#1 Health and Access to Care Among Reproductive-Age Women by Sexual Orientation and Pregnancy Status
Authors: Dr. Gilbert Gonzales, PhD, MHA; Nicole Quinones; Dr. Laura Attanasio, PhD, MS
Background. A large body of research has documented disparities in health and access to care among sexual minority populations, but very little population-based research has focused on health care needs among pregnant sexual minority women. Methods. Data for this study came from 4,020 reproductive-age (18-44 years) women who identified as lesbian or bisexual and 64,188 reproductive-age women who identified as heterosexual in the 2014-2016 Behavioral Risk Factor Surveillance System. Logistic regression models were used to compare health care access, health outcomes, and health behaviors by sexual orientation and pregnancy status while controlling for demographic characteristics and socioeconomic status. Results. Approximately 3% of reproductive-age sexual minority women were pregnant. Pregnant sexual minority women were more likely to have unmet medical care due to cost, frequent mental distress, depression, poor/fair health, activity limitations, chronic conditions, and risky health behaviors compared to pregnant heterosexual women. Non-pregnant sexual minority women were more likely to report barriers to care, activity limitations, chronic conditions, smoking, and binge drinking compared to non-pregnant heterosexual women. Health outcomes were similar between pregnant and non-pregnant sexual minority women, but pregnant sexual minority women were less likely to consume alcohol compared to non-pregnant sexual minority women. Conclusions. This study adds new population-based research to the limited body of evidence on health and access to care for pregnant sexual minority women, who may face stressors, discrimination, and stigma during pregnancy. More research and programs should focus on perinatal care that is inclusive of diverse families and sexual orientations.
#2 Adherence to dietary recommendations and colorectal cancer risk: results from two prospective cohort studies>
Authors: Sang Nguyen, Honglan Li, Danxia Yu, Jing Gao, Huong Tran, Yong-Bing Xiang, Wei Zheng, Xiao-Ou Shu
Background. Understanding the association between diet and colorectal cancer (CRC) risk is essential to curbing the epidemic of this cancer. This study prospectively evaluated adherence to the Chinese Food Pagoda (CHFP), and two American Dietary Guidelines: The Alternative Healthy Eating Index (AHEI-2010) and the Dietary Approaches to Stop Hypertension (DASH) in association with CRC risk among Chinese adults living in urban Shanghai, China.
Methods. Participants included 60,161 men and 72,445 women aged 40-74 from two ongoing population-based prospective cohort studies. Associations between dietary guideline compliance scores and CRC risk were evaluated by Cox proportion hazard regression analyses with age as time metric and potential confounders adjusted.
Results. We identified 1,670 CRC incidence cases (691 males and 979 females) during an average 8.1 years of follow-up for men and 13.4 for women. A higher CHFP score was associated with decreased risk of CRC, with HR (95% CI) of 0.88 (0.77, 1.00), 0.86 (0.75, 0.99) and 0.84 (0.73, 0.97) for the 2nd, 3th and 4th quartile versus 1st quartile, respectively (p-trend=0.012). The inverse association appears stronger for rectal cancer, and among younger-age groups (<50 years), individuals with a lower BMI (<25 kg/m2) or without any metabolic conditions although interaction tests were not significant. No consistent association pattern was observed for the modified DASH score and the modified AHEI-2010.
Conclusion. Compliance with the Dietary Guidelines for Chinese was statistically associated with reduced risk of CRC among Chinese adults. To maximize health impact, dietary recommendations need to be tailored for specific populations.
#3 Tennessee Stroke Registry Report 2017
Author: Natalie Stanley
Legislation enacted on July 1, 2017 requires all certified comprehensive and primary stroke centers in Tennessee to share their data with the Tennessee Stroke Registry (TSR) in order to improve stroke care in the state. Analyzed in this report are aggregate data from the 31 hospitals that reported to the TSR from January through December 2017. Similarities and differences between 2016 and 2017 data are also provided. The total number of stroke cases for 2017 was 12,768. The most common cases were ischemic strokes at 71.3% of strokes. The proportions of male and female stroke cases for most stroke types were similar, except subarachnoid hemorrhage, with 61% percent of cases occurring in females and 39% occurring in males. These gender differences were less pronounced than in 2016, where 66% of cases occurred in females and 34% occurred in males. Arrival mode and times from last known well were also studied. Overall, private transport observed longer transportation times from home/scene in comparison to Emergency Medical Services (EMS) transport. Most patients arrived at the hospital in over 300 minutes via private transportation (76.3%), while only 52.4% of patients via EMS arrived in that time frame. Compared to 80.6% of those arriving via EMS, only 71.1% of patients arriving via private transport received treatment with tissue plasminogen activator (IV r-tPA) within three hours. Data on age, race, and co-morbidities were also included in the report.
#4 The PathLink Acquired Gestational Tissue Bank: Feasibility of Project PLACENTA
Authors: Kisha Batey; Jodell E. Linder, Rebecca Johnston, Ethan M. Cohen, Yu Wang, Xiaoming Wang, Lisa M. Rogers, William Hayes McDonald, Michelle L. Reyzer, Audra Judd, Jeffery Goldstein, Hernán Correa, Jill Pulley, David M. Aronoff
Background: Despite advances, premature births and other pregnancy complications continue to be major problems across the world. In order to accelerate advancements in pregnancy outcomes, Project PLACENTA investigated the feasibility of a developing a fresh gestational tissue biobank and a research platform to explore perinatal adverse outcomes, especially issues faced by the greater Nashville community.
Methods: A survey conducted across Vanderbilt researchers determined interest in usage of the proposed biobank. An email alert system was developed to alert staff of delivery for timely collection of the placenta. Study staff piloted collection methods for ascertaining samples. Community members who had delivered babies within the last three years were consulted for feedback on the biobank, approaches to consent, and suggestions on increasing participation.
Results: The pilot phase of the email alert system and collection methods was successful. Of 60 deliveries, 25 were sent to Pathology or to other research protocols, 10 were discarded, and 25 were available for collection. Twenty placentas were collected and processed. The project is now in the second phase where participants will be consented for connection of patient data to physical samples. Project PLACENTA is actively engaging providers and community members to raise awareness of the biobank.
Conclusions: The creation of this tool uniquely connects patient data to the physical tissue samples, enabling researchers to utilize clinical data in their research the links between environment in the womb and disease. Project PLACENTA will enrich knowledge of both maternal and fetal short- and long-term health through gestational tissue research.
#5 Let’s Talk About It: Student Facilitated One-on-One Health Coaching for Residents In Recovery
Authors: Kathryn Biette, BA, MSN(c), Ellie Blauw, BA, MSN(c), Bailey Grace Elkin, BA, MSN(c), Daniela Falcone, BA, MSN(c), Leah LaRussa, BS, MSN(c), Jennifer Nguyen, BA, MSN(c), Kelly Quaine, BS, MSN(c), Abby Scanlan, BS, MSN(c), Lauren Sylwester, BS, MSN(c), Brittany Haskell, MSN, MA, PMHNP-BC
Background: Residents at a voluntary addiction treatment facility for women have psychoeducational groups that provide information and support with an identified gap being lack of individualized one-on-one health education. Motivational interviewing through one-on-one interactions has the potential to increase confidence in making positive lifestyle changes, which could ultimately decrease relapse due to life stressors.
Objective: This quality improvement initiative aims to use motivational interviewing to increase residents’ confidence in applying various healthcare topics through one-on-one health coaching. The goal is to obtain an increase of two points on a 5-point Likert Scale measuring confidence in application and a total average attendance of five clients each session.
Methods: Baseline interviews with staff and residents identified and prioritized residents’ knowledge deficits about the following healthcare topics: stress management, nutrition, exercise, navigating healthcare, pain management and women’s health. Over a 16-week period, 9 nursing students delivered one-on-one, topically-focused, weekly health coaching sessions to residents. Each 15-minute session included individualized handouts for discussion guidance. Residents completed a self-report, pre- and post-survey measuring confidence in applying learned knowledge.
Results: 381 residents participated over 16 weeks, with a mean of 23.8 residents each week. The average pre-confidence rating was 2.66/5, and the average post-confidence rating was 4.72/5. Confidence increased by 2.07 points, on average.
Conclusion: Health coaching sessions are a valuable activity for residents. The residents indicated an increased confidence in applying the chosen topic(s). Future research should be done to determine long term benefits of one-one-one health coaching for women in addiction recovery.
