Download Sustaining Community Health Assessment (MAPP) through a Larger

Practitioners
A Unified Vision for Healthy Communities: Sustaining Community
Health Assessment (MAPP) through a Larger Community Visioning
Process
Authors:
Sonja Armbruster, Ty Kane, and Claudia Blackburn
Objectives: The goal of this project was to engage community stakeholders in the
Mobilizing for Action through Planning and Partnerships (MAPP) process to increase
awareness about the issues affecting the health of the community, as well as identify
strategic priorities, focus community health efforts, and mobilize new partners.
Methods: Using the framework provided through MAPP, the Community Health
Priorities was coordinated by the Sedgwick County Health Department and organized
through Visioneering Wichita. “Visioneering” unites cities, as well as, public and private
organizations to adopt shared values, vision and strategies for a regional community
based strategic plan. Community forums brought together representatives from private
business sector, health care, public health, government and community leaders. Four
forums were held to review community health assessment data, select priorities, identify
best practices and develop potential strategies for action. As the result of these forums,
five community health priorities were identified: mental health, oral health, obesity and
diabetes, access, and health disparities.
Results: Forums engaged 143 community leaders. This project is in the action stage
and these community health priorities have been shared with over 2000 community
members, physicians, and dentists through presentations, and thousands more through
the web, radio, and print media. This process is the foundation for Sedgwick County’s
health improvement plan.
Conclusions: Embedding this health assessment work in the overarching community
visioning process is one key to sustainability over time. This strategy for community
health planning provides external infrastructure support and opportunities to engage
unique business and community leaders.
Integrating the CHANGE Tool Local Health Department Accreditation
Authors:
Candace Ayars and Travis Rickford
Background: The Kansas Department of Health and Environment’s (KDHE) Bureau of
Health Promotion oversees the Chronic Disease Risk Reduction (CDRR) Grant
Program that provides funding and technical assistance directly to Kansas communities
for reduction of the primary risk factors for chronic disease through evidence-based
strategies.
CDRR is structured to promote policy, systems, and environment (PSE) changes at the
community level and supports community program development from initial planning to
sustainability and maintenance with guidance from Local Public Health Agencies and
KDHE. A requirement of the program is the completion of the Community Health
Assessment and Group Evaluation (CHANGE) tool to assess barriers and assets in the
community’s PSE infrastructure for addressing tobacco use, physical activity, and
nutrition. Twenty-one counties are implementing the CHANGE tool. Concurrently, local
health agencies have been tasked with achieving national accreditation, a process
requiring a community health assessment. Although not a community health
assessment, the CHANGE tool is a strong complement to the accreditation process
through its emphasis on priority setting and action planning to impact many of the
indicators identified through the community health assessment.
Methods/Activities:
1. Technical review of the CHANGE Tool and its integration with the ten public
health domains required for national accreditation.
2. Experiences of CDRR communities integrating CHANGE with accreditation
requirements.
Outcomes/Results:
1. CHANGE tool can be successfully integrated into the national accreditation
program.
2. Communities can use the CHANGE tool to achieve some data collection required
by the national accreditation program (e.g. Domain 5: Community Health
Improvement Plan).
Examining False Negative Pap Smear Rates within a High Risk
Population: A Retrospective Analysis
Authors:
Caleb Bowers, Paul Callaway, Hannah Haack, Amy Chesser, Nikki
Woods, and Frank Dong
Background: Approximately 12,000 women in the U.S.A. are diagnosed with cervical
cancer annually. Routine screening can identify cervical cancer and reduce causespecific mortality. Although conflicting evidence exists regarding which method(s) are
optimal for early detection, liquid-based techniques have reportedly lower false negative
screening results as compared to conventional practices. This study sought to evaluate
liquid-based Pap smear false negative rates within a known high-risk population.
Methods: A retrospective chart review will be conducted in August 2011. Participants
will be included if they meet the following criteria: female patient of Wesley FM
gynecology clinic, referred for colposcopic evaluation following an abnormal index
cervical screen, Pap smear (with one of two liquid-based tests) and colposcopy
evaluation during follow-up appointment from June 1, 2008, to July 20, 2011. Variable
will include: patient age, days between initial Pap smear and follow-up visit, results of
repeated Pap smear, colposcopic exam impression, and histological diagnosis from
biopsy.
Anticipated Results: It is hypothesized the rate of false negatives among high-risk
patients will be higher than the 10-20% false negative rate frequently reported in the
literature and accepted among clinicians.
Conclusions: Comparing the false negative rate within a high-risk population to the
10-20% rate from the literature may support additional vigilance and training in known
high-risk populations. Future prospective studies based on preliminary findings could
inform screening recommendations for high-risk populations.
Every Day Improvement
Authors:
Kathleen Colson, Kim Ens, Charlotte Marthaler, and Pat Meyers
Background: Establishing quality improvement (QI) into public health practice and
operations requires commitment at all organizational levels. Employing QI methods can
appear to compete with service provision unless public health professionals make time
for improvement in their daily work schedules.
Objective: To test effort and systems needed to use QI processes in daily work.
Methods: After monthly Co-CASA reports showed childhood immunization rates were
below agency standards, staff with limited QI experience and training embarked on a
Plan-Do-Check-Act (PDCA) cycle aimed at improving rates. Available resources such
as the “Public Health Memory Jogger II” and Kansas Public Health Grand Rounds
sessions were used to learn about QI tools and processes. Routine staff meetings and
established data systems (Co-CASA and KIPHS) supported QI efforts. New work
related to the improvement strategy (sending birthday cards on client’s first birthday and
tracking results) was assigned to complement staff’s daily work processes.
Results: Use of systems already in place and available resources made the QI
process manageable with minimal time and cost. Two additional team meetings were
needed for reviewing data and developing Aim Statement and Improvement Theory.
Data are gathered monthly and results will be evaluated to determine if the change
resulted in improved immunizations rates.
Conclusions: There are several good resources to assist public health professional
with creating QI processes within their daily work. By making small adjustments to
established processes the task of incorporating a QI PDCA cycle is easily
accomplished. The tendency is to make QI a bigger process than it needs to be.
Keeping it simple enables staff to contribute daily to improvement efforts.
The Relationship between Select Socioeconomic Factors and the
Initiation of Breastfeeding
Author:
Ashley Hinkson
Aim: This paper is a report of a study of the relationship between poverty status,
maternal age, maternal education level, and initiation of breastfeeding infants.
Background: Identification and understanding of factors that influence a woman’s
decision to breastfeed is important to promote interventions for those women least likely
to breastfeed. The purpose of this study is to identify if there is a relationship between
the socioeconomic factors of poverty status, maternal age, maternal education level,
and initiation of breastfeeding of infants.
Method: Data from the Infant Feeding Practices Study II (Centers for Disease Control
and Prevention, 2008) were obtained and used in an independent samples t-test and
chi-square to determine if there was a significant relationship between the
socioeconomic factors of poverty status, maternal age, maternal education level and
initiation of breastfeeding of infants.
Findings: Family income, X2 (4, N = 172) = 8.56, p = .73, and maternal education
level, X2 (3, N = 155) = 6.50, p = 0.09, were not determined to be significant predictors
of breastfeeding initiation and there was no significant difference found between
maternal age and initiation of breastfeeding, t (27.79) = 1.032, p = .31.
Conclusions: It is of importance to ensure breastfeeding education and resources are
directed at factors that significantly impact breastfeeding initiation to help attain higher
breastfeeding rates. This study suggests that the social inequalities impacting the
initiation of breastfeeding a decade ago may no longer be relevant with today’s
population.
Building a Quality Improvement Culture at the Sedgwick County
Health Department
Authors:
Ty Kane, Sonja Armbruster, and Claudia Blackburn
Background: In 2008, SCHD launched an initiative to build an organizational culture of
QI. The impetus for the project was primarily PHAB Standards requirements, but also
the move toward greater accountability, QI and performance management in all sectors
of public health.
Methods: In 2009, SCHD sought private funding to hire a consultant. Project objectives
were developed: recruit and train a quality council, develop a QI Plan and train staff.
From August, 2010 through January 2011, SCHD worked with John W. Moran, Senior
Quality Advisor to the Public Health Foundation, to achieve these objectives.
Results: Forty directors, managers and Q-Team members were trained to understand
QI principles and tools. Eight improvement projects and storyboards were completed.
All staff participated in based QI training. An agency Q-Team was developed. SCHD
launched a 2011 QI Plan and wrote a QI Policy.
