Public Health Theses

INTRODUCTION: Kenya like the rest of Sub-Saharan Africa continues to be plagued with high rates of AIDS/HIV. Research has shown that cultural practices have serious implications for the spread of HIV/AIDS, as well as other communicable diseases. One of the practices that have been speculated to have an impact on AIDS/HIV is female genital mutilation (FGM). Despite efforts to eradicate the practice, prevalence of FGM in Kenya remains relatively high. Researchers have postulated that various forms of FGM may be associated with the spread of HIV/AIDS.

OBJECTIVE: The purpose of this study is to determine the relationship between FGM and HIV/AIDS using a representative sample of Kenyan girls and women.

METHODS: Data (n=3271) from the Kenya 2003 Demographic and Health Survey was used for this study. Chi-square test was used to examine the distribution of selected risk factors across HIV/AIDS status. Odds ratios from multivariate logistic regression analyses were used to determine association between FGM and HIV/AIDS.

RESULTS: This study shows an inverse association (OR=0.508; 95% CI: 0.376-0.687) between FGM and HIV/AIDS, after adjusting for confounding variables.

DISCUSSION: The inverse association between FGM and HIV/AIDS established in this study suggests a possible protective effect of female circumcision against HIV/AIDS. This finding suggests therefore the need to authenticate this inverse association in different populations and also to determine the mechanisms for the observed association.

Child malnutrition is a problem in all countries and centers in poorer communities. Biological and socioeconomic factors alike contribute to malnutrition with recent studies focusing on aspects of maternal autonomy as an influencing factor. In this study, maternal autonomy is defined as the independence in her actions and control over resources a mother has within her household and is made up of several factors, including decision-making power, opinion of domestic abuse, and financial independence. Child nutritional outcomes were operationalized using the anthropometric measures height-for-age (HAZ), weight-for-height (WHZ), and weight-for-age (WAZ). For this study, the 2004-2005 Tanzanian Demographic and Health Survey (DHS) dataset was examined using weighted logistic regression in SPSS version 17. After controlling for sociodemographic covariates, the only maternal autonomy variable which was statistically associated with child nutritional outcome (associated with height-for-age) was if the mother had final say in decisions regarding her own healthcare (OR=0.857, 95% CI=0.749-0.980). Sociodemographic variables which were statistically associated with child nutritional outcome were child age (older children had higher odds ratios for stunting and lower odds ratios for wasting), child gender (being female was a protective factor against stunting and underweight), duration of breastfeeding (intervals longer than 24 months had higher odds ratios for stunting, wasting, and underweight), and family’s position in the wealth index (being in the richer and richest quintiles were protective factors against stunting and underweight). While further research is needed to examine other influencing factors such as sanitation, diet, and disease prevalence, decision-making power regarding a mother’s own healthcare is an important factor that may influence her ability to meet the nutritional needs of her children. This implies that public health professionals may want to look into avenues by which maternal autonomy may be enhanced for possible interventions to improve child nutritional status in Tanzania.

Hunger and food insecurity exist across millions of households in the US, and in even greater numbers in the state of Georgia. In fact, Georgia ranks fourth among the ten states with the highest food insecurity. Hunger and food insecurity have negative implications for the health and well being of children and adults. Such outcomes include fatigue, headaches, and frequent colds among children, and worsening chronic and acute diseases among adults. A non-governmental approach to addressing hunger and food insecurity includes food-banking. The Atlanta Community Food Bank (ACFB) collects, warehouses, and distributes 2 million pounds of food and other donated items to Georgia households each month. Among its other activities, the ACFB collects food donations through food drives. The capstone project, Colleges Connect to Collect, was created to assist Atlanta college students in hosting food drives on their college campuses. There were 2088 pounds of food collected and donated to the ACFB through the project. Recommendations for sustaining the project are included in this report.

