Keith Nicholls’s research while affiliated with University of South Alabama and other places

Community health workers (CHWs) have significant potential to contribute to public health in the United States by promoting disaster preparedness, speeding postdisaster recovery, and building disaster resilience in their communities. To maximize this potential, however, they must undergo rigorous and relevant training. As part of the Gulf Region Health Outreach Program, an appropriate curriculum was developed and delivered in several training sessions conducted from 2013 to 2016. This article provides insights into the primary issues associated with such training and offers a detailed elaboration of the basic and specialized curricula as presented and adapted over the course of the program. We present lessons learned from these training experiences, as reflected in participants' initial ratings and comments, training staff debriefings, and feedback from CHWs working in the field. Informed by this feedback, as well as additional research and conceptual development, we offer recommendations aimed at expanding and refining CHW training curricula in the areas of chronic disease, psychosocial symptoms, community resilience, and environmental health. In addition to curriculum changes, we review policy implications aimed at promoting and facilitating the inclusion of CHWs in disaster response and recovery teams.

This article examines the relationship of environmental stress to disturbances in behavior, mental health functioning, and public health for people impacted by a variety of ecosystem disruptions. The biophysical environment has enduring characteristics that are intimately linked to human social systems. Economic, social, cultural, and spiritual connections between the ‘social’ and ‘biophysical’ environments have been compellingly identified in the literature. Such exchange relationships between natural and human systems establish continuous dialectical interactions, which often results in changes to both. Extreme environmental stress in the form of catastrophic natural and technological disasters seriously undermines the human condition and quality of life in the modern world. We will briefly identify the context of contemporary risk and review the health consequences of extreme environmental stress.

Lay Health Workers can play a pivotal role in improving disaster response and recovery because of their potential effectiveness in enhancing the overall health of their communities, increasing disaster preparedness, supplementing the efforts of disaster responders, and building relationships of trust among all interested parties. Such activities build social capital and significantly enhance community resiliency in anticipation of future disasters. Although there are a number of different types of lay health workers, the version with the greatest potential in this area is the Community Health Worker (CHW). Recent research findings confirm that CHWs serving in the communities where they live have been beneficial in emergency management planning and disaster recovery, following both natural and technological disasters. When properly trained, they constitute a proven strategy for timely interventions aimed at reducing long-term collective trauma and building social capital. In this paper, we elaborate the characteristics and roles of CHWs as a specific type of lay health worker; review research on the utility of CHWs in health care generally, as well as in the area of emergency management; describe their potential for building social capital and enhancing community resilience; and provide an overview of essential training needed to prepare them to participate in disaster preparedness, response, and recovery efforts. We conclude with some suggestions for future research.

To ascertain barriers to colorectal cancer screening in an environment of changing recommendations, payment structures, and information access, and to develop strategies for overcoming these barriers by undertaking a population survey of colorectal cancer (CRC) screening knowledge and attitudes in Alabama. An 80-item questionnaire focused on cancer screening, specifically CRC screening, was developed and pretested. A random sample of Alabama residents was generated using random-digit dial methods and interviews of 615 participants aged 50 and older were conducted in March 2012 and April 2012. Screened and unscreened groups were compared using χ statistics. Sixty-one percent of Alabamians who participated in this survey reported being screened for CRC, the majority (95%) of these by colonoscopy. Both screened and unscreened participants reported using the Internet for health information more often if they were younger than 65 years. Those screened often reported feeling well informed regarding the guidelines, often to have discussed CRC screening with their family physician, and often to have had other cancer screenings. All of the respondents, screened and unscreened, reported financial considerations to be the most significant barriers to screening. Although educating the general population could be helpful, a physician championing screening is key. Home stool testing is underused in Alabama in part because physicians are not fully aware of its utility. As financial barriers diminish, it is important to offer multiple effective modalities when available, and insurance reform, which includes payment for preventive care, may improve screening rates.

