Metro Atlanta Area Research Articles

The impact of congestion and dedicated lanes on on-demand multimodal transit systems

Traffic congestion can have a detrimental effect on public transit systems, and understanding and mitigating these effects is of critical importance for effective public transportation. Implementing Dedicated Bus Lanes (DBLs) is a well-known intervention to achieve this goal. A DBL is a designated lane for bus transit, which avoids congestion and substantially lowers the travel time. This makes transit more attractive, encouraging more travelers to adopt public transportation. This paper studies the impact of congestion and DBLs on novel On-Demand Multimodal Transit Systems (ODMTS). ODMTS combine traditional rail and bus networks with on-demand shuttles. Previous case studies have shown that ODMTS may simultaneously improve travel time, reduce system cost, and attract new passengers. Those benefits were shown for an ideal world without traffic congestion, and this paper hypothesizes that the advantages of ODMTS can be even more pronounced in the real world. This paper explores this hypothesis by creating realistic congestion scenarios and solving bilevel optimization problems to design ODMTS under these scenarios. The impact of DBLs on ODMTS is evaluated with a comprehensive case study in the Metro Atlanta Area. The results show that DBLs can significantly improve travel times and are effective at increasing adoption of the system.

Climate drivers of migration and neglected tropical disease burden in Latin American and Caribbean immigrants: A pilot study in Atlanta, Georgia

IntroductionClimate change has negatively impacted the agricultural and socioeconomic infrastructure of Latin American and Caribbean (LAC) countries leading to conditions that promote human migration. It has also led to emergence and reemergence of infectious diseases. This pilot study aimed to identify climate-related drivers of migration and to describe the burden of climate-sensitive neglected tropical diseases (NTD) in immigrants living in Atlanta, Georgia, USA. MethodsFirst generation immigrants from LAC countries living in the Atlanta-metro area were recruited between May and December 2021. Participants completed a survey concerning demographics, socioeconomics, living conditions in their country of origin and living conditions in Atlanta, and motivations for migration. Blood and stool samples were collected to identify Chagas disease and soil-transmitted helminths, and skin exams screened for leprosy and leishmaniasis. Descriptive, univariate, and multivariable analyses of this dataset looked at the association between a climate-driven motivation to migrate and geographic and socioeconomic factors. ResultsFifty-seven individuals were recruited representing 11 LAC countries of origin. Most originated from Central America (n = 32; 56 %) and Mexico (n = 13; 23%). Forty-two participants reported a change in climate or weather in their country of origin prior to moving and direct climate drivers of migration (e.g., floods, drought, etc.) were identified by 12 participants (21.1%). Infectious diseases screening found one definitive case of Chagas (2.5%) out of 40 blood samples screened. Food insecurity was significantly associated with a climate-related factor for migrating: aOR = 6.3 (95 % CI 1.1, 35.5). ConclusionsWhile most participants did not directly identify “climate change” as a reason for migration, our study reveals many factors such as food insecurity, agricultural occupations, and region of origin that may underlie climate-motivated migration. Finding one case of Chagas was also noteworthy and shows the need for improved surveillance for this important NTD.

Association of PM2.5 Exposure and Alzheimer Disease Pathology in Brain Bank Donors-Effect Modification by APOE Genotype.