Conclusions: Upon completion of this initiative, twenty-five percent of staff
experienced a formal PDSA process and nearly all staff have been involved in based QI
training. Additionally, managers have reported improvement in programs, processes
and staff-use of QI tools attributable to the training.
Acknowledgments: Thanks to the Sunflower Foundation of Kansas for funding this
initiative, to John W. Moran at PHF for sharing perspective, resources and direction,
and to the NACCHO APQI team for their ongoing support and resources.
Strategic Planning = A Sustainable Future for Local Coalitions
Authors:
Jamie Katz and Sue Matson
A community coalition is a union of individuals or organizations working to influence
outcomes on specific problems1. High performing coalitions typically implement a
strategic plan, while those that struggle have not developed or implemented one. A
strategic plan assists a coalition in determining priorities 2. There is no perfect strategic
planning model. Coalitions develop or modify existing models to meet community
needs2. Examples of the many models, approaches, and tools available include:
Communities that Care®; SAMHSA’s Strategic Prevention Framework; CSAP’s
Western CAPT model; and KU Work Group’s Community Tool BoxTM. Strategic
planning should be an inclusive process, including anyone impacted or influential in
implementation.
A meaningful strategic plan will3:
- identify the current status of the coalition
- develop goals
- develop its mission and vision for the future
- monitor plans
- prioritize action and strategies
- evaluate programs
- clarify values and needs (strengths, weaknesses, opportunities & threats)
These steps lead a coalition to develop evidence based policies, programs and
practices that enhance sustainability and success.
Community Health Priorities: Call to Action
Authors:
John Kephart, Sonja Armbruster, and Meghan Hampton
In 2010, The Community Health Priorities plan was developed by Visioneering Wichita
Health Alliance, Sedgwick County Health Department, and Sedgwick County leaders
and partners to focus on “actionship” in five health priority areas: Health Access,
Obesity and Diabetes, Mental Health, Oral Health, and Health Disparities. Following
completion of the plan a “Call to Action” survey was developed to share new ideas and
solicit feedback on steps that can be taken to improve the wellness of Sedgwick County
residents. Its purpose was: (1) To help residents/respondents think about actions that
they could take to improve our community’s health, (2) To help community leaders focus
resources and (3) To share new ideas about improving health. A total 901 individuals
completed the survey and 1465 individuals started the survey but did not complete it.
More than 77% of survey respondents were women and ages ranged from <18 to >85
years, with 42% being between 45-64 years. Concern over Access to Health Care was
the selected by 89% of respondents. Concern over Obesity and Diabetes, Mental
Health, and Oral Health was selected by 88%, 84%, and 84% of respondents,
respectively. Social media was found in 68% of respondents, 67% of which use
Facebook, and 41% said they would share their health behaviors with others via e-mail
or social media. Data suggest new opportunities to develop targeted policies and plans
for the improvement of health within the community. This survey was an important first
step toward implementation strategies for the Community Improvement Plan.
Perinatal Periods of Risk (PPOR) Phase I and II: A State-Level
Analysis in Kansas, 2005-2009
Authors:
Jamie Kim, Carol Gilbert, and Laurin Kasehagen Robinson
Background: Kansas’ infant mortality rate (IMR) has been persistently higher than the
national rate. In recent years, Kansas’ IMR has stagnated while the national rate has
declined. Furthermore, while many states have made progress closing the mortality gap
between non-Hispanic black and non-Hispanic white infants, Kansas has not.
Methodology: Fetal death and linked birth-infant death certificate files (2005-2009)
were compiled and analyzed using the Perinatal Periods of Risk approach to gain
greater insight into the underlying factors contributing to Kansas’ fetal and infant deaths.
Results: When compared to a national reference group, 42.4% of Kansas’ excess
fetal-infant mortality was in the post-neonatal period among infants ≥1500g. The excess
mortality rate for non-Hispanic blacks (10.9) was >4 times greater than non-Hispanic
whites (2.4). Among non-Hispanic white and Hispanic mothers excess mortality was
attributable to risks relating to infant health and injury/safety. For non-Hispanic black
mothers, the excess fetal-infant mortality was attributable to maternal health and
prematurity. Further analysis showed that 88.6% of the non-Hispanic black mortality in
very low birth weight births was attributable to birthweight distribution. Only 11.4% of the
non-Hispanic black VLBW disparity was due to birthweight-specific mortality.
Conclusions: Causes of excess fetal-infant death and consequent opportunities for
intervention vary according to the mother’s race/ethnicity. To significantly impact
Kansas’ overall IMR, community-specific, tailored prevention efforts on prematurity, safe
sleep, and injury prevention may be necessary.
Public Health Implications: Complex factors necessitate a multi-pronged approach to
reduce Kansas’ overall IMR and collaborative efforts of community members, public
health, and the medical community.
Building a Community Response to Compulsive Hoarding
Authors:
Krista Lovette, Deborah B. Fromer, and John W. Kephart
This session will include a discussion of how the AAA established and implemented a
local task force which is a partnership between the AAA and a variety of community
providers. An overview of the multidisciplinary response to hoarding cases and the tools
developed will be provided in addition to a discussion of how this process can be
replicated. During the session, presenters will encourage the audience to share their
own experiences in addressing older adult hoarding issues.
By the end of the session, attendees should be able to explain how the Sedgwick
County Hoarding Coalition was created and how to get one started in your community.
By the end of the session, attendees should be able to explain how our hoarding
coalition intervenes in cases of older adult hoarding.
By the end of the session, attendees should be able to state at least 5 types of
organizations typically in a hoarding coalition.
Examining Social Norms, Barriers, and Facilitators among Urban
Adolescents
Authors:
Candi Nigh, Nikki Keene Woods, Jennifer Wipperman, and Amy Chesser
Background: One third of the African American infant deaths in Kansas between 1998
and 2007 took place in only five zip codes. Breastfeeding has been shown to be a
protective factor that could help address infant mortality, yet adolescent mothers are
least likely to initiate breastfeeding and frequently do so for the shortest amount of time.
Methods: Four focus groups were held to discuss: environmental elements of the
Wichita community, participants’ experiences, and describe how these elements interact
in relation to breastfeeding outcomes. Adolescent mothers and pregnant adolescents
were invited to a one-hour focus group. Each group discussed their attitudes towards
breastfeeding, common attitudes among family and friends, their knowledge, as well as
identified personal and environmental barriers and facilitators for breastfeeding. At the
end of the session, participants were asked to submit photographs to help depict their
breastfeeding experience. The focus groups were audio recorded and transcribed. Data
was hand coded by four scores to identify themes.
Results: Participants identified technology (i.e. breast pumps), mentors, and the desire
to be a good mother as facilitators. Lifestyle, independence, lack of support from family,
social stigma/embarrassment, and difficulty with breastfeeding techniques were
described as barriers. Photographs were compiled to visually confirm the qualitative
data.
Conclusions: These findings are important for Kansas because of its high infant
mortality rates. Further research is needed to examine local interventions that target
identified environmental factors that support adolescent breastfeeding and related
health behaviors with the goal of reducing infant deaths within the community.
Inclusion of Tobacco Guidelines into the Kansas Model Wellness
Policies: Creating a Framework for Statewide Youth Tobacco Use
Prevention
Authors: Mark Thompson and Liesl Hays
Objective: One of the nation’s leading public health concerns is inarguably childhood
health. In response to this concern, national attention on this topic has garnered public
awareness. Health advocates have capitalized on this momentum by promoting
evidenced-based policies targeted at youth. Kansas is no exception. As a result of State
Law (SB-154) passed in May 2005, which was in response to the Child Nutrition
Reauthorization of 2004, the Kansas State Department of Education (KSDE)
developed nutrition guidelines for all foods and beverages made available to students in
Kansas public schools during the school day. The result of this effort was the
establishment of the Kansas Model Wellness Policies which provide all school statewide
guidelines on nutrition, nutrition education, and physical activity. Currently, Kansas
schools report on these guidelines to the Kansas State Department of Education. While
the model guidelines provide an excellent framework for its focus areas, schools and
tobacco advocates have envisioned the inclusion of tobacco specific guidelines. With
the onset of Child Nutrition Reauthorization of 2010, states have been asked to revise
their current model wellness policies. This revision process sets the stage for
consideration of tobacco specific guidelines.
