with age or length of incarceration. The findings related to gender warrant further investigations to explain these disparities and to evaluate the capacity of the corrections system to meet the health needs of women.
    • Geographic modelling of sickle cell trait in four US regions

      Bhattacharya, Anunay; Tabi, Marian (Georgia Public Health Association, 2017)
      Background: Many studies have been done concerning the prevalence of sickle cell trait, its incidence and screening techniques. It is most commonly observed in the Black and Hispanic population in the United States. This study used retrospective data from the Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report (MMWR – December 12, 2014) to model, analyze, and substantiate the geographic distribution of sickle cell trait, its incidence, prevalence and screening in 44 states divided into 4 regions in the United States. Methods: We conducted data modelling of geographic regions in the United States. The four regions were West, Midwest, South and Northeast. The research question was: How is screening rate related to sickle cell trait in the regions of the United States? The data were pooled in an Excel file and analyzed using linear regression and generalized linear modelling in SAS 9.4. Results: The results showed that (1) there is a significant relationship between incidence and the number of infants screened for region 2 (Midwest), p=0.0020; (2) a significant relationship between incidence and sickle cell trait for region 2 (Midwest), p=0.000; (3) incidence with screening and trait for region 1 (West), region 2 (Midwest) and region 3 (South), p<0.05. (4) Generalized linear modelling was also significant with interactions for the region 1, region 2, and region 3, with p<0.05. Conclusions: Findings indicate that more screening is needed to diagnose sickle cell trait, particularly among Black and Hispanic infants from the region 2 (Midwest) states. There should be more intervention programs implemented to promote early screening among newborns to reduce disparities and the burden of prevalence.
    • Georgia Latino enrollment in the Affordable Care Act: A qualitative, key informant analysis

      McCulloch, Audrey; Evans, P Dabney; Emory University (Georgia Public Health Association, 2016)
      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 to enrollment in Marketplace health insurance coverage. Methods: A semi-structured interview guide based on a review of relevant literature and consideration of the study goal and aims was developed. Fourteen in-depth interviews with key informants (participants) from Georgia’s Latino community, including nonprofit leaders, health media professionals, and community health promoters, were conducted between June and September 2014. Results: Participants described perceived barriers to enrollment during the initial ACA enrollment period and made recommendations for the design and implementation of future outreach, education and enrollment strategies. Major themes that emerged involved basic health literacy, misinformation, enrollment opportunities, the importance of place and politics, and technology and language as barriers. Conclusions: To target Georgia Latinos, we provide seven recommendations for outreach, education and enrollment, including the organization of one-on-one services in locations of familiarity and comfort to Georgia Latinos and the hiring and training of Spanish-speaking enrollment professionals. When providing ACA education to Latinos, stakeholders should begin with basic health literacy concepts and education regarding the fundamentals of the United States health insurance system. The findings of this study may serve to guide future design and provision of culturally competent outreach, education and enrollment services.
    • Georgia’s critical access hospitals: Financial performance and process improvement

      Mase, William; Apenteng, Bettye; Carhuff, Lisa; Hanna, Mark; Boakye, Kwabena; Kimsey, Linda; Opoku, Samuel; Owens, Charles; Tedders, Stuart; Whaley, Patricia; et al. (2017)
      Background: Georgia’s Critical Access Hospitals (CAH) are in crisis. Within the last 2 years, four CAHs have closed their doors due to failed financial and operational performance. Evidence points to the risk that several more are on the brink of closure. CAH closures have far-reaching impact on residents. Negative impacts include the extra distance that patients must travel to seek care, the displacement of health professionals and the unravelling of the entire fabric of the communities these hospitals serve. We hope to help participants understand the financial and operational challenges of CAHs, and to identify realistic strategies to enhance the resilience of these hospitals. Methods: The Georgia Southern team worked with a cohort of CAHs across the state of Georgia to identify financial and operational best practices. Year 1 of this project focused on data collection, analysis and benchmarking. Year 2 is currently focused on performance improvement through Lean Six Sigma. Results: CAHs face financial constraints due to factors such as low volume, declining market share, unfavorable payer mix, challenges relating to collections, and difficulties in recruiting providers. CAHs in Georgia performed more poorly on the financial indicators assessed, in comparison to respective national medians. Many CAHs in our cohort are better organized to deal with crises – utilizing strong executive and bureaucratic structures – than to pursue ongoing improvement through employee empowerment and a process focus. Conclusions: Improvements in the operational and financial management practices of Georgia’s CAHs may significantly improve performance. Evidence-based strategies for operational and financial improvement are vital to sustainability. Opportunities exist for collaboration between public health systems and rural hospitals, including CAHs in assuring healthcare access for rural populations.
    • Georgia’s rural hospital closures: The common-good approach to ethical decision-making

