BACKGROUND:School-environments are thought to be strong influences of behavioral choices. There is limited research available on the role of physical activity (PA) and school success among children with special health care needs (CSHCN). The purpose of this study was to explore differences in PA among CSHCN and non-CSHCN and how the school success index is related to PA in both groups.METHODS:Data were taken from new version of the National Survey of Children's Health (NSCH), which consolidated questions from the previous NSCH and the National Survey of Children with Special Health Care Needs (NS-CSHCN). Chi-square and logistic regression analyses were employed to examine group differences.RESULTS:There were significant differences among both subgroups, although most school-aged children did not meet recommended PA guidelines. Chi-squared analyses indicated; school engagement and the parent's perception of child safety at school were associated with the likelihood of meeting PA guidelines. Logistic regression analyses showed that the odds of meeting PA guidelines were associated with the school success index.CONCLUSIONS:Comprehensive school health programs should focus on PA both subgroups. School health educators should continue to advocate for safe and structured extracurricular activities to improve the child and adolescent's engagement and overall well-being.

Purpose: The purpose of this study was to use a qualitative, community-based participatory action research method - Photovoice - to identify perceived facilitators and barriers to physical activity among adolescents with cerebral palsy (CP) in a rural community. Materials and methods: Fifteen participants including adolescents with CP (n = 7) and parents (n = 8) were included in this study. The researchers followed the nine-step methodology recommended for Photovoice. During the training session, participants completed versions of the Barriers to Physical Activity Questionnaire for People with Mobility Impairments. This questionnaire was used to generate descriptive information about participant barriers and facilitators. Participants were given 14 days to take photographs after which researchers used in-depth and focus group interviews structured by the SHOWeD method. Content analysis of transcripts was used to identify common themes. Results and conclusions: Photographs and accompanying text were presented to local stakeholders and an action plan to increase physical activity for adolescents with CP was created. Perceived barriers included lack of inclusiveness, family isolation, and limited accessibility of equipment and resources. Facilitators included support services for families and adaptive sport leagues. Photovoice serves as a powerful tool to initiate change to promote physical activity among rural adolescents with CP.

Introduction: substance abuse is an important public health issue affecting West Africa; however, there is currently a dearth of literature on the actions needed to address it. The aim of this study was to assess the risks and protective factors of substance abuse in Ghana, West Africa, using the photovoice method. Methods: this study recruited and trained 10 participants in recovery from substance abuse and undergoing treatment in the greater Accra region of Ghana on the photovoice methodology. Each participant received a disposable camera to take pictures that represented the risk and protective factors pertinent to substance abuse in their communities. They were also given the opportunity to provide narratives of the pictures using pre-identified themes and the different levels of the social-ecological model and participatory action research (PAR). Results: participants identified at the individual level: ignorance; interpersonal level: family and peer pressure; organizational level: lack of regulation; community level: media, availability of drugs, cost of drugs, urbanization, slum communities and cultural factors; and policy level: lack of regulations and their enforcement. Education and beliefs were cited at the individual level; family at the interpersonal level; religion at the organizational level; organizing youth, media and narcotics anonymous at the community level; and nothing at the policy level. Conclusion: this is an exploratory study that will add to the limited body of knowledge in the scientific literature with respect to substance abuse in the country and also help develop interventions to address the respective needs of several communities in Ghana.

The purpose of this study was to examine predictors of coordinated and comprehensive care within a medical home among children with special health care needs (CSHCN). The latest version of the National Survey of Children with Special Health Care Needs (NS-CSHCN) employed a national random-digit-dial sample whereby US households were screened, resulting in 40,242 eligible respondents. Logistic regression analyses were performed modeling the probability of coordinated, comprehensive care in a medical home based on shared decision-making and other factors. A total of 29,845 cases were selected for inclusion in the model. Of these, 17,390 cases (58.3%) met the criteria for coordinated, comprehensive care in a medical home. Access to a community-based service systems had the greatest positive impact on coordinated, comprehensive care in a medical home. Adequate insurance coverage and being White/Caucasian were also positively associated with the dependent variable. Shared decision-making was reported by 72% of respondents and had a negative, but relatively negligible impact on coordinated, comprehensive care in a medical home. Increasing age, non-traditional family structures, urban residence, and public insurance were more influential, and negatively impacted the dependent variable. Providers and their respective organizations should seek to expand and improve health and support services at the community level.