#6 EXPOSURE TO CIGARETTE SMOKING AND ALCOHOL CONSUMPTION AS RISK FACTORS FOR STROKE MORTALITY IN TENNESSEE COUNTIES FROM 2006- 2015
Authors: Myrna Pierre, Chau-Kuang Chen, Millard Collins, Green Ekadi
Stroke is identified as the fifth leading cause of death in Tennessee, affecting approximately 3.8% of the state’s population. According to the Behavioral Risk Factor Surveillance System (BRFSS), exposure to second-hand smoke and alcohol consumption are among the risk factors for stroke mortality in Tennessee. The study used the population health framework to demonstrate factors that pose a risk to the health of the population beyond clinical factors. As such, this study was designed to assess the relationship between stroke mortality rate, and its risk factors including exposure to cigarette smoking, alcohol consumption for African-American and Caucasian population in Tennessee within a ten-year period between 2006 and 2015. Data were collected from the Tennessee Department of Health, Division of Health Statistics. In this study, the dependent variable is stroke mortality rate and independent variables were exposure to cigarette smoking, alcohol consumption, race group (African-Americans vs, Caucasians), county characteristics (rural vs urban), and time period (2006-2010 vs. 2011-2015). Multiple linear regression analysis was implemented to quantify the magnitude effect of risk factors on the stroke mortality. General linear regression approach was used as a benchmarking tool to validate the study results and to ensure the model robustness. The study findings indicated that both exposure to cigarette smoke and alcohol consumption were significant risk factors. Also, there was a significant mean difference of the stroke mortality rate between African-American and Caucasian populations. However, there was no stroke mortality rate difference with respect to temporal effect between the two five-year periods.
#7 Vicious Cycle: How Health Factors Impact Child Poverty
Authors: Melissa Gomez, Ed.D. and Kadi Bliss, Ph.D., CHES
Background: Children under the age of 18 have a higher percentage of living under the poverty line than any other age group. Understanding the characteristics associated with child poverty is essential due to the high number of impoverished children, negative consequences associated with child poverty, and potential positive impact public policies can have in fighting child poverty. This poster will focus on the Southern United States due to persistent poverty rates in the region.
Research Question: What health characteristics that are associated with child poverty, and do county level child poverty rates in the Southern United States tend to cluster together?
Methods: County-level child poverty rates were retrieved from the U.S. Census Bureau’s American Community Survey, which provides annual estimates based on a smaller sample size than the decennial census (2016). Data for the independent variables were retrieved from County Health Rankings (2010), specifically teen birth rate, percentage of births to unmarried mothers, percentage of single mother households, and percentage of population uninsured. Multivariate analysis was performed in R to examine the relationship between the independent variables and the 2015 child poverty rate for the entire South, and spatial analysis was conducted to provide GIS mapping.
Results: Most health variables were positively related to child poverty, including percent births to unmarried mothers (b = .04; p ≤.001), percent single-mother households (b = .67; p ≤.001), and percent uninsured (b = .69; p ≤.001).
Conclusion: Health variables consistently and positively predicted child poverty. Specific relationships and policy implications will be presented.
#8 Screening for Depression, Anxiety, and Substance Abuse among College Students in Tennessee
Author: Charles Brown, PhD
Background: Public health officials and researchers in Tennessee are becoming increasingly concerned about the prevalence of mental illness and substance abuse among college-aged young adults (18-25 years old).
Objectives: This study assessed the prevalence of mental health illnesses and substance abuse issues among young adult college students.
Methods: The study population included undergraduate students enrolled in a public university in Tennessee. The data for this study involved self-reported data collected in 2015 and 2018, which included one single question screen for alcohol use and one single question screen for drug use (Peter Smith et al, 2009), four questions from the Patient Health Questionnaire (PHQ-4) to screen for depression and anxiety (Kroenke, Spitzer, Williams, & Löwe, 2009), and four questions concerning demographic characteristics.
Results: One hundred and nineteen (Age 18–25) students provided usable data. The results revealed that at least once in the past year, 66% of males reported binge drinking (5 or more drinks in a day), and 57% of females consumed 4 or more drinks of alcohol in a day. Nearly half (46%) of males and 29% of females reported using a recreational drug or prescription medication other than how it was prescribed in the past year. A considerable number of students (19%) reported mild to moderate depression, while more than one fifth (23%) of students reported symptoms of anxiety.
Conclusion: Routinely screening for depression, anxiety, binge drinking, and drug abuse are critical to identifying major health issues facing college-aged young adults in Tennessee.
#9 “Are You Ready? Are We Ready? A Mixed Methods Approach in Assessing Readiness for Health Equity Discussions at the Local Health Department”
Authors: Obrenka Thompson, MPH, Tracy Buck MS, RDN, Fonda Harris PhD, Tina Lester BSN, MSN, Raquel Qualls-Hampton PhD, MS
Background: 2014 Healthy Nashville Community Health Improvement Plan identified Advancing Health Equity as a strategic priority. Health departments across the country have begun incorporating health equity into everyday work. Nashville, TN possesses a difficult past around conversations of race and racism, requiring a pause in advancement. In efforts to understand perceptions of staff, Pre- Baseline Sample Survey was developed to measure staff readiness to have conversations about institutional racism, prejudice and health equity.
Objectives: To understand baseline attitudes, knowledge and perceptions of staff about health equity and other encompassing topics. Having understanding will allow for education and training to be mapped in a more strategic and culturally appropriate way.
Methods: Mixed methods baseline survey was created. Participants were asked to define health equity and health disparities as well as questions about management support around difficult conversation topics such as institutional racism and discrimination.
Results: 75%of the 124 randomly selected staff members participated with 14% being supervisors. On average, staff believed supervisors were slightly more supportive of open/honest conversations about prejudice, institutional racism and discrimination compared to upper level management. Staff reported greater confidence that supervisors are supportive of health equity conversations than upper level management. Approximately 3 of 4 participants practice health equity in their job.
Conclusion: Employees express concern about lack of support from upper level management. To make a successful culture shift in practice of health equity additional topics such as institution racism and prejudice must be discussed. By increasing these conversations, strategic education and increased support can occur.
#10 “Health Equity vs. Health Disparities, Do We Really Understand the Difference at a Local Level?”
Authors: Obrenka Thompson, MPH, Tracy Buck MS, RDN, Fonda Harris PhD, Tina Lester BSN, MSN, Raquel Qualls-Hampton MS, PhD
Background: Understanding Health Equity and Health Disparities can be complex. In the process of educating we want to make sure each concept is understood correctly. Health equity is becoming a much-needed addition to public health practice with many organizations creating definitions and explaining how to apply the concept in everyday work.
Objectives: To assess staff knowledge of health equity and health disparities. Using assessment data will assist in creating educational materials to meet staff at their knowledge level.
Methods: During a monthly supervisors meeting, supervisors were asked to provide their personal definition of health equity and health disparities. In addition, staff was asked in a Pre-Baseline Sample Survey the same questions. Health equity key elements were developed from the Robert Wood Johnson definition and health disparities key elements were developed from the HealthyPeople2020 definition. Based on what was reported each, response was scored accordingly.
Results: Using qualitative analysis, key elements from each definition were determined and each response was scored as correct, in the right direction and incorrect. Out of 140 respondents only 19% defined health disparities correctly and only 6% defined health equity correctly.
Conclusion: Key elements of each definition have been developed and can be used in the future to assist with educating staff on the specifics of each term and what makes them different. Additionally, staff will understand how they are already addressing health disparities and advancing health equity in their daily work and how they can use a health equity lens going forward.
#11 An Educational Strategy to Improve Adolescents’ Knowledge of Prescription Medications.
Authors: Sean R. King, Erica R. Rogers, Chance Mattox, PharmD. Candidate
Objectives: To evaluate the impact of an education intervention, based on Theory of Planned Behavior (TPB), on improving adolescents’ attitudes, subjective norms, and knowledge concerning prescription medications.
Methods: This project employed a pretest-posttest, control group design. High school students (n=243) were recruited from two rural high schools in northeast Mississippi. A pharmacist researcher delivered experimental students (n=123) a TPB-based educational intervention, lasting approximately 120 minutes. Students attending the control school did not receive the TPB-based intervention (n=120). The questionnaire utilized collected demographic information and responses to questions based on selected constructs from the TPB from all students.
Results: IBM SPSS Statistics version 24.0 was used for data analysis. Descriptive statistics were generated for all demographic variables. Chi-square tests were used to compare demographics at pretest between the control and experimental groups. Univariate one-way analysis of variance (ANOVA) was used to compare TPB constructs at pretest between the two groups. Comparisons were made between the groups for each posttest measure using analysis of covariance (ANCOVA), with the corresponding pretest score as covariate. All comparisons were made at the a priori alpha level of 0.05. Significant improvements at posttest for the intervention group when compared to the control group were observed for attitudes (p=0.003), subjective norms (p=0.037), and knowledge (p=0.003) concerning prescription medications.
Conclusion: The results suggest lessons based on TPB to improve the attitudes and subjective norms of an adolescent population concerning the consumption of prescription medications may assist in developing the knowledge and skills needed to consume these products properly.
#12 The Potential Impact of Removing Public Fund Restriction for Syringe or Needle Exchange Programs in Tennessee
Authors: Jasmine T. John, MD, MSPH, Muktar Aliyu, MD, MPH, Dr.PH, Michele Etling, MD, PhD, MSPH, Heather O’Hara, MD, MSPH
Background: In an effort to provide harm reduction services for injection drug users, there are 228 needle/syringe exchange programs (SEPs) in the United States. SEPs provide sterile supplies as well as access to services for screening and treatment of blood-borne infections and substance use disorders. In May 2017, Tennessee enacted legislation allowing non-profit organizations to supply these services but prohibits use of public funds for exchange supplies. Currently, there are three non-profit SEPs operating in Tennessee.
