Georgia Counties Research Articles

Spatial patterns of HPV and Tdap vaccine dose administration and the association of health department clinic access in Georgia counties

ObjectiveTo characterize counties in GA by quantifying administered doses of the HPV and Tdap vaccines collected by the state health department immunization registry and indicators of Health Department (HD) clinic access. MethodsUsing a cross sectional study design, secondary data were collected from public health data sources for the years 2016 to 2018 for 159 counties of Georgia. The study population was male and female adolescents aged 13–17. The number of administered HPV and Tdap vaccine doses were modeled in relation to number of private and public HD clinics, number of HD clinics registered in the VFC program and the availability of public transportation using Poisson regression, negative binomial regression, and Bayesian spatial analysis. ResultsChoropleth maps showed similar clustering patterns between administered doses of the HPV vaccine and Tdap vaccine and increased counts of administered vaccine doses in counties with both public and private clinics. Administered doses of HPV and Tdap vaccines were found to exhibit spatial dependence across counties. Accounting for spatial dependence, the availability of public transit had a significant positive effect on administered HPV vaccine doses, while the number of private HD clinics had a significant positive effect on administered Tdap vaccine doses. ConclusionsMaps at the county level show vaccination variability, clustering patterns and provide additional insights on the access to health care. Bayesian spatial models are needed to accurately identify and estimate factors associated with administering doses of the HPV and Tdap vaccines. Future work is needed to further examine the utilization of HPV vaccination services among urban groupings.

Healthfulness of Fast-Food and Full-Service Restaurants in 16 Georgia Counties after Mandatory Menu Labeling

Healthfulness of Fast-Food and Full-Service Restaurants in 16 Georgia Counties after Mandatory Menu Labeling

Knowledge Gleaned From the First Great Georgia Pollinator Census

AbstractIn August 2019, Georgians were provided the opportunity to participate in a pollinator census, called the Great Georgia Pollinator Census (https://GGaPC.org). This initiative evolved from two pilot projects conducted in 2017 and 2018. Citizen scientists counted insects and placed them into one of eight insect categories: (1) carpenter bee, Xylocopa sp. (Hymenoptera: Apidae); (2) bumble bee, Bombus sp. (Hymenoptera: Apidae); (3) honey bee, Apis mellifera L. (Hymenoptera: Apidae); (4) small bee (Hymenoptera); (5) wasp (Hymenoptera: Vespidae); (6) fly (Diptera); (7) butterfly or moth (Lepidoptera); or (8) other insects. This project was a yearlong effort that included assisting Georgians in creating sustainable pollinator habitat and increasing participant knowledge of insects and insect-mediated ecosystem services. A sustainable education effort involved the use of a website, newsletters, social media, University of Georgia Extension personnel, and project partners. Over 4,500 participants recorded over 151,000 insect counts in 135 Georgia counties, including 134 schools. Data analysis indicated a significant difference between pollinator counts in rural and urban areas (e.g., carpenter bees were more abundant in urban than in rural areas). Analysis also showed a significant influence of the local presence of honey bee hives on relative proportion of other pollinators as represented in the survey counts.

Severe Acute Respiratory Syndrome Coronavirus 2 Transmission in Georgia, USA, February 1-July 13, 2020.

The serial interval and effective reproduction number for coronavirus disease (COVID-19) are heterogenous, varying by demographic characteristics, region, and period. During February 1–July 13, 2020, we identified 4,080 transmission pairs in Georgia, USA, by using contact tracing information from COVID-19 cases reported to the Georgia Department of Public Health. We examined how various transmission characteristics were affected by symptoms, demographics, and period (during shelter-in-place and after subsequent reopening) and estimated the time course of reproduction numbers for all 159 Georgia counties. Transmission varied by time and place but also by persons’ sex and race. The mean serial interval decreased from 5.97 days in February–April to 4.40 days in June–July. Younger adults (20–50 years of age) were involved in most transmission events occurring during or after reopening. The shelter-in-place period was not long enough to prevent sustained virus transmission in densely populated urban areas connected by major transportation links.

