Background:The COVID-19 vaccine is a critical tool in reducing COVID-19 related morbidity and mortality. Unfortunately, vaccine hesitancy is an ongoing public health challenge, especially in certain geographic areas and sub-populations. This study assessed factors associated with COVID-19 vaccine uptake and hesitancy among individuals who smoke in rural communities in southwest Georgia, one of the first COVID-19 "hot spots" in the U.S. Methods:We conducted qualitative interviews (n=23) using a semi-structured interview guide, informed by the Integrated Behavioral Model (IBM), that assessed vaccine-related behavior, intention to be vaccinated, perceived risk, social norms, attitudes, and environmental barriers and facilitators influencing vaccine hesitance and uptake. Results:Participants were 46 years old on average (SD=9.9; range: 25-63), 82.6% female, 60.9% Black, and 43.5% with an annual income <$25,000. Slightly over half (56.5%) had received at least one dose of the vaccine, 17.4% planned to, and 26.1% were unsure or did not plan to. Generally, participants acknowledged that those who smoke were at risk for worse COVID-19 related outcomes. Positive attitudes toward vaccination included reduced stress or concern about contracting and/or spreading the virus, less worry about becoming severely ill and/or dying from the virus, and reduced stress about socializing and inviting people over. Negative attitudes commonly focused on the speed of vaccine development and unknown long-term side effects, but also included distrust of government, fear of getting the virus from the vaccine, fear of needles, conspiracy theories, and dislike of mandates. Normative influences, most often from family members, were especially salient in the decision to get the vaccine, as was "doing research." Conclusions:Current results uncovered several salient factors aligning with IBM that should be considered when addressing vaccine uptake and hesitancy among priority populations, particularly those in rural areas who smoke, and improving vaccination outreach efforts.
Background: This study evaluated the effects of an online nutrition intervention program, Food Fitness First, Inc.®, on health indicators for diabetes, cardiovascular disease and obesity among senior center participants. Methods: Thirty individuals aged over 60 completed the 3-month Food Fitness First program, which included initial counseling and 12 educational sessions utilizing the Diabetes FOOD SPIRAL® book and bifold. Pre- and post-treatment assessments measured various health parameters. Results: Results showed significant improvements in Favorable Fitness Factor (FFF) score, which encompasses four key domains: Nutrition, Exercise, Health/Disease, and Lifestyle. FFF factor difference was equal to 13.63, with 95% CI [11.22; 16.03;]. The Eating component also demonstrated a significant improvement, with mean difference = 9.39, 95% CI [7.68; 11.10], p = 0.000. Medical indicators experienced a slight but significant increase, with mean difference =1.23, 95% CI [0.18; 2.27], p = 0.022. Lifestyle factors showed a modest improvement, with mean difference = 0.56, 95% CI [0.07; 1.06], p = 0.027. Conclusion: These findings support the efficacy of the intervention in enhancing multiple health domains. Despite limitations, this study underscores the effectiveness of online nutrition interventions in improving health outcomes among older adults with chronic conditions. By providing accessible and evidence-based nutrition education, online intervention programs can effectively empower individuals to take control of their health and well-being.
Background: Safe, reliable, and clean drinking water sources are a basic necessity. More than 1.7 million individuals rely on private wells for drinking water in Georgia and are confronted with water quality challenges stemming from chemical contamination as private wells are not under mandated regulations as public water supplies. In Georgia, previous studies suggested that the variation of soil and rock in a physiographic province (region) plays an essential role in the quality of private well water. There is a need to understand the distribution of these chemical contaminants above the federal Maximum Contaminant Level (MCL) and how different geologies in each physiographic province might influence such concentrations. This study examines the distribution of arsenic, uranium, radon, nitrate-nitrogen, and lead concentrations above the MCL in private well water and their association of contamination with physiographic provinces in Georgia. Methods: The study used private well water test results available from 2010 through 2022 at the University of Georgia’s Agricultural and Environmental Services Laboratories (AESL). The test results are exclusively from the well owners’ voluntary submission of water samples. Univariate and bivariate analyses were performed to investigate the distribution of contaminants and their association (chi-sq) with physiographic provinces with p set at < .05 for results to be considered statistically significant. Results:Over 26,000 well water samples were received via voluntary submission by the well owners and tested for at least one chemical contaminant, such as arsenic, uranium, radon, nitrate-nitrogen, and lead. Well water samples submitted voluntarily to AESL from Coastal Plain had higher proportions of arsenic concentrations exceeding the MCL, χ2(3) = 95.53, p = Conclusions: Gaining insight into the geological factors responsible for the suboptimal quality of well water can facilitate the development of public health initiatives that raise public awareness and create opportunities to preserve and maintain healthy well water quality in Georgia.
