• A preliminary examination of elevated blood lead levels in a rural Georgia county

      Rustin Chrstopher; Sun, Yu; Calhoun, Chris; Kuriatnyk, Christy; Georgia Southern University, Georgia Department of Health (Georgia Public Health Association, 2016)
      Background: Rural areas are often viewed as lower risk for lead poisoning and toxic exposures seriously impacting development of the brain and central nervous system; this report examines the prevalence of elevated blood lead levels for children <6 years of age in rural Ben Hill County, GA. Methods: Lead surveillance data from the Georgia Department of Public Health (DPH) were analyzed using SAS®v-9.3 to calculate the prevalence of elevated blood lead levels (≥5ug/dL) among those children in Ben Hill County who had been tested for lead; the results were compared to Georgia and national data. Results: A preliminary analysis of 2010-2015 screening data for Ben Hill County indicates that 8.73% (95%- CI: 7.4%-10.1%) of children that were tested for lead exceeded the Centers for Disease Control reference level (≥5ug/dL) and is approximately 3.5 and 2.4 times higher, respectively, when compared to the National (2.5%) and State (3.64%) percentages of children exposed to lead at or above the reference level. Conclusions: While these data are preliminary and more analysis is planned to ascertain the full breadth, source, and scope of the problem, it highlights lead poisoning risks rural communities face that are often overlooked in population-based risk analysis and research on lead exposure in children.
    • A preliminary examination of elevated blood lead levels in a rural Georgia county

      Rustin, Christopher; Sun, Yu; Calhoun, Chris; Kuriatnyk, Christy; Georgia Southern University, Georgia Department of Health (Georgia Public Health Association, 2017)
      Background: Children in Flint, Michigan were exposed to lead at unsafe levels in drinking water bringing renewed interest and national attention to an old public health problem. In Georgia, thousands of children are exposed annually to lead at unsafe levels primarily from paint in homes built before 1978. With lead poisoning typically viewed as an urban problem, rural areas are often considered lower-risk in light of similar lead poisoning risk factors, albeit on a smaller scale. The purpose of this preliminary study was to examine the prevalence of elevated blood lead levels in children <6 years of age tested in rural Ben Hill County, Georgia, a county designated as lower risk. Methods: Lead surveillance data from the Georgia Department of Public Health (DPH) were analyzed using SAS®v-9.3 to calculate the prevalence of elevated blood lead levels (≥5ug/dL) among those children in Ben Hill County who had been tested for lead; the results were compared to state and national data. Results: A preliminary analysis of 2010-2015 screening data for Ben Hill County indicates that 8.73% (95%- CI: 7.4%-10.1%) of children who were tested for lead exceeded the Centers for Disease Control reference level (≥5ug/dL). This is approximately 3.5 and 2.4 times higher, respectively, when compared to national (2.5%) and state (3.64%) percentages of children exposed to lead ≥5ug/dL. Analysis also indicated low screening rates, which limits interpretation of population prevalence. Conclusions: Lead poisoning is often viewed as an urban, inner-city problem due to a higher percentage of older homes clustered together, exposing more children, compared to rural areas with homes geographically dispersed. While these data are preliminary and more analysis is planned to understand the problem, it highlights lead poisoning risks rural communities face that are often overlooked in population-based risk analysis and research on lead exposure in children.
    • Probiotics as a novel treatment of mastitis in dairy goats to combat a nutritional concern

      Singh, Vishal; Fort Valley State University (Georgia Public Health Association, 2017)
      Background: The demand for goat dairy products has grown in the US and continues to increase. This is partially due to nutritional advantages that include higher protein, lower cholesterol, ease in digestibility and low fat content as compared to cows’ milk. Goat milk is also used in a variety of health and beauty products such as lotions, soaps and creams. Mastitis continues to have a negative impact on the supply of and demand for goat milk as well as contributing to lack of financial gains for farmers. Methods: Faculty and graduate students of Department of Veterinary Science and Public Health at Fort Valley State University are conducting research both in vitro and in vivo to determine if mastitis may be prevented and/or treated with probiotics. To demonstrate that probiotics will be an effective alternative to traditional antibiotic therapy in treatment of mastitis in dairy goats, antibiotic-resistant bacteria will be treated in vitro with Lactobacillis sp. probiotics to determine bacterial susceptibility. This study has two phases. In Phase I, bacteria isolated from milk from goats with mastitis is subjected to Kirby-Bauer testing to ascertain antibiotic resistance. Once resistance is observed, bacterial sub-colonies will then be subjected to treatment with probiotics (L. plantarum, B. subtilus, B. licheniformis, S. cerevisiae). Phase II involves treatment of antibiotic resistant mastitis in dairy goats to treat and prevent mastitis. Results: Results are pending completion of all testing, to be reported in 2017. Conclusions: Mastitis, an inflammatory process involving the mammary glands, has a negative effect on milk production which in turn influences the supply of and demand for goat milk products. Probiotics present the possibility of a novel treatment in the treatment of antibiotic resistant mastitis.
    • Promoting colorectal cancer screening among Haitian Americans