Objective: To demonstrate the need to remove this restriction of public funding which will further support SEPs to reduce harms associated with injection drug use.
Methods: An online literature search of peer-reviewed articles published during January 2000 – September 2017 with free full-text access, outcome data, and published in the U.S. were reviewed. Twenty-four articles met criteria for review. Included summary reports from Street-Works, SEP in Davidson County, from February 2018 – April 2018.
Results: SEPs were associated with ≥ 50% decrease in high-risk injection behaviors, improved access to health services, reduced improper needle disposal, and a 33% reduction in health care expenditures. A trend toward reduced HIV incidence was found in states with public funding, while HCV transmission remains unclear. Street-Works provided a 3- month total of 52,824 syringes with a 22% return for proper disposal.
Conclusion: SEPs can reduce harm from associated infections, addiction, and environmental factors. Lack of funding is the primary challenge reported by most programs. Using public funds for SEPs supports multi-level harm reduction caused by injection drug use.
#13 Health Literacy Initiative at an Addiction Treatment and Recovery Program
Authors: Rachel Adeoye, McKenna Bagan, Jazmin Bennett, Kassidy Bishop, Jane Bradley, Chelsea Coates, Naomi Hetzel, Marleigh Higgins, Charlotte Hook, Kendall Jefferson, Sarah Luo, Eva Muschkin, Lea Sherman, Claire Streeter, Allison Warnick, Kate Zoppoth, & Cole Powers, DNP, FNP-BC
Background and Significance: In the U.S., 90% of adults lack proficient health literacy skills, which is associated with poor health outcomes. Nationally, 30% of adults who receive Medicaid are at a below-basic level of health literacy. All residents at this addiction treatment program have Medicaid, and the director indicated poor health literacy among residents.
Statement of Purpose: Two student groups at Vanderbilt University School of Nursing collaborated to improve participants’ ability to obtain, understand, and use health information to at least a basic level. Students strove for 50% of the participants to increase knowledge of health topics and at least 60% to demonstrate a basic level of health literacy.
Methods: Over 5 months, students implemented a biweekly 7-series health literacy initiative on health topics of interest to the participants. The topics included: self-care, nutrition/exercise, health insurance, women’s health, heart health, effects of drug recovery, and a final review. One student group taught health concepts; the second group taught ways of obtaining and using health information. Understanding, obtaining, and utilizing health information were measured through pre- and post-surveys, application questions, Ask Me 3 tool, games, and teach back.
Results: In 13 out of 14 interventions, at least 60% of participants increased understanding and skills in obtaining health information. Additionally, 89% applied the information to make an appropriate health decision.
Conclusions: Improving health literacy increases participants’ ability to make appropriate health care decisions and, hopefully, improve health outcomes. Future research would enhance and measure outcome sustainability.
#14 Trends of Cervical Cancer Screening and Adherence to New Guidelines in Davidson County, Tennessee Women during 2006‐2017
Authors: Manideepthi Pemmaraju MBBS, MPH, CCRP, Sheelah Iyengar, MS, CCRP, Stephanie Allen, MPH, Edward Mitchel, MS, Marie R. Griffin, MD, MPH
OBJECTIVES: We examined changes in prevalence of cervical cancer screening among Davidson County, Tennessee women associated with 2012 guidelines, which recommended no screening for age <21 years and less frequent screening for 21‐64 years.
METHODS: We identified women ages 18‐64 years, enrolled in Tennessee Medicaid (TennCare) 2006‐2017, and receipt of screening by Current Procedural Terminology codes indicating Papanicolaou (Pap) smears and human papillomavirus (HPV) detection tests. We evaluated prevalence of annual Pap smear (old guidelines) and of less frequent screening as recommended by 2012 guidelines.
RESULTS: Overall, the number of Davidson County women age 18‐64 years enrolled in TennCare increased from 27,603 in 2006 to 38,691 in 2017. Percent with annual pap screening declined in all age groups from 2006 to 2017 (figure 1a). Receipt of Pap within 3 years (age 21‐64 years) or Pap plus HPV test within 5 years (age 30‐64 years) also decreased in all age groups (figure 1b). Screening consistent with these 2012 guidelines declined from 2006 to 2017 in every age group: 77.9% to 61.6% age 21‐29 years, 55.4% to 41.3% age 30‐39 years, and 37.3% to 24.2% age 40‐64 years.
CONCLUSIONS: The new cervical cancer screening guidelines were associated with declines in annual Pap screening as recommended. During the period when annual screening was recommended, a relatively high proportion of women were screened at least every 3 years. However, adherence to screening every 3 to 5 years as currently recommended has declined substantially for women age 21‐64 years.
#15 Utilizing Model Builder in ArcGIS to Inform Community Outreach Efforts to Improve Birth Outcomes Tennessee
Author: Lamar S. Coats
Background: Various birthing facilities across Tennessee employ staff in the maternity department that goes out in their community to educate future mothers. Their objective is to improve the health outcomes of newborns.
Objective: Utilize ArcGIS as a tool in partnership with the facilities for efficient strategic planning in order to identify high risk mothers.
Methods: The first step was to geocode Tennessee birthing facilities. The second was to geocode Tennessee birth statistical file and fetal death statistical file from 2014 to 2016 based on the Mother’s residential address. Third step was to utilize the ArcGIS tool Model Builder, which assisted in creating a map layout using a zip code shapefile and generate a 100-mile buffer shapefile around selected facility. The final step was to link facility records to geocoded file by state file number and executing a frequency count for each zip code within buffer region.
Results: Maps were presented to several hospitals across Tennessee to educate staff about the spatial locations with a higher density of births, the influence of out of state residents from adjacent states, and areas of concerns pertaining to fetal or infant deaths.
Conclusion: Hospital feedback has been very positive. Several facilities utilize our information to reach out to educate their community better, while requesting more in-depth analysis to improve the health outcomes of newborns in Tennessee. The hot spot areas for fetal deaths and infant deaths illustrated in the maps gives evidential support to known outbreaks such as the opioid epidemic.
#16 Exploring ZIP Code-Level Life Expectancy in East Tennessee
Authors: Brandy Fuesting, Kathleen Brown, Kristina W. Kintziger
Introduction: Life expectancy (LE) can be used to examine localized health disparities and identify areas where targeted public health interventions may influence important contributors of negative health outcomes. LE can be used to inform healthy policy and programing, particularly when addressing inequalities. We calculated county- and ZIP code-level LE estimates at birth for East Tennessee.
Methods: We used the adjusted Chiang II method to calculate LE estimates using five years (2008-2012) of mortality data to increase the stability of estimates. This period was chosen based on availability of denominator data, as we were limited to using 2010 Decennial Census for ZIP code-level estimates. We included the 15 counties in East TN and three metro areas (Knox, Hamilton, and Sullivan), and estimates are based on geocoded addresses.
Results: County-level estimates ranged from 71.8 (Scott) to 77.4 (Loudon) years (range: 5.6 years). Valid ZIP-level estimates ranged from 67.5 (37902 – Knoxville) to 87.3 years (37336 – Georgetown; range: 19.8 years). When assessing data for accuracy, significant discrepancies were identified between reported and geocoded ZIP, particularly for rural counties, which could not be accounted for by place of death (residence vs. healthcare facility).
Conclusions: Examining county- or state-level LE masks important health disparities, which can be identified with sub-county indicators. These sub-county indicators are an important tool for successful policy and program planning, but requires accurate data. Further investigation is needed to ensure that LE estimates are accurate at sub-county levels, especially in rural counties, so that health disparities can be correctly identified and addressed.
#17 Relationship between School District Wellness Policies and Student BMI Data: A Case Study in Tennessee
Author: Savannah Morrow
Background: As the Office of Coordinated School Health (a joint effort of TDH and TDE) has a presence in all 140 school districts of Tennessee, every district must maintain a “wellness policy” that outlines their commitment to student health. While the Tennessee School Board Association encourages use of their model policy, the content of these policies varies greatly. I have highlighted best wellness policies and identified the relationship between policy strength and district levels of overweight and obesity.
Objectives: 1. Score Tennessee school districts’ wellness policies based on the TSBA model. 2. Identify strong wellness policies that go beyond the model. 3. Find correlation (if any) of high quality wellness policies with student BMI data. 4. Suggest best practices regarding wellness policies
Methods: Using the TSBA’s model wellness policy as a 50 point rubric, all 140 wellness policies were scored out of 50 for compliance then awarded extra points for additional policies. The policies were separately scored out of 10 points for compliance with USDA standards.
Results: The raw scores, scores with extra points, and scores based on USDA standards were plotted with the district rates of overweight and obese students. There was no correlation between policy strength and student BMI.
Conclusion: In the end, wellness policies did not directly correlate to student BMI, but they still outline health as a priority and remind the local education agency that health directly impacts students’ performance.