A Methodological Approach for Evaluating the Enterprise Community Healthy Start Program in Rural Georgia: An Analysis Using Linked PRAMS, Birth Records and Program Data.

Community Healthy Start program evaluations are often limited by a lack of robust data and rigorous study designs. This study describes an enhanced methodological approach using local program data linked with existing population-level datasets for external comparison to evaluate the Enterprise Community Healthy Start (ECHS) program in two rural Georgia counties and presents results from the evaluation. ECHS program data were linked to birth records and the Pregnancy Risk Assessment Monitoring System (PRAMS) for 869 women who delivered a live birth in Burke and McDuffie counties from 2010 to 2011. Multivariate logistic regressions with and without propensity score methods modeled the association between ECHS participation and maternal health indicators and pregnancy outcomes. 107 ECHS participants and 726 non-participants responded to PRAMS and met eligibility criteria. Compared with non-participants, ECHS participants were younger, completed fewer years of education, and were more likely to be non-Hispanic Black, unmarried, insured with Medicaid, participating in WIC, and having an unintended pregnancy. Models with and without propensity score weighting derived similar results: there was a positive association between ECHS participation and receiving adequate or adequate plus prenatal care (p < 0.05); no statistically significant associations were observed between ECHS participation and any other health behaviors, health care access and utilization measures or pregnancy outcomes. Rigorous evaluation of a local Healthy Start program using linked PRAMS and birth records with a population-based external comparison group and propensity score methods is an enhanced and feasible approach that can be applied in other local and state jurisdictions.

Financial manager professionalism and use of interfund transfers: Evidence from Georgia counties

AbstractPublic managers strategically use resources to smooth out cash receipts and disbursements. As a cash flow management tool, managers can use interfund transfers, which are flows of assets without equivalent return flows and without repayment. This study asserts that managerial professionalism, in the form of a full‐time finance director, drives the likelihood of interfund transfers. Using 2010–2017 data from Georgia counties, hurdle model results indicate that full‐time finance directors are more likely to use interfund transfers and increase their level. This finding demonstrates the role of financial management expertise in increasing the strategic options available to manage cash flows.Applications for Practice Local governments with a full‐time finance director use more interfund transfers as one working capital management strategy to manage cash flows. Results from this study provide a justification for local governments to hire a full‐time finance director to improve the array of financial management strategies accessed. Local governments that increase tax base diversity have reduced engagement for General fund interfund transfers in, while higher levels of reported cash generate larger amounts of transfer activity.

School and Community Garden Pollinator Census: A Pilot Project in Georgia

Abstract During 2017 and 2018, gardeners at 36 locations across 21 Georgia counties volunteered to be part of the Georgia Pollinator Census project. The goals of the project were to generate a snapshot of pollinator population data while educating gardeners about the importance of pollinators and other beneficial insects and assisting schools with science, technology, engineering, art, and math programming. Effective insect identification training and on-going support were crucial parts of this citizen science project. Insect counting was conducted in September and October on an aster species and another plant species chosen by the participants. Twenty-eight plant taxa were chosen by participants to be frequently visited by pollinators. Analysis of the data indicates a higher number of sightings of bumble bees, Bombus spp. Latrelle (Hymenoptera: Apidae); honey bees, Apis mellifera L. (Hymenoptera: Apidae), and wasps (Hymenoptera: Vespidae) in rural areas and a higher number of sightings of carpenter bees, Xylocopa spp. Latrelle (Hymenoptera: Apidae); flies (Diptera); and “other insects” (e.g., those that did not fall into any of the other seven categories) in urban areas. We also saw an increase in entomological interest among the participants as well as an increase in insect knowledge. This pilot project was used to refine criteria for a larger state-wide census.