      Coughlin, Steven S.; Lubetkin, Erica I.; Hay, Jennifer L.; Raphael, Renald; Smith, Selina A.; University of Massachusetts; Emory University; The City College of New York; Medical College of Georgia; Georgia Regents University (Journal of the Georgia Public Health Association, 2015)
      Background: Few studies have examined colorectal cancer screening among Haitian Americans, although striking disparities in colorectal cancer screening and mortality are well-documented among U.S. Blacks. Race, socioeconomic status, and place of birth are factors associated with colorectal cancer incidence and mortality patterns. Methods: In this article, we summarize published studies on colorectal cancer screening among Haitian Americans, identified through bibliographic searches in PubMed and CINAHL through August 2015, and offer recommendations for further research. Results: Only one qualitative study and three quantitative surveys have examined colorectal cancer screening among Haitian Americans. A qualitative study found important differences in perceptions of the curability of colorectal cancer, preventive practices, and preferred sources of information among Haitian Americans and other ethnic subgroups of U.S. Blacks. Awareness of colorectal cancer screening tests, risk perception, healthcare provider recommendation, and self-reported use of screening are suboptimal among Haitian Americans and other subgroups. In preliminary quantitative studies, Haitian immigrants have been found to have lower colorectal cancer screening rates than other groups such as African Americans. Conclusions: Culturally appropriate educational interventions are needed to encourage Haitian American adults aged > 50 years to undergo screening for colorectal cancer and to ensure that they are well informed about the value of healthy eating and physical activity.
    • Promoting policy and environmental change in faith-based organizations: Organizational level findings from a mini-grants program

      Hermstad, April K; Arriola, Kimberly; Clair, Shauna; Honeycutt, Sally; Carvalho, Michelle; Cherry, Sabrina; Davis, Tamara; Fraizer, Sheritta; Escoffery, Cam; Kegler, Michelle C.; et al. (Georgia Public Health Association, 2015)
      Background: High rates of heart disease, cancer, and stroke exist in rural South Georgia, where Emory’s Cancer Prevention and Control Research Network provided mini-grants and technical assistance to six faith-based organizations to implement policy and environmental changes to promote healthy eating (HE), physical activity (PA), and tobacco use prevention (TUP). Drawing from a Social Ecological Framework, we hypothesized that church members would perceive an increase in messages, programs, and the availability of facilities to support HE, PA, and TUP over a 1-year period. Methods: Members (N=258) completed self-administered questionnaires that assessed perceptions of the existing church health promotion environment relative to HE, PA, and TUP policies, as well as their eating behavior and intention to use PA facilities at church at baseline and 1-year follow-up. Results: Members at three of the six churches perceived increases in delivery of HE messages via sermons, church bulletins, and food labels, and increased availability of programs that support HE (p<0.05). Members at four churches reported increases in healthy foods served and decreased unhealthy foods served at three churches over the 1-year period (p<0.05). Of the five churches that implemented changes to promote PA, members at two churches perceived increases in healthy PA messages (p<0.05) and those at three churches perceived increased PA facilities (p<.05). One of two churches that implemented TUP policies, according to responses of members, had an increase in messages on smoking, (p<0.05). Conclusions: Community mini-grants may be a viable mechanism for promoting environmental change supporting HE, PA, and TUP policies in church environments.
    • Psychotropic medications, weight gain and chronic diseases in a correctional setting: Impact on women’s health

