• 86th Annual Georgia Public Health Association Meeting & Conference Report

      Smith, Selina A.; Abbott, Regina; Sims, Christy; Medical College of Georgia, Georgia Public Health Association (Georgia Public Health Association, 2015)
      The 86th annual meeting of the Georgia Public Health Association (GPHA) and joint conference with the Southern Health Association was held in Atlanta, Georgia, on April 13-14, 2015, with pre-conference (April 12th) and post-conference (April 14th) Executive Board meetings. As Georgia’s leading forum for public health researchers, practitioners, and students, the annual meeting of the GPHA brings together participants from across the state to explore recent developments in the field and to exchange techniques, tools, and experiences. Historically, the GPHA conference has been held in Savannah (n=24); Jekyll Island (n=20); Atlanta (n=16); Augusta (n=4); and Gainesville (n=1). There was no annual meeting during the early years (1929-1936); during World War II (1941-1943 and 1945); and for four years during the 1980s. Between 2006 and 2010, GPHA held one-day annual meetings and business sessions with educational workshops. Several new initiatives were highlighted as part of this year’s conference. These included a “move and groove” physical activity lounge, registration scholarships for students with a dedicated meet-and-greet reception, an expanded exhibit hall, presentation and approval of three resolutions (related to healthy foods at official activities and events; weapons at official activities and events; and memorials), and approval of the 2015 legislative policy positions and amended association bylaws. The theme for the conference was Advocacy in Action for Public Health. Specifically, the program addressed ensuring access to care; protecting funding for core programs, services, and infrastructure; eliminating health disparities; and addressing key public health issues important to the state of Georgia. One hundred and nine (109) abstracts were submitted for peer review; 36 were accepted for poster and 40 for workshop presentations. Four plenary sessions with keynote speakers covered the intersection between advocacy and policy, Georgia’s response to the Ebola crisis, palliative care, and essentials of advocacy in action for public health. Concurrent workshops focused on Board of Health training, public health accreditation, capacity building, collaboration, patient-centered outcomes, synthetic cannabinoid use, the HIV care continuum, use of data for informed decision making, environmental threats, organizational development, epidemiology, policy, and regulation. Thirty-two (32) awards were presented, including Lawmaker of the Year Award to Governor Nathan and First Lady Sandra Deal for their active and engaged role in promoting public health in Georgia; and the Sellers-McCroan Award to Commissioner Brenda Fitzgerald, Georgia Department of Public Health (DPH) State Health Officer, for her leadership of the Georgia Ebola Response Team and leadership of the newly formed department. The conference attracted 569 registrants primarily through pre-registration (n=561) with limited onsite registration (n=8). For this year’s conference, there was a significant increase in attendance (36%) and exhibitors (33%) relative to 2014. Of registrants reporting GPHA section participation, representation included: academic (5%); administration (10%); boards of health (13%); career development (15%); emergency preparedness (2%); epidemiology (5%); health education and promotion (2%); information technology (2%); maternal and child health (3%); medical/dental (3%); nursing (10%); nutrition (<1%); and other/no record (15%). There was 100% participation in the conference from the state’s 18 public health districts. The conference evaluation completed by a representative sample of registrants indicated areas of potential improvement as: starting sessions on time, using electronic and social media for the conference agenda/syllabus, and decreasing workshop sessions to 45 minutes. Most rated the conference as “good” or “excellent.”
    • Advocating for pregnant women in prison: Georgia can do better

      Webb, Nancy C.; Gates, Madison L. (Georgia Public Health Association, 2015)
      Background: Women are the fastest growing segment of the U.S. prison populace and approximately 1 in 25 were pregnant when they were incarcerated. However, women, including pregnant women, are receiving unacceptable health care in correctional systems. Further, many correctional systems lack policies to protect the best interest of incarcerated women, mothers and their children. Methods: We reviewed the literature on pregnant women in prison and found that corrections has been slow in making changes and adapting facilities for women, especially related to pregnancy, parenting skills and nurseries. It has been suggested the parent-infant attachment and the involvement incarcerated parents have with their children can help in preventing intergenerational crime. Results: The prison system in the U.S. is not set up to meet the needs of pregnant women prisoners. Many states, including Georgia, do not have policies regarding prenatal care or the use of restraints during labor and delivery. Conclusions: Georgia should rethink its prison-spending model. It would behoove Georgia’s leaders to take a look at what programs exist for pregnant women and mothers and consider adopting a model that would be a good fit for our state. We propose a collaborative approach for stakeholders to improve the care of pregnant offenders and the health of their children.
    • Association between air temperature and heart disease death rates in Georgia counties

