Background: Despite the benefits of physical activity, only 12.1% of women in rural Georgia aged 20-44 years, fully adhere to the recommended amount of physical activity. According to previous research studies, health care provider support is an important factor in promoting physical activity among patients. Methods: The purpose of this qualitative study was to understand the presence and importance of the health care provider support for physical activity in women aged 20-44 years. A semi-structured question guide directed by a Critical Theory of Medical Discourse was utilized for twenty in-depth interviews. To answer qualitative questions of the study, an intensity sampling was used to identify excellent examples of the phenomenon of interest. The participants were interviewed until theoretical saturation was reached. Results: The majority of the participants felt more comfortable having a woman as their primary health care provider, Most participants utilized the Obstetrician-Gynecologist (OBGYN) for the primary care, physical activity information was provided mostly to patients who were overweight, provided physical activity information wasn’t sufficient nor tailored to each patient. Conclusion: Primary care setting could be a powerful outlet for the promotion of physical activity. However, health care providers might need to expend the range of expertise and collaborate with other community members to increase the physical activity level among women aged 20-44 years.

Abstract Background: Prostate cancer is the most commonly diagnosed cancer among men living in the United States. All men diagnosed with prostate cancer must undergo the complex process of treatment decision-making. Men have to be exposed to a range of issues related to treatment care planning and aftercare before they can make an informed treatment choice. The literature suggests that many men make prostate cancer treatment decisions before having all of their information needs satisfied. Patients who do not satisfy all of their information needs before undergoing treatment will have unmet needs. Men with unmet needs are more susceptible to making ill-informed choices and selecting treatment options that are poorly aligned with their preferences. Objectives: To quantify levels of unmet treatment information needs and to explore sociodemographic correlates of unmet needs among a sample of localized prostate cancer survivors. Methodology: From 2013 to 2014, sixty-three prostate cancer survivors completed self-administered surveys on a touch-screen computer. All participants were 40 years or older, self-identified as African American or White, was treated for or actively monitoring localized prostate cancer (Stage T1 or T2), and lived or worked in Western New York or Georgia. The survey collected information on sociodemographic variables, information seeking behavior, and treatment information needs. Unmet treatment information needs were classified as details or issues that survivors deemed important to know but did not explore before making their treatment decision. Each of the 20 treatment information need items was rated as “0 = unimportant” or “1= important”. An unmet needs composite scale was created which ranged from 0 - 20 (α = 0.895). Univariate statistics (frequencies, means and standard deviations) were computed to describe the study sample. Bivariate (T-test, ANOVA and Chi-square) and multivariate statistics were computed to examine associations between study variables. Significance levels for all statistical procedures was set at p ≤ 0.05. Results: Most participants were White (58.7%), college graduates (54.0%), not working (58.7%), married (78.4%) and had annual household incomes of $45,000+ (49.2%). A majority of participants (57.0%) reported at least one unmet information need (range = 0 – 19 unmet needs, mean = 2.83). African Americans reported more unmet needs than Whites (3.64African American vs. 2.50Whites). Results from multiple linear regression analysis indicated that race (β = -2.14, p = 0.05), income (β = -4.60, p = 0.01), and insurance status (β = 6.73, p = 0.01) were significant predictors of unmet information need (F(9,41) = 2.34; p = 0.03). African Americans were less likely to get information they wanted about “How different treatment options work (χ2 = 0.02)” and “How much time is required to complete treatment (χ2 = 0.04).” Conclusions: These results suggest that many prostate cancer patients do not receive all of the information they deem important for treatment decision-making. Treatment information seeking behavior appears to be an emerging area of disparity for African Americans and men with lower income. Patient centered interventions need to be developed and implemented to reduce unmet treatment information needs within these medically underserved populations. Citation Format: Jarrett Johnson, Sarbesh Pandeya, Ahmed Kabore, Stuart H. Tedders, Levi Ross. Examining sociodemographic differences in unmet treatment information needs among localized prostate cancer survivors. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A54.

Background: Georgia’s Critical Access Hospitals (CAH) are in crisis. Within the last 2 years, four CAHs have closed their doors due to failed financial and operational performance. Evidence points to the risk that several more are on the brink of closure. CAH closures have far-reaching impact on residents. Negative impacts include the extra distance that patients must travel to seek care, the displacement of health professionals and the unravelling of the entire fabric of the communities these hospitals serve. We hope to help participants understand the financial and operational challenges of CAHs, and to identify realistic strategies to enhance the resilience of these hospitals.

