• An assessment of data related to inspections of risk factors for public swimming pools

      Shack, Shanita; Redmond, Maurice; Rustin, Christopher; Emory University; Georgia Southern University (Georgia Public Health Association, 2016)
      Background: The Georgia Department of Public Health (DPH) is mandated to ensure that public swimming pools are safe for those who use them. This mandate is carried out by the DPH and local environmental health professionals through regulations and inspections. In 2015, legislation was introduced proposing to reduce the authority of the DPH to inspect certain pool types (apartments, subdivision, condominiums) and thus reduce regulatory protections in place for swimmers. To ensure that the DPH had current information on the risks associated with pools, the EH team, with assistance from a graduate student, analyzed inspection data to evaluate risk factors associated with these pool types and summarized drownings and waterborne disease outbreaks (WBDOs). Methods: Pool inspection data (n=4,441 pools) for 2014 were retrieved from the Environmental Health Information System (EHIS) of the DPH. Data from the 2010 Census and epidemiological data on drownings and water-borne disease outbreaks (WBDOs) were also evaluated. Data were stratified by public health district and type/number of pools and analyzed for selected violations of health risk factors (pH, barriers, disinfectant residual). Drownings and WBDOs were described and summarized. Results: Approximately 55% of inspected pools were for apartments, condominiums, and subdivisions. These pool types were consistently cited by inspectors for the selected risk factors and ranked in the top five for these violations. In 2013, children aged 1-17 had the highest percentage (30%) of deaths from drowning. In 2001-2014, there were 28 WBDOs, with 39% occurring at public pool venues. Conclusions: Data from this research provided information on risks associated with pools and supported the importance of inspection programs for public swimming pools. The data were used to inform policy makers on the risks associated with the pool venues under legislative review. These data, combined with other risk factor information, were utilized by the DPH to inform training needs and to reinforce public health messaging on protecting swimmer health.
    • Assessment of distress, unmet needs, and receipt of care plans among cancer survivors in Georgia

      Escoffery, Cam; Patterson, Angie; Paris, Nancy; Kirsch, Logan; Frank, Cassiopeia; O'Connor, Jean (Georgia Public Health Association, 2016)
      Background: Cancer survivors have distinctive healthcare needs. The Survivorship Working Group of the Georgia Cancer Control Consortium conducted an assessment to understand the physical, psychological, practical, and spiritual needs of adult cancer survivors; patient perceptions regarding patient-provider communications; and their perceived need for services. Methods: In 2014, a convenience sample of Georgia cancer survivors completed a paper or online survey about the presence of and distress associated with unmet physical, emotional, spiritual, and practical needs, and receipt of assistance in those areas. They were also asked about receipt of cancer treatment and survivorship care plans. Results: Survivors were primarily female, married, White, and within 5 years of treatment. High proportions reported moderate to extreme levels of distress with depression (32.7%), anxiety (32.1%), stress (30.2%), and fear of recurrence (28.2%). Many reported no receipt of assistance in emotional needs such as changing relationships and defining a new normal and physical needs such as intimacy and body image. Fewer than half (48%) reported having received a cancer treatment summary from their physician and only 37% received a survivorship care plan. Of those who received either, 98% reported that the information was helpful. Conclusions: Cancer survivors in Georgia who responded to the survey had unmet needs, especially related to physical and mental health. More widespread adoption of guidelines of the Commission on Cancer, including the use of distress screening tools, would assist providers in addressing identified needs directly or through referrals. A limitation is that the racial and ethnic minority participation of 20.1% is insufficient to generalize results to all cancer survivors in Georgia. Subsequent surveys would benefit from targeted approaches to reach diverse and underserved survivors.
    • Assessment of early intervention services to better child outcomes among Part C infants and toddlers

