APHA Reflections: Naima Wells

Naima_smallFrom November 5 to 7, 2017,  members of the Center for Healthy Communities Research Core attended the American Public Health Association’s Annual Meeting and Expo in Atlanta, GA. Below, Mrs. Naima Wells, research coordinator,  shares some thoughts on her first time attending the APHA meeting.

In general, what was your impression of the event?
Although, APHA was a large event it felt inclusive and interactive through the use of the APHA app and social media. Overall, it was well organized and well managed.

Tell us about one session or activity that stood out to you?
One session that stood out was “Qualitative Research & The Arts: Translating Results Into Action”. Through a CBPR partnership with youth in the community and the session presenter, an art-based youth driven conceptual model was used to present qualitative data that expressed the voice and lived experiences of the community. It also helped to contextualize the data. The youth would create drawings, poems, rap songs, or other creative mediums to share findings with the community and government officials. One interesting component was the media campaign to present positive imagery of young black males by taking “mugshots” of the young men in a cap and gown holding a sign that displayed their career goals.

What are some lessons you learned at APHA?
One lesson I learned is how public administration and public policy factor into the social determinants of health and health equity.  Typically, public administration focuses on effectively and efficiently achieving public policy goals through administrative systems, insomuch there are some areas that interrelate to public health concerns.  I also learned that as a public administrator, I could address some of the challenges and opportunities in population health and health equity through a policy framework.

Is there anything else you would like to share about your experience?
The “Industry Expert Theater” was very informative and effective considering each presentation was very short lasting approximately 15 minutes each. I also, appreciate that there are opportunities for free training offered by ChangeLab Solutions on public health law and policy.


New study: nearly half of US medical care comes from emergency rooms

The following excerpt comes from the article published October 17, 2017, in EurekaAlert!.

Nearly half of all US medical care is delivered by emergency departments, according to a new study by researchers at the University of Maryland School of Medicine (UMSOM). And in recent years, the percentage of care delivered by emergency departments has grown. The paper highlights the major role played by emergency care in health care in the U.S.

“I was stunned by the results. This really helps us better understand health care in this country. This research underscores the fact that emergency departments are critical to our nation’s healthcare delivery system.” said David Marcozzi, an associate professor in the UMSOM Department of Emergency Medicine, and co-director of the UMSOM Program in Health Disparities and Population Health. “Patients seek care in emergency departments for many reasons. The data might suggest that emergency care provides the type of care that individuals actually want or need, 24 hours a day.”

Although he now focuses on population health, Dr. Marcozzi is an emergency room doctor himself, and works one or two days a week in the University of Maryland Medical Center emergency department, treating patients.

This is the first study to quantify the contribution of emergency department care to overall U.S. health care. The paper appears in the latest issue of International Journal for Health Services.

For this study, Dr. Marcozzi and his colleagues examined publicly available data from several national healthcare databases, which covered all 50 states and the District of Columbia. They studied the period between 1996 and 2010.

For 2010, the most recent year studied, the study found that there were nearly 130 million emergency department visits, compared with almost 101 million outpatient visits and nearly 39 million inpatient visits. Inpatient visits typically involve a hospital stay, but are planned ahead, as opposed to emergency department visits, which are generally at least somewhat unexpected.

Over the 14-year period of the study, more than 3.5 billion health care contacts – emergency department visits, outpatient visits, and hospital admissions took place. Over that time, emergency care visits increased by nearly 44 percent. Outpatient visits accounted for nearly 38 percent of contacts. Inpatient care accounted for almost 15 percent of visits.

Certain groups were significantly more likely to use the emergency department as their method of healthcare. African-American patients were significantly more likely to have emergency department visits than patients in other racial groups; patients in the “other” insurance category, which includes those without any type of insurance, were significantly more likely to have emergency department visits than any other group. And patients living in the South were significantly more likely to have emergency department visits than patients living in other areas of the country.

African-American patients used emergency departments at a higher rate than other groups. In 2010, this group used the emergency department almost 54 percent of the time. The rate was even higher for urban African-American patients, who used emergency care 59 percent of the time that year. Emergency department use rates in south and west were 54 percent and 56 percent, respectively. In the northeast, use was much lower, 39 percent of all visits.


Read the full article.


BayouClinic Hosts 3rd Annual Bayou on the Move Event

On October 27, 2017, BayouClinic hosted its 3rd Annual Bayou on the Move event offering services and resources to households in the Bayou La Batre, AL, area. As a part of the event, more than 25 organizations provided an average of 16 services to each of the 76 households in attendance. Bayou on the Move activities included:

  • Screenings: Breast Exams, Blood Sugar Checks, Blood Pressure Checks, and HIV Testing
  • Healthy Lifestyle tips: Healthy Cooking Demonstrations, Walking Path to Live Music
  • Resources: Disaster Preparedness, Disability Services, Job Resources and Referrals, GED Registration, Parent Education, Housing Services, Senior Services, Domestic Violence Services, Mental and Behavioral Health Services, Substance Abuse Services, Homeless Services, WIC, Medicare Part D, and Prescription Assistance.