Background: On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law. The law became effective on March 23, 2012. The ACA stipulates that non-profit hospitals must demonstrate benefit to their communities through the process of community health needs assessments (CHNAs). Failure to comply with this law may result in loss of non-profit status or large fines. This report describes strategies for engaging rural communities in Internal Revenue Service (IRS)-mandated CHNAs.

Birth weight is an important indicator of overall infant health and a strong predictor of infant morbidity and mortality, and low birth weight (LBW) is a leading cause of infant mortality in the United States. Numerous studies have examined the associations of birth weight with ambient air pollution, but the results were inconsistent. In this study, a spatial statistical technique, geographically weighted regression (GWR) is applied to explore the spatial variations in the associations of birth weight with concentrations of ozone (O3) and fine particulate matter (PM2.5) in the State of Georgia, USA adjusted for gestational age, parity, and six other socioeconomic, behavioral, and land use factors. The results show considerable spatial variations in the associations of birth weight with both pollutants. Significant positive, non-significant, and significant negative relationships between birth weight and concentrations of each air pollutant are all found in different parts of the study area, and the different types of the relationships are affected by the socioeconomic and urban characteristics of the communities where the births are located. The significant negative relationships between birth weight and O3 indicate that O3 is a significant risk factor of LBW and these associations are primarily located in less-urbanized communities. On the other hand, PM2.5 is a significant risk factor of LBW in the more-urbanized communities with higher family income and education attainment. These findings suggest that environmental and health policies should be adjusted to address the different effects of air pollutants on birth outcomes across different types of communities to more effectively and efficiently improve birth outcomes.

Community-based participatory research (CBPR) is becoming one of the dominant approaches for bringing evidence- and consensus-based cancer prevention and control practices to medically underserved communities. There are many examples of how CBPR has been useful for generating culturally specific solutions for different health issues that affect African-Americans. However, few examples exist in the literature on how the CBPR approach can be applied to address prostate cancer. This paper describes a collaborative process for linking inner-city, African-American men to free prostate cancer education, physician counseling, and screening opportunities (prostate-specific antigen (PSA) testing and digital rectal examination (DRE)). The site of this community-based participatory project was the city of Buffalo, located in Erie County, New York. The collaborative, community-academic process that is described includes the following: (1) planning and conducting a community needs assessment to contextualize local prostate cancer issues, (2) organizing town and gown event planning, and (3) manipulating aspects of the built environment to build an infrastructure within the community to address disparities in screening opportunities. This paper concludes with a description of lessons learned that can help others develop and implement similar activities in other communities.

Physical activity rates in rural women are very low. The purpose of this study was to explore the determinants of physical activity in rural women aged 20 to 44 years. A survey was used to collect data on a cluster sample of 184 participants. This study was guided by Self-Determination Theory. Survey data suggest that the highest type of motivation was identified regulation, and husband's support had the strongest effect on physical activity. Findings suggest that a history of sports participation can lead to the formation of intrinsic motivation. The results will assist in developing effective physical activity interventions.

Background: On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (ACA) into law. The law became effective on March 23, 2012. The ACA stipulates that non-profit hospitals must demonstrate benefit to their communities through the process of community health needs assessments (CHNAs). Failure to comply with this law may result in loss of non-profit status or large fines. This report describes strategies for engaging rural communities in Internal Revenue Service (IRS)-mandated CHNAs. Methods: Public health practitioners from Georgia Southern University’s Jiann Ping Hsu College of Public Health collaborated with 18 rural, non-profit hospitals to complete community-specific CHNAs. Quantitative and qualitative data were gathered from primary and secondary data sources to provide a comprehensive assessment of the needs and the assets of each of the communities. Results: The project team assisted 18 rural, non-profit hospitals in assessing the needs of their communities. Technical reports provided to the hospitals described the issues discovered during the assessment. Hospitals were empowered to utilize the information to prioritize communityspecific issues and to develop comprehensive plans for implementation. Conclusions: The CHNA process provides an opportunity to strengthen relationships between public health services and hospitals as well as between hospitals and the communities they serve. Hospitals need to identify and engage diverse sectors of the community in order to comprehensively assess the needs and assets of communities to address the social determinants of health and to reduce health inequities/disparities.

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.