      Gates, Madison L.; Ferguson, Elizabeth; Wilkins, Thad; Balance, Darra; Yoo, Wonsuk; Augusta University (Georgia Public Health Association, 2016)
      Background: Studies with non-incarcerated populations have found a relationship between psychotropic medications and metabolic side effects, such as weight gain. Few studies have investigated the relationship between psychotropic medications associated with weight gain in prisoners, despite data showing that 73% of female and 55% of male offenders have a mental health problem and 15% have had medications prescribed. Methods: This longitudinal study investigated the relationship among psychotropic medications and weight gain in prisoners. We hypothesized that women prescribed psychotropic medications gain more weight than men. Data were extracted from Department of Corrections’ electronic health records. All prisoners with active records that included weight pre and post initiation of psychotropic medication were included in the study. Results: Women were prescribed antidepressants in higher proportions compared to men (χ2 = 58.3, p < .01). The differences for antipsychotics were not significant (χ2 = 2.3, p = .13). There were no significant gender differences regarding the percentage of inmates who gained weight. In regard to changes in weight (kg), women on antidepressants gained more weight (mean 6.4 kg) compared to men (mean 2.0 kg), which was significant (p < .01). Although women prescribed antipsychotics gained an average of 8.8 kg compared to men prescribed antipsychotics, who gained an average of 1.6 kg, this difference was not significant (p = .12). Further, there were no weight gain differences in terms of race or age in contrast to non-incarcerated populations. Conclusions: The significant weight gain among women prisoners raises important questions about the effects of incarceration on women’s health. Despite the significantly greater weight gain among women prisoners, other correlates of weight gain found in non-incarcerated populations are not evident in corrections.
    • Public Health for Young Adults Day: Recruiting the next generation

      Pung, Mary-Kate; Williams, Nicholas; Kirkland, Rachel; Peden, Angie; Walker, Ashley; Georgia Southern University (Georgia Public Health Association, 2016)
      Background: Public Health for Young Adults Day (PHYA Day) is a one-day program designed to educate high school-age students about the principles and values of the five core areas of public health. The goal of PHYA Day is to foster interest and ultimately increase recruitment into the field of public health. This goal is essential due to the impact of the economic recession of 2008. It was estimated that the local public health workforce decreased from 191,000 to 168,000 across the nation between 2008 and 2013. In spite of 2008’s recession, a well-trained, competent public health workforce remains an imperative component of effective public health service delivery. The researchers believe that PHYA Day encourages young people to explore the idea of a public health-focused career by increasing their knowledge of the field as a whole. Methods: A pre- and post-test survey was used to evaluate this program, determine if participants gained an interest in joining the public health workforce, and measure the learning outcomes of those participants. After gaining proper Institutional Review Board approval the evaluation was completed in April 2015. Results: When the averages of the post-test were compared to those of the pre-test the results showed that there was a significant gain in knowledge among participants. Conclusions: Based off of their findings the researchers were able to conclude that PHYA Day is effective in educating high school age students about the options that the public health field have to offer and therefore may increase the number of young adults choosing public health as a career.
    • Quality Rated childcare programs and social determinants of health in rural and nonrural Georgia

      Webb, Nancy C.; Gates, Madison L.; Augusta University (Georgia Public Health Association, 2016)
      Background: Early childhood is linked to school readiness and early school achievement. Through its Quality Rated (QR) program, which was designed to improve the quality of care in early childhood programs, the state of Georgia has been a trailblazer in funding universal preschool and in improving the quality of childcare programs. We have assessed differences in the availability of QR childcare programs in Georgia to learn if, in rural versus non-rural counties, there is a relationship between QR childcare programs and health-related outcomes. Methods: This cross-sectional study evaluated county-level data to evaluate the relationship between QR childcare programs and social determinants of health. County-level data for Georgia were extracted from the Georgia Department of Early Care and Learning, County Health Rankings and Roadmaps, and the Georgia Juvenile Justice Data Clearinghouse. Results: Counties without QR childcare programs had child mortality rates 3.5 times higher than those for the state overall. Other differences in health-related outcomes included, but were not limited to, teen birth rates, low birth-weight babies, children in poverty, housing problems, and food insecurity. Conclusions: It is now appropriate to address the prevalence of health disparities in rural areas of Georgia and focus on some of the disparities through the QR early childhood programs and other state agencies. Empowering rural communities to address health disparities may be the most favorable path toward diminishing these inequalities.
    • Quantitative Data Analysis of Multiple Factors Associated with Low Birth Weight in Bibb County, Georgia

