Browsing by Subject "Community Health and Preventive Medicine"
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Item A Faith Based Approached to Cervical Cancer Screening in Latina and Vietnamese Women: Outcome Analysis(2005-05-01) Perez, Robin Z.; Gonzalez, Adela; Lykens, Kristine; Galvan, RobertPerez, Robin Z., A Faith Based Approach to Cervical Cancer Screening in Latina and Vietnamese Women: Outcome Analysis. Master of Public Health (Health Management and Policy), May 2005, 34pp., 4 tables, 3 illustrations, bibliography, 6 titles. A secondary data analysis study of the cervical cancer screening collaboration hosted by the St. Joseph Health Care Trust through six area Catholic churches was conducted to describe a program that has been recognized as a best practice for serving minority communities in Texas. The objectives of the study were to list demographic characteristics associated with the screening participants; to review culturally sensitive programming and approaches to serving both Latina and Vietnamese women. The results of this study will assist in implementation of similar interventions. The conclusions demonstrate that interventions that are tailored to specific communities may influence program participants and increase screening turnout.Item A Health Assessment of Refugee Children From Former Yugoslovia in Tarrant County(2001-12-01) Podgore, John K.; Marshall, Murial; Rene, Antonio; Sandhu, RaghbirThis study was conducted to provide an assessment of the health status and health care utilization of children from former Yugoslavia living in Tarrant County. Additionally an assessment of barriers and problems encountered by these families in obtaining health care for their children was presented. One hundred thirteen households of refugee families arriving in Tarrant County from 1998 through 2000 participated by answering a 79 item health information questionnaire. The results revealed that most of the refugee families had no regular health care provider to assure continuity of medical care. Lack of access to dental care and inappropriate utilization of hospital emergency facilities were also identified as problems. Insufficient understanding of health insurance issues and inability to access health information were additional problems. Addressing these problems by local and state health care agencies may help to improve health care delivery for these and future refugee children.Item A Review of the Literature on Faith-Based Organization's HIV/AIDs Care and Prevention Efforts in Sub-Saharan Africa(2005-05-01) Rojas, Zeida G.; Lurie, Sue; Urrutia-Rojas, XimenaRojas, Zeida G., A Review of the Literature on Faith-Based Organization’s HIV/AIDS Care and Prevention in Sub-Saharan Africa. Master of Public Health (Community Health), May 2005, 83 pp., 20 diagrams, bibliography, 10 titles. The thesis assesses the role of faith-based organizations (FBOs) involved in HIV/AIDS related care and prevention activities in Sub-Saharan Africa. Do FBOs have the ability to address the multi-faceted syndrome that HIV/AIDS brings to an individual, their family and community? Can FBOs be effective partners to carry out prevention and care initiatives? Faith-based organizations are generally overlooked as potential partners and leaders in the fight against HIV/AIDS. FBOs are often the only genuine nongovernmental organizations in many rural parts of poor countries, or at a minimum, they are the strongest and most influential. Due to their organizational networks, FBOs are able to mobilize people and resources, and to reach rural or isolated areas. Evidence of current FBO efforts demonstrates that FBOs have the ability to address the multifaceted effects of HIV/AIDS and can become indispensable partners for government health agencies and NGOs.Item A Six-Year Analysis of the Distribution of Time to Death Among Colorectal Cancer Patients in the State of Texas(2000-05-01) Williams, Vanessa P.; Antonio A. Rene; Thomas J. Fairchild; Sally BlakleyWilliams, Vanessa P., A Six-Year Analysis of the Distribution of Time to Death Among Colorectal Cancer Patients in the State of Texas. Master of Public Health (Epidemiology), May 2000, 55 pp., 11 tables, 9 figures, references, 52 titles. The cancer experience of Texans differs substantially by race/ethnicity. Among Caucasian, African American, and Hispanic men and women, colon cancer is either the second or third leading type of cancers among Texans. The distribution of time to death over a six-year period were assessed from a cohort of African American, Hispanic, and Caucasian men and women diagnosed with colon cancer in 1992. The purpose of this study is to determine if there is a difference in the overall death time distribution