A County-Level Analysis of Socioeconomic and Clinical Predictors of COVID-19 Incidence and Case-Fatality Rates in Georgia, March-September 2020.

The global COVID-19 pandemic has affected various populations differently. We investigated the relationship between socioeconomic determinants of health obtained from the Robert Wood Johnson Foundation County Health Rankings and COVID-19 incidence and mortality at the county level in Georgia. We analyzed data on COVID-19 incidence and case-fatality rates (CFRs) from the Georgia Department of Public Health from March 1 through August 31, 2020. We used repeated measures generalized linear mixed models to determine differences over time in Georgia counties among quartile health rankings of health outcomes, health behaviors, clinical care, social and economic factors, and physical environment. COVID-19 incidence per 100 000 population increased across all quartile county groups for all health rankings (range, 23.1-51.6 in May to 688.4-1062.0 in August). COVID-19 CFRs per 100 000 population peaked in April and May (range, 3312-6835) for all health rankings, declined in June and July (range, 827-5202), and increased again in August (range, 1877-3310). Peak CFRs occurred later in counties with low health rankings for health behavior and clinical care and in counties with high health rankings for social and economic factors and physical environment. All interactions between the health ranking quartile variables and month were significant (P < .001). County-level Gini indices were associated with significantly higher rates of COVID-19 incidence (P < .001) but not CFRs. From March through August 2020, COVID-19 incidence rose in Georgia's counties independent of health rankings categorization. Differences in time to peak CFRs differed at the county level based upon key health rankings. Public health interventions should incorporate unique strategies to improve COVID-19-related patient outcomes in these environments.

Geospatial analysis, web-based mapping and determinants of prostate cancer incidence in Georgia counties: evidence from the 2012\u20132016 SEER data

BackgroundProstate cancer (CaP) cases are high in the United States. According to the American Cancer Society, there are an estimated number of 174,650 CaP new cases in 2019. The estimated number of deaths from CaP in 2019 is 31,620, making CaP the second leading cause of cancer deaths among American men with lung cancer been the first. Our goal is to estimate and map prostate cancer relative risk, with the ultimate goal of identifying counties at higher risk where interventions and further research can be targeted.MethodsThe 2012–2016 Surveillance, Epidemiology, and End Results (SEER) Program data was used in this study. Analyses were conducted on 159 Georgia counties. The outcome variable is incident prostate cancer. We employed a Bayesian geospatial model to investigate both measured and unmeasured spatial risk factors for prostate cancer. We visualised the risk of prostate cancer by mapping the predicted relative risk and exceedance probabilities. We finally developed interactive web-based maps to guide optimal policy formulation and intervention strategies.ResultsNumber of persons above age 65 years and below poverty, higher median family income, number of foreign born and unemployed were risk factors independently associated with prostate cancer risk in the non-spatial model. Except for the number of foreign born, all these risk factors were also significant in the spatial model with the same direction of effects. Substantial geographical variations in prostate cancer incidence were found in the study. The predicted mean relative risk was 1.20 with a range of 0.53 to 2.92. Individuals residing in Towns, Clay, Union, Putnam, Quitman, and Greene counties were at increased risk of prostate cancer incidence while those residing in Chattahoochee were at the lowest risk of prostate cancer incidence.ConclusionOur results can be used as an effective tool in the identification of counties that require targeted interventions and further research by program managers and policy makers as part of an overall strategy in reducing the prostate cancer burden in Georgia State and the United States as a whole.

Erratum: Percentage of Black Population and Primary Care Shortage Areas Associated with Higher COVID-19 Case and Death Rates in Georgia Counties: Erratum.

[This corrects the article DOI: 10.14423/SMJ.0000000000001212.].

