Alabama Black Belt Research Articles

Sustainable Development in Rural Underserved Communities through Improved Responsible Management of Decentralized Wastewater Infrastructure: A Focus on the Alabama Black Belt.

Despite global efforts on meeting sustainable development goals by 2030, persistent and widespread sanitation deficits in rural, underserved communities in high-income countries─including the United States (US)─challenge achieving this target. The recent US federal infrastructure funding, coupled with research efforts to explore innovative, alternative decentralized wastewater systems, are unprecedented opportunities for addressing basic sanitation gaps in these communities. Yet, understanding how to best manage these systems for sustainable operations and maintenance (O&M) is still a national need. Here, we develop an integrated management approach for achieving such sustainable systems, taking into account the utility structure, operational aspects, and possible barriers impeding effective management of decentralized wastewater infrastructure. We demonstrate this approach through a binomial logistic regression of survey responses from 114 public and private management entities (e.g., water and sewer utilities) operating in 27 states in the US, targeting the rural Alabama Black Belt wastewater issues. Our assessment introduces policy areas that support sustainable decentralized wastewater systems management and operations, including privatizing water-wastewater infrastructure systems, incentivizing/mandating the consolidation of utility management of these systems, federally funding the O&M, and developing and retaining water-wastewater workforce in rural, underserved communities. Our discussions give rise to a holistic empirical understanding of effective management of decentralized wastewater infrastructure for rural, underserved communities in the US, thereby contributing to global conversations on sustainable development.

Abstract A081: Comprehensive examination of disparities in cancer incidences by race, gender, and age over 65 years in Alabama's Black belt counties, USA

Abstract In the United States, significant disparities persist in cancer incidence, mortality, and treatment outcomes, particularly among Black populations. Despite advances in medical care, disparities continue to challenge efforts to achieve health equity. Understanding and addressing these complex issues are imperative to ensure that all individuals, regardless of race or ethnicity, have equal access to effective cancer prevention, diagnosis, and treatment. Alabama stands out as the leading state among the top ten in terms of densely populated Black Belt counties in the United States. With 67 counties in total, Alabama is home to 24 designated Black Belt counties. Given this concentration, Alabama becomes a key focus for comprehending cancer disparities. The ongoing research seeks to examine the occurrence of various types of cancer among the predominant racial groups in the United States, focusing particularly on the Black Belt counties of Alabama. Data on cancer occurrences, obtained from the database of National Cancer Institute (NIH) and the Centers for Disease Control and Prevention (CDC), offer insights into cancer incidences among various demographic groups, age categories, and specific types of cancer spanning the last five years (2016-2020). Analysis of the data, focusing on patients aged 65 years and older, was performed using GraphPad Prism 5 software. Graphs were created to visually represent and interpret the data regarding incidences per 100,000 populations. We observe significantly elevated incidences of major cancer types such as prostate, colon, lung, stomach, pancreas, and liver among Black males, and similarly heightened rates of uterus, cervix, stomach, pancreas, and kidney cancers among Black females, when compared to white populations. Notably, within Alabama's Black Belt regions, only a small number of counties have reported incidences of cancer regardless of gender and cancer types, except for prostate cancer in males and breast cancer in females. Moreover, in certain Black Belt counties, rates of colon and lung cancer (in both males and females), as well as prostate cancer in males and breast cancer in females, are exceptionally elevated compared to both the statewide average in Alabama and even the national average in the United States. Generally, females tend to have lower rates of cancer across various types compared to males. In conclusion, factors contributing to these disparities include genetic predispositions, socioeconomic status, healthcare accessibility, systemic biases, and cultural influences. Further investigations, including molecular screening studies, are imperative to corroborate these health disparities and foster community-wide cancer awareness and public health initiatives. Citation Format: Faith Onomeh, Anathbandhu Chaudhuri. Comprehensive examination of disparities in cancer incidences by race, gender, and age over 65 years in Alabama's Black belt counties, USA [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A081.