and tumor histology among African Americans, Hispanics, and Caucasian men and women who were diagnosed with colon cancer in 1992 in the state of Texas. Analysis results indicated that Hispanic females (65.59%) and Caucasian males (65.52%) had higher survival times among the race/ethnic groups. African American males (53.85%) and females (56.40%) experienced lower survival time for the cohort. For overall distribution of time to death among deceased subjects, African American males and Hispanic females experienced the lowest distribution times among the subjects. The overall distribution of time to death for all histology types were the same for each type.Item A Study of Pesticide Safety and Health Perceptions Among Tarrant County Pesticide Applicators(2001-05-01) Martinez, Robert A.; Terrance B. Gratton; Claudia S. Coggin; Sam AtkinsonPesticides have become an important part of our lives. We rely on them to help protect our crops from pest; they rid our homes of unwanted pests and help us make our lawns and public parks beautiful. Pesticides are also important to public health. They are a major source of vector control and help stop the spread of vector-borne disease. Even though we used them in our everyday lives, it is important to remember that pesticides are poisons, and that great care must be taken to ensure the safety of the public and safety of those who work with pesticides. This study looked at the safety knowledge and health perceptions among Tarrant County, Texas licensed applicators. Much research has been focused on the effects of pesticides on human health. Much of this research has been focus on the farmer applicator (Alavanja, 1999). This study focuses on applicators that work mostly in the urban areas of the County, as well as ranchers live in the County. These licensed urban applicators included those who work for city parks departments, golf courses, commercial applicators, lawn care service, pest control and some private ranchers. The Texas Pesticide Regulations require that a person may not use a restricted-use or state-limited use pesticides or herbicides unless licensed by the Texas Department of Agriculture (2000). Therefore the purpose of this study is to see if an association between health beliefs and pesticide safety knowledge exist. The reason it is important is because these people can have either a positive or negative impact on the safety of themselves and their crews. Acute pesticide poisoning is one of the biggest risks that applicators face. The state of Texas conducts an active surveillance of occupational-related pesticide poisonings. The Environmental Epidemiology and Toxicology Division at the Texas Department of Health (TDH) have had this system in place since 1985. TDH reported that 107 work related cases occurred during 1998, with 55 confirmed as occupational pesticide poisoning (1998). The most frequent symptoms reported were neuromuscular symptoms such as headaches, dizziness, confusion, irritability, and twitching muscles. Pyrethroids and pyrethins were the most commonly reported class of pesticides exposure (51%) followed by Organophosphates (25%), which are the most widely used form of insecticides, as well as herbicides and fungicides. Pesticide safety and the TDH surveillance system are two very important ways of informing pesticide applicators about the risk and what can be done to minimize that risk to themselves and their crew.Item A Study to Determine Improved Compliance of Biophosphonate Treatment in Subjects with Osteoporosis(2005-02-01) Enard, April T.; Gwirtz, Patricia A.; Jimenez-Williams, Cynthia; Rubin, BernardEnard, April T. A Study to Determine Improved Compliance of Bisphosphonate Treatment in Subjects with Osteoporosis. Master of Science, February 11, 2005. The ability of patients to adhere to treatment regimens is very poor and continues to impede optimal therapy of osteoporosis. The shortcomings in treating osteoporosis are: a) noncompliance and/or lack of continued persistence of therapy, b) efficacy of therapy on bone turnover marker levels and fracture prevalence, and c) tolerability of therapy to patients. Studies have shown that interventions such as education and awareness of bone mineral density promote patient usage compliance. The slightest improvement in compliance allows further understanding of accurate efficacy of medication therapy to fractures, bone marker levels, and overall improvement of bone mass. Increased compliance/persistence allows accurate comparison of bisphosphonates to one another for effectiveness on osteoporosis patients and allows improvement opportunity in treatment modalities that can positively influence the course of osteoporosis. This phase IV study targets