Fine particulate matter (PM2.5) exposure has been found to be associated with Alzheimer disease (AD) and is hypothesized to cause inflammation and oxidative stress in the brain, contributing to neuropathology. The APOE gene, a major genetic risk factor of AD, has been hypothesized to modify the association between PM2.5 and AD. However, little prior research exists to support these hypotheses. This study investigates the association between traffic-related PM2.5 and AD hallmark pathology, including effect modification by APOE genotype, in an autopsy cohort. A cross-sectional study was conducted using brain tissue donors enrolled in the Emory Goizueta AD Research Center who died before 2020 (n = 224). Donors were assessed for AD pathology including the Braak stage, Consortium to Establish a Registry for AD (CERAD) score, and combined AD neuropathologic change (ABC) score. Traffic-related PM2.5 concentrations were modeled for the metro-Atlanta area during 2002-2019 with a spatial resolution of 200-250 m. One-year, 3-year, and 5-year average PM2.5 concentrations before death were matched to participants' home address. We assessed the association between traffic-related PM2.5 and AD hallmark pathology and effect modification by APOE genotype, using adjusted ordinal logistic regression models. Among the 224 participants, the mean age of death was 76 years, and 57% had at least 1 APOE ε4 copy. Traffic-related PM2.5 was significantly associated with the CERAD score for the 1-year exposure window (odds ratio [OR] 1.92; 95% CI 1.12-3.30) and the 3-year exposure window (OR 1.87; 95% CI 1.01-3.17). PM2.5 was also associated with higher Braak stage and ABC score albeit nonsignificantly. The strongest associations between PM2.5 and neuropathology markers were among those without APOE ε4 alleles (e.g., for the CERAD score and 1-year exposure window, OR 2.31; 95% CI 1.36-3.94), though interaction between PM2.5 and APOE genotype was not statistically significant. Our study found traffic-related PM2.5 exposure was associated with the CERAD score in an autopsy cohort, contributing to epidemiologic evidence that PM2.5 affects β-amyloid deposition in the brain. This association was particularly strong among donors without APOE ε4 alleles. Future studies should further investigate the biological mechanisms behind this association.

A qualitative assessment of cleaning and hand hygiene practices at shelters serving people experiencing homelessness during the COVID-19 pandemic, Atlanta, GA – May-June, 2020

BackgroundCleaning practices and hand hygiene are important behaviors to prevent and control the spread of infectious disease, especially in congregate settings. This project explored hygiene- and cleaning-related experiences in shelters serving people experiencing homelessness (PEH) during May–June 2020 of the COVID-19 pandemic.MethodsWe conducted qualitative, in-depth interviews by phone with 22 staff from six shelters in Atlanta, Georgia. The interview guide included questions about cleaning routines, cleaning barriers and facilitators, cleaning promotion, hand hygiene promotion, and hand hygiene barriers and facilitators. We analyzed interview transcripts using thematic analysis.ResultsMultiple individuals, such as shelter individuals (clients), volunteers, and staff, played a role in shelter cleaning. Staff reported engaging in frequent hand hygiene and cleaning practices. Barriers to cleaning included staffing shortages and access to cleaning supplies. Staff reported barriers (e.g., differing perceptions of cleanliness) for clients who were often involved in cleaning activities. Barriers to hand hygiene included limited time to wash hands, forgetting, and inconvenient handwashing facilities. Specific guidance about when and how to clean, and what supplies to use, were requested.ConclusionDuring the early months of the COVID-19 pandemic, shelters serving PEH in the Atlanta-metro area needed resources and support to ensure sufficient staffing and supplies for cleaning activities. As part of future pandemic planning and outbreak prevention efforts, shelters serving PEH could benefit from specific guidance and training materials on cleaning and hand hygiene practices.

Abstract A047: Increasing cancer-related community-engagement strategies among Historically Black Colleges and Universities and Minority Serving Institutions

Abstract Addressing cultural beliefs and barriers is imperative to successfully designing and implementing behavior change interventions to increase cancer screening and treatment among underserved communities. Community-based participatory research (CBPR) fosters proven strategies that reduce barriers to cancer screening in several diverse population groups. Citizen scientists are laypersons who do not have formal science training but receive training to engage in research efforts responsive to community needs. Project Brotherhood, a community-based health organization on Chicago’s southside, has developed a community engagement model known as the Murray Model. It specifically engages black men in improving their health status. One aspect is engaging black men as citizen scientists to address cancer disparities within their communities. Evidence shows that citizen scientists were better equipped to understand lung cancer risks and increased their advocacy for better health within their communities. In partnership with Project Brotherhood and the University of Illinois Cancer Center, the National Cancer Institute, Informatics Technology for Cancer Research (ITCR) Training Network (ITN) Program is scaling up the citizen scientist Train-the-Trainer program at historically black colleges and universities and minority-serving universities. The Train-the-Trainer ITCR citizen scientist program is partnering with the Morehouse School of Medicine to increase its community and academic capacities in the Atlanta metro area to address cancer disparities. Citation Format: Rohan D. Jeremiah, Marcus Murray, Maisha Standifer, LeChaun Kendall, Carrie Wright, Candace Savonen, Jeff Leeks. Increasing cancer-related community-engagement strategies among Historically Black Colleges and Universities and Minority Serving Institutions [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A047.

