• Assessing a comprehensive approach to prevent sexual violence on campus: Implications for program improvement

      Ejikeme, Chinwe; Powell, Threets Kia; Bayo, Mosi; Toddle, Kia L; O'Connor, Jean; Georgia Department of Public Health (Georgia Public Health Association, 2017)
      Background: On college campuses, sexual violence (or sexual assault) is at epidemic proportions. As many as one in four college women experience sexual assaults, most of which are not reported, likely due to the adverse reactions stemming from social norms and attitudes about rape. To prevent sexual violence on college campuses, the multi-level factors influencing it necessitate implementation of a holistic approach channeled at all levels. The present multi-method study assessed the feasibility and effectiveness of a peer educator (PE)-facilitated program implemented as part of a comprehensive sexual assault prevention program in three small Georgia colleges. Methods: Student participants (N=128) were questioned on their attitude toward rape myths, intention to rape, and likelihood to intervene in a potential rape situation. Paired t-tests for pre-/post-test scores assessed statistical differences in mean levels of outcomes at the data collection points. In addition, a qualitative assessment explored the feasibility of implementing, on campus, a long-duration program for prevention of sexual violence. Results: The findings indicated that, after exposure to the program, participants demonstrated decreased rape myth beliefs and intention to commit rape and an increased likelihood to intervene in a potential rape situation. In addition, apart from attaining regular student attendance in the 10-week sessions of the program, implementation of the “One on Four & Beyond” program proved to be feasible. Conclusions: This preliminary, multi-approach study suggests the effectiveness of a school PE-facilitated prevention program as a component of a comprehensive approach in reducing sexual violence on campus. Future studies are necessary to enhance understanding of the impact of the program.
    • The burden and social determinants of asthma for adults in the state of Georgia

      Ebell, Mark; Marchello, Christian; O'connor, Jean; University of Georgia, Georgia Department of Public Health (Georgia Public Health Association, 2017)
      Background: Asthma is a serious chronic health condition, and social determinants may affect its prevalence. Methods: Data from the Behavioral Risk Factors Surveillance Survey (BRFSS), the Georgia Asthma Call-back Survey (ACBS), and the Georgia hospital and emergency department survey for patients with a diagnosis of asthma were used. All data were from the years 2011 through 2014. SAS and SUDAAN software were used to calculate weighted prevalence estimates and to perform univariate and multivariate analyses of the association between social determinants, other risk factors, and asthma outcomes. Results: The prevalence of asthma was highest among non-Hispanic blacks, women, and persons with less than a high school education, with an annual household income below $25,000, and in rural parts of the state (south and northwest Georgia). Those without insurance for more than three years had a higher prevalence of asthma than those who had insurance or had been uninsured less than 6 months. Although the percentage without insurance declined from 2012 to 2014, more than 1 in 5 adults of working age with asthma still lacked health insurance, and more than half had been without it for more than 3 years. One-third of Georgians with asthma could not see a doctor, at least on one occasion, because of cost, and more than a third were currently paying off medical bills. Approximately one quarter did not report having a personal physician, and a similar percentage reported having more than one year since their last check-up. In multivariate analyses, women (adjusted odds ratio [aOR] 1.61), smokers (aOR 1.54), and persons with a higher BMI (aOR 1.56) were all independently associated with having asthma. Conclusions: For the state of Georgia, there are associations between social determinants, such as education, income, and geography, and the prevalence of asthma, and many patients lack access to care. Addressing social determinants, including having affordable health insurance, is necessary to improve management of asthma.
    • Chronic disease prevention as an adaptive leadership problem

      O'Connor, Jean; Georgia Department of Public Health (Georgia Public Health Association, 2017)
    • Community-based approaches to reduce chronic disease disparities in Georgia

      Rollins, Latrice; Akintobi, Tabia Henry; Hermstad, April; Cooper, Dexter; Goodin, Lisa; Beane, Jennifer; Spivey, Sedessie; Riedesel, Amy; Taylor, Olayiwola; Lyn, Rodney; et al. (Georgia Public Health Association, 2017)
      Background: Among underserved and racial/ethnic minority populations in Georgia, there are profound health disparities and a burden of chronic diseases. Such diseases, which are preventable, are influenced by risk factors, including poor nutrition, physical inactivity, lack of quality health care, and tobacco use and exposure. Awardees of the Racial and Ethnic Approaches to Community Health (REACH) and Partnerships to Improve Community Health (PICH) are implementing community-based initiatives using evidence-based, policy, systems, and environmental approaches to reduce racial and ethnic health disparities and the chronic disease burden in underserved urban and rural Georgia communities. Methods: Within the context of a social ecological framework, the REACH and PICH awardees selected interventions. Their impact in the areas of tobacco use and exposure, chronic disease prevention and management, and nutrition are described. Results: To date, the interventions of Georgia’s PICH and REACH awardees have reached approximately 805,000 Georgia residents. Conclusions: By implementing strategies for community-based policy, systems, and environmental improvement, Georgia’s PICH and REACH awardees are reducing tobacco use and exposure; increasing access to healthy foods; and providing chronic disease prevention, risk reduction, and management opportunities for underserved communities in urban and rural Georgia communities. Their efforts to address chronic disease risk factors at various social and ecological levels are contributing to a reduction in racial/ethnic health disparities and the chronic disease burden in Georgia.
    • Efficacy of chronic disease self-management among low-income Black males with behavioral health disorders: Pilot study