      Hart, John (Georgia Public Health Association, 2016-07-19)
      Background: In this ecological study, global warming theory was tested on a local level, in Georgia. The hypothesis was that warmer counties would be associated with higher death rates. Methods: Heart disease death rates (HDDR) for 2008-2010 by Georgia county were compared to air temperature, also by county for the same years. Three race categories for HDDR were studied: black, white, and all races. Since there is evidence that living at higher land elevations provides a protective effect against heart disease, land elevation by county was included as a second predictor. Results: Correlation analyses revealed low strength, statistically significant correlations with white and all races HDDR as follows: direct for air temperature and indirect for land elevation. Correlations for blacks were negligible strength and statistically non-significant. Thus, multiple linear regressions (MLRs) were considered appropriate for whites and all race HDDR. In MLRs, temperature and elevation essentially cancelled each other relative to HDDR, resulting in statistically non-significant regression coefficients for each in both race categories (p > 0.15). This may have in part been due to the slight collinearity that was observed between the two predictors (variance inflation factor = 10.6 for both predictors in both race categories). The study is limited by: a) its (ecological) design, where individual exposures are unknown; and b) the-less-than ideal regression model that revealed slight collinearity between the predictors. Further research is required to verify these findings. Conclusions:
    • The care continuum for people living with HIV in Georgia: How can we raise the bar?

      Kelly, Jane; Rane, Deppali; Wortley, Pascale; Drenzek, Cherie; Georgia Department of Public Health (Georgia Public Health Association, 2015)
      Background: Viral suppression (VS) improves quality of life and longevity for people living with HIV (PLWH) and reduces viral transmission, but is achieved by only a minority of PLWH in Georgia Methods: By use of the Georgia HIV/AIDS surveillance database, the HIV Care Continuum was stratified by age. Results: Retention in care and VS generally increased with increasing age, with the exception of adolescents (aged 13-18 years), who had the highest retention and VS. Differences by sex, race and transmission category persisted across age groups. Among persons retained in care, the proportion achieving VS also generally increased with age. Linkage to care within 3 months of HIV diagnosis was lower among young adults (aged 19-24 years) (54%); young Black, non-Hispanic (NH) males (49%); and young Black NH men who have sex with men (MSM) (49%) as compared to those among adolescents (66%, 58%, and 57%). Conclusions: Retention in care and VS decreases with the transition from adolescence to young adulthood, possibly reflecting loss of support systems and competing priorities. At the other end of the age spectrum, health care and social support systems will be confronted with increasing numbers of older PLWH in Georgia. Challenges in HIV treatment and prevention include (a) the need for integrated medical care for aging PLWH with co-morbid conditions, and (b) the changing social environment of young PLWH.
    • Childhood cancer incidence in Georgia: Descriptive epidemiology, geographic trends, and disparities in insurance coverage and health care access

      Kanu, Florence; Robb, Wagner Sara; Corriero, Rosemary; University of Georgia (Georgia Public Health Association, 2015)
      Background: Limited research has been conducted concerning childhood cancer (CC) incidence in Georgia, which is a leading cause of death for children in the US. The purpose of this study was to determine if county-level CC incidence rates differed by geography or race and if health care access disparities exist. Methods: Incidence data were obtained from the Georgia Comprehensive Cancer Registry for 2000-2011. Age-adjusted incidence rates per 100,000 were analyzed by sex, race, and county. Hotspots and coldspots of CC incidence were analyzed using the Getis-Ord GI* statistic. Health care access data for children under 19 were obtained using US Census Bureau’s Small Area Health Insurance Estimates for 2011. Georgia’s three children’s oncology group (COG) treatment facilities with 40-mile buffer zones were geographically overlaid with CC incidence rate maps and health insurance maps using Geographic Information Systems (GIS). Results: For leukemia and central nervous system cancers, incidence rates were significantly different between Whites [7.8, 95% confidence interval (CI) (7.4, 8.2)] and Blacks [5.2, 95% CI (4.8, 5.6)]. Statistical hotspots of CC were observed in north Georgia. A lower percentage of insurance coverage among children was observed in southeast GA. Approximately 25% of Georgia counties that were not within a COG buffer had a higher percentage of children who were uninsured (mean ± SD: 10.28% ± 1.86%). Conclusion: Higher CC incidence rates and disparities in access to care were evident in north Georgia. Future research is needed in these geographies to investigate potential risk factors associated with CC incidence patterns and racial differences in Georgia.
    • Community-based participatory research principles for the African American community