Background: Adolescent mental health declined during the COVID-19 pandemic. Racial discrimination, which may negatively affect adolescent mental health, has increased. This study sought to understand whether pre-pandemic reports of racial discrimination predicted changes in adolescent depression, anxiety, and self-esteem from before to during the COVID-19 pandemic. Methods: Two online surveys were administered at two public high schools in semi-rural, north-central Georgia; one in Spring 2020, just before the closing of public schools due to COVID-19; the other to the same students in Fall 2020. Results: Most participants were White (62%) and the majority (88%), reported the same or better treatment than other races. No significant associations were found between baseline perceived racial discrimination and changes in mental health outcomes (depression, p=0.6194; anxiety, p=0.8240; self-esteem, p=0.0731). Conclusions: This study did not find that racial discrimination affected adolescent mental health during the COVID-19 pandemic in a sample with majority White students; however, there is a need for future research to examine racial discrimination and mental health stigma among rural adolescents. These findings could help to improve access and utilization of mental health services as well as promote policy reform to foster more equitable practices.
Background: This study seeks to identify targets to increase HIV pre-exposure prophylaxis (PrEP) uptake in Athens-Clarke County, GA, a non-urban area with high HIV burden and poor PrEP utilization. Methods: A cross sectional survey of adults attending HIV outreach screenings in Athens, GA between November 2022 and March 2023 describes participant demographics and validated scales measuring PrEP knowledge, attitudes, stigma, descriptive norms, and intentions. Results: Of 136 total participants, key demographic groups included Black (N=84, 61.8%), Latinx (N=10, 8.1%), LGBTQ+ (N=25, 18.4%), and persons who use injection drugs (N=19, 15%); overall, less than half of the PrEP knowledge items were answered correctly (M = 4.4 items out of 13, SD = 3.6), attitude towards PrEP were positive (M = 3.6 out of 5, SD = 1.1), stigma was low-neutral (M = 2.5 out of 5, SD = 1.1), descriptive norms were neutral-positive (M=3.6 out of 5, SD = 1.2), self-efficacy was somewhat positive (3.2 out of 4, SD = 0.7), and intentions to start PrEP were neutral (M=2.6 out of 4, SD=0.9). Conclusions: Low PrEP knowledge was characterized as a key target to increase PrEP uptake in Athens, GA.
Objective: This study examines the association between two air pollutants (PM2.5 and ozone), and the prevalence of adult diabetes mellitus in relation to various confounding factors. Methods: We collected diabetes prevalence data from the 2015 County Health Ranking and Georgia Health Data Hub. A negative binomial regression analysis was conducted to examine the associations between the county-level dependent variable “adult diabetes” (for adults aged> 18 years diagnosed with Type 1 and Type 2 diabetes) and two independent county-level variables: percentage of days ³ NAAQS for ozone and PM2.5 concentration levels while controlling for confounders. Results: At the county level of the Georgia state, every 35 µg/m3 increase in PM2.5 was associated with a 79% increase in adult diabetes prevalence (PRR=1.788, CI=1.123-2.847). 1% increase in the percentage of African-Americans and percentage of females were associated with a 1% increase (PRR=1.012, CI=1.001-1.024), and 6% increase in adult diabetes (PRR=1.056; CI=1.002-1.113). Every 75 parts per billion (ppb) increase in ozone concentrations was associated with a 19% increase in adult diabetes (PRR=1.19, CI=1.036-1.497). Smoking status was a significant confounder for the associations between PM2.5 (PRR=1.018; CI=1.001-1.036) and ozone (PRR=1.019; CI=1.002-1.037) and adult diabetes prevalence. Conclusions: Our finding suggests significant associations between two specific air pollutants and adult diabetes prevalence rates in the Georgia state. Because diabetes prevalence is sharply increasing in the state, we believe regulatory policies should consider controlling PM2.5 and ozone levels in the state and additional evidence-based data should be collected to better understand the synergistic impact of air pollutants on diabetes prevalence rates.