BACKGROUNDYouth living with disabilities are at risk of experiencing poor health outcomes. Coordinated school health programs have an opportunity to help youth with disabilities and their families through health education, health services, and community engagement. The World Health Organization developed the International Classification of Functioning, Disability, and Health (ICF) as a framework to analyze factors related to health conditions. We used the ICF to examine parental perceptions of health and function among students with disabilities living in rural and urban areas. METHODSWe surveyed parents (N = 71) using the parent-report versions of the Pediatric Outcomes Data Collection Instrument and Child Health and Illness Profile. From this group, parents were asked to volunteer to participate in in-depth, individual interviews (N = 18). The interviews were audio-recorded and transcribed verbatim. Researchers used the ICF linking rules to analyze and code the transcriptions. Emergent themes were assigned numerical ICF codes. RESULTSThere were more similarities than differences among rural and urban families. Children living with disabilities face significant environmental barriers regardless of context. CONCLUSIONSSchools can facilitate education to improve the quality of life of parents and families of children with disabilities. School authorities should consider the many environmental barriers both urban and rural these families face in the community. The ICF can be used as a framework for program planning for community-based, health education for this population.

Background and Objective(s): Adults with cerebral palsy (CP) who are wheelchair dependent (Gross Motor Function Classification System, GMFCS, Level IV or V) are particularly vulnerable to spinal, pelvic and hip postural asymmetry arising from neuromuscular dysfunction. A common postural problem is characterised by abduction and external rotation of one lower limb and adduction and internal rotation of the opposite lower limb, known as ‘windsweeping’. Regular radiographs to monitor skeletal changes in this population are challenging to implement due to cognition and / or an inability to achieve a standardised supine position. The Goldsmith Indices of Body Symmetry (GIofBS), used in paediatrics, may be a simple clinical measurement tool to facilitate the postural monitoring process in adults with CP however its clinical utility in this population is unknown. This study aimed to describe the postural status of adults with CP (GMFCS IV and V) using the GIofBS and compare to normative data on young adults with no movement disorders. Study Design: Case control study. Study Participants & Setting: Participants were 23 adults with CP (GMFCS IV and V) (mean age 23 years, range 17–38), attending an outpatient tertiary clinic, and 48 young adults without movement disorders (mean age 23 years, range 18– 34). Materials/Methods: All participants underwent a single measurement of spinal and pelvic/hip alignment using the GIofBS. A Windsweeping Index (indicative of severity of overall postural asymmetry), chest right/left ratio (thoracic symmetry), and a chest depth/width ratio (thoracic shape) were calculated. Descriptive analyses were utilised with non-parametric group comparisons. Results: The windsweeping index for participants with CP was median 10.5 (IQR 23.6; range 0.8–81.0), compared to those without movement disorder median 2.9 (IQR 3.7, range 0.0– 14.3). A Mann Whitney U test demonstrated a significant difference between the two groups (p<0.000). There were no significant differences (p>0.05) between the two groups for chest right/left ratio (Median CP: 0.99; normative: 1.02) and chest depth/width ratio (Median CP 0.65; normative 0.60). Conclusions/Significance: The GIofBS measurement procedure is well tolerated by adults with significant physical disability. There was a significant difference in the windsweeping index for those with CP compared to healthy adults. The GIofBS appears able to identify and quantify the degree of windsweeping in this population, making it potentially suitable for use in regular clinical monitoring and for future evaluation of the efficacy of interventions to manage postural asymmetry. Further investigation regarding the value of GIofBS to describe thoracic shape and thoracic asymmetry is warranted.

There is limited research that includes democratic practices to evaluate the PETE program in its ability to prepare preservice teachers (PTs). In other areas such as community health, methodologies have been used to provide a voice to individuals living the experience. The purpose of this study was to examine PTs’ perceptions of a teacher education program during the student teaching experience using Photovoice. A group of PTs (N = 16) from a university in southeast Georgia were given 14 days to capture the strengths and weakness of their teacher preparation program through photography. The PTs then discussed their photographs during two focus groups with the researcher. The focus groups were audio recorded and transcribed. Data analysis included an evaluation of interview transcripts and photographs using content analysis to identify significant themes that emerged. An action plan to promote curricular change was created by the PTs and presented to PETE faculty.