#18 Screening for Lung Cancer among a Racially Diverse and Medically Underserved Population
Authors: Nancy Liu, Valerie Welty, Sophie Jouan, William J. Blot, Pierre P. Massion, Melinda C. Aldrich
Lung cancer screening is recommended by the United States Preventive Services Task Force (USPSTF) for the early detection of lung cancer. However, most screening studies to date have been conducted among whites and high socioeconomic status individuals. We are conducting a lung cancer screening pilot study to identify biomarkers for the early detection of lung cancer among a medically underserved and primarily African American population of high-risk smokers. From the Southern Community Cohort Study (SCCS), a prospective cohort of adults enrolled primarily at community health centers throughout the Southeastern U.S., we identified participants residing in the Nashville metropolitan area and presumed eligible for lung cancer screening according to USPSTF guidelines. To date, we have sought contact with 82 of these SCCS participants and reached 44, among whom 8 refused and 15 were found to be ineligible. Among the 21 eligible, 12 have enrolled, 4 refused and 5 are pending enrollment. Comparing individuals who enrolled vs refused participation, differences in race, smoking pack-years, education, and insurance status were apparent. Individuals who refused participation vs enrolled were more often African American (58.3% vs 50%, respectively), had higher median baseline smoking pack-years (42.3 vs 41.0, respectively), less than a high-school education (33.3% vs 25%) and were uninsured at the time of phone interview (81.8% vs 8%, respectively). Recruitment for this ongoing study will help to assess the characteristics of individuals screened for lung cancer vs high-risk individuals that refuse screening. Ultimately, lung cancer screening opportunities should be equitable to avoid disparities in outcomes.
#19 Association between a Physician’s Recommendation for a Lifestyle Change and Cholesterol-Lowering Medications
Authors: Sarah T. Murfree, M.S., Garvita Thareja, M.S., Bethany A. E. Wrye, PhD, Norman L. Weatherby
The American Heart Association and American College of Cardiology advise healthcare providers to recommend lifestyle changes – healthy diet and physical activity- for adults with heart disease risk factors. Effective communication regarding these recommendations is an important aspect of quality healthcare. Data from the National Health and Nutrition Examination Survey was used to conduct logistic regressions to examine the relationship between prescription of cholesterol-lowering medications and lifestyle change counselling by physicians.
First, the relationship between receiving a lifestyle change recommendation and receiving a prescription for cholesterol-lowering medication (CLM) (n=3813) was examined. Persons prescribed CLM were more likely to receive a lifestyle change recommendation than persons not prescribed CLM (χ2 = 608.72, df = 17, p = .00). Persons with health insurance were more likely to receive a lifestyle change recommendation than the uninsured. Persons reporting poor health were more likely to receive a lifestyle change recommendation than persons reporting excellent, very good, or good health. Mexican, Hispanic, and Black patients were more likely than White patients to receive a lifestyle change recommendation.
The second analysis included only persons prescribed CLM (n = 1368) with statistically significant predictors of receiving a lifestyle change recommendation found in health insurance status and health status (χ2 = 102.71, df = 16, p = .00). Hispanic and Black patients were more likely to receive a lifestyle change recommendation than their White counterparts.
Our results indicate physicians often recommend lifestyle changes for patients prescribed CLM with differences identified in demographics, health insurance coverage, and health status.
#20 Fighting Food Deserts with Photography: A Community Based Approach
Authors: Kori Hahn, BS, Erika Stuart, MS, Janel Jones, Shewanee Howard-Baptiste, PhD
Background: Over 23 million Americans live without access to affordable nourishment. The United States Department of Agriculture has defined the parts of the country that lack access to healthful whole foods and consequently are disproportionately saturated with high rates of obesity and diet related disease as, food deserts. Chattanooga, Tennessee is currently one the nations more notable urban food deserts. As the fourth largest city in Tennessee, it is estimated that over 70,000 people live within census tracts that meet food desert designation. Objectives: To understand the economic development and community health implications of food deserts in Chattanooga. Methods: This pilot united UTC faculty and graduate students with high school students and community members, to explore the factors associated with the creation of food deserts and the social determinants of health. Photovoice, a community-based participatory research (CBPR) approach, was used examine participants lived experiences. The team analyzed and interpreted data to identify themes. Results: The themes that emerged as the most prevalent barriers to healthy eating among this population were: time, sugar, and location. Participants reported having an increased awareness of the food environment and their behavior related to food. Findings were presented to neighborhood leadership roundtables and the Chattanooga Times Free Press. Conclusion: For the political and/or environmental changes that need to be made in order to improve the health and well-being of individuals living in these areas, opportunities for outreach, education, and advocacy must continue to be developed and sustained.
#21 Personal Opinions on Influenza Vaccination is Contributing to the Vaccination Disparity in Hancock County, Tennessee
Author: Daniel Mok
Between 2012-2017 Hancock County, Tennessee has averaged the lowest yearly county influenza vaccination rate (25.71%) for Medicare Fee-For-Service beneficiaries. Other rural counties with similar demographic and socioeconomic characteristics do not show the same persistently low vaccination rates and instead average 45.37% . To understand the influenza vaccination disparity in Hancock County, door-to-door surveying was conducted. Likert style questions on a 1 (strongly disagree) to 5 (strongly agree) scale was used to assess various social determinants of health that could be contributing to the county’s vaccination disparity. Preliminary results from the surveys (n=83) show that those who choose not to vaccinate believe that the influenza vaccine on a 1 to 5 Likert Scale is less worthwhile (2.90±1.48) with respect to those that do vaccinate (4.82±0.52), p<0.001. Attitudes towards cost, accessibility, and time to
complete vaccination are similar amongst vaccinators and non-vaccinators. Both groups are in agreement that the flu shot is affordable and convenient to receive. This study finds that structural and economic barriers are not the underlying cause of the low influenza vaccination rates in this rural area, rather public opinion on influenza vaccination seems to be the cause of the disparity.
#22 Non-Traditional Partnerships: Collaborating with Memphis College of Art to develop a local opioid communications campaign
Authors: Dr. Alisa Haushalter, Reginald Bernard, Courtney Tipper
Background: Shelby County (SC) experienced 901 opioid-related emergency room visits in 2017 and over 500 opioid overdose deaths over four years. With leadership of elected officials, a countywide response plan was developed that includes four pillars: data, prevention & education, treatment & recovery, and first response & law enforcement.
Objectives: The project aims to integrate art into public health practices to encourage dialogue around public health issues.
Methods: An innovative partnership evolved with a non-traditional partner – the Memphis College of Art. Health department staff engaged with a team of students and their instructor, sharing the local plan with an emphasis on communication. The team collaborated to develop graphic design concepts that support identified goals.
Results: Students created three distinct concepts for use with multiple media. Concepts were created to change individual attitudes and behaviors as well as social norms. The concepts are “All About the Person”, “All About the Visibility”, and “All About the Feeling.” Each concept includes promotion of the Tennessee Redline. Concepts were unveiled in a public forum. All concepts will be implemented in Shelby County. Materials are available for use by other municipalities.
Conclusions: The partnership creates an opportunity to engage artistic talent as well as the younger generation. It affords an opportunity for students to utilize their talents to effect community change and address local health issues. Students also have the opportunity to engage in projects that provide income, prepare them for the workplace and expose them to public health. Lastly, it is cost effective.
#23 Dental Health Attitudes and Perceptions Among WIC Staff: MPHD WIC/Dental Health Collaboration
Authors: Kiana Radney, RDH BS; Obrenka Thompson, MPH; Michelle Pardue, DDS; Raquel Qualls-Hampton, PhD, MS
Background: The Supplemental Nutrition Program for Women, Infants and Children (WIC) is one of the largest service providers to low-income children who may be at increased risk for developing dental decay. Consequently, WIC Program Sites are ideal settings to address early childhood caries (ECC) with dental health collaborations. WIC staff plays a major role in encouraging dental program participation. Their oral health attitudes and perceptions could influence participant engagement and utilization.
Objective: To assess current dental health attitudes and perceptions among MPHD WIC staff.
Methods: Focus groups were conducted with WIC staff at two of five Davidson County WIC sites. This included a brief survey assessing basic demographics and personal dental health, a Q-sort assessment to assess oral health perceptions and attitudes and a focused conversation evaluating perceptions of pilot WIC/Dental program as well as WIC client barriers. Finally, key informant interviews were conducted with WIC supervisors. Qualitative data analysis is ongoing to identify themes for staff education and engagement.
Results: Eighty percent of WIC nutritionists participated in the focus groups. Nearly 1 in every 2 nutritionists (54%) strongly agreed that they feel comfortable providing oral health counseling. All nutritionist strongly agreed that oral health counseling to WIC clients is effective in preventing poor oral health outcomes. Additional analysis is still being compiled.
#24 Epidemiology of Early Childhood Caries Among MPHD WIC Participants: WIC Dental Program Pilot
Author: Kiana Radney, RDH. BS; Obrenka Thompson, MPH; Dr. Michelle Pardue, DDS; Dr. Raquel Qualls-Hampton, PhD, MS
Background: The Supplemental Nutrition Program for Women, Infants and Children (WIC) is one of the largest service providers to low-income mothers and young children who may be at increased risk for developing dental decay. Consequently, WIC Program Sites are ideal public health settings to address early childhood caries (ECC) with dental health collaborations. This internal collaboration positions MPHD to reduce untreated decay for Davidson County children as outlined in the Healthy People 2020 oral health objectives.