compliancy/persistence in bisphosphonate therapy in treatment of osteoporosis.Item A Sun Awareness Pilot Project(2002-05-01) Franklin, Gillian A.; Claudia Coggin; Kristine A. Lykens; Doug A. MainsFranklin, Gillian A., A Sun Awareness Pilot Project. Masters of Public Health (Health Management and Policy), May 2002, 53 pp., 7 tables, bibliography, 48 titles. The most common cancer in the United States today is skin cancer; it is also the most preventable. At least 90% of all skin cancers is caused by sun exposure. Americans have a one in six lifetime risk of developing skin cancer and in Texas the rate is one in three. The purpose of this pilot project was to increase the level of sun protection knowledge and awareness in parents who brought their children in for a six-month immunization visit. The project was modeled after the Australian Cancer Council’s “Slip! Slop! Slap!” campaign. Data was collected from five pediatric clinics in this pretest/posttest design study. Multiple variables regarding demographics, skin type, knowledge, beliefs, sun-protective practices, and attitudes were included. Overall, parental sun protective knowledge and awareness increased. The information obtained from this pilot project may influence future public health decisions regarding education and prevention of skin cancers.Item Access to Care and Hospitalizations for Diabetes Complications Among Elderly Hispanics and African Americans in Texas(2005-08-01) Chaudhary, Prateek; Kristine Lykens; Julian Borejdo; Antonio A. ReneChaudhary, Prateek. Access to Care and Hospitalizations for Diabetes Complications Among Elderly Hispanics and African Americans in Texas. Master of Public Health, August 2005, 52 pp, 6 tables, bibliography. The mismanagement of diabetes care, due to disparities in access, deficiencies in health insurance, or poor quality of primary care, can lead to preventable microvascular complications which force diabetics to utilize hospital emergency departments (ED). This study uses 2002 hospital discharge data from the Texas Health Care Information Collection to determine whether diabetic and elderly (65+) African Americans and Hispanics from Texas counties with a low ratio of physicians per, 1,000 population (PPR) are more likely to be admitted through the ED with complications from diabetes. Findings indicate that while Hispanic ethnicity is significantly associated with ED use as a source of admission, diabetics from counties with higher PPR are more likely to be admitted through the ED for diabetes complications than diabetics from counties with a lower PPR.Item Acculturation and Psychological Distress in Mexican-American Health Fair Participants(2004-12-01) Bereolos, Nicole M.; Coggin, Claudia; Franks, Susan; Simpkins, JamesBereolos, Nicole M., Acculturation and psychological distress in Mexican-American health fair participants. Master in Public Health (Health Behaviors), December 2004, 20 pp., 3 tables, 23 titles. Immigrants who have integrated into their host culture along with maintaining their cultural identity have better psychological well-being. Greater degrees of psychological distress in less acculturated immigrants may occur due to stressors associated with the transition. This isolation has prevented providers from addressing their mental health needs. This project studied psychological well-being as its relates to acculturation. Self-report questionnaires were offered at the Hispanic Health Fair in Fort Worth, Texas. Psychological distress was significantly higher for the low acculturated (LA) than the moderately acculturated (MA). Specifically, a higher degree of anxiety for the LA group was found compared to the MA. The difference in depression was not significant, however results suggest that mild psychological distress is likely prevalent in the LA. Results underscore the importance of gaining knowledge about the needs of Mexican-Americans that are rarely seen within traditional health service.Item Advance Directives Planning Among Mexican-Americans in Dallas-Fort Worth(2005-05-01) Santiago, Carmen; Lurie, Sue; Gonzalez, Adela; Rene, AntonioSantiago, Carmen C., Advance Directives Planning Among Mexican-American in Dallas Fort Worth. Doctor of Public Health (Social and Behavioral Sciences), May 2005, 133 pp., bibliography, 33 titles. This qualitative study explored the knowledge base of advance directives planning among Mexican-Americans in the Dallas-Fort Worth area. In addition, the study explored areas that influenced their willingness to engage in advance directives and their preferences related to family collective decision-making. Two focus groups, representing two different populations were conducted. One focus group represented second generation