Background: Developing a health promotion program plan requires attention to the links between objectives, activities, and overall program goals. Instructors developed the “Connecting the Dots” worksheet to help students establish these linkages. Methods: The “Connecting the Dots” worksheet included six questions pertinent to the students’ health promotion program plans. The worksheet was given to the students in a flipped classroom setting. Evaluation of the effectiveness of the tool was based upon group presentations at the end of the semester. Results: Students developed more viable program plans that included stronger links between objectives and corresponding program activities. Conclusions: The “Connecting the Dots” worksheet is a promising tool for engaging public health students in the process of developing health promotion program plans. Key words: Health promotion program planning, public health, pedagogy

Background: Health disparities exist among individuals living in rural and urban contexts in terms of access to health care and overall mortality. These disparities are typically greater for youth with disabilities living in rural areas, who face additional barriers in receiving health and support services specific to their disability. Parents are typically the ones responsible for coordinating the care needed by children with a disability; however, with numerous barriers present families are not provided adequate support to care for a child with disabilities.Objective: The purpose of this study was to examine barriers and facilitators to accessing health and support services among urban and rural families of children with disabilities.Methods: In-depth interviews were conducted with parents who provide care for an adolescent with a disability. The sample was comprised of parents from one rural county (N = 9) and one urban county (N = 10) in Georgia. Parental interviews were conducted face to face by a trained researcher. Each interview was audio-recorded. The recordings were transcribed and content analysis used to create codes and identify emerging themes.Results: The common themes found during the analysis include accessibility of health and support resources, transitions, and social isolation.Conclusions: When comparing urban and rural areas, barriers to access do differ in terms of availability, but analysis revealed more similarities existed among parents from both contexts. Efforts must be made to increase opportunities for youth with disabilities to become connected with the local community in order to improve quality of life for families. (C) 2016 Elsevier Inc. All rights reserved.

Background: Public Health for Young Adults Day (PHYA Day) is a one-day program designed to educate high school-age students about the principles and values of the five core areas of public health. The goal of PHYA Day is to foster interest and ultimately increase recruitment into the field of public health. This goal is essential due to the impact of the economic recession of 2008. It was estimated that the local public health workforce decreased from 191,000 to 168,000 across the nation between 2008 and 2013. In spite of 2008’s recession, a well-trained, competent public health workforce remains an imperative component of effective public health service delivery. The researchers believe that PHYA Day encourages young people to explore the idea of a public health-focused career by increasing their knowledge of the field as a whole. Methods: A pre- and post-test survey was used to evaluate this program, determine if participants gained an interest in joining the public health workforce, and measure the learning outcomes of those participants. After gaining proper Institutional Review Board approval the evaluation was completed in April 2015. Results: When the averages of the post-test were compared to those of the pre-test the results showed that there was a significant gain in knowledge among participants. Conclusions: Based off of their findings the researchers were able to conclude that PHYA Day is effective in educating high school age students about the options that the public health field have to offer and therefore may increase the number of young adults choosing public health as a career.

Background : Physical activity offers children and youth many well-documented positive effects on health. The present study adapted a community-based prevention marketing campaign (CBPM), VERB TM Summer Scorecard (VSS) to promote physical activity among minority youth in rural, southeast Georgia. The purpose of this paper is to describe the adaptation process, emphasizing methods used and lessons learned. Methods : A qualitative study design was used to identify social marketing concepts that informed program adaptation, including two focus groups with 12 children and two focus groups with 14 parents. Qualitative thematic data analysis was used to analyze formative research. The adapted program was implemented for three summers, from 2012 through 2014. A case study of program implementation and lessons learned is provided. Results : Formative research results suggested two changes to VSS that would be required for the program to work in this rural community - a focus on parent-child activities instead of a sole focus on youth and changes to the Scorecard that was used to track physical activity. Over the course of three years of implementation, several lessons were learned about university-community partnerships (e.g., the need for a balance of power), having a program champion, and program evaluation. Conclusions : Rural communities are a unique context, with barriers to health promotion efforts that serve to contribute to negative health behaviors and resistance to change. The limited capacity of rural communities to address physical activity makes these barriers difficult to overcome, even during implementation of evidence-based practices.