This study estimates the neighborhood socioeconomic status (SES) effect on the risk of preterm birth (PTB) using multilevel regression (MLR) models. Birth data retrieved from year 2000 and 2010 Georgia Vital Records were linked to their respective census tracts. Principle component analysis (PCA) was performed on nine selected census variables and the first two principal components (Fac1 and Fac2) were used to represent the neighborhood-level SES in the MLR models. Two-level random intercept MLR models were specified using 122,744 and 112,578 live and singleton births at the individual level and 1613 and 1952 census tracts at the neighborhood level, for 2000 and 2010, respectively. After adjustment for individual level factors, Fac1, which represents disadvantaged SES, respectively generated an Odds Ratio of 1.056 (95% CI: 1.031-1.081) and 1.080 (95% CI: 1.056-1.105) for these two years, showing a modest but statistically significant effect on PTB. After adjusting for individual level factors and the census tract level factors, Intra-class correlation (ICC) was 1.2% and 1.4%, for year 2000 and 2010, respectively. The two IOR-80% intervals, 0.73-1.52 (year 2000) and 0.73-1.59 (year 2010) suggest large unexplained between census tract variation. The Median Odds Ratio (MOR) value of 1.21(year 2000) and 1.23 (year 2010) revealed that the un-modeled neighborhood effect was smaller than two individual-level predictor variables, race, and tobacco use but larger than the fixed effect of census tract-level predicting variable, Fac1 and all the other individual level factors. Overall, better census tract level SES was found to have a modest protective effect for PTB risk and the effects of the two examined years were similar. Large unexplained between census tract heterogeneity warrants more sophisticated MLR models to further investigate the PTB risk factors and their interactions at both individual and neighborhood levels.

The challenge of evaluating community asthma management programs is complicated by balancing the emphasis on health outcomes with the need to build community process capacity for conducting and monitoring evidence-based programs. The evaluation of a Georgia Childhood Asthma Management Program, a Healthcare Georgia Foundation-supported initiative for multiple diverse programs and settings, provides an example of an approach and the results that address this challenge. A "developmental evaluation" approach was applied, using mixed methods of quantitative and qualitative data collection and analysis, to assess the progress of community asthma prevention programs in building community within the context of: where the community is starting, community-level systems changes, and the community's progress toward becoming more outcome measurement oriented and evidence based. Initial evaluation efforts revealed extensive mobilization of community assets to manage childhood asthma. However, there were minimal planned efforts to assess health outcomes and systems changes, and the lack of a logic model-based program design linking evidence-based practices to outcomes. Following developmental technical assistance within evaluation efforts, all programs developed logic models, linking practices to outcomes with data collection processes to assess progress toward achieving the selected outcomes. This developmental approach across diverse projects and communities, along with a quality improvement benchmarking approach to outcomes, created a focus on health status outcome improvement. Specifically, this approach complemented an emphasis on an improved community process capacity to identify, implement, and monitor evidence-based asthma practices that could be used within each community setting.

This study investigates the contextual effect of neighbourhood socio-economic status (SES) on the risk of preterm birth (PTB) using multilevel models. Birth data retrieved from 2000 Georgia Vital Records were geocoded and joined to their respective census tracts. The census tract level Index of Deprivation (IoD) was calculated using nine 2000 Census variables based on a previously proposed ‘standard’ index. Two-level random intercept regression models were developed using 117,329 live and singleton births at the individual level and 1618 census tracts at the neighbourhood level. After adjustment for individual-level factors, IoD generated an odds ratio of 1.006 (95% CI 1.00–1.01), showing a modest but significant effect on PTB. Intra-class correlation (ICC) was 0.83% after adjusting for individual-level factors and the census tract level IoD. A wide IOR-80% interval (0.74–1.36) suggests large unexplained residual in between census tract variation remained. The median odds ratio (MOR) value of 1.17 revealed that the unmodelled neighbourhood effect was stronger than the fixed effect of census tract-level predicting variable, IoD, but weaker than the effects of several individual-level predictor variables, including race, tobacco use, prenatal care, foetal death history and marital status. Overall, better census tract-level SES would have a modest protective effect for PTB risk. The full strength of multilevel models should be exploited further to help our understanding of PTB aetiology.

OBJECTIVE:This study explores the prevalence and provider- and practice-related correlates of physician recommendation and administration of the quadrivalent human papillomavirus (HPV) vaccine, Gardasil, to 11- to 12-year-old girls and the intention to recommend the HPV vaccine to 11- to 12-year-old boys in Georgia. The study also describes physician knowledge about and barriers to HPV vaccination.MATERIALS AND METHODS:This cross-sectional study was conducted from December 2010 to February 2011. The study sample was drawn using the Georgia Vaccines for Children (VFC) provider list as a sampling frame and probability 1-stage cluster sampling with counties as clusters. The final analytic sample was restricted to 206 provider locations. Weighted percentages and corresponding statistics were calculated accounting for selection probabilities, nonresponse, and the cluster sample design.RESULTS:Among Georgia VFC providers attending to 11- to 12-year-old girls, 46% had always recommended that their patients get the HPV vaccination and 41% had vaccinated their female patients. Among Georgia VFC providers attending to 11- to 12-year-old boys, 20% would always recommend that their male patients get vaccinated.Physicians most frequently endorsed costs of stocking the vaccine (73%), upfront costs (69%), vaccination (68%), and insurance reimbursements (63%) as barriers to their HPV vaccination practices.CONCLUSIONS:Despite the Advisory Committee on Immunization Practices' recommendations on HPV vaccination, the prevalence of recommending and administering the HPV vaccine to female and male patients, aged 11 to 12 years, by VFC providers is an ongoing challenge in Georgia.