Previous studies based on data from the World Bank have shown a negative association between governance and HIV prevalence. Using the Index of African Governance, this study investigates the correlation between governance and HIV prevalence in all African countries (N = 53) in order to determine which dimension of governance is more predictive of this relationship. No statistically significant association was found between governance and HIV prevalence across the whole spectrum of countries. In the multivariate analysis, the most predictive dimension of governance, “Rule of Law, Transparency and Corruption” was found to be positively associated with HIV prevalence across all African countries (p <.001), Beta =.816 .When grouped by clusters, only two regions (North and West Africa) out of five showed negative significant associations between governance and HIV prevalence. The analysis of socio cultural and geographical factors revealed significant associations with HIV prevalence; religion and HIV prevalence ( p < .003), region, and HIV prevalence ( p < .001). French colonial heritage was found to be negatively associated with HIV prevalence. This study suggests that geographical location and religion predict HIV prevalence rather than governance. International organizations and public health program managers should consider these findings in the implementation of large multi-country and regional HIV programs in Africa.

BACKGROUND: Soldiers face extraordinary circumstances while serving in the U.S. Armed Forces. Soldiers are required at times to live away from family and friends for extended periods of time and work in hazardous environments. Once soldiers become veterans, the experiences of military life may continue to affect them long after their duties have been carried out. These conditions put them at greater risk for alcohol misuse and depression. The purpose of this is to determine whether there is an association between alcohol misuse and depression symptomology among males who have a history of service in the U.S. Armed Forces. METHODS: Secondary data from NHANES 2005-2008 were used to analyze 1,381 men who expressed alcohol misuse and depressive symptomology. Chi-square tests were used to attain descriptive frequencies for alcohol misuse and depressive symptomology and demographic factors. Binary logistic regression was used for univariate and multivariate to test for associations between alcohol misuse, depressive symptomology, and demographic variables. RESULTS: Alcohol misuse and depressive symptomology were significantly associated with male veterans with a history of service in the Armed Forces, p= .041. Age (p< .001), race (p< .05) marital status (p<.05), and educational attainment (p< .01) are the best predictors of alcohol misuse among male veterans. Similarly, depressive symptomology had the same predictors as alcohol misuse, except race. CONCLUSIONS: The complex relationship between alcohol misuse and depressive symptomology among male veterans warrants further research. Public health professionals need to clearly establish standard measurement instruments for diagnosing these conditions. Once established, appropriate interventions can be implemented in order to combat these alcohol misuse and depressive symptomology among male veterans. INDEX WORDS: alcohol misuse, depressive symptomology, military, veterans

Background: An estimated 50,000 adults in the United States (U.S.) die each year from one of 10 vaccine preventable diseases. For those who survive vaccine preventable infections, health care costs and loss of income become more significant. While children in the U.S. aged 0-2 exhibit vaccine prevalence rates of almost 90%, some adult vaccine prevalence rates in the U.S. population are reported to be nearly 30-40% less than the goals set forth by Healthy People 2010. The purpose of this study was to examine the associations between socio-demographic characteristics of U.S. adults and adult vaccination prevalence for pneumococcal, hepatitis A, hepatitis B, tetanus, and pertussis.

Methods: Data from the 2008 National Health Interview Survey were assessed examining various health indicators and characteristics of non-institutionalized adults and children. The sample was restricted to adults ≥18 years of age. Odds ratios were calculated and multivariate logistic regression was also conducted. P-values of

Results: There were 21781 total observations; 19.3% received the pneumococcal vaccine, 9.4% received the hepatitis A vaccine, 27.2% received the hepatitis B vaccine, 55.1% received the tetanus vaccine, and 15.2% received the pertussis vaccine. Of the socio-demographic characteristics examined, age, health insurance, marital status, and education were significant for either all five or at least four of the vaccines included in this study. As one might expect those who reported health insurance and those who had a higher level of education usually had a higher likelihood of vaccine receipt as compared to those without health insurance and those with less than a high school education. Age associations varied due to age-related recommendations for certain vaccines such as pneumococcal (recommended for adults ≥65). Compared to the married population (referent), marital status results varied, but for reasons unclear. Whites, the referent group, were the most likely to be vaccinated as compared to Blacks, Hispanics/Latinos, and Asians. Hispanics/Latinos typically had the lowest likelihood of vaccination in this examination.