Objectives To explore the impact Hurricane Katrina on citizens’ trust in government. Of primary interest is the relationship between poor governmental performance in the aftermath of the storm and low levels of political trust. In addition, levels of trust are related to respondents’ predictions regarding the time it will take their communities to recover. Methods Relationships are investigated through an analysis of data from a survey of residents in the Katrina-affected areas of Louisiana and Mississippi. For this initial exploration, bivariate analysis is used to elaborate relationships between measures of trust in government and the experiences and attitudes of survey respondents. ResultsAnalyses reveal interesting and significant relationships among the variables. Negative experiences during and after Hurricane Katrina are correlated with low levels of political trust. Also, low levels of trust are associated with pessimistic predictions of the time it will take communities to recover from the storm. Conclusions Given the importance of political trust for the long-term health of the political system, it is critical that governments at all levels enhance their effectiveness in dealing with such disasters.

In order to inform efforts to increase screening rates for colorectal cancer (CRC), we conducted a survey of Alabama primary care physicians regarding CRC screening practices, educational preferences, and perceptions of obstacles to screening. A mail survey of 2,378 Alabama physicians in Family Medicine, Internal Medicine, and Obstetrics & Gynecology was conducted. Many physicians are not fully up-to-date with current CRC screening practices that could improve patient compliance with screening guidelines. One example is the potential use of high-sensitivity stool tests, such as the fecal immunochemical test, instead of the no longer recommended low-sensitivity guaiac fecal occult blood tests. In addition, enhanced multimedia and web-based approaches to educating physicians and patients could be more fully utilized. Further, greater use of health information technologies could increase screening rates. Enhancing primary care physicians' knowledge of screening modalities and increasing their use of electronic technology could significantly improve colorectal cancer screening outcomes.

To evaluate the utility of offering physicians electronic options as alternatives to completing mail questionnaires. A survey of colorectal cancer screening practices of Alabama primary care physicians, conducted May-June 2010. In the follow-up to a mail questionnaire, physicians were offered options of completing surveys by telephone, fax, email, or online. DATA COLLECTION METHOD: Detailed records were kept on the timing and mode of completion of surveys. Eighty-eight percent of surveys were returned by mail, 10 percent were returned by fax, and only 2 percent were completed online; none were completed by telephone or email. Offering fax options increases response rates, but providing other electronic options does not.

This article develops a new and useful indicator to aid in identifying Christian fundamentalism. " Affect" measures individuals' affective attitudes toward the role of Christian fundamentalists in Alabama politics. We demonstrate the analytic utility of this indicator by quantitatively comparing it to other more traditional and direct measures of fundamentalism, such as belief in the Bible as the literal word of God, self-identification as a fundamentalist, and whether one considers oneself to be " born again." We then compare the utility of these different measures of Christian fundamentalism in explaining electoral support for the archetype Christian fundamentalist political candidate, the " Ten Commandments Judge" Roy Moore, former chief justice of the Alabama Supreme Court. We find that our affect indicator compares well to other measures of fundamentalism and actually outperforms all of the more traditional measures in explaining support for Moore. Data used in the analysis come from a public opinion poll conducted by the USA Polling Group in April 2006.

Recent research in the United States reveals that although men are more accepting of risk than women, and Whites more accepting of risks than non-whites, more notable patterns lie at the intersection of race and gender. Evidence of the white male effect has been found in both national and local samples. The present study examines the environmental risk perceptions of deep-South coastal residents in counties adjacent to Mobile Bay and the Gulf of Mexico. These areas are characterized by heavy industrial pollution and significant airborne mercury fallout, resulting in numerous health advisories regarding fish consumption. The analysis supports a growing body of literature that finds, compared to other race-gender groups, white males are more accepting of environmental risks, especially those risks posing a threat to human health and safety. The significance of the white male effect for policy and future applied risk research are discussed, and suggestions for future research are presented.