PractitionersA Unified Vision for Healthy Communities: Sustaining Community Health Assessment (MAPP) through a Larger Community Visioning ProcessAuthors: Sonja Armbruster, Ty Kane, and Claudia Blackburn

Objectives: The goal of this project was to engage community stakeholders in the Mobilizing for Action through Planning and Partnerships (MAPP) process to increase awareness about the issues affecting the health of the community, as well as identify strategic priorities, focus community health efforts, and mobilize new partners.

Methods: Using the framework provided through MAPP, the Community Health Priorities was coordinated by the Sedgwick County Health Department and organized through Visioneering Wichita. “Visioneering” unites cities, as well as, public and private organizations to adopt shared values, vision and strategies for a regional community based strategic plan. Community forums brought together representatives from private business sector, health care, public health, government and community leaders. Four forums were held to review community health assessment data, select priorities, identify best practices and develop potential strategies for action. As the result of these forums, five community health priorities were identified: mental health, oral health, obesity and diabetes, access, and health disparities.

Results: Forums engaged 143 community leaders. This project is in the action stage and these community health priorities have been shared with over 2000 community members, physicians, and dentists through presentations, and thousands more through the web, radio, and print media. This process is the foundation for Sedgwick County’s health improvement plan.

Conclusions: Embedding this health assessment work in the overarching community visioning process is one key to sustainability over time. This strategy for community health planning provides external infrastructure support and opportunities to engage unique business and community leaders.

Integrating the CHANGE Tool Local Health Department AccreditationAuthors: Candace Ayars and Travis Rickford

Background: The Kansas Department of Health and Environment’s (KDHE) Bureau of Health Promotion oversees the Chronic Disease Risk Reduction (CDRR) Grant Program that provides funding and technical assistance directly to Kansas communities for reduction of the primary risk factors for chronic disease through evidence-based strategies.

CDRR is structured to promote policy, systems, and environment (PSE) changes at the community level and supports community program development from initial planning to sustainability and maintenance with guidance from Local Public Health Agencies and KDHE. A requirement of the program is the completion of the Community Health

Assessment and Group Evaluation (CHANGE) tool to assess barriers and assets in the community’s PSE infrastructure for addressing tobacco use, physical activity, and nutrition. Twenty-one counties are implementing the CHANGE tool. Concurrently, local health agencies have been tasked with achieving national accreditation, a process requiring a community health assessment. Although not a community health assessment, the CHANGE tool is a strong complement to the accreditation process through its emphasis on priority setting and action planning to impact many of the indicators identified through the community health assessment.

Methods/Activities:1. Technical review of the CHANGE Tool and its integration with the ten public

health domains required for national accreditation.2. Experiences of CDRR communities integrating CHANGE with accreditation

requirements.

Outcomes/Results:1. CHANGE tool can be successfully integrated into the national accreditation

program.2. Communities can use the CHANGE tool to achieve some data collection required

by the national accreditation program (e.g. Domain 5: Community Health Improvement Plan).

Examining False Negative Pap Smear Rates within a High Risk Population: A Retrospective AnalysisAuthors: Caleb Bowers, Paul Callaway, Hannah Haack, Amy Chesser, Nikki Woods, and Frank Dong

Background: Approximately 12,000 women in the U.S.A. are diagnosed with cervical cancer annually. Routine screening can identify cervical cancer and reduce cause-specific mortality. Although conflicting evidence exists regarding which method(s) are optimal for early detection, liquid-based techniques have reportedly lower false negative screening results as compared to conventional practices. This study sought to evaluate liquid-based Pap smear false negative rates within a known high-risk population.

Methods: A retrospective chart review will be conducted in August 2011. Participants will be included if they meet the following criteria: female patient of Wesley FM gynecology clinic, referred for colposcopic evaluation following an abnormal index cervical screen, Pap smear (with one of two liquid-based tests) and colposcopy evaluation during follow-up appointment from June 1, 2008, to July 20, 2011. Variable will include: patient age, days between initial Pap smear and follow-up visit, results of repeated Pap smear, colposcopic exam impression, and histological diagnosis from biopsy.

Anticipated Results: It is hypothesized the rate of false negatives among high-risk patients will be higher than the 10-20% false negative rate frequently reported in the literature and accepted among clinicians.

Conclusions: Comparing the false negative rate within a high-risk population to the 10-20% rate from the literature may support additional vigilance and training in known high-risk populations. Future prospective studies based on preliminary findings could inform screening recommendations for high-risk populations.

Every Day ImprovementAuthors: Kathleen Colson, Kim Ens, Charlotte Marthaler, and Pat Meyers

Background: Establishing quality improvement (QI) into public health practice and operations requires commitment at all organizational levels. Employing QI methods can appear to compete with service provision unless public health professionals make time for improvement in their daily work schedules.

Objective: To test effort and systems needed to use QI processes in daily work.

Methods: After monthly Co-CASA reports showed childhood immunization rates were below agency standards, staff with limited QI experience and training embarked on a Plan-Do-Check-Act (PDCA) cycle aimed at improving rates. Available resources such as the “Public Health Memory Jogger II” and Kansas Public Health Grand Rounds sessions were used to learn about QI tools and processes. Routine staff meetings and established data systems (Co-CASA and KIPHS) supported QI efforts. New work related to the improvement strategy (sending birthday cards on client’s first birthday and tracking results) was assigned to complement staff’s daily work processes.

Results: Use of systems already in place and available resources made the QI process manageable with minimal time and cost. Two additional team meetings were needed for reviewing data and developing Aim Statement and Improvement Theory. Data are gathered monthly and results will be evaluated to determine if the change resulted in improved immunizations rates.

Conclusions: There are several good resources to assist public health professional with creating QI processes within their daily work. By making small adjustments to established processes the task of incorporating a QI PDCA cycle is easily accomplished. The tendency is to make QI a bigger process than it needs to be. Keeping it simple enables staff to contribute daily to improvement efforts.

The Relationship between Select Socioeconomic Factors and the Initiation of BreastfeedingAuthor: Ashley Hinkson

Aim: This paper is a report of a study of the relationship between poverty status, maternal age, maternal education level, and initiation of breastfeeding infants.

Background: Identification and understanding of factors that influence a woman’s decision to breastfeed is important to promote interventions for those women least likely to breastfeed. The purpose of this study is to identify if there is a relationship between

the socioeconomic factors of poverty status, maternal age, maternal education level, and initiation of breastfeeding of infants.

Method: Data from the Infant Feeding Practices Study II (Centers for Disease Control and Prevention, 2008) were obtained and used in an independent samples t-test and chi-square to determine if there was a significant relationship between the socioeconomic factors of poverty status, maternal age, maternal education level and initiation of breastfeeding of infants.

Findings: Family income, X2 (4, N = 172) = 8.56, p = .73, and maternal education level, X2 (3, N = 155) = 6.50, p = 0.09, were not determined to be significant predictors of breastfeeding initiation and there was no significant difference found between maternal age and initiation of breastfeeding, t (27.79) = 1.032, p = .31.

Conclusions: It is of importance to ensure breastfeeding education and resources are directed at factors that significantly impact breastfeeding initiation to help attain higher breastfeeding rates. This study suggests that the social inequalities impacting the initiation of breastfeeding a decade ago may no longer be relevant with today’s population.

Building a Quality Improvement Culture at the Sedgwick County Health DepartmentAuthors: Ty Kane, Sonja Armbruster, and Claudia Blackburn

Background: In 2008, SCHD launched an initiative to build an organizational culture of QI. The impetus for the project was primarily PHAB Standards requirements, but also the move toward greater accountability, QI and performance management in all sectors of public health.

Methods: In 2009, SCHD sought private funding to hire a consultant. Project objectives were developed: recruit and train a quality council, develop a QI Plan and train staff. From August, 2010 through January 2011, SCHD worked with John W. Moran, Senior Quality Advisor to the Public Health Foundation, to achieve these objectives.

Results: Forty directors, managers and Q-Team members were trained to understand QI principles and tools. Eight improvement projects and storyboards were completed. All staff participated in based QI training. An agency Q-Team was developed. SCHD launched a 2011 QI Plan and wrote a QI Policy.