Conclusions: This study further explores the impact of socio-demographic disparities on vaccination status and adds new information to the literature regarding adult vaccination rates for preventable diseases. While research exists related to strengthening interventions such as patient reminder systems, those who do not see the same health care providers on a regular basis remain at risk for lower vaccination prevalence. It is important to better understand the role of social determinants of health, specifically in terms of vaccinations. Future research is needed to further characterize the association of socio-demographic factors with receipt of optional vaccines in adults.

Background: Prediabetes (PD) defined as having glucose values above normal but not high enough to be diagnosed as diabetes, is known to be a risk factor for type 2 diabetes and associated complications. Early prevention efforts can reverse the condition or delay the development of type 2 diabetes. This study examines the sociodemographic risk factors for PD in women. Methods: Using secondary data from National Health and Nutrition Examination Survey NHANES 2005-2006, chi-square analysis was done to find the prevalence of the disease among different categories of women with respect to age, ethnicity, and socioeconomic status. Univariate and multivariate analyses were performed to determine the associations of the sociodemographic factors with PD among women. A p-value of <0>.05 and 95% confidence intervals were used to determine statistical significance throughout all the analyses performed. Results: In total, 3,461 cases were included in the study analysis. Cases with indications of PD were found in 716 (20.7%) of the sample. Increased age was consistently associated with PD in women [χ=392.3(3), p<.001]. Prevalence of PD peaked for those aged 60 and above. Results of multivariate analysis suggested that being non-Hispanic Blacks was associated with increased likelihood of PD. Education was found to be significantly associated with PD but an inverse relationship could not be established. Conclusions: As an increase in age was found to be associated with PD in women, early screening and education regarding lifestyle changes can help reverse the condition. Minority groups should be an important focus for PD prevention efforts.

Introduction:

A mercury fact sheet that contains essential information and can be clearly understood by majority of adults is needed. In Fiscal Year 2009, EPA responded to more releases related to mercury than any other release. Since 2003, EPA has responded to more than 200 mercury releases. The American Association of Poison Control Centers estimate more than 50,000 people have been exposed to mercury vapors from 2003 to 2008, and 19,000 mercury cleanups have occurred from 2006 to 2008.

Purpose:

To determine what information needs to be included in a mercury fact sheet and how it should be created to inform adults who may be important in preventing and limiting exposure during accidental mercury release in the United States.

Methods:

The Flesch-Kincaid Grade Level Formula Data and the Suitability Assessment of Materials (SAM) tool were used to determine readability and appropriateness of twelve fact sheets related to elemental mercury. Length of fact sheets and illustration coverage percentage were also assessed. In addition, surveys were performed with four people who were involved in response to mercury releases in 2007 to 2009. The information they provided was also summarized to determine important elements that should be included in the fact sheets.

Results:

Information in a fact sheet should include the background of mercury, procedures in the event of a release, and ways to prevent releases. Based on the Flesch-Kincaid Grade Level, the literacy levels required to comprehend the 12 facts sheets was 11.4 on average. The majority of adults cannot comprehend the twelve fact sheets evaluated. Based on the evaluation of the material using SAM, none of the fact sheets scored higher than adequate with SAM. Only two fact sheets were written on one page and none of the fact sheets used relevant, simple illustrations with captions.