      Bastian G., Randi; Garner, Marcus; Barron S., John; Akowuah A., Emmanuel; Mase A. William; Jiann-Ping Hsu College of Public Health, Department of Health Policy and Management, Georgia Southern University (2016)
      ABSTRACT 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 influenced the viability or rural hospitals? 2) What are the ethical implications of Medicaid expansion and state policy reform/adoption pertaining to viability of rural hospitals? and 3) What are the ethical implications of critical access hospitals closures on rural communities in Georgia? Information related to these questions is presented, along with tactics to addressing these in an ethical manner. Results: This descriptive analysis shows that the largest number of state-specific closures have occurred in states with a federal exchange and which chose not to expand Medicaid. Characteristics of the state of Georgia and the counties with recent closures show that these counties typically have smaller populations with a high minority presence, lower education and income levels, and higher numbers of medically uninsured. Conclusions: The common-good approach to ethical decision-making is suitable for evaluating the ethical implications of policy-level decisions impacting the closure of critical access hospitals serving the rural communities of Georgia.
    • Give Rise

      Visintainer, Rachel; Communications (Augusta University Libraries, 2020-05-04)
      This item presents the abstract for an oral presentation at the 21st Annual Phi Kappa Phi Student Research and Fine Arts Conference.
    • GPHA www.jgpha.com 153 Georgia Public Health Association Impact of the Georgia Charitable Care Network on cost savings from lowering blood pressure and decreasing emergency department use

      Corso, Phaedra; Walcott, Rebecca; Ingels, Justin; University of Georgia (Journal of the Georgia Public Health Association, 2015)
      Background: The Georgia Charitable Care Network (GCCN) is a non-profit organization whose primary mission is to foster collaborative partnerships to deliver compassionate health care to low-income, uninsured individuals. Hypertension screening and management is a service provide by 90+ clinics in the GCCN statewide. Methods: With data from N=1661 patients who were screened and treated for hypertension at n=12 clinics in 2013, the impact of hypertension management on blood pressure levels, the incidence of coronary heart disease (CHD) and stroke, and utilization of emergency departments (EDs) were examined. The resulting changes in healthcare utilization were converted to changes in healthcare costs and compared to the expenditures for clinics providing screening and treatment services to the same population over a one-year period. Results: Patients with an initial diagnosis of hypertension or prehypertension experienced average reductions of 10.27 mmHg and 6.32 mmHg in systolic and diastolic blood pressure, respectively, during their follow-up visits. These changes were associated with 32.0% and 44.3% reductions in the relative risk of CHD and stroke, respectively. The savings from this reduction in blood pressure and avoided ED visits for 1661 hypertensive patients produced positive net benefits in 2013 US$, of more than $400,000, with a benefit-cost ratio of 1.6. Conclusions: For every dollar invested in GCCN clinics for hypertension screening and management, there is a benefit to the healthcare system through reduced costs of $1.60. GCCN clinics are a cost-saving delivery model for underserved communities with poor health status and high ED usage.
    • Health Literacy Levels Among Adult Support Group Members and the General Adult Public : A Focus Group Approach

