jGPHA Volume 1 (2007)
Volume 1, Number 1, 2007Original Research
The Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA) in Georgia: Women Covered and Medicaid Costs in 2003, E. K. Adams, S. C. Blake, C. Raskind-Hood, L. Chien, M. Zhou, J. Liff, & W. Eley
Clinicians’ Perception of Inmates’ Satisfaction with Mental Health Services, J. B. Daniel & W. S. Korr
Modifying and Validating a Quality of Life Measure to Fit your Patient Population, M. R. Johnson, J. R. Maclean, R. Rogers, D. M., Fick, & A. Kallab
Multi-Level Evaluation of a Perinatal Health Program in Rural Southeast Georgia, S. Raychowdhury, S. Tedders, G. O’Steen, & S. Jones
Relationship of Fruit and Vegetable Servings and Self-Reported Diabetics in the Southeast and northeast, M. Rimando, F. Lopez, & H. Battula
Volume 1, Number 2, 2007Original Research
Health Literacy Levels Among Adult Support Group Members and the General Adult Public : A Focus Group Approach, Czech, D. R., Alberto, J., & Joyner, A. B.
Infant Mortality Trends among Georgia Residents, 1995-2003: Targeting Healthy People’s 2010 Goals, Sturges, D., Gunn, L., Shankar, P., & Shroff, S.
Risk Factors for HIV Transmission among Hispanic Men Who Have Sex with Men in Atlanta, Nanan, D. N. C., & Hepburn, V. A.
McKinley Thomas, Mercer University School of Medicine
Randolph S.Devereaux, University of Alabama
Paula Dohoney, Augusta State University
Jessie R. Legros, Mercer University
Mary W. Mathis, Mercer University
Anthony Parrillo, Georgia Southern University
Rakshitkumar Patel, University of Alabama
Rebecca Rogers, Augusta State University
Michael U. Smith, Mercer University
Arun Vaithi, Mercer University
Naomi Williams, Medical College of Georgia
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Infant Mortality Trends among Georgia Residents, 1995 – 2003: Targeting Healthy People’s 2010 GoalsPopulation-based trends in infant mortality among Georgia Residents between 1995 and 2003 were assessed on characteristics such as race, birth weight, neonatal and post-neonatal periods, and cause of death. A statistical analysis was conducted to show that the Georgia infant mortality rate (IMR) remained constant throughout the study period and averaged 8.67 per 1,000 live births. The analysis revealed racial disparities, with an IMR ranging from 6.03 in white infants to 13.76 in black infants, with less than one percent (0.86%) change, on average, among the differences between black and white mortality rates across the nine-year period. The disparities were also evident in infants with low birth weight (LBW) and very low birth weight (VLBW). Black infants born with LBW (12.9%) and VLBW (9.98%) have more than twice the rate of infant mortality compared to white infants born with LBW (6.64%) and VLBW (1.12%). Mortality in the neonatal period accounted for more than half (67.96%) of all infant deaths and exhibited considerable ethnic differences. Among all groups, black male neonates (10.7) have the highest mortality rates. The average neonatal mortality rate across the entire study period is 5.89 (SD=0.20); the average postneonatal mortality rate across the entire study period is 2.78 (SD=0.22). The five leading causes of death among Georgian infants in descending order were: birth defects, prematurity and low birth weight, Sudden Unexplained Infant Deaths (SUID), other perinatal conditions and respiratory conditions with racial differences in the ordering.
Risk Factors for HIV Transmission among Hispanic Men Who Have Sex with Men in AtlantaThis 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.
Health Literacy Levels Among Adult Support Group Members and the General Adult Public : A Focus Group ApproachHealth literacy has been identified as lacking in 47% of Americans (The National Academies, 2004). While health literacy reports of studies conducted in the southern section of the United States are available (DeWalt et al., 2004; Kennen et al. 2005), this research team found limited research that provides health literacy levels of the southeast, rural Georgia population. The purpose of this exploratory study was to examine and compare health literacy of health-related support group members and non group members in southeast Georgia utilizing a focus group methodology developed by Kreuger (1994). After Institutional Review Board approval at a local university, the research team utilized 5- 10 established Health-related Support Groups of 6-10 individuals in the southeastern part of the United States. An additional four focus groups composed of persons not associated with a health-related support group were also used for comparative purposes. Participants were recruited with the assistance of local health care providers. The initial open-ended questions consisted of items such as: “Describe your experience reading health resources.” "What makes a health resource difficult to read, as well as easy to read?" The moderator utilized additional probing questions and reframing comments as necessary (Kreuger, 1994). The data were analyzed by the qualitative content analysis method described by Berg (1989). The themes that emerged across groups reflected confusion about medication directions, health terms, and communication from health care providers and doubt about the integrity of and inability to read the small print of health information. Prevention and faith in God were identified as important to self-care. Rationales for themes and future research ideas are discussed.
