Rural Alabama Research Articles

Barriers and facilitators to HPV vaccination among rural Alabama adolescents and their caregivers

IntroductionHalf of all new human papillomavirus (HPV) infections occur in adolescents and young adults, and this population has poor HPV vaccination rates. Rural areas of the U.S. have high rates of HPV-related diseases and low vaccination rates as well. The purpose of this study was to determine the perceived barriers and facilitators to HPV vaccination among adolescents and their caregivers in rural south Alabama. MethodsVaccinated and non-vaccinated adolescents ages 11–18 years old and primary caregivers were recruited from three rural counties in south Alabama. Participants completed individual interviews to discuss perceived barriers to vaccination and factors influencing their decision to vaccinate. Discussion groups were held to determine potential solutions to barriers elucidated from the interviews. Interview and discussion group transcripts were analyzed, and themes were identified. ResultsApproximately 62.5% of adolescents had not initiated the HPV vaccine series. Of those adolescents who started the vaccine series (n = 9, 37.5%), about half completed it (n = 5). Few participants in this study reported speaking with their health care provider (HCP) about the vaccine in the past year. Lack of information about the vaccine, its side effects, and no HCP recommendation were common barriers cited by non-vaccinators. Facilitators to vaccination included cancer prevention, discussion with HCP, and peer testimonials. Potential solutions to barriers were also discussed. ConclusionsProposed strategies to increase HPV vaccination were similar between vaccinated and non-vaccinated groups. Education about HPV and the HPV vaccine is needed throughout these rural south Alabama communities to ensure informed decisions are made about vaccination and to increase vaccination rates.

Extending access to care across the rural US south: Preliminary results from the Alabama eHealth programme

Purpose Using a mixed-methods formative evaluation, the purpose of this study was to provide a broad overview of the Alabama eHealth programme set-up and initial patient outcomes. The Alabama eHealth programme uses telemedicine to provide medical care to people living with HIV in rural Alabama. It was led by a community-based organisation, Medical Advocacy and Outreach (MAO), and supported by AIDS United and the Corporation for National Community Service’s Social Innovation Fund with matching support from non-federal donors. Methods We conducted and transcribed in-depth interviews with Alabama eHealth staff and then performed directed content analysis. We also tracked patients’ (n = 240) appointment attendance, CD4 counts, and viral loads. Findings Staff described the steps taken to establish the programme, associated challenges (e.g., costly, inadequate broadband in rural areas), and technology enabling this programme (electronic medical records, telemedicine equipment). Of all enrolled patients, 76% were retained in care, 88% had antiretroviral therapy and 75% had a suppressed viral load. Among patients without missing data, 96% were retained in care, 97% used antiretroviral therapy and 93% had suppressed viral loads. There were no statistically significant demographic differences between those with and without missing data. Conclusions Patients enrolled in a telemedicine programme evaluation successfully moved through the HIV continuum of care.

Sharecropper’s Tuberculosis: Pathologies of Power in a Fatal Outbreak

ABSTRACTTuberculosis Bacilli (TB) is a global scourge that affects poor people and regions. Drawing on Farmer’s (2003) pathologies of power, and a case study approach, we examine the sociostructural landscape of a fatal outbreak of Sharecropper’s TB among African Americans in rural Alabama. In a mixed-method qualitative approach involving oral history, surveys, interviews and documentary analysis, we identified three pathologies that contribute to TB susceptibility: corporate power, land wealth, and structural racism. While medicine can cure non-resistant forms of TB, control of future outbreaks will depend upon a social “cure” such as addressing structural inequality and building community trust in the health system.

Telemedicine in the Management of Type 1 Diabetes.