Family-Centered Prevention Effects on the Association Between Racial Discrimination and Mental Health in Black Adolescents

Some Black adolescents who frequently experience racial discrimination develop mental health problems. Protective caregiving may buffer adolescents from the negative mental health outcomes associated with experiencing racial discrimination. To examine if participation in programs that enhance protective caregiving will attenuate the positive association between Black adolescents' encounters with discrimination and subsequent increases in mental health problems. This secondary analysis used data from 2 randomized clinical trials testing family-centered prevention programs: the Strong African American Families-Teen (SAAF-T) program and the Adults in the Making (AIM) program. The programs were implemented in community locations convenient for participants in 12 rural Georgia counties. For the SAAF-T trial, Black adolescents and their primary caregivers were recruited from 2007 to 2008. In the AIM trial Black adolescents and their primary caregivers were recruited from 2006 to 2007. Data for this study were analyzed from June to August 2020. Adolescents provided data at baseline on the frequency of their encounters with racial discrimination. Treatment group participants in each trial took part in a family-centered prevention program designed to prevent substance use and mental health problems. SAAF-T is a 5-session, 10-hour psychosocial intervention for families with a Black adolescent aged 14 to 16 years. AIM is a 6-session, 12-hour psychosocial intervention for families with a Black youth who is a high school senior. The primary outcomes were mental health problems, including conduct problems and depression or anxiety symptoms. The SAAF-T study included 502 Black adolescents (mean [SD] age, 16.0 [0.6] years; 281 [56.0%] girls), including 252 randomized to the intervention and 250 randomized to the control, and the AIM trial included 367 Black adolescents (mean [SD] age, 17.7 [0.8] years; 217 [59.1%] girls and women), including 187 randomized to the intervention and 180 randomized to the control. Adolescents assigned to the SAAF-T intervention group who frequently experienced discrimination at baseline evinced fewer subsequent increases in conduct problems (incident risk ratio, 0.530 [95% CI, 0.340 to 0.783]). Adolescents assigned to the AIM intervention group who frequently experienced discrimination at baseline evinced fewer subsequent increases in conduct problems (mean difference, -0.361 [95% CI, -0.577 to -0.144]) and fewer subsequent increases in depression or anxiety symptoms (mean difference, -0.220 [95% CI -0.402 to -0.038]). Moderated mediation analyses suggested that enhanced protective caregiving was partially responsible for all observed interaction effects (indirect effect: SAAF-T conduct problems, -0.063 [95% CI, -0.127 to -0.001]; AIM conduct problems, -0.048 [95% CI, -0.095 to -0.001]; AIM depression or anxious symptoms, -0.036 [95% CI, -0.074 to 0]). This secondary analysis of 2 randomized clinical trials found that participation in family-centered preventive interventions attenuated the association between frequent exposure to discriminatory behaviors and subsequent mental health problems. Notably, all but 1 of the treatment and moderated-mediation findings were reproduced across the SAAF-T and AIM trials. ClinicalTrials.gov Identifiers: SAAF-T, NCT04501471; AIM, NCT04510116.

Association of Self-Reported Depression and Anger with Law Enforcement Officers’ Physical Abuse of Black Men in 4 Georgia Counties, 2011

IntroductionThe association between the behavioral affect of black men and law enforcement officers’ physical abuse of those men is not well-understood. This analysis measures the association between self-reported negative affect behavior (anger or depression) by the men and physical abuse by law enforcement officers, controlling for demographic and behavioral attributes. MethodsA single point-in-time cross-sectional survey was conducted in 2011 through random-digit telephone dialing among a sample of English-speaking black men aged 18-65 years in 4 Georgia (USA) counties. Associations among the outcomes, self-reported history of physical abuse by law enforcement officers, and the predictor variables of interest (self-reported anger or depression) was conducted through multivariable logistic regression. Other independent variables of interest measured were age; country of origin; parental country of origin; education; income; employment status; previous residency in a juvenile, jail, or prison facility; coping styles; and self-reported gender role and racism stress levels. ResultsOf the 633 survey participants who had interacted with law enforcement officers within the past 5 years, 129 (20.4%) reported physical abuse by law enforcement officers. Three factors had statistically significant, independent associations with reported law enforcement officer physical abuse: high levels of depression stratified by often or sometimes coping with stress through anger (adjusted odds ratio [aOR] = 4.9; 95% confidence interval [CI]: 1.4-16.9), previous residency in a jail or prison (aOR = 2.3; 95% CI: 1.8-3.1), and higher levels of exposure to racism (aOR [high levels of racism] = 15.0; 95% CI: 6.7-33.7 and aOR [medium levels of racism] = 6.5; 95% CI: 3.4-12.3). ConclusionCohort studies are needed to determine if a black man's negative coping style, history of incarceration or exposure to racism is causally related to his history of physical abuse by a law enforcement officer.