Conclusions: Upon completion of this initiative, twenty-five percent of staff experienced a formal PDSA process and nearly all staff have been involved in based QI training. Additionally, managers have reported improvement in programs, processes and staff-use of QI tools attributable to the training.

Acknowledgments: Thanks to the Sunflower Foundation of Kansas for funding this initiative, to John W. Moran at PHF for sharing perspective, resources and direction, and to the NACCHO APQI team for their ongoing support and resources.

Strategic Planning = A Sustainable Future for Local CoalitionsAuthors: Jamie Katz and Sue Matson

A community coalition is a union of individuals or organizations working to influence outcomes on specific problems1. High performing coalitions typically implement a strategic plan, while those that struggle have not developed or implemented one. A strategic plan assists a coalition in determining priorities 2. There is no perfect strategic planning model. Coalitions develop or modify existing models to meet community needs2. Examples of the many models, approaches, and tools available include: Communities that Care®; SAMHSA’s Strategic Prevention Framework; CSAP’s Western CAPT model; and KU Work Group’s Community Tool BoxTM. Strategic planning should be an inclusive process, including anyone impacted or influential in implementation.

A meaningful strategic plan will3:- identify the current status of the coalition- develop goals- develop its mission and vision for the future- monitor plans- prioritize action and strategies- evaluate programs- clarify values and needs (strengths, weaknesses, opportunities & threats)

These steps lead a coalition to develop evidence based policies, programs and practices that enhance sustainability and success.

Community Health Priorities: Call to ActionAuthors: John Kephart, Sonja Armbruster, and Meghan Hampton

In 2010, The Community Health Priorities plan was developed by Visioneering Wichita Health Alliance, Sedgwick County Health Department, and Sedgwick County leaders and partners to focus on “actionship” in five health priority areas: Health Access, Obesity and Diabetes, Mental Health, Oral Health, and Health Disparities. Following completion of the plan a “Call to Action” survey was developed to share new ideas and solicit feedback on steps that can be taken to improve the wellness of Sedgwick County residents. Its purpose was: (1) To help residents/respondents think about actions that they could take to improve our community’s health, (2) To help community leaders focus resources and (3) To share new ideas about improving health. A total 901 individuals completed the survey and 1465 individuals started the survey but did not complete it. More than 77% of survey respondents were women and ages ranged from <18 to >85 years, with 42% being between 45-64 years. Concern over Access to Health Care was the selected by 89% of respondents. Concern over Obesity and Diabetes, Mental Health, and Oral Health was selected by 88%, 84%, and 84% of respondents, respectively. Social media was found in 68% of respondents, 67% of which use Facebook, and 41% said they would share their health behaviors with others via e-mail or social media. Data suggest new opportunities to develop targeted policies and plans

for the improvement of health within the community. This survey was an important first step toward implementation strategies for the Community Improvement Plan.

Perinatal Periods of Risk (PPOR) Phase I and II: A State-Level Analysis in Kansas, 2005-2009Authors: Jamie Kim, Carol Gilbert, and Laurin Kasehagen Robinson

Background: Kansas’ infant mortality rate (IMR) has been persistently higher than the national rate. In recent years, Kansas’ IMR has stagnated while the national rate has declined. Furthermore, while many states have made progress closing the mortality gap between non-Hispanic black and non-Hispanic white infants, Kansas has not.

Methodology: Fetal death and linked birth-infant death certificate files (2005-2009) were compiled and analyzed using the Perinatal Periods of Risk approach to gain greater insight into the underlying factors contributing to Kansas’ fetal and infant deaths.

Results: When compared to a national reference group, 42.4% of Kansas’ excess fetal-infant mortality was in the post-neonatal period among infants ≥1500g. The excess mortality rate for non-Hispanic blacks (10.9) was >4 times greater than non-Hispanic whites (2.4). Among non-Hispanic white and Hispanic mothers excess mortality was attributable to risks relating to infant health and injury/safety. For non-Hispanic black mothers, the excess fetal-infant mortality was attributable to maternal health and prematurity. Further analysis showed that 88.6% of the non-Hispanic black mortality in very low birth weight births was attributable to birthweight distribution. Only 11.4% of the non-Hispanic black VLBW disparity was due to birthweight-specific mortality.

Conclusions: Causes of excess fetal-infant death and consequent opportunities for intervention vary according to the mother’s race/ethnicity. To significantly impact Kansas’ overall IMR, community-specific, tailored prevention efforts on prematurity, safe sleep, and injury prevention may be necessary.

Public Health Implications: Complex factors necessitate a multi-pronged approach to reduce Kansas’ overall IMR and collaborative efforts of community members, public health, and the medical community.

Building a Community Response to Compulsive HoardingAuthors: Krista Lovette, Deborah B. Fromer, and John W. Kephart

This session will include a discussion of how the AAA established and implemented a local task force which is a partnership between the AAA and a variety of community providers. An overview of the multidisciplinary response to hoarding cases and the tools developed will be provided in addition to a discussion of how this process can be replicated. During the session, presenters will encourage the audience to share their own experiences in addressing older adult hoarding issues.

By the end of the session, attendees should be able to explain how the Sedgwick County Hoarding Coalition was created and how to get one started in your community.

By the end of the session, attendees should be able to explain how our hoarding coalition intervenes in cases of older adult hoarding.By the end of the session, attendees should be able to state at least 5 types of organizations typically in a hoarding coalition.

Examining Social Norms, Barriers, and Facilitators among Urban AdolescentsAuthors: Candi Nigh, Nikki Keene Woods, Jennifer Wipperman, and Amy Chesser

Background: One third of the African American infant deaths in Kansas between 1998 and 2007 took place in only five zip codes. Breastfeeding has been shown to be a protective factor that could help address infant mortality, yet adolescent mothers are least likely to initiate breastfeeding and frequently do so for the shortest amount of time.

Methods: Four focus groups were held to discuss: environmental elements of the Wichita community, participants’ experiences, and describe how these elements interact in relation to breastfeeding outcomes. Adolescent mothers and pregnant adolescents were invited to a one-hour focus group. Each group discussed their attitudes towards breastfeeding, common attitudes among family and friends, their knowledge, as well as identified personal and environmental barriers and facilitators for breastfeeding. At the end of the session, participants were asked to submit photographs to help depict their breastfeeding experience. The focus groups were audio recorded and transcribed. Data was hand coded by four scores to identify themes.

Results: Participants identified technology (i.e. breast pumps), mentors, and the desire to be a good mother as facilitators. Lifestyle, independence, lack of support from family, social stigma/embarrassment, and difficulty with breastfeeding techniques were described as barriers. Photographs were compiled to visually confirm the qualitative data.

Conclusions: These findings are important for Kansas because of its high infant mortality rates. Further research is needed to examine local interventions that target identified environmental factors that support adolescent breastfeeding and related health behaviors with the goal of reducing infant deaths within the community.

Inclusion of Tobacco Guidelines into the Kansas Model Wellness Policies: Creating a Framework for Statewide Youth Tobacco Use PreventionAuthors: Mark Thompson and Liesl Hays

Objective: One of the nation’s leading public health concerns is inarguably childhood health. In response to this concern, national attention on this topic has garnered public awareness. Health advocates have capitalized on this momentum by promoting evidenced-based policies targeted at youth. Kansas is no exception. As a result of State Law (SB-154) passed in May 2005, which was in response to the Child Nutrition Reauthorization of 2004, the Kansas State Department of Education (KSDE)

developed nutrition guidelines for all foods and beverages made available to students in Kansas public schools during the school day. The result of this effort was the establishment of the Kansas Model Wellness Policies which provide all school statewide guidelines on nutrition, nutrition education, and physical activity. Currently, Kansas schools report on these guidelines to the Kansas State Department of Education. While the model guidelines provide an excellent framework for its focus areas, schools and tobacco advocates have envisioned the inclusion of tobacco specific guidelines. With the onset of Child Nutrition Reauthorization of 2010, states have been asked to revise their current model wellness policies. This revision process sets the stage for consideration of tobacco specific guidelines.

