Pasalic, Emilia; Hayat, Matthew J; Greenwald, Roby (Georgia Public Health Association, 2016)
Background: The airway inflammatory response is likely the mechanism for adverse health effects related to exposure to air pollution. Increased ventilation rates during physical activity in the presence of air pollution increases the inhaled dose of pollutants. However, physical activity may moderate the relationship between air pollution and the inflammatory response. The present study aimed to characterize, among healthy adolescents, the relationship between dose of inhaled air pollution, physical activity, and markers of lung function, oxidative stress, and airway inflammation. Methods: With a non-probability sample of adolescents, this observational study estimated the association between air pollution dose and outcome measures by use of general linear mixed models with an unstructured covariance structure and a random intercept for subjects to account for repeated measures within subjects. Results: A one interquartile range (IQR) (i.e., 345.64 μg) increase in ozone (O3) inhaled dose was associated with a 29.16% average decrease in the percentage of total oxidized compounds (%Oxidized). A one IQR (i.e., 2.368E+10 particle) increase in total particle number count in the inhaled dose (PNT) was associated with an average decrease in forced expiratory flow (FEF25-75) of 0.168 L/second. Increasing activity levels attenuated the relationship between PNT inhaled dose and exhaled nitric oxide (eNO). The relationship between O3 inhaled dose and percent oxidized exhaled breath condensate cystine (%CYSS) was attenuated by activity level, with increasing activity levels corresponding to smaller changes from baseline for a constant O3 inhaled dose. Conclusions: The moderating effects of activity level suggest that peaks of high concentration doses of air pollution may overwhelm the endogenous redox balance of cells, resulting in increased airway inflammation. Further research that examines the relationships between dose peaks over time and inflammation could help to determine whether a high concentration dose over a short period of time has a different effect than a lower concentration dose over a longer period of time.
Whitaker, Daniel; Glasheen, Theresa (Georgia Public Health Association, 2017)
Background: The SafeCare model is a behaviorally-based parenting model used in the prevention of child maltreatment. SafeCare targets three proximal risk factors for child neglect and abuse: parent-child interactions, home safety, and child health. SafeCare is one of only a few evidence-based practices for preventing child neglect, the dominant problem in child welfare, accounting for over 75% of child maltreatment cases. SafeCare has been broadly implemented in several states in the US, including Georgia, and is disseminated by the National SafeCare Training and Research Center (NSTRC) at Georgia State University. The presentation will (1) describe SafeCare and associated data, (2) describe the SafeCare implementation. Methods: SafeCare has been implemented in Georgia since 2008 using a rigorous implementation model, which includes on-going quality assurance of SafeCare providers and skill acquisition evaluation in families. Providers of child welfare services have been trained to deliver SafeCare and have been coached by trainers from NSTRC. Evaluation data are regularly collected which include provider fidelity via observed sessions, family outcomes relating to completion of SafeCare, and skill acquisitions (i.e., changes in parenting behaviors, reductions in home hazards, and increases in knowledge and behaviors regarding child health care). Results: Recent evaluation data (2013-2015) indicate 115 families have been referred to a SafeCare provider and 100 families completed at least one session. Thirty-eight (38%) have completed the program in its entirety. Provider fidelity data collected monthly indicate high program fidelity (mean of 91% of desired behaviors performed). Family behavior data indicate excellent skill acquisition among families completing each SafeCare model. Parenting skills increased by 104%; home hazards were reduced by 85%, and child health care skills increased by 34%. Conclusions: The SafeCare model is an effective parenting program for reducing child maltreatment, and has been implemented successfully in Georgia. Broader impact of SafeCare will require increased implementation of the model to increase reach.
Minyard, Karen; Parker, Chris; Butts, John (Georgia Public Health Association, 2016)
Background: In Georgia, the safety net provides health care services to vulnerable populations scattered across 74 urban and 85 rural counties. In rural communities, the safety net is challenged with longstanding gaps in service provision and persistent difficulty in making services accessible. The rural safety net in Georgia is vulnerable. Methods: An environmental scan was conducted of the Georgia rural safety net to assess who it serves, its providers, and how care is accessed in light of the Affordable Care Act (ACA). The scan included analysis of population-based census and health databases and a literature review to inform recommendations. Results: The population served by the rural safety net is typically older, poorer, and less healthy than the population in urban areas. The principal providers of care in the rural safety net are community hospitals, federally sponsored and free or charitable clinics, and some health departments. While the ACA provides an opportunity to increase insurance coverage and access to care, it poses a financial challenge to providers of the rural health safety net. As the health system evolves, the rural health safety net must adapt to shifting priorities and patient populations. Conclusions: To enhance the sustainability of the rural safety net, it is necessary for providers to focus on coordination of care through integration of services and broader health system partnerships. Providers of the Georgia rural safety net and stakeholders should focus on (a) ensuring a comprehensive assessment of all components of the safety net, (b) facilitating change through high-performing health departments and community-based organizations, (c) funding efforts to provide patient-centered medical homes for the rural uninsured, (d) emphasizing the value of technology in the provision of care and information/data exchange, and (e) rewarding innovations in rural and safety net workforce development and deployment.
Nanan, Denyse N. C.; Hepburn, Valerie A. (Georgia Public Health Association, 2007)
This study assessed and compared demographic factors, psychosocial factors, health seeking behavior, and sexual practices of two convenience samples of Hispanic/Latino gay men and men who have sex with men (MSM) in the metropolitan Atlanta region. The aim was to obtain data on emerging HIV/AIDS patterns in this group. Bilingual surveys were conducted in 2000 and 2006 at local gay bars. Discrepancies observed between HIV/AIDS knowledge and sexual behaviors in 2000 were replicated in 2006. Contrary to expected improvements due to enhanced HIV/AIDS education and awareness, risk behavior for HIV/STDs increased significantly between 2000 and 2006. These findings should inform the design and delivery of programs aimed at meeting the HIV/AIDS prevention, education and treatment needs of this growing population.
