Background: Early detection can reduce colorectal cancer (CRC) mortality by 15%–33%, and screening is widely recommended for average-risk adults beginning at age 50 years. Colorectal cancer mortality rates are higher in African Americans than in whites, while screening rates are somewhat lower. Individual social networks can reduce emotional and/or logistical barriers to health-promoting but distasteful procedures such as CRC screening. The aim of this study was to examine social network interactions, and their impact on CRC screening among African Americans. We hypothesized a positive association between social network index (SNI) scores and CRC screening. Methods: In a community intervention trial with four arms, we previously demonstrated the efficacy of a small group educational intervention to promote CRC screening among African Americans. This intervention outperformed a one-on-one educational intervention, a reduced out-of-pocket expense intervention, and a control condition. In the present analysis, we compared the SNI scores for participants in the small group intervention cohort with a comparison group comprised of the other three cohorts. Social networks were assessed using the Social Network Index developed by Cohen. Results: Small group participants had a significantly higher network diversity score (Mean difference 0.71; 95% CI, 0.12-1.31; p=0.0017) than the comparison group. In the second component of the SNI score - -the number of people talked to over a two week period -- the small group intervention cohort also scored significantly higher than the comparison group. (Mean difference, 9.29; 95% CI, 3.963-14.6266; p=0.0004). Conclusions: The findings suggest that social interaction and support was at least partially responsible for the relatively high post-intervention screening rate in the small group intervention participants. Education in small groups could foster strong social networks. Strong and positive network diversity and a large number of people in social networks may enhance CRC screening rates among African Americans.

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.

Background: The elderly, especially those who reside in institutions and have a minority or low-income background, often have unmet oral health needs. As life expectancy increases, so will the need for oral health providers skilled in addressing the unique challenges presented by geriatric patients. Methods: Dentists for Della is a student organization at the Dental College of Georgia that aims to improve the oral health status of residents at the Georgia War Veterans Nursing Home (GWVNH) in Augusta, Georgia. The students conduct fundraising activities so that third and fourth year students can provide needed dental treatment at no cost to the residents. Students also regularly rotate at GWVNH in order to provide tooth brushing help, denture cleanings, and head and neck examinations, including oral cancer screenings. Results: Dentists for Della has funded approximately $40,000 worth of dental work since 2013. The program also provides an educational experience valued by students: the ability to interact with patients as early as their first semester of dental school. Conclusions: Dentists for Della is a vital program which not only provides educational opportunities in institutional public health dentistry and geriatrics for dental students, it also provides a much needed safety net for Georgia veterans with no ability to access other means of dental care

Background: Low health literacy has been identified as a significant public health problem. Also, higher expenditures due to longer hospital stays have been reported for persons with low health literacy. Nurses can assist patients with low health literacy to reduce their hospital stays and increase compliance with discharge instructions. Methods: A quantitative, descriptive research design was employed to assess knowledge and experiences of 192 senior nursing students. These students were administered the Health Literacy Knowledge and Experiences Survey (HL-KES), a 2-part survey that included assessment of knowledge about health literacy and experience in working with populations of low health literacy. Additional questions to assist in describing the sample population were included. Analysis of variance (ANOVA) and post-hoc tests were used to measure differences. Results: The results reveal that, at this point in their nursing education, senior nursing students lack health literacy knowledge and experiences. Statistically significant differences were found for health literacy knowledge among participants in the same program and for those enrolled at different program sites. Differences were found for health literacy experiences among participants, but these were not statistically significant due to unequal sample sizes between BSN and RN to BSN, and LPN/LVN to BSN participants. Conclusions: Regardless of program site, senior nursing students have some health literacy knowledge, but gaps exist. Mean scores for health literacy knowledge varied for participants and as a whole for program sites. Thus, differences in health literacy knowledge are most likely the result of how health literacy is addressed by different programs.

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.

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.

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.

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.