A Roadmap for Sustainable Community-Engaged Partnerships in Athletic Training and Using a Traveling Athletic Training Camp as an Implementation Strategy.

Improving access to athletic trainers and increasing diversity in the profession have been major goals of the Strategic Alliance, with a particular interest in the secondary school setting. Within many marginalized communities, individuals are often faced with a lack of resources, high rates of poverty, and limited access to health care. This social and economic climate often extends to inequitable athletic training services and patterns of disparate health. Widely used and recognized strategies to cultivate diversity and address health inequities include community-engaged partnerships; however, these approaches are not well implemented across the athletic training discipline. Successful community-engaged partnerships link communities and universities, and they are rooted in intentionality to address intermediate and long-term health equity outcomes. Athletic training professionals and scholars frequently encounter gaps in resources and process-oriented methods to participate in community-engaged efforts that could include a roadmap or pathway to follow. To bridge this gap, our aims were 2-fold: (1) to disseminate a roadmap for building sustainable community-engaged partnerships in athletic training with the intent of promoting diversity, equity, inclusion, and social justice across athletic training education, research, and professional service and (2) to demonstrate how the roadmap can be implemented using a community-based athletic training education camp as an example. Implementation of the athletic training camp using the roadmap took place at secondary schools where community-engaged partnerships have been established throughout a geographic region known as the Alabama Black Belt, a region burdened with poor health outcomes, limited athletic trainer presence, and lower quality of life, exacerbated by racial and socioeconomic inequalities. Implementing this roadmap as a strategy to build sustainable community-engaged partnerships offers an innovative, interactive, and effective approach to addressing community needs by exposing secondary school students to the athletic training profession, advancing equitable athletic training research practices, and upholding and promoting the principles of diversity, equity, inclusion, and social justice in athletic training education.

The effect of the housing crisis in the Alabama Black Belt on respiratory health.

There is a growing housing crisis in rural America with homelessness growing in addition to a growing number of substandard homes due to an inability to afford the costs of repair and maintenance. The goal of the current study was to assess the housing concerns in rural Alabama Black Belt communities which are often understudied and the relationship between housing quality and respiratory health. A semi-random sampling of five Black Belt counties was conducted to obtain a sample of 253 rural households. The survey was designed to obtain information regarding household income, housing status including a list of safety concerns and respiratory health. A χ 2 analysis was performed to examine the effect of housing type and income on prevalence of respiratory illness and safety home concerns (e.g., roofing, windows/doors, floors, mold/mildew). The majority of households surveyed had an annual income below $15,000 and owned their homes with over half of the homes being manufactured homes. Lower income was associated with increased prevalence of asthma [χ 2(2, N = 237) = 7.75, p = 0.021], while living in a manufactured home was associated with increased risk of allergies [χ 2(1, N = 251) = 7.88, p = 0.005]. Additionally, poor windows and doors [χ 2(1, N = 253) = 3.8, p = 0.05] was associated with higher prevalence of asthma. The results confirm and expand previous results and demonstrate the relationship between quality housing and allergy and asthma prevalence in rural areas with an abundance of aging manufactured homes.

Impact of the COVID-19 Pandemic on Physical Activity among Mostly Older, Overweight Black Women Living in the Rural Alabama Black Belt.

Despite well-documented global declines in physical activity (PA) during the COVID-19 pandemic, little is known regarding the specific impact among underserved, rural Alabama counties. This is concerning as this region was already disproportionately burdened by inactivity and related chronic diseases and was among the hardest hit by COVID-19. Thus, the current study examined the effect of COVID-19 on PA in four rural Alabama counties. An ancillary survey was administered between March 2020 and August 2021 to the first cohort (N = 171) of participants enrolled in a larger PA trial. Main outcomes of this survey included the perceived impact of COVID-19 on PA, leisure-time PA, and social cognitive theory (SCT) constructs at 3 months. Almost half of the participants reported being less active during the pandemic (49.7%) and endorsed that COVID-19 made PA more difficult (47.4%), citing concerns such as getting sick from exercising outside of the home (70.4%) and discomfort wearing a face mask while exercising (58%). Perceived COVID-19 impact on PA was significantly associated with education, household dependents, and gender (p's < 0.05). More women, parents, and college graduates reported that the COVID-19 pandemic made PA more difficult. Overall, there were no significant associations between PA, SCT constructs, or perceived COVID-19 impact on PA scores at 3 months. While the pandemic made PA difficult for many participants, these barriers were not associated with leisure-time PA levels or related theoretical mechanisms of action, which bodes well for the success of our ongoing intervention efforts and the resiliency of these communities.