All of the households attending the event received a food box from Feeding the Gulf Coast.

According to BayouClinic’s website, Bayou on the Move is  “an ongoing initiative to improve the health of residents in Bayou La Batre and surrounding South Mobile County.”

CHC Represented at APHA 2017

Four members of the Center for Healthy Communities Research Core attended the American Public Health Association (APHA) Annual Meeting and Expo in Atlanta, GA during early November.  Along with learning from the diverse sessions and experiences offered by the event, the team presented two posters related to the Sentinel Surveillance to Monitor Progress Towards Health Equity Project (Sentinel Surveillance).

Arreita Poster Cropped smallDuring the session “Recent Studies on Health Disparities in Public Health Epidemiology,” Dr. Martha Arrieta presented a poster that discussed a comparison between data provided by the Sentinel Surveillance methodology — primary data — with small area estimates (SAEs) based on the Behavioural Risk Factor Surveillance System (BFRSS) and Census data. Titled “Can we sharpen the focus? Small Area and Sentinel Surveillance Estimates for a Health Disparate Population, “ the poster provided a comparison of both types of data from the focus area for the Sentinel Surveillance project with a review of the estimates for the prevalence of diabetes, high blood pressure, asthma, stroke, cancer, and kidney disease as well as the proportion of persons lacking health insurance. The analysis showed that while the SAEs pinpoint geographic areas of health inequity, the SS sample provides age-specific estimates and can further delineate person-level characteristics useful to focus and tailor health equity interventions.

Lynette poster cropped smallIn the session “Diversity and Dynamics in CBPR Partnerships and Coalitions,”  Lynette Parker presented an overview of the team’s dissemination planning process developed to ensure that Sentinel Surveillance findings are communicated to the community in a useful manner. Titled “Returning what was given: Communicating research findings in the community,” the poster provided a description of the engagement process used to include three distinct community voices into the dissemination planning process: 1) the Community Advisory Board consisting of community leaders who had advised on the project from its inception; 2) Research Apprentices who had been recruited and trained to collect data for the Sentinel Surveillance project as well as conducting other important tasks on the project; and 3) Community Health Advocates who had been involved in various projects through the Center for Healthy Communities Community Outreach Core. The presentation highlighted the importance of listening to diverse community voices in developing an effective dissemination plan.

The three days spent at the APHA Annual Meeting were fruitful and informative. Staff reflections on the event will be posted in the coming weeks.






Upcoming HDRG Meeting

The Health Disparities Research Group (HDRG) is a multidisciplinary assembly of faculty, students, staff, and community representatives with a vision “to become an integral facilitator in eliminating health disparities through partnerships with our community.” Held the 3rd Friday of each month throughout the academic year, the meetings provide an opportunity to share research and cultivate a positive atmosphere for community-engagement in addressing health disparities.

The next meeting is November 17, at 1:00 pm in Bio-medical Library Room 222-A. Danny Patterson, Coordinator, Collaborations and Partnerships, Gulf States Health Policy Center, will share about their work in his presentation “Building Community Based Research through Community Coalitions.” Danny’s presentation is based on a poster that he and colleagues presented at the 4th Annual Community Engagement Institute in Birmingham that won an award in the conceptual framework category.

Please join us on November 17.

Useful Resource: Finding a way to Stick With Exercise

In a short video posted to YouTube by the National Institute on Aging, Dr. Eliseo J. Perez-Stable, Director of the National Institute on Minority Health and Health Disparities, describes his exercise routine and how he stays on track. In the two-minute video, he talks about the ease and accessibility of brisk walking, the benefits he has experienced through exercise, and the importance of maintaining a regular schedule.

4th Annual CEI Advances Regional Health Equity Dialogue

The following excerpt is from the article posted by the UAB Center for Clinical and Translational Science.

On Friday, Oct. 6, the 2017 Community Engagement Institute (CEI) drew a large crowd, both live and virtual, interested in sharing best practices at the nexus of health, environmental renewal, and civil inclusion and empowerment. From the opening keynote speaker to the final networking session, the call for health equity resounded, creating a strong sense of connection and shared purpose among the diverse attendees.

The theme of the CEI 2017 was “Community Health from Engagement and Environmental Renewal (CHEER) for Civil Inclusion and Empowerment.” More than 125 attended in person at the Birmingham-Jefferson Convention Center (BJCC), with dozens more participating at the sister event hosted by CCTS Partner University of South Alabama (USA), which conducted its own breakout sessions in between the livestreamed keynotes from the BJCC.

