• Assessing the Validity of Statistical Inferences in Public Health Research: An Evidence-Based, ‘Best Practices’ Approach

      Peace, Karl E.; Parrillo, Anthony V.; Hardy, Charles J.; Georgia Southern University (Georgia Public Health Association, 2008)
      Like many fields, public health has embraced the process of evidence-based practice to inform practice decisions and to guide policy development. Evidence-based practice is typically dependent upon generalizations made on the bases of the existing body of knowledge – assimilations of the research literature on a particular topic. The potential utility of scientific evidence for guiding policy and practice decisions is grounded in the validity of the research investigations upon which such decisions are made. However, the validity of inferences made from the extant public health research literature requires more than ascertaining the validity of the statistical methods alone; for each study, the validity of the entire research process must be critically analyzed to the greatest extent possible so that appropriate conclusions can be drawn, and that recommendations for development of sound public health policy and practice can be offered. A critical analysis of the research process should include the following: An a priori commitment to the research question; endpoints that are both appropriate for and consistent with the research question; an experimental design that is appropriate (i.e., that answers the research question[s]); study procedures that are conducted in a quality manner, that eliminate bias and ensure that the data accurately reflect the condition(s) under study; evidence that the integrity of the Type-I error – or false-positive risk – has been preserved; use of appropriate statistical methods (e.g. assumptions checked, dropouts appropriately handled, correct variance term) for the data analyzed; and accurate interpretation of the results of statistical tests conducted in the study (e.g., the robustness of conclusions relative to missing data, multiple endpoints, multiple analyses, conditions of study, generalization of results, etc.). This paper provides a framework for both researcher and practitioner so that each may assess this critical aspect of public health research.
    • Social, Economic and Health Costs of Unintended Teen Pregnancy: The Circle of Care Intervention Program in Troup County, Georgia

      Brace, Andrea M.; Hall, Michael; Hunt, Barry P.; Center for Community Studies; Mississippi State University (Georgia Public Health Association, 2008)
      Unintended teenage pregnancy in the United States is a public health concern with ramifications that include a variety of social, economic and health costs. It has been estimated that adolescents giving birth before the age of 18 cost the United States at least $9.1 billion dollars annually (NCPTUP, 2008). Latest available national data indicate a slight increase in rates of unintended teen pregnancy after a 15 year period of steady decline. The unintended teen pregnancy rate in Troup County, Georgia in 2006 was 51.9/1,000 which was higher than the national average of 41.9/1,000(Kids Count, 2008). The purpose of this study was to review the Circle of Care intervention program, a collaborative multi-agency teen pregnancy prevention program. The Circle of Care program was developed in 1997 through the efforts of multiple community partner organizations. These organizations included the local school system, the Division of Family and Children Services, Public Health, Troup County Family Connection, the local teen clinic, the local hospital and other organizations. Participants in the Circle of Care program receive multiple services, including case management, a family assessment, parenting classes, home visits from the case manager, family planning assistance, services from the teen health clinic and the Division of Family and Children Services. Preliminary data indicate that Circle of Care participants gained social, economic and health benefits from participation in the program including: higher rates of high school enrollment, no repeat pregnancies, and no reported incidences of child abuse or child neglect. Projected cost savings from these outcomes are also reported. Preliminary examination of the Circle of Care program supports the efficacy of multi-level, collaborative efforts to reduce unintended teen pregnancy and subsequent social, economic and health risks. Future research should examine longer term outcomes of this program.
    • 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.
    • Impact of Chlamydia & Gonorrhea in Georgia: An Urban/Rural Comparison (2000-2004)

      Raychowdhury, Swati; Tedders, Stuart H.; Jones, Sarah K.; Georgia Southern University (Georgia Public Health Association, 2008)
      Background: In 2005, 33,562 cases of chlamydia and 15,860 cases of gonorrhea were reported in the State of Georgia, respectively corresponding to 3.4% and 4.7% of all cases reported nationally (CDC, 2005). Disparities of infection with respect to race and gender are evident for both diseases. The objective of this study was to determine the magnitude of chlamydia and gonorrhea in rural Georgia compared to urban areas of the state. Methods: County level data necessary for analysis were acquired using the Georgia Division of Public Health’s Online Analytical Statistical Information System database (GDHR, 2007). Rates of infection by gender and race (black vs. white) were aggregated over a five year period (2000 – 2004) and indirectly adjusted using Georgia as the standard. Rates for rural counties, defined as populations less than 35,000, were statistically compared to urban rates using a test of proportions (α = 0.05). Additionally, rate ratios and 95% confidence intervals were calculated to further quantify risk. Results: Although variation exists, data suggest infection of both diseases in Georgia is an urban problem, disproportionately impacting black residents. For chlamydia, adjusted rates for white males (21.0/100,000) and black males (313.9/100,000) were significantly higher in urban counties. Quantified risk as indicated by rate ratios [RR] and 95% confidence intervals [95%CI] suggest an 18% increase of risk among white males (RR = 1.18; 95%CI = 1.07, 1.30) and 33% increase of risk among black males (RR = 1.33; 95%CI = 1.27, 1.38). Among females, rates in rural areas of the state were higher for whites (121.9/100,000) and blacks (1,045.5/100,000). However, these differences were not significant. For gonorrhea, rates in urban areas were significantly higher among white males (15.5/100,000), black males (519.6/100,000), and black females (414.2/100,000) as compared to rural populations. Additionally, elevated risk of gonorrhea among these groups ranged from a 10% increase among black females (RR = 1.10; 95%CI = 1.07, 1.14) in urban areas to a 65% increase among white males (RR = 1.64; 95%CI = 1.43, 1.85) in urban areas. Conclusions: The State of Georgia continues to report two of the most common sexually transmitted infections at an alarming rate. The disproportionate impact of minorities is evident, although further assessment of the variation between urban and rural areas is warranted to more fully explain risk of infection.