Student-Centered Computing: Teacher Experiences in a New Introductory Computer Science Curriculum

Objectives. The goal of this paper is to introduce and describe a new introductory computer science course. Research results from the implementation of this curriculum will be presented to demonstrate the nature of teachers’ experiences with the curriculum. Participants. Participants are teachers implementing the new curriculum at two schools in the metro Atlanta area. Study Method. This paper is partly descriptive, presenting the theory underlying the newly developed curriculum as well as its various features. An organizing framework, the Teacher Accessibility, Equity, and Content (TEC) rubric from Weintrop et al. (2019) [ 1 ], is used to structure the curriculum description. Teacher perceptions were gathered via both structured interviews and short online enactment surveys. These perceptions are summarized and presented thematically, corresponding to the features of the curriculum. Findings. A newly developed introductory computer science (CS) curriculum, Student-Centered Computing (SCC), utilizes project-based learning (PBL) and culturally authentic practices (CAPs) to help promote a sense of belonging and intent to persist within computer science among all students. Teachers successfully implemented the curriculum and generally found it to be beneficial for their students, though they struggled with some of the pedagogical demands of project-based learning as well as some of the most advanced technical content associated with the music coding and app development platforms. Conclusions. This paper provides a detailed overview of a year-long introductory computer science curriculum focused on the creation of culturally relevant digital artifacts. The curriculum represents a strong effort to make CS content relevant and appealing to the full range of students by relating it to their lives and experiences. Teacher surveys and interviews revealed that both teachers and students had positive views of the course. However, teaching using inclusive PBL pedagogy and culturally authentic practices takes skill and practice by teachers, supporting the need for CS teachers to have good pedagogical training as well as a strong knowledge of computer science to create a classroom environment that promotes success for all students.

Using Existing School Messaging Platforms to Inform Parents about Their Child’s Attendance

School attendance is strongly associated with academic success and high school completion, but approximately one-in-seven students miss nearly one month of school each year. To address absenteeism, we partnered with four public school districts in the metro-Atlanta area and experimentally deployed email and text messages to inform parents about their child’s attendance. Parents received personalized monthly messages through the school districts’ existing messaging platforms that had zero marginal cost per message. The messages informed parents about their child’s number of absences and how that number compared to absences of their peers. For most parents, this information was delivered through email as opposed to text, and parents of students most in need of improved attendance were the hardest to reach. Intent-to-treat estimates show the intervention reduced end-of-year absences by four-tenths to two-thirds of a day (2 to 3%) and reduced the probability of chronic absenteeism by 2 to 6%, while actually receiving the messages reduced end-of-year absences by two-thirds to almost one day (3 to 4%) and reduced the probability of chronic absenteeism by 4 to 7%.

Combining crowd-sourcing, census data, and public review forums for real-time, high-resolution food desert estimation