      Jackson, Haley D.; Wei, Yudan; Chen, Fan; Mercer University (Georgia Public Health Association, 2008)
      Objective This study aims to identify and evaluate significant risk factors associated with low birth weight in Bibb County, Georgia. Methods Data used in this study was obtained from the Georgia Department of Human Resources’ Vital Records Offices. The sample consists of 2,346 white and black or African American women giving birth in Bibb County, Georgia in 2005. Logistic regression was used to analyze the risk factors associated with low birthweight in Bibb County, Georgia. The multiple factors analyzed as independent variables included maternal race, maternal education, maternal age group, socioeconomic status, marital status, maternal tobacco use during pregnancy, maternal alcohol use during pregnancy, trimester mother began prenatal care and number of prenatal care visits mother received. The dependent variable analyzed was whether the infant was born low birth weight. Results Logistic regression analysis showed that the most significant risk factor associated with low birth weight in 2005 was receiving less than six prenatal care visits (odds ratio [OR] = 3.6; 95% CI = 2.5, 5.3). Maternal education of 12th grade of less (OR = 1.7; 95% CI = 1.2, 2.3), maternal race of black or African American (OR = 2.0; 95% CI = 1.5, 2.6), and use of tobacco during pregnancy (OR = 1.7; 95% CI = 1.2, 2.4) were also significant factors for low birth weight. Conclusions Based on the observations of the present study, it is recommended that intervention programs and communication tools should focus on those significant risk factors associated with low birth weight and target at-risk pregnant women; hence, reducing the incidence of infants born low birth weight in Bibb County, Georgia.
    • Racial Differences in Perception of Breast Cancer Risk in Rural Southeast Georgia

      Tedders, Stuart H.; Parrillo, Anthony V.; Peace, Karl E.; Knight, Jannell R.; Georgia Southern University; South Central Health District (Georgia Public Health Association, 2006)
      A university-public health collaborative was formed to more fully understand cancer risk among rural women in Georgia. Objectives: This study sought to gain an understanding of racial differences with regard to behavioral risk, perception of breast cancer risk, and perception of barriers to screening. Design: Differences in subjects’ risk and risk perception were assessed by creating, piloting, and administering a written survey at local health departments. Sample: A purposive sample of females enrolled in breast and cervical cancer screening programs in four rural counties in southeast Georgia (n = 147) were surveyed. Subjects were randomly invited to participate. Incentives were provided to enhance participation. Results: White females were significantly more likely than were black females to perceive pollution (OR: 4.63; p = 0.038), smoking (OR: 2.39; p = 0.018), age (OR: 3.01; p = 0.013), and hormone replacement therapy (OR: 3.17; p = 0.005) as factors influencing their breast cancer risk, and to perceive cost as a barrier to screening (OR: 2.89; p = 0.032). From a risk perspective, black females were more likely than white females to have had five-or-more pregnancies (p = 0.005), and to have given birth before age fifteen (p = 0.011). Conclusions: This study provided important baseline data about breast cancer risk necessary in developing effective health promotion programs.
    • Racial Segregation and COVID-19 Health Outcomes: Evidence from the State of Georgia

      Patel, Palak; Medcalfe, Simon; Slade, Catherine; Hull College of Business (Augusta University Libraries, 2021-05-18)
      This item presents the abstract for a presentation at the 2021 Annual Phi Kappa Phi Student Research and Fine Arts Conference at Augusta University.
    • Randomness and inference in medical and public health research

      Hayat, Matthew J; Knapp, Thomas; Georgia State University, Ohio State University (Georgia Public Health Association, 2017)
      Background: The purpose of this study was to provide a basis for describing the types of randomness used and statistical inferences reported in the medical and public health research literature. Methods: A study was conducted to quantify the types of research designs and analyses used and reported in medical and public health research studies. A stratified random sample of 198 articles from three top-tier medical and public health journals was reviewed, and the presence or absence of random assignment, random sampling, p-values, and confidence intervals, as well as type of research design, were quantified. Results: Random sampling was used in 58 (29.3%) and random assignment in 21 (10.6%) articles. Most (n=125; 63.1%) research studies did not report random assignment or random sampling; however, statistical inference was applied in more than 90%. Conclusions: Results revealed a concerning overuse of statistical inference. Incorrectly applying statistical inference when not warranted has potentially damaging medical and public health consequences. Researchers should carefully consider the appropriateness of using statistical inference in medical and public health research.
    • The Real "Monster" in Frankenstein