Background: Research shows that nurses are often ill-prepared for disaster response. A survey conducted by the Georgia Department of Public Health Office of Nursing in April of 2021, demonstrated that 45% of the public health nurses surveyed had never deployed to a mass congregate shelter, and 43% reported they had no formal training related to emergency preparedness or mass sheltering. The purpose of this pilot study was to measure public health nurses’ improvement in familiarity with emergency preparedness and disaster response core competencies as defined by the Emergency Preparedness Information Questionnaire (EPIQ) after a focused educational program and tabletop workshop. Methods: This project used a pre-and post-survey descriptive survey design, integrated six education modules delivered via an asynchronous learning platform, and participation in one synchronous interactive workshop. Results: Pre- and post-responses to individual items in the EPIQ survey were compared using a paired samples t-test to determine if any significant change occurred (ɑ = 0.05). In addition, an overall familiarity score was computed as the sum of responses for each participant in the EPIQ survey (max of 90) and compared using a pre to post paired t-test to determine if there was an overall statistical change. A total of 249 Georgia department of public health nurses participated in the Emergency Preparedness and Mass Sheltering training. The overall familiarity score showed a statistically significant improvement (p < .001; 98% confidence interval) related to emergency preparedness core competencies with an average pre-survey familiarity score of 57.78 and an average post-survey familiarity score of 70.43.
Perinatal mood and anxiety disorders (PMADs) have become a leading cause of maternal mortality due to suicide among women in the first year following pregnancy. Although the profile for new mothers who die by suicide is predominantly white, disparities exist between Black and White women in their seeking help for perinatal and/or post-natal mood disorders. For Black, Indigenous, and People of Color (BIPOC), there are differences in the perceptions of the benefits of seeking help for PMADs. The COVID-19 pandemic exacerbated maternal mental health disorders in the United States particularly for women who live in communities with limited access to maternity care. This paper proposes a two-fold approach: Health Belief Model combined with Community-based Participatory Research/Engagement (CBPR/E) to reduce disparities in seeking care for PMADs with recommendations of strategies for working in rural communities.
Background: Responding to HIV clusters detected using molecular data has been shown to reduce transmission and improve testing, treatment, and prevention. However, there are varied opinions about the use of cluster detection activities, and some advocates have raised concerns about patient consent, data security, and the potential for HIV criminalization. Incorporating the perspectives of marginalized populations that are disproportionately affected by HIV is essential to understanding the diversity of those perspectives, yet it is often overlooked in the literature. Thus, our study seeks to highlight the perspectives of Black/African American and Hispanic/Latino individuals in the Southern United States on HIV molecular cluster detection. Methods: Twenty participants identifying as Black/African American or Hispanic/Latino were recruited by three community-based organizations that serve these populations in Atlanta, Georgia, in December 2022 and interviewed in four virtual focus groups. Participants were given an introductory presentation on molecular cluster detection and were asked about cluster detection activities. Results: Our data reveal three primary results. First, most participants were unaware of cluster detection activities, but they expressed both curiosity and excitement about their use. Second, most participants would prefer to receive immediate notification if they were found to be part of an HIV cluster. Third, participants highlighted challenges with partner services that were not limited to but could affect cluster response contexts, including concerns about privacy and shame. Conclusion: These findings indicate high levels of support in the study population for molecular HIV cluster detection. To strengthen implementation, public health officials should develop culturally sensitive educational materials, consider approaches to notify individuals who are part of an HIV cluster, and partner with marginalized communities and community-based organizations to educate about these activities and how public health data are protected.