      Czech, Daniel R.; Alberto, June; Joyner, A. Barry; Georgia Southern University (Georgia Public Health Association, 2007)
      Health literacy has been identified as lacking in 47% of Americans (The National Academies, 2004). While health literacy reports of studies conducted in the southern section of the United States are available (DeWalt et al., 2004; Kennen et al. 2005), this research team found limited research that provides health literacy levels of the southeast, rural Georgia population. The purpose of this exploratory study was to examine and compare health literacy of health-related support group members and non group members in southeast Georgia utilizing a focus group methodology developed by Kreuger (1994). After Institutional Review Board approval at a local university, the research team utilized 5- 10 established Health-related Support Groups of 6-10 individuals in the southeastern part of the United States. An additional four focus groups composed of persons not associated with a health-related support group were also used for comparative purposes. Participants were recruited with the assistance of local health care providers. The initial open-ended questions consisted of items such as: “Describe your experience reading health resources.” "What makes a health resource difficult to read, as well as easy to read?" The moderator utilized additional probing questions and reframing comments as necessary (Kreuger, 1994). The data were analyzed by the qualitative content analysis method described by Berg (1989). The themes that emerged across groups reflected confusion about medication directions, health terms, and communication from health care providers and doubt about the integrity of and inability to read the small print of health information. Prevention and faith in God were identified as important to self-care. Rationales for themes and future research ideas are discussed.
    • Helping public health professionals access infectious disease trainings and resources: The Region IV PHTC infectious diseases training database

      Lloyd, Laura; McCormick, Lisa; Alperin, Melissa; Carvallo, Michelle; Wilson, Cidney; Bergland, Brita; Patel, Arti; Miner, Kathleen; Emory University (Georgia Public Health Association, 2017)
      Background: The Region IV Public Health Training Center (R-IV PHTC), located at Emory University’s Rollins School of Public Health, has a mission that includes providing training and educational offerings to strengthen the competency of the current public health workforce in HHS Region IV (which includes GA). Additionally, the R-IV PHTC has been charged with serving as a national resource in the area of infectious disease. To fulfill this charge, the R-IV PHTC conducted an environmental scan to identify and increase access to existing infectious disease trainings and resources currently available to the public health workforce. Methods: From June 2015 – February 2016, the R-IV PHTC systematically reviewed infectious disease-related trainings developed by credible organizations between 2011-2015. We reviewed the websites and learning management systems of 73 different organizations including but not limited to the TrainFinder Real-time Affiliated Integrated Network (TRAIN), Centers for Disease Control and Prevention, Association of State and Territorial Health Officials (ASTHO), and other PHTCs. Trainings were identified utilizing several search terms including infectious disease, vaccination, HIV/AIDS, tuberculosis (TB), Ebola, measles, etc. Results: Altogether, the R-IV PHTC identified over 500 training programs and resources in our designated content area of Infectious Disease developed by other public health organizations between 2011-2015. The final trainings are available in an easy-to-use searchable database and can be filtered by sponsor, title, year, provision of continuing education credits, addressed competencies, cost, length, infectious disease category, and modality. The database will be updated at least once yearly to ensure currency. Conclusions: This poster will describe the methodology that the R-IV PHTC used to conduct an environmental scan of infectious diseases trainings. In addition, the poster will explain how to locate and access infectious disease trainings in one database on the R-IV PHTC website using a variety of search filters
    • Hepatitis C and HIV screening

      Perry, Merry (Georgia Public Health Association, 2017)
      Background: Chronic hepatitis C virus (HCV) affects more than 3 million people in the United States. Current HCV treatment offers a shorter treatment interval with fewer adverse reactions as well as improved cure rates of 96%. The increasing rates of hepatitis C infections in adults have been accompanied by multifaceted adverse health outcomes. The purpose of this screening program is to identify HCV-infected individuals, which will lead to clinical interventions and treatment that will improve health outcomes compared to no screening. Methods: The Centers for Disease Control and Prevention guidelines recommend that anyone with risk factors should be screened for HCV infection. In addition, all persons born between 1945 and 1965 should be screened once in their lifetime. Screening at Curtis V. Cooper Primary HealthCare Inc. (CVCPHC) includes individuals 18 and over for HCV and HIV. Results: CVCPHC’s screening program was implemented in January 2016. As of October 1, 2016, 4054 individuals had been screened for HCV with 187 antibody-positive. Of the individuals with positive antibody tests, 179 were RNA tested, and of these, 122 tested positive. Seventy four percent of those with a positive RNA test were linked to care. Eighty five percent of individuals with a positive RNA test were born between 1945 and 1965. The current case reports consist of 57 active HCV patients on medication and/or have completed therapy; 10 have a viral load not detected (ND) > 4-6 weeks after starting medication; 15 completed therapy with a ND viral load resulting in a 100% cure rate; 12 are currently on medication < 4 weeks; 15 were referred to GI; and five deferred treatment. Conclusions: Screening for HCV and HIV lead to the appropriate interventions and treatments for persons infected, preventing the progression of liver disease and reducing morbidity and possibly mortality.
    • Hepatitis C and injection drug use: Testing and linkage to care