Church Leaders Share and Implement Solution-Focused Health Strategies During the COVID-19 Pandemic in Rural Alabama.

Bridging the healthcare access gap and addressing COVID-19 vaccine hesitancy among rural-dwelling Black American adults residing in the Deep South require involvement of faith-based leaders in the community. This study explored perceived barriers and resources to meeting community needs, including vaccination, during the COVID-19 pandemic as reported by 17 Black American church leaders in the rural West Alabama Black Belt geographic region in May 2022. The main themes that emerged included (1) attending to community impact of COVID-19 illness and death; (2) maximizing health literacy and diminishing vaccine hesitancy through engaging in preventive health practices and sharing public health information; (3) addressing challenges created or exacerbated by COVID-19, including reduction in in-person attendance (particularly among adolescents and young adults), limited access to and literacy with technology, and political perceptions influencing engagement in preventive health behaviors; (4) maximizing technological solutions to increase attendance in the church; and (5) engaging in solution-focused and innovative initiatives to meet the identified needs in the congregation and community. Church leaders in West Alabama rural areas facing economic, health, and technological disparities identified "silver linings" as well as challenges created or exacerbated during the pandemic. As the need for COVID-19 vaccination and booster vaccination continues, Black American church leaders play pivotal roles in meeting rural community needs.

Perceived transportation barriers moderate the association between depressive symptoms and household transportation use: A pilot study

IntroductionAlthough transportation use and related barriers in rural areas are substantially related to individual mental health outcomes, the relationship among depressive symptoms, perceived transportation barriers, and household transportation use remains underexplored. This study aimed to investigate possible factors associated with household transportation use and examined whether perceived transportation barriers moderate the relationship between depressive symptoms and household transportation use among residents in the southeastern U.S. rural areas after controlling for covariates. MethodsIn this cross-sectional study, a convenience sample of 191 Black/African American adults (18–84 years old) were recruited from four communities in the Alabama Black Belt areas. A multiple linear regression was performed using the PROCESS macro in SPSS. ResultsOur regression model found that depressive symptoms and perceived transportation barriers interacted with one another to be related to the use of household transportation (p < .05). Amongst people who faced transportation barriers, the higher the depressive symptoms, the more likely they were to use household transportation. Health insurance and income were also significantly associated with household transportation use (p < .05). ConclusionsOur finding posited that people with depressive symptoms who experience transportation barriers need more personal mobility over other modes. Such needs should be considered when developing better policies/interventions for transportation assistance, particularly for those living in rural areas.

Harvest for health in survivors of chronic disease: A demonstration project in the Alabama Black Belt and Mississippi Delta Region.

This demonstration project expands upon the Harvest for Health vegetable gardening intervention for cancer survivors by: (i) including survivors of other chronic diseases (i.e. heart disease and diabetes); and (ii) targeting an area with known health inequities (Alabama Black Belt and Mississippi Delta Region). To assess: (i) gardening acceptability (engagement, satisfaction, sustainability, and safety); and (ii) changes over time in health behaviors (fruit and vegetable [F&V] intake, and physical activity) and outcomes (physical performance and anthropometrics). Chronic disease survivors (CDS) were recruited across 15 counties in Alabama and Mississippi and provided with gardening supplies and paired with a master gardener (MG). MGs mentored participants in planning, planting, and maintaining a vegetable garden over a 3-month period. Data collection consisted of an electronic survey (baseline, post-intervention, 6-month follow-up) and community-based physical assessments (baseline and post-intervention). Participants (n = 137; 92% African American; Mage = 65) included individuals with a history of diabetes (56%), heart disease (29%), and cancer (26%). Seventy-five percent of participants engaged in gardening ≥3 times a week. Significant improvements in F&V intake (+0.73, P = .04), physical activity (+49.6, P < .01), and 4 of 7 physical performance measures were observed, while positive trends were seen in others. Eighteen participants withdrew (13% attrition rate). No adverse events occurred. Participants were satisfied with their gardening experience (90%) and were still gardening at 6-month follow-up (85%). Seventy-two percent of participants expanded, or planned on expanding, their garden at 6-month follow-up. Harvest for Health was acceptable and associated with improved health behaviors and outcomes.