Purpose: The COVID-19 epidemic led to significant morbidity and mortality globally, especially among the elderly. Because SARS-CoV-2 is a novel viral pathogen, there was a lack of preventative and treatment options. Availability of effective vaccines has been an important factor in determining the epidemic trajectory. Analyzing the effects of the vaccines in reducing mortality across age groups is important for guiding future public health responses. The objective of this study was to determine the association between age and COVID-19 mortality pre- and post-vaccination periods amongst Georgians. Methods: This cross-sectional study used COVID-19 case numbers, COVID-19 deaths, age at time of death, and vaccination status from the Georgia Department of Public Health’s COVID-19 Status Report. The main outcomes were COVID-19 case mortality rates, and the main independent variables were COVID-19 vaccination period and age. Logistic regression was performed to determine the association between mortality rate and age group, and vaccination period. ANOVA test was done to determine if case mortality rates increased with age group, and how it changed in the pre- and post-vaccination periods. Results: Case mortality rates differed significantly by age groups (p Conclusion: The vaccines appear to have mortality protective effects among those aged 60 and older. There were no such mortality benefits comparing pre- and post-vaccination periods for groups younger than 60.
Background: H-2A farmworkers are disproportionately vulnerable to COVID-19 and understanding their beliefs regarding COVID-19 vaccines is important for public health outreach, yet to date little research has examined the influence of country of origin (COO) on the vaccine beliefs of this uniquely transient population. Methods: Three focus groups (N=30) were held with H-2A farmworkers in South Georgia to explore their beliefs on COVID-19 vaccines, using thematic analyses to identify COO influences on these beliefs. Results: Family in COO influenced worker vaccine beliefs through direct advice, commonly held beliefs in COO about harmful government agendas via vaccines increased worker vaccine fears, and responsibilities workers felt towards family in COO during the pandemic influenced their fear levels and vaccine motivation. Conclusions: By understanding the ways in which COOs influence H-2A farmworkers’ view on COVID-19 vaccines, public health workers can engage in outreach in ways that more fully respond to their concerns and better promote farmworkers’ health and wellbeing.
The 93rd Annual Meeting and Conference of the Georgia Public Health Association (GPHA) was held in Jekyll Island, Georgia, at the Jekyll Island Convention Center, on May 3-5, 2023. The goal of the 2023 Georgia Public Health Association Annual Meeting and Conference was to assemble emerging public health professionals, current practitioners, academicians, governing entities, and community stakeholders for educational opportunities and networking to support the vision and mission of GPHA. The theme for the 2023 Georgia Public Health Association Annual Meeting and Conference theme was selected by the GPHA Executive Board during a meeting in the early fall of 2022 and was “Creating a Healthy Georgia: Conversations and Collaborations for Change”. One hundred and seventy (170) abstracts were submitted for peer review: sixty-three (63) were accepted for poster presentations, sixty-seven (67) for workshop presentations and twenty-three (23) for roundtable sessions. Of the 63 posters, 30 were student submissions. Three plenary sessions with diverse, internationally known, public health practitioners and clinicians addressed key areas of public health advocacy, the “All of Us Research Program”, and critical and strategic thinking to improve the health of the public. The 93rd Annual Meeting and Conference brought together five hundred and ninety-seven (597) conference attendees, which is the highest number of conference attendees to date for an Annual Meeting and Conference and provided an opportunity for participants to earn up to eleven (11) continuing education credits. An online, post-conference evaluation was completed by two hundred (200) attendees and will be used to identify areas of achievement and opportunities for improvement.
Background: According to the Georgia Department of Public Health (GDPH), the state of Georgia reported 563,658 cumulative COVID-19 cases and 9,845 total deaths in 2020. Decades of research on racial disparities in health outcomes suggest we should not be surprised with the disproportionate number of cases, hospital visits, and deaths of non-white and Black Georgia residents. Racial disparities in health are often defined by a Social Determinants of Health (SDOH) model. One understudied SDOH is racial residential segregation. In this study we explore the relationship between racial residential segregation and COVID-19 health outcomes. Our paper addresses critical challenges for racial health disparities research with guidance for legal and policy approaches to the reduction of racial health disparities. Methods: The 2020 University of Wisconsin Population Health Institute and GDPH datasets were used to explore the relationship between segregation and COVID-19 health outcomes in Georgia. Independent variables included those SDOH most associated with racial health disparities. Dependent variables were COVID-19 case rate, hospitalization rate and death rate. Results: Our findings suggest that racial residential segregation is directly associated with Black COVID-19 case rate and indirectly associated with Black hospitalization and death rate through its effect on Black case rate. Conclusions: Racial residential segregation is an often-overlooked SDOH since it is secondary to more prominent social issues such as education and economic opportunities for reducing racial disparities in health. For the Black population, especially for public health issues like COVID-19, we make the case for a better focus on racial residential segregation policy, as a social and economic factor for disease transmission. The ultimate goal is to improve health outcomes for all. A focus on racial residential segregation policy can impact better prepared health services entities and ultimately improve population health.