Discussion:

An effective mercury fact sheet needs to be about one page long and focuses on background, procedures, and prevention of exposure during a mercury release. Information obtained from interviews found that people focused the majority of their attention on the first page only. The fact sheet needs to be written at a sixth grade reading and to be able to receive a superior rating when assessed with SAM. This will ensure that the fact sheet is readable and comprehendible by the majority of adults and include the necessary information that the public must know regarding mercury. A new fact sheet was developed and assessed using both Flesch-Kincaid level and SAM and was found to have a 6.6 reading grade level and received a superior score under SAM. This fact sheet will be used by EPA along with the existing more comprehensive fact sheets at state agencies, and poison control centers for future releases and will be given to schools to educate and prevent future releases.

The relationship between mental health and public health has been debated for decades. But when services are delivered through publically funded mental health clinics, it clearly becomes a public health endeavor. One of the latest trends in mental health service delivery is the recovery concept. Developed in the 1990’s, the recovery concept represents a paradigm shift where successful treatment is defined by self-awareness, self-care, and self-fulfillment. Furthermore, patients are encouraged to assess their own progress in the recovery process. There are currently nine unique assessment tools to measure recovery progress, including the Mental Health Recovery Measure (MHRM), which was used in this study. The current study followed the implementation of the recovery model in the DeKalb Community Service Board (DeKalb CSB). DeKalb CSB has 12 locations that serve 10,000 patients with mental illness, substance abuse, and developmental disabilities each year. Only patients with primary diagnoses of mental health or substance abuse disorders were considered for this study. Implementation of the MHRM began in December 2008 and included all DeKalb CSB patients, however only new DeKalb CSB patients were considered for this study. During 13 months of data collection 960 clients completed 2 assessments and 196 completed 3 assessments. A new consumer is defined as someone who has just completed the intake process and has no record of previous service at DeKalb CSB. The current study examined trends in MHRM data in the DeKalb CSB population; and offered recommendations for future implementation.

Every corner of the globe has been touched by the HIV/AIDS epidemic, and local communities have responded in different ways. There is widespread agreement in the international community that by learning from each locality's response we will be able to improve our education, prevention, and treatment efforts. United Nations agencies can play an important role in facilitating the sharing of information and innovative practices for local authorities. The CITY-AIDS Americas program of CIFAL Atlanta is a UN initiative that promotes exchanges of ideas and practices among HIV experts in the western hemisphere. The program is based on the principles of participatory and action learning, and knowledge management. The purpose of this study was to evaluate the program's effectiveness in facilitating communication between HIV experts and the acquisition of resources following participation in the program. Data was collected through an online questionnaire completed by CITY-AIDS 2006 program participants. Secondary data such as HIV prevalence rates and census data were also used in this study. The results of this study show that certain city and participant characteristics are associated with increased program effectiveness and resource allocation. Based on these findings, recommendations will be made to CIFAL Atlanta.

BACKGROUND: The under-5 mortality rate in Ethiopia is 118/1000. A child in Ethiopia is 30 times more likely to die before age 5 than a child in Western Europe. Children are the most vulnerable segment of the population, but many of the ailments that cause death in this population can be avoided by completion of routine childhood vaccination.

METHODS: Data regarding child health from the Demographic and Health Survey (DHS), a periodic cross-sectional survey administered at the household level was utilized in this study. Data from 8,905 mothers of living children between 0-5 years of age was included in the study. Univariate and multivariate analyses of selected socio-demographic variables were conducted to examine association with vaccination status.

RESULTS: Risk factors for vaccination defaulting were identified. Logistic modeling with the selected factors was conducted with vaccination status and the demographic characteristics of families as independent factors. Type of Residence, Region and Wealth Index were the only significant characteristic in predicting the likelihood of a child being vaccinated when controlled for other factors.

CONCLUSION: The results of this study illustrate that geographic disparities result in lower vaccination completion for lower income families from rural settings than other groups. Families’ behavior around child vaccination is a microcosm of various social determinants affecting their decision-making. Resources further removed from health such as better roads and education can improve vaccination uptake.