Methodology: In response to the vision of tobacco-specific guidelines, the Kansas Department of Health and Environment (KDHE) and KSDE staff conducted a literature review on evidenced-based youth tobacco interventions and updated draft tobacco guidelines. In an effort to solicit feedback on the draft policies, the formulation of a sector-diversified advisory committee was established. The advisory committee was tasked with providing recommendations on draft tobacco guidelines. With their feedback, the tobacco guidelines were updated and sent out to the committee for further comment.

Results: The creation and update of tobacco specific guidelines has created a practical evidenced-based framework for schools implementing your based tobacco interventions, a unified state-wide vision, and the possibility of the inclusion of tobacco specific guidelines into the Kansas Model Wellness Policies.

Physical Activity and Arthritis: Results from the Arthritis Call Back SurveyAuthors: Elizabeth Walsh and Ghazala Perveen

Background: Approximately 24% of Kansas adults have doctor-diagnosed arthritis. Successfully managing arthritis symptoms, such as through regular, moderate physical activity helps prevent disability and improves quality of life. However, Kansas adults with arthritis are twice as likely to be inactive as compared to those without arthritis.

Objective: To examine the relationship between attitudes toward, confidence in, and barriers to physical activity among Kansas adults with arthritis.

Methods: Respondents to the 2009 BRFSS during March-September who report having doctor-diagnosed arthritis were invited to participate in the Arthritis Call Back Survey. Respondents who agree to participate were called back within two weeks of their original interview. Questions regarding attitudes toward, confidence in, and barriers to physical activity were analyzed using statistical procedures for weighted data.

Results: The majority (90%) of adults with arthritis agrees that it is important for someone with arthritis to get regular, moderate physical activity. However, smaller proportions (72%) of adults are highly confident that they can meet recommended levels of activity. Confidence in ability to get physical activity decreases if adults with arthritis

have another injury/health condition (60%) or have a fear of falling due to their arthritis (50%).

Conclusions: While the majority of Kansas adults with arthritis agree it is important for them to get recommended levels of moderate physical activity, a smaller percentage are highly confident they will be able to do so. This is compounded if adults with arthritis experience additional barriers, such as having other health conditions or a fear of falling.

ResearchersDevelopment of a Professional Education Program about Mental Health Needs of American IndiansAuthors: Stacy Braiuca; Susan Crain Lewis; William F. Gabrielli, Jr.; Kimberly Engelman; and Christine M. Daley

Depression and related outcomes (e.g. suicide, violence, etc.) affect American Indians (AI) disproportionally. Nonetheless, there are no large-scale epidemiologic studies in the literature to understand this disparity. Furthermore, historical and current policies impact mental health for AIs. Underfunded healthcare systems, conflicting system policies, and indirectly, two centuries of government policies have resulted in unfortunate mental health outcomes and negatively shaped the mental health information and treatment choices for AIs.

We will describe the development and qualitative testing of a professional education curriculum comprised of a booklet and presentation slides about AI mental health concerns and treatment considerations. The booklet development commenced after a health literacy assessment of current materials at Mental Health America of the Heartland. Following this assessment, education materials were drafter and subsequently were assessed qualitatively via semi-structured interviews and focus groups with community members. The developed materials took into consideration difference between Western medicine’s and Traditional AI definitions of, and treatment of, mental illness.

A collaborative effort, such as the one taken by our team, to include members of underserved communities and providers in the materials development process will do nothing but help to move us toward the creation of culturally accepted mental illness definitions and treatment. With improved educational communication vehicles, such as the booklet and presentation developed for this project, we can begin the critically important journey of effectively integrating Western and Traditional medicine and better serving the mental health needs of American Indians.

Health Literacy Assessment for Mental Health America of the Heartland Using Fry, SMOG, and SAM Readability ToolsAuthors: Stacy Braiuca, Susan Cain Lewis, Kimberly Engelman, and Christine M. Daley

Mental Health America of the Heartland (MHAH) is a community advocacy and education agency located in the Kansas City metropolitan area. MHAH is affiliated with a National organization that was established in 1909, during the beginning of the “consumer movement” which involves adults and children living with mental illness with their own recovery.

This poster presents assessment results from a sample of mental health literatures (N=15) available to patients, professionals and the public from MHAH. These materials are taken to local and regional school presentations, health fairs, the agency’s own

education events, and had previously not been assessed for health literacy, according to the agency’s Executive Director.

Materials were each assessed using three different measures of health literacy. The Fry (Fry Readability Formula, a form of regression analysis for literacy), measures reading grade level, the SMOG (Simple Measure of Gobbledygook), estimates the education reading level for an individual to understand the material, and SAM (Suitability Assessment of Materials) assesses the overall suitability of materials, including the reading level, writing style, vocabulary, content, cultural appropriateness, and clarity. Considering the wide range of educational attainment of MHAH’s audience, assessment of their materials for appropriate literacy levels is important to their mission.

The grade level of most items on the materials was Graduate level and beyond, which highlights the need for future study and development of more appropriate literature for future readers of all literacy levels.

Keywords: health literacy, mental health, literature, readability.

Assessment of Alternate Approaches for Health Information Technology in Family MedicineAuthors: Amy Chesser, Jennifer Wipperman, Frank Dong, Nikki Keene Woods, Aron Fast, Traci Hart, and Rick Kellerman

Introduction: Health information technology (HIT) has been used to improve healthcare through enhanced clinician-patient communication. The Centers for Disease Control and Prevention (2011) published health literacy goals promoting patient-centered technologies throughout healthcare processes. One form of HIT with potential to solve clinical communication problems is the Apple iPad. However, a lack of evidence exists for iPad integration feasibility within existing systems.

Methods: This study was a prospective assessment of physicians’ experiences with iPad functionality in the clinical settings. Three faculty in-depth interviews were conducted to discuss methods for integrating iPad technology with current information technology (IT) systems, interfacing systems and software, and practically of data entry and extraction throughout the tasks of clinical care; followed by 42 faculty/resident surveys assessing physicians’ readiness to adopt tablet technology.

Results: Several benefits specific to iPad use were stated. Physicians described Apple iPad implementation as integral to patient education. Physicians reported the physiological processes of medical diagnoses were more easily illustrated anatomically and visualized with greater clarity. Effortless extraction of information to include electronic health records and radiological imaging was achieved within one patient appointment. However, physicians faced difficulty with keyboarding and data entry as compared to current technologies, such as a laptop computer.

Conclusion: Public healthcare is influenced by the effectiveness of clinician-patient communication, health education and promotion. Our findings suggest the iPad may prove feasible and novel for improving efficacy. However, the iPad may be only one

element to a comprehensive solution, where extensive IT infrastructure support is necessary for implementation.

Examination of the Principal Components to Identify Social Values Impacting Health Behaviors for the HEARTLINES Life Orientation Campaign in South AfricaAuthors: Amy Chesser, Traci Hart, Carolyn Ahlers-Schmidt, and Frank Dong

Background: The objective of this study was to describe the effects of an item correlation and factor analysis performed on existing evaluation data. The intervention consisted of the use of media utilization (a.k.a. Entertainment Education) to educate and inform student audiences to motivate them toward positive health behaviors while they were engaged in an entertainment activity. The Heartlines campaign incorporated curriculum for learners grades 10 and 11 enrolled in public schools in South Africa. The overall purpose of the research was to assess student knowledge, beliefs, intentions and self-efficacy of value-based topics related to health and risky behaviors which may impact the spread of HIV/AIDS.

Methods: A quasi-experimental, repeated measures survey design was used to assess the impact of the Life Orientation curriculum. There were three phases to the study which included the pre-test survey (a baseline measure of pre-intervention responses), the intervention (an eight-week curriculum administered during the Life Orientation class period), and the post-test survey (designated for the session following the completion of the curriculum intervention). Data from a convenience sample of 11 public schools was collected January through May of 2008. Data were analyzed at group level only. There were 53 questions for grade 10 pre-test survey (N=784) and 67 questions on the post-test survey (N=650). Similarly, there were 50 questions for grade 11 pre-test survey (N=691) and 58 questions on the post-test survey (N=732).