Background: A prerequisite for National Public Health Accreditation is completion of a Community Health Assessment (CHA) that presents an exhaustive profile of the population served by a particular public health agency. Methods: The Georgia Department of Public Health (GA DPH) contracted with the Center for Public Health Practice and Research at Georgia Southern University to facilitate five state-wide community health forums. Results: Evaluation of the forums yielded qualitative data illustrating current challenges faced by Georgians, as well as assets that could be leveraged to improve health status. Conclusion: Lessons learned from these state-wide community health forums can be applied to improve the overall process of gathering data for a comprehensive CHA throughout Georgia or other areas interested in pursuing public health agency accreditation.

The number of Internet users around the word is at an all-time high. The majority of North Americans are internet users and over two-thirds participate in some kind of social network (i.e. Facebook, Twitter, etc.). Social networks and mobile technology enable individuals to connect instantaneously or asynchronously, across geographic boundaries publicly or anonymously. Few studies exploring cyber harassment have been conducted, primarily because these technologies are relatively recent. The purpose of this descriptive study was to examine U.S. women's experiences with and attitudes toward cyber harassment by way of an anonymous electronic survey. A total of 293 adult women (mean age 24.6) recruited from popular social networking sites participated in the research. The majority of participants (58.5%) reported being a student enrolled at a college or university. Close to 20% repeatedly received an unsolicited sexually obscene message and/or sexual solicitation (excluding Spam messages for all categories) on the Internet. More than 10% (11.5%, n = 33) repeatedly received pornographic messages from someone they did not know. More than a third of those who did experience some form of cyber harassment reported feeling anxious. One- fifth indicated they noticed changes in their sleeping and eating patterns as well as feeling helpless because of the harassment. Implications and recommended strategies for health education and personal safety in the online environment are provided.

BACKGROUND Young adults have the highest participation in physical activity but also have the highest incidence rates of binge drinking, cigarette smoking, and smokeless tobacco use. We examined these factors to determine whether there are relationships among physical activity and health risk behaviors. METHODS We conducted correlation and χ² analyses using the American College Health Association-National College Health Assessment fall 2009 data set (N = 34,208) to examine the relationship among meeting physical-activity guidelines, binge drinking, and tobacco use among survey participants. RESULTS The data suggest a positive relationship between meeting physical-activity guidelines and binge drinking, with the strongest relationship between those reporting binge drinking 4 times in a 2-week period. Meeting physical-activity guidelines was negatively associated with cigarette use but positively associated with all other types of tobacco use. CONCLUSIONS Associations between physical activity and binge-drinking episodes indicate a need to address the relationship between heavy drinking and alcohol dependence and physical-activity behavior patterns. Further studies should examine relationships between physical activity and binge drinking in other age groups. Results also suggest the need to examine differing associations between physical activity and types of tobacco use.

Purpose: The purpose of this qualitative study was to explore rural/urban differences in service providers’ perceptions of challenges and facilitators to services for children with special health care needs (CSHN) and their families in southeast Georgia. Methodology: A total of 23 individual interviews were conducted with service providers in one rural county in southeast Georgia (N = 12) and in one urban county in north central Georgia (N = 11). Interviews were based on the National Survey of Children with Special Health Care Needs 2009-2010 survey. All interviews were audio recorded, transcribed and coded with the intent of identifying themes and illustrative quotes. Findings: Service providers discussed a variety of challenges to accessing services related to socioeconomic status and the transition out of the school system. Urban and rural service providers’ perceptions were similar overall, with the exception of lack of transportation and access to a variety of services in rural area. Service providers overcome challenges through identifying parents’ needs and limitations and adapting service provision. Some of the facilitators mentioned by both urban and rural service providers are availability of transportation and resources. Practical Implications: The results of this study provide public health practice and policy implications that could guide the pathways of targeted interventions to improve the access and availability of variety of services for CSHCN. Originality/value of paper: This paper represents an in-depth exploration of service provider’s perceptions of challenges and facilitators related to service provision for children with special healthcare needs.