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.

Background: A critical task of public health is the development and assessment of programs to address needs, concerns and issues of populations. The overall purpose of this workshop is to enhance the core public health workforce functional knowledge and skills (competencies) in the areas of program development and evaluation leading to improvements in population health and reducing health disparities. Methods: The hour long workshop will serve as an introduction and review of methods of program monitoring and assessment (M & A). The training approach will be an oral presentation with PowerPoint slides and hands -on practice that will include review of M & A terminology and review of M & A basic methodologies. Results: (Outcomes) Participants will become familiar with the basic terms and methods of program monitoring and assessment (M & A). Conclusions: The topics of this workshop will primarily benefit state and local health departments and public health districts that share services and face challenges in building or enhancing their functional public health knowledge and skills, improvement efforts and the documentation of those efforts.

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.

Background: To build on current research involving faith-based interventions (FBIs) for addressing mental and physical health, this study a) reviewed the extent to which relevant publications integrate faith concepts with health and b) initiated analysis of the degree of FBI integration with intervention outcomes. Methods: Derived from a systematic search of articles published between 2007 and 2017, 36 studies were assessed with a Faith-Based Integration Assessment Tool (FIAT) to quantify faith-health integration. Basic statistical procedures were employed to determine the association of faith-based integration with intervention outcomes. Results: The assessed studies possessed (on average) moderate, inconsistent integration because of poor use of faith measures, and moderate, inconsistent use of faith practices. Analysis procedures for determining the effect of FBI integration on intervention outcomes were inadequate for formulating practical conclusions. Conclusions: Regardless of integration, interventions were associated with beneficial outcomes. To determine the link between FBI integration and intervention outcomes, additional analyses are needed.

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.

Background: Since Cobb & Douglas Public Health (CDPH) achieved accreditation in May 2015, efforts to mature a culture of quality have been emphasized. In addition, the Adult Health Clinic moved to a new facility in Spring 2016. This move has improved many patient flow issues, but also has had unexpected consequences that spurred interest in doing several quality improvement (QI) projects. Methods: Rather than doing one QI project at a time, a kaizen event was held. Kaizen is a Japanese term for continuous improvement. This workshop allowed the Adult Health Team to plan seven QI projects and implement them simultaneously over the next several weeks. After the first six weeks of implementation, nearly 14 different projects were in various stages of the Plan-Do-Study-Act (PDSA) cycle. Baseline average patient flow for 1880 patient encounters was 75.11 minutes. Results: Results are still pending. Preliminary results reflect increased collaboration among clinic staff and an increase in staff members taking the initiative to make improvements. Employee morale has improved, and employee and customer satisfaction seems to be improved. Conclusions: The Adult Health Clinic used the LEAN methodology to reduce waste in the patient flow process and used the PDSA framework to structure their 14 QI projects. A kaizen event allows rapid improvements to be planned and implemented in a short period of time.

Background: As Georgia’s Emergency Medical Services (EMS) system approaches 50 years in operation, the Georgia EMS Association and Georgia Southern University’s Center for Public Health Practice and Research began an evaluation of the strengths, weaknesses, opportunities, and threats facing Georgia’s EMS system. Methods: During the first year of the study, eight meetings were held across Georgia involving EMTs, physicians, hospital administrators, emergency planners, and state policy makers to identify strengths, weaknesses, opportunities, and threats facing the system. Results: Results obtained during the first year of this study offered valuable insight into current and future factors affecting the ability of Georgia’s EMS system to provide effective care to an expanding population. Conclusions: Quality of care, financial solvency, community paramedicine models, and reimbursement strategies were discussed and numerous strategies were evaluated to improve EMS operations in both urban and rural populations.

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.

Background: Office-based physicians can practice in a solo or group setting. Solo physician practices are staffed by a single physician who is responsible for all the care of the patients. Physicians in solo practices are also responsible for the infrastructure, personnel and investment cost of their practices. Further, evidence suggests that physicians in solo practices are more likely to be dissatisfied with their medical career compared to those in group practices. Given these challenges, current trend suggests a shift away from solo physician practices. However, there are still physicians in solo practices in Georgia but little is known about them. This study attempts to characterize the physicians working in solo practices and in so doing, add to the growing knowledge of the healthcare workforce in Georgia. Methods: The 2014 Physician Compare data were used for this study. This database contains information on individual physician level characteristics including gender, credential, primary specialty and practice type. The data were linked to the 2014 Area Resource File to provide information on the rural/urban location of physician practices. Physician practices were classified as rural or urban based on the Economic Research Service classification. Chi square and t-tests were carried out to examine the characteristics of physicians practicing in solo practices. Statistical analyses were conducted in StataMP 14. Results: Of the 13,499 Georgia physicians studied, 1448 physicians were in solo practices. The majority of these physicians were in urban areas (78.30%; p<0.001), male (72.18% p<0.001), had primary care specialties (46.31% p<0.001) and more experience in practice (27.6 years; p<0.001). In addition, almost three quarters did not use electronic health records (71.97% p<0.001) and the majority did not report on quality measures to the Centers for Medicare and Medicaid Services (66.7%; p<0.001). Conclusions: There are a large number of physicians in solo practices in Georgia. Given the challenges facing these physicians, it is important for Georgia to consider approaches to decrease the burden on physicians working in solo practices.

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