The Strategic Use of Multimedia in the Great Georgia Pollinator Census Citizen Science Project

In August of 2019, citizens from across the state of Georgia, USA, participated in the Great Georgia Pollinator Census (GGaPC). This University of Georgia Extension initiative recruited citizen scientists to count for 15 minutes the number and types of insects visiting pollinator plants. The project was web based and used multiple media strategies to recruit citizen scientists, to educate the participants on the entomology required, and to collect the data generated. WordPress website-building software allowed us to create the project website (<a href="http://ggapc.org/" target="_blank"><em>GGaPC.org</em></a>). This served as the center of the project as it contained project details and educational materials as well as the portal for uploading count data. The social media outlets Facebook and Instagram were used to promote the project and to provide insect identification and pollinator education, and social media memes were created easily using Canva software. MailChimp emailing services assisted us in providing educational e-newsletters and local counting event newsletters to participants and partners. The Zoom online meeting platform allowed our team to meet with partners and Extension offices across the state to share resources and to plan events. More than 4,600 counts were uploaded, documenting more than 131,000 insect visits tallied from 134 Georgia counties including 135 schools. Multimedia tools allowed us to conduct the project with limited personnel on a small budget while providing comprehensive participant education and an extensive project reach.

Percentage of Black Population and Primary Care Shortage Areas Associated with Higher COVID-19 Case and Death Rates in Georgia Counties.

We hypothesized that the proportion of Black individuals in a county would be associated with higher rates of coronavirus disease 2019 (COVID-19) cases and deaths, even after accounting for other high-risk socioecologic factors such as poverty, population density, and household crowding, and uninsured rates. We also expected that counties designated as primary care health professional shortage areas (PCHPSAs) would be associated with higher COVID-19 death rates, and the lack of primary care access would exacerbate racial disparities in death rates. We undertook this study to test these hypotheses and discern the independent effects of racial composition, socioecologic characteristics, and healthcare system factors on COVID-19 cases and deaths in Georgia counties. We used county-level COVID-19 cases and deaths on April 23, 2020 from the Johns Hopkins Coronavirus Resource Center and estimates of 2019 county-level populations from the US Census Bureau to calculate the cumulative event rates for the state of Georgia. We used multiple regression models to examine crude and adjusted associations of socioecologic and health system variables with county-level COVID-19 case and mortality rates. After adjustment, a 1% increase in the proportion of Black people in the county resulted in a 2.3% increase in the county COVID-19 confirmed case rate and a 3.0% increase in the death rate (relative risk 1.03, 95% confidence interval 1.01-1.05, P < 0.001). Primary care shortage areas had a 74% higher death rate (relative risk 1.74, 95% confidence interval 1.00-3.00, P = 0.049). These results highlight the impact of racial disparities on the spatial patterns of COVID-19 disease burden in Georgia, which can guide interventions to mitigate racial disparities. The results also support the need for robust primary care infrastructure throughout the state.