BackgroundIt has been hypothesized that low access to healthy and nutritious food increases health disparities. Low-accessibility areas, called food deserts, are particularly commonplace in lower-income neighborhoods. The metrics for measuring the food environment’s health, called food desert indices, are primarily based on decadal census data, limiting their frequency and geographical resolution to that of the census. We aimed to create a food desert index with finer geographic resolution than census data and better responsiveness to environmental changes.Materials and methodsWe augmented decadal census data with real-time data from platforms such as Yelp and Google Maps and crowd-sourced answers to questionnaires by the Amazon Mechanical Turks to create a real-time, context-aware, and geographically refined food desert index. Finally, we used this refined index in a concept application that suggests alternative routes with similar ETAs between a source and destination in the Atlanta metropolitan area as an intervention to expose a traveler to better food environments.ResultsWe made 139,000 pull requests to Yelp, analyzing 15,000 unique food retailers in the metro Atlanta area. In addition, we performed 248,000 walking and driving route analyses on these retailers using Google Maps’ API. As a result, we discovered that the metro Atlanta food environment creates a strong bias towards eating out rather than preparing a meal at home when access to vehicles is limited. Contrary to the food desert index that we started with, which changed values only at neighborhood boundaries, the food desert index that we built on top of it captured the changing exposure of a subject as they walked or drove through the city. This model was also sensitive to the changes in the environment that occurred after the census data was collected.ConclusionsResearch on the environmental components of health disparities is flourishing. New machine learning models have the potential to augment various information sources and create fine-tuned models of the environment. This opens the way to better understanding the environment and its effects on health and suggesting better interventions.

Exploring police legitimacy and other factors in predicting cooperation with police in the Atlanta Korean American community

PurposeLimited research exists on the perceptions of police within specific ethnic minority groups. The primary purpose of this study is to investigate the experiences of Korean and Korean American residents in the Metro Atlanta area regarding their perceptions of cooperation with the police, particularly in relation to hate crimes, along with their perceptions of police legitimacy and other relevant factors. By focusing on this specific population, the study aims to shed light on their unique perspectives and contribute to a deeper understanding of the complex dynamics between ethnic minorities and law enforcement.Design/methodology/approachThe authors’ sample comprised 128 Korean residents who were asked about their demographics, victimization experiences, self-rated English proficiency and police legitimacy. Multiple linear regression analyses were employed to investigate the impact of police legitimacy, victimization experiences and English-speaking skills on the participants' level of cooperation with the police.FindingsPolice legitimacy and self-rated levels of English proficiency emerged as the most significant factors in predicting the level of cooperation among residents with the police. Furthermore, individuals who have experienced crime victimization in the past were more willing to cooperate with the police compared to those who have not. Additionally, men showed a higher tendency to cooperate with the police compared to women participants.Originality/valueThe findings of this study suggest important implications for the policies and strategies aimed at enhancing the relationship between the Korean American community and the police. These implications include the need for improved language support for non-English speaking community members and the importance of building trust and fostering mutual understanding to cultivate positive police-community relations. By implementing measures based on these findings, it is recommended to promote a more inclusive and effective approach to policing within the Korean American population.

553-P: Perspectives on Culture, Health Beliefs, and Diabetes Risk among Asian Indians in Atlanta—A Qualitative Study

Background and Purpose: South Asians are a fast-growing ethnic minority in the Atlanta metro area and are at high risk for developing diabetes. In order to create culturally competent practices and interventions, it is critical to understand the nuances in health beliefs, attitudes towards diabetes, and cultural and religious practices. Methods: Design: Key informant interviews were conducted with participants as part of a mixed-methods study. After 5 interviews, a codebook was created with themes through inductive analysis, and interview questions were adjusted for clarity. Analyses were done using MAXQDA. Transcripts were reviewed and coded; any discrepancies in coding were discussed and resolved in weekly meetings. Semi-structured 60 minute interviews (n=8) were conducted online or in-person and recorded. Results: Of 2,460 participants enrolled in the parent study, 71 were selected for interviews based on age (18-79), gender, and religious backgrounds. Stratifying by generational cohort and nativity revealed differences in beliefs about healthy behavior (including physical activity and nutritional preferences) and interactions with various healthcare systems. Participants’ beliefs on mindfulness, meditation, and cultural foods affected their health and lifestyle choices. Most immigrants had different perceptions of western medicine and experiences with the U.S. healthcare system compared to ayurvedic medicine. Common areas of confusion included prescriptions and obtaining medications, insurance status, and distrust in medical practitioners. Conversely, first generation participants reported greater health knowledge and engagement in healthy practices to prevent diabetes. Discussion: Health beliefs and practices among South Asians vary by nativity, education, age, generational cohort, and sociocultural customs. Future studies should address how nativity and age might affect engagement in lifestyle change for South Asians. Disclosure D.Arora: None. I.Rajwani: None. M.K.Shah: None.