Using SPSS Version 18, the principle components were extracted using iterative principles axis method with the objective of achieving a simple structure independently for each grade. A scree plot and the total variance explained by the number of principle components methods were examined to determine the number of principle components. These two methods yield four principle components. Varimax rotation method was applied to achieve a better interpretation of the four principle components. Variables with the principle component loading less than 0.35 were excluded in the interpretation of principle component content.

Results: Through the factor analysis, four principle components were identified for each grade and confirmatory factor analysis was carried out to verify the factor structures. The four factors for the grade 10 learners are Acceptance, Honesty, Forgiveness and Perseverance. The four factors for the grade 11 learners are Compassion, Second Chance, Self-control and Responsibility.

Significance: This study will provide preliminary evidence regarding which instructional method should be used in the future implementation of large-scale national values-based, Entertainment Education programs for the public school setting in South Africa.

Quantitative Analysis of The Adverse Effects of Not Maintaining Regular Dental Clinic Visits for Senior CitizensAuthors: Frank Dong, Amy Chesser, and Nikki Woods

Background: Medicare provides optional dental care for people age 65 or older, which requires individuals to pay for dental care. Seventy-seven percent of elderly patients (age 65 or older) had one or more or all of their teeth permanently removed. Elderly patients suffered in their mental health, physical health and depression status due to permanent teeth removal.

Method: Behavioral Risk Factor Surveillance System data (2008) was used to study the relationship between the number of dental clinic visits and mental health, physical health and depression. Negative binomial regression and logistic regression were conducted to explore the relationship between the response and number of dental clinic visits.

Result: Individuals age 21 or older, 45% of respondents, did not have any teeth removed. The number of dental clinic visits had a positive effect on the number of mentally healthy days, the number of physically healthy days, and the self-report general health. For elderly respondents, 23% of respondents did not have any teeth removed. The effects of dental clinic visits have stronger positive effects on the number of mentally healthy days, the number physically healthy days, and the self-report general health.

Discussion: For elderly respondents having a regular dental clinic visit to prevent removal of permanent teeth had stronger positive effects on their mental health and physical health than younger respondents. Preventing permanent teeth removal may also have a positive effect on depression, which could reduce the chance of suicide.

Informative Community-Based Participatory Research among a Refugee PopulationAuthors: Melissa Filippi, Babalola Faseru, Joseph LeMaster, and Fanta Kuhlman

Background: Health data concerning African immigrants and refugees living in the United States is dearth. No national database exists which provides standardized information regarding health indicators, country specific concerns, and ethnic group status. In addition, the data that characterizes the health experience literature of African immigrants and refugees are sparse. Thus, to better understand the health priorities and needs of the Somali community in Kansas City, we interviewed Somali community members to determine the most pressing health needs as they see fit (N=11). This formative research will help direct future community-based participatory research (CBPR) endeavors.

Methods: This formative research used a community-based participatory approach. Recruitment was accomplished through word-of-mouth. After obtaining informed oral consent, we asked open-ended questions based on research aims. We conducted 11

semi-structured interviews. The interviews were recorded and transcribed verbatim (with the exception of one interview). The transcripts were coded inductively and we used standard text analysis to identify themes.

Results: Community members identified specific health condition, such as: diabetes, high blood pressure, high cholesterol, administering medications, and mental health, as areas that need particular attention. All participants discussed lack of health knowledge and length. Generally, interviewees thought that community health workers could bridge some of the barriers mentioned.

Discussion: Health issues and barriers to care are couched within larger, structural conditions such as education, socioeconomic concerns, and migration processes. Through partnerships, perhaps some of these health issues and barriers can be addressed in a culturally-appropriate way.

Eating Away-From Home Foods: Important Characteristics by weight status groupsAuthors: Katie M. Heinrich, Nattinee Jitnarin, C. Keith Haddock, Joseph Hughey, LaVerne A. Berkel, and W. S. Carlos Poston

Away-from-home food consumption is linked to obesity; both have dramatically increased since the mid-1970s. This study examined the relationship between characteristics of different types of away-from-home food establishments and weight status.

Cross-sectional data were from 586 adults completing in-person surveys in the Kansas City Metropolitan area. Measured height and weight were used for BMI (<18.5 underweight, 18.5-24.9 normal weight, 25-29.9 overweight, 30+ obese). Participants indicated where they primarily ate away-from-home. Participants also indicated the frequency of eating at six away-from-home establishments.

Participants were female (69.8%), White (65.4%), married (51.5%), employed/self-employed (58.5%), ≤$60,000 incomes (54.6%); average age 45±14.7. Mean BMI was 28.4±7.7 with 3.1% underweight, 35.7% normal weight, 28.0% overweight, and 33.3% obese. In the past 12 months, doctors had told 17.2% to lose weight, 2.4% to gain weight, and 1.9% to maintain weight.

Participants’ primary away-from-home food establishments included full service (31.7%), ethnic/specialty (17.7%), fast food (14.0%), and other (e.g., buffet). Greater weight status was correlated with eating more fast food (p<.01), but fewer meals from soup kitchens/churches/community centers (p<.05). Participants told to lose weight were ate more at fast food restaurants (p<.05) and buffets (p<.05), while participants told to gain weight ate more at worksites/cafeterias (p<.05).

Despite being told to lose weight, obese individuals still reported frequent fast food consumption as well as buffets. Non-obese participants and those told to gain weight were more likely to eat at worksites/cafeterias or churches/community centers. Future

research could examine underlying causes as well as protective effects for these choices.

Improving Birth Outcomes through the Healthy Babies Northeast Wichita Healthy Start InitiativeAuthors: Michelle L. Redmond, Susan E. Wilson, Linda M. Frazier, Rosalee E. Zachula, Darren M. Farley, and Liesa Hopper

Background: Concern is growing regarding the racial disparity of poor birth outcomes. Programs targeting high-risk mothers can help reduce adverse birth outcomes. Birth outcomes were examined for clients served by the Healthy Babies program and living in the federally-funded Health Start zip codes (referred to as NEWHSI). NEWHSI clients were compared to non-NEWHSI clients residing within the same three high-risk zip codes (67208, 67214, and 67219) in Sedgwick County, KS.

Methods: A cross-sectional design was used, involving secondary analysis of de-identified birth certificate data obtained from Kansas Department of Health and Environment. Birth outcomes were examined for non-Hispanic white, black and Hispanic women (n=3,644) living in NEWHSI target zip code areas Main outcome measures were very low birth weight (<1500g), low birth weight (1500g-2500g), preterm birth (<37 weeks) and prenatal care.

Results: Rates for very low birth weight were 2.7% for non-clients and 0% for NEWHSI clients. Most Health Babies NEWHSI clients reported receiving prenatal care within the 1st trimester with 100% receiving some prenatal care during pregnancy; reports were similar for non-clients.

Conclusion: Health Babies NEWHSI clients displayed similar outcomes as non-clients in the same community. However, Health Babies NEWHSI was successful in decreasing preterm births and maintaining other outcomes, even with a high rate of teen and first-time moms among the client population. Results may reflect a high percentage of at-risk mothers that the program actively recruits in Sedgwick County. Findings reveal a continued need for the Health Babies NEWHSI program as they work to improve poor birth outcomes in the community.

Defining Physical Activity in Older WomenAuthor: Nicole L. Rogers

Older adults are the fastest growing population in the US, yet the least physically active. Physical inactivity is a leading public health problem associated with decreased longevity as well as cardiovascular disease, cancer, obesity, and diabetes. Several organizations recommend older adults engage in at least 30 minutes, 5 days/week of moderate-intensity physical activity (PA). In spite of the benefits of PA, only 25% of women aged 65-to-74 years participate in regular PA. Women older than 75 years have even lower participation with 14% engaging in any PA. With respect to the amount (steps) of daily PA, there are few recommendations. Research suggest the following:

Sedentary=2,000-4,999, Low Active=5,000-7,499, Somewhat Active=7,500-9,999, and Active=10,000-12,999.