      Ibe, Brendan; Fowles, Tiffany; Csukas, Seema; Conner, Jackie; Kelley, Grace; Johnson, Donna; Bryant, Cynthia; Allen, Michelle; Georgia Department of Public Health (Georgia Public Health Association, 2016)
      Background: Early intervention services have been shown to improve child outcomes. Rapid proliferation of neural connections and circuits contribute to the rapid growth of the brain in the first three years of life. These neural circuits which create the foundation for learning are most flexible in this period and become increasingly more difficult to change thereafter. The purpose of this study is to examine the relationship between early enrollment in Georgia’s Part C birth to three early intervention program and improved child outcome ratings upon exiting the program at 3 years of age. The study used 2013 & 2014 Annual Performance Report (APR) data. Methods: This study included 6,309 participants who enrolled and received services in the Part C, Babies Can’t Wait (BCW) program. A Pearson’s correlation analysis was used to assess if there was an association between age at enrollment and improved child outcome score. One-way analysis of variance (ANOVA) was used to test the variances within the age groups for equality. Bonferroni post hoc test was used to compare the mean child outcome score across the enrollment age groups. Results: A statistically significant inverse correlation was found between enrollment age and improved child outcome score at 3 years of age. One-way ANOVA showed that the variances within the enrollment age groups were equal while the mean child outcome scores were not. Bonferroni post hoc test revealed that the mean child outcome score in the enrollment age group 0 to ≤ 6 months was significantly higher than the other age groups. Conclusions: Significantly better child outcomes were associated with enrollment in early intervention services before 6 months of age.
    • Assessment of medical needs of the Hispanic community in Macon-Bibb County, Georgia

      Giguere-Belanger, Kim; Pino, Jose; Lian, Brad; Mercer University (Georgia Public Health Association, 2011)
      Background: Little is known about the health concerns and issues among the Hispanic community in growing, mid-sized cities, such as Macon, Georgia. Methods: A questionnaire on general health-related issues was given to a sample of 125 Hispanic participants. Results: The top health concerns of the Hispanic community were diabetes, obesity, and dental hygiene; the most common factors preventing Hispanics from receiving medical treatment were the lack of insurance, language barriers, and copayments or deductibles being too high. Conclusions: Lack of higher education and the inability to communicate effectively in English may be manifested as difficulties in finding proper information about where to access insurance and healthcare. Therefore, awareness campaigns, more advertising in Spanish, and perhaps increasing the availability of English lessons may be helpful for this population.
    • Assessment of the Building Collaborative Research Capacity Model: Bridging the community-academic researcher divide

      Akintobi, Tabia Henry; Wilkerson, Donoria Evans; Rodgers, Kirsten; Escoffery, Cam; Haardoeerfer, Regine; Kegler, Michelle; Morehouse School of Medicine, Georgia College and State University, Emory University (Georgia Public Health Association, 2016)
      Background: Community–based Participatory Research (CBPR) can be challenging when community leaders and academic researchers have not previously co-led research or worked together with established rules guiding their relationships, roles, and respective functions. The objective of this investigation was to assess the processes and outcomes of the Building Collaborative Research Capacity Grant Program, sponsored by the Community Engagement Research Program of The Atlanta Clinical and Translational Science Institute and designed to foster CBPR. Methods: Four competitively selected community-based organizations (CBOs) participated in capacity-building workshops designed to build research skills and receive technical assistance to plan a pilot study with academic researchers. Pre- and post-surveys were used to assess the impact of the training and technical assistance on the CBOs’ knowledge and skills and abilities to plan, implement, and evaluate research. Key informant interviews were conducted with academic researchers and CBO dyads to identify experiences, perceptions, and recommendations related to the program model, and seven identified domains of collaborative research including research skills, attitudes toward collaboration, shared goals, institutional factors, mutual respect, human and fiscal resources, and partnering skills. Results: Areas of research competency increased from pre- to post-survey, with statistically significant increases in Community Assessment (p= 0.046) and Program Planning (p= 0.046). Each partnership had inherent characteristics related to strengths and barriers affecting the research outcomes. Conclusions: The present results contribute to the literature through assessment of processes, outcomes, and partner insights of a model designed to facilitate collaborative community-engaged research partnerships. Future research should examine the model to expand understanding of the dimensions of effective community and academic research collaboration.
    • Association between air temperature and heart disease death rates in Georgia counties

      Hart, John (Georgia Public Health Association, 2016-07-19)
      Background: In this ecological study, global warming theory was tested on a local level, in Georgia. The hypothesis was that warmer counties would be associated with higher death rates. Methods: Heart disease death rates (HDDR) for 2008-2010 by Georgia county were compared to air temperature, also by county for the same years. Three race categories for HDDR were studied: black, white, and all races. Since there is evidence that living at higher land elevations provides a protective effect against heart disease, land elevation by county was included as a second predictor. Results: Correlation analyses revealed low strength, statistically significant correlations with white and all races HDDR as follows: direct for air temperature and indirect for land elevation. Correlations for blacks were negligible strength and statistically non-significant. Thus, multiple linear regressions (MLRs) were considered appropriate for whites and all race HDDR. In MLRs, temperature and elevation essentially cancelled each other relative to HDDR, resulting in statistically non-significant regression coefficients for each in both race categories (p > 0.15). This may have in part been due to the slight collinearity that was observed between the two predictors (variance inflation factor = 10.6 for both predictors in both race categories). The study is limited by: a) its (ecological) design, where individual exposures are unknown; and b) the-less-than ideal regression model that revealed slight collinearity between the predictors. Further research is required to verify these findings. Conclusions:
    • 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.
    • Association between intimate partner violence and mentally unhealthy days in women in the U.S.