Background: The purpose of this study was to evaluate reimbursable pulp therapy trends in primary teeth performed by general and pediatric dentists. Methods: Aggregate Medicaid claims data from 2010-2019 were obtained from the state of Georgia’s Department of Community Health. Two different primary dentition pulp therapy rates were compared between general and pediatric dentists: procedures per provider and children treated per provider. Descriptive statistics, poisson regression, and correlational analysis were performed. Results: Pulp therapy utilization for procedures per provider and children treated per provider decreased (Incidence rate ratio (IRR)=0.97, 95% confidence interval (CI): 0.95 to 0.99; IRR=0.97, 95% CI: 0.94 to 1.01, respectively). The rate differences between general and pediatric dentists were negatively correlated with the number of pediatric dentists. Conclusions: The downward trend in pulp therapy utilization was largely correlated with an increased number of pediatric dentists. This increased access to providers likely contributed to improved oral health utilization. Practical Implications: For a growing workforce, translating clinical guidelines into changes in quality of care may require changes to reimbursement policy.
Objective: Cooking emits a huge concentration of indoor air pollutants, including particulate matter (PM). Exposure to PM can lead to long-term adverse respiratory effects among workers engaged in cooking. Only a few studies have measured cooking-related air pollutants in large school cafeterias where young student workers are frequently employed. The objective of this research was to compare stationary exposures to PM from cooking during two work shifts at a very large university dining commons kitchen. Methods: Number concentrations of PM of varying aerodynamic sizes (1, 2.5, 5, and 10 µm) were measured at the back kitchen, DC grill, and brick oven during two work shifts using the CEM DT-9881 air monitor and mass concentrations of PM1, PM2.5, and PM10 were measured simultaneously using the DustTrakTM aerosol monitor. PM number concentrations were higher in the afternoon shift than in the evening shift. Results: The mean number concentrations of PM2.5, PM5, and PM10 during the afternoon shift were 1,335,783, 320,471, and 87,915 particles/m3 respectively. In the evening shift, the values were 207,020, 23,745, and 4,146 particles/m3 respectively. The mass concentrations of PM1, PM2.5, and PM10 were higher during the afternoon shift compared to the evening shift. PM2.5 levels at the back kitchen and PM10 levels at the brick oven exceeded the 24h US-EPA NAAQ and WHO mean standards. The brick oven had the highest concentrations of PM compared to the other cooking sites. Conclusion: The increased concentration of PM could be associated with increased cooking activities and the number of staff.
Recreational water-related activities have important public health benefits, however, pollution at beaches may have serious health risks. Although there is a substantial amount of research and policies in place at federal and state levels, oftentimes these efforts may not be well translated to the public. This paper evaluates the effectiveness of routine water quality monitoring and warning systems in Georgia, USA. A survey was conducted among 238 beachgoers in Georgia, asking about awareness of water quality monitoring and warning signs for beach advisories. Surveys were collected directly at beaches as well as through an online questionnaire. Results show that more than a third of the respondents (36.1%) are unaware that Georgia beaches are monitored for water quality and public health with nearly two-thirds (64.7%) feeling current signage is inadequate. Most (89.9%) want signs to report the sources of pollution. Residents (compared to visitors), older, White, wealthier, and college-educated respondents are more likely to be aware of water monitoring. In terms of having ever read a water quality advisory, residents and older respondents are more likely to have read a warning. While most respondents have read such warning signs, a large percentage, 41.2%, have never read any beach advisory. Public health and environmental agencies must improve communications about polluted waters to the public using symbols and campaigns with a special emphasis on visitors and younger beachgoers.