      Smith, Selina A.; Whitehead, Mary S.; Sheats, Joyce Q.; Ansa, Benjamin E.; Coughlin, Steven S.; Blumenthal, Daniel S.; School of Medicine; Georgia Regents University; University of Massachusetts; Morehouse College (Georgia Public Health Association, 2015)
      Background: Numerous sets of principles have been developed to guide the conduct of community-based participatory research (CBPR). However, they tend to be written in language that is most appropriate for academics and other research professionals; they may not help lay people from the community understand CBPR. Methods: Many community members of the National Black Leadership Initiative on Cancer assisting with the Educational Program to Increase Colorectal Cancer Screening (EPICS) had little understanding of CBPR. We engaged community members in developing culturally-specific principles for conducting academic-community collaborative research. Results: We developed a set of CBPR principles intended to resonate with African-American community members. Conclusions: Applying NBLIC-developed CBPR principles contributed to developing and implementing an intervention to increase colorectal cancer screening among African Americans.
    • Community-based participatory research principles for the African American community

      Smith, Selina A.; Whitehead, Mary S.; Sheats, Joyce Q.; Ansa, Benjamin E.; Coughlin, Steven S.; Blumenthal, Daniel S. (Georgia Public Health Association, 2015)
      Background: Numerous sets of principles have been developed to guide the conduct of community-based participatory research (CBPR). However, they tend to be written in language that is most appropriate for academics and other research professionals; they may not help lay people from the community understand CBPR. Methods: Many community members of the National Black Leadership Initiative on Cancer assisting with the Educational Program to Increase Colorectal Cancer Screening (EPICS) had little understanding of CBPR. We engaged community members in developing culturally-specific principles for conducting academic-community collaborative research. Results: We developed a set of CBPR principles intended to resonate with African-American community members. Conclusions: Applying NBLIC-developed CBPR principles contributed to developing and implementing an intervention to increase colorectal cancer screening among African Americans.
    • E-cigarette use among undergraduate liberal arts and health sciences students: A study protocol

      Dicks, Vivian; Stone, Rebecca; Georgia Regents University (Georgia Public Health Association, 2015)
      Background: Electronic cigarettes (e-cigarettes) are battery operated devices that deliver nicotine as an inhaled vapor. Use of E-cigarettes has gained in popularity since 2007, and their use is often promoted as a safer alternative to tobacco smoking. A concern among public health experts is whether e-cigarettes can be used as an alternative method for tobacco cessation or whether they lead to nicotine dependence and use of other tobacco products. Several studies have shown a higher prevalence of use of e-cigarettes among young adults between the ages of 18 and 25, but varying results on the association between their use and perceptions of harm. For the present survey, this age group was selected because, in this group, addiction to tobacco and the likelihood for adverse effects would be lower. Thus, for this group, the chances of not starting or consideration for quitting would be higher. The purpose of this study is to investigate the knowledge, attitudes, and beliefs about using tobacco products, smoking, and e-cigarettes among undergraduate students on liberal arts and health sciences campuses of a university. Methods: Participants will be invited via email and directed to a secure website where the survey can be completed anonymously. To assess knowledge, attitudes, and beliefs, the survey will include validated questions based on recommendations by the World Health Organization ((2000) appendix A)). Anticipated Results: We anticipate that the results will show an improvement in the behavioral aspect among undergraduates at the liberal arts and health sciences campuses. We also expect that results will show an improvement in knowledge among liberal arts students but less improvement in knowledge for health sciences students. Finally, we predict an overall improvement in attitudes about tobacco use and e-cigarette use.
    • Ebola: Working through fear