      Broadnax, Danielle; Waldrop, Reinetta Thompson; Claridy, Mechelle D; Booker, Elain Archie; Alema-Mensah, Ernest; Morehouse School of Medicine (Georgia Public Health Association, 2016)
      Background: In the United States (U.S.), intimate partner violence (IPV) is a serious public health concern, mainly affecting the health and well-being of women. The objective of this study was to identify the IPV and socio-demographic factors associated with mentally unhealthy days among women in the U.S. of ages ≥18 years. Methods: Data for this study were obtained from the 2007 Behavioral Risk Factor Surveillance System. Multivariable analyses were used to estimate adjusted odds ratios (AORs) and 95% confidence intervals (95% CIs) for factors associated with IPV and 14 or more mentally unhealthy days per month. Analyses were conducted using SAS 9.3. Results: The analyses show that the following factors increase the likelihood of self-reported 14 or more mentally unhealthy days: having a high school level of education or less (AOR: 1.732; 95% CI: 1.415-2.119) and having an income < $50,000. In addition, experiencing IPV such as: ever being threatened by a sex partner (AOR: 1.499; 95% CI: 1.264-1.779); having a sex partner ever attempt violence (AOR: 1.461; 95% CI: 1.224-1.743); having a sex partner ever become violent (AOR: 1.541; 95% CI: 1.303-1.823); and ever having unwanted sex with a partner (AOR: 1.929; 95% CI: 1.584-2.350) also increased the likelihood of self-reported 14 or more mentally unhealthy days per month. Conclusions: The results indicate that, for women in the U.S., IPV and socio-demographic factors have an effect on self-reported 14 or more mentally unhealthy days. Improving access to services that offer protection and guidance for women abused by their intimate partner could decrease the likelihood of self-reported 14 or more mentally unhealthy days and long-term negative mental health outcomes among women
    • The association between nutrition, physical activity, and weight status among adults in Georgia

      Nguyen, Trang; Thapa, Janani; Zhang, Donglan; Pullekines, Elizabeth; University of Georgia (Georgia Public Health Association, 2017)
      Background: Obesity is classified as having a body mass index (BMI) greater than 30 and is associated with higher risks of type 2 diabetes, coronary heart diseases, hypertension, and other adverse health outcomes. In 2015, the prevalence of self-reported obesity among adults in Georgia was 30.7. The present study focused on how, in 2015, lifestyle factors, specifically nutrition and physical activity levels, related with weight status in Georgia. Methods: The dataset used for this analysis was from the 2015 Behavioral Risk Factor Surveillance System. The association between weight status (as measured by BMI) and nutrition and physical activity levels was examined by use of linear regressions, controlling for socio-demographic variables. Results: The sample consisted of 3,543 adult respondents in Georgia, of whom 2,285 (64.5%) were overweight or obese. Regarding the variables assessing nutrition, vegetable consumption had a significant association with weight status: one unit increase in consumption of vegetables decreased BMI by 0.009 (p=0.039). Conclusions: Vegetable consumption was negatively associated with BMI. Future research should examine, with more robust measures, the relationship between physical activity levels and weight status and determine how other lifestyle factors relate to weight status. This will become increasingly relevant, as the rates for obesity in Georgia and the United States continue to trend upward.
    • The association of stress with anxiety and depression: Evidence from a community health needs assessment