This study explores the prevalence and provider- and practice-related correlates of physician recommendation and administration of the quadrivalent human papillomavirus (HPV) vaccine, Gardasil, to 11- to 12-year-old girls and the intention to recommend the HPV vaccine to 11- to 12-year-old boys in Georgia. The study also describes physician knowledge about and barriers to HPV vaccination.This cross-sectional study was conducted from December 2010 to February 2011. The study sample was drawn using the Georgia Vaccines for Children (VFC) provider list as a sampling frame and probability 1-stage cluster sampling with counties as clusters. The final analytic sample was restricted to 206 provider locations. Weighted percentages and corresponding statistics were calculated accounting for selection probabilities, nonresponse, and the cluster sample design.Among Georgia VFC providers attending to 11- to 12-year-old girls, 46% had always recommended that their patients get the HPV vaccination and 41% had vaccinated their female patients. Among Georgia VFC providers attending to 11- to 12-year-old boys, 20% would always recommend that their male patients get vaccinated.Physicians most frequently endorsed costs of stocking the vaccine (73%), upfront costs (69%), vaccination (68%), and insurance reimbursements (63%) as barriers to their HPV vaccination practices.Despite the Advisory Committee on Immunization Practices' recommendations on HPV vaccination, the prevalence of recommending and administering the HPV vaccine to female and male patients, aged 11 to 12 years, by VFC providers is an ongoing challenge in Georgia.

Quality improvement (QI) and evaluation are frequently considered to be alternative approaches for monitoring and assessing program implementation and impact. The emphasis on third-party evaluation, particularly associated with summative evaluation, and the grounding of evaluation in the social and behavioral science contrast with an emphasis on the integration of QI process within programs or organizations and its origins in management science and industrial engineering. Working with a major philanthropic organization in Georgia, we illustrate how a QI model is integrated with evaluation for five asthma prevention and control sites serving poor and underserved communities in rural and urban Georgia. A primary foundation of this merged model of QI and evaluation is a refocusing of the evaluation from an intimidating report card summative evaluation by external evaluators to an internally engaged program focus on developmental evaluation. The benefits of the merged model to both QI and evaluation are discussed. The use of evaluation based logic models can help anchor a QI program in evidence-based practice and provide linkage between process and outputs with the longer term distal outcomes. Merging the QI approach with evaluation has major advantages, particularly related to enhancing the funder’s return on investment. We illustrate how a Plan-Do-Study-Act model of QI can (a) be integrated with evaluation based logic models, (b) help refocus emphasis from summative to developmental evaluation, (c) enhance program ownership and engagement in evaluation activities, and (d) increase the role of evaluators in providing technical assistance and support.

Quality improvement (QI) and evaluation are frequently considered to be alternative approaches for monitoring and assessing program implementation and impact. The emphasis on third-party evaluation, particularly associated with summative evaluation, and the grounding of evaluation in the social and behavioral science contrast with an emphasis on the integration of QI process within programs or organizations and its origins in management science and industrial engineering. Working with a major philanthropic organization in Georgia, we illustrate how a QI model is integrated with evaluation for five asthma prevention and control sites serving poor and underserved communities in rural and urban Georgia. A primary foundation of this merged model of QI and evaluation is a refocusing of the evaluation from an intimidating report card summative evaluation by external evaluators to an internally engaged program focus on developmental evaluation. The benefits of the merged model to both QI and evaluation are discussed. The use of evaluation based logic models can help anchor a QI program in evidence-based practice and provide linkage between process and outputs with the longer term distal outcomes. Merging the QI approach with evaluation has major advantages, particularly related to enhancing the funder's return on investment. We illustrate how a Plan-Do-Study-Act model of QI can (a) be integrated with evaluation based logic models, (b) help refocus emphasis from summative to developmental evaluation, (c) enhance program ownership and engagement in evaluation activities, and (d) increase the role of evaluators in providing technical assistance and support.