      Fitzgerald, Brenda; Georgia Department of Public Health (Georgia Public Health Association, 2015)
    • Evaluation results of an innovative pilot program to increase access to fresh fruits and vegetables in Cobb County, GA

      Woodruff, C Rebecca; Shipley, Rebecca; Brown, Agnes F.; Coleman, Anne-Marie; Munoz, Jennifer; Honeycutt, Sally; Hermstad, April K; Loh, Lorna; Kegler, Michelle C.; Emory University (Georgia Public Health Association, 2015)
      Background: This abstract describes a public health practice initiative called the Farm Fresh Market (FFM) and presented pilot evaluation results. Methods: The FFM, developed by Cobb and Douglas Public Health, the McCleskey-East Cobb Family YMCA, and Cobb2020, sold low-cost fruits and vegetables to families living in the 30168 zip code of Austell, Georgia. The evaluation focused on documenting to what extent the FFM reached its intended population and increased perceived access to fresh fruits and vegetables among customers. A convenience sample of 100 returning FFM customers completed self-administered, written intercept surveys at the end of the 2014 market season. Results: The market served customers from a range of socioeconomic backgrounds. Most customers strongly agreed that the FFM made it easier (69%) and less expensive (79%) for them to buy fresh fruits and vegetables and easier for them (63%) and their families (64%) to eat a healthy diet. Most customers reported that they ate more vegetables (65%) and fruit (55%) as a result of shopping at the FFM and reported high levels of satisfaction with all aspects of the FFM. Conclusions: The results suggest that the FFM served customers from the local area and that the FFM may have increased perceived access to healthy food options among customers. Community-level interventions to increase access to healthy foods may play an important role in chronic disease prevention.
    • Immunization policies for employees of childcare facilities within the North Central Health District of Georgia

      Kamara, Paula; Lian, Brad; Smith, Jimmie; McChargue, Judy; Mercer University, North Central Health District (Georgia Public Health Association, 2015)
      ABSTRACT Background: Since the early 1980s, vaccinations have generally been required for children in licensed daycare and school settings. In these settings, vaccinations have reduced disease rates. Adults occupy these settings as well, and ensuring they are vaccinated should also reduce the potential for disease and disease transmission. Yet, there are few vaccination requirements for adults employed at daycare facilities, although such requirements have been recommended (CDC Adult immunization schedule, 2015; ACIP General Recommendations, 2011). The objective of this study was to examine current vaccination policies among childcare facilities within Georgia’s North Central Health District (District 5-2) and the climate for possible policy directives in the future. Methods: A 10-item questionnaire regarding vaccination requirements and policies and the importance of vaccination education was mailed to administrators of all 271 licensed childcare facilities within the North Central Health District in Georgia. A total of 76 questionnaires were returned, representing a 28% response rate. The district has approximately 530,000 residents and is comprised of 13 counties. Results: Of the childcare facilities, 79% have no vaccination policies in place. However, most facility directors (75%) indicated that such policies should be required, and 93 % stated that vaccination education is important for their staff members. Conclusions: Vaccination requirements can help protect children and their caregivers from communicable diseases. From a policy perspective, the climate may be favorable for the implementation of such requirements, in that most childcare directors recognize the importance of such policies and state that they should be required.
    • Impact of 1918 Spanish influenza pandemic on mortality rates in Savannah, GA, and implications for future epidemic prevention

      Plasphol, Sara; Dixon, Betty; Armstrong State University (Georgia Public Health Association, 2015)
      Background: The Spanish Influenza pandemic struck the United States in waves from September 1918 through March 1919. This study investigates the impact of the Spanish Influenza on Savannah and Chatham County, Georgia. Methods: Primary death records from the Chatham County Health Department were examined and analyzed for the years of 1917, 1918, and 1919. Historical mortality rates in the Savannah area were compared to those for other parts of the United States and world. Results: Mortality rates attributed to the Spanish Influenza within Savannah closely paralleled similar flu-related mortality rates for comparison populations in New York, London, and Madrid. Conclusions: These local primary data enable Savannah public health officials to understand the historical trends of communicable disease mortality in relation to other parts of the world, and have the potential to serve as a reference when channeling future resources into epidemic prevention in Chatham County.
    • Increased perception of mosquito problems during a stormwater restoration project