      Tournous, Nicloe La; Bagwell-Adams, Grace; University of Georgia (Georgia Public Health Association, 2016)
      Background: Mental illness affects approximately 1 in 5 Americans, making mental health an important area of study for public health. Much research has been conducted on two of the most prevalent mental health disorders, anxiety and depression. However, the association of stress with these disorders, especially specific types of stress (e.g., financial, health, relationship), has been under-studied at the local level. This study aimed to gain insight into the relationship between stress, anxiety, and depression in Athens-Clarke County, Georgia. Methods: Data collected in the 2015 Athens-Clarke County Community Health Needs Assessment were analyzed using linear regression models to explore the association between stress and anxiety and depression. Results: When the data were aggregated, the presence of stress in a respondent’s household was associated with a 17.8% (p<0.001; t=5.21) increase in the likelihood of reporting the presence of anxiety and a 10.0% (p<0.01; t=2.96) increase in the likelihood of reporting the presence of depression. Significant associations with mental health status were also found for race, insurance status, perceptions of neighborhood safety, and discrimination. Conclusions: The results demonstrated that, in Athens-Clarke County, Georgia, stress was significantly and positively associated with both anxiety and depression. Financial, home environment, and neighborhood safety stressors were the strongest predictors of household mental health disorders. These results have implications for public health policy and clinical professionals, including the possibility of tailoring treatment strategies to the types of stress present in a patient’s life. Further research is needed to explore this relationship in other communities.
    • Associations between major depression, health-risk behaviors, and medication adherence among HIV-positive adults receiving medical care in Georgia

      Clubreth, Rachel; Dube, Shanta; Maggio, David; Georgia State University; Georgia Department of Public Health (Georgia Public Health Association, 2016)
      Background: There are approximately 1.2 million people in the United States living with HIV, and 25.6% of HIV-positive adults suffer from depression. The purpose of this study is to examine the contribution of depression to substance use and medication adherence among HIV-positive adults receiving medical care for HIV in Georgia. Methods: Secondary data with a probability sample of 775 HIV-positive adults who took part in the 2009-2013 Georgia Medical Monitoring Project (MMP) were analyzed. Descriptive analyses and multivariate logistic regressions were conducted to assess relationships between depression and current cigarette smoking, injection drug use, other non-injection drug use, and medication adherence, adjusting for sociodemographic covariates (age, gender, race, and education). All analyses accounted for non-response and complex sampling design. Results: Among HIV-positive adults in Georgia, 8.5% met the criteria for major depression, including 13.7% of women and 6.5% of men. Heterosexual adults had a higher percentage of major depression (10.7%) compared to adults who identified as bisexual (7.4%) or homosexual (5.8%). Major depression was also higher among adults with a high school diploma or GED (12.7%) compared to adults with a higher level of education (5.2%). Major depression was associated with a greater odds of current cigarette smoking (AOR 2.7; 95% CI: 1.5, 5.2) and other non-injection drug use (2.5; 95% CI: 1.4, 4.4), after adjusting for sociodemographic variables. The three measures of medication adherence were not statistically significantly associated with major depression. Conclusions: As previously observed for the general population, we found, among HIV-positive adults, significant associations between depression and smoking and other non-injection drug use. Because HIV-positive adults have ongoing encounters with healthcare providers, screening and treatment for depression and other co-morbid substance use is needed to reduce an additional health burden in this population.
    • Associations between multi-level contextual factors and mental health service utilization in adolescents with comorbid depression and substance-use: Moderating role of school connectedness on racial/ethnic disparities in service utilization

      Thornton, Kate; Georgia State University (Georgia Public Health Association, 2017)
      Background: Comorbid depression and substance use has been a prevalent issue in adolescent health. Although rates have remained relatively stable, their level is still alarming and efforts to see a decrease have led leaders and organizations to call for research to better understand factors related to both depression and substance use as well as how these factors may change when these disorders occur together. Methods: Data from the National Survey on Drug Use and Health (NSDUH) were utilized to pursue the research objectives for this study. The NSDUH is an ongoing cross-sectional survey of the civilian and non-institutionalized population of the United States. Multi-level logistic regression procedures were used to determine the relationship between mental health care utilization and research variables in adolescents with comorbid depression and substance-use. Results: Multi-level modeling showed that the model that controlled for individual-level and family-level factors was able to best predict mental health care use (model 4, -2LL=945,303, p << 0.001). In addition, school attachment was shown to be positively associated with mental health care use in all models tested, including the best-fit model selected (OR=2.18;(95% CI 2.13, 2.22). Other contextual factors that were significantly associated with mental health care use were gender (OR=1.92;95% CI 1.88, 1.94), parental attachment (OR=1.72; 95% CI 1.70, 1.74), and poverty (OR=1.59; 95% CI 1.58, 1.62). In addition, the school attachment and race/ethnicity interaction term was found to be significant with an odds ratio of 3.02 (95% CI 2.96, 3.22). Conclusions: This research has shown the importance of contextual factors, specifically the school environment, on the service use of comorbid adolescents. Particularly interesting in the world of mental health promotion is the use of schools as key coordinators in providing specialty mental health services to adolescents, especially for those who suffer from service use disparities.
    • ATAD3A: A Critical Driver for Head and Neck Cancer