Background: Anxiety and depression can affect adolescents’ health and current literature lacks studies of youths living in non-urban settings. Methods: We used chi-square and t-tests on data collected from self-administered online surveys, completed by 9th-grade students (n=222) attending a large, semi-rural public high school in the state of Georgia, to assess the prevalence of symptoms of anxiety and depression and associated factors. Results: Almost half of the students self-reported anxiety (43%) or depression (55%) and students who self-reported either condition were more likely to report poorer sleep hygiene, sleepiness, race-related mistreatment, and higher stress. Conclusions: Our findings suggest that symptoms of anxiety and depression are prevalent among youths in semi-rural settings and further research is needed to understand the role of modifiable risk factors and identify effective interventions. Keywords: adolescent mental health; adolescent sleep; anxiety; depression; semi-rural
Background: The ability to offer and sustain interprofessional collaboration and education (IPE) in an academic setting could potentially serve as a training model for other academic institutions to implement programs that will increase the number of practice-ready, culturally competent healthcare professionals. We designed, implemented, and evaluated an Area Health Education Center (AHEC) Scholars Program to train culturally competent interdisciplinary students to provide quality, patient-centered healthcare in rural and underserved communities post-graduation. Methods: Two cohorts of students (Cohort 1, n = 15, Cohort 2, n = 14) were recruited into a two-year longitudinal program with 80 hours of didactic learning and 40 community-based training. Core areas included: 1) interprofessional education and practice; 2) social determinants of health; 3) cultural competency; 4) behavioral health integration; 5) practice transformation; and 6) emerging health topics. Following completion of each content area, students participated in synchronous debriefing sessions and provided feedback via surveys. Wilcoxon ranks test assessed differences in pre- and post-scores in intention, perceived knowledge, and perceived skills for each content area. Results: Students’ intention, perceived knowledge, and perceived skills significantly changed from pre- to post-program in all core areas (p < .05). The greatest change from pre- to post-program was perceived knowledge in interprofessional education (D = 1.75). Interactive activities were most useful for keeping students engaged. Conclusion: The program resulted in significant changes for participating students in their intention, perceived knowledge, and perceived skills. Implications for this training program include guidance for academic institutions and AHECs to integrate IPE training.
Intersex is an umbrella term for individuals who are born with sex characteristics that do not typically fall into male or female categories. Individuals who are intersex make up about 1.7% of the United States population today and are identified within the lesbian, gay, bisexual, transgender, and intersex (LGBTQIA+) community. Many people who are intersex identify as transgender, which relates to the social process of gender change, as they develop into adults. In Georgia, approximately 4% of the population identify as LGBTQIA+. The purpose of this paper is to increase awareness of the perceived discrimination from healthcare providers, non-inclusive organizational practices, and lack of skilled providers that serve as barriers to healthy outcomes for transgender and intersex individuals. Culturally competent care is necessary for physicians to provide an openly safe environment for people who are LGBTQIA+ to help improve their comfort level to disclose their health information. Recommendations for physicians caring for people who are LGBTQIA+ to incorporate into their clinics include: having acceptable advertising practices, educating staff and providers, maintaining biases, and providing inclusive intake forms.
Objective: Air pollutants are linked to asthma exacerbation. The study purpose was to demonstrate an association between air pollutants levels and asthma emergency room (ER) visit trends in a highly populated US urban county in Georgia during 2018-2019. Methods: Time series analyses were conducted for the variations in daily numbers of children and adult asthma emergency room visits and changes in daily mean PM2.5, daily mean PM10 concentrations, daily max 1-hour SO2 concentrations, daily max 1-hour NO2 concentrations, daily max 8-hour ozone concentrations, and airborne pollen loads for 2018 to 2019 and potential trends were estimated by using the autoregressive integrated moving average or ARIMA model. Results: During 2018-2019, 15,418 asthma-related ER visits occurred. The pollutants NO2, PM2.5, PM10, and pollen were strong predictors of children's asthma ER visits between 2018 and 2019. No significant associations were observed between the levels of SO2, ozone, and children's asthma emergency ER visits. Conclusions: The findings from this time series study strongly suggest that there is a significant contributing relationship between certain air pollutants (NO2, PM2.5, PM10, and pollen) and asthma ER visits in children.