Objectives: To assess and describe dental health among MPHD WIC Dental Program participant population.
Methods: A descriptive analysis will be conducted using our WIC Clinic and WIC Dental database. These databases capture caries prevalence and risk among WIC dental program participants as well as WIC demographics. Estimates will describe prevalence of dental caries and potential risk factors in our WIC population.
Results: Since program inception (September 2017) more than 50% of program participants were classified as moderate to high risk for dental caries (e.g., fluoride exposure, sugary food/drink consumption, dental home establishment, etc.). Although only 8% of WIC dental program participants are Asian, cavities occur in nearly 1 in 4 children in this population (28%). Additional analysis, including risk scores by demographics, is ongoing.
Conclusion: This collaboration provides the opportunity to focus efforts in an equitable manner to prevent further dental health disparities. Potential recommendations could address both racial and cultural disparities by continuing to partner with WIC staff to support improved oral health.
#25 A Geospatial Analysis of Maternal Smoking to Improve the Reach of Tobacco Cessation Programs
Authors: Brook McKelvey, MA, MPH, Dr. Raquel Qualls-Hampton, Tracy Buck, MS, RDN, Lillian Maddox-Whitehead, MS, BSW, Camille Farmer
Background: Maternal smoking rates in Davidson County are low compared to the State (6.5% versus 13.3%), creating difficulties with outreach and recruitment for tobacco cessation programs. Identifying and training medical providers who serve maternal smokers could expand awareness and outreach efforts.
Methods: Vital records analysis and GIS mapping was conducted using two years of data (2014 & 2015) to identify hospitals and providers with higher rates of maternal smoking. A list of providers and practices with addresses was created and used to match provider names from vital records to their practices using SAS. Maps displaying the relationship between provider locations and maternal smoking were produced.
Results: In Davidson County, there were a total of 20,597 live births during the two-year period investigated. Nearly all (86.2%) providers were identified and matched to a practice. Maternal smoking at each practice ranged from a low of 3.8% to a high of 32.6%. Practices that delivered the most live births in the county served fewer maternal smokers than practices with smaller client bases. For example, one practice delivered nearly 20% of total births in the county, of which 9.4% were maternal smokers. In contrast, another practice delivered 1% of total births, of which 32.6% were maternal smokers.
Conclusion: In Davidson County, the highest concentrations of maternal smokers are found at specialized medical practices with smaller client bases, or individual physicians engaged in private practice. These providers may not be affiliated with hospitals where ongoing smoking cessation training is provided.
#26 Pilot Testing in Health Research: Recruiting Underrepresented Populations
Authors: Alexandra Minor, Rebecca Johnston, Raquel Rivas, Regina Andrade, Brandy Mapes, Rob Cronin
Background: The All of Us Research Program is enrolling 1 million people, especially those underrepresented in biomedical research, into a 10-year study to create the nation’s largest public biomedical resource. The Pilot Research Core (PRC) was created to assess materials and concepts with diverse communities prior to public release in the Program.
Objectives: The PRC aimed to 1) build a centralized mechanism for recruitment and 2) involve recruited individuals in qualitative and quantitative pilot testing.
Methods: The PRC developed a website for individuals interested in pilot activities to sign up for a contact list called the Expression of Interest Registry (EOI). Individuals were also recruited through community organizations.
Results: Over 5,000 individuals joined the EOI from 48 states. Of these individuals, 1,652 (33%) completed pilot testing through surveys, interviews, and community engagement studios. Recruitment through our online website created barriers when recruiting rural, low education, male, Spanish speaking and ethnic/minority populations. Recruitment through community organizations diversified our testing population and established trust.
Conclusion: For communities underrepresented in biomedical research, outreach and recruitment through community organizations is often more effective than recruitment through passive means like websites. Although staff and time intensive, recruitment with community organizations promotes trust and engagement. To improve future pilot testing recruitment, improving relationships with local organizations is imperative.
#28 County Health Council Effectiveness Survey, Process Evaluation, and Strategic Planning in Northeast TN
Authors: LeighAnne Taylor, MPH, Jayne Harper, MS, MCHES, Terry Henson, Jacy Weems
Background: Community Health Councils were formed under the Tennessee State Senate Community Health Agency Act of 1989. The community health council concept was conceived to give rural constituencies a voice in defining and resolving their local health needs. Since the establishment of health councils in each of the seven Northeast Tennessee counties, many independent grassroots community groups have been created to help address community health needs. The influx of operational groups has led to competing time demands for community members and redundant efforts between groups.
Objective: A two-part mixed-methods process evaluation was conducted to assess the current state of the health councils and to identify opportunities for quality improvement.
Methods: Each county health council and the regional health council were asked to complete online Health Council Effectiveness Surveys. The survey assessed five areas: clarity of health council priorities and goals, effectiveness of addressing priorities, leadership, meeting participation, and level of organization. After sharing the survey results with council members, each council was led through a six-question feedback session and open discussion.
Results: The response rate of the online survey was 78.5% (n=106). The majority of the survey respondents rated their council either “good” or “excellent” in the areas assessed. The feedback session and discussion synthesized ideas for council revitalization and restructuring.
Conclusions: The data obtained from this evaluation are presently guiding the 2018-2019 strategic planning processes intended to revise the councils’ existing missions, goals, and by-laws to better serve the health needs of the communities of Northeast Tennessee.
#29 Geographic characteristics of changes in life expectancy at birth in Davidson County, Tennessee
Authors: Abraham Mukolo, Justin Gatebuke, Brook McKelvey, Tracy Buck, Bill Paul, Raquel Qualls-Hampton
Introduction: Geographic differences in life expectancy (LE) at birth can highlight population health inequities. However, sub-county data are not readily available. LE at birth in Davidson County was estimated and compared across zip-codes to examine potential disparities in community health.
Methods: All-cause mortality data for each Davidson County zip-code were aggregated into 5-year cohort periods from 2007 through 2016. LE estimates were calculated using an age-adjuster tool – a Microsoft EXCEL macro program developed for the Sub-County Assessment of Life Expectancy (SCALE) Project. Denominators are the 5-year population estimates for each period from the American Community Survey (ACS), US Census Bureau. Estimates were stabilized by combining zip-codes with similar socio-economic and demographic characteristics.
Results: LE at birth in Davidson County from 2012 to 2016 was 77.2 years. Among zip-codes, the difference between the lowest and highest LE estimate was 14 years. Between 2007 and 2016, the highest net increase in LE at birth was 2.5 years (Zip-code 37135/37027 combined), and the greatest net decrease was 2.3 years (Zip-code 37217). One zip-code (37228/37208 combined) consistently had the lowest LE estimate, which declined marginally (-0.1 years overall). The gap between the highest period-to-period gain and highest loss decreased from 3.6 years between 2011 and 2012 to 2.4 years between 2015 and 2016.
Conclusions: There is a steady increase in LE at birth for Davidson County, but significant sub-county disparities exist and could be narrowing over time. Understanding the drivers of these trends could inform public health interventions in Davidson County.
#30 SEXUAL HEALTH KNOWLEDGE AND ATTITUDES AMONG COLLEGE STUDENTS AT A MID-SIZED REGIONAL UNIVERSITY IN TENNESSEE
Authors: Sarah E. Hawkins, MPH, Katie Baker, DrPH, MPH, and Anthony Peluso, MPH
Sexual health remains a controversial topic for public health education campaigns in Tennessee. The objective of this study was to explore the knowledge, attitudes, and behaviors of students at a mid-sized regional university in Tennessee regarding sexual health (i.e. where do they obtain their information, what knowledge do they lack, and what could be done in the future to educate students about sex?). Undergraduate students recruited from the Department of Psychology’s research subject pool completed a sexual knowledge and attitudes survey. Participation was tracked using SONA Systems, a web-based software which allows researchers to manage their studies. The sample (n=133) was mostly female (69.5%) with an average age of 19 years, predominantly heterosexual (85.5%), single (54.2%), and white (85.5%). The survey questions were generated following a literature review of similar surveys. A few of the most noteworthy results included: 92.8% of respondents stated they have received informal sex education, compared with 88.8% who stated they had received formal sex education in a classroom; 40% stated they were unsure or unaware of the local resources they could utilize to obtain treatment for sexually transmitted diseases; 80% believed comprehensive sex education is necessary and important for college students. The results indicate the desire and need for a standardized, comprehensive, and widespread sex education curriculum for university students. Homogeneity became an apparent limitation of this sample, and thus, additional research would be useful to ensure generalizability toward nationwide populations; however, the sample demographics were representative of the university’s undergraduate student body overall.
#31 AIDE (Accessible Instruction via Distance Education) for the LPN-BSN Student
Authors: Melessia D. Webb, EdD, MSN, RN, Tabitha Quillen, MSN, RN-BC
Motivation: Licensed Practical Nurses in Tennessee have two opportunities to earn an academic credential: community college associate degree or baccalaureate degree from either ETSU (the only state institution that has a completion program) or one private institution in the state.
Problem statement: It is important to note that most Tennessee Centers for Applied Technology (TCATs) are located in very rural areas of west and middle TN, spanning two-time zones and close to a 500-mile commute east and west. An average of 1,385 students graduate annually from the 21 TCATs.