      Urizar, David O.; Department of Biological Sciences (Augusta University Libraries, 2016-10)
      The story of Frankenstein is typically seen as a battle between Victor Frankenstein and the “monster” of the story. However I argue that that the real “monster” of the story is in fact Victor Frankenstein who is suffering from paranoid schizophrenia and that the “monster” is really just a delusions that Victor uses to cope with the idea that he in fact is the killer of the story. This concept is evident in the fact that no one in the story has ever seen both Victor Frankenstein and the “monster” alive in the same place. The characteristics of the “monster’ also point towards the idea that the “monster” could not possibly exist. Even the way that Victor acts throughout the book point to the idea that he does not really care for the safety of his loved ones. Overall the actions that play out in the story point towards the idea that Victor Frankenstein is the real “monster” of the story.
    • Recruitment, retention, and succession planning for district health directors

      Rudd, Lee; Georgia Department of Health (Georgia Public Health Association, 2017)
      Background: Since the District Health Director (DHD) leads the district health organization, plans must be put in place to ensure that we retain current directors and anticipate the future when the DHD retires from the position. Methods: Best practices in the areas of recruiting, retention, and succession planning are used to present resolutions to the problems. Results: By following the steps identified in the best practices, there is a reasonable chance that the district will be prepared for any change in leadership. Conclusions: Using the best practices identified by human resources professionals combined with the unique characteristics of public health districts will ensure success.
    • Reducing and eliminating health disparities through prevention and public health

      Blumenthal, Daniel S.; Morehouse School of Medicine (Georgia Public Health Association, 2016)
      African Americans suffer more from health disparities than any other racial or ethnic group. In fact, African Americans have the highest mortality rate from every major cause of death. If public health is (as it fancies itself) social justice in health and health care, then it must address this injustice. The underlying cause of disparities is social determinants: income, education, discrimination, powerlessness, and other social factors. In the long run, a “level playing field” must be developed for these factors. But considerable progress in reducing disparities can be achieved through health promotion and disease prevention initiatives that focus on lifestyle determinants of health: tobacco control, improvements in diet, increases in physical activity, firearm control, and other wellknown measures
    • Reducing sexual risk behaviors and intentions among rural African American youth

      Brown, Natasha; Georgia State University (Georgia Public Health Association, 2017)
      Background: In spite of dramatic declines in teen pregnancy and childbearing in every state and amongst all racial groups, progress to-date remains unbalanced and disparities persist. Blacks, Hispanics, and youth residing in southern states or rural areas continue to experience the highest teen pregnancy rates in the nation. In an effort to enhance protective factors that help youth avoid behaviors placing them at risk for pregnancy, between September 2011 and May 2013, a public school district in rural southeast U.S. implemented an evidence-based youth development program designed to address these issues. Methods: A single-group, repeated measures design was employed to assess changes over time in past sexual risk behaviors, intentions regarding future behaviors, use of contraceptives, and pregnancy. The main questions answered were: does the program make a difference in the lives of youth involved, and to what extent? To answer these questions, participants completed brief self-administered surveys during the first and last sessions of the intervention (pre-/post-intervention surveys). Results: 447 predominantly African American (98%) students in grades 8-12 were enrolled; 94% completed the program. There were significant improvements in participants’ self-reported behaviors and intentions. For instance, when asked about their sexual activity during the three months before the pre-test, 69.0% of the students surveyed had sex at least once, but only 47.6% at post. Of those, 48.8% at pre and 58.2% at post reported having used a condom; 52.9% (pre) versus 69.6% (post) used some form of birth control. Conclusions: Students participating in this youth development program reported reductions in sexual risk behaviors and greater intentions to engage in safer sex practices in the future. Among the many lessons learned was the importance of offering incentives throughout the program’s duration to retain participants for the 9-month, 25-session intervention period.
    • Reflections on mental health advocacy across differing ecological levels