Our lab recently measured PA levels of 107 older women in 3 age groups: 60-69 (n=38, 65.26 ± 2.71 years), 70-79 (n=46, 74.04 ± 2.99 years), and 80-89 (n=23, 8 ± 2.71 years). With respect to amount of PA, no group was “Active”. For highest step day, the two most active age-groups (60s and 70s) were considered “Somewhat Active” (~8,200 daily steps). No group achieved 30 minutes of moderate-intensity PA. The highest 5-day average was for 70-year olds (~16 minutes), followed by 60-year olds (~14 minutes), and then 80-year olds (~8 minutes). Evaluating the number of older adults meeting recommendations, results are not encouraging. Eight of 38 (21%) 60-year olds, 4 of 45 (11%) 70-year olds, and 1 of 22 (5%) 80-year olds spent at least 30 minutes, five days per week engaging in moderate-intensity PA.

Adult Survivors of Childhood Cancers: Survey Results of Long-Term Survivorship IssuesAuthors: Robin Ryan, Kristin Stegenga, Wendy McClellan, Hope Krebill, Jennifer R. Klemp, and Eve-Lynne Nelson

Increasing cure rates has led to an expanding percentage of the population identifying as a childhood cancer survivor. For this population, cancer therapies and the psychosocial impact of diagnosis present the potential for healthcare needs beyond the therapeutic treatment period. A large obstacle to meeting these needs is this group’s transition from pediatric oncology healthcare to adult primary healthcare. This transition can occur years after cancer treatment. The Children’s Oncology Group, the largest pediatric cooperative clinical research group, has published extensive long term follow-up recommendations based on the type and amount of cancer therapy survivors received. Disseminating this information to the population is challenging. Additionally, the individual healthcare needs and practices of this population continue to be defined. To address this public health dilemma, researchers from a metropolitan pediatric cancer center and a university medical center collaborated to determine how to identify the region’s survivor population and to measure what would be important in the development of a regional approach to the management of this population’s needs. Using Tumor Registries from both institutions, an Institutional Review Board approved survey was mailed to 710 subjects eighteen years and older who were registered with a malignant diagnosis prior to their eighteenth birthday. Survey questions were chosen with the intent to characterize the population and to seek paths for regional programming. The project process can provide public health professional with a framework to develop similar collaborations and provides an opportunity to identify future programs to address the needs of this population.

Enhancing Health Career Pathways through Health Disparities Research: The Latino Internship in Health Disparities ResearchAuthors: Natalia Suarez, A. Paula Cupertino, and Susan Garrett

There is a pressing need to expand the number of underserved minority students pursuing careers in the health professions and health disparities research. In response to this priority, since 2009, the KUMC Department of Preventive Medicine and Public Health has hosted the Latino Internship in Health Disparities Research program which, thus far, has engaged 24 minority youth from the Kansas City area.

Our goal is to create a cohort of investigators that can address health disparities in the future. We feel that using a community-engaged approach to both education and research training will help us achieve that goal.

The Latino Internship in Health Disparities Research program is a 6-week training program for underserved minority high school and undergraduate students. We train students in the CBPR process of identifying problems, creating solutions, evaluating and disseminating project findings.

In the summer of 2011, the program served seven Kansas City area students. The training curriculum focused on five central goals: 1) Understanding medical careers; 2) Comprehensive understanding of health disparities; 3) Health disparities research among Latinos; 4) Development of professional skills; and 5) Cultural competency.

In a program evaluation, students self-reported an increased understanding of health careers and health disparities, and an increased ability to think critically about health issues in their community. Education programs are needed to provide underserved minority youth with skills in health disparities research. These can ultimately enhance the health of disadvantaged communities by encouraging students to return to their own communities and contribute to its health and wellness.

Healthcare Services Preferences: Dimensions of Uninsured Consumers Priorities and ChoicesAuthors: Ruth Wetta-Hall, Karen M. Kramer, Lisette T. Jacobson, and Ashley Moss

Access to health care continues to pose problems for a significant portion of Americans. Communities have developed local solutions to address the health care needs of uninsured populations such as the Sedgwick County Health Access Project in south-central Kansas. The purpose of this project was to explore county residents’ perceptions toward affordability and availability of healthcare services. One survey item asked respondents to rank order, by perceived need for their families and themselves, eight healthcare services. A hierarchical cluster analysis using Ward’s method identified three groups with varying preferences for healthcare services. Service preferences in grou 1 (primary care, lab tests and prescription medication support) suggested needs of an acute nature. Group 2 preferences (specialty care and hospitalization) suggested experience with and need for chronic disease care. Group 3 showed another pattern, a preference for emergency services only. No participants indicated a preference for mental health services. Multidimensional scaling analysis (MDS) further described these clusters by classifying participants along three dimensions that suggested higher versus lower perceived need for services. Dimension 1 reflected participants’ likeliness to use the service. Dimension 2 differentiated between preferences for services that might be needed by people with chronic disease(s). Dimension 3 reflected perceptions of the cost

associated with services. Psychometric analyses may uncover additional dimensions of preference that would not be revealed by standard statistical analyses. This study’s outcome shows that these techniques reveal critical information when analyzing perception datasets, which may be helpful in guiding policymakers and clinics that serve the uninsured population.

The Multi-State Learning Collaborative: A Public Health Quality Improvement Initiative in KansasAuthors: Ruth Wetta-Hall, Gianfranco Pezzino, Edie Snethen, Tatiana Lin, Lisette T. Jacobson, and Ashley Moss

The purpose of this project was to explore the design, implementation, and short-term outputs of the Multistate Learning Collaborative (MLC) in Kansas and its impact on preparation for public health accreditation and progress in developing a quality improvement (QI) culture. Using telephone-based focus group methods, participants’ perceptions from three separate training initiatives were assessed. Participants were representatives of regions that participated in the MLC training. Themes identified through the focus group process were categorized based on program strength, perceived barriers to progress, and sustainability. The results of this study point to four specific strengths that were influential in the success of the MLC initiative when achieving program goals: (1) interactive training activities and the ability to learn from their peers, (2) enhanced communication among regions and team members, (3) easy to access technical support, and (4) the ability to collaborate via the Internet from remote locations. The interaction of these elements combined to create lines of communication between and among teams while facilitating the learning and application of QI methods. Perceived barriers to progress included the challenges of public health data sets, adoption of the QI philosophy within an organization’s culture, and evolving governmental guidelines requiring continual adaptation. Identification of long-term program sustainability issues included (1) funding sources for technical assistance, training, and travel; (2) organization-wide commitment to QI requiring ongoing training and support; and (3) continued collaboration among and across regions. Altogether, organizations continue to make progress toward public health accreditation and integration of a quality improvement culture.

StudentsIntern Management: Improving the Quality of Workforce DevelopmentAuthors: Pamela Behnk, Sonja Armbruster, and Ty Kane

Introduction: Workforce development is one of the ten essential public health services: “8. Assure a competent public and personal health care workforce.” New state, local and tribal health department accreditation standards are framed by the ten essential public health services. The standards require that departments demonstrate their relationships and collaborations that promote public health as a career.

Background: The Sedgwick County Health Department has and continues to successfully host interns from over a dozen educational institutions, but lacks a standard documentation system. In preparation for meeting accreditation standards, SCHD program mangers recognized gaps in documentation and management of intern experiences. A Quality Improvement project team was formed to assess current efforts and plan improvements.

Methods: Methodology centered on a nine step PDSA process. Multiple stakeholder meetings took place to identify issues, examine current/future approaches, develop a plan for all interns and develop an interactive online database for documentation of intern activities.

Results: A SharePoint site was created to provide a consistent data collection strategy that will allow leaders to assess the full impact of intern efforts. This tool provides reports of intern hours worked, projects completed, and partnerships with institutions of higher education.

Discussion/Conclusion: Developing new documentation strategies require time, training, and shared interest among staff. Illustrating the significance of completed activities, collaboration with schools, and hours of mentoring provided to the future public health workforce will assist the SCHD to meet accreditation standards.

A Tour of Diabetes Education Programs in Kansas CityAuthor: Steve Daniel

Diabetes has become a rapidly growing epidemic over the past two decades, increasingly impacting the Latino community. Diabetes education health centers around the country have been one of the answers used to combat this widespread disease. However, this seems to also have led to mixed results. Grants and other types of fundings have at times, slowed the development of education centers, which are sorely needed around the country. We visited four well known institutions that offered education classes in the Kansas City area, with a goal of understanding how each of these centers appealed to their patients, mainly Latino, with improved knowledge, reduced fear, and better diet consistent with management of Type II diabetes. Of the four, it appeared that one was more engaging for patients, had less of a didactic atmosphere and its utilization of conversation maps in a round table like discussion, and

suggested this was a more effective way of educating patients. Another class offered was well known for offering insulin to its participants. The remaining clinics, while, drawing the same number of participants, had some limitations, especially due to not being open to the public.