Approach: ETSU has had an LPN-BSN completion program since 2001. This program was revised in spring 2018 with implementation to begin fall 2018 with 50% didactic content delivered asynchronous, online and 50% Instructional Television delivery to TCAT institutions, and clinical in the student’s geographic region. Students will receive 23 credit hours of nursing articulation credit. Students can complete the nursing portion of the curriculum in four semesters.
Results: First application deadline is July 1, 2018. Currently, 89 applications have been received for fall 2018 start.
Conclusions: ETSU is the only public institution offering an LPN-BSN program. Redesigning the LPN-BSN curriculum solves the accessibility problem for LPNs. Increased accessibility allows 180 LPN-BSN students to be admitted each year, thus increasing the number of BSN prepared nurses entering the TN workforce and addressing the nursing shortage in TN.
#32 Migrant Farm Workers and Pesticide Exposure: The Need for Increased Awareness and Action
Authors: Ghino Francois, MD, Heather O’hara, MD, MSPH; Meharry Medical College, Nashville, TN
Background: Exposure to agricultural pesticides pose health risks for farm workers and the environment. There is considerable evidence to suggest that migrant farm workers are particularly at a higher risk for pesticide-related illness or disease.
Objectives: To explore the impact of pesticide use among migrant farm workers in the United States using a review of the scientific literature.
Methods: An electronic search of PubMED and other bibliographic databases was conducted, using medical subject headings and keywords including pesticides, exposure, agriculture, migrant farm workers, environmental health, food, and health outcomes. The eligibility criteria for selected studies included: primary and secondary research, peer-reviewed articles, publication date from 2002 to 2017, and published in English language.
Results: A total of 18 studies met the eligibility criteria. Pesticide exposure was found to be more frequently associated with an increased risk for neurologic, neoplastic, respiratory, or reproductive disorders. Systematic barriers, impractical use of personal protective equipment (PPE), and stressful employer-employee relations were common factors that increased the risk to pesticide exposure. Moreover, family members were indirectly exposed to pesticides brought home from work.
Conclusion: Migrant farm workers continue to experience chronic low-dose exposure to pesticides, with multiple factors that contribute to exposure. There remains the need to educate migrant farm workers on the hazards of pesticides exposure, on how to recognize early symptoms of exposure, and to train for appropriate use of PPE.
#33 Smile SMART – Dental Providers as Tobacco Educators
Author: Cynthia Chafin, M.Ed., MCHES
Background: Smoking, tobacco use, and secondhand smoke are controllable risk factors that contribute to premature birth, low-birth-weight and other health risks with lifelong health implications and financial burden. Tobacco cessation and avoiding secondhand smoke have significant impact on maternal child health.
Smile SMART is a cessation training program for dentists, hygienists and dental assistants and is implemented through Middle Tennessee State University Center for Health and Human Services in conjunction with Marshall University Joan C. Edwards School of Medicine and the University of Alabama at Birmingham Department of Periodontology.
Objectives: Empower dental professionals to use the evidence-based 5As tobacco cessation model to encourage patients to quit smoking or decrease tobacco use; Reduce women’s and infants’ exposure to secondhand smoke, ultimately reducing tobacco-related preterm birth, low-birth weight, and other adverse birth outcomes.
Methods: Dental providers and pre-service dental students in multiple Tennessee counties participate in training offering education on the 5 A’s and R’s model, motivational interviewing techniques, and how to implement Smile SMART with patients.
Results: Data demonstrate change in provider knowledge and behavior, with providers more educated on tobacco and effective ways of providing cessation counseling, performing more interventions, and reporting increased self-efficacy and preparedness to address tobacco with patients.
Conclusion: When provided with education on best-practices for smoking cessation counseling, dental providers increase their knowledge on tobacco issues and effective ways of providing cessation counseling, perform more interventions, and report increased self-efficacy and preparedness to address tobacco issues with patients.
#34 Are We Pushing Kids Out of School by Trying to Keep Them In? Truancy Policies in The United States
Author: Grace Carpenter
Background: Over a dozen Healthy People 2020 objectives focus on improving children’s educational outcomes, including chronic absenteeism. Poor attendance is strongly associated with school failure and poor health status in adulthood. Although few high-quality evaluations exist of efforts to reduce chronic absenteeism, we do know that punitive strategies do not work. We document the extent to which punitive attendance policies are implemented in U.S. school districts.
Methods: A random sample of 138 U.S. school districts with more than 5,000 students was drawn from the National Center for Education database, and the policies regarding chronic absenteeism were documented. This sample has adequate power to estimate proportions of 0.10 or greater.
Results: Most school districts use multiple strategies to improve attendance. Punitive programs are common: 43% of schools deny chronically absent students class credit, 54% require Saturday or after-school school sessions, and 22% fine parents. A quarter (24%) send truancy officers to homes. Court-based diversion strategies to keep students and families out court are almost universally implemented (85%). Most diversion programs have three steps: a letter to parents, meetings and an attendance contract, and referral to court. Just over half of school districts use positive social-emotional support programs (55%).
Conclusions: Although punitive programs have been shown not to prevent truancy, they are still commonly implemented. If schools want to reduce the numbers of students who are chronically absent, then there is a need to change truancy policies. In addition, rigorous evaluations of court-based diversion programs are needed.
#35: Emergency Preparedness Education and Partnership in West Tennessee
Authors: Monique Anthony, MPH, CHES, Darryl Edmisson, MS Ed, Francis Garcia, BA, Jennifer Johnson, MPA
Significance to Public Health: Informing, educating, and empowering people about health issues and mobilizing community partnerships to identify and solve problems are two essential population-based services for which public health systems are responsible. These functions call for involvement and collaboration between public health programs and communities to increase awareness of relevant threats and hazards and knowledge of how best to prepare.
Background: This project represents collaboration between the Tennessee Department of Health’s Office of Minority Health and Disparities Elimination (OMHDE) and Emergency Preparedness (EP) Program to deliver preparedness education to populations in West, TN. Racial and ethnic minorities are disproportionately vulnerable to disasters, particularly in rural areas that may be geographically isolated. Training was provided to address knowledge gaps and better prepare people for disasters.
Methods: Extensive pre-planning and community outreach occurred via in-person meetings and conference calls with community-based organizations, faith partners, and public health practitioners from state and local government. Research was conducted to determine the most appropriate approaches for content to be inclusive and accessible for Spanish-speaking communities. The preparedness training was held in Brownsville, TN with a pre and post test administered to audience and onsite translator.
Results: Forty-four participants from Black and Hispanic communities from multiple counties in West, TN participated. Topics presented included basic preparedness, building emergency kits, developing a communication plan, and behavioral health preparedness skills for coping with the effects of disasters. This collaboration has shown to be valuable in strengthening trust and relationships between government and community members.
#36 Leveraging a Community-Academic Partnership to Address Childhood Obesity among Low-Income, Food Insecure Children
Authors: Megan Rodgers, MS, RDN, LDN, Cheryl Hill, MS-MPH, RDN, LDN, Marissa Black, BA, Cristina Barroso, DrPH, Marsha Spence, PhD, MPH, RDN, LDN
As a result of mutual research and practice goals, the Knox County Health Department and University of Tennessee Departments of Public Health and Nutrition established a community-academic partnership. This collaborative approach created hands-on opportunities for graduate students to apply their academic training and conduct a plate waste audit of dinner meals at three afterschool sites who serve at-risk, food insecure children.
Trained staff and students followed standard plate waste procedures and obtained a stratified random sample of 199 dinner meals from three afterschool sites on two separate occasions. Three standard meals were collected from the community kitchen to determine the average amount of each meal component served. These meals were used as a reference for calculating the amount of food wasted. The average food wasted for each meal component at all sites were: Swiss steak and gravy 68.90% (2.95 oz); mashed potatoes 84.42% (3.56 oz); cornbread 72.04% (1.63 oz); and skim milk 67.74% (159.87 mL). The food wasted at the afterschool sites was very high for all meal components. This was the first step in the development of interventions to increase consumption of dinner meals at the sites.
Shared values, defined roles, shared decision-making and mutual benefit were the keys to success for this community-academic partnership. Collaborative partnerships like this are essential pieces to addressing public health issues such as food insecurity and childhood obesity while training the future of the public health workforce. Currently, our group is seeking grant funding to address this problem.
#37 Barriers and Facilitators to the Recruitment and Retention of Male Peer Health Educators in a College Peer Health Education Program: An Exploratory Study
Authors: Aubrey Ray, Sarah Walsh, Will Hendon, Megan Butler, Clea McNeely
Background: Peer health education programs are a common way to deliver sexual health education and sexual violence prevention on college campuses. Yet many college peer health education programs have trouble recruiting and retaining male peer educators. Currently, there is no research on how to best recruit and retain male peer health educators.
Methods: Focus groups and interviews were conducted with undergraduate men in three leadership roles on campus –peer health educators, resident assistants, and fraternity leaders. These groups were chosen to provide insight into the reasons undergraduate men take on distinct leadership roles, in particular what attracted them to their specific roles.