Relationship of Fruit and Vegetable Servings and Self-Reported Diabetics in the Southeast and NortheastAccording 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.
Multi-Level Evaluation of a Perinatal Health Program in Rural Southeast GeorgiaProblem: Infant mortality has declined steadily in the past decade, however, significant disparities associate with lack of adequate perinatal health services and barriers to access disproportionately impact women residing in rural areas. In Georgia, data suggest significant challenges with respect to birth outcomes, and this problem seems to be exacerbated in rural regions of state. The objective of this presentation is to report on the impact of a regional perinatal health care collaborative implemented in rural southeast Georgia. Method: Analysis of pre-intervention and post-intervention birth outcomes (gestational age, birth weight and infant mortality) served as the focal point programmatic evaluation. Differences in mean gestational age and mean birth weight were analyzed using a t-test (α = 0.05). Proportional differences in low birth weight and infant mortality were assessed using the chi-square test (α = 0.05). Differences were investigated relative to race (white and nonwhite). Results: Analysis of white participants showed no significant difference in any birth outcomes investigated. Furthermore, analysis of non-white PHP participants suggested significant improvements in all birth weight (p < 0.001), gestational age (p = 0.007), low birth weight (p = 0.002), and infant mortality (p = 0.007). Conclusion: The perinatal health program in southeast Georgia demonstrated considerable effectiveness as measured through pre-intervention and post-intervention birth outcomes. The potential for improved health outcomes of high risk pregnant women and infants as a result of adequate perinatal care may also lead to the achievement of Healthy People 2010 within this region.
Modifying And Validating A Quality Of Life Measure to Fit Your Patient PopulationIntroduction: A well-developed quality of life (QoL) instrument is valuable in identifying the burden of illness. We were interested in exploring whether existing QoL instruments were suitable for patients in our medical setting and, if not, whether this could be rectified by adapting an existing valid and reliable instrument to meet the specific needs of our patient population. For the purposes of this study, we chose to evaluate the quality of life of patients with breast cancer. Specifically, we were interested in two aspects of QoL in women with breast cancer. The first was whether existing instruments were pertinent to the women in our venue. The second research interest was dependent upon the first. If current instruments were found wanting, could this be rectified through the creation and validation of new domains of relevance to these patients? Method: First, five patients were interviewed to ascertain QoL issues pertinent to women in our medical setting. Second, to determine regional appropriateness of existing breast cancer QoL instruments, a search was conducted to identify and review existing breast cancer specific QoL instruments. Third, an addendum was created (to be used in conjunction with an existing instrument identified through the search) that contained three QoL domains not typically found: Financial, Spirituality and Satisfaction with Medical Care. The addendum was then tested along with an existing instrument (FACT-B). Results: Internal consistency for the new scales, Satisfaction with Medical Care, Spirituality, and Financial had alpha coefficients of 0.81, 0.80, and 0.63 respectively. The total score for FACT-B plus addendum was 0.69. Pearson’s correlation coefficients were 0.49 for Financial, 0.64 for Satisfaction with Medical Care, and 0.70 for Spirituality. Total test/retest was 0.71.
Clinicians’ Perception of Inmates’ Satisfaction with Mental Health ServicesA growing body of literature addresses the mental health needs of prison inmates; however, very little research has examined mental health services among this population. Based on the Behavioral Model of Health Services Use (Andersen Model), the current study examined clinicians’ perception of inmates’ satisfaction with mental health services. The study’s main objective was to identify the effect of three major groups of predictor variables (predisposing, enabling, and need) on clinicians’ perception with inmates’ satisfaction with mental health services. The study utilized an exploratory, survey methodology. Although only a few variables were found to be statistically significant in the multivariate analyses, the findings of the study are a significant step in beginning to understand satisfaction of mental health services by inmates. The link between satisfaction and treatment outcome has great significance in the correctional environment, where staff and inmates may tend to see each other as adversaries.
The Breast and Cervical Cancer Prevention and Treatment Act (BCCPTA) in Georgia: Women Covered and Medicaid Costs in 2003The 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.