Tailoring capture-recapture methods to estimate registry-based case counts based on error-prone diagnostic signals.

Surveillance research is of great importance for effective and efficient epidemiological monitoring of case counts and disease prevalence. Taking specific motivation from ongoing efforts to identify recurrent cases based on the Georgia Cancer Registry, we extend recently proposed "anchor stream" sampling design and estimation methodology. Our approach offers a more efficient and defensible alternative to traditional capture-recapture (CRC) methods by leveraging a relatively small random sample of participants whose recurrence status is obtained through a principled application of medical records abstraction. This sample is combined with one or more existing signaling data streams, which may yield data based on arbitrarily non-representative subsets of the full registry population. The key extension developed here accounts for the common problem of false positive or negative diagnostic signals from the existing data stream(s). In particular, we show that the design only requires documentation of positive signals in these non-anchor surveillance streams, and permits valid estimation of the true case count based on an estimable positive predictive value (PPV) parameter. We borrow ideas from the multiple imputation paradigm to provide accompanying standard errors, and develop an adapted Bayesian credible interval approach that yields favorable frequentist coverage properties. We demonstrate the benefits of the proposed methods through simulation studies, and provide a data example targeting estimation of the breast cancer recurrence case count among Metro Atlanta area patients from the Georgia Cancer Registry-based Cancer Recurrence Information and Surveillance Program (CRISP) database.

Welcoming immigrant integration beyond the local level: Atlanta’s One Region Initiative

ABSTRACT Welcoming America, a nonprofit organization based in metropolitan Atlanta, has grown a membership network throughout the U.S. of nonprofit organizations and municipalities that present their communities as “welcoming cities” for immigrants. In 2018, Welcoming America launched the “One Region Initiative” to cultivate a concept of a “welcoming region” to transcend municipal boundaries. The purpose of this paper is to examine One Region member municipalities’ implementation of the plans and recommendations set forth in 2018. We specifically examined Phase I of the pilot program, which took place between 2019 and 2021 amid the broader multiscalar context of changing geographies of immigrant settlement and immigration policy. We do so through participant observation as One Region steering committee members, and applied researchers who have been engaged in immigrant integration work in the Atlanta metro area and throughout the country for over a decade. Overall, we find unevenly completed recommendations across locales (often more tied to resources than actual immigrant population share) and core areas (often tied to business friendliness and government).

Ethnicity in housing markets: Buyers, sellers and agents

AbstractThis paper examines how ethnicity related to cultural differences arising from ethnic background affects housing market transactions in the Atlanta metro area. Using both the US Census and Wikipedia approaches to infer ethnicity from individuals' names, we find that the interplay of buyer, seller, and agent ethnicity composition affects interaction in the housing market. Sellers working with listing agents in the same ethnic group set higher listing prices and enjoy higher selling prices and quicker sales. Agents working with same ethnicity buyers yield higher prices and liquidity. Even though sellers only communicate with buyers through their agents, houses sold by sellers to buyers of same ethnicity have higher prices and sell faster. And while the ethnic mix of agents and their clients matter, the ethnic mix of agents in the transaction does not.

Impact and analysis of rider comfort in shared modes during the COVID-19 pandemic.