Results: Preliminary findings point to several reasons men do not become peer health educators. First, male students were unclear how being a peer educator would build their resumes. This may be an issue for female students as well, but women were not included in this research. Second, although men viewed sexual health education and sexual violence prevention as important, some were unsure whether it was culturally appropriate for them speak on these issues. Third, being a model for healthy behavior on campus was seen by some men as incompatible with being in a fraternity.
Discussion: Recruitment and retention of male peer educators in college peer health education programs is complex and involves issues of gender roles and cultural appropriateness. Given that research shows that peer health education for male students tends to be more effective with male peer health educators, this is an issue worthy of further exploration.
#38 IMPROVING RECRUITMENT AND RETENTION OF PUBLIC HEALTH NURSES IN A LOCAL HEALTH DEPARTMENT
Authors: Tina R. McElravey, MPH, BSN, RN, Alisa R. Haushalter, DNP, RN, PHNA-BC, Sara Day, PhD, RN, FAAN, Judy Martin, PhD, MSN, FNP-BC, Ernestine Small, EdD, RN
Background: The United States is experiencing a critical nursing shortage that includes public health nurses (PHNs). Continued shortages within local health departments (LHDs) can negatively influence population health. The purpose of this project was to identify strategies for improving recruitment and retention of PHNs within LHDs.
Methods: Literature review to identify best evidence regarding recruitment and retention of PHNs, roles and value of PHNs for population health and historic shortages of PHNs over time. Analyzed PHN vacancy, turnover and retirement rates. Reviewed related county and organizational policies and processes. Reviewed internal documents to identify division goals, PHN feedback, current salaries and compensation study recommendations. Conducted key informant interviews. Identified system barriers and enhancers.
Results: Factors influencing recruitment and retention include salaries below market value, lack of a career ladder and pay inequities based upon funding source. Processes are layered with significant variability existing. Lack of promotional, educational and mentoring opportunities exists. Lastly, there is a need for an organizational cultural shift towards open communication, respect of PHNs and employee empowerment.
Conclusion: Multiple strategies are necessary to address the PHN workforce shortage in LHDs. Failure to recruit and retain PHNs in LHDs may significantly effect population health now and in the future.
Recommendations: Promote public health as a nursing specialty. Implement innovative recruitment strategies. Streamline and decentralize hiring processes. Increase salaries to market. Offer recruitment and retention bonuses. Implement a clinical career ladder. Provide educational and mentoring opportunities to prepare PHNs for promotional opportunities. Focus on organizational culture. Institute a PHN Committee to continue efforts.
The College of Public Health at East Tennessee State University is fortunate to possess the Eastman Valleybrook facility located off the main campus on an old farm property. The college takes advantage of this one-of-a-kind facility by hosting several public health events and classes at this location. In this venue, participants are able to immerse themselves in hands-on, interactive activities that cannot be replicated in a traditional classroom. This facility uniquely provides an environment which naturally fosters the concepts of innovation, creativity, and communication. Participants engage in health challenge simulations where they have to think creatively to solve problems, build with their hands and practice effective communication skills, all while being exposed to many aspects of public health. While much emphasis is focused on low-resource environments, these basic concepts apply to any situation.
High school students to healthcare administration executives have participated in various types of simulations at this facility. One example of a simulation is the Refugee Experience, where participants are tasked with setting up a temporary refugee camp and navigating the complexities and health challenges that come with such a setting. Other simulations currently offered include Tortilla Experience, Otzi Experience, and Pioneer Experience. Offering such rare opportunities for engagement, helps distinguish the College of Public Health as an innovator in public health education, and as a valuable resource for the development of our region’s public health workforce.
#40 Developing Interactive Dashboards for Communicable Disease Data in Tennessee
Author: Nhut Nguyen, MPH; Caleb Wiedeman, MPH; Julie Shaffner, MS, MPH; Rendi Murphree, PhD; Paul E. Petersen, PharmD
Background: Interactive dashboards can serve as a useful tool for visualizing health data and supporting decision making. Accessible and flexible data visualization tools allow stakeholders to interact with and interpret health data relevant to their community. The Tennessee Department Health (TDH) currently aggregates disease data in an interactive visualization gallery. However, software limitations negatively impact the accessibility of these data. Tableau® is an interactive data visualization product recently made available to TDH that can address the gaps of the current dashboard program.
Objectives: To update surveillance visualization of TDH’s reportable disease conditions and events by improving data accessibility, reliability and usage.
Methods: Dashboards were constructed using Tableau version 10.5. State and regional/metro staff were consulted on data design, display, accessibility, and ease of usage.
Results: The dashboard filters disease condition by year (1995-2016) and displays state and county/region level data. The dashboards display count and rate per 100,000 population of conditions by year and the county/region level data displays county level data in comparison to its region/metro. All dashboards allow data to be extracted for additional analyses. Current feedback suggests that the new dashboard visualization software solves previously encountered issues related to accessibility and provides greater control.
Conclusion: The updated design has improved readability, accessibility and reliability to surveillance data public health staff, community partners, and the general public. The next step of this project will be to integrate and promote these dashboards within the TDH website to increase their use among stakeholders.
#41 Perceptions and Food Acquisition Behaviors Among Food Pantry Users in Rural Appalachia
Author: Adeline Grier-Welch
Objective: To ascertain how food pantry users perceive their use of the food pantry and how the food pantry fits into the broader scope of food acquisition among rural households.
Design: Using a grounded theory approach, semi-structured interviews with food pantry users were conducted in-person and over-the-phone. Verbatim interview transcripts were uploaded into NVivo 11.4 software for thematic analysis and theory formulation. Demographic data were collected via survey.
Setting: Rural Appalachian food pantries.
Subjects: Participants (n=20) were predominately female (80%) and Caucasian (95%) with a mean age of 48 years (+SD= 13.4) who used food pantries in rural Appalachia.
Results: Food pantry users reported consistently acquiring food from the grocery store, food pantry, and family and friends. Reciprocal, informal, food sharing networks were common. Factors such as lack of transportation, uncontrollable external factors, and insufficient food quantity depleted food resources. Food stretching, refusing to waste food, using money-saving strategies, and the overall acceptability of food pantry food enhanced food resources. Food pantry users reported having to “make it work” when food resources were low.
Conclusions: Food pantries are a consistent food source for those who use them. Food pantry users are savvy with their resources and have multiple strategies to maintain their food supply despite high levels of food insecurity. While most members in the sample were pleased with their food pantry experiences, areas remain to improve the food pantry experience while promoting adequate nutrition.
#42 Evaluation of Existing Latent Tuberculosis Infection Policy and Procedure for Local Government Employees
Authors: Phyllis Crump, RN, FNP-BC; Judy C. Martin, PhD, FNP-BC; Alisa R. Haushalter, DNP, RN; Ernestine B. Small, EdD, MSN; Sara Day, PhD, RN, FAAN
Background: Mycobacterium tuberculosis (TB) results in latent tuberculosis infection (LTBI) or TB disease. Because individuals with LTBI are at risk for progression to TB disease, annual screening of high-risk local government employees monitors for conversion from LTBI to TB disease. The project purpose was to determine if the current procedure for monitoring employees with LTBI aligns with current evidence and standards of care, and if not, update the policy and procedure.
Methods: Benchmarks for current recommendations, screening and follow-up care of healthcare workers with LTBI included guidelines from the Centers for Disease Control, National Institutes of Health, World Health Organization, and policies used by other HDs. A LTBI Committee conducted the reviews and proposed more modernized approaches for management of all government employees with LTBI.
Results: Current recommendations supported use of a risk assessment survey that guides further screening by the HD practitioner and does not include x-rays for non-symptomatic employees with LTBI. The committee developed a revised countywide policy and procedure, redesigned the employee risk assessment survey, and designed a decision tree to guide HD provider decision-making.
Conclusion: The revised policy will systematically assure appropriate risk assessment to monitor disease progression while controlling radiation exposure and healthcare costs.
Recommendations: Assure evidence-based practice regarding TB screening of employees with LTBI through administrative adoption of the proposed policy/procedure. Provide periodic staff education regarding best practices. Institute a HD Policy/Procedure Review Committee to assure and implement annual review to maintain ongoing alignment with benchmarks.
#43 The role of community-based crisis assessment services in reducing criminal justice involvement among adults experiencing mental health challenges
Authors: Abraham Mukolo, Adam Graham, Angie Thompson, Raquel Qualls-Hampton
Background: Community-based crisis assessment services could enhance efforts to divert adults experiencing mental health crises from incarceration into community-based mental healthcare. The study investigated in/out-patient visits and jail admissions among adults who received community-based mental health crisis assessment services.
Methods: 4,648 adults who received mental health crisis assessment services in Davidson County in 2015 were matched by social security number and date of birth to the 2014-2016 Hospital Discharge Data System datasets and the 2015 Davidson County jail admission records. Mental health hospitalizations were identified through International Classification of Disease codes (IDC-9 and IDC-10) for mental disorders. Admissions in either data system were classified by whether they occurred before, during or after crisis center admission dates.