      Kelly, Rosmarie; Georgia Department of Public Health (Georgia Public Health Association, 2015)
      In 2008, a plan for improvement of the McDaniel Branch Watershed was prepared for the city of Atlanta, Department of Watershed Management. This included the construction of ponds in a kudzu-covered area at Bowen Circle. There is a perception that wetlands create mosquito problems. In point of fact, most of the vector and nuisance species in Atlanta are either container breeders or floodwater species, and do not breed in ponds. Because there is an average of 5 cases of West Nile virus (WNV) reported in Fulton County per year, most of these near Combined Sewer Overflow streams, county residents are aware of the connection between mosquitoes and WNV. As the McDaniel Branch Watershed Improvement Plan progressed, neighborhood residents became convinced that the changes being implemented in the area were increasing mosquito problems and increasing their risk of WNV infections. In Oct 2013, the Environmental Health Section of the Georgia Department of Public Health was contacted by the City of Atlanta Department of Watershed Management concerning control of mosquitoes in the ponds being created at the Bowen Circle site. It was determined that mosquito surveillance should be implemented in the area to determine if the changes to the watershed area were creating a mosquito problem. At the end of the 2014 mosquito surveillance season, it was established that there was little association between the watershed improvement project, the reported mosquito exposure, and measures of mosquito production within this neighborhood.
    • Legislative smoking bans for reducing exposure to secondhand smoke and smoking prevalence: Opportunities for Georgians

      Coughlin, Steven S.; Anderson, Jennifer; Smith, Selina A.; Emory University; Georgia Regents University (Georgia Public Health Association, 2015)
      ABSTRACT Background: Secondhand smoke, which is also referred to as environmental tobacco smoke and passive smoke, is a known human carcinogen. Secondhand smoke also causes disease and premature death in nonsmoking adults and children. Methods: We summarize studies of secondhand smoke in public places before and after smoking bans, as well as studies of cardiovascular and respiratory disease before and after such bans. Results: To protect the public from the harmful effects of secondhand smoke, smoke-free legislation is an effective public health measure. Smoking bans in public places, which have been implemented in many jurisdictions across the U.S. and in other countries, have the potential to influence social norms and reduce smoking behavior. Conclusions: Through legislative smoking bans for reducing secondhand smoke exposure and smoking prevalence, opportunities exist to protect the health of Georgians and other Americans and to reduce health care costs. These opportunities include increasing the comprehensiveness of smoking bans in public places and ensuring adequate funding to quit line services.
    • A multisite evaluation of pediatric asthma-related treatment in accordance to the 2007 National Heart, Lung, and Blood Institute Expert Panel Report – 3 guidelines

      Oraka, Emeka; Robinson, Brittani; Ousley, Trevor; Lopez, Francesca; Graham, LeRoy (Georgia Public Health Association, 2016-08-18)
      Background: To determine if Georgia-based healthcare providers who received continuing education on pediatric asthma as described by 2007 National Heart, Lung, and Blood Institute Expert Panel Report – 3 guidelines demonstrated improvements in asthma-related treatment. Methods: We used a multi-site, cross-sectional design. Data were collected via surveys administered to healthcare providers and via randomized medical chart abstractions. Chart abstraction occurred at 12 months prior to intervention (n = 149); one-month post-intervention (n = 208); and three months post-intervention (n = 123). Results: Substantial improvements were observed among the providers who used pre/post bronchodilator spirometry (5% at baseline, 12% at one month, and 19% at three months), and there was a significant increase in the number of patients being advised to improve conditions at home or school to avoid asthma triggers (9% at baseline, 43% at one month, and 37% at three months). However, prescription of preventive medications and patients being taught proper medication/spacer technique by providers decreased from baseline to three-months (69% vs 55% and 41% vs 27%, respectively). Providers’ self-reported barriers and patient load were consistently associated with poorer treatment outcomes. Healthcare providers who received continuing education on NHLBI - EPR 3 guidelines demonstrated an increase in spirometry use and in advising patients on improving home and school conditions. While these findings are useful, provider-reported barriers such as time, organizational, and insurance barriers prevent providers from effectively systematically incorporating all of the EPR 3 guidelines. Conclusions: Internal efforts to address clinical barriers combined with continued education may result in improvements in pediatric asthma-related treatment outcomes.
    • Nonprofit hospitals and community health needs assessments

