Background: Millions of children still remain unvaccinated despite efforts to eradicate some of the vaccine preventable diseases globally. The African continent harbors the most burdens as and millions of children do not have access to basic immunization services. As Malawi thrives to meet the MDGs of reducing the infant mortality rate and decrease the proportion of one year-old children immunized against measles, a considerable proportion of children still remain with incomplete vaccination status.

Objective: The study examined some of the selected mothers’ socio-demographic factors that are associated with incomplete vaccination status among the under-five populations in Malawi. Socio-demographic factors such as age of the mother; household wealth index; educational level of the mother; region, place of residence and religion were evaluated to assess their associations with vaccine status outcome.

Methodology: The selected demographic factors were analyzed using the SPSS version 20. In this study, the rate of incomplete vaccination was 22% among the study population. Data were obtained from the MEASURE DHS-2010 data base. Frequencies for the selected demographics were created; univariate and multinomial logistic regression analyses were also run to measure the associations between the mother’s socio-demographic factors and the vaccination status population under study.

Results: The study revealed statistically significant results between the northern region and vaccination coverage which has higher vaccination coverage as compared to the Central and Southern region in Malawi respectively. The results also revealed a positive association between wealth index of the household specifically the middle level class that had a statistically significant association between vaccination and wealth. Importantly, factors like education, religion, age of mother, ownership of a radio and a television had statistically insignificant associations.

Conclusion: This study did not find a statistically significant association between education and status of vaccination including factors related to living in rural or the urban set up. More research studies on regional boundaries and health disparities specifically on vaccination coverage among the under-five populations should be taken into consideration.

Background: Major depressive disorder or depression is a mental illness which affects people of a range of different ages. In terms of years lost due to disability, it is a leader. Physical activity is currently being used as a therapeutic treatment of depression that decreases levels of depression in individuals suffering from it. Physical activity can also be used as a form of prevention against depression. This study examines the association between vigorous physical activity and depression.

Methods: This is a cross-sectional study that utilized the secondary data from the National Health and Nutritional Examination Survey (NHANES) 2007-2008. Statistical Package for the Social Sciences (SPSS) is the software used in analyzing the descriptive data for the study. SAS was used for the logistic regression models. Univariate logistic regression was used to determine the association between physical activity and depression. A Multivariate analysis using SPSS determined the association between physical activity and depression adjusting for age, race, education, substance use, alcohol use, BMI and gender.

Results: The sample size for the cross-sectional study is 5553. The prevalence of depression in the different levels of physical activity are as follows: no physical activity (15.8%), insufficient physical activity (15.1%), moderate physical activity (12.8%), and vigorous physical activity (17.4%). The unadjusted odds ratio for the association between vigorous physical activity and depression is 1.15, and the adjusted odds ratio is 1.14. There is no significant association between vigorous physical activity and depression.

Conclusion: This study shows that there is no significant association between physical activity levels and depression. More research should be done to better understand the association between physical activity and depression.

A policy brief with recommendations for Georgia’s health policy and legislative leaders will be developed as a product of this capstone. The brief will be based on the environmental scan of Georgia’s current policies surrounding childhood obesity and the lessons learned from the five successful states and localities. The intention of the policy brief is to provide a blueprint for Georgia’s leaders to build support, organize resources, and achieve effective policy implementation to address childhood obesity.

Methods: FGM was chosen as the main independent variable of interest. Other independent variables such as age, education, marital status, residence, beliefs associated with FGM, history of blood transfusion, surgery, sharing needles, and history of schistosomiasis were included in the analysis. Throughout the analysis, HCV infection was used as the main dependent variable.

Results: Univariate analysis of FGM and HCV showed a statistically significant association with a Prevalence Odds Ratio of 4.82 (2.91 -7.96), after adjusting for age and schistosomiasis injection, the association between FGM and HCV remained statistically significant with an odds of 2.98 (1.76 – 5.05)Among the category for FGM performer and association with HCV infection, the OR was 4.28 (2.31 – 7.91) when the FGM was performed by a ghagaria, 3.68 (2.76 - 4.90) when the FGM was performed by daya, and 3.30 (1.81 -5.88) when the FGM was performed by a barber. Among other independent variables, a lack of education, rural residence, and having religious precepts for FGM had statistically increased odds of association with HCV infection.

Conclusion: There is a statistically significant association between FGM and HCV infection. There are increased odds of HCV when the FGM is performed by providers other than doctors. Participants from a rural residence and who those who did not have any education were at increased odds of HCV. Subjects who believed in religious precepts for FGM and also who answered that FGM can continue had increased odds of association with HCV infections.