Mexican-Americans, 65 years old and older, both men and women that were hospitalized or participated in home health care programs between January 2004 and January 2005. The second focus group consisted of Mexican-Americans, 18 years and older who were family members or caregivers of sick elders in the same time frame. Questions utilized to gather the knowledge and beliefs of the focus group participants, were based on a previous study by Dr. Morrison and Dr. Meir conducted in New York. Participant’s responses were analyzed using NVIVO software. Findings indicated a lack of knowledge of advance directives and confusion about state wills and living wills among Mexian-Americans in Dallas-Fort Worth. A majority of the focus group participants expressed a preference for their older children to make the decisions of their end of life care. This was due to a belief that their child is better educated and could make the right decision. Participants also revealed the importance of a family collective decision. This belief in family unity kept them from excluding members from the decision of end of life care. Another interesting finding from this study was a majority of the participants had already made funeral plans such as arranging for the lot to be buried in and funeral service pre-paid, but had not considered advance care directives. According to both groups of participants, arranging for their funeral service gave them a peace of mind and dignity since they had established where they will be interred. These findings suggested that the Mexican-American population needs to be informed about this legal process. Mexican-Americans need to be aware that the State provides ways to obtain this documentation at no cost. Health care providers should be involved in the education about advance directives and encourage their patients to learn more and consider obtaining one. Further research studying Mexican American knowledge and beliefs, at state level and a comparison among states should be explored. Keywords; advance directives, decision making, end of life, ethical issuesItem An Analysis of Osteoporosis-Related Hip Fractures, Using Hospital Discharge Data(2001-12-01) Rubin, Bernard; Antonio A. Rene; Douglas Mains; Muriel MarshallThe purpose of this study is to assess whether a current physician practice may inadequately diagnose osteoporosis in a high risk population of postmenopausal women who have sustained a hip fracture. A review of all patients discharged from Texas hospitals during calendar year 1999 was analyzed, using the Public Use Data File provided through the Texas Health Care Information Council. A total of 13,628 women over the age of 55 were admitted to hospital with a fractured hip. Only 2,233, or 16.3%, of women were also coded with the diagnosis of osteoporosis (P [less than] 0.001). Forty to fifty percent of postmenopausal women have osteoporosis. Therefore, women presenting with a fragility fracture form an even more at-risk subset of the population, such that one would expect a majority of these women to carry a diagnosis of osteoporosis. Percentages of Caucasian, non-Hispanic women in each group were comparable. The age distribution in each group was comparable, implying that the coded diagnosis of osteoporosis was not related to the age of the women when admitted to the hospital. In conclusion, physicians practicing in Texas during calendar year 1999 inadequately diagnosed osteoporosis in a high risk population of postmenopausal women who were admitted to hospital with fractured hip. Future analysis of subsequent analysis databases will be able to identify whether or not continuing medical education efforts will cause physicians to diagnose osteoporosis in this high risk population more frequently.Item An Analysis of Texas Hospitals: Assessing the Association between Charity Care, Uncompensated Care, & Community Benefits(2007-05-01) Mitias, Marcus J.; Nuha Lackan; Jeff Talbert; Douglas MainsMitias, Marcus J. An Analysis of Texas Hospitals: Assessing the Association between Charity Care, Uncompensated Care, & Community Benefits. Master of Public Health (Health Management & Policy), May 2007, 47 pp., 5 tables, 11 illustrations, references, 45 titles. The question of whether not-for-profit hospitals are meeting their charitable obligations is once again starting to intensify. Congress is calling for increased scrutiny of not-for-profit hospitals. Similarly, pressure is mounting in Texas where the not-for-profit hospital sector struggles to justify the contributions they make to the community. This cross-sectional study examines the county level association between charity care, uncompensated care expenditures, and community benefits, and hospital