Brown, Natasha (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.
Landers, Glenn; Fuller, Kristi; Zhou, Mei (Georgia Public Health Association, 2017)
Background: The aim of this analysis was to compare Georgia’s Medicaid expenditures for participants in the Money Follows the Person (MFP) six months before, 12 months during, and 12 months after MFP participation. Methods: Differences in Medicaid expenditures for three populations of MFP participants (individuals with developmental disabilities, individuals with physical disabilities, and older adults) were compared by use of repeated measures t-tests. Results: Per-member per-month Medicaid expenditures were lower across the three populations when comparing six months prior to transition from an institution to 12 months after leaving the MFP program. Conclusions: The incorporation of features from programs such as MFP into existing state Medicaid long-term services and supports may assist in reducing the growth of future expenditures.
Cormier, Jacque-Corey; Nava, Nancy; Mora, Charmaine; Rodriguez, Rebecca (Georgia Public Health Association, 2016)
Background: In the United States, Latino families affected by domestic violence (DV) often face unique challenges influenced by changing ecologies and personal/political histories. Caminar Latino is Georgia’s first and only comprehensive DV intervention program for Latino families. The program is geared towards helping family members begin their journey towards non-violence. The purpose of this evaluation is to better understand how Caminar Latino is benefiting families within the program. Baseline data of interest included perceptions of power in the relationship among family members and whether mothers and/or youth had safety plans. Methods: A longitudinal, quasi-experimental research design was utilized to collect quantitative and qualitative data. This study was approved by Georgia State University’s Institutional Review Board. Study participants (N = 82) were men, women, and youth (8 – 17 years old only) selected from families that started the program between August 2014 and August 2015. Members of the research team read the survey questions in English or Spanish to all participants. A univariate analysis was utilized to assess baseline data. Results: There were major inconsistencies found regarding power distribution in the relationships. Half of women (50%) reported their partner having more power in the current relationship, while majority of men (77%) reported their partner and themselves sharing equal power. All men and women felt power should be equal in an ideal relationship. Only 13% of mothers and 44% of youth had a safety plan pertaining to violence. Conclusions: By examining DV in a manner consistent with the needs and preferences of families, and offering support directly within communities, community practitioners have the opportunity to capitalize on existing strengths and abilities of Latina women and families. Findings from this program evaluation provide Caminar Latino with a better understanding of the ways in which they can promote wellness and non-violence in Latino communities.
Thornton, Kate (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.
Tiwari, Ashwini; Self-Brown, Shannon; Robinson, Charles; McCarty, Colleen; Carruth, Laura (Georgia Public Health Association, 2016)
among parents at high risk of child maltreatment (CM). However, no known studies on these programs have examined physiological biomarkers for stress, such as impaired levels of cortisol and dehydroepiandrosterone (DHEA), and telomere length. Further, no details are known regarding the feasibility of collecting biological markers from parents. This research examined qualitative findings from a multidisciplinary neurobiology and public health study that examined physiological responses to a six-week, evidence-based, behavioral parenting program, among a maternal population at risk of CM perpetration in Atlanta, Georgia. Methods: Eighteen high-risk mothers were assessed at pre-intervention and post-intervention for parental stress and behavior (i.e., self-report, observational), and non-invasive physiological markers for cortisol, DHEA, and telomere length, Hormones were measured using two salivary methods, passive drool and Salivette swabs, as well as hair samples. Telomere length was assessed using cheek swabs. Semi-structured interviews were conducted at baseline to examine the feasibility of collecting biological samples for parental stress research among a sub-sample of participants (n=13). Results: Early qualitative themes suggest interest in providing hair and cheek swab samples. Notable suggestions were made to improve saliva collection. Particularly, participants showed clear preference for swabbing methods over passive drool collection. Conclusions: These study findings add novel results to the parenting literature on parental stress and provide emerging evidence on parental willingness to engage in physiological research. Acceptance of collection methods encourages further examination of biomarker correlates using non-invasive and inexpensive methods in biobehavioral research.
Jackson, Matt; Osborne, Melissa; Self-Brown, Shannon (Georgia Public Health Association, 2016)
Background: Home visiting receives bipartisan support at both the state and federal level, because several models have demonstrated significant results in both reduction of child maltreatment as well as parenting behavior modification. Yet, parenting research and services lack further engagement and involvement as a primary component. That is, even though research has shown that fathers play an integral role in child development, there is very little research done in which fathers are the primary focus; most of this research focuses on mothers. When it comes to serving children who are victims of child abuse and neglect, this is a problem at both the programmatic and legislative level. Methods: This study took place within the context of a broader NIH funded trial to examine the efficacy of an adapted (technologically enhanced) version of an evidence-based parenting program, SafeCare, for fathers. This was a cross-sectional examination of the results from a survey in which mostly African-American, at-risk fathers (n=84), reported on – using putative measures – parenting practices, mental health, and behavior of their children. This initial assessment used linear regression to examine the association between fathers’ mental health and their child’s externalizing and internalizing problem behaviors. Results: On average, higher levels of father depression and anxiety corresponded to higher scores for child behavior problems. That is, there was a significant correlation between the fathers’ anxiety and depression and the child’s problem behaviors. Conclusions: These findings suggest a need for acknowledging the father’s role in child development as well as any potential external factors that might have a pernicious effect on the father’s mental state[s]. In addition, more attention should be given to separating data within studies that examine both mothers and fathers in order to assess individual effects by each parent.
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