Opening keynote speaker Dr. Errol Crook, Abraham A. Mitchell Chair, Professor and Chair of the Department of Internal Medicine, University of South Alabama College of Medicine, set the tone with his inspirational personal journey from a basic scientist to a “multi-focused health disparities physician investigator.” He shared how he realized during his medical training that a patient’s background includes important information that wasn’t taken into account but had tremendous bearing on health outcomes “and [social determinants of health (SDHs)] is now a burgeoning field of science.”

Crook highlighted the key ingredients that constitute a healthy community: walkable, easily navigable; safe; good jobs; good educational opportunities; healthy and trusting relationships with neighbors; access to all the necessities of life nearby; low stress; no exposure to environmental toxins; able to make decisions regarding its destiny. The latter, he said, was often overlooked but critical to health. The “opportunity to participate in society” reflects a “difference between being poor and being impoverished,” with impoverishment rooted in a lack of education and a voice as well as income.

The challenge and opportunity for academic-community partnerships are “how to give greater voice to those communities whose voices are most ignored.” Crook stressed the most important ingredient for the success of such a partnership is “respect.” He described the current health care disagreement as a debate between those who see health care as a right versus those who see it as a privilege. He challenged the audience to move past this to instead imagine a nation that has achieved health equity. “Are all Americans empowered to make the decisions that will ensure good health over their lifetime?”

Ms. Diane Bell McCoy, the second keynote speaker, also shared a personal journey of finding her voice and learning to use it to dismantle systemic racism by working within such systems. Her story was at times painfully raw, underscoring the link between racism and its negative mental health impacts, such as depression and suicidal ideation. She described the difficulty she faced in getting culturally relevant mental health services as a young college student, struggling to find an African American therapist who “helped me find my gift and apply it to the world around me.”

Bell McCoy is now the President and CEO of Associated Black Charities, a public foundation credited for its work as a catalyst for statewide advocacy, policy design, and innovative transactional strategies as they relate to the impact of structural racism in depressing the economic and health outcomes for the African American community. She explained her approach is grounded in “the Ps”: the intersectionality of Policies that support the racial distribution of both health and wealth; the Process of community engagement; changing Programs not just People (“lives can change, but if systems do not, racial inequities remain”); and keeping it Personal. “This work takes courage…there can be a shared vision, but you have to get past language barriers and establish trust, build relationships, before you can discuss the issue of privilege,” she said.

Read the full article.

Partnering to Make a Difference


Hodnett and Free_edited
CHA Barbara Hodnett with Mr. Clint Free from Trinity Family Ministries

Recently, the Center for Healthy Communities (CHC) formed a partnership with Trinity Family Ministries to provide health education services during the organization’s annual Fall Festival and Health Fair. Through the partnership, Community Health Advocates (CHA) will teach participating youth about container gardening as a way to improve nutrition.


The partnership idea originated with a suggestion from Mr. John Jones, a member of the Sentinel Surveillance project Community Advisory Board. Through that connection, Dr. Martha Arrieta and Ms. Candis Patterson from the  CHC met with Mr. Clint Free, Coordinator of Community Development with Trinity Family Ministries to discuss ways in which the two organizations could partner. The result was CHA participation in the November 18th health fair. To learn more about the event, download the Fall Festival and Health Fair flyer.

Reducing and Breaking Barriers to Empowerment and Health

The following article was submitted by guest contributor Dr. Jeremy Fletcher, Assistant Professor, Department of Physical Therapy at USA.

The International Classification of Function, Disability, and Health provides researchers and clinicians with a framework to conceptualize terms such as participation, or one’s involvement in life situations while considering the barriers and facilitators to achieving health within the context of their environment. It is well established that children with disabilities participate in less physical activity compared to their typically developing peers. Participation in physical activity by children, including those with disability, enhances body composition, bone health, psychological health and promotes social engagement.

Children with disabilities often face many barriers to physical activity, including a need for extra support to participate, a lack of practical instructor training, and the extra costs associated with raising a child with a disability. Additionally, the Alabama Department of Rehabilitative Services’ statewide five-year maternal and child health needs assessment, with a focus on children and youth with special health care needs has identified five unmet community-based service needs. Three of these needs, recreational opportunities, respite care, and support for families are being met by one local non-profit organization, Dance Without Limits Foundation, LLC.

Dance Without Limits (DWL) was founded by Kerrie Benson, a dance teacher and mother to a special needs child, Rock, also known as “Rockstar”. Rock’s love of music and movement was the inspiration behind DWL. DWL currently teaches dance classes to 120 children or adults with disabilities, across ages ranging from 3 to 50. It operates out of two locations, Mobile and Fairhope, with the addition of a third location in Birmingham scheduled for the spring. When the needs of these children, their families – including spouses and siblings – are considered, DWL provides a tremendous service at a very low cost to the participant. Because of its non-profit status, DWL is able to meet the needs of the children through scholarships to assist with the $50/month fee.