structure, and the number of uninsured. Descriptive and multi-linear regression analyses are used to compare hospital charity care and uncompensated care expenditures in Texas. Results indicate the number of uninsured is significantly associated with charity care expenditures and uncompensated care expenditures.Item An Economic Analysis of Texas' Measles Vaccination Program: 1990-1996(2000-08-01) MacDonald, Tammy O.; Claudia S. CogginIn order to get the most benefit out of limited resources, public health departments must examine the costs and benefits of their activities to determine the most cost-effective method to allocate these scarce resources. The use of economic analysis can inform and help clarify upon which decisions are to be made. (CDC, 1996). The resources used to produce most goods and services in society are efficiently allocated through markets. However, markets can fail to efficiently provide goods and services that largely benefit individuals other than the consumer. The types of goods and services that public health departments provide often fall into that category. Cost-benefit analysis is one type of economic decision-making tool used when market forces are not in control Cost-benefit analysis (CBA) places a dollar value on the costs and benefits of each outcome so they can be compared. This type of economic analysis can then be taken one step further. An incremental or marginal analysis can determine changes in the relative costs and benefits’ resulting from increase or decreases in the amount of resources used in a program. Such an analysis should be part of the decision making process, so that scarce resources can be used efficiently. This paper examines not only the costs and benefits of the measles immunization program in Texas but also, the expansion of the program in the 1990’s. The most significant changes in Texas’ immunization program took place in 1994 as a result of the measles outbreak of 1989-1990. The years 1992, 1993, 1994 and 1996 were chosen for this analysis because of the difference in immunization rates, incidence rates and the level of State funding. This time period represents the most dramatic changes to these three areas. Since the measles vaccination was put into use in 1963, the number of measles cases in the United States has decreased dramatically. An average of 450 measles-associated deaths was reported each year between 1953 and 1963. (TDH, unpublished). Widespread use of the vaccine has led to a 95% reduction in measles compared with the pre-vaccine era. (TDH, unpublished). However, during 1989-1990, the number of measles cases and deaths rose sharply. During 1989, more than 18,000 cases and 41 deaths were reported. The largest number of reported cases since 1978 and the largest number of deaths in two decades in the U.S. (National Vaccine Advisory Committee, 1991). The major cause of the epidemic of 1989 and 1990 was a low vaccination rate among preschool children. (TDH, unpublished). The Centers for Disease Control and Prevention (CDC) estimates national measles vaccine coverage for 2-year-olds in 1985 was 61%, compared with 82% in 1991 and 1992. (CDC, 1994). The CDC has set a goal of 90% of 2-year-olds to be immunized against measles, mumps and rubella. Texas reported 11% of all measles cases in the U.S. between 1989 and 1990, although it only accounted for 7% of the total U.S. population (Schulte et al. 1996). This is likely due to the fact that immunization rates were low throughout the state. In 1989, only 66% of the children in Dallas and 58% in Houston were estimated to be immunized against polio, diphtheria, pertussis, tetanus, measles, mumps, and rubella by the age of two. Nationally, immunization rates were estimated to be 70% at the same time (Schulte et al., 1996). This paper will proceed as follows. Two benefit/cost studies will be outlined in the background section. These studies compare the total benefits and costs of current vaccination programs to no vaccination program. Then a history of Texas’ measles vaccination program will be discussed. It will explain how the measles outbreak of 1989-1990 brought about organizational and financial changes to the immunization program within the Texas Department of Health (TDH). In the method section, the disease costs and costs associated with a vaccination program are used to calculate a benefit/cost ratio. The changes in immunization rates and the associated marginal costs and benefits are then compared. The results of the CBA and marginal analysis indicate that the benefit to cost (B/C) ratios range from 17 to 30:1. After reaching an immunization rate of about 81%, marginal benefits become smaller and smaller while the cost of increasing the immunization