      Stephens, Beth (Georgia Public Health Association, 2015)
      Background: The Patient Protection and Affordable Care Act of 2010 requires all hospitals filing as 501(c)(3) nonprofit organizations to conduct a Community Health Needs Assessment (CHNA) every three years. Many Georgia hospitals published their first CHNAs in 2012 and 2013. The goals of this research and policy project were to assess compliance with the new CHNA requirements for nonprofit hospitals, provide recommendations to hospital administrators and policymakers, and encourage hospitals to engage in meaningful ways with community-based organizations and local public health departments in the next round of CHNAs. Methods: With funding from the Healthcare Georgia Foundation, Georgia Watch reviewed the initial CHNAs of 38 nonprofit hospital facilities in Georgia. Georgia Watch developed an evaluation tool to assess hospital compliance with five major components of the new CHNA requirements: 1) defining community; 2) collecting secondary data on community health; 3) gathering community input and primary data; 4) prioritizing community health needs; and 5) implementing strategies to address identified community health needs. To gain a deeper understanding of hospital processes, Georgia Watch supplemented document review with hospital leadership interviews and a survey of community input providers. This research was intended to inform, assist, and encourage citizens, community health stakeholders, public health departments, and hospital administrators. At the end of the session, audience members were better equipped to evaluate the adequacy of nonprofit hospital CHNAs within their own communities and encourage local hospitals to develop effective community benefit programs. Results: Georgia Watch found that hospitals are still learning how to navigate the CHNA process and that improvements can be made during the next round of CHNAs. Conclusions: Georgia Watch’s research provides insight on how hospitals can best engage their communities, prioritize local health concerns, initiate valuable partnerships, and develop meaningful, evidence-based strategies to address community health needs.Methods: With funding from the Healthcare Georgia Foundation, Georgia Watch reviewed the initial CHNAs of 38 nonprofit hospital facilities in Georgia. Georgia Watch developed an evaluation tool to assess hospital compliance with five major components of the new CHNA requirements: 1) defining community; 2) collecting secondary data on community health; 3) gathering community input and primary data; 4) prioritizing community health needs; and 5) implementing strategies to address identified community health needs. To gain a deeper understanding of hospital processes, Georgia Watch supplemented document review with hospital leadership interviews and a survey of community input providers. This research was intended to inform, assist, and encourage citizens, community health stakeholders, public health departments, and hospital administrators. At the end of the session, audience members were better equipped to evaluate the adequacy of nonprofit hospital CHNAs within their own communities and encourage local hospitals to develop effective community benefit programs. Results: Georgia Watch found that hospitals are still learning how to navigate the CHNA process and that improvements can be made during the next round of CHNAs.
    • Patient-centered outcomes for GoStrong: A self-management diabetes program in Savannah, GA

      Yang, Frances; Roberts, Lizzann; Davis, Bionca; Christianson, Angela (Georgia Public Health Association, 2015)
      Background: To advance the goal of health improvement for diverse populations with diabetes, a patient-centered approach is foundational. Methods: Innovative methods were used to initiate and advance an approach to diabetes engagement and self-management. We began with a strategy to understand how patients with diabetes view and interact with the disease via the medical community and moved to program development through patient-centered design and to the development of strategic partnerships and continuous learning from patients, stakeholders, and academic research partners. Results: The mean age of the participants in the GoStrong™ program (n=106) was 51 ±9.2 (SD) years. There were significant differences in the HbA1c levels over time compared to the Control group (n=100). The mean HbA1c level from baseline to 36 months decreased from 7.49% to 6.89%, with the largest decline (to 6.28%, p<0.01) at 12 months. The mean HbA1c level for the control group increased from 8.38% to 8.49% from baseline to 36 months, with the largest increase (to 8.89%, p<0.01) at 18 months. There were significant differences for total medical costs at 12 months prior to and 12 months after starting the GoStrong program, a difference in total prescription drug costs at 12 months, and differences within the total group in number of emergency room (ER) visits. Claims information showed that GoStrong produced significantly lower total medical costs and ER visits. There was also an increase in total prescription drug costs that may be due to better medication adherence. Conclusions: For diabetics, the GoStrong program results in reduced HbA1c levels, reduced costs, and reduced ER visits.
    • Perceptions of HIV/AIDS testing among urban and rural African American church members