Methods: Data was obtained from similar Georgia indoor air surveys conducted in 2006 and 2012. Both surveys were designed to gather information about restaurant and bar smoking policies and examine owner and manager perceptions of the Georgia Smokefree Air Act. Descriptive analysis and paired sample t-tests were performed to identify changes in smoking policy status and other variables over time. Chi-square and logistic regression analysis were used to test for significant associations between establishment smoking policy status and other characteristics.

Results: The percent of restaurants and bars in Georgia allowing smoking nearly doubled from 9.2% in 2006 to 18.2% in 2012. The analysis showed a statistically significant increase in the percentage of establishments allowing smoking when minors are present. After adjusting for the effects of other variables, three variables were significant predictors of allowing smoking: having seats for drinking outdoors, having a liquor license, and generating greater than or equal to 25% of gross sales from alcohol.

Conclusions: The Smokefree Air Act was enacted to protect the health and welfare of Georgia citizens, but the percentage of establishments allowing smoking has risen since it was implemented. These results suggest that policy makers should reevaluate the law and consider strengthening it to make restaurants and bars 100% smokefree without exemptions.

METHODS: 211 Georgia State University undergraduate and graduate students were surveyed in Fall 2011. The data they provided were then analyzed and compared to the 2009 bicycle data using independent-samples t­-tests and a chi-square analysis to identify significant differences between the two data sets.

RESULTS: Few significant differences between the two sets of data were identified. Participants in 2011 had significantly higher agreement that they could locate information regarding bicycle safety and repairs, as well as reported a significantly greater likelihood of bicycling to campus if educational programs to, from, and around the GSU campus were implemented. Written feedback suggested that fear of collisions was still a major barrier; many students suggested a campus bicycle-share program and more information disseminated to students about bicycling to campus.

DISCUSSION: The results from this study demonstrate that efforts aimed at encouraging students to bicycle to campus, between the 2009 and 2011 data collections, may not have been as effective as they were intended. Bicycle promotion that reaches a greater number of Georgia State University students is suggested. Because of the method of data sampling in this study, the data analyzed may not be truly representative of the Georgia State University population. In the future, an improved survey that is disseminated electronically may result in a larger sample size, increasing statistical validity and ability to generalize findings.

Methods: Cross-sectional data from the Measure Demographic and Health Survey (MDHS) involving 9,686 Ivorian and 18,363 Senegalese from 2005 were used. The Pearson Chi-square test were performed to determine any significant relationship between the variables across the two countries with respect to socio-demographic and HIV risky behaviors status. Univariate and multivariate analyses were performed to test the significance of any association between the independent and the dependent variables (Condoms used at last sexual intercourse). Throughout all the analysis performed, a p-value of 0.05 and confidence interval of 95% were used to determine any statistical significance.

Results: Logistic regression models showed that Côte d’Ivoire respondents had decrease odds of using condoms during their last sexual intercourse (OR=0.7; 95% CI 0.62 - 0.79) as compared to Senegal and the difference was statistically significant at p < 0.05. In Côte d’Ivoire and Senegal, wealth and education have been consistently found to be positively associated with condoms used at last sexual intercourse.

Conclusion: HIV risk behaviors seem to be associated with condoms used and marital status. The results in our study suggest a possible relation with condoms used, HIV prevalence and polygamy in Senegal, so men use condoms less frequently with marital partners. More studies need to assess the role of polygamy in the transmission and/or acquisition of HIV in Sub-Saharan Africa.

Key words: HIV/AIDS, Risky behaviors, Condoms used, Côte d’Ivoire, Senegal

Some researchers believe that cyberbullying can be even more detrimental than traditional bullying because cyberbullies can target victims through a variety of mediums, at any time. Cyberbullying can lead to harms ranging from short to long-term physical, psychological, intrapersonal and interpersonal effects in bullies, victims, and even cyberbystanders.

School administrators struggle with the desire to help protect students from cyberbullying but are unsure of how they can intervene in activities involving off-campus behavior. These administrators have to find balance between protecting victims and avoiding violating the legal rights of bullies. Therefore, legislation and school policies must be updated and implemented to offer more guidance to administrators and protect students against cyberbullying.

The purpose of this capstone project is to synthesize cyberbullying research among school-aged children and describe current policies in place to address this problem. Finally, policy recommendations for the state of Georgia will be offered so that systems and programs created to respond to and prevent cyberbullying may effectively reduce the occurrence of this behavior.

Objective: The study investigated the association between living in food desert and developing diabetes or dying from the disease. It considered factors such as access to grocery stores and supermarkets, convenience stores, food joints and owning a personal vehicle that might affect diabetes related morbidity and mortality. It has also looked at factors such as income and race which might influence the association.