BackgroundVeterans with type 1 diabetes who live in rural Alabama and Georgia face barriers to receiving specialty diabetes care because of a lack of endocrinologists in the Central Alabama Veterans Health Care System. Telemedicine is a promising solution to help increase access to needed health care. We evaluated telemedicine’s effectiveness in delivering endocrinology care from Atlanta-based endocrinologists.MethodsWe conducted a retrospective chart review of patients who were enrolled in the Atlanta VAMC Endocrinology Telehealth Clinic from June 2014 to October 2016. Outcomes of interest were hemoglobin A1c levels, changes in glycemic control, time savings for patients, cost savings for the US Veterans Health Administration, appointment adherence rates, and patient satisfaction with telehealth.ResultsThirty-two patients with type 1 diabetes received telehealth care and in general received the recommended processes of diabetes care. Patients trended toward a decrease in mean hemoglobin A1c and glucose variability and a nonsignificant increase in hypoglycemic episodes. Patients saved 78 minutes of travel time (one way), and the VA saved $72.94 in travel reimbursements per patient visit. Patients adhered to 88% of scheduled telehealth appointments on average, and 100% of surveyed patients stated they would recommend telehealth to other veterans.ConclusionsSpecialty diabetes care delivered via telemedicine was safe and was associated with time savings, cost savings, high appointment adherence rates, and high patient satisfaction. Our findings support growing evidence that telemedicine is an effective alternative method of health care delivery.

Photo-Elicitation Interviews with Vulnerable Populations: Practical and Ethical Considerations

ABSTRACTPhoto-elicitation is a qualitative interview technique where researchers solicit responses, reactions, and insights from participants by using photographs or other images as stimuli. Images can be researcher-generated or participant-generated and each has particular benefits and challenges. Though not new, the use of images within criminology is an underused technique. In this paper we advocate the use of photo-elicitation techniques suggesting that they offer a powerful addition to standard data collection and presentation techniques. In making our case, we draw on our experiences from an 18-month long photo-ethnography of people living in rural Alabama who use methamphetamine. The ethnography consisted of formal interviews and informal observations with 52 participants and photography of 29 of them. While we draw on our overall experiences from the project we focus specifically on the photographs generated by, and taken of, one key participant—Alice. We demonstrate the benefits and challenges of using photo elicitation interviews with vulnerable individuals such as Alice, by considering themes such as representation, empowerment and emotionality. Additionally, we highlight the practical and ethical issues that confront researchers who incorporate the visual into their research.

Meeting Health Care Needs in Rural Alabama: The Power of Partnerships.

Recruiting and retaining rural primary care providers is challenging. The Graduate Nursing Education Primary Care Scholars (GNEPCS) is a partnership between a philanthropic organization and a school of nursing to recruit, educate, train, and retain primary care advanced practice registered nurses (APRNs) for practice in rural Alabama with a focus on improving the state's health outcomes. In its initial four years, the GNEPCS partnership has been successful in identifying 60 registered nurses interested in becoming rural primary care APRNs. These students have received mentoring, individualized content on rural health, preceptorships with rural providers, and opportunities for professional and leadership development. Pilot philanthropic funding has allowed us to develop sustainable curricula, attract additional complementary federal funds, and create a critical mass of practice-ready APRNs who are improving primary care access for some of the state's most rural and underserved populations.

Symbolic perceptions of methamphetamine: Differentiating between ice and shake

BackgroundAlthough public perceptions of methamphetamine (meth) consider all forms of the drug as the same, this is not true among those who use it. Our aim is to examine how those who use meth perceive two forms of meth (ice and shake) using the theoretical framework of symbolic boundaries. MethodsWe rely on data collected from a photo-ethnography with people who use methamphetamine in rural Alabama. The ethnography consisted of formal interviews (with 52 participants), informal observations, and photography. ResultsParticipants had a strong preference for ice (49 of 52 preferred ice over shake). In discussing why they prefer ice they point to the various short- and long-term health problems associated with shake. This distinction allowed them to create symbolic definitions of shake as being dirty due to impure chemicals and its users as desperate. ConclusionWe argue that this symbolic differentiation of the two forms allows users to frame themselves as rational users (i.e., they avoid the unsafe form of meth) and shape use patterns and prevalence, with shake being used infrequently and often intravenously.

Testing our FAITHH: HIV stigma and knowledge after a faith-based HIV stigma reduction intervention in the Rural South

ABSTRACTEliminating racial/ethnic HIV disparities requires HIV-related stigma reduction. African-American churches have a history of addressing community concerns, including health issues, but may also contribute to stigma. We developed and pilot tested a faith-based, anti-stigma intervention with 12 African-American churches in rural Alabama. We measured HIV-related stigma held by 199 adults who participated in the intervention (individual-level) and their perception of stigma among other congregants (congregational-level). Analyses of pre- and post-assessments using a linear mixed model showed the anti-stigma intervention group reported a significant reduction in individual-level stigma compared with the control group (mean difference: −.70 intervention vs. −.16 control, adjusted p < .05). Findings suggest African-American churches may be poised to aid HIV stigma-reduction efforts.