      Collard, Carol; Robinson-Dooley, Vanessa; Patrick, Frances; Farabaugh, Kayla; Kennesaw State University (Georgia Public Health Association, 2017)
      Background: This study examined the effectiveness of Stanford University’s Chronic Disease Self-management Program (CDSMP) among men living with co-morbidities of chronic physical health disease and behavioral health disorders. Methods: The study was conducted at a community-based, non-profit organization in partnership with a large suburban university. Two pilot studies were completed with the population of interest. Low-income adult males with behavioral health disorders were recruited to participate in the program provided by a local behavioral health agency. Facilitators trained in the CDSMP program administered it at the agency site, and participants attended weekly meetings. Descriptive data collected included health history, demographic information, and assessments of knowledge with the Chronic Disease Self-Efficacy Scale and the Chronic Disease Self-Management Questionnaire created by the Stanford Patient Education Research Center. Due to the small sample size, n=12, the Wilcoxon signed rank test was used to evaluate before and after differences in the sample. Results: For the participants, there were increases in overall activity, stretching activities, and equipment activities. Additionally, participants experienced a decrease in the number of days affected by poor physical or mental health. However, there was no significant increase in perceived self-efficacy, a factor in patient confidence and possibly compliance. Limitations included the small sample size, lack of a control group, and convenience sampling. Conclusions: Various aspects of the program were helpful to some participants, but cultural factors made other areas less compatible for this population. A larger study, utilizing a comparison group, could generate data relevant to hypotheses based on these observations. By collecting qualitative data, focus groups could contribute to understanding the experiences and needs of the participants. Development of a curriculum for self-management of chronic disease with a focus on intercultural competence is presently of interest.
    • Evaluation of trends in diabetes care in a patient-centered medical home

      Saucier, Ashley N; McMechan, Danielle; Dahl-Smith, Julie; Duffie, Carla; Hodo, Denise; Andrews, Holly E; Hobbs, Joseph; Augusta University (Georgia Public Health Association, 2017)
      Background: The patient-centered medical home (PCMH) is a model used in primary care to achieve effective management of chronic diseases. The Augusta University Health Family Medicine Center (AUFMC), a PCMH recognized by the National Committee for Quality Assurance, has implemented strategies to manage its patient population with diabetes. The present study evaluated the effects of these interventions through trend analysis of selected diabetic core measures by use of a qualified clinical data registry, the Practice Partner Research Network. Methods: For this retrospective study, de-identified data were abstracted for adult patients with diabetes for the period of 2013-2015. Process and outcome measures were determined for selected diabetic core measures, based on the 2015 American Diabetes Association and Physician Quality Reporting System of the Centers for Medicaid and Medicare (CMS). These measures included glycated hemoglobin (HbA1c), blood pressure (BP), low-density lipoprotein cholesterol (LDL), urine microalbumin (Um), diabetic foot and eye exams, and influenza and pneumococcal vaccinations. These values were analyzed by the Cochran-Armitage test for trends over time to determine the proportions of patients at the recommended goals. Results: Over time, there were increasing trends for patients who were at the goals for frequencies of HbA1c, Um, LDL, pneumococcal vaccinations, and diabetic retinal exams (p<0.01). Increasing trends were also evident for patients at goal values for HbA1c, BP, and LDL levels (p<0.01). Decreasing trends were noted, however, in the rate of diabetic foot exams (p<0.01). Conclusions: Since AUFMC achieved PCMH recognition status, efforts to improve the management of patients with diabetes have yielded positive outcomes and valuable lessons. Areas of strength include utilization of the diabetes registry, education by regular providers, tailored use of electronic health records for patient education and physician documentation, and appropriate utilization of all team members. Trend analysis indicated that targeted diabetic interventions contributed to improved outcomes in selected diabetic core measures.
    • Letter to the Editor in response to “STD services delivery arrangements in Georgia county health departments”

      Moore, Kathryn; Terry, Latasha; Allen, Michelle (Georgia Public Health Association, 2017)
    • TEACH Kitchen: A Chronological Review of Accomplishments

      Chea, Jung Hee; Ansa, Benjamin E.; Smith, Selina A.; Augusta University (Georgia Public Health Association, 2017)
      Background: The Eating and Cooking Healthy (TEACH) Kitchen was founded at the Medical College of Georgia in 2015 as a nutrition-based intervention to combat the high prevalence of obesity and obesity-related chronic diseases in the area of Augusta, Georgia. Despite the importance of diet in the management of chronic diseases, inadequate nutrition education among patients and healthcare providers presents a barrier. The purpose of TEACH Kitchen is to address this gap. Methods: TEACH Kitchen is as a student-led initiative that promotes healthy cooking among medical students and patients with chronic diseases. Healthy nutrition and cooking classes are held during the academic year. Participants spend four weeks on each of four modules: obesity, hypertension, hyperlipidemia, and diabetes mellitus. Data collection, which began in January 2017, is currently on going. TEACH Kitchen has collaborated with Augusta University, Sodexo, and Kohl’s. Results: Currently, TEACH Kitchen has enrolled 14 patients and 6 children. Anticipated results include measurements of preand post-intervention changes in knowledge, attitudes, beliefs, and competence in nutrition, as well as differences in clinical indicators, including body mass index, blood pressure, lipid profile, and HbA1c. Conclusions: TEACH Kitchen is the first medical school-based nutrition/cooking education initiative in Augusta, Georgia. It provides patients and medical students with hands-on healthy nutrition/cooking experience with the goal of decreasing the prevalence and improving the outcome of obesity-related diseases.