• Screening for developmental delay in Georgia's family shelters: Formative evaluation of a quality improvement initiative

      So, Marvin; Agbayani, Luistita; Gutierrez, Mariel; Griffins, Josef; Emory University; Atlanta Children's Shelter; Greenbriar Children's Shelter; Interfaith Hospitality Network (Georgia Public Health Association, 2016)
      Background: Children in families experiencing homelessness are at elevated risk for cognitive, motor, speech, and other developmental delays. Given the prevalence of family homelessness in Georgia and across the U.S., investigating the feasibility of implementing developmental screeners while families are in shelters is warranted. Methods: Three pilot shelters were selected for the development and implementation of Quality Improvement (QI) Teams, who used Plan-Do-Study-Act (PDSA) Cycles to make progress towards universally screening children for delay. We employed a formative evaluation to (1) characterize screening rates and shifts in shelter as a result of QI initiatives, and (2) identify barriers and facilitators to implementing QI interventions in family shelters. Results: Screening rates in all three shelters increased over the study period between 13-50%. Primary implementation facilitators included team members with experience in QI principles; having a medical provider on the team; possessing an “improvement culture;” and having diverse perspectives represented. Primary barriers included a lack of time or commitment in QI team leaders; medical providers with limited time in shelter; lack of training on how to represent and discuss QI data; and restrictive organizational policies. Conclusions: Family shelters demonstrate promise for implementing developmental screeners for at-risk children. Although challenges have been identified, facilitating factors are prevalent and underscore the importance of QI team preparation, composition, and cohesion. The relative availability, low-cost, and potential for impact of developmental screeners offer credence to their uptake and implementation within shelter clinical contexts.
    • Colon cancer knowledge, screening barriers, and information-seeking in Northeastern Georgia

      Springstion, Jeffrey; Hou, Su-I; University of Georgia; University of Central Florida (Georgia Public Health Association, 2016)
      Background: The present study assessed utilization of colorectal cancer (CRC) screening and knowledge, barriers, and information-seeking among adults in northeastern Georgia. Methods: A total of 245 people aged 40 years and older from selected rural, suburban, and small towns in northeastern Georgia participated in this cross-sectional survey. Results: Respondents aged 50 years and older were more likely to think that they “don’t need screening at their current age” as compared with those in their 40s. Higher information-seeking correlated with lower screening barriers (p<0.001), and colonoscopy history correlated with higher levels of information-seeking (p=0.001). Discussion: Respondents generally had a low level of knowledge about CRC. Individuals with lower perceived screening barriers indicated a higher likelihood to seek more information about CRC and therefore might be more likely to be screened by colonoscopy.
    • Exploration of barriers and facilitators to publishing local public health findings: A mixed methods protocol

      Smith, Selina; Webb, Nancy; Blumenthal, Daniel S.; Willcox. Bobbie; Ballance, Darra; Kinard, Faith; Gates, Madison L. (Georgia Public Health Association, 2016)
      Background: Worldwide, the US accounts for a large proportion of journals related to public health. Although the American Public Health Association (APHA) includes 54 affiliated regional and state associations, little is known about their capacity to support public health scholarship. The aim of this study is to assess barriers and facilitators to operation of state journals for the dissemination of local public health research and practices. Methods: A mixed methods approach will be used to complete the 12-month study. Affiliate websites will be accessed through the APHA membership portal to evaluate organizational infrastructure and ascertain the presence/absence of a journal. The leader of each affiliate will be contacted via email containing a link to a 12-question on-line survey to collect his/her perceptions of scholarly journals and the publication of local health data. To determine barriers and facilitators to publication of local public health findings, 30-minute semi-structured telephone interviews will focus on the infrastructure of the association, perceptions of the leader about the journal (if in place), and its operation. Anticipated Results: We anticipate that 54 affiliate websites will be reviewed to complete the extraction checklist, that 74% of affiliate leaders will respond to the survey, and that 11 semi-structured interviews will be conducted. A limited number of state/regional public health associations will operate journals and a small percentage of those without journals may express an interest in implementing them. Barriers to operation of journals may include lack of resources (i.e., personnel, funding), and low prioritization of publication of state and local public health findings. Facilitators may include strong affiliate-academic relationships, affiliate leadership with experience in publications, and affiliate relationships with state and local departments of health. Conclusions: The research proposed in this protocol may stimulate other state public health associations and other academic public health programs to follow suit; it would not be the first time that an observational research study served as an intervention.
    • A preliminary examination of elevated blood lead levels in a rural Georgia county