From Ambient to Personal Temperature: Capturing the Experience of Heat Exposure.

Vol. 125, No. 9 Science SelectionOpen AccessFrom Ambient to Personal Temperature: Capturing the Experience of Heat Exposureis accompanied byOpportunities and Challenges for Personal Heat Exposure Research Nate Seltenrich Nate Seltenrich Search for more papers by this author Published:22 September 2017CID: 094002https://doi.org/10.1289/EHP2469View Article in:中文版AboutSectionsPDF ToolsDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InReddit Heat exposure can have a wide range of adverse effects on the human body.1 But when researchers set out to measure the precise size of those effects across populations, they typically are forced to rely on imprecise exposure data. The authors of a new commentary in EHP outline an alternative approach to better assess how individuals experience heat.2Most studies on heat health rely on ambient temperature readings from airports and other fixed weather stations. These data cannot capture social and behavioral factors that influence heat exposure on a finer scale, nor do they reflect temperatures indoors, where many of us spend our time. Thus, they do not reflect what most individuals experience in their daily lives.2In contrast, so-called personal heat exposure research uses wearable sensors and advanced modeling to capture data at the individual level. “We’re trying to measure what an 80- or 90-degree day means in terms of what people actually experience,” explains senior author David Hondula, an assistant professor in the School of Geographical Sciences and Urban Planning at Arizona State University.“One of the values of this kind of data is it allows us to make what is otherwise invisible visible,” says co-lead author Evan Kuras, a graduate student at the University of Massachusetts Amherst. By studying heat exposure at the individual level, he says, “We may discover things that we might not have thought to pay attention to.”Only a few studies have used personal heat monitoring in the general population, as opposed to groups at high risk for heat stress, such as athletes, outdoor workers, and members of the military. In one example, commentary coauthor Molly (Bernhard) Richardson, a postdoctoral fellow in population health sciences at Virginia Tech, measured temperatures experienced by 81 individuals in rural and urban Alabama over the course of a week in the summer of 2012.3 In another, Hondula and Kuras measured temperatures experienced by 23 Boston residents over a week in July 2013.4For the duration of these studies, participants wore temperature monitors whenever possible, indoors and out. For the Boston study, dime-size iButton sensors were clipped to belt buckles or bags, while for the Alabama study, slightly larger HOBO Pendant sensors were clipped to subjects’ shoes.These studies, although small in scale, nonetheless produced noteworthy findings. Kuras and Hondula’s study found significant differences among the temperatures experienced by the participants, even though they all lived within the same urban neighborhood. Generally, however, the participants’ personal heat exposures were lower than the outdoor ambient temperature.Richardson’s study concluded that qualities of the participants’ home environment—including everything from location and quality of construction to presence of fans and air-conditioning—played an important role in determining their overall heat exposure.The authors of a new commentary point out that everyone has a different experience of and response to heat. Data on personal heat exposure are important for designing effective strategies to help whole populations cope with heat waves. Image © Andy Parker/iStockphoto.Both studies were designed primarily as pilots for future research. This summer, Richardson will lead a follow-up in Alabama with a new sensor and more than twice as many participants.5 Other ongoing work is being led by climatologist Chris Fuhrmann of Mississippi State University. Over the past year, Fuhrmann has used the iButton sensor to study temperatures experienced in football stadiums by spectators and athletes, and on university campuses among groundskeepers.6 This summer, he will measure heat in mature cornfields.Fuhrmann and Australian National University associate professor Kathryn Glass note that such precise ground-level data can serve additional roles by validating satellite-based thermal imagery and improving algorithms and models for research and public policy alike.“You need to know about individual-level factors across lots of individual people to know what is happening to the population,” says Glass, who specializes in epidemiological modeling. With heat exposure, “you are often having to make assumptions, [for instance] about what it is likely to be like inside a building. Having some actual data is very helpful.”

Longitudinal Analysis of Nut-Inclusive Diets and Body Mass Index Among Overweight and Obese African American Women Living in Rural Alabama and Mississippi, 2011-2013.