rate rises. Finally, the results will be discussed and conclusions made as to the efficiency of Texas’ measles vaccination program. There is some evidence that the CDC’s goal to immunize 90% of 2-year-old children for measles may not the most efficient goal for Texas.Item An Evaluation of Acanthosis Nigricans School Screening Results in Richardson Independent School District to Determine the Association of Acanthosis Nigricans and Other Factors for Type 2 Diabetes Mellitus(2005-05-01) Gardner, Janet E.; Urrutia-Rojas, Ximena; McConathy, Walter J.; Cipher, Daisha J.Gardner, Janet E., An Evaluation of Acanthosis Nigricans School Screening Results in Richardson Independent School District to Determine the Association of Acanthosis Nigricans and Other Risk Factors for Type 2 Diabetes Mellitus. Master of Public Health (Community Health), May 2005, 65 pp., 11 tables, reference list, 47 titles. Cases of Type 2 diabetes mellitus (T2DM) have been increasing at alarming rates in Texas. Identifying underlying factors, such as acanthosis nigricans (AN), elevated body mass index and hypertension, which might contribute to the development for type 2 diabetes, is critical. This study analyzed the relationship of AN with these risk factors of T2DM. Richardson Independent School District screening results for 2003-2004 were analyzed. This study concluded that calculated BMI values yielded the highest association with grades of AN. BMI-for-age percentiles greater than or equal to the 95th percentile and elevated diastolic and/or systolic blood pressures were strongly associated with AN grades.Item An Evaluation of an Interdisciplinary House Calls Program For the Frail Homebound Elderly(1999-05-01) Johs, Jennifer L.Johs, Jennifer L. An Evaluation of an Interdisciplinary House Calls Program For the Frail Homebound Elderly. Master of Public Health (Biomedical Sciences), May, 1999, 57 pp., 4 tables, references, 66 titles. The current study compared utilization markers of 87 frail elderly homebound patients prior to and subsequent to enrollment in an interdisciplinary, physician-led house calls program, as well as measured efforts to increase documentation of advance directives. After enrollment in the program the number of hospital admissions (p=0.047) and emergency department visits (p=0.030) were significantly decreased. The number of admissions to skilled nursing facilities (p=0.023) was also reduced, as was length of stay in skilled nursing facilities (p=0.018). The prevalence of advance directives increased from 26% to 74% (p [less than] 0.001) subsequent to enrollment. Patients who died were more likely to die at home (19) than in the hospital (6). All patients who died at home had documented advance directives.Item Assessment and Identification of Areas for Improvement of a Local Health Department Food Safety Program(2008-05-01) Harris, Ann MarieHarris, Ann Marie. Assessment and Identification of Areas for Improvement of a Local Health Department Food Safety Program. Master of Public Health (Environmental Health), May 2008, 14 pp. 1 table, 1 figure, references, 14 titles. The Fort Worth Public Health Department (FWPHD) established a standardized assessment to compare compliance rates for risk factors contributing to foodborne illness. The FWPHD identified significantly higher compliance rates in four out of six risk factors. Risk factors posing the greatest risk for out of compliance observations included threats from contaminated equipment and chemical/other hazards. Fast food establishments had a significantly greater risk for contaminated equipment (OR=1.81; CI=1.27, 2.58). Chemical/other hazards was the only risk factor with a higher overall out of compliance rate than the FDA. The FWPHD can now accurately track the effectiveness of training and education programs for food handlers, consumer health specialists, and the overall inspection process.Item Assessment of Obesity as a Cardiovascular Disease Risk Factor in a Geriatric Rural Texas Community - A Six Month Follow-Up(1999-12-01) Coustasse, Alberto; Antonio Rene; Doug A. Mains; Gilbert RamirezCoustasse, Alberto, Assessment of Obesity as a Cardiovascular Disease Risk Factor in a Geriatric Rural Texas Community – A Six Month Follow-up. Master of Public Health Track, Public Health Administration, December 1999, 22 pp., 9 tables, 9 illustrations, bibliography, 7 titles. The health fair approach was used as a method to establish individual and population health status baselines and to provide a mechanism to follow-up with an elderly population in a rural Texas community. A controlled trial sample of forty-four seniors was initially screened in a primary care clinic in August 1998. Patients were reevaluated at six months and