Alabama Black Belt Region Research Articles

Abstract 3687: Implementing geospatial technology to understand the prostate cancer health burdens and socioeconomic status in Alabama

Abstract Socioeconomic status and health disparities are a significant liability for the prevalence of many diseases, including cancer. Among many contributing factors, lack of socioeconomic advancement and inequality in resource distribution is closely associated with prostate cancer occurrence. The State of Alabama has one of the highest rates of prostate cancer in the nation and the third cancer epidemic at the state level. Due to widespread disparities in infrastructure development, political willpower, equal healthcare, and education opportunity, Alabama's Black Belt region has been further divided by socioeconomic statuses among the majority (Whites) and minority (African American) populations. The purpose of this research is to recognize Alabama's health burdens and socioeconomic status using geo-spatial technology (GIS) to examine prostate cancer health disparity. GIS has become a valuable decision-making tool in understanding the public health care sectors, including prostate cancer prevalence. GIS supports assembling spatial and non-spatial data, displays the spatial distribution of health disparities, and underlines further interconnectivity of policy-related questions. This research incorporates county-level prostate cancer data using GIS and outlining the correlation between prostate cancer prevalence and socioeconomic factors to understand Alabama's cancer health disparity and equity. A combination of socioeconomic factors and state and federal-level cancer epidemic data sources underline Alabama's black belt region (predominantly African American) prostate cancer prevalence is higher than the non-black belt. The GIS analysis demonstrated that effective cancer prevention programs are needed to eliminate health disparities and enhance health equity among underserved populations of Alabama. Citation Format: Ram Alagan, Seela Aladuwaka, Rajesh Singh, Upender Manne, Manoj K. Mishra. Implementing geospatial technology to understand the prostate cancer health burdens and socioeconomic status in Alabama [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3687.

County-Level Assessment of Vulnerability to COVID-19 in Alabama

The COVID-19 pandemic has posed an unprecedented challenge to public health across the world and has further exposed health disparities and the vulnerability of marginal groups. Since the pandemic has exhibited marked regional differences, it is necessary to better understand the levels of vulnerability to the disease at local levels and provide policymakers with additional tools that will allow them to develop finely targeted policies. In this study, we develop for the State of Alabama (USA) a composite vulnerability index at county level that can be used as a tool that will help in the management of the pandemic. Twenty-four indicators were assigned to the following three categories: exposure, sensitivity, and adaptive capacity. The resulting subindices were aggregated into a composite index that depicts the vulnerability to COVID-19. A multivariate analysis was used to assign factor loadings and weights to indicators, and the results were mapped using Geographic Information Systems. The vulnerability index captured health disparities very well. Many of the most vulnerable counties were found in the Alabama Black Belt region. A deconstruction of the overall index and subindices allowed the development of individual county profiles and the detection of local strengths and weaknesses. We expect the model developed in this study to be an efficient planning tool for decision-makers.

Nursing Leadership in Rural Hospitals: A Competency Needs Assessment

Purpose: Assess competence and competency needs of nursing leadership in rural hospitals located in the Alabama Black Belt Region. Determine the preferred method of continuing education to meet those identified competency needs. Sample: A purposeful sample of registered nurses currently working in leadership roles identified by the Chief Nursing Officer as nurse manager or nursing directors in a participating rural hospital within the Alabama Black Belt Region. Method: A pilot study using descriptive statistical analysis to assess competency needs of nursing leadership and preferred method of educational delivery through email survey and Likert-style questions. For purposes of recruitment, Chief Nursing Officers were personally introduced to the purpose and design of the study and asked to distribute the email survey to their staff. Descriptive statistics analysis was used to examine role preparation and experience of nurse managers and mean self-rated competency scores. Bivariate correlations were examined exploring relationships between nurse manager experience, education, and competency. Findings: Statistically significant at p=0.031, participants with <5 years of experience reported non-proficiency in their knowledge of quality improvement strategies and non-proficiency in their ability to lead multi-generational work teams as compared to those with > 5 years of experience who reported proficiency, p=0.026. Conclusions: In an environment where constant change and quality drive organizational success, nurse leaders with < 5 years of experience are not proficient in managing multi-generational work teams or in understanding or managing focused quality improvement strategies to monitor, analyze, and improve the quality of patient care processes to improve the healthcare outcomes in an organization. Realizing that more than 50% of the current nursing leadership has < 5 years of experience these findings would suggest that leading and managing, striving for clinical excellence in a diverse workforce would be difficult if not impossible to achieve. Keywords: Rural Hospital, Competency, Leadership, Needs Assessment, Nurse Manager DOI: https://doi.org/10.14574/ojrnhc.v22i1.701

Awareness of Hospice Care Among Rural African-Americans: Findings From Social Determinants of Health Framework.