      Jensen, Caleb; Lang, Liwei; Biological Sciences, Oral Biology, Georgia Cancer Center (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.
    • Attitude towards research among undergraduate nursing students

      Bhattacharya, Anunay; Tabi, Marian; Georgia Southern University (Georgia Public Health Association, 2016)
      Background: This study investigated undergraduate nursing students’ attitude towards research. It has been shown in numerous studies that there exists a negative attitude towards research among undergraduate students and this attitude acts as a barrier. This negative attitude affects the willingness and efforts of students to excel in a research course. Methods: A 15-item pre and post-test questionnaire was administered to undergraduate nursing students to identify the factors that may have an effect on their attitude towards research. The Georgia Southern University Institutional Review Board approved the study. Statistical analysis was performed using paired sample t-test and IBM SPSS 23.0. Results: Factors that affected students’ attitude towards research included ‘anticipatory anxiety taking a research course’ (p=0.005), ‘glad that research course was over’ (p=0.009), and ‘research is a boring field’ (p=0.040) were significant at the =0.05. However, students recognized the usefulness of research to their professional career (p=0.004) and indicated the importance of attending their research classes (p=0.039). Conclusions: With the drive to make a doctorate in nursing the entry level for advanced nursing practice, changing the mindset of undergraduate nursing students towards research is essential. Therefore, the selection of teaching methods and the development of content to promote student engagement can make a difference in students’ attitudes toward undergraduate research and optimize learning outcomes.
    • Atypical Magnesium Requirements in a Phyllite Population of Rare Plant Species, Pediomelum Piedmontatum

      Zimmerman, Matthew; Biological Sciences (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.
    • Better nutrition by increased knowledge of food nutritional components

      Hayworth,Lisa; Hendricks, Tangela; Matthews, Nicole; Brenau University (Georgia Public Health Association, 2017)
      Background: The purpose of this project was to teach nutritional concepts related to MyPlate to children and families who participate in the Boys and Girls Club of Hall County (BGCHC). MyPlate is the nutrition guide published by the US Department of Agriculture; it is a pie chart depicting a plate divided into five food groups. The educational event occurred at a fall festival sponsored by the BGCHC. The intent was to offer a fun and interactive game to allow children to learn from a hands-on experience. Methods: Participants in the game were between 4 and 12 years of age and were from low income families. A matching game was developed for associating foods with the correct category of MyPlate. Results: Sixty-three percent of the children selected healthy plates with 3 out of 5 categories correct; 37% chose the unhealthy plates. Seventy-three percent of the participants stated they had previous knowledge of MyPlate. Conclusions: The conclusion reached by the Brenau University nursing students was that the concepts of MyPlate need re-enforcement throughout the community and over time.
    • Black college women sexual health peer education at Clark Atlanta University

      Francis, Clarissa; Bradley, Josephine; Bass, Christopher; Scipio, Karla; Braithwaite, Ronald; Clark Atlanta University; Morehouse School of Medicine (Georgia Public Health Association, 2016)
      Background: This research was based on the premise that various factors, such as social determinants, cultural competency, use of statistics and location, contribute to the efficacy of the transmission of sexual health education. In the United States, African American women account for 60% of the cases of human immunodeficiency virus (HIV) of women. Considerable research has noted the high rates of HIV among African-American women. The present research, however, focused exclusively on Black college women at Clark Atlanta University (CAU). Methods: A mixed method approach using surveys and participant observation in an exploratory case study was used to evaluate responses of Black college women at CAU to sexual health peer education. Results: Most of the Black college women who attended an event sponsored by Health Services, the Health Peers Educating and Encouraging Responsible Students (H-PEERS), reported that it effectively impacted their overall sexual health. Conclusions: Although, the female students reported having prior knowledge of sexual health information prior to attending CAU, including risk reduction behaviors, they reported participating in sexual risky behaviors. Many of the female students whom reported attending an event sponsored by the H-PEERS effectively had an impact on their sexual health knowledge, attitudes and beliefs towards sex, sexual behaviors, and sexual health status. Further research is needed on how the overall sexual health of black college women at Historically Black Colleges and Universities (HBCU) and predominantly white schools (PWI), and how strategies, such as peer-led health education, differ in transmission and efficacy.
    • Brain development: A look at four programs in Georgia that support optimal brain development