Abstract A017: The geospatial analysis of the socioeconomic status and its impact on prostate cancer prevalence in Alabama

Abstract Background: This study aims to understand the impact of Socioeconomic status (SES) and how it influences the aging population, increasing the risk of many diseases, including prostate cancer. The cancer prevalence in Alabama is high; prostate cancer rates are particularly high in the diverse male populations. Alabama's Black Belt rural counties are closely associated with socioeconomic and health disparities, and political oppression, among which social equity and socioeconomic status have been closely associated with prostate cancer incidence. This study explores prostate cancer occurrence in the aging population in the major ethnic groups (African American and Whites) in the State of Alabama, mainly in the black belt of Alabama. Prior studies have revealed that prostate cancer prevalence is related to biological, environmental, and socioeconomic characteristics. A precise sense of the root causes of the age-related increase in prostate cancer incidence is required to develop a strategy for building primary spatial and non-spatial cancer data using machine-learning tools. Hypothesis/Objectives: We hypothesized that SES might impact prostate cancer occurrence among the aging population. Our study aims to explore the impact of SES factors to understand prostate cancer incidence in the aging population in Alabama. Methods: We utilized Geospatial Technology (GT) to analyze the connection between aging and prostate cancer prevalence in different ethnic populations in Alabama. This study incorporated county-level prostate cancer prevalence and association with aging, SES, and health disparities. The robust data mining (Alabama Department of Senior Services, Alabama State Cancer Profile data, Alabama Department of Health, American Cancer Society, Center for Disease Control, and National Cancer Institute) enabled us to explore the association between aging and prostate cancer in the spatial context. Integrating spatial and non-spatial data on prostate cancer prevalence to SES will help predict and formulate prostate cancer prevention methods. Results: The GT's secondary data analysis revealed that prostate cancer affects minority communities in the Black Belt in Alabama. The GT analysis further demonstrates that this disparity is due to a lack of access to health care and mitigation efforts. The diverse data integration reveals that the SES and related factors modulate the aging population and prostate cancer occurrence. Conclusions: The preliminary finding demonstrates that SES is an essential factor that modulates prostate cancer incidences in underserved minority aging populations in Alabama. Hence, understanding the association between aging and socioeconomic disparities will help predict and prevent prostate cancer more effectively. Citation Format: Manoj K. Mishra, Seela Aladuwaka, Ram Alagan. The geospatial analysis of the socioeconomic status and its impact on prostate cancer prevalence in Alabama [abstract]. In: Proceedings of the AACR Special Conference: Aging and Cancer; 2022 Nov 17-20; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2022;83(2 Suppl_1):Abstract nr A017.