The Impact of Rurality, Underlying Cardiovascular Disease, and Socioeconomic Vulnerability on COVID-19 Outcomes in Georgia

Background: COVID-19 related illnesses have been associated with an increased prevalence of cardiovascular disease sequelae and worsened socioeconomic variables. We sought to investigate the relationship between COVID-19 outcomes, underlying cardiovascular disease, and socioeconomic determinants of health in rural and non-rural counties in the state of Georgia. Methods: COVID-19, demographic, and socioeconomic data were acquired from publicly available databases including the Center for Disease Control and Prevention’s Social Vulnerability Index (SVI). The relationship between COVID-19 outcomes and markers of cardiovascular disease burden, rurality, and socioeconomic determinants of health was assessed at the county level in Georgia through the beginning of August 2020 using univariable and multivariable Poisson regression modeling. Results: In adjusted models, the risk of COVID-19 incidence was significantly higher in residents of non-rural Georgia counties while we observed no significant difference in COVID-19 case-fatality rates between residents of rural and non-rural Georgia counties. A significant adverse association between risk of COVID-19 cumulative case-fatality rates and recent mortality rates of stroke was detected, while counties with historically higher coronary heart disease death rates demonstrated significantly lower RR of COVID-19 cumulative case-fatality rates. Additionally, Georgia counties with worsened indices of social and economic vulnerability demonstrated significantly higher RR of COVID-19 incidence and case-fatality rates. Conclusions: In Georgia, COVID-19 incidence is adversely associated with non-rural county status, while both incidence and case-fatality rates are associated with historical indices of cardiovascular disease outcomes and higher social vulnerability. Efforts to mitigate COVID-19 spread and improve COVID-19 outcomes in Georgia may require additional focus on these most vulnerable areas.

Capturing the South: Imagining America’s Most Documented Region by Scott L. Matthews

Reviewed by: Capturing the South: Imagining America’s Most Documented Region by Scott L. Matthews Carol Quirke Capturing the South: Imagining America’s Most Documented Region. By Scott L. Matthews. Documentary Arts and Culture. (Chapel Hill: Published by University of North Carolina Press in association with the Center for Documentary Studies at Duke University, 2018. Pp. xvi, 312. Paper, $29.95, ISBN 978-1-4696-4645-9; cloth, $90.00, ISBN 978-1-4696-4644-2.) Travel writers, poets, ethnographers and other social scientists, musicologists, folklorists, journalists, and photographers made “the American South . . . the most documented place on earth” (p. 2). Scott L. Matthews surveys this oeuvre; his history’s title conveys that he is equally interested in what the [End Page 145] region’s rich vein of documentary studies communicates about its practitioners. For Matthews, documentarians’ will to chart “appealing primitivism and appalling pathology” often overshadowed much else—hence the book explores documentarians’ motives and mythologizing (p. 239). If James Agee claimed the camera testified to “the cruel radiance of what is” (James Agee and Walker Evans, Let Us Now Praise Famous Men [Boston, 1941], p. 9), Matthews argues that documentarians’ witnessing often resulted in patronizing attempts at reform or twisted caricature that still adhere to the South. They conspired to preserve a “premodern” regionalism before “modernity wiped it away,” yet Matthews evidences how documentary subjects often rejected such representations (p. 2). The author’s well-researched case studies span the twentieth century. Beginning with social scientist Howard W. Odum’s development of the University of North Carolina’s Institute for Research in the Social Sciences, Matthews moves to New Deal–era Farm Security Administration (FSA) images of a Georgia county through Jack Delano’s eyes. For the postwar period, Capturing the South: Imagining America’s Most Documented Region explores musicologist/musician John Cohen of the New Lost City Ramblers, who tracked down and then promoted the “high lonesome sound” of Appalachian singers (p. 113). Matthews then investigates Danny Lyon’s evocative photos of the Student Nonviolent Coordinating Committee (SNCC) and finishes with a deep dive into Hale County, Alabama, where Let Us Now Praise Famous Men is set. Matthews’s probing of a range of documentary materials is a strength, allowing him to identify common patterns of representation. He also delineates documentary projects’ overlapping audiences. For example, Odum’s staff introduced photographer Dorothea Lange to several southern communities. Photographers, academics, policy makers, and the general public then engaged with this imagery, a generation later embraced by folk lovers, art enthusiasts, and political activists. Another strength is Matthews’s mining of poor southerners’ reactions to their documentation. One Kentucky musician shot and killed an interviewer. Most subjects found less brutal forms of resistance. Matthews makes an important scholarly intervention in demonstrating how elites, such as Zora Neale Hurston or W. E. B. Du Bois, and common sharecroppers or churchgoers registered distaste or actively sabotaged documentarians’ efforts to pin down southern folkways. For half a century, critics and scholars have argued photographers exert an adverse power over their subjects. Matthews’s analysis provides evidence where others offer theory alone; but as each chapter shows documentarians forcing themselves upon resisting subjects, the argument becomes formulaic. Greater suppleness in limning the relations between subject and maker would persuade more. Similarly, Capturing the South flattens differences in the wide variety of practitioners who made the South their subject. Certainly, documentarians in the center (urban North) sought to preserve an “authentic” culture in the periphery (rural South). And yet what drew such diverse people as snobbish, WASPy Walker Evans; genteel, racist Odum, a southerner; or Jewish Brooklynite and antiracist Lyon to documenting the South? Lyon was held in high esteem by his subjects and his activist sponsor, SNCC. Ultimately, SNCC [End Page 146] advanced Black photographers, paralleling the movement’s radicalization to Black Power. This does not appear proof of Lyon’s “well-meaning white liberal[ism]” (pp. 187–88). A final concern is that Matthews’s southern documentarians are largely men. His discussion of Lyon’s SNCC work focuses on leaders such as Bob Moses and John Lewis. But one of Lyon’s most famous photographs portrays teenage women in the Leesburg, Georgia...

