HIV Rates in the State of Georgia: A Growing Threat Among Predominantly African American Populations

Background: US rates of HIV/AIDS continue to rise with over 55% of new cases identified in southern states in 2003. The objective of this study was to determine the magnitude of HIV/AIDS cases in rural southeast Georgia in comparison to urban areas of the state. Methods: County level data was acquired using OASIS. Rates of HIV infections by gender and race (black vs. white) were aggregated over a five year period (2000–2005) and indirectly adjusted using Georgia as the standard. Rates for rural counties, (populations less than 35,000), were statistically compared to urban rates (α = 0.05). Results: HIV infections in urban counties were significantly higher as compared to rural counties. Statistically high infection rates in urban areas were also evident when controlling race and gender. Black males and black females in urban counties were the groups most heavily impacted. Conclusions: HIV/AIDS is an increasingly complex problem throughout the state of Georgia. Although urban areas continue to be significantly impacted, HIV infections among rural populations, especially black residents, represent a serious and growing threat

HIV Rates in the State of Georgia: A Growing Threat among Predominately African American Populations

Background: US rates of HIV/AIDS continue to rise with over 55% of new cases identified in southern states in 2003. The objective of this study was to determine the magnitude of HIV/AIDS cases in rural southeast Georgia in comparison to urban areas of the state. Methods: County level data was acquired using OASIS. Rates of HIV infections by gender and race (black vs. white) were aggregated over a five year period (2000–2005) and indirectly adjusted using Georgia as the standard. Rates for rural counties, (populations less than 35,000), were statistically compared to urban rates (α = 0.05). Results: HIV infections in urban counties were significantly higher as compared to rural counties. Statistically high infection rates in urban areas were also evident when controlling race and gender. Black males and black females in urban counties were the groups most heavily impacted. Conclusions: HIV/AIDS is an increasingly complex problem throughout the state of Georgia. Although urban areas continue to be significantly impacted, HIV infections among rural populations, especially black residents, represent a serious and growing threat

A Multilevel Analysis of Neighborhood Socioeconomic Effect on Preterm Births in Georgia, USA

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

Impact of Chlamydia and Gonorrhea in Georgia: An Urban / Rural Comparison (2000-2004)

Background: In 2005, 33,562 cases of chlamydia and 15,860 cases of gonorrhea were reported in the State of Georgia, respectively corresponding to 3.4% and 4.7% of all cases reported nationally (CDC, 2005). Disparities of infection with respect to race and gender are evident for both diseases. The objective of this study was to determine the magnitude of chlamydia and gonorrhea in rural Georgia compared to urban areas of the state. Methods: County level data necessary for analysis were acquired using the Georgia Division of Public Health’s Online Analytical Statistical Information System database (GDHR, 2007). Rates of infection by gender and race (black vs. white) were aggregated over a five year period (2000 – 2004) and indirectly adjusted using Georgia as the standard. Rates for rural counties, defined as populations less than 35,000, were statistically compared to urban rates using a test of proportions (α = 0.05). Additionally, rate ratios and 95% confidence intervals were calculated to further quantify risk. Results: Although variation exists, data suggest infection of both diseases in Georgia is an urban problem, disproportionately impacting black residents. For chlamydia, adjusted rates for white males (21.0/100,000) and black males (313.9/100,000) were significantly higher in urban counties. Quantified risk as indicated by rate ratios [RR] and 95% confidence intervals [95%CI] suggest an 18% increase of risk among white males (RR = 1.18; 95%CI = 1.07, 1.30) and 33% increase of risk among black males (RR = 1.33; 95%CI = 1.27, 1.38). Among females, rates in rural areas of the state were higher for whites (121.9/100,000) and blacks (1,045.5/100,000). However, these differences were not significant. For gonorrhea, rates in urban areas were significantly higher among white males (15.5/100,000), black males (519.6/100,000), and black females (414.2/100,000) as compared to rural populations. Additionally, elevated risk of gonorrhea among these groups ranged from a 10% increase among black females (RR = 1.10; 95%CI = 1.07, 1.14) in urban areas to a 65% increase among white males (RR = 1.64; 95%CI = 1.43, 1.85) in urban areas. Conclusions: The State of Georgia continues to report two of the most common sexually transmitted infections at an alarming rate. The disproportionate impact of minorities is evident, although further assessment of the variation between urban and rural areas is warranted to more fully explain risk of infection

Multi-Level Evaluation of a Perinatal Health Program in Rural Southeast Georgia

Problem: Infant mortality has declined steadily in the past decade, however, significant disparities associate with lack of adequate perinatal health services and barriers to access disproportionately impact women residing in rural areas. In Georgia, data suggest significant challenges with respect to birth outcomes, and this problem seems to be exacerbated in rural regions of state. The objective of this presentation is to report on the impact of a regional perinatal health care collaborative implemented in rural southeast Georgia. Method: Analysis of pre-intervention and post-intervention birth outcomes (gestational age, birth weight and infant mortality) served as the focal point programmatic evaluation. Differences in mean gestational age and mean birth weight were analyzed using a t-test (α = 0.05). Proportional differences in low birth weight and infant mortality were assessed using the chi-square test (α = 0.05). Differences were investigated relative to race (white and nonwhite). Results: Analysis of white participants showed no significant difference in any birth outcomes investigated. Furthermore, analysis of non-white PHP participants suggested significant improvements in all birth weight (p \u3c 0.001), gestational age (p = 0.007), low birth weight (p = 0.002), and infant mortality (p = 0.007). Conclusion: The perinatal health program in southeast Georgia demonstrated considerable effectiveness as measured through pre-intervention and post-intervention birth outcomes. The potential for improved health outcomes of high risk pregnant women and infants as a result of adequate perinatal care may also lead to the achievement of Healthy People 2010 within this region

Engaging Rural Georgians in the Internal Revenue Service (IRS)-Mandated Community Health Needs Assessment

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 community- specific 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

Engaging Rural Georgians in Internal Revenue Service (IRS)-Mandated Community Health Needs Assessments

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 community- specific 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

Racial Differences in Perception of Breast Cancer Risk in Rural Southeast Georgia

A university-public health collaborative was formed to more fully understand cancer risk among rural women in Georgia. Objectives: This study sought to gain an understanding of racial differences with regard to behavioral risk, perception of breast cancer risk, and perception of barriers to screening. Design: Differences in subjects’ risk and risk perception were assessed by creating, piloting, and administering a written survey at local health departments. Sample: A purposive sample of females enrolled in breast and cervical cancer screening programs in four rural counties in southeast Georgia (n = 147) were surveyed. Subjects were randomly invited to participate. Incentives were provided to enhance participation. Results: White females were significantly more likely than were black females to perceive pollution (OR: 4.63; p = 0.038), smoking (OR: 2.39; p = 0.018), age (OR: 3.01; p = 0.013), and hormone replacement therapy (OR: 3.17; p = 0.005) as factors influencing their breast cancer risk, and to perceive cost as a barrier to screening (OR: 2.89; p = 0.032). From a risk perspective, black females were more likely than white females to have had five-or-more pregnancies (p = 0.005), and to have given birth before age fifteen (p = 0.011). Conclusions: This study provided important baseline data about breast cancer risk necessary in developing effective health promotion programs

Fulfilling Community Health Assessment Requirements: Lessons Learned From Facilitating State-Wide Community Health Forums

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

Fulfilling Community Health Assessment Requirements: Lessons Learned From Facilitating State-wide Community Health Forums

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