During the class, children and adults with disabilities are paired with a volunteer dance partner. Dance partners range from siblings to pre and post professionally trained therapists and nurses to community members with a passion to serve the underserved. The commonality of the expression of dance and empowering sentiment unite each participant, regardless of their ability, creating an environment of diversity, inclusion, and fun! And while each dancer is moving their body, experiencing the benefits of physical activity, parents are able to engage in discussions about navigating the world of disability or use the hour of respite to enjoy dinner.

In addition to providing a valuable community service, DWL has also partnered with the University of South Alabama’s Department of Physical Therapy to deliver a unique service-learning experience. First-year Doctor of Physical Therapy students complete a learning module on health care communication prior to serving as a dance partner, and then write a paper describing barriers to communication, nonverbal and verbal cues, and establishing rapport. Because many participants have communication deficits, students must focus on overcoming barriers to communication while seeking to improve rapport. By providing education in a real-world environment, the children get to do the teaching! Occupational therapy students also volunteer their time to support the effort making DWL an interprofessional experience.

DWL is an example of what is possible when passion, energy, and a willingness to address a common need collectively mold together to reduce and break barriers to empowerment and health. You can learn more about DWL by following them on Facebook or at their website.

HDRG Recap: Experiences with Community-Based Participatory Research

On October 20, 2017, the Health Disparities Research Group (HDRG) held its first meeting of the 2017-2018 academic year. Two speakers provided an overview of experiences related to health disparities and community-based participatory research.

Ms. Shelley-Tremblay, formerly the project manager for the Center for Healthy Communities and current Director of the Office of Community Engagement at the University of South Alabama, reported on her experience at the 2017 Summer Intensive hosted by the Community-Campus Partnerships for Health (CCPH). Titled “Structural Inequality: An On The Ground View”, the intensive provided a two-day experiential learning opportunity to the approximately 35 attendees who ranged in age from 16 to 86 and came from various walks of life. Each aspect of the Summer Intensive — 21C Museum Hotel, the University setting, the tour of Historic Stagville, and lecturers — was chosen to facilitate learning about the roots of structural inequality and how tools of Community-Based Participatory Research/Approach (CBPR) and Community Action Strategies can be used to address structural inequality.

In the session on the  “Groundwater” approach, presented by the Racial Equity Institute, LLC,  the group explored racism and inequity as touching and affecting all aspects of life. The facilitators used stories and data to demonstrate how racism is fundamentally structural in nature. With this framework for understanding and analyzing inequality, the final sessions explored how CBPR could be used in response. Shannon finished her presentation with questions for the HDRG group to consider:

  • How can we build on the work of HDRG to “help to ensure that the reality of community engagement and partnership matches the rhetoric?”
  • What role can we play in shifting the conversation about health in our community to an opportunities lens and away from the current focus on problems?
  • Is there value in bringing a similar experience to this region?
  • How can we leverage the assets in our region?
  • What aspects of our ongoing health disparities work can be expanded to make this focus on addressing the link between structural and inequality and health intentional?

In the second presentation of the day, Dr. Martha Arrieta, Director of the Research Core at the Center for Healthy Communities, informed the group of the recent publication of an article about the evolution of the HDRG in the Journal of Higher Education Outreach and Engagement. She explained that HDRG was starting its 13th year and had built a strong platform for health disparities research over its history. In exploring the history and accomplishments of the HDRG, Dr. Arrieta started by reviewing a 2008 publication which outlined the establishment of the group. She then provided an overview of the recent article on the strategies for consolidation. In doing so, she covered:

  • Promotion of Group Identity and Permanence: an overview of activities that were used to form the HDRG and develop connection and focus among the members.
  • Fostering Health Disparities Research Capacity: a review of research projects undertaken by the group over its history.
  • Engagement in Participatory Research: explanation of the partnership with the Bay Area Women’s Coalition and a diabetes research project with the Hands of Hope Clinic in Trinity Gardens.
  • Dissemination of CBPR Principles: an overview of the activities undertaken to disseminate CBPR and community engagement through the university campus.

Dr. Arrieta next discussed the challenges faced by the HDRG over the years and the keys to successfully overcoming those. She described the activities — such as faculty forums, meetings with university leadership, joint research projects, and community partnerships  — as contributing to establishing health disparities/health equity as a concern within the University and HDRG as a leader for community engagement on the campus. Dr. Arrieta ended her presentation by mentioning the plans for the community-engaged dissemination of the findings from the Sentinel Surveillance Project and the potential of work to promote bi-directional links between basic science labs on campus and the community -activities that become building blocks for continued work in community-engaged approaches to researching and addressing health disparities.


Presentation from Ms. Shannon Shelley-Tremblay.
Presentation from Dr. Arrieta.