BACKGROUND: HIV-related stigmatizing attitudes are persistent concerns in developing countries and have been shown to fuel the spread of the epidemics. The purpose of this study is to provide a comparative analysis between Haiti and the Dominican Republic in regards to the population’s attitude towards People Living with HIV/AIDS (PLWHA).

METHODS: Cross-sectional data from the Demographic Health Surveys involving 15,715 Haitians and 55,170 Dominicans from 2005 to 2007 were used. A score of attitudes was established from six items such as the willingness to care for infected relatives, the willingness to buy vegetables from an HIV infected vendor, the perception that HIV patients should be ashamed of themselves, the agreement to blame and force them to keep their serostatus secret and finally the agreement to allow infected teachers to continue their jobs. Descriptive statistics, univariate and multivariate analyses of selected socio-demographic variables were obtained by using the Statistical Package for Social Sciences (SPSS).

RESULTS: Logistic regression models showed that female Dominicans and male Haitians, respondents of higher socio-economic status and with more accurate HIV-related beliefs were significantly more tolerant towards PLWHA (p<.001). Furthermore, the Dominican Republic’s data analysis suggested that those aged between 30 and 44 years old, living in urban areas and married expressed more tolerance for the HIV- infected individuals. Overall, the attitudes and beliefs of the Haitians adjusted for socio-demographic variables did not differ markedly from the Dominicans.

CONCLUSION: The attitudes towards PLWHA seem to be associated with the nature of the HIV-related beliefs in some vulnerable groups. The findings of this study should guide the design of appropriate programs aimed at the education of targeted populations.

ABSTRACT An Examination of Socio-demographic Characteristics and Perceptions of Cycling among Students at Georgia State University (Under the direction of Christine Stauber, Faculty Member) Background: Bicycling as a form of transportation is important to public health and the improvement of the environment by way of sustainable transportation. Active transportation is inversely related to all-cause mortality, obesity, and levels of ozone and greenhouse gases. University communities have been shown to bicycle more than big cities. However, downtown setting of the Georgia State University (GSU) campus poses unique barriers to bicycling. Methods: A cross-sectional study was conducted in fall, 2009 at GSU. To determine perceptions and barriers to bicycling, the sample was divided into cyclists and non-cyclists. Chi square analysis, odds ratios, and multivariate logistic regression were used to compare the socio-demographic characteristics and perceptions surrounding bicycling between the groups. Results: The survey included 314 students; 60% female, 11.1% bicyclists, and mean age of 23. Of the socio-demographic characteristics examined, gender was the only factor significantly associated with bicycling, with males being 6.82 times more likely to cycle. Independent t-tests found that bicyclists viewed the built environment, social support, and future bicycling support more favorably than non-cyclists. Of the built environment factors, distance was the most important barrier to bicycling (OR=2.156, 95% CI= 1.484-3.133). Cyclists and non-cyclists were in agreement that bicycling was unsafe due to motor vehicle traffic, roadway conditions, and theft risk Conclusions: Overall, the findings were consistent with current knowledge about bicycling. The findings show that distance appears to be the most significant barrier to bicycling. Although safety due to roadway conditions and motor vehicle traffic and risk of bicycle theft did not produce significant results, these factors should be addressed in future studies and/or programs. Further investigation into how to alter these perceptions and create safer environments for the community would be beneficial.

The purpose of this capstone is to develop a program to address health literacy among African American adults. The social cognitive theory and the health belief model was used to create a model of an age appropriate, culturally sensitive program with a pre and post test to improve the health literacy in this population. The Community Health Literacy Improvement Program (CHIP) is a pilot program that will consist of a four week didactic intervention focused on combating prose, document, and quantitative health illiteracy. This program will be implemented through a community based nonprofit organization. Participants who complete the CHIP program will be able to identify risk factors for chronic diseases, assess their ability to avoid chronic diseases, and be able to locate community health resources. This proposed intervention will show that community based nonprofit organizations have an important role to play in building community buy in and establishing the agency necessary for community based, culturally sensitive programs such as CHIP to succeed.