Travel behavior has dramatically shifted during the COVID-19 pandemic as social distancing measures and stay-at-home orders are encouraged to prevent the spread of infection. Shared mobility, which includes transit, ride-hailing, and shared ride-hailing, typically involves contact with strangers and is now viewed as a potential risk. To understand current trends and predict potential modal shifts in a post-COVID-19 world, this research designed, developed, and deployed a short online survey about comfort with and usage of shared transportation. The survey was distributed through multiple recruitment methods to adults in the Atlanta metro area. Data collected from the survey (n=787) revealed preferences related to ride-sharing environments and safety procedures, frequency of travel on different modes before and during the pandemic, and level of comfort related to the usage of different modes. Despite reopening the economy in Georgia, this research found that the actual usage of private ride-hailing and transit has dramatically decreased. In addition to the usage, the indicated comfort level with usage of shared mobility has decreased since the pandemic. Looking to the future, regression models and data analysis indicated that although there would be an increase in comfort for all shared modes when a vaccine is available, it does not return to the pre-pandemic levels.

Abstract 3672: Area-level drivers of the breast cancer mortality race disparity in Georgia

Abstract In the US, breast cancer mortality is 40% greater among Black than White women. The mortality disparity varies geographically and has persisted despite improvements in survival. Georgia is one of six states where breast cancer recently surpassed lung cancer as the leading cause of cancer death among Black but not White women, is a large and diverse state, and thus, an ideal setting to study race disparities. Our work in the Atlanta Metro area has shown that the mortality disparity is pronounced among patients with clinically favorable subtypes, low Oncotype DX® recurrence scores, guideline-concordant care, and similar access to surgical facilities. The disparity also persists among patients with private insurance and those living in areas of low poverty, suggesting clinical and sociodemographic differences do not fully account for the observed disparity. Recent evidence suggests area-level factors may contribute to the disparity. Our group reported that neighborhood-level redlining (i.e., mortgage denial based on place) is associated with an increase in breast cancer mortality while neighborhood-level lending bias (i.e., mortgage denial based on race) is associated with a decrease in breast cancer mortality. In Atlanta, Black patients are more likely to live in redlined areas and less likely to live in areas with lending bias, than White patients, further suggesting place is an important driver of disparities. We investigated the role of other area-level factors on race-specific mortality in Georgia. Race-specific standardized mortality ratios were computed for each county in Georgia. Observed breast cancer deaths among non-Hispanic White (NHW) and non-Hispanic Black (NHB) women within 5 years of a stage I-III breast cancer diagnosis (2005-2013) were obtained from the Georgia Cancer Registry. County-level characteristics were derived from the American Community Survey and Georgia Department of Public Health. A Bayesian model-based approach was used to stabilize local estimates and estimate associations with area-level factors. Smoothed estimates of relative disparity ranged from 1.2 to 1.7, with pronounced disparity for counties surrounding the Atlanta and Savannah metropolitan areas and least pronounced disparity in Metro Albany counties. Among NHB women, living in a rural (versus non-rural) county was associated with a nearly 20% increase in breast cancer mortality (RR=1.19, 95% credible interval (CI): 0.96, 1.48); an association not observed in NHW patients (RR=0.93, 95% CI: 0.79, 1.07). In contrast, a 10-point increase in the percent of adults with ≤high school education was associated with a 10% increase (95% CI: 1.05, 1.17) in mortality for NHW patients only. The race disparity in Georgia is not evenly distributed across counties. We identified area-level characteristics associated with race-specific mortality. Identifying other area-level drivers of breast cancer mortality is an important area of inquiry. Citation Format: Rebecca Nash, Lindsay J. Collin, Jeffrey Switchenko, Lauren E. McCullough. Area-level drivers of the breast cancer mortality race disparity in Georgia [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 3672.

Exploring the Discursive Emphasis on Patients and Coaches Who Participated in Technology-Assisted Diabetes Self-management Education: Clinical Implementation Study of Health360x