Background: Despite the need for hospice care as our society ages, adults in the U.S.'s southern rural region have limited awareness of hospice care. Objective: This study aims to assess the rate of awareness of hospice care among rural residents living in Alabama's Black Belt region and examine social determinants of health (SDH) associated with the awareness. Methods: A cross-sectional survey was conducted among a convenience sample living in Alabama's Black Belt region (N = 179, age = 18-91). Participants' awareness of hospice care, demographic characteristics (ie, age and gender), and SDH (ie, financial resources strain, food insecurity, education and health literacy, social isolation, and interpersonal safety) were assessed. Lastly, a binary logistic regression was used to examine the association between SDH and hospice awareness among participants while controlling for demographic characteristics. Results: The majority of participants had heard of hospice care (n = 150, 82.1%), and older participants (50 years old or older) were more likely to report having heard of hospice care (OR = 7.35, P < 0.05). Participants reporting worries about stable housing (OR = 0.05, P < 0.05) and higher social isolation were less likely to have heard of hospice care (OR = 0.53, P < 0.05), while participants with higher health literacy had a higher likelihood to have heard of it (OR = 2.60, P < 0.01). Conclusions: Our study is the first study assessing the status of hospice awareness among residents of Alabama's Black Belt region. This study highlighted that factors including age and certain SDH (ie, housing status, health literacy, and social isolation) might be considered in the intervention to improve hospice awareness.

Enhancing the Awareness of Modifiable Risk Factors for Cancer Prevention in the Alabama Black Belt Region: A Follow-up Study.

We determined the profile of participants in the multi-level annual marathons held in Alabama Black Belt counties in terms of lifestyle characteristics and considered how these characteristics relate to a family history of cancer. Data on socioeconomic, health, and lifestyle characteristics of respondents were collected during the Annual Healthy Lifestyle Marathons of 2013-2019. These events were five miles in length and allowed participants to walk, bike, or run. Characteristics of respondents were compared using frequencies, percentages, and cross-tabulations. Most of the respondents with a family history of cancer were within the 18 to 24-year age category; had an annual income in the range of under U.S. $10,000; had received some college training; reported their overall health as good; and were African American. Although low consumption of fruits and vegetables has a demonstrated association with being diagnosed with cancer, in 2019 only 43% of respondents reported frequent intake of fruits and vegetables. Community-based health programs are critically needed to improve health in rural Black Belt communities.

Exploring different dimensions in defining the Alabama Black Belt

The Alabama Black Belt region has played a significant role throughout Alabama’s history. However, the geographical extent of the region is subject to dispute. Multiple definitions of the region’s boundaries using different dimensions, taken at different times have been put forth by scholars. The lack of consistency makes it difficult to compare study results. A historically-defined boundary has the potential to increase the effectiveness of policies developed and implemented to address the persistent poverty in portions of the region. This paper seeks to define the boundary using historical dimensions based on quantifiable characteristics of the cotton culture which were unique to the Alabama Black Belt region. It uses physical dimensions as well as quantifiable agricultural characteristics of the cotton culture at the county level at two points in time, 1860 and 1900 to show that at the county level the Black Belt region remained stable and well defined through the first 100 years of Alabama history.

Factors Associated with HPV Vaccination Uptake and HPV-Associated Cancers: A County-Level Analysis in the State of Alabama.

Despite availability of a safe, effective vaccination, uptake and completion rates of human papillomavirus (HPV) vaccination remain low in the United States. This is particularly true in the southeast, which also sees some of the highest rates of HPV-associated (HPVa) cancers. We aimed to identify areas in Alabama in need of intervention with respect to HPVa cancers and HPV vaccination, and factors potentially associated with these rates by performing county-level secondary data analysis using state and national data sources. Alabama ranks 15th nationally in HPVa cancer rates, with 66.7% and 80.8% of counties having higher HPVa cancer rates than the national incidences of males and females, respectively. Regarding HPV vaccination, 95.5% and 98.5% of Alabama's counties have uptake rates less than the national averages for males and females, respectively. The seven counties with the highest HPV vaccination uptake ranged in rates from 60.2 to 73.6%. Counties with the highest HPV vaccination rates for adolescents were majority African American with low adult educational attainment rates and high rates of poverty and publicly-insured children/adolescents. These counties were also located in Alabama's Black Belt region, traditionally known for low socioeconomics, reduced access to social services, and negative health outcomes. Some counties with the highest rates of HPVa cancers also had among the highest rates of HPV vaccination, indicating a potential association between perceived susceptibility and desire to get HPV vaccine in these communities, warranting further investigation. Future work is needed to translate these findings into actionable intervention practices to increase HPV vaccination.