Methodology: In response to the vision of tobacco-specific guidelines, the Kansas
Department of Health and Environment (KDHE) and KSDE staff conducted a literature
review on evidenced-based youth tobacco interventions and updated draft tobacco
guidelines. In an effort to solicit feedback on the draft policies, the formulation of a
sector-diversified advisory committee was established. The advisory committee was
tasked with providing recommendations on draft tobacco guidelines. With their
feedback, the tobacco guidelines were updated and sent out to the committee for further
comment.
Results: The creation and update of tobacco specific guidelines has created a practical
evidenced-based framework for schools implementing your based tobacco
interventions, a unified state-wide vision, and the possibility of the inclusion of tobacco
specific guidelines into the Kansas Model Wellness Policies.
Physical Activity and Arthritis: Results from the Arthritis Call Back
Survey
Authors:
Elizabeth Walsh and Ghazala Perveen
Background: Approximately 24% of Kansas adults have doctor-diagnosed arthritis.
Successfully managing arthritis symptoms, such as through regular, moderate physical
activity helps prevent disability and improves quality of life. However, Kansas adults with
arthritis are twice as likely to be inactive as compared to those without arthritis.
Objective: To examine the relationship between attitudes toward, confidence in, and
barriers to physical activity among Kansas adults with arthritis.
Methods: Respondents to the 2009 BRFSS during March-September who report
having doctor-diagnosed arthritis were invited to participate in the Arthritis Call Back
Survey. Respondents who agree to participate were called back within two weeks of
their original interview. Questions regarding attitudes toward, confidence in, and barriers
to physical activity were analyzed using statistical procedures for weighted data.
Results: The majority (90%) of adults with arthritis agrees that it is important for
someone with arthritis to get regular, moderate physical activity. However, smaller
proportions (72%) of adults are highly confident that they can meet recommended levels
of activity. Confidence in ability to get physical activity decreases if adults with arthritis
have another injury/health condition (60%) or have a fear of falling due to their arthritis
(50%).
Conclusions: While the majority of Kansas adults with arthritis agree it is important for
them to get recommended levels of moderate physical activity, a smaller percentage are
highly confident they will be able to do so. This is compounded if adults with arthritis
experience additional barriers, such as having other health conditions or a fear of falling.
Researchers
Development of a Professional Education Program about Mental
Health Needs of American Indians
Authors:
Stacy Braiuca; Susan Crain Lewis; William F. Gabrielli, Jr.; Kimberly
Engelman; and Christine M. Daley
Depression and related outcomes (e.g. suicide, violence, etc.) affect American Indians
(AI) disproportionally. Nonetheless, there are no large-scale epidemiologic studies in the
literature to understand this disparity. Furthermore, historical and current policies impact
mental health for AIs. Underfunded healthcare systems, conflicting system policies, and
indirectly, two centuries of government policies have resulted in unfortunate mental
health outcomes and negatively shaped the mental health information and treatment
choices for AIs.
We will describe the development and qualitative testing of a professional education
curriculum comprised of a booklet and presentation slides about AI mental health
concerns and treatment considerations. The booklet development commenced after a
health literacy assessment of current materials at Mental Health America of the
Heartland. Following this assessment, education materials were drafter and
subsequently were assessed qualitatively via semi-structured interviews and focus
groups with community members. The developed materials took into consideration
difference between Western medicine’s and Traditional AI definitions of, and treatment
of, mental illness.
A collaborative effort, such as the one taken by our team, to include members of
underserved communities and providers in the materials development process will do
nothing but help to move us toward the creation of culturally accepted mental illness
definitions and treatment. With improved educational communication vehicles, such as
the booklet and presentation developed for this project, we can begin the critically
important journey of effectively integrating Western and Traditional medicine and better
serving the mental health needs of American Indians.
Health Literacy Assessment for Mental Health America of the
Heartland Using Fry, SMOG, and SAM Readability Tools
Authors:
Daley
Stacy Braiuca, Susan Cain Lewis, Kimberly Engelman, and Christine M.
Mental Health America of the Heartland (MHAH) is a community advocacy and
education agency located in the Kansas City metropolitan area. MHAH is affiliated with
a National organization that was established in 1909, during the beginning of the
“consumer movement” which involves adults and children living with mental illness with
their own recovery.
This poster presents assessment results from a sample of mental health literatures
(N=15) available to patients, professionals and the public from MHAH. These materials
are taken to local and regional school presentations, health fairs, the agency’s own
education events, and had previously not been assessed for health literacy, according
to the agency’s Executive Director.
Materials were each assessed using three different measures of health literacy. The Fry
(Fry Readability Formula, a form of regression analysis for literacy), measures reading
grade level, the SMOG (Simple Measure of Gobbledygook), estimates the education
reading level for an individual to understand the material, and SAM (Suitability
Assessment of Materials) assesses the overall suitability of materials, including the
reading level, writing style, vocabulary, content, cultural appropriateness, and clarity.
Considering the wide range of educational attainment of MHAH’s audience, assessment
of their materials for appropriate literacy levels is important to their mission.
The grade level of most items on the materials was Graduate level and beyond, which
highlights the need for future study and development of more appropriate literature for
future readers of all literacy levels.
Keywords: health literacy, mental health, literature, readability.
Assessment of Alternate Approaches for Health Information
Technology in Family Medicine
Authors:
Amy Chesser, Jennifer Wipperman, Frank Dong, Nikki Keene Woods,
Aron Fast, Traci Hart, and Rick Kellerman
Introduction: Health information technology (HIT) has been used to improve
healthcare through enhanced clinician-patient communication. The Centers for Disease
Control and Prevention (2011) published health literacy goals promoting patientcentered technologies throughout healthcare processes. One form of HIT with potential
to solve clinical communication problems is the Apple iPad. However, a lack of evidence
exists for iPad integration feasibility within existing systems.
Methods: This study was a prospective assessment of physicians’ experiences with
iPad functionality in the clinical settings. Three faculty in-depth interviews were
conducted to discuss methods for integrating iPad technology with current information
technology (IT) systems, interfacing systems and software, and practically of data entry
and extraction throughout the tasks of clinical care; followed by 42 faculty/resident
surveys assessing physicians’ readiness to adopt tablet technology.
Results: Several benefits specific to iPad use were stated. Physicians described Apple
iPad implementation as integral to patient education. Physicians reported the
physiological processes of medical diagnoses were more easily illustrated anatomically
and visualized with greater clarity. Effortless extraction of information to include
electronic health records and radiological imaging was achieved within one patient
appointment. However, physicians faced difficulty with keyboarding and data entry as
compared to current technologies, such as a laptop computer.
Conclusion: Public healthcare is influenced by the effectiveness of clinician-patient
communication, health education and promotion. Our findings suggest the iPad may
prove feasible and novel for improving efficacy. However, the iPad may be only one
element to a comprehensive solution, where extensive IT infrastructure support is
necessary for implementation.
Examination of the Principal Components to Identify Social Values
Impacting Health Behaviors for the HEARTLINES Life Orientation
Campaign in South Africa
Authors:
Amy Chesser, Traci Hart, Carolyn Ahlers-Schmidt, and Frank Dong
Background: The objective of this study was to describe the effects of an item
correlation and factor analysis performed on existing evaluation data. The intervention
consisted of the use of media utilization (a.k.a. Entertainment Education) to educate and
inform student audiences to motivate them toward positive health behaviors while they
were engaged in an entertainment activity. The Heartlines campaign incorporated
curriculum for learners grades 10 and 11 enrolled in public schools in South Africa. The
overall purpose of the research was to assess student knowledge, beliefs, intentions
and self-efficacy of value-based topics related to health and risky behaviors which may
impact the spread of HIV/AIDS.
Methods: A quasi-experimental, repeated measures survey design was used to
assess the impact of the Life Orientation curriculum. There were three phases to the
study which included the pre-test survey (a baseline measure of pre-intervention
responses), the intervention (an eight-week curriculum administered during the Life
Orientation class period), and the post-test survey (designated for the session following
the completion of the curriculum intervention). Data from a convenience sample of 11
public schools was collected January through May of 2008. Data were analyzed at
group level only. There were 53 questions for grade 10 pre-test survey (N=784) and 67
questions on the post-test survey (N=650). Similarly, there were 50 questions for grade
11 pre-test survey (N=691) and 58 questions on the post-test survey (N=732).
Using SPSS Version 18, the principle components were extracted using iterative
principles axis method with the objective of achieving a simple structure independently
for each grade. A scree plot and the total variance explained by the number of principle
components methods were examined to determine the number of principle components.