IntroductionNuts, when eaten alongside other nutritionally rich foods, may decrease obesity and related chronic disease risks, which are high among African American women in the rural South. We monitored changes in nut intake, other obesity-related foods (fruits, vegetables, red or processed meats, added sugars), and body mass index (BMI) over a 2-year weight loss intervention among 383 overweight and obese African American women in rural Alabama and Mississippi.MethodsTwo dietary recalls were administered at 4 points over 24 months. Mann–Whitney tests compared differences in median food group intake between nut consumers and non-nut consumers, and t tests identified BMI differences between groups. Mixed linear models tested the relationship between nut intake and intake of the select food groups, and between nut intake and BMI over time.ResultsOverall nut consumers ate more fruits and vegetables and less red meat than non-nut consumers. Nut consumers had lower BMI values than non-nut consumers. Weight loss by the end of the intervention was significant for nut consumers but not for non-nut consumers, even after accounting for kilocalorie consumption and physical activity engagement.ConclusionNut consumption is associated with consumption of other nutritionally rich foods and lower BMI among African American women in rural Alabama and Mississippi. Future interventions should target increasing daily nut intake, decreasing added sugar intake, and identifying strategies to encourage positive dietary changes to continue after an intervention.

Human Intestinal Parasite Burden and Poor Sanitation in Rural Alabama.

.Hookworm infection affects 430 million people worldwide, causing iron deficiency, impaired cognitive development, and stunting in children. Because of the environmental conditions needed for the hookworm life-cycle, this parasite is endemic to resource-limited countries. Necator americanus was endemic in the southern United States before improvement of sewage disposal systems and eradication programs. With continued poverty, poor sanitation, and an environment suitable for the hookworm life-cycle in some regions of the southern United States, a current prevalence study using modern molecular diagnostics is warranted. Lowndes County, Alabama, was chosen as the study site given previous high hookworm burdens, degree of poverty, and use of open-sewage systems. Participants were interviewed, and stool, serum, and soil samples were tested for nine intestinal parasites using a multiparallel quantitative real-time PCR (qPCR) and enzyme-linked immunosorbent assays. We found that, among 24 households, 42.4% reported exposure to raw sewage within their home, and from 55 stool samples, 19 (34.5%) tested positive for N. americanus, four (7.3%) for Strongyloides stercoralis, and one (1.8%) for Entamoeba histolytica. Stool tested positive for N. americanus contained low levels of parasite DNA (geometric mean 0.0302 fg/μL). Soil studies detected one (2.9%) Cryptosporidium species, and Toxocara serology assay detected one (5.2%) positive in this population. Individuals living in this high-risk environment within the United States continue to have stool samples positive for N. americanus. Gastrointestinal parasites known to be endemic to developing countries are identifiable in American poverty regions, and areas with lower disease burden are more likely to be identified by using qPCR.

Good Choice Healthier Retail Initiative: Increasing Access and Appeal of Healthy Items in Rural Alabama

The purpose of this experimental study was to increase access and appeal of healthy items in seven convenience stores in Marengo and Washington Counties in Alabama. People with limited access to supermarkets suffer disproportionately high rates of diet-related diseases. Every county in Alabama has at least one neighborhood with limited access to a grocer, leaving 1.8 million Alabamians to rely on small food stores (e.g. convenience stores) for grocery shopping. Since convenience stores typically sell high fat, high sugar processed foods and offer few healthy options, interventions in this setting may reduce food access barriers and promote healthy eating. This one group, pretest posttest design focused on changes in inventory, product placement and point-of-purchase prompts. Convenience stores were selected based on convenience sampling and location in towns with high rates of residents living below 185% of the federal poverty level. Trained SNAP-Ed Extension educators used the Alabama Department of Public Health's Good Choice Checklist to assess the food environment based on availability and promotion of healthy foods and beverages. For the Good Choice Healthier Retail Initiative, Extension educators collaborated with convenience store owners to discuss assessment findings and determine priorities for implementation. This initiative reached an average of 4,100 customers per day. The convenience stores increased their healthy item inventory from an average 10 to 34 healthy items. Based on these results, convenience store interventions are a feasible option for increasing access and appeal of healthy items in underserved communities.

Educating Physicians for Rural America: Validating Successes and Identifying Remaining Challenges With the Rural Medical Scholars Program.