Estimated Community Seroprevalence of SARS-CoV-2 Antibodies - Two Georgia Counties, April 28-May 3, 2020.

Transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), is ongoing in many communities throughout the United States. Although case-based and syndromic surveillance are critical for monitoring the pandemic, these systems rely on persons obtaining testing or reporting a COVID-19-like illness. Using serologic tests to detect the presence of SARS-CoV-2 antibodies is an adjunctive strategy that estimates the prevalence of past infection in a population. During April 28-May 3, 2020, coinciding with the end of a statewide shelter-in-place order, CDC and the Georgia Department of Public Health conducted a serologic survey in DeKalb and Fulton counties in metropolitan Atlanta to estimate SARS-CoV-2 seroprevalence in the population. A two-stage cluster sampling design was used to randomly select 30 census blocks in each county, with a target of seven participating households per census block. Weighted estimates were calculated to account for the probability of selection and adjusted for age group, sex, and race/ethnicity. A total of 394 households and 696 persons participated and had a serology result; 19 (2.7%) of 696 persons had SARS-CoV-2 antibodies detected. The estimated weighted seroprevalence across these two metropolitan Atlanta counties was 2.5% (95% confidence interval [CI]=1.4-4.5). Non-Hispanic black participants more commonly had SARS-CoV-2 antibodies than did participants of other racial/ethnic groups (p<0.01). Among persons with SARS-CoV-2 antibodies, 13 (weighted % = 49.9; 95% CI=24.4-75.5) reported a COVID-19-compatible illness,* six (weighted % = 28.2; 95% CI=11.9-53.3) sought medical care for a COVID-19-compatible illness, and five (weighted % = 15.7; 95% CI=5.1-39.4) had been tested for SARS-CoV-2 infection, demonstrating that many of these infections would not have been identified through case-based or syndromic surveillance. The relatively low seroprevalence estimate in this report indicates that most persons in the catchment area had not been infected with SARS-CoV-2 at the time of the survey. Continued preventive measures, including social distancing, consistent and correct use of face coverings, and hand hygiene, remain critical in controlling community spread of SARS-CoV-2.