BackgroundA critical unmet need for underserved patients with diabetes is regular access to sufficient support for diabetes self-management. Although advances in digital technologies have made way for eHealth applications that provide a scalable path for tailored interventions for self-management of chronic conditions, health and digital literacy has remained an obstacle to leveraging these technologies for effective diabetes self-management education. Studies have shown that the availability of coaches helps to maintain engagement in internet-based studies and improves self-efficacy for behavior change. However, little is known about the substances involved in these interactions.ObjectiveThis study aims to compare the content of conversations between patient–coach pairs that achieved their self-management goals and those that did not. The context is a clinical implementation study of diabetes self-management behavior change using Health360x within the practices of the Morehouse Choice Accountable Care Organization in the Atlanta metro area. Health360x is a coach-assisted consumer health information technology designed to support self-management skills acquisition and behavior among underserved, high-risk patients with diabetes.MethodsWe provide a novel analysis of the discursive emphasis on patients and coaches. We examined transcripts of visits using a structural topic model to estimate topic content and prevalence as a function of patient and coach characteristics. We compared topics between patient–coach pairs that achieved diabetes-related self-management goals and those who did not. We also estimated a regression in which utterances are the units, the dependent variable is the proportion of an utterance that is about a given topic, and the independent variables are speaker types and explored other themes.ResultsTranscripts from 50 patients who were recruited and consented, starting in February 2015, were analyzed. A total of 44 topics were estimated for patient–coach pairs that achieved their intended health goals and 50 topics for those who did not. Analysis of the structural topic model results indicated that coaches in patient–coach pairs that were able to achieve self-management goals provided more contextual feedback and probed into patients’ experience with technology and trust in consumer information technologies. We also found that discussions around problem areas and stress, support (βCoach=.015; P<.001), initial visits (βCoach=.02; P<.001), problems with technology (βCoach=.01; P<.001), health eating goals (βCoach=.01; P=.04), diabetes knowledge (βCoach=.02; P<.001), managing blood sugar (βCoach=.03; P<.001), and using Health360x (βCoach=.003; P=.03) were dominated by coaches.ConclusionsCoach-facilitated, technology-based diabetes self-management education can help underserved patients with diabetes. Our use of topic modeling in this application sheds light on the actual dynamics in conversations between patients and coaches. Knowledge of the key elements for successful coach–patient interactions based on the analysis of transcripts could be applied to understanding everyday patient–provider encounters, given the recent paradigm shift around the use of telehealth.

Is There Discrimination in Property Taxation? Evidence from Atlanta, Georgia, 2010-2016

In the past, some localities have taxed blacks at higher real rates than whites by over-assessing property values in predominately blacks neighborhoods while taxing those properties at the same nominal rates. In 1974, the NAACP sued Fulton County, Georgia – the principal county of the Atlanta metro area – over this very issue. In 1991, a mass reappraisal intended to remedy this discrimination incited a tax revolt in Fulton. However, there are few recent studies of whether discrimination is still taking place. Using assessment data from Fulton County 2010-2016, I find little to no evidence of any racial or socioeconomic discrimination in ratios of property assessment to sale prices. This suggests that (1) the assessment process is uniform and non-discriminatory, and/or (2) the process and fee for appealing one's assessment is not inaccessible to a degree that would allow any disparities to persist, and/or (3) regression-based mass appraisal techniques are capable of eliminating racial discrimination from property assessment.

Evaluating the Effectiveness of a Telehealth Cancer Genetics Program: A BRCA Pilot Study

Introduction: Ashkenazi Jewish (AJ) individuals face a 1 in 40 (2.5%) risk of having a BRCA mutation, which is 10 times the general population risk. JScreen launched the PEACH BRCA Study, a telehealth-based platform for BRCA education and testing, with the goal of creating an effective model for BRCA testing in low-risk AJ individuals who do not meet national testing criteria. Other goals were to determine the rate of BRCA mutations in this group, to assess the adequacy of screening for the 3 common AJ founder mutations only, and to assess satisfaction with the telehealth model to help inform a national launch of a broader cancer genetic testing program. Methods: Criteria for participation included those who were AJ, resided in the metro-Atlanta area, were aged 25 and older, and had no personal or close family history of BRCA-related cancers. Pre-test education was provided through a video and written summary, followed by complimentary BRCA1/2 sequencing and post-test genetic counseling. Participants responded to pre- and post-test surveys, which assessed knowledge and satisfaction. Those who were not eligible to participate were sent genetic counseling resources and later surveyed. Results: Five hundred one participants were tested and the results included 4 positives (0.8% positivity rate), 494 negatives, and 3 variants of uncertain significance. Overall satisfaction with the study process was high (96.9/100), knowledge about BRCA was high (97.5% of participants passed a pre-test knowledge quiz), and satisfaction with pre- and post-test education was high (97.9% of participants were satisfied with the pre-test video and written summary, and 99.5% felt that their post-test genetic counseling session was valuable). Many participants expressed interest in receiving broader cancer testing. Conclusions: The BRCA founder mutation rate in a low-risk AJ population was significantly lower than the previously established AJ rate of 1 in 40. It was also determined that a telehealth model for a cancer genetics program is effective and acceptable to the population tested. This study established interest in broader cancer genetic testing through a telehealth platform and suggested that testing may be successful in the Jewish community at a national level and potentially in other populations, provided that patient education and genetic counseling are adequately incorporated.