Background:Today, 884 million people worldwide lack access to safe drinking water, and 2.6 billion are without access to improved sanitation facilities, with the majority of this burden falling upon citizens of the developing world. The purpose of this study was to determine what influence political and economic factors have upon the availability of improved water and sanitation services in developing nations, with a focus on sub-Saharan Africa.

Methods:Data from the Demographic and Health Surveys of 11 sub-Saharan African nations conducted from 2005-2008 were analyzed using SPSS 18.0. Five WASH-related dependent variables were examined: access to an improved water source, travel time to water, household water treatment, access to an improved sanitation facility, and shared sanitation facilities. Logistic regression and crosstabulated odds ratios were used to analyze the associations using both dichotomous and continuous independent variables (political stability, government effectiveness, and GNI) and dichotomous dependent variables. Chi-square analyses were performed to explore the discrepancies between observed and expected proportions of private and shared sanitation facilities.

Results: A total of 109,606 observations were included in this study. The majority of the study population had access to the improved drinking water sources (65.9%) and travel times < 30 minutes (83.3%). Most used no form of household water treatment (81.1%) and did not have an improved sanitation facility (64.1%). Rural residents had enerally less access to improved water/sanitation than urban residents. GE and GNI had the strongest positive associations with access to improved water source and household water treatment. GNI was also positively associated with access to an improved sanitation facility. Political stability was positively associated with travel time to water source. These associations varied between rural and urban settings.

Conclusion: The results of this study indicate that GNI, political stability, government effectiveness, and urban-rural setting have an impact upon water and sanitation in sub-Saharan Africa. With this information, context-specific interventions to improve and expand water and sanitation utilities/facilities in the region can be developed.

The refugee population within the United States is very dynamic, creating new challenges for county boards of health every day. To assist refugee groups in their transition to life in America, their needs must be thoroughly understood. County officials must also recognize their own limitations and be able to overcome them. Appropriate coordination with community resources relieves boards of health of some of the burden. However, county officials must also ensure that services provided in their domain are exceptional. This project aims to aid in this process for the DeKalb County Board of Health (DCBOH) and incoming refugees. A physician directory was created to improve the coordination between the DCBOH and community resources. In addition, a health manual geared towards informing refugees was updated and prepared for distribution.

Safe Routes to School is a national program funded by the Department of Transportation. The goal of the program is to increase children’s active transport to and from school, primarily by walking, in response to the epidemic of childhood obesity. Implementation at the state and local level has had varying success. In my capstone presentation, I discuss the creation, implementation, and ongoing success of the program at Oak Grove Elementary, a local public school in Georgia. The program is comprised of the 5 Es: Education, Encouragement, Enforcement, Engineering, and Evaluation. Each of these five components will be focused on, as well as ongoing challenges in the struggle to retrofit a school to make it more walker-friendly in a car-dependent environment.