Results: About 62% were hospitalized in 2015 (39% in 2014 and 42% in 2016). Mental health diagnoses were identified in at least 71% of these hospitalizations. In 2015 about 14% of all clients were incarcerated: 87% were also hospitalized and 93% of these hospitalizations had an associated mental health diagnosis. Among the incarcerated and hospitalized, 60% of hospitalizations preceded incarceration and 69% of such hospitalizations occurred after crisis center contact. Among those not incarcerated, about 51% of all hospitalizations occurred after the crisis center admission date.
Conclusions: Adults who used crisis assessment services and were later incarcerated had sought community-based mental healthcare prior incarceration. Improving co-ordination between community-based crisis assessment and in/outpatient services might potentially reduce criminal justice involvement among adults with mental health challenges in Davidson County. More in-depth investigations are needed.
#44 Assessing Barriers to Human Papillomavirus (HPV) by Public Health Nurses
Authors: Rudolph Gray, BSN, RN; Judy C. Martin, PhD, FNP-BC, Alisa R. Haushalter, DNP, RN; Ernestine B. Small, EdD, MSN; Sara Day, PhD, RN, FAAN
Background: Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States with over 14 million new cases identified annually, commonly causing cancers of the reproductive organs, anus, rectum, and oropharynx. Tennessee ranks in the lowest percentile for HPV vaccination of girls and boys and Shelby County has consistently ranked in the lower 1/3 of all Tennessee counties for vaccination of children aged from 11 – 14 years old. The project was intended to improve HPV vaccination rates in PHNs by identifying and addressing barriers affecting administration.
Methods: Participants were 25 PHNs that attended a Clinical Services Quarterly Meeting held in a public library classroom and completed a self-administered survey. Survey items were drawn from literature addressing HPV prevention best practices and representing 12 nurse-perceived barriers to HPV administration. Intervention included a 40-minute education session addressing barriers and a facilitated discussion to further identify barriers.
Results: Three major barrier categories identified were provider comprehension, provider bias, and provider resistance to change.
Conclusion: To improve HPV vaccine administration by PHNs, multi-factorial approaches must be implemented to eliminate barriers that interfere with PHN practice of this proven primary prevention strategy.
Recommendations: Enhance comprehension regarding HPV vaccine as primary prevention strategy to prevent cancer. Expand workforce development of PHNs to address personal bias and resistance to promotion of HPV vaccination. Implement strategies that positively motivate PHNs to administer HPV vaccine in accordance with CDC guidelines. Assign individual accountability for PHNs that are non-compliant with guidelines regarding HPV prevention.
#45 Furthering the Work of Collaborations: Perspective from A Local Child Death Review Team
Authors: Brook McKelvey, MA, MPH, Raquel Qualls-Hampton, Obrenka Thompson, MPH, D’Yuanna Allen-Robb, MPH, Dr. William S. Paul, MD, MPH
Issue: The Child Death Review Team (CDRT) has operated continuously in Davidson County (DC) since 1994, charged with understanding the causes of child deaths, and proposing recommendations designed to prevent future deaths. In 2016, the operational processes were modernized to achieve increases in three main objectives: 1) the ability to recognize patterns in child deaths, 2) team engagement, and 3) identifying and acting upon systems issues. This project evaluates the effectiveness and acceptability of those changes in advancing the work of the team.
Setting: In Davidson County, the largest county in Tennessee, approximately 22% of the population is under the age of 18. The DC CDRT reviews an average of 90 child deaths per year. The review team includes approximately 30 individuals representing a broad spectrum of governmental agencies, social service providers, and clinical professionals that serve children.
Project: Key informant interviews will be conducted with CDRT members who have participated on the team both before and after the operational processes were modernized. Questions are designed to evaluate the impact of process changes on the three main objectives. We hypothesize that long-standing members of a collaborative are dedicated to the work and want to be effective and expect the results from the key informant interviews to reveal increases on all three aspects under investigation.
Accomplishments: Two systems changes have been implemented since this project began: the development of a reporting system for drowning and near-drowning incidents at public pools, and a simplification of the home visiting referral system.
#46 Mapping Strategies for Small Areas: Infant Mortality in Davidson County
Authors: Brook McKelvey, MA, MPH, Justin Gatebuke, MPH, Raquel Qualls-Hampton, Tracy Buck, MS, RDN, D’Yuanna Allen-Robb, MPH
Background: There is an increased demand for health data for small geographic areas. For many health conditions census tract analysis produces unstable estimates due to small numbers inhibiting effective trend and pattern analysis. Utilizing multiple years of data is problematic for rare events such as infant mortality as the number of years required prevents trend analysis. As an alternative, the Metro Public Health Department (MPHD) grouped census tracts based on geographically and culturally relevant health reporting areas. This project uses infant mortality rates (IMR) to test the effectiveness and utility of these areas.
Methods: Yearly IMRs from 2007 through 2016 were calculated for census tracts and health reporting areas. An iterative process was used to determine how many years of data needed to be combined in order to produce stable estimates, defined as a relative standard error (RSE) <30%. IMRs will be mapped in both geographical constructs.
Results: There are 161 census tracts in Davidson County. Calculating IMRs in 5-year cohorts resulted in RSEs > 30% for all census tracts. A 10-year cohort resulted in 8 (5%) census tracts that could be mapped with an additional 4 (2.5%) census tracts with RSEs = 30.2%. Maps and RSE calculations by health reporting areas will be completed by August 2018.
Conclusion: Census tracts do not yield stable estimates for rare events. We are testing if estimates based on health reporting areas can provide a better alternative for analyzing rare health conditions at the local level.
#47 Factors influencing Recommended Cancer Screening in Low-Income African American Women in Tennessee
Authors: Kushal Patel, PhD, Jemal Gishe, PhD, Tanisha Adams, MPH, Gina Obiakor, MPH, Abiola Awofeso, DVM, Elizabeth Brown, PhD, Margaret Hargreaves, PhD
Background: As a part of the Meharry Community Networks Program (CNP) needs assessment, a 123-item community survey was administered to low-income African-American (AA) women to assess demographic characteristics, health care access, utilization, and screening practices for various cancers.
Objectives: This study examined predictive factors recommended for screening compliance of cervical, breast, and colorectal cancers in low-income AA women. The research examined obstacles to screenings by geographic region and screening practices.
Methods: African-American women 40 years and older (n = 308) were selected from the Meharry CNP community survey database. Women aged 40 and over were coded as compliant with their recommended cancer screenings, if screened for cervical cancer with a Pap test in the past three years and screened for breast cancer with a mammogram in the past two years. Women 50 years and older were compliant with recommended screenings if they had been screened for cervical and breast cancers. Women 50 and older were compliant if screened for colorectal cancer with a colonoscopy/sigmoidoscopy within the past five years.
Results: Thirty-two percent of the women were compliant with the recommended screenings for cervical, breast and colorectal cancers. Findings indicated predictors to recommended screening compliance including being employed, annual household income, smoking status, and having health insurance (P < .05). Finding child or elder care were obstacles to screening compliance.
Conclusion: More research needs to be conducted to determine if gaps exist among sociodemographic factors. Obstacles inhibiting the recommended cancer screenings need to be addressed in educational interventions aimed at improving primary prevention efforts.
#48 Use of Administrative Data Improved Completeness of Public Health Surveillance for Cervical Precancer, Davidson County, Tennessee
Authors: Sheelah Iyengar, MS, CCRP, Stephanie Allen, MPH, Manideepthi Pemmaraju MBBS, MPH, CCRP, Edward Mitchel, MS, Marie R. Griffin, MD, MPH
BACKGROUND: Human Papillomavirus (HPV) is the most prevalent sexually‐transmitted disease in the U.S., and the primary cause of cervical cancer. HPV IMPACT is a multi‐site public health surveillance program that monitors the impact of the HPV vaccine on cervical pre‐cancers.
OBJECTIVE: To demonstrate administrative database utility in improving data completeness.
METHODS: To identify women missed by standard surveillance of pathology reports, we searched three administrative data systems for Davidson County women age 18‐39 years with cervical dysplasia
diagnoses (International Classification of Diseases codes) or procedures (Current Procedural Terminology codes) in 2014. The Hospital Discharge Data System (HDDS), includes data on hospitalbased inpatient and outpatient surgical procedures, the Ambulatory Surgery Treatment Center (ASTC) database includes data on procedures in other surgical centers, and the Tennessee Medicaid (TennCare) database includes data on medical claims for low‐income women. We also attempted to link all women meeting surveillance criteria to TennCare to augment missing vaccination, insurance, and race/ethnicity information.
RESULTS: Through standard surveillance, we identified 375 women with cervical pre‐cancer in 2014. Using three administrative databases, we identified an additional 16 (4%) women with cervical precancer (5 HDDS, 4 ASC, 7 TennCare). Fifty‐eight percent of women (228/391) were ever enrolled in TennCare; for these women, linkage provided new information on vaccination status for 19%, insurance status for 32%, and race/ethnicity for 20%.
CONCLUSION: Augmenting standard surveillance with administrative data resulted in a 4% increase in case identification. In addition, linkage with an insurance database helped minimize missing vaccination, insurance and race/ethnicity information.