These two methods yield four principle components. Varimax rotation method was
applied to achieve a better interpretation of the four principle components. Variables
with the principle component loading less than 0.35 were excluded in the interpretation
of principle component content.
Results: Through the factor analysis, four principle components were identified for
each grade and confirmatory factor analysis was carried out to verify the factor
structures. The four factors for the grade 10 learners are Acceptance, Honesty,
Forgiveness and Perseverance. The four factors for the grade 11 learners are
Compassion, Second Chance, Self-control and Responsibility.
Significance: This study will provide preliminary evidence regarding which instructional
method should be used in the future implementation of large-scale national valuesbased, Entertainment Education programs for the public school setting in South Africa.
Quantitative Analysis of The Adverse Effects of Not Maintaining
Regular Dental Clinic Visits for Senior Citizens
Authors:
Frank Dong, Amy Chesser, and Nikki Woods
Background: Medicare provides optional dental care for people age 65 or older, which
requires individuals to pay for dental care. Seventy-seven percent of elderly patients
(age 65 or older) had one or more or all of their teeth permanently removed. Elderly
patients suffered in their mental health, physical health and depression status due to
permanent teeth removal.
Method: Behavioral Risk Factor Surveillance System data (2008) was used to study
the relationship between the number of dental clinic visits and mental health, physical
health and depression. Negative binomial regression and logistic regression were
conducted to explore the relationship between the response and number of dental clinic
visits.
Result: Individuals age 21 or older, 45% of respondents, did not have any teeth
removed. The number of dental clinic visits had a positive effect on the number of
mentally healthy days, the number of physically healthy days, and the self-report
general health. For elderly respondents, 23% of respondents did not have any teeth
removed. The effects of dental clinic visits have stronger positive effects on the number
of mentally healthy days, the number physically healthy days, and the self-report
general health.
Discussion: For elderly respondents having a regular dental clinic visit to prevent
removal of permanent teeth had stronger positive effects on their mental health and
physical health than younger respondents. Preventing permanent teeth removal may
also have a positive effect on depression, which could reduce the chance of suicide.
Informative Community-Based Participatory Research among a
Refugee Population
Authors:
Melissa Filippi, Babalola Faseru, Joseph LeMaster, and Fanta Kuhlman
Background: Health data concerning African immigrants and refugees living in the
United States is dearth. No national database exists which provides standardized
information regarding health indicators, country specific concerns, and ethnic group
status. In addition, the data that characterizes the health experience literature of African
immigrants and refugees are sparse. Thus, to better understand the health priorities and
needs of the Somali community in Kansas City, we interviewed Somali community
members to determine the most pressing health needs as they see fit (N=11). This
formative research will help direct future community-based participatory research
(CBPR) endeavors.
Methods: This formative research used a community-based participatory approach.
Recruitment was accomplished through word-of-mouth. After obtaining informed oral
consent, we asked open-ended questions based on research aims. We conducted 11
semi-structured interviews. The interviews were recorded and transcribed verbatim (with
the exception of one interview). The transcripts were coded inductively and we used
standard text analysis to identify themes.
Results: Community members identified specific health condition, such as: diabetes,
high blood pressure, high cholesterol, administering medications, and mental health, as
areas that need particular attention. All participants discussed lack of health knowledge
and length. Generally, interviewees thought that community health workers could bridge
some of the barriers mentioned.
Discussion: Health issues and barriers to care are couched within larger, structural
conditions such as education, socioeconomic concerns, and migration processes.
Through partnerships, perhaps some of these health issues and barriers can be
addressed in a culturally-appropriate way.
Eating Away-From Home Foods: Important Characteristics by weight
status groups
Authors:
Katie M. Heinrich, Nattinee Jitnarin, C. Keith Haddock, Joseph Hughey,
LaVerne A. Berkel, and W. S. Carlos Poston
Away-from-home food consumption is linked to obesity; both have dramatically
increased since the mid-1970s. This study examined the relationship between
characteristics of different types of away-from-home food establishments and weight
status.
Cross-sectional data were from 586 adults completing in-person surveys in the Kansas
City Metropolitan area. Measured height and weight were used for BMI (<18.5
underweight, 18.5-24.9 normal weight, 25-29.9 overweight, 30+ obese). Participants
indicated where they primarily ate away-from-home. Participants also indicated the
frequency of eating at six away-from-home establishments.
Participants were female (69.8%), White (65.4%), married (51.5%), employed/selfemployed (58.5%), ≤$60,000 incomes (54.6%); average age 45±14.7. Mean BMI was
28.4±7.7 with 3.1% underweight, 35.7% normal weight, 28.0% overweight, and 33.3%
obese. In the past 12 months, doctors had told 17.2% to lose weight, 2.4% to gain
weight, and 1.9% to maintain weight.
Participants’ primary away-from-home food establishments included full service
(31.7%), ethnic/specialty (17.7%), fast food (14.0%), and other (e.g., buffet). Greater
weight status was correlated with eating more fast food (p<.01), but fewer meals from
soup kitchens/churches/community centers (p<.05). Participants told to lose weight
were ate more at fast food restaurants (p<.05) and buffets (p<.05), while participants
told to gain weight ate more at worksites/cafeterias (p<.05).
Despite being told to lose weight, obese individuals still reported frequent fast food
consumption as well as buffets. Non-obese participants and those told to gain weight
were more likely to eat at worksites/cafeterias or churches/community centers. Future
research could examine underlying causes as well as protective effects for these
choices.
Improving Birth Outcomes through the Healthy Babies Northeast
Wichita Healthy Start Initiative
Authors:
Michelle L. Redmond, Susan E. Wilson, Linda M. Frazier, Rosalee E.
Zachula, Darren M. Farley, and Liesa Hopper
Background: Concern is growing regarding the racial disparity of poor birth outcomes.
Programs targeting high-risk mothers can help reduce adverse birth outcomes. Birth
outcomes were examined for clients served by the Healthy Babies program and living in
the federally-funded Health Start zip codes (referred to as NEWHSI). NEWHSI clients
were compared to non-NEWHSI clients residing within the same three high-risk zip
codes (67208, 67214, and 67219) in Sedgwick County, KS.
Methods: A cross-sectional design was used, involving secondary analysis of deidentified birth certificate data obtained from Kansas Department of Health and
Environment. Birth outcomes were examined for non-Hispanic white, black and
Hispanic women (n=3,644) living in NEWHSI target zip code areas Main outcome
measures were very low birth weight (<1500g), low birth weight (1500g-2500g), preterm
birth (<37 weeks) and prenatal care.
Results: Rates for very low birth weight were 2.7% for non-clients and 0% for NEWHSI
clients. Most Health Babies NEWHSI clients reported receiving prenatal care within the
1st trimester with 100% receiving some prenatal care during pregnancy; reports were
similar for non-clients.
Conclusion: Health Babies NEWHSI clients displayed similar outcomes as non-clients
in the same community. However, Health Babies NEWHSI was successful in
decreasing preterm births and maintaining other outcomes, even with a high rate of teen
and first-time moms among the client population. Results may reflect a high percentage
of at-risk mothers that the program actively recruits in Sedgwick County. Findings reveal
a continued need for the Health Babies NEWHSI program as they work to improve poor
birth outcomes in the community.
Defining Physical Activity in Older Women
Author:
Nicole L. Rogers
Older adults are the fastest growing population in the US, yet the least physically active.
Physical inactivity is a leading public health problem associated with decreased
longevity as well as cardiovascular disease, cancer, obesity, and diabetes. Several
organizations recommend older adults engage in at least 30 minutes, 5 days/week of
moderate-intensity physical activity (PA). In spite of the benefits of PA, only 25% of
women aged 65-to-74 years participate in regular PA. Women older than 75 years have
even lower participation with 14% engaging in any PA. With respect to the amount
(steps) of daily PA, there are few recommendations. Research suggest the following:
Sedentary=2,000-4,999, Low Active=5,000-7,499, Somewhat Active=7,500-9,999, and
Active=10,000-12,999.
