Browsing by Subject "Sociology"
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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 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 Exploratory Study of the Influence of Language and Ethnic Concordance on Hispanic Patients' Trust in their Healthcare Providers in Tarrant County(2007-08-01) Macias, Isela; Holly E. Jacobson; Francisco Soto-Mas; Daisha CipherMacias, Isela. An Exploratory Study of the Influence of Language and Ethnic Concordance on Hispanic Patients’ Trust in Their Healthcare Providers in Tarrant County. Master of Public Health (Health Interpreting & Health Applied Linguistics), August 2007, 76 pp., 8 tables, references, 57 titles. There is a scare number of Spanish-speaking, Hispanic physicians to serve a growing Spanish-speaking Hispanic population. A survey and interview were conducted in a primary health clinic with fifty-two Spanish-speaking Hispanic patients. The Introduction (Chapter 1), included the problem and purpose; Literature Review (Chapter 2), analyzed supporting literature; Methodology (Chapter 3), described data process; Results (Chapter 4), reported the findings; and Conclusions and Recommendations (Chapter 5), included the decision. Spanish-speaking Hispanics in the study had more trust in Spanish-speaking Hispanic physicians than in non-Hispanic physicians who did not speak Spanish. More studies should include Spanish-speaking Hispanics and focus on differences in acculturation and the patient-physician relationship.Item Are Patients Satisfied with Care in the Veterans Health Administration System?(2007-10-01) Budzi, Dorothy F.; Lurie, Sue; Singh, Karan; Stimpson, JimBudzi, Dorothy F., Are Patients Satisfied with Care in the Veterans Health Administration System? Doctor or Public Health (Social and Behavioral Sciences), October 2007, 152 pp, 9 tables, 66 figures, 107 reference, 45 titles. Over 5 million men and women of the U.S. armed forces receive care from the Veterans Affairs healthcare system. The Veterans Health Administration (VHA) is the largest healthcare system and the single largest employer of physician assistants (PAs) and nurse practitioners (NPs) in the United States. Research question: This study asks the question whether the utilization of PAs and NPs in the VHA is a satisfying experience for the patients. Methods: The study analyzed outpatient Survey of Healthcare Experiences of Patients (SHEP), a monthly survey that measures patient satisfaction with the VA healthcare system. Returned surveys of patients who completed their visits at VHA outpatient clinics, acute care centers, and primary care centers across the nation in 2002-2006 were analyzed to explain patients’ satisfaction with PAs, NPs, and physicians. Samplings: Of the 2,164,559 questionnaires that were mailed to patients, 1,601,828 were returned (response rate= 64%, P-value=.05, confidence interval=95%, margin of error +/-2.2). A difference of four or more points is statistically greater than could be caused by sampling error. Secondary data on primary care patient satisfaction scores per Veterans Integrated Network Service (VISN) and facility was analyzed, and compared with provider type ratio per VISN and per facility. Results: the study found that the utilization of non-physician clinicians such as PAs and NPs in the VHA system was a satisfying experience for patients. In certain VISNs, patient satisfaction scores increased by 5% when the number of non-physician clinicians (NPC) was increased compared to 1.8% when the number of physicians was increased. Physician to PA/NP ratio was 7:3, and majority of the primary care providers were male while most of the NPs were female. The dominant age group of the providers was 45-54 years of age. Considering veteran status, PA veteran and non-veteran were 50:50, NP veterans approximately 65%, NP non-veterans 45%, and physician veterans 20% to 80% non-veterans. The information gained from this research may permit the administrators to develop plans and adjustments that foster quality healthcare services.Item Differences in the Rates of Cardiovasular Surgical Procedures in Men and Women with Coronary Heart Disease in the State of Texas(2003-02-01) Moreland, Matthew C.; Marshall, Muriel; Mains, Doug A.Moreland, Mathew, Differences in the rates of cardiovascular surgical procedures between men and women with coronary heart disease in the state of Texas. University of North Texas Health Science Center, School of Public Health, February 2003, 19pp., 3 tables, references, 23 titles. Data for the Texas Health Care Information Council was analyzed to identify the difference in the rates of invasive cardiovascular procedures performed on men and women among 411 Texas hospitals with the diagnosis of coronary heart disease in 1999. In all, 150,361 cases were compared for differences between gender, race, age and type of invasive cardiovascular procedure using chi-square test. Frequencies were tabulated for age, race