Introduction: Human Immunodeficiency Virus (HIV) continues to threaten public health, despite a 40-year history of risk and prevention mitigation efforts. Advances in science and medicine have increased knowledge on how the virus is spread and how to treat it. This has driven clinical practices and policy initiatives. Policy has the capacity to drive primary prevention. Some policy, however, can pose barriers and impede primary prevention initiatives. This study investigates of the potential effect of sex education policy on primary prevention among young adults ages 13-24. Methods: Sex education policy in 8 states in the western and southern United States was collected and assessed for the impact these policies had on HIV incidence rates on young adults ages 13-24 using legal epidemiology methods. This cross-sectional study used data relevant to 2020-2022. Qualitative analysis state sex education and HIV education laws were coded for and analyzed in MonQcle. Statutes were assessed for inclusion of primary prevention education and resources within mandated curriculum. States were also assessed for type of content included in mandated curriculum and who mandated the curriculum (the state or local jurisdiction). An odds ratio was calculated at the end to assess the association between sex education of policy and HIV incidence. Findings: Young adults that live in states with opt-out parental consent sex education policy have higher odds of having a new diagnosis of HIV than young adults living in states with opt-in parental consent policy. A weak association of statistical significance was found during analysis, the OR was found to be 0.76, 95% CI [0.68, 0.86]. This association reflects that there is a weak association between sex education laws with opt-in parental permission and HIV incidence in young people ages 13-24, however, there are many policy elements and confounding factors that may affect the odds ratio for HIV surveillance data collected between 2020-2022. Conclusion: This study analyzed the association between opt-in parental consent policy and HIV incidence in young adults ages 13-24. Young adults have lower odds of having newly diagnosed HIV in states where active or opt-in consent is mandated for student participation in education programs. There are no strong associations between who sets the curriculum and HIV incidence in young adults, however, there is an opportunity to analyze the health impacts of mandated within each state and which of these sex education trends may not be keeping up with changing societal needs.

Alcoholic Liver Disease (ALD) leads to an estimated 30,910 deaths per year in the United States, for a mortality rate of 9.3/100,000 per year (CDC, 2024). Among patients who undergo liver transplant, recipients of livers from female donors tend to experience worse outcomes and higher rates of post-transplant mortality (Legaz, 2019). In particular, many studies have found that men who receive female donor livers are significantly more likely to experience graft failure than patients with other donor-recipient relationships (Lai, 2018). Little research exists on the relationship between donor sex and post-transplant outcome among individuals with ALD, specifically.

This study examines electronic health record data from a major transplant center in Atlanta, Georgia from the years 2013-2023 to identify the relationship between donor sex and post-transplant survival at 1 and 3 years in patients with Alcoholic Liver Disease. A number of potential covariates, including patient and donor age, donor circumstance of death, patient MELD score, and donor-recipient BMI difference were tested as potential mediators in the relationship between donor sex and survival.

The results of chi-square analysis found that contrary to the literature, female-female transplants performed significantly worse than other donor-recipient pairings, including female-male pairings. Stepwise logistic regression identified significant associations between female-female pairings and donor and recipient age, donor circumstance of death, and diabetes status. These covariates were not significant in explaining mortality rates in other donor-recipient pairing groups.

The existing literature suggests that among all-cause liver transplants, female-male pairings may experience poor outcomes due to a mismatch in estrogen levels between donor and recipient. This study hypothesizes that female-male transplants outperformed female-female transplants in this case due to the role of excessive alcohol consumption on estrogen production among recipients with ALD.

Diabetes mellitus is a significant problem in the United States with the burden being greater in the African American population. Because diabetes is complex and costly, the importance of self-care management changes the disease management paradigm from “provider-centered” to patient-centered”. Empowerment is a possible solution for barriers to better diabetes management. Patient empowerment is helping patients discover and develop the inherent capacity to be responsible for their own life. Although patient empowerment is a valuable philosophy, there are gaps between the philosophy and actual practice. There are limited studies addressing the effectiveness of patient empowerment at improving diabetes management. Therefore, this study examined the association of patient empowerment and diabetes management by gender, age, socioeconomic status and education level by using the data from the Patient Empowerment to Improve Diabetes Care intervention conducted in the Diabetes Clinic of the Grady Health System (GHS). In this study, diabetes management was measured by glycated hemoglobin (HbA1c) level which shows the average blood glucose level over the past two to three months. Patient empowerment was measured by two standardized tools which were the Diabetes Empowerment Scale-Short Form and Patient Activation Measure. In this study, patient empowerment scores measured by these tools were not associated with HbA1c level in African American diabetes patients of the Diabetes Clinic of the GHS. Further study is necessary to understand the association between patient empowerment and diabetes disease management by using different measures of patient empowerment, different levels of disease management, and measurement in different settings.