Our lab recently measured PA levels of 107 older women in 3 age groups: 60-69 (n=38,
65.26 ± 2.71 years), 70-79 (n=46, 74.04 ± 2.99 years), and 80-89 (n=23, 8 ± 2.71
years). With respect to amount of PA, no group was “Active”. For highest step day, the
two most active age-groups (60s and 70s) were considered “Somewhat Active” (~8,200
daily steps). No group achieved 30 minutes of moderate-intensity PA. The highest 5-day
average was for 70-year olds (~16 minutes), followed by 60-year olds (~14 minutes),
and then 80-year olds (~8 minutes). Evaluating the number of older adults meeting
recommendations, results are not encouraging. Eight of 38 (21%) 60-year olds, 4 of 45
(11%) 70-year olds, and 1 of 22 (5%) 80-year olds spent at least 30 minutes, five days
per week engaging in moderate-intensity PA.
Adult Survivors of Childhood Cancers: Survey Results of Long-Term
Survivorship Issues
Authors:
Robin Ryan, Kristin Stegenga, Wendy McClellan, Hope Krebill, Jennifer R.
Klemp, and Eve-Lynne Nelson
Increasing cure rates has led to an expanding percentage of the population identifying
as a childhood cancer survivor. For this population, cancer therapies and the
psychosocial impact of diagnosis present the potential for healthcare needs beyond the
therapeutic treatment period. A large obstacle to meeting these needs is this group’s
transition from pediatric oncology healthcare to adult primary healthcare. This transition
can occur years after cancer treatment. The Children’s Oncology Group, the largest
pediatric cooperative clinical research group, has published extensive long term followup recommendations based on the type and amount of cancer therapy survivors
received. Disseminating this information to the population is challenging. Additionally,
the individual healthcare needs and practices of this population continue to be defined.
To address this public health dilemma, researchers from a metropolitan pediatric cancer
center and a university medical center collaborated to determine how to identify the
region’s survivor population and to measure what would be important in the
development of a regional approach to the management of this population’s needs.
Using Tumor Registries from both institutions, an Institutional Review Board approved
survey was mailed to 710 subjects eighteen years and older who were registered with a
malignant diagnosis prior to their eighteenth birthday. Survey questions were chosen
with the intent to characterize the population and to seek paths for regional
programming. The project process can provide public health professional with a
framework to develop similar collaborations and provides an opportunity to identify
future programs to address the needs of this population.
Enhancing Health Career Pathways through Health Disparities
Research: The Latino Internship in Health Disparities Research
Authors:
Natalia Suarez, A. Paula Cupertino, and Susan Garrett
There is a pressing need to expand the number of underserved minority students
pursuing careers in the health professions and health disparities research. In response
to this priority, since 2009, the KUMC Department of Preventive Medicine and Public
Health has hosted the Latino Internship in Health Disparities Research program which,
thus far, has engaged 24 minority youth from the Kansas City area.
Our goal is to create a cohort of investigators that can address health disparities in the
future. We feel that using a community-engaged approach to both education and
research training will help us achieve that goal.
The Latino Internship in Health Disparities Research program is a 6-week training
program for underserved minority high school and undergraduate students. We train
students in the CBPR process of identifying problems, creating solutions, evaluating
and disseminating project findings.
In the summer of 2011, the program served seven Kansas City area students. The
training curriculum focused on five central goals: 1) Understanding medical careers; 2)
Comprehensive understanding of health disparities; 3) Health disparities research
among Latinos; 4) Development of professional skills; and 5) Cultural competency.
In a program evaluation, students self-reported an increased understanding of health
careers and health disparities, and an increased ability to think critically about health
issues in their community. Education programs are needed to provide underserved
minority youth with skills in health disparities research. These can ultimately enhance
the health of disadvantaged communities by encouraging students to return to their own
communities and contribute to its health and wellness.
Healthcare Services Preferences: Dimensions of Uninsured
Consumers Priorities and Choices
Authors:
Ruth Wetta-Hall, Karen M. Kramer, Lisette T. Jacobson, and Ashley Moss
Access to health care continues to pose problems for a significant portion of Americans.
Communities have developed local solutions to address the health care needs of
uninsured populations such as the Sedgwick County Health Access Project in southcentral Kansas. The purpose of this project was to explore county residents’ perceptions
toward affordability and availability of healthcare services. One survey item asked
respondents to rank order, by perceived need for their families and themselves, eight
healthcare services. A hierarchical cluster analysis using Ward’s method identified three
groups with varying preferences for healthcare services. Service preferences in grou 1
(primary care, lab tests and prescription medication support) suggested needs of an
acute nature. Group 2 preferences (specialty care and hospitalization) suggested
experience with and need for chronic disease care. Group 3 showed another pattern, a
preference for emergency services only. No participants indicated a preference for
mental health services. Multidimensional scaling analysis (MDS) further described these
clusters by classifying participants along three dimensions that suggested higher versus
lower perceived need for services. Dimension 1 reflected participants’ likeliness to use
the service. Dimension 2 differentiated between preferences for services that might be
needed by people with chronic disease(s). Dimension 3 reflected perceptions of the cost
associated with services. Psychometric analyses may uncover additional dimensions of
preference that would not be revealed by standard statistical analyses. This study’s
outcome shows that these techniques reveal critical information when analyzing
perception datasets, which may be helpful in guiding policymakers and clinics that serve
the uninsured population.
The Multi-State Learning Collaborative: A Public Health Quality
Improvement Initiative in Kansas
Authors:
Ruth Wetta-Hall, Gianfranco Pezzino, Edie Snethen, Tatiana Lin, Lisette
T. Jacobson, and Ashley Moss
The purpose of this project was to explore the design, implementation, and short-term
outputs of the Multistate Learning Collaborative (MLC) in Kansas and its impact on
preparation for public health accreditation and progress in developing a quality
improvement (QI) culture. Using telephone-based focus group methods, participants’
perceptions from three separate training initiatives were assessed. Participants were
representatives of regions that participated in the MLC training. Themes identified
through the focus group process were categorized based on program strength,
perceived barriers to progress, and sustainability. The results of this study point to four
specific strengths that were influential in the success of the MLC initiative when
achieving program goals: (1) interactive training activities and the ability to learn from
their peers, (2) enhanced communication among regions and team members, (3) easy
to access technical support, and (4) the ability to collaborate via the Internet from
remote locations. The interaction of these elements combined to create lines of
communication between and among teams while facilitating the learning and application
of QI methods. Perceived barriers to progress included the challenges of public health
data sets, adoption of the QI philosophy within an organization’s culture, and evolving
governmental guidelines requiring continual adaptation. Identification of long-term
program sustainability issues included (1) funding sources for technical assistance,
training, and travel; (2) organization-wide commitment to QI requiring ongoing training
and support; and (3) continued collaboration among and across regions. Altogether,
organizations continue to make progress toward public health accreditation and
integration of a quality improvement culture.
Students
Intern Management: Improving the Quality of Workforce Development
Authors:
Pamela Behnk, Sonja Armbruster, and Ty Kane
Introduction: Workforce development is one of the ten essential public health
services: “8. Assure a competent public and personal health care workforce.” New state,
local and tribal health department accreditation standards are framed by the ten
essential public health services. The standards require that departments demonstrate
their relationships and collaborations that promote public health as a career.
Background: The Sedgwick County Health Department has and continues to
successfully host interns from over a dozen educational institutions, but lacks a
standard documentation system. In preparation for meeting accreditation standards,
SCHD program mangers recognized gaps in documentation and management of intern
experiences. A Quality Improvement project team was formed to assess current efforts
and plan improvements.
Methods: Methodology centered on a nine step PDSA process. Multiple stakeholder
meetings took place to identify issues, examine current/future approaches, develop a
plan for all interns and develop an interactive online database for documentation of
intern activities.
Results: A SharePoint site was created to provide a consistent data collection strategy
that will allow leaders to assess the full impact of intern efforts. This tool provides
reports of intern hours worked, projects completed, and partnerships with institutions of
higher education.
Discussion/Conclusion: Developing new documentation strategies require time,
training, and shared interest among staff. Illustrating the significance of completed
activities, collaboration with schools, and hours of mentoring provided to the future
public health workforce will assist the SCHD to meet accreditation standards.
A Tour of Diabetes Education Programs in Kansas City
Author:
Steve Daniel
Diabetes has become a rapidly growing epidemic over the past two decades,
increasingly impacting the Latino community. Diabetes education health centers around
the country have been one of the answers used to combat this widespread disease.