and gender. Invasive cardiac procedures were differentiated by type: coronary angiography and coronary revascularization. Between the ages of 45 and 79 women were more likely to have angiography performed than men in the same age group. However, young (30-44) and elderly (80+) men were more likely to receive angiographic procedures when presenting with the same symptoms as women. Also, men of all ages and races were more likely to receive revascularization procedures (PTCA, CABG) than women when presenting with coronary heart disease symptomology. Additionally, men between the ages of 35 and 49 received twice the number of revascularization procedures than women. These findings identified patterns of treatment with defined differences between gender which may be attributed to external factors versus a true gender bias.Item Ethnic Differences in the Distribution of Factors Associated with Obesity in Children(2002-08-01) Ahmad, Naveed; Bayona, Manuel; Urrutia-Rojas, XimenaAhmad, Naveed M.D., Ethnic Differences in the Distribution of Factors Associated with Obesity in Children. Masters of Public Health (Biostatistics), August 2002, 31 pp., 6 tables, 1 illustration, references, 24 titles. Childhood obesity has risen dramatically during the last few decades and the factors associated with it vary for different ethnicities. The purpose of this study is to find ethnic differences in the distribution of factors associated with obesity in children. The data used in this study was collected in a school-based study of 1,076 school children in Fort Worth, Texas. Obesity was found to be more prevalent in Hispanics and African Americans than in Caucasians. Reported factors associated with childhood obesity, that were more prevalent in Hispanics were: eating more sweets and less vegetables, not doing regular daily exercise and watching more TV. In African Americans children the more common correlates of obesity were: reported eating more sweets, fewer fruits, watching more TV, and not doing daily exercise. For Caucasians reported correlates of obesity were: eating more chips, and being less involved in active sports, when compared to African American and Hispanic children.Item Hispanic Female Adolescents at Risk for Suicide and the Use of Illicit Drugs(2006-10-01) Luncheon, CecilyLuncheon, Cecily. M.D., M.P.H. Hispanic Female Adolescents at Risk for Suicide and the Use of Illicit Drugs. Doctor of Public Health, Fall 2006, 88 p.p., 31 tables, bibliography, 77 titles. This study examines the hypothesis that Latina adolescents in high school who were at risk for suicide are more likely to use illicit drugs than Non-Latinas in high school who are at risk for suicide. Data was analyzed from the 2003 Centers for Disease Control and Prevention Youth Risk Behavioral Survey. A national sample of 9th-12th grades students participated in a self-administrated questionnaire at school. The study who conducted based on 6,826 Hispanic/Latinas, black, non-Hispanic and white, non-Hispanic female adolescents. Three at risk for suicide, nine frequent illicit drugs and three controlling variables were chosen to conduct the study. Chi-square test assessed the significant of difference between races and binary logistic regression models were utilized to estimate the association between at risk for suicide and drug use. Among the three race/ethnicities who were at risk for suicide, Hispanic/Latinas had the highest drug use prevalence. The first logistic regression model that seriously consider attempting suicide were associated with Latinas (OR= 1/0.68 [95% CI, 1/0.53-1/0/87]), suburban youth (1.28 [1.02-1.63]), marijuana (1.79 [1.49-2.16]), inhalants (2.58 [1/46-3.28]), and steroids without MD’s prescription (1.98 [1.32-2.99]). The second logistic regression model established that those who made a suicide plan were associated with Latinas (OR=1/0.66 [95% CI, 1/0.48-1/0.91]), marijuana (1.40 [1.00-1.95]), inhalants (3.18 [2.05-3.79]), methamphetamines (2.21 [1.42-3.76]), and used a needle to inject any illegal drug (4.24 [1.29-12.66]). While the third logistic regression model found that attempted suicide were associated with Latinas (OR= 1/0.67 [95% CI, 1/0.48-1/0.94]), 11th and 12th grades (0.66 [0.46-0.94]) and (0.40 [0.27-0.60]), marijuana 2.50 [1.99-3.16]), cocaine (1.67 [1.09-2.58]), inhalants (2.69 [1.89-3.82]), methamphetamines, taken steroids without MD’s prescription (1.95 [1.12-3.40]) and used a needle to inject any illegal drug (4.30 [1.16-15.87]). Greater awareness about the physical and mental health status of Latinas are needed to ensure that good mental health programs are available for Latina adolescents.Item Is There a Relationship Between Impulsiveness, Risk Perception, Alcohol Problems, Race/Ethnicity, and Alcohol-Related Injury Type?