To evaluate the Rural Medical Scholars (RMS) Program's effectiveness to produce rural physicians for Alabama. A nonrandomized intervention study compared RMS (1997-2002) with control groups in usual medical education (1991-2002) at the University of Alabama School of Medicine's main and regional campuses. Participants were RMS and others admitted to regular medical education, and the intervention was the RMS Program. Measures assessed the percentage of graduates practicing in rural areas. Odds ratios compared effectiveness of producing rural Alabama physicians. The RMS Program (N = 54), regional campuses (N = 182), and main campus (N = 649) produced 48.1% (odds ratio 6.4, P < .001), 23.8% (odds ratio 2.5, P < .001), and 11.2% (odds ratio 1.0) rural physicians, respectively. The RMS Program, contrasted to other local programs of medical education, was effective in producing rural physicians. These results were comparable to benchmark programs in the Northeast and Midwest USA on which the RMS Program was modeled, justifying the assumption that model programs can be replicated in different regions. However, this positive effect was not shared by a disparate rural minority population, suggesting that models for rural medical education must be adjusted to meet the challenge of such communities for physicians.

Southern Religion and Christian Diversity in the Twentieth Century by Wayne Flynt

Reviewed by: Southern Religion and Christian Diversity in the Twentieth Century by Wayne Flynt Ted Mashburn Southern Religion and Christian Diversity in the Twentieth Century. By Wayne Flynt. Tuscaloosa: University of Alabama Press, 2016. xii, 386 pp. $33. ISBN 978-0-8173-1908-3. Who better to write a book on southern evangelical religion than Dr. J. Wayne Flynt? This award-winning Distinguished Professor Emeritus at Auburn University, Baptist minister, and Sunday school teacher extraordinaire has devoted most of his professional life to this study. Now, readers have the opportunity to see wisdom, wit, and a wealth of information bundled together in a collection of some fifteen essays, written over the span of nearly fifty years. The overarching theme that binds these essays together is this: southern religion, past and present, was and is diverse. Any attempt, therefore, to characterize it in neat, homogeneous categories simply will not work. Not only that, one of Professor Flynt’s notable achievements in the book is the attention he gives to the people in the pews, the practitioners of religion. Literally, we encounter religion, not from the seats of ecclesial authority, but as Flynt puts it, “bottom up rather than top down” (p. 8). Through interviews, letters, and oral histories, we get at the religion of the common folk, a perspective that is both enlightening and refreshing. Along this stimulating journey, we encounter some remarkable people. What about the Reverend Dr. Ruby Kile? Born in 1929 and short on education but long on spiritual experiences, this traveling evangelist became pastor of a small church with only eight white members, which by 1984 mushroomed to some 700 members, eighty percent of whom were black. All of this took place around Birmingham, a segregated city, in spite of repeated threats from the Ku Klux Klan against this white, female minister. Or, we could mention the Reverend Charles R. Bell Jr., who was pastor of Parker Memorial Baptist Church (Anniston, AL) from 1932–1944. Educated in southern and northern institutions, Bell took a six-month leave of absence four years into his ministry and toured the world with stops in India, where he spent time with Gandhi, and in Japan, where he attended training sessions for social ministries. Upon his [End Page 281] return, Bell shattered conventional southern stereotypes when he became a leading advocate of cooperative farms, ran camps for black children, supported conscientious objectors, and spoke in favor of racial equality, going so far as to entertain African Americans at a Christmas party in his home. All of this took place in a Baptist enclave in rural Alabama in the 1930’s! Or, what about the Reverend Sidney J. Catts? This Alabama-born lawyer turned Baptist minister was elected governor of Florida, having been a resident there for only five years, and with “no money, contacts, or name recognition” (p. 157). Racist and vehemently anti-Catholic, Catts spoke directly to the fears of his southern, white, Protestant constituents, warning of a combined plot among Catholics and African Americans to take over Florida. Flynt credits Catts with “discovering what many Florida politicians would learn: bad history can make good politics” (p. 159). Finally, we might consider Frank W. Barnett. This internationally-educated lawyer cum minister purchased the state Baptist paper (The Alabama Baptist) and became its owner/editor from 1901–1919. In this capacity, not only did he advocate strongly for the prohibition of alcohol, recognized by many as the “gateway drug” to other social ills, but he also lashed out at big business, monopolies, and child labor in editorials that could have come directly from the Marx-Engels playbook. Even more social problems were on Barnett’s radar: convict labor, race relations, public health, conservation, and education. His was not the lone voice on these matters, as Flynt points out, all of which serves to correct the prevailing twentieth-century scholarly opinion that southern religion rejected the social gospel. Flynt’s book is chock full of information, some of which might come as a pleasant surprise to readers. At the hands of the Methodists in the South, over forty-five settlement houses, staffed by some 300 “consecrated” deaconesses, ran kindergartens, taught literacy classes, developed...