41. Participant reflections from the program for evaluation of Ashkenazi Jewish Cancer heritability involving the BRCA genes

One in 40 Ashkenazi Jewish individuals carries a BRCA1/2 mutation, which confers significantly increased risks for breast, ovarian, prostate and pancreatic cancer. Targeted cancer screening and surgical management can substantially reduce morbidity and mortality for carriers. The JScreen program conducted The Program for Evaluation of Ashkenazi Jewish Cancer Heritability Involving the BRCA Genes Study ('The PEACH BRCA Study') to test low-risk Ashkenazi Jewish individuals in the metro-Atlanta area for mutations in the BRCA genes using at-home, saliva-based testing.

Condomless receptive anal intercourse is associated with markers of mucosal inflammation in a cohort of men who have sex with men in Atlanta, Georgia.

IntroductionWe previously showed that the rectal mucosal immune environment among men who have sex with men (MSM) engaging in condomless receptive anal intercourse (CRAI) is immunologically distinct from that of men who do not engage in anal intercourse (AI). Here, we further examined these differences with quantitative immunohistochemistry to better understand the geographic distribution of immune markers of interest.MethodsWe enrolled a cohort of MSM engaging in CRAI (n = 41) and men who do not engage in AI (n = 21) between October 2013 and April 2015. Participants were healthy, HIV‐negative men aged 18–45 from the metro Atlanta area. We performed rectal mucosal sampling via rigid sigmoidoscopy during two study visits separated by a median of nine weeks and timed with sexual activity for MSM engaging in CRAI. We used standardized, automated immunohistochemistry and quantitative image analysis to investigate the rectal mucosal distribution of neutrophils (MPO), IL‐17‐producing cells (IL‐17) and Tregs (FOXP3) in the lamina propria, and cellular proliferation (Ki67) and adherens junction protein (E‐cadherin) in the epithelium. We examined associations between biomarker expression and the rectal mucosal microbiota composition by 16s rRNA sequencing.ResultsRelative to the colonic crypt base, IL‐17, FOXP3, and MPO expression increased towards the rectal lumen, while Ki67 decreased and E‐cadherin was more uniformly distributed. Throughout the rectal mucosa distribution examined, MSM engaging in CRAI had higher mean lamina propria MPO expression (p = 0.04) and epithelial Ki67 (p = 0.04) compared to controls. There were no significant differences in IL‐17, FOXP3 or E‐cadherin expression. We found no significant associations of the five biomarkers with the global rectal microbiota composition or the individual taxa examined.ConclusionsUnderstanding the mucosal distribution of inflammatory mediators can enhance our knowledge of the earliest events in HIV transmission. Neutrophil enrichment and crypt epithelial cell proliferation likely represent sub‐clinical inflammation in response to CRAI in the rectal mucosa of MSM, which could increase the risk for HIV acquisition. However, the contributory role of the microbiota in mucosal inflammation among MSM remains unclear. HIV prevention may be enhanced by interventions that reduce inflammation or capitalize on the presence of specific inflammatory mechanisms during HIV exposure.