(2006-05-01) Hamann, Cara; Cardarelli, Kathryn; Field, Craig; Fischbach, LoriThis cross-sectional study examined the associations between impulsiveness, risk perception, alcohol problems, race/ethnicity and alcohol-related intentional injury of 1504 White, Black, and Hispanic trauma patients from the emergency department at a Level 1 Trauma center in Dallas, Texas. After controlling for race/ethnicity, age, gender, education, marital status, drug use, and annual frequency of heavy drinking, injury-related alcohol problems within the past 12 months (OR= 1.10, 95% CI 1.02-1.18) had a moderate effect on intentional injury. Impulsiveness (total score, motor, and non-planning) and alcohol problems (total score, physical, interpersonal, social responsibility, and injury) had moderate effects on intentional injury in univariate analyses, but these effects became null in multivariate analyses. Race/ethnicity had a large effect on injury type in all models considered in the study, with Blacks (estimated ORs ranged from 3.06 to 3.54, 95% CIs ranged from 2.08 to 5.18) and Hispanics (estimated ORs ranged from 2.29 to 2.47, 95% CIs ranged from 1.61 to 3.52) having greater odds of intentional in jury in comparison to Whites in univariate and multivariate analyses. Overall, race/ethnicity and injury-related alcohol problems were the only variable of interest that showed effects on intentional injury. Lack of significant results may be partially explained the use of ICD-9 codes to categorize injury type. Future studies should address limitations and alternatives of using ICD-9 codes to evaluate psychological and behavioral factors.Item Osteopathic Physicians in Primary Care, Texas 2003(2003-12-01) Miller, Thaddeus L.; Roderick Hooker; Doug A. MainsMiller, Thaddeus L., Osteopathic Physicians in Primary Care, Texas, 2003. Master of Public Health (Health Management and Policy), December 2003, 62 pp., 11 tables, 4 illustrations, bibliography, 51 titles. Physician demographics were examined to determine if female osteopaths differ in choice of practice specialty and location in Texas. Taken relative to gender and medical degree type female osteopaths have the highest rate of primary care practice, with over 70% engaged in family or general practice, internal medicine, or pediatrics. Female osteopaths have an odds ratio 4 times greater than other physicians to practice primary care. Female osteopaths are also 2.5 times likelier than female allopaths to practice rural primary care. Male osteopaths are 2.3 times likelier than other physicians to practice rural primary care. Primary care osteopaths are 1.4 times likelier to practice rural primary care than allopaths. Policy intended to produce primary or rural primary care physicians should encourage medical school candidates to consider osteopathy.Item Public Opinion of the Uninsured: Who Are They? Can They Get Care? Should Insurance be Publically Provided(2001-07-01) Miller, Rachel; Lykens, Kristine; Mains, Doug A.; Singh, KaranThe United States is at the pinnacle of medical expertise and exploration. Many people from around the world come here to receive that outstanding care. Unfortunately, many of our own citizens are unable to enjoy that same privilege. With mounting technological and research costs, Health Maintenance Organizations, State-funded health insurance, and federally funded programs, such as Medicaid, are struggling to meet the expanding numbers of uninsured. The public is the driving force behind the policy debate in this country, and the debate over the uninsured may be lacking some very important information. It was the aim of this study to evaluate the public’s view of the uninsured. Meta-analysis was used to evaluate three questions regarding the public’s opinions of the status of the uninsured in the country to better understand the true perception held.Item Recreational Justice and City Planning(2006-08-01) Romero, Ana; Lurie, SueRomero, Ana. Recreational Justice and City Planning. Master of Public Health (Environmental), August 2006, 70 pp., 14 tables, 3 illustrations, 4 maps, bibliography, 42 titles. Environmental justice has been defined by the unfairly exposure of minorities to hazardous materials, in this study we consider another aspect of environmental justice by analysis de exposure of population to beneficial sources for the environment. Population living around 1 mile from the parks of the cities of Dallas, Plano, Midlothian and McKinney were analyzed base on descriptive statistics, compare of means among and within the city by an analysis of variance, and a distance prediction on demographics characteristic of race/ethnicity, age, economics, and education obtained from the U.S. census of 2000. Plano and Dallas have 98% and 97% population coverage; this resulted in statistical significant differences in all demographics McKinney and Midlothian reported less than 78% of coverage with only education as significant predictor of distance. Recreational justice does not substitute environmental justice; however it should be considered to evaluate this condition.Item Risk Factors for Childhood Asthma in the United States: A Cross-Sectional Study Based on