results demonstrated a 46% increase in BMI [Body Mass Index]; 62% remained obese; 62% maintained elevated cholesterol or increased cholesterol values to abnormal values; 61% maintained or increased their BP [blood pressure] to abnormal values. A significant finding was that a change of one unit in the BMI correlated with a change of 19.88 mmHg [millimeter mercury] of SBP [systolic blood pressure] and 18.59 mmHg of DBP [diastolic blood pressure]. The societal economic impact of mortality and morbidity (without the benefit of target interventions) for the initial forty-four seniors was projected at & 74,949. Keywords: Health fairs; obesity; cardiovascular; cost; case management.Item Barriers to Health Care Access Among Vietnamese Refugees in Tarrant County, Texas.(2004-05-01) Le, Tuan D.; Chiehwen Ed Hsu; Sue Lurie; Raghbir SandhuLe, Tuan D., Barriers to Health Care Access among Vietnamese Refugees in Tarrant County, Texas. Master of Public Health (Health Management & Policy), May 2004, 88 pp., 17 tables, 11 illustrations, bibliography, 56 titles. The refugee community is the most vulnerable community due to existing medical conditions without proper treatment and many barriers in accessing the health care system, including different language, cultural conflict, legal restrictions, and socioeconomic status. The purpose of this study is to determine the nature of these barriers that keep the Vietnamese refugees from accessing the health care system in Tarrant County. The study found that 45.8% have no health insurance, 17.4% received Medicaid, 53.7% have no primary care physician, and 57.14% of Vietnamese elderly refugees, who have been living in the U.S. between seven and ten years, and have lost SSI and Medicaid. These findings are significant at p [less than] .001. Vietnamese refugees perceived factors that kept them from accessing the health care system as major barriers, including language (14%), legal issues (17%), misunderstanding of the medical system (15%), lack of insurance (14%), and different culture (11%). These results may assist social service providers, health care providers, and policy activists to enhance their services and advocate for legal issues, in order to remove these barriers and help refugees to access health care better.Item Barriers to Medicaid Enrollment: A Study of the Texas Healthy Kids Corporation(2000-12-01) Barlow, Daphne J.; Doug A. Mains; Sally BlakleyBarlow, Daphne J., Barriers to Medicaid Enrollment: A Study of the Texas Healthy Kids Corporation. Masters of Public Health (Health Administration), December, 2000, 38 pp., 18 tables, References, 13 titles. Recently Medicaid eligibility was expanded to include more children than ever before in Texas. However, many Medicaid eligible families have not obtained benefits. This study concerns potentially Medicaid eligible families who applied to the Texas Health Kids Corporation. A random telephone survey of these applicants examined the outcome of Medicaid eligibility notification. Data was analyzed to determine the predictors of attempting or completing an application. No significant sensitivity to profilers such as primary language, race/ethnicity, education level or age was detected. Instead, having prior knowledge of Medicaid eligibility and being female were predictive factors to consider when engineering outreach programs. While these results indicated a statistical significance, further study of repeat notification and gender in order to conclusively recommend policy change. These results have implicated for the Texas CHIP program.Item Barriers to Women's Cardiovascular Risk Knowledge: A Tarrant County Study(2004-05-01) Liewer, Linda J.; Kristine LykensLiewer, Linda J., Barriers to Women’s Cardiovascular Risk Knowledge: A Tarrant County Study. Master of Public Health (Health Management and Policy), May 2004, 71 pp., 19 tables, 6 illustrations, 36 references, 17 titles. Women’s death rate from cardiovascular disease is greater than the death rate from all cancers. Awareness and knowledge of a disease are key to dealing with it, yet many women are still unaware of their CVD risk. The purpose of this study is to identify the barriers to knowledge about cardiovascular disease risk in women in Tarrant County. Interviews with administrative personnel in 10 community organizations confirmed the lack of awareness of CVD. Barriers included: women in caregiver roles advocate effectively for their family members, but less effectively for themselves; physician communication with women regarding CVD is often suboptimal; women fear breast cancer far more than CVD; a program deficiency exists in Tarrant County; lack of a visible woman champion and heart disease is still seen as a man’s disease.