Effect of Marital Status on Colorectal Cancer Screening Participation in the United StatesAuthors: Boutros El Haddad and Olusegun Olaosebikan

Objective: The objective of this study was to compare the participation rate in colorectal cancer screening among married, separated, widowed, never married, and divorced adults living in the United States.

Introduction: Marital status has been implicated as a factor affecting colorectal screening participation.

Methods: The population studied included 139,273 participants, aged 50 to 75, who completed the Behavioral Risk Factor Surveillance System survey (BRFSS) in 2008.

Participants were considered to be current on colorectal screening if they have had a FOBT done within the past year, or sigmoidoscopy performed with the last five years, or a colonoscopy within the past 10 years.

Results: Logistic regression analysis that included marital status, education level, income, and the presence of health care coverage suggested that individuals who are divorced (OR=0.826; p<0.001), widowed (OR=0.890; p<0.001), never married (OR=0.755; p<0.001), and those who are members of an unmarried couple (OR=0.756; p<0.001) were less likely to be appropriately screened than married individuals. There was no significant difference in the current colorectal screening between the separated and the married group.

Discussion: Married individuals were more likely to be screened compared to divorced, widowed, never married, and members of unmarried couples.

Conclusion: Unmarried individuals are at risk for not receiving appropriate colorectal cancer screening.

Kansas Kids Keep It HealthyAuthors: Jennie Guerrero, Christine Krill

Our poster puts an emphasis on the importance of keeping children healthy and active. This came about from developing two projects, Exergames and a Read and Ride program, which kids enjoy and keeps them active at the same time. The description of the Exergames is to turn passive screen time into physical fitness times using the technology of video game systems. It is based on a similar program done in Idaho that is titled “Fit and Healthy: Incorporating Exergames and Nutrition”. The kids will play an interactive video game on Nintendo Wii, such as dance game, and show how being active can be in many forms and if it is fun then the kids will want to be active. The

description for the Read & Ride program is designed to have the students read a book while riding a stationary exercise bike. This program can be used as an incentive for students to complete their class work in school or an outlet to release some fun energy while in camp. Riding a bike provides children with a difference aspect of exercising that can be fun to engage with family and friends. Our program is different from others because it combines two different activities that are fun and challenging for kids. We tested out the program at a local community center which yielded positive results because the kids had fun while participating in a healthy activity while staying focused.

Study of ASCUS Pap Management Practices in Underserved WomenAuthors: Steven Haenchen, Sue Min Lai, Ghazala Perveen, and Rebecca Horvat

Background: The widespread adoption of Papanicolaou (Pap) screening has decreased the cervical cancer mortality rate in the United States, but discrepancies remain regarding care for the 5% of Pap tests with a minimally abnormal result of abnormal squamous cells of undetermined significance (ASCUS). Research regarding HPV testing to understand ASCUS Pap results has demonstrated a positive HPV test result with an ASCUS result has greater sensitivity for underlying abnormalities than rescreening methods. New guidelines reflect these findings.

Methods: Data from a cervical cancer screening program for underserved women in Kansas (Early Detection Works) spanning 15 years of procedures performed on 25,512 women was analyzed. Relative risk regression determined factors associated with HPV testing following an ASCUS Pap result. Published colposcopy referral rates combined with follow-up rates for recommended procedures in these data were used to compare the cost of an HPV test triage following an ASCUS Pap to current practice.

Results: Women under 40 years old and those residing in urban areas were less likely to receive HPV testing as follow-up for their abnormal screening. A substantial cost increase was associated with HPV triage, but lower loss to follow-up is predicted, thus completing screening in a larger proportion of women.

Conclusion: Though the cost of caring for ASCUS Paps by HPV triage is greater, a larger proportion of women complete screening. HPV triage should be utilized, particularly for women easily lost to follow-up. Women not cared for by HPV triage should have their results explained to encourage compliance.

Differences in Access to Healthcare between Hispanics and non-Hispanics in the United StatesAuthors: Marissa Higinio, Fannette Thornhill-Scott, Kimberly Walker, and Frank Dong

Introduction: Approximately 45 million Hispanics live in the US. Research suggests that Hispanics are less likely to have health insurance coverage compared to non-Hispanics. This study examines if there is a difference in health care coverage and preventive services between Hispanic and non-Hispanics.

Methods: Data from the 2009 Behavioral Risk Factor Surveillance System (BRFSS) survey were analyzed utilizing the Predictive Analytics Software (PASW 18.0). Participants included Hispanic and non-Hispanic respondents 18 years and older. Prior to randomization, there were 400,118 non-Hispanic individuals and 30,075 Hispanic individuals. Randomly, 30,075 non-Hispanics were selected, which resulted in a total of 60,150 respondents. Health care access was defined in four health indicators (health insurance status, having a personal doctor, obtaining routine check-ups, and avoiding seeing physician when care was needed due to cost). These four health indicators were compared between Hispanics and non-Hispanics.

Results: Hispanic individuals were less likely to have health insurance than non-Hispanics, 2 (2, N=60) = 2475.801, p<0.001; less likely to see a physician because of cost than non-Hispanic individuals, 2 (1, N=60009) = 1479.456, p<0.001; less likely to have a personal doctor, 2 (2, N=59985) = 1894.573, p<0.001; and there was a difference between Hispanic and non-Hispanic individuals in obtaining routine checkups, 2 (4, N=59469) = 339.621, p<0.001.

Conclusions: The results of this study suggest there is a difference in access to healthcare between Hispanic and non-Hispanic individuals in the United States.

Breastfeeding: An Initiative to Increase the Initiation and Duration of Breastfeeding Rates among Mothers in KansasLisette T. Jacobson, Ruth Wetta-Hall, and Ashley Moss

The purpose of this project was to evaluate the goals and objectives of an initiative to increase the initiation and duration of breastfeeding rates among mothers in Kansas. Using structured telephone interviews, this research study examined: (1) how well program goals and objective were met, (2) progress made by grantee towards achieving purpose of the grant, (3) problems encountered in an effort to achieve the grant’s purpose, and (4) evaluation measures implemented to determine program improvement. Across the state of Kansas, eighteen public health departments received funding through the Kansas Public Health Association’s Breastfeeding Grant Initiative. Based on 2010 U.S. Census data, fifteen health departments were rural and four health departments were urban. Findings indicate most funded health departments were meeting their goals and objectives. Themes identified through the interview process were categorized based on program strength, recommendations and sustainability. Most LHDs reported the availability of adequate resources and their primary use of funds included the purchase/rental of breast pumps, resource bags, and distribution of educational materials. The majority of LHDs recommended the administration of a survey measuring program effectiveness and continuing support for breastfeeding mothers. Most LHDs reported not having measurements in place to evaluate program outcomes. In order to sustain current programs, most LHDs desired continued funding for breastfeeding programs. At the time that this study was conducted, the majority of LHDs reported that it was too early to tell whether they would achieve the grant’s purpose or encounter problems in their effort to achieve the grant’s purpose.

The Effect of Physical Activity on Number of Unhealthy Days among Individuals Reporting Doctor-Diagnosed ArthritisAuthors: Erin Locke-Nilhas, Arraya Paksin-Hall, Pamela Behnk

Introduction: Persons with arthritis report fewer healthy days than those without arthritis. This study examined individuals who reported doctor-diagnosed arthritis and the difference in the number of reported unhealthy days between those who reported physical activity and those who did not.

Methods: This study utilized the national 2009 Behavioral Risk Factor Surveillance System (BRFSS) survey data for 129,566 adults who reported being age 50 years and older and reported doctor-diagnosed arthritis. Variables used in the analysis were sociodemographics, body mass index (BMI), physical activity (PA) level, and three categories of unhealthy days, mental, physical, and limited activity. Sufficient PA was defined as 150 minutes of moderate PA per week or 75 minutes of vigorous PA per week. Unhealthy days were dichotomized into ≥14 or <14 days. Proportions were calculated and logistic regression was conducted with SPSS Version 18.0.