However, this seems to also have led to mixed results. Grants and other types of
fundings have at times, slowed the development of education centers, which are sorely
needed around the country. We visited four well known institutions that offered
education classes in the Kansas City area, with a goal of understanding how each of
these centers appealed to their patients, mainly Latino, with improved knowledge,
reduced fear, and better diet consistent with management of Type II diabetes. Of the
four, it appeared that one was more engaging for patients, had less of a didactic
atmosphere and its utilization of conversation maps in a round table like discussion, and
suggested this was a more effective way of educating patients. Another class offered
was well known for offering insulin to its participants. The remaining clinics, while,
drawing the same number of participants, had some limitations, especially due to not
being open to the public.
Effect of Marital Status on Colorectal Cancer Screening Participation
in the United States
Authors:
Boutros El Haddad and Olusegun Olaosebikan
Objective: The objective of this study was to compare the participation rate in
colorectal cancer screening among married, separated, widowed, never married, and
divorced adults living in the United States.
Introduction: Marital status has been implicated as a factor affecting colorectal
screening participation.
Methods: The population studied included 139,273 participants, aged 50 to 75, who
completed the Behavioral Risk Factor Surveillance System survey (BRFSS) in 2008.
Participants were considered to be current on colorectal screening if they have had a
FOBT done within the past year, or sigmoidoscopy performed with the last five years, or
a colonoscopy within the past 10 years.
Results: Logistic regression analysis that included marital status, education level,
income, and the presence of health care coverage suggested that individuals who are
divorced (OR=0.826; p<0.001), widowed (OR=0.890; p<0.001), never married
(OR=0.755; p<0.001), and those who are members of an unmarried couple (OR=0.756;
p<0.001) were less likely to be appropriately screened than married individuals. There
was no significant difference in the current colorectal screening between the separated
and the married group.
Discussion: Married individuals were more likely to be screened compared to
divorced, widowed, never married, and members of unmarried couples.
Conclusion: Unmarried individuals are at risk for not receiving appropriate colorectal
cancer screening.
Kansas Kids Keep It Healthy
Authors:
Jennie Guerrero, Christine Krill
Our poster puts an emphasis on the importance of keeping children healthy and active.
This came about from developing two projects, Exergames and a Read and Ride
program, which kids enjoy and keeps them active at the same time. The description of
the Exergames is to turn passive screen time into physical fitness times using the
technology of video game systems. It is based on a similar program done in Idaho that
is titled “Fit and Healthy: Incorporating Exergames and Nutrition”. The kids will play an
interactive video game on Nintendo Wii, such as dance game, and show how being
active can be in many forms and if it is fun then the kids will want to be active. The
description for the Read & Ride program is designed to have the students read a book
while riding a stationary exercise bike. This program can be used as an incentive for
students to complete their class work in school or an outlet to release some fun energy
while in camp. Riding a bike provides children with a difference aspect of exercising that
can be fun to engage with family and friends. Our program is different from others
because it combines two different activities that are fun and challenging for kids. We
tested out the program at a local community center which yielded positive results
because the kids had fun while participating in a healthy activity while staying focused.
Study of ASCUS Pap Management Practices in Underserved Women
Authors:
Steven Haenchen, Sue Min Lai, Ghazala Perveen, and Rebecca Horvat
Background: The widespread adoption of Papanicolaou (Pap) screening has
decreased the cervical cancer mortality rate in the United States, but discrepancies
remain regarding care for the 5% of Pap tests with a minimally abnormal result of
abnormal squamous cells of undetermined significance (ASCUS). Research regarding
HPV testing to understand ASCUS Pap results has demonstrated a positive HPV test
result with an ASCUS result has greater sensitivity for underlying abnormalities than
rescreening methods. New guidelines reflect these findings.
Methods: Data from a cervical cancer screening program for underserved women in
Kansas (Early Detection Works) spanning 15 years of procedures performed on 25,512
women was analyzed. Relative risk regression determined factors associated with HPV
testing following an ASCUS Pap result. Published colposcopy referral rates combined
with follow-up rates for recommended procedures in these data were used to compare
the cost of an HPV test triage following an ASCUS Pap to current practice.
Results: Women under 40 years old and those residing in urban areas were less likely
to receive HPV testing as follow-up for their abnormal screening. A substantial cost
increase was associated with HPV triage, but lower loss to follow-up is predicted, thus
completing screening in a larger proportion of women.
Conclusion: Though the cost of caring for ASCUS Paps by HPV triage is greater, a
larger proportion of women complete screening. HPV triage should be utilized,
particularly for women easily lost to follow-up. Women not cared for by HPV triage
should have their results explained to encourage compliance.
Differences in Access to Healthcare between Hispanics and nonHispanics in the United States
Authors:
Dong
Marissa Higinio, Fannette Thornhill-Scott, Kimberly Walker, and Frank
Introduction: Approximately 45 million Hispanics live in the US. Research suggests
that Hispanics are less likely to have health insurance coverage compared to nonHispanics. This study examines if there is a difference in health care coverage and
preventive services between Hispanic and non-Hispanics.
Methods: Data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS)
survey were analyzed utilizing the Predictive Analytics Software (PASW 18.0).
Participants included Hispanic and non-Hispanic respondents 18 years and older. Prior
to randomization, there were 400,118 non-Hispanic individuals and 30,075 Hispanic
individuals. Randomly, 30,075 non-Hispanics were selected, which resulted in a total of
60,150 respondents. Health care access was defined in four health indicators (health
insurance status, having a personal doctor, obtaining routine check-ups, and avoiding
seeing physician when care was needed due to cost). These four health indicators were
compared between Hispanics and non-Hispanics.
Results: Hispanic individuals were less likely to have health insurance than nonHispanics, 2 (2, N=60) = 2475.801, p<0.001; less likely to see a physician because of
cost than non-Hispanic individuals, 2 (1, N=60009) = 1479.456, p<0.001; less likely to
have a personal doctor, 2 (2, N=59985) = 1894.573, p<0.001; and there was a
difference between Hispanic and non-Hispanic individuals in obtaining routine
checkups, 2 (4, N=59469) = 339.621, p<0.001.
Conclusions: The results of this study suggest there is a difference in access to
healthcare between Hispanic and non-Hispanic individuals in the United States.
Breastfeeding: An Initiative to Increase the Initiation and Duration of
Breastfeeding Rates among Mothers in Kansas
Lisette T. Jacobson, Ruth Wetta-Hall, and Ashley Moss
The purpose of this project was to evaluate the goals and objectives of an initiative to
increase the initiation and duration of breastfeeding rates among mothers in Kansas.
Using structured telephone interviews, this research study examined: (1) how well
program goals and objective were met, (2) progress made by grantee towards achieving
purpose of the grant, (3) problems encountered in an effort to achieve the grant’s
purpose, and (4) evaluation measures implemented to determine program
improvement. Across the state of Kansas, eighteen public health departments received
funding through the Kansas Public Health Association’s Breastfeeding Grant Initiative.
Based on 2010 U.S. Census data, fifteen health departments were rural and four health
departments were urban. Findings indicate most funded health departments were
meeting their goals and objectives. Themes identified through the interview process
were categorized based on program strength, recommendations and sustainability.
Most LHDs reported the availability of adequate resources and their primary use of
funds included the purchase/rental of breast pumps, resource bags, and distribution of
educational materials. The majority of LHDs recommended the administration of a
survey measuring program effectiveness and continuing support for breastfeeding
mothers. Most LHDs reported not having measurements in place to evaluate program
outcomes. In order to sustain current programs, most LHDs desired continued funding
for breastfeeding programs. At the time that this study was conducted, the majority of
LHDs reported that it was too early to tell whether they would achieve the grant’s
purpose or encounter problems in their effort to achieve the grant’s purpose.
The Effect of Physical Activity on Number of Unhealthy Days among
Individuals Reporting Doctor-Diagnosed Arthritis
Authors:
Erin Locke-Nilhas, Arraya Paksin-Hall, Pamela Behnk
Introduction: Persons with arthritis report fewer healthy days than those without
arthritis. This study examined individuals who reported doctor-diagnosed arthritis and
the difference in the number of reported unhealthy days between those who reported
physical activity and those who did not.
Methods: This study utilized the national 2009 Behavioral Risk Factor Surveillance
System (BRFSS) survey data for 129,566 adults who reported being age 50 years and
older and reported doctor-diagnosed arthritis. Variables used in the analysis were
sociodemographics, body mass index (BMI), physical activity (PA) level, and three
categories of unhealthy days, mental, physical, and limited activity. Sufficient PA was
defined as 150 minutes of moderate PA per week or 75 minutes of vigorous PA per
week. Unhealthy days were dichotomized into ≥14 or <14 days. Proportions were
calculated and logistic regression was conducted with SPSS Version 18.0.
