The Determinants of Physical Activity in Rural Women, Aged 20 to 44 Years, in Georgia.

Physical activity rates in rural women are very low. The purpose of this study was to explore the determinants of physical activity in rural women aged 20 to 44 years. A survey was used to collect data on a cluster sample of 184 participants. This study was guided by Self-Determination Theory. Survey data suggest that the highest type of motivation was identified regulation, and husband's support had the strongest effect on physical activity. Findings suggest that a history of sports participation can lead to the formation of intrinsic motivation. The results will assist in developing effective physical activity interventions.

Spatial variations in the associations of term birth weight with ambient air pollution in Georgia, USA.

Birth weight is an important indicator of overall infant health and a strong predictor of infant morbidity and mortality, and low birth weight (LBW) is a leading cause of infant mortality in the United States. Numerous studies have examined the associations of birth weight with ambient air pollution, but the results were inconsistent. In this study, a spatial statistical technique, geographically weighted regression (GWR) is applied to explore the spatial variations in the associations of birth weight with concentrations of ozone (O3) and fine particulate matter (PM2.5) in the State of Georgia, USA adjusted for gestational age, parity, and six other socioeconomic, behavioral, and land use factors. The results show considerable spatial variations in the associations of birth weight with both pollutants. Significant positive, non-significant, and significant negative relationships between birth weight and concentrations of each air pollutant are all found in different parts of the study area, and the different types of the relationships are affected by the socioeconomic and urban characteristics of the communities where the births are located. The significant negative relationships between birth weight and O3 indicate that O3 is a significant risk factor of LBW and these associations are primarily located in less-urbanized communities. On the other hand, PM2.5 is a significant risk factor of LBW in the more-urbanized communities with higher family income and education attainment. These findings suggest that environmental and health policies should be adjusted to address the different effects of air pollutants on birth outcomes across different types of communities to more effectively and efficiently improve birth outcomes.

Using CBPR to Extend Prostate Cancer Education, Counseling, and Screening Opportunities to Urban-Dwelling African-Americans.

Community-based participatory research (CBPR) is becoming one of the dominant approaches for bringing evidence- and consensus-based cancer prevention and control practices to medically underserved communities. There are many examples of how CBPR has been useful for generating culturally specific solutions for different health issues that affect African-Americans. However, few examples exist in the literature on how the CBPR approach can be applied to address prostate cancer. This paper describes a collaborative process for linking inner-city, African-American men to free prostate cancer education, physician counseling, and screening opportunities (prostate-specific antigen (PSA) testing and digital rectal examination (DRE)). The site of this community-based participatory project was the city of Buffalo, located in Erie County, New York. The collaborative, community-academic process that is described includes the following: (1) planning and conducting a community needs assessment to contextualize local prostate cancer issues, (2) organizing town and gown event planning, and (3) manipulating aspects of the built environment to build an infrastructure within the community to address disparities in screening opportunities. This paper concludes with a description of lessons learned that can help others develop and implement similar activities in other communities.

Recommendations and administration of the HPV vaccine to 11- to 12-year-old girls and boys: a statewide survey of Georgia vaccines for children provider practices.

OBJECTIVE: This study explores the prevalence and provider- and practice-related correlates of physician recommendation and administration of the quadrivalent human papillomavirus (HPV) vaccine, Gardasil, to 11- to 12-year-old girls and the intention to recommend the HPV vaccine to 11- to 12-year-old boys in Georgia. The study also describes physician knowledge about and barriers to HPV vaccination. MATERIALS AND METHODS: This cross-sectional study was conducted from December 2010 to February 2011. The study sample was drawn using the Georgia Vaccines for Children (VFC) provider list as a sampling frame and probability 1-stage cluster sampling with counties as clusters. The final analytic sample was restricted to 206 provider locations. Weighted percentages and corresponding statistics were calculated accounting for selection probabilities, nonresponse, and the cluster sample design. RESULTS: Among Georgia VFC providers attending to 11- to 12-year-old girls, 46% had always recommended that their patients get the HPV vaccination and 41% had vaccinated their female patients. Among Georgia VFC providers attending to 11- to 12-year-old boys, 20% would always recommend that their male patients get vaccinated.Physicians most frequently endorsed costs of stocking the vaccine (73%), upfront costs (69%), vaccination (68%), and insurance reimbursements (63%) as barriers to their HPV vaccination practices. CONCLUSIONS: Despite the Advisory Committee on Immunization Practices' recommendations on HPV vaccination, the prevalence of recommending and administering the HPV vaccine to female and male patients, aged 11 to 12 years, by VFC providers is an ongoing challenge in Georgia.