Results: A quarter of all respondents reported being inactive. Inactive respondents were 1.89 times more likely to report ≥14 physically unhealthy days (95% CI, 1.73-2.08) and 1.83 times more likely to report ≥14 mentally unhealthy days (95% CI, 1.74-2.04). In addition, inactive respondents were 2.40 times more likely to report ≥14 days when activity was limited (95% CI, 2.21-2.78).

Conclusions: Those reporting doctor-diagnosed arthritis who meet sufficient PA levels are more likely to report fewer unhealthy physical and mental days and to report fewer days when activity is limited from these unhealthy days. Patients diagnosed with arthritis could benefit from sufficient levels of physical activity to improve quality of life.

Relationship of Health Care Coverage and Usual Source of Care with Physical ActivityAuthor: Colleen Loo-Gross

Background: Health care coverage and a usual source of care are independent predictors of receipt of preventive services, such as lifestyle modification counseling. However, it is not yet clear whether these factors are associated with actual behavioral change.

Methods: Secondary data for this study were collected from the 2009 Behavioral Risk Factor Surveillance System (BRFSS). Data were stratified into four categories based on health care coverage status and whether respondents had a personal health care provider. A chi-square test and logistic regression were used to determine association of health care coverage and a usual source of care with the outcome of meeting recommended levels of moderate or vigorous physical activity.

Results: Among respondents, 81.7% (n=322,061) reported having both health care coverage and a personal provider, 8.0% (n=31,640) reported having only health care

coverage, 5.3% (n=20,757) reported having only a personal provider, and 5.0% (n=19,818) reported having neither. Logistic regression suggested a positive association of having health care coverage and meeting physical activity recommendations, 2 (1, N=394,276) = 4.4296, p<0.001. Having a usual source of care was not found to have a significant association with achievement with achievement of physical activity recommendations.

Conclusions: Though having a usual source of care improves the likelihood of receiving behavioral modification counseling, initial results indicate that having a personal provider is not associated with completing recommended levels of physical activity. Thus, stronger public health involvement is needed in addressing healthy lifestyle behaviors.

Exploring the Limitations of HIV Medication Effectiveness: An Analysis of Changes in P-Glycoprotein Expression in HIV-Infected Gastrointestinal CellsAuthors: Kelstan E. Lynch, Greg Rice, Jerry Marlin, Tracey H. Taylor, and Mary Peace McRae

Background: Treatment of HIV-infected persons with highly active antiretroviral therapy suppresses plasma viral load below the limit of detection for standard assays. However, if therapy is halted, viremia levels rapidly increase, indicating the presence of reservoirs for HIV that persist despite “effective” treatment. Although it is likely that multiple mechanisms exist, our hypothesis it that reservoirs are maintained, in part, due to an overexpression of the drug overexpression in the gastrointestinal tract limits antiretroviral penetration into this important reservoir tissue resulting in decreased effectiveness of antiretroviral drugs. This study analyzed changes in P-glycoprotein in small intestine tissues from HIV-infected and uninfected persons and in an intestinal epithelial cell model, Caco2 cells.

Methods: Five HIV-positive and 4 uninfected small intestine cadaveric human samples were obtained from National Disease Research Interchange. Subjects were not on medications that inhibit or induce P-glycoprotein for at least 2 weeks prior to harvest. Tissues were snap frozen and membrane proteins extracted and analyzed by immunoblotting. P-glycoprotein expression was quantified relative to the enterocyte marker villin. To examine the effect of HIV infection on P-glycoprotein in vitro, Caco2 cells (a model for enterocytes) were infected with HIV, cells lysed at 6, 24, and 48 hours post-infection, and P-glycoprotein expression quantified. ImageJ was used for quantitation of immunoblots.

Results: In human intestinal tissue, P-glycoprotein expression was increased by 12% in enterocytes of HIV-infected samples. In vitro experiments of HIV-infected cells revealed an initial decrease in P-glycoprotein expression of 46% and 15% at 6 and 24 hours, respectively. At 48 hours, however, P-glycoprotein expression was increased by 36.6% compared to uninfected controls.

Conclusions: Preliminary results demonstrate an increase in enterocyte-specific P-glycoprotein in HIV-infected intestinal samples compared to controls, supporting our

hypothesis that HIV increases the expression of this protein in intestinal epithelial cells, which in turn could decrease the efficacy of HIV therapies in these tissues. These initial results warrant further investigation and contribute to overall understanding of the effects of HIV on drug transport proteins within the intestinal tract.

Does Posting Messages on YouTube Lead to Better Mental Health?: A Thematic Analysis of the “It Gets Better Project”Author: Pamela K. O’Neal

Studies indicate young gay, lesbian, bisexual and transgendered (LGBT) adolescents are more likely to attempt suicide than their straight peers. (Russel, S & Joyner, K. 2001; Silenzio et al., 2007). Young LGBT people who have been bullied may also suffer long lasting effects into adulthood making social acceptance crucial to their well-being (USDHHS, 2010). In response to recent, widely publicized suicides by gay and lesbian teens, attributed to bullying, syndicated columnist Dan Savage developed the “It Gets Better Project” on YouTube. Since the inception of the “It Gets Better Project” on September 1, 2010 over 5,000 videos had been posted by November 28, 2010 (It Gets Better Project, 2010). Those who have posted videos range from celebrities such as Anne Hathaway, to U.S. President Barack Obama, to average citizens.

The videos are uploaded to establish a channel where messages could be posted and conversations generated with the intention of creating an environment of support for youth struggling with negative social reaction to their sexual identity.

The overarching message of the “It Gets Better Project” is hope; the 25 most often viewed videos were analyzed to identify emergent themes (Boyatzis, 1998). Analysis also analyzed gender self presentations (female, male, transgender) of those posting videos and the average video length. Results include possible connections to increased number of calls to suicide hotline for LGBT youth.

Developing a Writing Intervention to Mediate Stress among Women Leaving JailAuthors: Sydni Pankey, Megha Ramaswamy, Patricia J. Kelly, and Nikki Nollen

Women in the criminal justice system have experienced violence and trauma in myriad forms throughout their lives. Residual effects of these experiences are seen in mental, physical health and drug problems, as well as recidivism. Few resources are available for women to address unresolved sexual and physical abuse and current family violence. As women leave jails and return to their communities, these histories of violence further complicate their ability to navigate post-release sexual partnerships, familial relationships, obligations to children and securing housing, employment, and income.

Traumatic experiences can adversely affect physical and mental health. Expressing these experiences through language, however, can alleviate the physical burden of such stressors. Research suggests expression through writing can be beneficial and

can be used outside of traditional psychotherapy. For example, people often show immediate signs of stress reduction while writing. To the best of our knowledge, no studies have examined how writing could benefit women moving through jail.

This poster will describe the development, implementation, and evaluation of a free-writing intervention for female inmates to address high levels of stress, a critical mediator for mental, physical health, and drug problems. We will describe the feasibility of implementing a five-session writing workshop with women in jail and collecting paper/pencil and biological markers of stress pre- and post-intervention.

A free-writing intervention is a cost-effective and sustainable approach to addressing stress and health among women in the criminal justice system. If we can demonstrate the feasibility and efficacy of this approach, our intervention could be widely reproducible.

The Association between Perception of Neighborhood Disadvantage and Drug Problems among Women and Men in JailAuthors: Jessica Rogers, Megha Ramaswamy, Kimber P. Richter, and Patricia J. Kelly

There is increasing evidence that neighborhood disadvantage and lack of a sense of community influence an individual’s susceptibility to drug and alcohol problems. However, this has never been examined within an incarcerated population, where frequent transitions between institution and neighborhood are common. Increasing our understanding of these correlations could help us to implement more targeted programs to decrease drug and alcohol problems and recidivism among the incarcerated population. For this study, 596 men and women from three Kansas City jails were surveyed over the course of six months in 2010. The analysis is expected to show that perceptions of neighborhood disadvantage are correlated with alcohol problems and substance dependence among the incarcerated population. It is expected that these correlations will be more direct for the men surveyed, while women will have many more variables (history of intimate partner violence, number of children, mental health) to consider in addition to neighborhood perceptions. We will also look at the number of arrests each study participant had, to see if time in the system (and therefore out of their own neighborhood) had an effect on drug and alcohol problems. If the conclusions of this study are as expected, preventative programs may need to take a more community-based approach to the problem, implementing more programs that address the transition from jails to disadvantage communities.