Attitudes and Perceptions on Potential Development of Nature-Based Enterprises among Landowners in the Alabama Black Belt

The Alabama black belt region is one of the poorest areas in the country, characterized by predominantly African American population and dark rich soil. Creating nature-based ventures is an opportunity that can be realized to alleviate poverty and improve quality of life in the region. The objective of this study is to examine landowner attitudes and perceptions towards nature-based activities on their land and the potential development of nature-based enterprises. Descriptive statistics and logit analysis were utilized to analyze survey data. Results indicate that the top two available nature-based activities are hunting and fishing. Hunting and fishing are also perceived to be the most potentially-profitable nature-based businesses that could be developed on the respondents’ land. Logit results show that a landowner is more likely to use the land for nature-based activities if he has a relatively large land, large family, and if recreation is one of his primary reasons for using the land.

Childhood obesity and community food environments in Alabama's Black Belt region.

Childhood obesity has been rising rapidly in the USA. The rate is higher among those at a lower socioeconomic status and racial/ethnic minority groups. In Alabama, nearly half of the children from rural African American families are overweight or obese. Studies suggest that children's eating behaviours and weight could be influenced by surrounding food environments. The purpose of this paper is to assess the community food environment and examine the associations with childhood obesity in Alabama's Black Belt region. This research uses both qualitative and quantitative methods. Weight status of 613 African American students in four elementary schools in a rural county of Alabama was assessed. We examined community food environments around children's home through GIS (Geographic Information System) and statistical methods. The interrelations between children's weight and community food environments are explored with multi-level models. Approximately 42.1% of surveyed children were overweight or obese, much higher than the national average, 30.6%. In Model 1, convenience stores (3.44; P < 0.01), full service restaurants (8.99; P < 0.01) and supermarkets (-37.69; P < 0.01) were significantly associated with the percentile of body mass index. Fast food stores (-0.93; P = 0.88) were not related to children's weight. In Model 2, the additions of sociodemographic factors and school effects cause significant changes of the relationships between children's weight and four types of food outlets. The percentage of African American population (90.23, P < 0.01) and school (6.68, P < 0.01) were positively associated with children's weight; while median household income (-39.6; P < 0.01) was negatively related to it. Children's weight is influenced by community food environments, sociodemographic factors and school context. Findings suggest that policymakers and planners need to improve community food environments of low-income minority communities. Parents and schools should pay more attention to reduce the negative impacts of food environments on children.

School Reform: The Role of Physical Education Policy in Physical Activity of Elementary School Children in Alabama's Black Belt Region

To investigate the implementation of state- and school-mandated physical education (PE) and physical activity policies on students' school-day physical activity behaviors. Observational, cross-sectional study. Five elementary schools in rural Alabama. Six hundred and eighty-three school-age children. School-day physical activity behaviors were assessed with pedometer step count, the System for Observing Fitness Instruction Time (SOFIT), and the System for Observing Play and Leisure Activity in Youth (SOPLAY). Descriptive statistics (means and standard deviations) were used to describe the current health and in-school physical activity behaviors of students. Students accumulated a daily average of 4079.57 (± 1678.1) and 3473.44 (± 1073.37) steps for boys and girls, respectively, throughout the school day. SOFIT findings indicate that students spent an average of 23.80 ± 5.33 min/d in PE and that 14.33 ± 6.10 min/d were spent in moderate to vigorous physical activity (MVPA). This equates to 59.38% of PE time spent in MVPA. SOPLAY findings showed that recess and before/after school activity was not provided. It appears that schools were in compliance with the state-mandated PE policies on paper but not in actuality. Students did not attend PE for 30 min/d. The implementation of PE as the sole physical activity opportunity provides inadequate amounts of physical activity during the school day.

Assessing the Status of Onsite Wastewater Treatment Systems in the Alabama Black Belt Soil Area

This study for the first time evaluated the soil suitability for onsite wastewater treatment systems (OWTS) within the Alabama Black Belt region and assessed the current status of those OWTS within this area. A local OWTS soil suitability rating system was developed based on current Alabama OWTS regulations and was compared with the existing nationwide Natural Resources Conservation Service soil limitation rating system based on their soil assessment results over the study area. Both rating systems indicate that a large percentage (52%–89%) of land within the study area should not be recommended for conventional OWTS. However, OWTS are widely used and aging in this region. Raster-based OWTS-soil suitability rating system results and US Census–derived demographics were combined in a GIS to prioritize the study area in terms of potential public health threat from OWTS. Although the results lack field verification, two parallel strategies to limit the public health risk from OWTS malfunction are suggested: to extend municipal sewer service to high-risk city fringe areas and to subsidize system retrofit, repair, or replacement of aged OWTS with alternative engineered systems for rural households. Although this study only focused on the Alabama Black Belt area, the presented GIS and demographic methods can be referenced by other regions for similar OWTS assessment purposes.