      Sutton, Marie; Youngner, Cole; Holloway, Winona; Emory University (Georgia Public Health Association, 2016)
      Background: The recent outbreak of HIV infection in Indiana linked to injection drug use demonstrates the importance of timely HIV and Hepatitis C surveillance and rapid response to interrupt disease transmission. An estimated 2.7 – 3.9 million Americans have chronic hepatitis C virus (HCV) infection. Of those, 50 – 70% are unaware of their infection. People who inject drugs account for more than half of new HCV cases. Within 5 years of beginning injection drug use, 50 – 80% of injection drug users (IDUs) become infected with HCV. Since 2007, HCV-related deaths have surpassed HIV-related deaths. CDC reported 19,368 death certificates listing HCV as a cause of death in 2013, adding that this figure represents a fraction of deaths attributable to HCV. Method: Imagine Hope, supported by a grant from a pharmaceutical company, initiated HCV rapid testing in April 2015. The Georgia-wide project includes 10 agencies serving substance-using populations, including 4 methadone clinics. The project offers free, routine HCV testing and linkage to care. Results: Over the first 12 months of testing, 3,226 clients received HCV antibody testing. Of those, 344 (10.7%) were HCV antibody positive (Ab+), with 186 completing confirmatory RNA testing. Confirmatory tests yielded 132 (71%) RNA positive cases; 56 (42.4%) of these were linked to care. Five clients have achieved sustained viral load suppression which is considered a cure for hepatitis C. Numerous others have begun direct acting antiviral regimens. Conclusion: HCV testing in substance abuse facilities is feasible. Among substance users, HCV prevalence is high and awareness of infection risk is low. Linkage to care is enhanced by the use of a navigator. RNA screening prior to the 1st medical appointment expedites linkage to care; RNA positive clients are more motivated to keep appointments and RNA negative clients do not clog an already burdened system of care for the uninsured.
    • HIV Rates in the State of Georgia: A Growing Threat among Predominantly African American Populations

      Raychowdhury, Swati; Tedders, Stuart H.; Georgia Southern University (Georgia Public Health Association, 2009)
      Background: US rates of HIV/AIDS continue to rise with over 55% of new cases identified in southern states in 2003. The objective of this study was to determine the magnitude of HIV/AIDS cases in rural southeast Georgia in comparison to urban areas of the state. Methods: County level data was acquired using OASIS. Rates of HIV infections by gender and race (black vs. white) were aggregated over a five year period (2000–2005) and indirectly adjusted using Georgia as the standard. Rates for rural counties, (populations less than 35,000), were statistically compared to urban rates (α = 0.05). Results: HIV infections in urban counties were significantly higher as compared to rural counties. Statistically high infection rates in urban areas were also evident when controlling race and gender. Black males and black females in urban counties were the groups most heavily impacted. Conclusions: HIV/AIDS is an increasingly complex problem throughout the state of Georgia. Although urban areas continue to be significantly impacted, HIV infections among rural populations, especially black residents, represent a serious and growing threat.
    • How can we promote mentored student research in Georgia?

      Webb, Nancy C; Smith, Selina A; Augusta University (Georgia Public Health Association, 2016)
    • How Does Economic Turmoil Affect Alcohol Consumption?

      Bruker, Augustus; Finance and Economics (Augusta University Libraries, 2020-05-05)
      This item presents the abstract for a poster presentation at the 21st Annual Phi Kappa Phi Student Research and Fine Arts Conference.
    • How Does Industrial Concentration Prepare an Economy for Business Cycle Change?