Methodology: The study emphasizes on the lack of access to food, in low income and deprived neighborhoods and its impact on diabetes mortality and morbidity at the micro level of census tracts in Fulton County, Georgia. Diabetes related data was obtained from OASIS and Fulton County Department of Health and Wellness for the years 1994-2010 for 204 census tracts of Fulton County. Data for food desert distribution was extracted from the ‘Food desert Locator’ tool of the United States Department of Agriculture (USDA). Data on food stores was obtained through ReferenceUSA. Demographic information was acquired from American Fact Finder of the US Census Bureau. SPSS version 21 was used to calculate Pearson’s correlation to find the association between food environment and diabetes as well as to see whether there is an association between income and vehicle ownership with diabetes occurrence. ArcGIS 10.1 was used to represent data as maps showing the geographical distribution of various factors across the County and their association with the occurrence of diabetes.

Results: Low income African American dominated census tracts which have been designated as food deserts have a higher occurrence of morbidity and mortality from diabetes. The correlation between number of supermarkets and grocery stores, convenience stores and full service restaurants has no statistically significant relation with diabetes. Similarly, there is no statistically significant relation between car ownership and diabetes. But the relationship between income and diabetes has a statistical significance.

Conclusion: This study did not find any significant statistical association between diabetes and living in food desert. But from the GIS maps it can be observed that the number of food markets (supermarkets and grocery stores) is much less in the low income tracts than elsewhere and these are also the tracts which have higher occurrence of diabetes. Similarly, the numbers of convenience stores, which usually do not have a healthy collection of food, are more in the low income neighborhoods. The weak association between the factors studied might be because other factors such as education and access to healthcare have not been considered for this study. More research in this field is required to get a better picture of the diabetes health status in food desert areas.

ABSTRACT

INTRODUCTION: Multi-drug resistant tuberculosis (MDR-TB) poses a great threat to the eradication of TB. In the US, MDR-TB is faced with inadequate diagnostic tools and long and expensive treatment regimens. Therefore, preventing the disease is the key to saving lives and resources. Social and behavioral variables play a big part in this prevention. It is important to determine the social factors that may lead to MDR-TB in order to set up prevention programs and more efficient treatment regimens.

AIM: This study was conducted to ascertain the social determinants of MDR-TB in the US between the years of 2005 and 2009 to better equip public health officials to deal with this growing threat.

METHODS: This study used the Centers for Disease Control and Prevention (CDC) Online Tuberculosis Information System (OTIS) database to find associations between certain social variables and MDR-TB. The variables that were tested were whether or not the individual had lived in a correctional facility for the past year; HIV status; homelessness; whether or not the individual had an occupation; and whether the individual was foreign-born or US-born. An unadjusted odds ratio (OR) was calculated to find this association. The variables were then stratified with age; sex; race; age and race; age and sex; and age, sex, and race to see whether or not the strata were confounders.

RESULTS: The variables of having lived in a correctional facility and homelessness were found to be associated with MDR-TB. However, all of the strata were found to be confounders for this relationship. Having HIV and being US-born were not found to be associated with MDR-TB. All of the strata for HIV were found to be confounders. But for place of birth, stratifying by age, sex, and both age and sex were not confounders. The rest of the strata were. The OR for occupation versus MDR-TB was almost at 1, meaning that those with a job and those without a job had almost equal odds of having MDR-TB. Effect modification was present for the strata in all variables, meaning that the risk of having MDR-TB varied with each different age, sex, and racial group.

DISCUSSION: Results from this study showed which variables were more likely to be associated with MDR-TB in the US between the years of 2005 and 2009. However, when compared to the literature that exists, the results showed that more research needs to be done to properly ascertain this relationship. Using this study, public health officials can identify which populations to focus prevention efforts on.

BACKGROUND: Malaria remains a big challenge in Africa where 45 countries, including Nigeria, are endemic for the disease. Pregnant women living in malaria-endemic countries are of interest because of the reduced immunity during pregnancy. Reports show that malaria control efforts by the government and other programs like Roll Back Malaria might not be effective due to limited resources. The purpose of the study is to evaluate the knowledge of pregnant Nigerian women regarding malaria and their behavior towards the use of bed net as a method for malaria control. Specifically, this study examined the effect of malaria knowledge on the use of bed net among pregnant Nigerian women. This study will provide insight for a further study.

METHODS: The study was conducted at the Federal Medical Centre Abeokuta, Ogun State, Nigeria. The study population consisted of 61 pregnant women that attended the antenatal care clinic. Questionnaires were given to women who gave their consent and the questionnaires were self administered.

RESULTS: The pregnant women had very good knowledge of the general knowledge on malaria. However, the amount of pregnant women who choose the correct answer reduced with questions pertaining to malaria’s effect on the mother and fetus health. General knowledge had no effect on bed net use but the more knowledgeable the pregnant women were in regards to how malaria affected the mother’s health and fetus’ health, the more likely they were to use bed net. In this study, 73% of the women used bed net.