Assessing the Feasibility of Measuring Biomarkers of Stress in Incarcerated WomenAuthors: Satyasree Upadhyayula, Megha Ramaswamy, and Patricia J. Kelly

Incarceration is a stressful life event that can have immediate and long-term negative effects on an individual’s physiology, mood, and behavior. Previous studies have shown that emotional writing is effective in reducing stress. In one study, after writing,

participants found that facial muscles were more relaxed and they had reduced perspiration, blood pressure, and liver enzymes. Although several previous studies looked into measuring physiologic factors associated with stress in the general population, few were done in jails. Before doing a large-scale study in this population, it is important to first assess the feasibility of collecting biomarkers for stress. This poster will present a review of literature on biomarkers of stress, their efficacy, and methods of collection. After identifying the biomarker that is most appropriate for this population, we will collect samples from 10 incarcerated women who are participating in a 5 day writing intervention program. Samples will be collected twice (once on day 1 and again at the 1 month follow-up session after their release from jail), but they will not be analyzed. Feasibility of this protocol will be reported. If we can show that taking these measurements in the jail setting is possible, then we can use this protocol as part of a larger jail study. By measuring biomarkers, we will have a more complete and objective understanding of the effects of the writing intervention program on participants’ health.

Environmental Justice and Physical Activity: Examining Disparities in Access to Parks in Kansas City, MOAuthors: Katherine Vaughan, Andrew T. Kaczynski, Sonja Wilhelm Stanis, Ryan Bergstrom, and Gina Besenjy

Background/Purpose: Parks are key community assets for promoting physical activity, but some evidence suggest these integral resources are not equitably distributed. The purpose of this study was to examine disparities by income and race/ethnicity in the availability, features, and quality of parks across Kansas City, Missouri (KCMO).

Methods: All parks in KCMO were mapped using GIS and park features and quality were determined via on-site audits. Data from the American Community Survey were used to designate all 174 census tracts (CTs) within KCMO as either low, medium, or high income and percent minority. MANCOVA was used to analyze differences in park availability, features, and quality across income and race/ethnicity tertiles.

Results: Low income CTs contained significantly more parks (M=1.46) than medium (M=1.25) or high (M=1.00) income CTs, but also had more quality concerns (e.g., vandalism) per park. High income CTs contained more playgrounds per park (M=.69) than low (M=.62) and medium (M=.52) income tracts. There were more basketball courts per park in high minority CTs (M=.59) than low (M=.13) or medium (M=.30) minority CTs, and more trails per park in low (M=.60) and medium (M=.55) minority CTs than high (M=.39) minority CTs. Finally, there were more sidewalks around parks in low (M=.87) and high (M=.74) income CTs than medium (M=.61) income CTs.

Conclusion: Park availability was greater in low income areas, but several key park characteristics were less common in low income or high minority areas. Future research should examine policies that contribute to and that might rectify such disparities.

The Necessity for Strategic Alliances in the Health Care IndustryAuthor: William Venable

In the exploration of public-private partnerships, health facilities, public health, and human services, there is wealth of credible sources to justify the position for the use of strategic alliances as a development and advancement tool in the health care sector. Research has shown that in most cases strategic alliance are developed to add value, reduce cost, improve productivity, or achieve goals that would otherwise go unmet. This analysis presents key objectives that support the position in favor of strategic alliances in health care. This analysis further provides insight and supports the position with regard to how strategic alliances function in the provision of competitive advantage for health care providers, added financial benefit for investment partners, and in the improvement of access to the health care system for an aging world population.

Putting One Health into Practice: Examining Strategies for Disease Prevention Using Rabies as a ModelAuthors: Kristina Wert, Cathleen Hanlon, Beth Montelone, and Elizabeth Davis

Healthy communities, including both people and animals, are reliant on public health strategies to demonstrate proper control for zoonotic disease prevention. By examining current practices used for rabies prevention, the model can provide an insight into surveillance and strategies that can be applied to new or emerging diseases. This project focused on the examination of state testing policies, the epidemiological evaluation of rabies cases in Kansas and Nebraska, and finally the development of educational materials regarding prevention measures for rabies aimed towards middle and high school audiences. The investigation into state rabies testing policies was necessary to demonstrate adequate preparedness and maintenance of surveillance systems and diagnostic access for rabies and other core public health diseases. An epidemiological study was conducted from a selected sample of submissions to Kansas State University Rabies Lab and prevalence was compared by species and county. Key factors in understanding epizootiology of rabies are that submitted samples are a selected sub-set of the population and positive cases are only the tip of the iceberg of the true number of rabies cases, particularly among wildlife species. Lastly, a poster campaign was created in collaboration with One Health Kansas to develop age appropriate educational materials. A preliminary survey of high school students showed rudimentary knowledge about rabies and an incomplete awareness of the virus, post-exposure procedures and treatments for both animals and humans. Overall, the current model for rabies, using these vantage points, was analyzed to determine community impact and allow better preparedness for future potential challenges.

Excessive Alcohol Consumption and Receipt of Pneumococcal VaccinationAuthors: Jennifer Wipperman, Scott Taylor, Frank Dong, and Elizabeth Ablah

Background: Streptococcus pneumonia is a major cause of mortality among the elderly and those with high risk medical conditions, such as alcoholism. Current immunization guidelines recommend that all people ages 65 years and older and those with underlying medical conditions be vaccinated against S. pneumonia. However,

people with alcoholism are less likely to use preventive services than the general population.

Research Question: Are vaccination rates among heavy alcohol drinkers ages 18-64 different than then general population ages 65 years and older?

Methods: Data were retrieved from the 2009 Behavioral Risk Surveillance System database. Demographics assessed included race, gender, income, health care access and education level. Heavy drinking was defined as having more than 30 drinks per month for women and more than 60 drinks per month for men. Logistic regression was used to predict the odds of PPSV23 receipt among adults ages 65 years or older versus heavy drinkers ages 18-64, and included variables for gender, education, health care access and race.

Results: Adults ages 65 years and older were nearly twice as likely to report having received PPSV23 than heavy drinkers (OR=1.93, p<0.001).

Conclusion: Heavy drinkers are significantly less likely to report having received the PPSV23 vaccination than those aged 65 years and older. Since heavy drinkers suffer increased mortality from pneumococcal infection, it is important to target this group for vaccination.

Health Literacy Assessment of the STOFHLA: Paper versus Online Administration Continuation StudyAuthors: Jennifer Wipperman, Nikki Keene Woods, Rachel Wilson, Frank Dong, Amy Chesser, and Rick Kellerman

Background: Health literacy is the “degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions”. Nearly half of all US adults have difficulty comprehending health information. Low Health literacy is associated with poor health outcomes and increased health care expenditures. Knowledge of health literacy status may improve patient-provider communication and health outcomes. This preliminary study evaluates the feasibility of using a health literacy assessment tool, the Short Test of Functional Health Literacy in Adults (S-TOFHLA), electronically (via computer).

Research Question: Is there a difference in scores and time to completion between computer and paper delivery of the S-TOFHLA?

Methods: Eighty participants were recruited from a Midwest Family Medicine residency clinic. Inclusion criteria were: 18 years and older, English-speaking, and average reported computer skills. Patients were randomized to take either the S-TOFHLA computer or paper format first, followed by the opposite format 30-days later. Difference in scores and time to completion between the first and second test was calculation, and a regression model was used to determine the significance of test order.

Results: All data will be collected by mid-August. Preliminary results indicate there is no difference in scores or time to completion between S-TOFHLA delivery methods.

Conclusion: The electronic administration of the S-TOFHLA will be validated. This format may be useful for rapid assessment of patients’ health literacy status resulting in improved patient-physician communication, enhanced patient understanding of medical information, and improved patient outcomes.