Healthy Kids: Impacting Children’s Health in Rural Alabama

Significant changes have occurred in the healthcare community as a result of legislative decisions, the economic downturn, and long range effects of consistent annual reductions in public funding. Community partnerships have become vital to the existence of many areas of healthcare delivery, including the Alabama State Department of Education’s School Health Services Program which is charged with the oversight of the health of students while they are enrolled in Alabama public schools. This program, along with many state agencies, continues to struggle in finding creative ways to stretch every education dollar in order to adjust to the impact of across the board budget cuts. A decrease in the number of registered nurses and the increasingly complex medical issues of students requiring individualized care have potentially jeopardized the ability of school nurses to adequately monitor and detect changes in the overall health status of children in the Alabama School Health Services Program. Nursing, Medical Laboratory Sciences, and Communication Disorder students from the College of Nursing and Health Sciences (CONHS) at Auburn University Montgomery (AUM) conducted health screenings for school age children in medically underserved counties of rural Alabama. The purpose of this article will be to discuss the collaboration and implementation of an interprofessional, community-based, service-learning project entitled Healthy Kids. Keywords : rural health; interprofessional collaboration; child health; service learning DOI : http://dx.doi.org/10.14574/ojrnhc.v17i1.432

The Role of Focal Laser in the Anti-Vascular Endothelial Growth Factor Era.

Introduction:To review important studies examining focal laser for diabetic macular edema (DME), to examine real-world data regarding actual treatments patients are receiving, to present long-term visual outcomes in real-world practice, and to suggest an evidence-based approach for the use of focal laser.Methods:This study is a review of landmark studies evaluating focal laser and pharmacologic therapy for DME. In addition, the authors include a retrospective review of 102 consecutive eyes of 53 patients in our practice setting in rural Alabama. A chart review was performed, and patients were included if they were diagnosed with DME and were treated with both focal laser and bevacizumab. Bevacizumab and focal laser were given on a “as needed basis” at the discretion of one treating physician (J.O.M.). Worse visual acuity or worsening macular edema were indications for additional treatment. Statistical analysis was performed using frequencies and percentages. Best-corrected visual acuity (BCVA) was recorded at baseline and at the end of treatment (mean of 5 years) in the medical record. Primary outcome measures were BCVA, patients with better than 20/40 BCVA, patients with worse than 20/200 BCVA, and patients with stable BCVA.Results:Anti–vascular endothelial growth factor (VEGF) therapies are the first-line treatment for DME, but real-world claims data suggest that diabetic patients cannot come in for monthly injections as in large clinical trials. In our series, after a mean of 5 lasers and 5.5 injections, 90% of eyes had stable or better BCVA, 65% were ≥20/40, and only 13% were ≤20/200.Conclusions:Laser treatment for DME remains an important adjunctive therapy

Chemical Characterization of Water-Soluble Organic Aerosol in Contrasting Rural and Urban Environments in the Southeastern United States.

We developed a novel system for direct and online characterization of water-solubility of organic aerosol (OA) by coupling a Particle Into Liquid Sampler (PILS) to a High-Resolution Time-of-Flight Aerosol Mass Spectrometer (HR-ToF-AMS). We showed that approximately 88% and 77% of OA are water-soluble in rural Centreville, Alabama and urban Atlanta, Georgia, respectively. The water-solubility of OA factors, resolved with Positive Matrix Factorization analysis of AMS data, is directly investigated for the first time. Above 80% of isoprene-derived OA is water-soluble and its water-soluble fraction has the least variability among all OA factors. This is consistent with that the majority of this factor represents OA formed through the aqueous-phase reaction of isoprene epoxydiols. More-oxidized oxygenated OA is dominantly water-soluble, consistent with this factor representing highly oxidized compounds. Less-oxidized oxygenated OA has the lowest water-solubility among all secondary OA factors, which agrees with the hypothesis that this factor in the southeastern U.S. includes contributions from organic nitrates. While hydrocarbon-like OA is largely water-insoluble, biomass burning OA and cooking OA have the largest range of water-soluble fraction. This study on the water-solubility of OA factors provides insights for interpretation of OA factors and improves understanding of the complex OA sources in the atmosphere.