      Rustin Chrstopher; Sun, Yu; Calhoun, Chris; Kuriatnyk, Christy; Georgia Southern University, Georgia Department of Health (Georgia Public Health Association, 2016)
      Background: Rural areas are often viewed as lower risk for lead poisoning and toxic exposures seriously impacting development of the brain and central nervous system; this report examines the prevalence of elevated blood lead levels for children <6 years of age in rural Ben Hill County, GA. Methods: Lead surveillance data from the Georgia Department of Public Health (DPH) were analyzed using SAS®v-9.3 to calculate the prevalence of elevated blood lead levels (≥5ug/dL) among those children in Ben Hill County who had been tested for lead; the results were compared to Georgia and national data. Results: A preliminary analysis of 2010-2015 screening data for Ben Hill County indicates that 8.73% (95%- CI: 7.4%-10.1%) of children that were tested for lead exceeded the Centers for Disease Control reference level (≥5ug/dL) and is approximately 3.5 and 2.4 times higher, respectively, when compared to the National (2.5%) and State (3.64%) percentages of children exposed to lead at or above the reference level. Conclusions: While these data are preliminary and more analysis is planned to ascertain the full breadth, source, and scope of the problem, it highlights lead poisoning risks rural communities face that are often overlooked in population-based risk analysis and research on lead exposure in children.
    • Brain development: A look at four programs in Georgia that support optimal brain development

      Webb, Nancy; Gates, Madison L.; Augusta University (Georgia Public Health Association, 2016)
      Background: Georgia is making strides to improve its early care and education system through program development within state agencies and alliances. These timely, statewide programs are focused on improving understanding of the importance of brain development. Methods: We reviewed the mission and information provided by four Georgia agencies with the aim of developing and improving programs and educational opportunities to instruct educators, policy makers, the general public, and others about child development in the context of brain development. Results: For young children in Georgia, the four organizations are committed to ensuring opportunities for well-being. Georgia is moving forward in its quest to improve resources and environments for young children, families, and citizens. The agencies and activities include Better Brains for Babies; the Georgia Department of Early Care and Learning; Georgia Early Education Alliance for Ready Students; and the Talk With Me Baby program. Conclusions: Georgia is making substantial efforts to provide and support early education environments based on emerging research on how brain development
    • The importance of early brain development

      Fitzgerald, Brenda; Georgia Department of Health (Georgia Public Health Association, 2016)
    • Assessment of distress, unmet needs, and receipt of care plans among cancer survivors in Georgia

      Escoffery, Cam; Patterson, Angie; Paris, Nancy; Kirsch, Logan; Frank, Cassiopeia; O'Connor, Jean (Georgia Public Health Association, 2016)
      Background: Cancer survivors have distinctive healthcare needs. The Survivorship Working Group of the Georgia Cancer Control Consortium conducted an assessment to understand the physical, psychological, practical, and spiritual needs of adult cancer survivors; patient perceptions regarding patient-provider communications; and their perceived need for services. Methods: In 2014, a convenience sample of Georgia cancer survivors completed a paper or online survey about the presence of and distress associated with unmet physical, emotional, spiritual, and practical needs, and receipt of assistance in those areas. They were also asked about receipt of cancer treatment and survivorship care plans. Results: Survivors were primarily female, married, White, and within 5 years of treatment. High proportions reported moderate to extreme levels of distress with depression (32.7%), anxiety (32.1%), stress (30.2%), and fear of recurrence (28.2%). Many reported no receipt of assistance in emotional needs such as changing relationships and defining a new normal and physical needs such as intimacy and body image. Fewer than half (48%) reported having received a cancer treatment summary from their physician and only 37% received a survivorship care plan. Of those who received either, 98% reported that the information was helpful. Conclusions: Cancer survivors in Georgia who responded to the survey had unmet needs, especially related to physical and mental health. More widespread adoption of guidelines of the Commission on Cancer, including the use of distress screening tools, would assist providers in addressing identified needs directly or through referrals. A limitation is that the racial and ethnic minority participation of 20.1% is insufficient to generalize results to all cancer survivors in Georgia. Subsequent surveys would benefit from targeted approaches to reach diverse and underserved survivors.
    • Evaluating public and private partnership to improve food and language nutrition among children 0-5 years

      Ejikeme, Chinwe; Threets-Powell, Kia; Vall, Emily Anne; Wagner, Laura; Fiedorowicz, Luke; Idaikkadar, Audrey; O'connor, Jean (Georgia Public Health Association, 2016)
      Background: Racial and ethnic minority populations in Georgia experience increased rates of chronic disease and poor health and education outcomes, which can be prevented through enhanced public- private partnerships. Using the Centers for Disease Control and Prevention (CDC) evaluation framework, the Evaluation Subcommittee for the Georgia Partnership for Food and Language Nutrition Project comprised of representatives from various stakeholders affiliated with state agencies, academia, and community-based organizations developed an evaluation plan to improve the collaborative effort designed to improve food and language nutrition among children 0-5 years. The purpose of this mixed-methods study was to assess influential collaborative factors. Methods: An online assessment survey that included open-ended qualitative questions was administered to all stakeholders (n=15; response rate=67%) to assess the strengths and weaknesses of the partnership, its leadership effectiveness and partners’ perceptions about the partnership. Baseline descriptive statistics were calculated and content analysis was performed with the qualitative data to understand partners’ perceptions. Results: The partnership scored variably across four categories that determine partnership strengths. Five factors were identified as the strengths of the partnership: favorable political and social climate; members see collaboration as in their self interest; unique purpose of partnership mission and goals; skilled leadership; and sufficient resources to support its operation.However, other areas were found to need urgent intervention, including improving on the leadership of the Georgia Department of Public Health (GA-DPH). In addition, communication as well as process and structure factors were identified as weaknesses including: a need to establish informal relationships and develop communication skills; a lack of flexibility; and an absence of clear roles and policy guides. Conclusions: Developing an action plan to address identified weaknesses will help ensure the accomplishment of the expected health and education outcomes among targeted, minority Georgia communities.
    • Disparities in health insurance coverage among children and young adults in Georgia and the U.S.