Body mass index and death rate of colorectal cancer among a national cohort of U.S. adults.

Substantial evidence suggests that increasing adiposity is associated with an increased death rate of colorectal cancer, but no studies were conducted among national representative populations in the United States. The current study examined the death rate across BMI levels in 7,016 adults who participated in the National Health and Nutrition Examination Survey in 1971-1975. BMI categories were defined as normal (18.5-24.9 kg/m(2)), overweight (25-29.9), and obese (≥30). A total of 519 cancer deaths were identified during a 17-yr follow-up with 118,998 person-years. No significantly increased death rates of total cancers, lung, breast, and prostate cancer were observed among participants with an increased BMI. However, colorectal cancer death rates were 0.39, 0.68, and 0.96/1,000 person-years, respectively, for normal weight, overweight, and obese (P value for log-rank trend test < 0.001), and the corresponding adjusted hazard ratios [95% confidence intervals (CI)] were 1.00 (reference), 1.25 (95% CI = 0.72-2.19), and 2.04 (1.08-3.83), respectively. No gender difference of the association was identified. The authors conclude that a significantly increased death rate of colorectal cancer was associated with excess body weight. The current study is an addition to the expanding body of literature indicating an increased risk of colorectal cancer development among the obese.

Low cholesterol is associated with depression among US household population.

OBJECTIVE: Serum cholesterol was reported to be associated with depressed mood, but the studies conducted among household population are rare. METHODS: We used the data of 4115 men and 4275 women aged 18 or older, who completed a depression screening interview and had blood collected as a part of the National Health and Nutrition Examination Survey, 2005-2008. The serum concentrations of total cholesterol, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were gender-specifically categorized into lower, intermediate, and upper quartiles. Depression was measured using the Patient Health Questionnaire, a 9-item screening instrument asking about the frequency of depression symptoms over the past 2 weeks. RESULTS: After adjustment for socio-demographics and behavioral risks, a U-shaped association was detected between severe depression and LDL-C among men. The odds ratios (ORs) of severe depression were 5.13 (95% CI=1.74-15.09), 1 (reference) and 2.28 (1.07-4.86) respectively for the men with lower (<169 mg/dL), intermediate (169-221 mg/dL), and upper quartile (≥ 222 mg/dL) LDL-C. Among women, lower HDL-C was significantly associated with an elevated odds of severe depression [OR=2.96 (1.59-5.52)] compared with upper quartile of HDL-C, the association diminished after adjustment for covariates [OR=1.24 (0.66-2.32)]. No clear pattern of association between cholesterol and moderate depression was observed from either men or women. LIMITATION: The inherent limitation of cross-sectional design prevented the authors from investigating causality. CONCLUSIONS: A U-shaped association was identified between LDL-C and severe depression among men. Further studies are necessary to explore the biological mechanism and identify the clinical implication among populations vulnerable to psychiatric disorders.

Dietary protein and protein-rich food in relation to severely depressed mood: A 10 year follow-up of a national cohort.

High-protein diets are advocated to facilitate weight loss, and improve cardiovascular risk factors, but data on psychiatric effects are lacking. We analyzed data from 1947 men and 2909 women aged 25-74 years when examined in 1971-1975 as the baseline of the National Health and Nutrition Examination Follow-Up Study. The amounts of macronutrients were obtained from a 24-hour recall, and frequencies of eating protein-rich foods were estimated using a 3-month food frequency questionnaire. Severely depressed mood (SDM) was defined as Center for Epidemiologic Studies Depression Scale score ≥ 22 or taking anti-depression medication after an average of 10.6 years of follow-up. A significant gender difference was observed in the prevalence of SDM and its association with protein intake. The weighted prevalence of SDM was 11.45 (SE = 0.96) % and 17.45(1.05) % respectively among men and women. Among men, the relative risk (RRs) of SDM were 1.00, 0.46 (95% CI = 0.22-0.99) and 0.38 (0.16-0.92) respectively for the lowest, middle and highest third protein intake (p for trend=0.0347). Among women, the RRs were 1.00, 1.93 (1.23-3.08) and 2.47 (1.24-4.90) respectively with lowest, middle and the highest third intakes (p for trend = 0.0023). These estimates were adjusted for cigarette smoking, alcohol consumption, BMI, socioeconomic status at baseline, and the history of cancer, stroke, heart attack and diabetes assessed at follow-up interview. The authors concluded that increased intake of protein demonstrated a protective effect among men but a deleterious effect among women.