Lower depression scores associated with greater weight loss among rural black women in a behavioral weight loss program.

Depression and stress have been associated with less weight loss among some participants in behavioral weight loss (BWL) programs. The purpose of this study was to (1) measure the levels of depression and stress among a sample of black women living in rural Alabama and Mississippi who were participating in a BWL program and (2) examine the association between these psychosocial variables and weight loss outcomes of participants at 6months. Overweight and obese black women in a BWL program (n=409) completed validated surveys to measure depression and stress at baseline and 6months. Weight and height were also measured at baseline and 6months. Statistical tests were conducted to examine associations between depression, stress, and weight loss. Mean BMI at baseline was 38.68kg/m2. Participants achieved a 1.17kg/m2 reduction in BMI at 6months. When comparing by baseline depression or stress categories, no significant differences in weight loss outcomes were observed. Analysis of continuous data revealed a significant correlation between baseline depression score and change in BMI. In adjusted models, change in depression score over time was significantly associated with change in weight. No differences in weight loss outcomes at 6months were observed when comparing participants with and without elevated depressive symptoms or elevated stress at baseline. This suggests that potential participants may not need to be excluded from BWL programs based on pre-specified cut points for these psychological conditions. Greater improvements in depression were associated with better weight loss outcomes suggesting that more emphasis on reducing depression may lead to greater weight losses for black women in BWL programs.

Nut Intake among Overweight and Obese African-American Women in the Rural South

Nut consumption decreases risk for obesity and chronic diseases, which are prevalent among African-American women in the rural southeastern United States. The quantity and quality of nut intake in this population is unclear. We examined the amount, source, and quality of nut consumption among overweight and obese African-American women in rural Alabama and Mississippi. Two 24-hour dietary recalls were administered to 426 women. Mann-Whitney tests, t-tests, and linear regression models identified differences in added sugar and sodium intake between nut consumers and non-consumers, differences in mean nut, added sugar, and sodium intake between stand-alone and incorporated nut sources, and a relationship between nut intake and added sugar and sodium intake. Forty-two percent of participants consumed nuts, and 16% met federal recommendations for nut intake. Nut consumption was mainly from incorporated sources (65%), which were higher in added sugar (p < .001) and sodium (p < .001), and lower in nut quantity (p < .001) than stand-alone sources. Nut consumers consumed more daily added sugar (p = .004) and sodium (p = .04) than non-consumers. Suboptimal quantity and quality of nut intake may impede the health benefits of nut consumption among African-American women in the rural South.

Volunteer peer support, diabetes, and depressive symptoms: Results from the ENCOURAGE trial

AimsDepression in diabetes mellitus (DM) is common and is associated with poor health outcomes. Peer support DM interventions include encouraging interactions that could improve depressive symptoms. We examined intervention effects for those with and without depressive symptoms in a peer support trial. MethodsThe 1-year ENCOURAGE trial included 424 persons with DM living in rural Alabama. Intervention participants worked with community volunteers who encouraged participants to engage in daily self-management; control arm participants received usual care. Outcomes included HbA1c, body mass index (BMI) and quality of life (QoL) with EuroQuol-5D (range 0.0–1.0). Depressive symptoms were assessed with the Patient Health Questionnaire (PHQ-8, range 0–24). Generalized Additive Models (GAM) examined control–intervention differences in changes in HbA1c, BMI, and QoL for those with PHQ-8 ≥ 5 and PHQ-8 < 5. ResultsOf the 424 participants enrolled at baseline, 355 completed follow-up and had data were that could be included into the study; they were aged 60.2 ± 12.1 years, 87% African American, 75% female, and 39% insulin-treated. In an overall GAM adjusting for imbalance across trial arms and time-related covariates, depressive symptoms improved for all, but after 15 months of follow-up intervention, participants experienced greater reduction in PHQ-8 score than control participants (p = 0.01). In stratified analyses, those with PHQ-8 ≥ 5 had unchanged HbA1c, lost weight (p = 0.03) and improved QoL (p = 0.04). Those with PHQ-8 < 5 also had unchanged HbA1c and lost weight, but did not improve QoL (p = 0.06). ConclusionsPeer support improved depressive symptoms for all, but resulted in greater weight loss and gains in QoL for those with baseline depressive symptoms compared to those without.