Results: A quarter of all respondents reported being inactive. Inactive respondents
were 1.89 times more likely to report ≥14 physically unhealthy days (95% CI, 1.73-2.08)
and 1.83 times more likely to report ≥14 mentally unhealthy days (95% CI, 1.74-2.04). In
addition, inactive respondents were 2.40 times more likely to report ≥14 days when
activity was limited (95% CI, 2.21-2.78).
Conclusions: Those reporting doctor-diagnosed arthritis who meet sufficient PA levels
are more likely to report fewer unhealthy physical and mental days and to report fewer
days when activity is limited from these unhealthy days. Patients diagnosed with arthritis
could benefit from sufficient levels of physical activity to improve quality of life.
Relationship of Health Care Coverage and Usual Source of Care with
Physical Activity
Author:
Colleen Loo-Gross
Background: Health care coverage and a usual source of care are independent
predictors of receipt of preventive services, such as lifestyle modification counseling.
However, it is not yet clear whether these factors are associated with actual behavioral
change.
Methods: Secondary data for this study were collected from the 2009 Behavioral Risk
Factor Surveillance System (BRFSS). Data were stratified into four categories based on
health care coverage status and whether respondents had a personal health care
provider. A chi-square test and logistic regression were used to determine association
of health care coverage and a usual source of care with the outcome of meeting
recommended levels of moderate or vigorous physical activity.
Results: Among respondents, 81.7% (n=322,061) reported having both health care
coverage and a personal provider, 8.0% (n=31,640) reported having only health care
coverage, 5.3% (n=20,757) reported having only a personal provider, and 5.0%
(n=19,818) reported having neither. Logistic regression suggested a positive association
of having health care coverage and meeting physical activity recommendations, 2 (1,
N=394,276) = 4.4296, p<0.001. Having a usual source of care was not found to have a
significant association with achievement with achievement of physical activity
recommendations.
Conclusions: Though having a usual source of care improves the likelihood of
receiving behavioral modification counseling, initial results indicate that having a
personal provider is not associated with completing recommended levels of physical
activity. Thus, stronger public health involvement is needed in addressing healthy
lifestyle behaviors.
Exploring the Limitations of HIV Medication Effectiveness: An
Analysis of Changes in P-Glycoprotein Expression in HIV-Infected
Gastrointestinal Cells
Authors:
Kelstan E. Lynch, Greg Rice, Jerry Marlin, Tracey H. Taylor, and Mary
Peace McRae
Background: Treatment of HIV-infected persons with highly active antiretroviral
therapy suppresses plasma viral load below the limit of detection for standard assays.
However, if therapy is halted, viremia levels rapidly increase, indicating the presence of
reservoirs for HIV that persist despite “effective” treatment. Although it is likely that
multiple mechanisms exist, our hypothesis it that reservoirs are maintained, in part,
due to an overexpression of the drug overexpression in the gastrointestinal tract limits
antiretroviral penetration into this important reservoir tissue resulting in decreased
effectiveness of antiretroviral drugs. This study analyzed changes in P-glycoprotein in
small intestine tissues from HIV-infected and uninfected persons and in an intestinal
epithelial cell model, Caco2 cells.
Methods: Five HIV-positive and 4 uninfected small intestine cadaveric human samples
were obtained from National Disease Research Interchange. Subjects were not on
medications that inhibit or induce P-glycoprotein for at least 2 weeks prior to harvest.
Tissues were snap frozen and membrane proteins extracted and analyzed by
immunoblotting. P-glycoprotein expression was quantified relative to the enterocyte
marker villin. To examine the effect of HIV infection on P-glycoprotein in vitro, Caco2
cells (a model for enterocytes) were infected with HIV, cells lysed at 6, 24, and 48 hours
post-infection, and P-glycoprotein expression quantified. ImageJ was used for
quantitation of immunoblots.
Results: In human intestinal tissue, P-glycoprotein expression was increased by 12%
in enterocytes of HIV-infected samples. In vitro experiments of HIV-infected cells
revealed an initial decrease in P-glycoprotein expression of 46% and 15% at 6 and 24
hours, respectively. At 48 hours, however, P-glycoprotein expression was increased by
36.6% compared to uninfected controls.
Conclusions: Preliminary results demonstrate an increase in enterocyte-specific Pglycoprotein in HIV-infected intestinal samples compared to controls, supporting our
hypothesis that HIV increases the expression of this protein in intestinal epithelial cells,
which in turn could decrease the efficacy of HIV therapies in these tissues. These initial
results warrant further investigation and contribute to overall understanding of the
effects of HIV on drug transport proteins within the intestinal tract.
Does Posting Messages on YouTube Lead to Better Mental Health?: A
Thematic Analysis of the “It Gets Better Project”
Author:
Pamela K. O’Neal
Studies indicate young gay, lesbian, bisexual and transgendered (LGBT) adolescents
are more likely to attempt suicide than their straight peers. (Russel, S & Joyner, K.
2001; Silenzio et al., 2007). Young LGBT people who have been bullied may also suffer
long lasting effects into adulthood making social acceptance crucial to their well-being
(USDHHS, 2010). In response to recent, widely publicized suicides by gay and lesbian
teens, attributed to bullying, syndicated columnist Dan Savage developed the “It Gets
Better Project” on YouTube. Since the inception of the “It Gets Better Project” on
September 1, 2010 over 5,000 videos had been posted by November 28, 2010 (It Gets
Better Project, 2010). Those who have posted videos range from celebrities such as
Anne Hathaway, to U.S. President Barack Obama, to average citizens.
The videos are uploaded to establish a channel where messages could be posted and
conversations generated with the intention of creating an environment of support for
youth struggling with negative social reaction to their sexual identity.
The overarching message of the “It Gets Better Project” is hope; the 25 most often
viewed videos were analyzed to identify emergent themes (Boyatzis, 1998). Analysis
also analyzed gender self presentations (female, male, transgender) of those posting
videos and the average video length. Results include possible connections to increased
number of calls to suicide hotline for LGBT youth.
Developing a Writing Intervention to Mediate Stress among Women
Leaving Jail
Authors:
Sydni Pankey, Megha Ramaswamy, Patricia J. Kelly, and Nikki Nollen
Women in the criminal justice system have experienced violence and trauma in myriad
forms throughout their lives. Residual effects of these experiences are seen in mental,
physical health and drug problems, as well as recidivism. Few resources are available
for women to address unresolved sexual and physical abuse and current family
violence. As women leave jails and return to their communities, these histories of
violence further complicate their ability to navigate post-release sexual partnerships,
familial relationships, obligations to children and securing housing, employment, and
income.
Traumatic experiences can adversely affect physical and mental health. Expressing
these experiences through language, however, can alleviate the physical burden of
such stressors. Research suggests expression through writing can be beneficial and
can be used outside of traditional psychotherapy. For example, people often show
immediate signs of stress reduction while writing. To the best of our knowledge, no
studies have examined how writing could benefit women moving through jail.
This poster will describe the development, implementation, and evaluation of a freewriting intervention for female inmates to address high levels of stress, a critical
mediator for mental, physical health, and drug problems. We will describe the feasibility
of implementing a five-session writing workshop with women in jail and collecting
paper/pencil and biological markers of stress pre- and post-intervention.
A free-writing intervention is a cost-effective and sustainable approach to addressing
stress and health among women in the criminal justice system. If we can demonstrate
the feasibility and efficacy of this approach, our intervention could be widely
reproducible.
The Association between Perception of Neighborhood Disadvantage
and Drug Problems among Women and Men in Jail
Authors:
Kelly
Jessica Rogers, Megha Ramaswamy, Kimber P. Richter, and Patricia J.
There is increasing evidence that neighborhood disadvantage and lack of a sense of
community influence an individual’s susceptibility to drug and alcohol problems.
However, this has never been examined within an incarcerated population, where
frequent transitions between institution and neighborhood are common. Increasing our
understanding of these correlations could help us to implement more targeted programs
to decrease drug and alcohol problems and recidivism among the incarcerated
population. For this study, 596 men and women from three Kansas City jails were
surveyed over the course of six months in 2010. The analysis is expected to show that
perceptions of neighborhood disadvantage are correlated with alcohol problems and
substance dependence among the incarcerated population. It is expected that these
correlations will be more direct for the men surveyed, while women will have many more
variables (history of intimate partner violence, number of children, mental health) to
consider in addition to neighborhood perceptions. We will also look at the number of
arrests each study participant had, to see if time in the system (and therefore out of their
own neighborhood) had an effect on drug and alcohol problems. If the conclusions of
this study are as expected, preventative programs may need to take a more communitybased approach to the problem, implementing more programs that address the
transition from jails to disadvantage communities.