Legume consumption and severe depressed mood, the modifying roles of gender and menopausal status.

OBJECTIVE: Legumes have been recommended as staple foods in the anticipation of disease prevention. However, the scientific evidence of their benefits, particularly on mental well-being, remains preliminary. We longitudinally assessed the association between legume consumption and the risk of severe depressed mood (SDM) among a national cohort. DESIGN: The study included adults aged 25-74 years who were examined in 1971-1975 as a part of the National Health and Nutrition Examination Survey. Legume consumption at baseline was obtained from a 3-month FFQ and categorised as infrequent (<1 time/week), moderate (1-2 times/week) and frequent (> or = 3 times/week). SDM was defined as Center for Epidemiologic Studies Depression Scale score > or = 22 or taking anti-depression medication after an average of 10.6 years of follow-up (from 8.0 to 12.5 years). RESULTS: Among women, the proportion of individuals with SDM was 17.75 %. For premenopausal women (n 1778), a significant linear trend of deleterious effect from legume consumption was observed (P for trend = 0.0148). The relative risks (RR) for infrequent, moderate and frequent consumptions were 1 (reference), 1.24 (95 % CI = 0.91, 1.70) and 1.75 (1.12, 2.75), respectively. However, moderate consumption showed a significant protective effect (RR = 0.52 (0.27, 1.00)) among women undergoing the menopausal transition (n 454). No association was obtained from either postmenopausal women (n 601) or men (n 2036). CONCLUSIONS: These findings suggest that gender and menopausal status were effect modifiers of the association between legume consumption and SDM. Detrimental effects of frequent consumption of legumes may exist among premenopausal women; moderate consumption, however, may protect perimenopausal women against SDM.

Estimated risk of death among employees in agriculture and agriculture-related industries in Georgia, 1985-1994.

Farming has an enormous impact on the economy of Georgia, with as many as one in six Georgians working in agriculture. The purpose of this study was to compare the risk of death of white and black farmers to non-farmers in Georgia. Mortality data stratified by age and aggregated by race were retrieved from the Georgia Office of Vital Statistics for the years 1985-1994. The classification system used to code occupation on the death certificate was W473-489, which includes farmers and most all other agricultural occupations. For each cause of death, the Breslow-Day Test was used to determine homogeneity of risk across all age strata (alpha=0.05). A common odds ratio (OR) and 95% confidence intervals were calculated for all homogeneous causes of death using the Mantel-Haenzel procedure. Among white farmers, the risk of death was significantly high for tuberculosis [OR=1.64 (1.01, 2.65)], fires [OR=1.60 (1.15, 2.22)], and accidental drowning [OR=1.52 (1.01, 2.28)]. The leading causes of death among black farmers were accidental drowning [OR=1.53 (1.03, 2.26)], cerebrovascular disease [OR=1.27 (1.18, 1.38)], and ischemic heart disease [OR=1.21 (1.14, 1.29)]. Causes of death reported to be significantly low were also investigated. The findings of this study are varied, but trends related to risk of death appear to be similar to observed national trends.

Improving medical students' knowledge of systems-based practice.

Systems-based practice is an important aspect of medical education. This study evaluates the effectiveness of an eight-hour intervention on medical students' knowledge of the principles of managed care. A pre-test on basic managed care principles was administered to freshman medical students at Mercer University. After an eight- hour managed care curriculum was presented to these students, a post-test was administered. The pre-test and post-test scores on the material increased a mean score of 9.7 points (p < 0.001). Our conclusion is that providing as little as eight-hours of instruction on managed care topics can significantly improve first-year medical students' knowledge and understanding of systems-based practice.