P167 Feasibility of ASA-24 in Community-Based Settings

<h3>Background</h3> While many valid dietary assessment methods are available for nutrition research, feasibility is a concern in community-based settings. ASA-24 is a self-guided option for collecting 24-hour dietary recalls, but its use in community-based settings is limited. <h3>Objective</h3> To determine the feasibility of utilizing ASA-24 for collecting 24-hour dietary recalls in community-based settings. <h3>Study Design, Setting, Participants</h3> A cross-sectional study design was used to evaluate feasibility of ASA-24 among overweight and obese adults at high risk for type 2 diabetes participating in the National Diabetes Prevention Program (NDPP). NDPPs were delivered in 12 Georgia counties (7 metropolitan; 5 nonmetropolitan) by Cooperative Extension. Participants were asked to complete two 24-hour recalls, 1 weekday and 1 weekend day, using ASA-24, without individual instruction. <h3>Measurable Outcome/Analysis</h3> Number and percentage of participants who completed >1 ASA-24s and mean + standard deviation Calorie, carbohydrate, protein, and fat intakes were calculated. <h3>Results</h3> Of the 86 participants asked to complete 2 ASA-24s, 54 (63%) completed >1 recall. Forty-eight (56%) participants completed 1 weekday; 27 (31%) completed 1 weekend day; and 31 (36%) completed >2 days, with 20 (23%) completing 1 weekday and 1 weekend day as instructed. Mean reported Calorie intake was 1,691+1,088 kcal (range, 128-7444 kcal). Mean carbohydrate, protein, and fat intakes reported were 180+109 g (range, 10-688 g), 77+47 g (range, 2-233 g), and 75+60 (range, 10-418 g), respectively. Of those who completed >1 recall, 83% were female and had at least some college education, with 100% being high school graduates and 48% college graduates. <h3>Conclusions</h3> While a majority (63%) of participants completed >1 ASA-24 recall, <25% completed 1 weekday and 1 weekend day as instructed. While mean nutrient intakes were reasonable, standard deviations indicate further instruction may be needed. Future analyses will assess other factors influencing feasibility.

Epidemiology of the 2020 pandemic of COVID-19 in the state of Georgia: Inadequate critical care resources and impact after 7 weeks of community spread.

ObjectivesNovel coronavirus (COVID‐19) is a global pandemic currently spreading rapidly across the United States. We provide a comprehensive look at COVID‐19 epidemiology across the state of Georgia, which includes vast rural communities that may be disproportionately impacted by the spread of this infectious disease.MethodsAll 159 Georgia counties were included in this study. We examined the geographic variation of COVID‐19 in Georgia from March 3 through April 24, 2020 by extracting data on incidence and mortality from various national and state datasets. We contrasted county‐level mortality rates per 100,000 population (MRs) by county‐level factors.ResultsMetropolitan Atlanta had the overall highest number of confirmed cases; however, the southwestern rural parts of Georgia, surrounding the city of Albany, had the highest bi‐weekly increases in incidence rate. Among counties with >10 cases, MRs were highest in the rural counties of Randolph (233.2), Terrell (182.5), Early (136.3), and Dougherty (114.2). Counties with the highest MRs (22.5–2332 per 100,000) had a higher proportion of: non‐Hispanic Blacks residents, adults aged 60+, adults earning <$20,000 annually, and residents living in rural communities when compared with counties with lower MRs. These counties also had a lower proportion of the population with a college education, lower number of ICU beds per 100,000 population, and lower number of primary care physicians per 10,000 population.ConclusionsWhile urban centers in Georgia account for the bulk of COVID‐19 cases, high mortality rates and low critical care capacity in rural Georgia are also of critical concern.

Provider recommendations for human papillomavirus vaccine (HPV) among adolescent males in Southwest Georgia counties and the associated HPV prevalence in this population

Provider recommendations for human papillomavirus vaccine (HPV) among adolescent males in Southwest Georgia counties and the associated HPV prevalence in this population