Conclusion: In this study, the use of bed net was higher than other studies and this might have been due to bed nets been distributed at the clinic. Even though many of the women used bed net and other preventive measures, about 56% of the pregnant women had experienced malaria during their current pregnancy. General knowledge on malaria did not seem to affect bed net use; however, knowledge on the consequences of malaria affected bed net use. The pregnant women who had the knowledge of how malaria affected the fetus were more likely to use bed net. For programs like Roll Back Malaria and other government programs to reduce the mortality and morbidity rate due to malaria, it will be beneficial to provide the pregnant women tailored information about the health consequences of malaria and how malaria affects the mother and the fetus.

KEY WORDS: Malaria, Pregnant women, Knowledge, Bed Net, Nigeria

AIM: The goal was to compare two groups of prenatal mothers and see if mobile phone technologies provided a viable resource to better serve the health care needs of those in the rural area of Mozambique.

METHODS: The mobile phones were used for health promotion plus data collection, CHW training and emergency referral. The mobile phones were implemented into the intervention group and were compared to control group: CHWs without the mHealth intervention. A survey was administered at the end of the study to women in both groups and the data was analyzed to compare the experimental group with the control group to see if the intervention led to more awareness and knowledge of pregnancy and postpartum danger signs in women. Odds ratios, confidence intervals and p-values for each indicator were calculated and compared between groups.

RESULTS: The results above show, mothers who know at least 2 danger signs in pregnancy is significantly higher in the control area (68%, OR=0.4, p-value=0.009) than in the intervention group (51.6%). The proportion of mothers who know danger signs in the postpartum period is fairly low in both groups, but the intervention group (11.8%, OR=0.4, p-value=0.05) is significantly higher than the control group (5.3%).

DISCUSSION: Based on the findings, the interventions group was also more likely to know about pregnancy and postpartum danger signs than the control group. Because the difference in the two groups was the mHealth intervention modules, it can be proven that the cause of the improvements between the groups was the mobile phones; though a self-selection bias could have accounted for the difference between the groups.

Methods: Researchers recruited residents of former public housing communities BEFORE/ AFTER demolishment. Data were collected by interview by research staff supported by the Georgia State University Partnership for Urban Health Research Center. The second set of interviews were collected from the same sample population, no additional recruiting was done. This second cross-sectional wave (out of 4 total) of interviews is the data source analyzed in this study. Chi-square tests were run to examine associations of risk factors with having an asthma diagnosis within the last 12 months.

Results: There were 310 complete interviews obtained with public housing residents during the second wave of data collection. Results showed that 13% (n= 40) of respondents reported an asthma diagnosis within the last 12 months. Chi-square analyses demonstrated statistically significant associations between the following variables: Presence of Leaky Roof, Presence of Mice and Rats, and Going Without Necessary Medication.

Conclusions: Results of this study reveal important relationships between risk factors associated with asthma among public housing residents recently displaced from their communities. Risk factors representative of individual, interpersonal, and community levels of influence demonstrate clear associations with asthma for this vulnerable population. Continued investigation on the predictive value of risk factors related to asthma among residents of public housing communities is warranted. Deepening understanding of how a person, the environment, and their behaviors are connected will inform more sensitive public housing decisions—that ultimately, hold the promise of improving asthma prevalence, maintenance, and outcomes for the 1,000s of sufferers in Georgia alone.

Methods: The purpose of this study was to determine the extent to which birthing facilities in Atlanta incorporate BFHI elements. Lactation policies among hospitals in the City of Atlanta with maternity wards were solicited, reviewed, and rated by two independent reviewers. Additional observations about environmental supports for breastfeeding were also noted.

Results: Four out of 5 eligible hospitals provided their lactation policies for review (80%). Eight of out 10 BFHI elements were present in the 4 hospital policies. One element not present was distribution of reinforcing/educational materials to new mothers—although it was evident in an appendix. Another element that was not clearly stated in one policy was which states that breastfeeding initiation should occur within the first half hour after birth. Observations by reviewers included that ¾ (75%) of study sample were in the midst of drafting new policies. Another note was that ¾ (75%) of study sample was supported by a Centers for Disease Control and Prevention (CDC)/National Initiative for Children’s Healthcare Quality (NICHQ) effort—Best Fed Beginnings.

Conclusions: This study is important as it addresses an unexplored question. Establishing such a baseline reveals that while nearly all the BFHI elements are present within the participating City of Atlanta hospitals, the administrative barriers that pursuit of BFHI accreditation poses should be considered. Given the fact that no hospital in Georgia has BFHI accreditation underscores an important new direction for public health researchers’ attention.