      Webb, Nancy; Gates, Madison L.; Augusta University (Georgia Public Health Association, 2016)
      Background: Georgia is making strides to improve its early care and education system through program development within state agencies and alliances. These timely, statewide programs are focused on improving understanding of the importance of brain development. Methods: We reviewed the mission and information provided by four Georgia agencies with the aim of developing and improving programs and educational opportunities to instruct educators, policy makers, the general public, and others about child development in the context of brain development. Results: For young children in Georgia, the four organizations are committed to ensuring opportunities for well-being. Georgia is moving forward in its quest to improve resources and environments for young children, families, and citizens. The agencies and activities include Better Brains for Babies; the Georgia Department of Early Care and Learning; Georgia Early Education Alliance for Ready Students; and the Talk With Me Baby program. Conclusions: Georgia is making substantial efforts to provide and support early education environments based on emerging research on how brain development
    • Breaking the chains: A public health approach to modern day slavery

      Nosin, Rachael; Deloitte Consulting (Georgia Public Health Association, 2017)
      Background: Modern day slavery is a $150 billion industry and the second largest criminal enterprise, behind drug trafficking.1 Approximately 21-30 million men, women, and children are modern day slaves worldwide, and over 200 cases of human trafficking were confirmed in GA in 2016 alone.2, 3 In 2006 Georgia incorporated a statute against trafficking of persons for labor or sexual servitude into its criminal code (see O.C.G.A. § 16-5-46). The penalties for this crime are stiff, and those convicted face a minimum of 10 years in state prison and up to a $100,000 fine. This is not enough, however. There is a need to identify this as a public health issue and work to create Georgia’s “Freedom Ecosystem,” a network of key players, including state government, businesses, consumers, and non-profit organizations. Together, these players can make strides in ending and preventing modern day slavery. Methods: Human trafficking is prevalent across our state, partly due to factors related to supply, demand, and facilitation. By applying a public health lens to human trafficking, we may deconstruct the issue across the socio-ecological model to identify the root causes and the most strategic approaches to overcoming systemic barriers, identifying and aiding victims, and empowering survivors. To do so, the Freedom Ecosystem can be used as a framework for harnessing change. Results: Through external interviews and research, we identified nine ways that organizations play a role in the Freedom Ecosystem. Conclusions: Members of Georgia’s private sector, civil society, government, funding communities, academia, and the broader public can use a collective-action framework with a public health lens to promote prevention and advance freedom from modern-day slavery.
    • The Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA) in Georgia: Women Covered and Medicaid Costs in 2003

      Adams, E. Kathleen; Blake, Sarah C.; Raskind-Hood, Cheryl; Chien, Linien; Zhou, Mei; Liff, Jonathan; Eley, William; Georgia Health Policy Center; Emory University (Georgia Public Health Association, 2007)
      The Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA) provided states with an optional Medicaid eligibility category for uninsured women with breast and/or cervical cancers. The BCCPTA is the first and only such effort to use a population-based public health screening program, the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) to provide a pathway to publicly funded health insurance for otherwise uninsured low-income women. Georgia was one of the first states to adopt the BCCPTA and was one of only twelve states that provided Medicaid eligibility to women screened by non-NBCCEDP providers. We use 2003 Georgia Medicaid claims and enrollment data to investigate the scope of the state’s BCCPTA enrollment and enrollees’ costs as well as demographic characteristics of breast and cervical cancer patients in Georgia’s BCCPTA and other Medicaid eligibility categories. Georgia’s Medicaid coverage of women with breast and/or cervical cancer under BCCPTA accounted for over one-third of all women with these cancers covered by the state in 2003 alone. Those newly eligible under BCCPTA were more likely to have breast, as opposed to cervical, cancer and to be older than those women with breast/cervical cancers enrolled in Georgia Medicaid due to low-income, pregnancy or disability status. Georgia’s Medicaid program spent over $29 million on BCCPTA enrollees in 2003 at a cost of over $12,000 per enrollee. BCCPTA enrollee costs were more similar to those for disabled women with these cancers, about $19,500, than to costs for low-income/pregnant women which equaled about $7,500. By expanding Medicaid coverage, BCCPTA can potentially bring women in at earlier stages of their cancer and provide needed coverage/treatment. Future research should examine the potential effect of BCCPTA on reduced morbidity and mortality among these low-income women.