District 8-1: Valdosta Addressing Community Health Disparities

1. District 8-1: Valdosta Addressing Community Health Disparities By Meryl Abrams, David Berndt, Molly Cinderella, Ashley Davis, Trace Deighan, Jada Fambrough, Stephen Hammett, Sarah Jansen, Neil Patel, Taylor Phelps, John Shapiro, Pat Simmons, Benjamin Sookhoo, and Allesyn Young

2. Counties of District 8-1

3. Criteria for Ranking Two components • Health Outcomes • Morbidity • Mortality • Health Factors • Behaviors • Clinical Care • Social and Economic • Physical Environment • Changing health factors can shape health outomes

4. Areas of Concern for District 8-1 • Health Behaviors • Diet and exercise • Sexual activity and teen birth rates • Clinical Care • Access to care • Golden Hour • Quality of care • Social Factors • Education • Employment • Income

5. Health Behaviors: Diet and Exercise Georgia Avg. 28% Problems • Obesity • Lack of physical activity Potential Solutions • Physically active classrooms • Social support in community settings • Buddy system walking groups

6. Health Behaviors: Sexual Activity Problems • Teen Birth Rate Potential Solutions • Condom availability program • Mass media campaigns • Sexual education addressing pregnancy and STDs Georgia Avg. 5.0%

7. Clinical Care: Access to and Quality of Care Problems • Uninsured • Primary care physicians • Doctor: Patient ratio • Golden Hour Potential Solutions

9. Clinical Care: Access to and Quality of Care Problems • Uninsured • Primary care physicians • Doctor: Patient ratio • Golden Hour Potential Solutions • Telemedicine • Extended privileges of nurse practitioners • Expand rural training tracts

10. Social Behaviors: Education, Income Employment Problems • High unemployment • Low median household income Potential Solutions • Summer work experience programs • Career pathway and bridge programs for adults • Drop-out prevention programs • Early Head Start

11. Health Disparities Amongst the Counties • Counties differ by • Demographics • Geography • Access to care • Education • Economics • Disparities were identified based on African-American constitution Hypothesized explanations • Disparity in health education • Community ties • Program efficacy

12. Disparities in Morbidity and Mortality • Rural districts are more prone to specific health outcomes • Urban settings provide: • Better access to health facilities • Improved capacity for health education of population • Broader range of programs tailored to community • Greater opportunities for social support **Lines represent Georgia Avgs**

13. Risk Factors Modifiable • Self risk behaviors • Access to primary care • Health education curriculum Limited Modifiability • Number of facilities and hospitals • Homicide/MVA rate • Income/Economics of counties Criteria for recommendations: • Fiscally feasible • Geographically accessible • Relevant to the community • Culturally appropriate

14. How can we, as physicians, help? • Assist in modification of risky behaviors • Facilitate access to primary care • Enlist help of teachers and counselors • Identify and communicate health disparities

15. Special thanks to… • Dr. William Grow, Health District Director; South District • Patrina Bowles, Health District Administrator Assistant • Erin Mundy, Director of Community Based Training Programs • Anne Hinton; Information Technology Support and Services

16. Bibliography • Alford S. Science and success, 3rd edition: Sex education and other programs that work to prevent teen pregnancy, HIV and sexually transmitted infections. Washington, DC: Advocates for Youth; 2012. • Barr-Anderson DJ, AuYoungM, Whitt-Glover MC, Glenn BA, Yancey AK. Integration of short bouts of physical activity into organizational routine: A systematic review of the literature. American Journal of Preventive Medicine. 2011;40(1):76-93.  • BartfeldJ, Kim M, Ryu JH, Ahn H-M. The School Breakfast Program: Participation and impacts. Madison: University of Wisconsin-Madison; 2009. • Bashshur RL, Shannon GW. National telemedicine initiatives: Essential to healthcare reform. Telemedicine Journal and e-Health. 2009;15(6):600-10 • Blake SM, Ledsky R, Goodenow C, et al. Condom availability programs in Massachusetts high schools: Relationships with condom use and sexual behavior. American Journal of Public Health. 2003;93(6):955-62.  • Christenson SL, Thurlow ML. School dropouts: Prevention considerations, interventions, and challenges. Current Directions in Psychological Science. 2004;13(1):36-9. • Daniels ZM, Vanleit BJ, Skipper BJ, Sanders ML, Rhyne RL. Factors in recruiting and retaining health professionals for rural practice. Journal of Rural Health. 2007;23(1):62–71 • Georgia Department of Health. Online Analytical Statistical Information System. Available at http://oasis.state.ga.us/oasis/. Accessed on October 27, 2013. • Georgia Department of Public Health. South Health District Programs and Services. Available at http://www.southhealthdistrict.com/default.asp. Access on October 27, 2013 • Havnes T, Mogstad M. No child left behind: Subsidized child care and children’s long-run outcomes. American Economic Journal. 2011;3(2):97-129.

17. Bibliography cont. • Keller SN, Brown JD. Media interventions to promote responsible sexual behavior. Journal of Sex Research. 2002;39(1):67-72. • KropskiJA, Keckley PH, Jensen GL. School-based obesity prevention programs: An evidence-based review. Obesity. 2008;16(5):1009-18. • Laurant M, Reeves D, Hermens R, et al. Substitution of doctors by nurses in primary care. Cochrane Database of Systematic Review. 2004;(4):CD001271. • McCombs JS, Augustine CH, Schwartz HL, et al. Making summer count: How summer programs can boost children's learning. Santa Monica: RAND Corporation; 2011: Monograph Report 1120. • National Center for Health Statistics. Vital Statistical Data: 1996-2005. Available at http://www.cdc.gov/nchs/data_access/VitalStatsOnline.htm. Accessed on October 27, 2013 Smith E, Green A. How workplace experiences while at school affect career pathways. Adelaide: National Centre for Vocational Education Research (NCVER); 2005. • Social Security Administration. National Average Wage Index. Available at http://www.ssa.gov/oact/cola/AWI.html. Accessed on October 27, 2013. • Sum A, McLaughlin J. Out with the young and in with the old: US labor markets 2000-2008 and the case for an immediate jobs creation program for teens and young adults. Boston: Center for Labor Market Studies Publications, Northeastern University; 2008. • Tucker, Cherri, Colette Caldwell, Carla Graves, Kelly McNamara, and Allen Dever. "Fact Sheet on Georgia's Trauma Physicians." Gpbw.georgia.gov. Georgia Board for Physician Workforce, Apr. 2011. Web. 27 Oct. 2013. • United Health Foundation. America’s Health Rankings, 2013 ed. Available at http://www.americashealthrankings.org/GA/2012-2012. Accessed on October 27, 2013.

18. Group member roles: • Meryl Abrams – County Researcher, PowerPoint Contributor • David Berndt – County Researcher • Molly Cinderella – Communications Officer • Ashley Davis – County Researcher • Trace Deighan – County Researcher • Jada Fambrough – County Researcher • Stephen Hammett – Podcast Producer • Sarah Jansen – County Researcher, PowerPoint Contributor, Podcast Voice • Neil Patel – Podcast Producer • Taylor Phelps – County Researcher • John Shapiro – Data Analyzer, PowerPoint Contributor, Podcast Voice • Pat Simmons – Data Analyzer, PowerPoint Contributor • Benjamin Sookhoo – County Researcher, Meeting Coordinator • AllesynYoung – County Researcher