      Attell, Brandon; Georgia Health Policy Center (Georgia Public Health Association, 2016)
      Background: In this brief report, I compare rates of health insurance coverage for children and young adults in Georgia and the United States. Methods: Utilizing data from the 2014 American Community Survey, I performed two-sample tests of weighted proportions for a variety of health insurance coverage indicators. Results: Although there is little difference between Georgia and the United States in the proportion of those covered by Medicare and Medicaid, in Georgia there are fewer individuals with private health insurance and more uninsured individuals. Conclusions: Progress toward universal coverage will require continued examination of insurance status at both the state and national level.
    • Integrating food and language nutrition to reach Georgia’s children in early care and education environments

      O'Connor, Jean; Ejikeme, Chinwe; Fernandez, Maria; Powell-Threets, Kia; Idaikkadar, Audrey; Kay, Christi; Vall, Emily; Ross, Kimberly; Fitzgerald, Brenda (Georgia Public Health Association, 2016)
      Background: Educational attainment and health are mutually reinforcing outcomes. Good health supports children in the achievement of academic milestones, such as grade-level reading, and is associated with higher socio-economic status, longer life expectancy, and lower lifelong chronic disease. Improving health outcomes and increasing the potential for high educational attainment is necessary for reducing disparities, improving population health, and reducing morbidity. Early childhood and associated settings present opportunities to address lifelong health. Methods: To guide the development of programs to reach large numbers of children, we reviewed the literature associated with interventions during early childhood to promote healthy food consumption patterns and language development—“food and language nutrition.” Results: Identified in the systematic review were 12 articles. A recurrent theme was the social-ecological model, widely used in the studies identified through the literature review. Conclusions: The findings suggest a theoretical framework and key considerations that could guide the development of integrated interventions to improve food and language nutrition. With these findings, the authors propose a conceptual model and outline a public health program to address food and language nutrition together in early care settings in the state of Georgia, with the potential for application in other geographic areas.
    • Assessment of the Building Collaborative Research Capacity Model: Bridging the community-academic researcher divide

      Akintobi, Tabia Henry; Wilkerson, Donoria Evans; Rodgers, Kirsten; Escoffery, Cam; Haardoeerfer, Regine; Kegler, Michelle; Morehouse School of Medicine, Georgia College and State University, Emory University (Georgia Public Health Association, 2016)
      Background: Community–based Participatory Research (CBPR) can be challenging when community leaders and academic researchers have not previously co-led research or worked together with established rules guiding their relationships, roles, and respective functions. The objective of this investigation was to assess the processes and outcomes of the Building Collaborative Research Capacity Grant Program, sponsored by the Community Engagement Research Program of The Atlanta Clinical and Translational Science Institute and designed to foster CBPR. Methods: Four competitively selected community-based organizations (CBOs) participated in capacity-building workshops designed to build research skills and receive technical assistance to plan a pilot study with academic researchers. Pre- and post-surveys were used to assess the impact of the training and technical assistance on the CBOs’ knowledge and skills and abilities to plan, implement, and evaluate research. Key informant interviews were conducted with academic researchers and CBO dyads to identify experiences, perceptions, and recommendations related to the program model, and seven identified domains of collaborative research including research skills, attitudes toward collaboration, shared goals, institutional factors, mutual respect, human and fiscal resources, and partnering skills. Results: Areas of research competency increased from pre- to post-survey, with statistically significant increases in Community Assessment (p= 0.046) and Program Planning (p= 0.046). Each partnership had inherent characteristics related to strengths and barriers affecting the research outcomes. Conclusions: The present results contribute to the literature through assessment of processes, outcomes, and partner insights of a model designed to facilitate collaborative community-engaged research partnerships. Future research should examine the model to expand understanding of the dimensions of effective community and academic research collaboration.
    • Assessment of medical needs of the Hispanic community in Macon-Bibb County, Georgia

      Giguere-Belanger, Kim; Pino, Jose; Lian, Brad; Mercer University (Georgia Public Health Association, 2011)
      Background: Little is known about the health concerns and issues among the Hispanic community in growing, mid-sized cities, such as Macon, Georgia. Methods: A questionnaire on general health-related issues was given to a sample of 125 Hispanic participants. Results: The top health concerns of the Hispanic community were diabetes, obesity, and dental hygiene; the most common factors preventing Hispanics from receiving medical treatment were the lack of insurance, language barriers, and copayments or deductibles being too high. Conclusions: Lack of higher education and the inability to communicate effectively in English may be manifested as difficulties in finding proper information about where to access insurance and healthcare. Therefore, awareness campaigns, more advertising in Spanish, and perhaps increasing the availability of English lessons may be helpful for this population.