Abstract B094: Cancer awareness and prevalence in the Black Belt of Alabama: A geospatial analysis

Abstract Objective: Socioeconomic status (SES) disparity is one of the primary factors for cancer disease. The majority of research on cancer disease and SES has been conducted for African American and white populations. This study explores the relationship between SES and cancer prevalence (Breast Cancer and Prostate Cancer) in Alabama's Black Belt for major ethnic groups. Historically, Alabama's Black Belt counties are embedded with SES disparities, health care inequality, politics, race, ethnicity, oppression, and most importantly, lack of awareness of the cancer epidemic. Methods: Geospatial technology (GIS) has been employed to analyze the last two decades SES and cancer statistics from the U.S. Census, Alabama Department of Health (ADH), American Cancer Society (ACS), Center for Disease Control (CDC), and National Cancer Institute (NCI). The GIS analysis indicates an apparent SES disparity between the Black Belt (BB) and Non-BB (NBB) counties of Alabama and especially among African American population. Results: The geospatial analysis indicates SES is positively associated with cancer prevalence. Research also shows that African American cancer prevalence rates are higher than whites due to poor social and health equity, including access to health care, green food, transportation, and education. Conclusions: Alabama is one of the top states concerning the cancer epidemic. The research employed SES and cancer prevalence using geospatial technology. Data shows a close relation between SES and cancer prevalence in the African American population in the Black Belt of Alabama. The research strongly recommends the state adopt cancer awareness programs and social and health equity policy planning. Citation Format: Ram Alagan, Seela Aladuwaka, Upender Manne, Rajesh Singh, Manoj K Mishra. Cancer awareness and prevalence in the Black Belt of Alabama: A geospatial analysis [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B094.

A Black Belt-ocene

AbstractPopular conceptualizations of the Anthropocene tend to blur and blend humanity into a singular lump and task it with combating anomalous climate change. This essay questions the dominant narratives of the Anthropocene by excavating the author’s life in the Alabama Black Belt. Through a blend of autoethnography and historical research, it explores life in the Black Belt as an example of the ways in which Black and brown people, and their narratives, are erased in the Anthropocene. The Black Belt is home to rich advocacy movements led by those most impacted. This activism demonstrates that Black people are not passive in the climate movement. In fact, the Black Belt has engaged with ecological injustice movements throughout its modern history. Guided by Kathryn Yusoff’s conception of “a billion Black Anthropocenes,” this article aims to encourage praxis that is guided by inclusive and honest historical accounts of humanity and ecological injustice.

SHOT ON THE SPOT VACCINATION COMMUNITY OUTREACH

Abstract Due to the COVID-19 pandemic disproportionately affecting Black communities, The University of Alabama (UA) partnered with the Rural Alabama Prevention Center (RAPC), a community-based healthcare organization to improve the vaccination rate from 34% vaccinated Alabama Black Belt residents to 70% over a year. Health literacy training is provided to community health workers and students who, along with the team members, volunteer at pop-up Shot on the Spot vaccination sites to administer surveys collecting demographics and vaccine hesitancy data. Team members provide health literacy information and answer questions non-vaccinated individuals have. This vaccination intervention has led to drastic rate increases, such as, Choctaw County having a 36.6% increase since the beginning of the project in August (30.7% to 67.30%). However, some counties have low vaccination rate changes, such as, Crenshaw County with a rate change of 15.4% (19.5% to 34.90%). Notably, the Alabama Black Belt currently stands at a higher vaccination rate compared to Tuscaloosa County (UA’s location), only having a rate of 44.3%. Within one year, there have been a total of 44 administered first and second vaccine doses and 435 booster doses, resulting in 50.24% vaccinated Black Belt residents. As the virus evolved into different variants, team members were able to observe an increase in administered booster doses in congruence with the rise of a new coronavirus variant. The partnership formed between RAPC and UA scientists and students is an important step in improving vaccination rates and building community research on minority and diverse populations.

Endogenous, Regime-Switching Hedonic Estimation of Commercial Waterway Water Quality Impact on Home Values in the Alabama Black Belt

We are the first researchers to investigate the impact of the water quality of a commercial marine waterway on the housing market. We use housing data for properties in proximity to the major waterways and minor tributaries of the Gulf Intracoastal Waterway in the Alabama Black Belt. Research shows a positive relationship between water quality and the value of waterfront properties. We use waterway impairment as a proxy to measure water quality to conduct a counterfactual analysis based on a unique endogenous regime-switching hedonic price model. We find significant empirical evidence that properties in proximity to the Black Belt’s major waterways could depreciate by approximately 22% compared to the counterfactual case of properties located on or near minor tributaries. A possible implication might be that homeowners prefer properties on or near minor tributaries of the Alabama Black Belt because of perceptions that the water quality is better than on major commercial waterways.