The Black Belt Environmental Science and Arts Program

The goal of the Black Belt Environmental Science and Arts Program (BBSEAP) is to enhance classroom instruction in the environmental sciences for students in grades 5-8 of selected counties in Alabama's Black Belt region. BBSEAP differs from traditional outreach activities in that public school students come to off-campus, outdoor sites for instruction. The Auburn University Environmental Institute (AUEI) administers the program with support from local Alabama Cooperative Extension System (ACES) representatives. Since 2005, more than 2,000 students have participated in the program. Funding for BBESAP comes from government and corporate grants.

Production of Gulf Killifish in the Black Belt Region of Alabama Using Saline Groundwater

AbstractThe Gulf killifish Fundulus grandis, commonly called the bull minnow, mudminnow, or cacahoe, is a popular live bait along the Gulf of Mexico coast in the United States. Although culture techniques for Gulf killifish have been established for more than 30 years, this species is not commonly produced. Suitable coastal areas are thought to be one of the limitations. Low‐salinity groundwater occurs in much of the United States, including portions of the Alabama Black Belt region; however, the relative abundance of minerals in the water varies. Spawning success was compared among Gulf killifish held in saline groundwater (salinity = 4.2–11.1‰) from four inland sites and in 5‰ synthetic seawater. Gulf killifish production (fry to subadult) was compared between two sites of similar salinity but with different mineral profiles (site A had 4.0‰ salinity and received water from a fertilized source pond; site B had 3.2‰ salinity and received water with no fertilizer additions); initial stocking densities in 1.15‐m2 outdoor tanks were 25, 50, and 100 fry/m2. Gulf killifish spawned successfully under all conditions tested. Mean (±SD) fry production of 1.7 ± 0.88 fry/g of female was obtained. The yields and mean weights obtained differed by site and stocking density. After 104 d of production, the highest yield was 133.3 ± 40.4 g/m2 (1,333 ± 404 kg/ha) at site A for fish stocked at 100 fry/m2. The yield at site B for fish at the same stocking density was 62.6 ± 18.8 g/m2. Market‐sized fish (total length ≥ 6.35 cm; weight = 3.3 g) were obtained at site A for the stocking density of 25 fry/m2, but market‐sized fish were not obtained for any stocking density at site B. Although the mineral profiles differ between saline groundwater and natural seawater, saline groundwater is suitable for the reproduction and growth of this species. Egg production and fish growth were similar to levels expected for Gulf killifish culture in brackish‐water ponds along the Gulf of Mexico coast.

A community-based forestry approach to poverty alleviation in Alabama's Black Belt Region

SUMMARY The Black Belt region of Alabama is endowed with immense forest resources. However, land-loss, high poverty, unemployment, and low education levels have persisted among African Americans, the majority population in the region. This paper discusses the approach, the challenges and the lessons learned by the Federation of Southern Cooperatives in their adaptation of a community-based forestry approach with a focus on social, economic and political benefits for private landowners. Education and technical assistance, coalition-building, networking and cooperative development strategies were used to increase land-retention, improve access to public and private services and implement land-based income-earning opportunities. This approach resulted in the engagement of a marginalised people in land-based poverty reduction strategies. However, many of the poorest have not yet realised the direct benefit of the community-based forestry approach because of its low credibility among private and public land ma...

Effects of Selected Tax Policies on Management and Growth of A Catfish Enterprise

AbstractA multiperiod programming model was used to simulate the effects of lower marginal income tax rates, the soil and water conservation deduction, and the cash tax accounting option on firm growth for a “representative” farm operating in the Alabama Black Belt region. Results show the lowered marginal income tax rates associated with the Economic Recovery Tax Act (ERTA) of 1981 provide a positive growth stimulus to the modeled firm as measured by accumulated net worth over a 10-year planning horizon. The soil and water conservation deduction in general provides greater tax relief to the modeled firm than either the ERTA income tax rate changes or the cash tax accounting provision. Important complementary and substitute relationships were found to exist between marginal income tax rates and the various tax provisions studied, implying care must be exercised when attempting to evaluate the impact on farm firms of changes in tax policy.