      Walker, Aaron; Business (Augusta University Libraries, 2020-05-04)
      This item presents the abstract for an oral presentation at the 21st Annual Phi Kappa Phi Student Research and Fine Arts Conference.
    • Human papillomavirus-associated cancers in Georgia, 2008-2012

      Solomon, Irene; McNamarea, Chrissy; Bayakly, Rana A (Georgia Public Health Association, 2016)
      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 Disease Control and Prevention (CDC). Data for anatomic sites known to have HPV-associated cancers, including the cervix, vulva, vagina, penis, anus, and oropharynx, were analyzed. Also derived were ageadjusted rates, age-specific incidence rates, the percentage of each cancer found attributable to HPV, and ageadjusted incidence rates by geography. Results: During 2008-2012, a total of 6,056 HPV-associated cancers were diagnosed (males, 2,408; females, 3,648). Of these, 4,629 cancers were attributable to HPV (males, 1,574; females, 3,055). The most common cancers attributable to HPV were oropharyngeal cancers among males (1,182); and cervical cancers (1,862) among females. Females living in smaller urban counties had a higher cervical cancer incidence rate than females living in metropolitan counties and metro areas (1 million or more population). Males living in rural counties had a lower oropharyngeal cancer incidence compared to the state incidence rate. Conclusions: Since HPV vaccination at age 11-12 years can prevent HPV-related cancers in adulthood, clinicians should promote HPV vaccination along with routine immunizations to adolescents. Surveillance of HPVassociated cancers using GA cancer registry data is needed to track future changes in incidence data due to administering the HPV vaccine, increasing cervical cancer screening, and educating youth in GA about HPV risk factors.
    • “Illegal”: Job Attainment and Socio-Economic Status Among First-Generation Mexican Americans, 1980s-2000s

      Esteban, Isabella; History, Anthropology, and Philosophy (Augusta University Libraries, 2020-05-05)
      This item presents the abstract for an oral presentation at the 21st Annual Phi Kappa Phi Student Research and Fine Arts Conference.
    • Immunization policies for employees of childcare facilities within the North Central Health District of Georgia

      Kamara, Paula; Lian, Brad; Smith, Jimmie; McChargue, Judy; Mercer University, North Central Health District (Georgia Public Health Association, 2015)
      ABSTRACT Background: Since the early 1980s, vaccinations have generally been required for children in licensed daycare and school settings. In these settings, vaccinations have reduced disease rates. Adults occupy these settings as well, and ensuring they are vaccinated should also reduce the potential for disease and disease transmission. Yet, there are few vaccination requirements for adults employed at daycare facilities, although such requirements have been recommended (CDC Adult immunization schedule, 2015; ACIP General Recommendations, 2011). The objective of this study was to examine current vaccination policies among childcare facilities within Georgia’s North Central Health District (District 5-2) and the climate for possible policy directives in the future. Methods: A 10-item questionnaire regarding vaccination requirements and policies and the importance of vaccination education was mailed to administrators of all 271 licensed childcare facilities within the North Central Health District in Georgia. A total of 76 questionnaires were returned, representing a 28% response rate. The district has approximately 530,000 residents and is comprised of 13 counties. Results: Of the childcare facilities, 79% have no vaccination policies in place. However, most facility directors (75%) indicated that such policies should be required, and 93 % stated that vaccination education is important for their staff members. Conclusions: Vaccination requirements can help protect children and their caregivers from communicable diseases. From a policy perspective, the climate may be favorable for the implementation of such requirements, in that most childcare directors recognize the importance of such policies and state that they should be required.
    • Impact of 1918 Spanish influenza pandemic on mortality rates in Savannah, GA, and implications for future epidemic prevention

      Plasphol, Sara; Dixon, Betty; Armstrong State University (Georgia Public Health Association, 2015)
      Background: The Spanish Influenza pandemic struck the United States in waves from September 1918 through March 1919. This study investigates the impact of the Spanish Influenza on Savannah and Chatham County, Georgia. Methods: Primary death records from the Chatham County Health Department were examined and analyzed for the years of 1917, 1918, and 1919. Historical mortality rates in the Savannah area were compared to those for other parts of the United States and world. Results: Mortality rates attributed to the Spanish Influenza within Savannah closely paralleled similar flu-related mortality rates for comparison populations in New York, London, and Madrid. Conclusions: These local primary data enable Savannah public health officials to understand the historical trends of communicable disease mortality in relation to other parts of the world, and have the potential to serve as a reference when channeling future resources into epidemic prevention in Chatham County.
    • The Impact of Cardiac Rehabilitation on CVD Risk Factors in Diabetic Patients

      Thomas, Eyana; Lian, Eric; Roberts, Kimberly; Nursing (Augusta University Libraries, 2020-05-04)
      This item presents the abstract for a poster presentation at the 21st Annual Phi Kappa Phi Student Research and Fine Arts Conference.