Assessing the Feasibility of Measuring Biomarkers of Stress in
Incarcerated Women
Authors:
Satyasree Upadhyayula, Megha Ramaswamy, and Patricia J. Kelly
Incarceration is a stressful life event that can have immediate and long-term negative
effects on an individual’s physiology, mood, and behavior. Previous studies have shown
that emotional writing is effective in reducing stress. In one study, after writing,
participants found that facial muscles were more relaxed and they had reduced
perspiration, blood pressure, and liver enzymes. Although several previous studies
looked into measuring physiologic factors associated with stress in the general
population, few were done in jails. Before doing a large-scale study in this population, it
is important to first assess the feasibility of collecting biomarkers for stress. This poster
will present a review of literature on biomarkers of stress, their efficacy, and methods of
collection. After identifying the biomarker that is most appropriate for this population, we
will collect samples from 10 incarcerated women who are participating in a 5 day writing
intervention program. Samples will be collected twice (once on day 1 and again at the 1
month follow-up session after their release from jail), but they will not be analyzed.
Feasibility of this protocol will be reported. If we can show that taking these
measurements in the jail setting is possible, then we can use this protocol as part of a
larger jail study. By measuring biomarkers, we will have a more complete and objective
understanding of the effects of the writing intervention program on participants’ health.
Environmental Justice and Physical Activity: Examining Disparities in
Access to Parks in Kansas City, MO
Authors:
Katherine Vaughan, Andrew T. Kaczynski, Sonja Wilhelm Stanis, Ryan
Bergstrom, and Gina Besenjy
Background/Purpose: Parks are key community assets for promoting physical
activity, but some evidence suggest these integral resources are not equitably
distributed. The purpose of this study was to examine disparities by income and
race/ethnicity in the availability, features, and quality of parks across Kansas City,
Missouri (KCMO).
Methods: All parks in KCMO were mapped using GIS and park features and quality
were determined via on-site audits. Data from the American Community Survey were
used to designate all 174 census tracts (CTs) within KCMO as either low, medium, or
high income and percent minority. MANCOVA was used to analyze differences in park
availability, features, and quality across income and race/ethnicity tertiles.
Results: Low income CTs contained significantly more parks (M=1.46) than medium
(M=1.25) or high (M=1.00) income CTs, but also had more quality concerns (e.g.,
vandalism) per park. High income CTs contained more playgrounds per park (M=.69)
than low (M=.62) and medium (M=.52) income tracts. There were more basketball
courts per park in high minority CTs (M=.59) than low (M=.13) or medium (M=.30)
minority CTs, and more trails per park in low (M=.60) and medium (M=.55) minority CTs
than high (M=.39) minority CTs. Finally, there were more sidewalks around parks in low
(M=.87) and high (M=.74) income CTs than medium (M=.61) income CTs.
Conclusion: Park availability was greater in low income areas, but several key park
characteristics were less common in low income or high minority areas. Future research
should examine policies that contribute to and that might rectify such disparities.
The Necessity for Strategic Alliances in the Health Care Industry
Author:
William Venable
In the exploration of public-private partnerships, health facilities, public health, and
human services, there is wealth of credible sources to justify the position for the use of
strategic alliances as a development and advancement tool in the health care sector.
Research has shown that in most cases strategic alliance are developed to add value,
reduce cost, improve productivity, or achieve goals that would otherwise go unmet. This
analysis presents key objectives that support the position in favor of strategic alliances
in health care. This analysis further provides insight and supports the position with
regard to how strategic alliances function in the provision of competitive advantage for
health care providers, added financial benefit for investment partners, and in the
improvement of access to the health care system for an aging world population.
Putting One Health into Practice: Examining Strategies for Disease
Prevention Using Rabies as a Model
Authors:
Kristina Wert, Cathleen Hanlon, Beth Montelone, and Elizabeth Davis
Healthy communities, including both people and animals, are reliant on public health
strategies to demonstrate proper control for zoonotic disease prevention. By examining
current practices used for rabies prevention, the model can provide an insight into
surveillance and strategies that can be applied to new or emerging diseases. This
project focused on the examination of state testing policies, the epidemiological
evaluation of rabies cases in Kansas and Nebraska, and finally the development of
educational materials regarding prevention measures for rabies aimed towards middle
and high school audiences. The investigation into state rabies testing policies was
necessary to demonstrate adequate preparedness and maintenance of surveillance
systems and diagnostic access for rabies and other core public health diseases. An
epidemiological study was conducted from a selected sample of submissions to Kansas
State University Rabies Lab and prevalence was compared by species and county. Key
factors in understanding epizootiology of rabies are that submitted samples are a
selected sub-set of the population and positive cases are only the tip of the iceberg of
the true number of rabies cases, particularly among wildlife species. Lastly, a poster
campaign was created in collaboration with One Health Kansas to develop age
appropriate educational materials. A preliminary survey of high school students showed
rudimentary knowledge about rabies and an incomplete awareness of the virus, postexposure procedures and treatments for both animals and humans. Overall, the current
model for rabies, using these vantage points, was analyzed to determine community
impact and allow better preparedness for future potential challenges.
Excessive Alcohol Consumption and Receipt of Pneumococcal
Vaccination
Authors:
Jennifer Wipperman, Scott Taylor, Frank Dong, and Elizabeth Ablah
Background: Streptococcus pneumonia is a major cause of mortality among the
elderly and those with high risk medical conditions, such as alcoholism. Current
immunization guidelines recommend that all people ages 65 years and older and those
with underlying medical conditions be vaccinated against S. pneumonia. However,
people with alcoholism are less likely to use preventive services than the general
population.
Research Question: Are vaccination rates among heavy alcohol drinkers ages 18-64
different than then general population ages 65 years and older?
Methods: Data were retrieved from the 2009 Behavioral Risk Surveillance System
database. Demographics assessed included race, gender, income, health care access
and education level. Heavy drinking was defined as having more than 30 drinks per
month for women and more than 60 drinks per month for men. Logistic regression was
used to predict the odds of PPSV23 receipt among adults ages 65 years or older versus
heavy drinkers ages 18-64, and included variables for gender, education, health care
access and race.
Results: Adults ages 65 years and older were nearly twice as likely to report having
received PPSV23 than heavy drinkers (OR=1.93, p<0.001).
Conclusion: Heavy drinkers are significantly less likely to report having received the
PPSV23 vaccination than those aged 65 years and older. Since heavy drinkers suffer
increased mortality from pneumococcal infection, it is important to target this group for
vaccination.
Health Literacy Assessment of the STOFHLA: Paper versus Online
Administration Continuation Study
Authors:
Jennifer Wipperman, Nikki Keene Woods, Rachel Wilson, Frank Dong,
Amy Chesser, and Rick Kellerman
Background: Health literacy is the “degree to which individuals have the capacity to
obtain, process, and understand basic health information and services needed to make
appropriate health decisions”. Nearly half of all US adults have difficulty comprehending
health information. Low Health literacy is associated with poor health outcomes and
increased health care expenditures. Knowledge of health literacy status may improve
patient-provider communication and health outcomes. This preliminary study evaluates
the feasibility of using a health literacy assessment tool, the Short Test of Functional
Health Literacy in Adults (S-TOFHLA), electronically (via computer).
Research Question: Is there a difference in scores and time to completion between
computer and paper delivery of the S-TOFHLA?
Methods: Eighty participants were recruited from a Midwest Family Medicine residency
clinic. Inclusion criteria were: 18 years and older, English-speaking, and average
reported computer skills. Patients were randomized to take either the S-TOFHLA
computer or paper format first, followed by the opposite format 30-days later. Difference
in scores and time to completion between the first and second test was calculation, and
a regression model was used to determine the significance of test order.
Results: All data will be collected by mid-August. Preliminary results indicate there is
no difference in scores or time to completion between S-TOFHLA delivery methods.
Conclusion: The electronic administration of the S-TOFHLA will be validated. This
format may be useful for rapid assessment of patients’ health literacy status resulting in
improved patient-physician communication, enhanced patient understanding of medical
information, and improved patient outcomes.