      Walker, Roblena E; Walden University (Georgia Public Health Association, 2015)
      Background: The prevalence of the human immunodeficiency virus (HIV) continues to affect African Americans (AA) disproportionately. The purpose of this mixed methods study, guided by the health belief model, was to examine associations linking church and ambient social environment with knowledge and perceptions of HIV/AIDS testing amongst urban and rural AA church members. Methods: Multiple regressions and t tests were used to compare perceptions of HIV/AIDS testing and knowledge of HIV/AIDS among 236 participants selected from two AA churches located in a large city (n = 122) and in a rural town (n = 114) in the Southern U.S. Results: The quantitative findings indicated that the urban participants reported significantly higher rates of testing than the rural participants, but the groups had equally high HIV knowledge and positive perceptions of HIV/AIDS testing. In-depth, individual interviews (24 urban; 24 rural) were conducted to gain a better understanding of the factors that contribute to perceptions of HIV/AIDS testing and knowledge of HIV/AIDS. Transcripts were axially coded for a priori themes and then analyzed for emergent categories of responses. These interviews indicated that the participant’s perceptions of HIV/AIDS testing were in general, not influenced by the church and that there were no noticeable distinctions regarding why HIV/AIDS testing was sought. The combined results of this study suggested that the churches surveyed were not promoting HIV/AIDS awareness and that the participants felt that the church should do more as it relates to HIV/AIDS. Conclusions: Since the AA church plays an important role in the lives of many AAs, it potentially can, particularly in rural areas, bring forth social change by advocating HIV/AIDS testing and prevention efforts in order to reduce the rate of HIV infections.
    • Promoting policy and environmental change in faith-based organizations: Organizational level findings from a mini-grants program

      Hermstad, April K; Arriola, Kimberly; Clair, Shauna; Honeycutt, Sally; Carvalho, Michelle; Cherry, Sabrina; Davis, Tamara; Fraizer, Sheritta; Escoffery, Cam; Kegler, Michelle C.; et al. (Georgia Public Health Association, 2015)
      Background: High rates of heart disease, cancer, and stroke exist in rural South Georgia, where Emory’s Cancer Prevention and Control Research Network provided mini-grants and technical assistance to six faith-based organizations to implement policy and environmental changes to promote healthy eating (HE), physical activity (PA), and tobacco use prevention (TUP). Drawing from a Social Ecological Framework, we hypothesized that church members would perceive an increase in messages, programs, and the availability of facilities to support HE, PA, and TUP over a 1-year period. Methods: Members (N=258) completed self-administered questionnaires that assessed perceptions of the existing church health promotion environment relative to HE, PA, and TUP policies, as well as their eating behavior and intention to use PA facilities at church at baseline and 1-year follow-up. Results: Members at three of the six churches perceived increases in delivery of HE messages via sermons, church bulletins, and food labels, and increased availability of programs that support HE (p<0.05). Members at four churches reported increases in healthy foods served and decreased unhealthy foods served at three churches over the 1-year period (p<0.05). Of the five churches that implemented changes to promote PA, members at two churches perceived increases in healthy PA messages (p<0.05) and those at three churches perceived increased PA facilities (p<.05). One of two churches that implemented TUP policies, according to responses of members, had an increase in messages on smoking, (p<0.05). Conclusions: Community mini-grants may be a viable mechanism for promoting environmental change supporting HE, PA, and TUP policies in church environments.
    • Reflections on mental health advocacy across differing ecological levels

      Thompson, J Nancy; McGee, E Robin; Munoz, C Leslie; Walker, R Elizabeth (Georgia Public Health Association, 2015)
      ABSTRACT Background: According to the World Health Organization, mental health advocacy is comprised of a range of actions designed to change aspects of attitudes and structures that impede the achievement of positive mental health in populations. Methods: According to the World Health Organization, mental health advocacy is comprised of a range of actions designed to change aspects of attitudes and structures that impede the achievement of positive mental health in populations. Results: We have proposed interventions and advocacy effort for each ecological level. Project UPLIFT, a distance-delivered intervention for mental health is presented as an example of an effort that can affect several levels of the social ecology. Conclusions: Advocacy and interventions that make an effort to encompass the levels of the social-ecological model may contribute to greater progress in improving mental health outcomes.