Remote-Control Plantations and Black Forest Relations in the Black Belt

This article examines the contemporary timber industry as a reproduction of plantation power via remote control, which occurs through absentee landowners, Black family land grabs, new markets for energy, and legal regimes designed to “devalue” common property in favor of individual ownership and profit-seeking productivity. Multi-generation Black homeplaces and communities possess alternative modes of land relations to sustain themselves despite the friction between the economic interests forced by racial capitalism and the ecological interests arising from long-standing forest interdependence. With the Alabama Black Belt and the larger US South experiencing expansion of concentrated forestland ownership and local divestment, most recently through the rise of the biomass industry, the reciprocal traditions of Black forest traditions represent modes of land relation and intervention that are necessary for livable futures.

Overweight and Obesity Challenges Among African Americans in Rural Alabama Black Belt

This study aimed at averting challenges of overweight and obesity among African Americans in rural Alabama. Focus group discussions and surveys were used to design a 12-week nutrition education and physical activity program. Results showed a significant improvement (p&lt;0.05) in participants’ knowledge scores. Values for systolic blood pressure significantly reduced (p&lt;0.00). There was an increase in number of participants with normal blood pressure and a reduction in number of participants with stage 2 hypertension. The study highlights that nutrition education and physical activity can lead to improved health outcomes among African Americans in rural Alabama.

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.

Willingness to Discuss End-of-Life Care Wishes Among Rural Black/African American Residents of the Alabama Black Belt.

Willingness for end-of-life discussion and related factors among rural Blacks/African Americans of the Alabama Black Belt have not been well-studied. This study aims to assess their willingness for the discussion and examine its relationship with social determinants of health (SDH) and demographic factors. A cross-sectional survey was conducted with a convenience sampling of 182 participants. Most participants were willing to discuss end-of-life wishes with family (77.1%) or doctors (72.1%). Controlling for demographics, results from binary logistic regressions showed those with hospice awareness were more likely to have willingness for discussion with family (OR = 10.07, p < .01) and doctors (OR = 7.23, p < .05). Those who were older (50+) were less likely to have willingness for discussion with doctors (OR = 0.19, p < .05), whereas those who were more socially isolated were less likely to have willingness for discussion with family (OR = 0.53, p < .05). Therefore, end-of-life discussion efforts should focus on older, socially isolated individuals and consider hospice awareness.

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 &lt;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 &gt; 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 &lt; 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 &lt; 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

Utilizing Readers Theater for Health Promotion Education in a Rural Setting

Purpose: The aims of the study were to bring in healthy foods, such as fruits and vegetables, provide cardiac health promotion information, and build a community-based partnership with a rural community in West Alabama by soliciting members of the community to participate in and attend a play on cardiovascular health promotion. Sample: The sample population was mostly older African American community members from a non-incorporated, rural area along with individuals from surrounding communities in an Alabama Black Belt county. Through community collaboration, 67 persons were recruited to participate as actors via reading a script and (n =13) and all remaining persons were audience members for the community play (n = 54). Method: This study utilized a community-based participatory research approach with a qualitative, descriptive research design. The Farmers Theater Toolkit, which utilizes a readers theater technique was used to bring cardiovascular health promotion information to a rural community setting. Findings: The majority of audience participants either strongly or somewhat agreed that what they learned from the community play would help them make better food choices (96.3%). Conclusion: Utilizing the Farmers Theater Toolkit in a rural community was an innovative, fun way to share health promotion information. The citizens of this community were very welcoming to the researcher and were excited to partner with an academic institution. Health promotion education may reduce health risk behaviors such as unhealthy food choices. This type of intervention may serve as an impetus to making better food choices. Keywords: rural community, theater, health eating, health promotion DOI: https://doi.org/10.14574/ojrnhc.v22i1.696