      Thompson, J Nancy; McGee, E Robin; Munoz, C Leslie; Walker, R Elizabeth (Georgia Public Health Association, 2015)
      ABSTRACT Background: According to the World Health Organization, mental health advocacy is comprised of a range of actions designed to change aspects of attitudes and structures that impede the achievement of positive mental health in populations. Methods: According to the World Health Organization, mental health advocacy is comprised of a range of actions designed to change aspects of attitudes and structures that impede the achievement of positive mental health in populations. Results: We have proposed interventions and advocacy effort for each ecological level. Project UPLIFT, a distance-delivered intervention for mental health is presented as an example of an effort that can affect several levels of the social ecology. Conclusions: Advocacy and interventions that make an effort to encompass the levels of the social-ecological model may contribute to greater progress in improving mental health outcomes.
    • A region-wide field placement program built on the foundation of mentorship and professionalism

      Carvallo, Michelle; Lloyd, Laura; Alperin, Melissa; Miner, Kathleen (Georgia Public Health Association, 2016)
      Background: The Region IV Public Health Training Center (R-IV PHTC) provides public health students from the eight states of HHS Region IV with essential practice experiences that demonstrate the value of working with underserved populations. The Pathways to Practice Scholars field placement program is built on a foundation of mentorship, professionalism, and community. Methods: Sixteen student scholars (13 graduate; 3 undergraduate) were selected to work during May-August 2015 in practice-oriented agencies serving underserved populations. Each scholar received a $1500 living allowance. Seven of 16 accepted an internship outside the state of their university. In conjunction with mentors, Scholars developed work plans based on Council on Linkages Core Competency domains. Requirements included a pre-, mid- and post-assessment, an executive summary/reflection, and a virtual webinar presentation. Results: Student Scholars worked at sites across eight states in state or local health departments, Area Health Education Centers (AHECs), and healthcare settings. Students identified Core Competency domains they developed most during the field placement: Communication, Analytical/Assessment, Leadership/Systems Thinking, and Community Engagement. The R-IV PHTC asked mentors to treat interns as valued employees and include them in activities beyond their specific project. Indicators of successful mentorship included expressed appreciation for student assistance and the desire to enrich the student experience while benefiting the agency mission. Mentors provided clearly defined projects for a short timeframe (10-12 weeks), adjusted to the students’ capacity and readiness, and offered opportunities to apply classroom skills to practice. They helped students develop immediately useful products in collaboration with community stakeholders. Conclusions: Mentors play a crucial role in the development and success of field placement students, but students and mentors share equal responsibility in fostering the relationship. Past case studies from this program demonstrate that some students find employment in these same agencies after graduation, and become mentors for future students, thus, creating a self-perpetuating learning communit
    • The Relationship between Dynamic Knee Valgus and Lower Extremity Muscle Activity in Patients with Chronic Ankle Instability

      Eboigbe, Tammy; Hogan, Valerie; Department of Physical Therapy (Augusta University Libraries, 2021-05-18)
      This item presents the abstract for a presentation at the 2021 Annual Phi Kappa Phi Student Research and Fine Arts Conference at Augusta University.
    • Relationship of Fruit and Vegetable Servings and Self-Reported Diabetics in the Southeast and Northeast

      Rimando, Marylen; Lopez, Faye; Battula, Haritha; Mercer University (Georgia Public Health Association, 2007)
      According to the American Diabetes Association, most diabetic patients are not consuming the recommended 3-5 servings of vegetables and 2-4 servings of fruits a day. This study examined fruit and vegetable servings of self-reported diabetics (N=35,407) in select southeastern and northeastern states using Behavioral Risk Factor Surveillance System (BRFSS) 2005 data. The estimate for both fruit and vegetable servings and self-reported diabetes was determined using multivariate logistic regression, adjusting for sociodemographics and geographic region. The results indicated a significant difference between fruit and vegetable servings for diabetics and non-diabetics (p<0.0001). A higher percentage of diabetics in the northeast consumed more than three servings of fruit and vegetables when compared to diabetics in the southeast. Respondents in the northeast were 21% more likely to consume five or more servings of fruit and vegetables and 16% less likely to be diabetic than those in the southeast after adjusting for age, race, sex, and geographic region. In conclusion, diabetics in the northeast consumed more servings of fruit and vegetables than did those in the southeast. Multiple factors influence fruit and vegetable consumption and diabetes and should be considered when developing targeted nutritional interventions. Diabetes educators, nurses, and physicians can encourage diabetic patients to consume more fruit and vegetables and motivate them to continue eating fruit and vegetables.