District 8.1: ValdoSTa

District 8.1: ValdoSTa

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 Counties of District 8-1 County Ranking Echols (EC) 60 Lowndes (LW) 72 Berrien (BI) 76 Brooks (BO) 82 Tift (TI) 89 Lanier (LN) 100 Cook (CO) 108 Irwin (IR) 132 Ben Hill (BH) 147 Turner (TU) 153 Health District Population by County

Echols Cook Ben Hill Turner Irwin Lanier Berrien Brooks Tift; 16.06% Lowndes 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

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 Health Behaviors: Diet and Exercise Problems Obesity Lack of physical activity Potential Solutions Physically active classrooms Social support in community settings Buddy system walking groups Adult Obesity 40% 35% 34% 29% 30%

33% 31% 34% 33% LN; 31% 31% 31% 30% BI TI Georgia Avg. 28% 25% 20% 15% 10% EC TU IR LN BO CO BH LW Physical Inactivity 35% 33% 30% 31% 29% 29% 31% 30% 29% 26% 24% 25%

27% Georgia Avg. 24% 20% 15% 10% EC TU IR LN BO CO BH BI TI LW Health Behaviors: Sexual Activity Teen Birth Rate Problems Teen Birth Rate 11.00% 10.10% 9.00% Potential Solutions Condom availability program 9.30% 8.30% 9.30% 7.80% 6.80% 6.70% 7.00% 6.30% 5.70% 5.00%

Mass media campaigns 3.00% Sexual education addressing pregnancy and STDs 1.00% EC TU IR Georgia Avg. 5.0% LN BO CO BH BI 5.00% TI LW Clinical Care: Access to and Quality of Care Problems Uninsured Primary care physicians Doctor: Patient ratio Golden Hour Potential Solutions Uninsured 38% 36% 33% 28% 25% 25% IR; 25% 23% 18% EC

26% 26% 24% 24% 25% 22% Georgia Avg. 22% TU IR LN BO CO BH BI TI LW Pop. per primary care physician 8800 7800 6443 6800 5800 4800 3800 2800 1604 1800 800 EC TU 8000 5296 3205 3370 1917 Georgia Avg. 1611 IR LN BO CO BH 2238 1925 1010

BI TI LW 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 Uninsured Uninsured 38% 36% 38% 36% 36% 34% 33% 32% 30% 28% 28% 26%

26%26% 26% 2 5% 25% 25% 25% 25% 25% 26% 25%25% IR; 3; 24% 24%24% 24% 24% 22% 23% 22% Georgia Avg. 22% 22% 20% 18% 18% EC 1 TU2 IR 3 LN4 BO5 CO6 BH7 BI8 TI9 LW 10 Pop. per primary care physician 8800 7800 6443 6800 5800 4800 3800 2800 1604 1800 800 EC TU 8000 5296 3205 3370 1917 Georgia Avg. 1611 IR LN BO CO BH 2238

1925 1010 BI TI LW Social Behaviors: Education, Income Employment Problems Unemployment 15.00% 13.00% 9.00% Low median household income 7.00% Summer work experience programs Career pathway and bridge programs for adults Drop-out prevention programs Early Head Start 12.00% 11.50% 11.00% High unemployment 12.70%

11.60% Potential Solutions 13.80% 13.20% 9.40% 8.50% Georgia Avg. 9.8% 9.30% 7.30% 5.00% EC TU IR LN BO CO BH BI TI LW Median Income 50000 45886 BO; 45886 EC; 45886 TU; 45886 IR; 45886 CO; 45886 BH; 45886 BI; 45886 TI; 45886 LW; 45886 45000 40000 35000 30000 25000 20000 15000 EC TU IR LN BO CO BH BI TI LW Health Disparities Amongst the Counties differ by Counties 50% 40%

30% Demographics 20% Geography 10% Access to care Education Economics Disparities were identified based on African-American constitution Hypothesized explanations County Health Ranking by African American Pop.% Disparity in health education 0% 50 60 70 80 90 100 110 120 130 140 150 160 County Teen Birth Rate by African American Pop. % 45% 40% 35% 30%

25% 20% 15% 10% Community ties 5% Program efficacy 0% 5% 6% 7% 8% 9% 10% 11% Disparities in Morbidity and Mortality Disparities in Mortality by County Size 250 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 200 150 100 50 0 Lung Cancer Stroke Heart Disease **Lines represent Georgia Avgs** Risk Factors Criteria for recommendations: Fiscally feasible Geographically accessible Relevant to the community Culturally appropriate Modifiable 1) Self risk behaviors 2) Access to primary care 3) Health education curriculum

Limited Modifiability 1) Number of facilities and hospitals 2) Homicide/MVA rate 3) Income/Economics of counties 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 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 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, AuYoung M, 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. Bartfeld J, 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):6271 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 childrens long-run outcomes. American Economic Journal. 2011;3(2):97-129. Bibliography cont.

Keller SN, Brown JD. Media interventions to promote responsible sexual behavior. Journal of Sex Research. 2002;39(1):67-72. Kropski JA, 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. Americas Health Rankings, 2013 ed. Available at http://www.americashealthrankings.org/GA/2012-2012. Accessed on October 27, 2013. 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 Allesyn Young County Researcher

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