NHANES 1999-2000 Data(2005-05-01) Alvarez-Garriga, Carolina; Sandhu, Raghbir; Cipher, Daisha; Rene, AntonioAlvarez-Garriga, Carolina, Risk Factors for Childhood Asthma in the United States: A Cross-Sectional Study Based on NHANES 1999-2000 Data. Doctor of Public Health (Epidemiology), May 2005, 114 pp., 18 tables, 4 figures, bibliography, 93 titles. The purpose of this study was to identify and assess risk factors for childhood asthma. A total of 158 asthmatics were compared to 1,104 non-asthmatics regarding selected factors by using the multiple logistic regression adjusted odds ratio as a measure of association. A 2.3 times higher prevalence (13.8 per 100) was found for the U.S. than that reported in the previous national surveys (NHANES III) during 1994 (5.9 per 100). Males and all race/ethnic minorities showed higher probability to have asthma. Income was inversely related to having asthma, and, among other results, renting a house, low birthweight, hay fever, chickenpox, learning disabilities, ear infections, trouble seeing even with glasses, and not covered by private insurance had higher chance of having asthma. Childhood asthma is still alarmingly increasing, and results from this study about high-risk groups and modifiable factors can be used for public health interventions.Item The Relationship Between Adolescent Suicide and Income Inequality(2007-12-01) Harris, LauraleeHarris, Lauralee. The Relationship Between Adolescent Suicide and Income Inequality. Doctor of Public Health (Social and Behavioral), December 2007, 52 pp., 22 tables, 4 figures, references, 43 titles. Suicide is the third leading cause for adolescents in the United States. This study is an attempt to provide a tool for targeting suicide prevention efforts using measures of income inequality. Income inequality measurements included the Gini coefficient and housing value as a percent of median value of single family homes. The study included youth ages 13-21 who committed suicide in Tarrant County, Texas during a ten-year period. Analysis was conducted at the zip code level and included suicide rates, housing value, gender, ethnicity and age. Hypotheses were: there is a positive relationship between the Gini coefficient and suicide rates; there is a relationship between suicide and the median value of housing in the zip code; these relationships will be stronger for males than females. Results of regression analysis showed a positive linear relationship between the Gini coefficient and suicide, though it did not reach the .05 level of significance. The relationship was stronger for males than females. The relationship was stronger for Hispanics and Blacks than for Whites. Frequencies for the relationship between percent of median home value and suicide indicated suicides clustering within 20% +/- of the median for the zip code. Analyses of variance did not show a relationship between percent of median home value and age, gender or ethnicity. These findings do not support the use of Gini coefficient as a predictor for adolescent suicide, but do provide some support for focusing prevention efforts on youth who are near the median income within their zip code. Recommendations are made for further research into the relationship of adolescent suicide and income inequality and for strategies to minimize the effects of relative deprivation.Item Unmet Health Care Needs Stratified by Socioeconomic Status: Results of the National Survey of Children with Special Health Care Needs(2006-12-01) Fulda, Kimberly G.; Lykens, Kristine; Singh, Karan; Bae, SejongFulda, Kimberly G., Unmet Health Care Needs Stratified by Socioeconomic Status: Results of the National Survey of Children with Special Health Care Needs. Doctor of Public Health (Clinical Research), December 2006, 200 pp., 15 tables, 4 figures, references, 73 titles. The purpose of this research study was to identify factors that affect unmet health care needs for children with special health care needs (CSHCN) and to identify how these factors vary by socioeconomic status. Data were obtained from an already existing publicly available database from the National Survey of Children with Special Health Care Needs, 2000-2002, available through the Centers for Disease Control and Prevention. Approximately 750 CSHCN from each of the 50 states and the District of Columbia were included. Survey data represented parent responses on health care and health care needs for CSHCN. Responses for 38,866 CSHCN up to 17 years of age were included in the analysis. Four hypotheses were tested: having received all needed routine, preventive care; having received all needed care from a specialist; having received all needed mental health care or counseling; and having received comprehensive, coordinated care in a medical home. Within each of the four hypotheses, four models were presented for socioeconomic status (SES): [less than] 133% of the federal poverty level (FPL); 133-199% of the FPL, 200-299$ of the FPL, and ≥ 300% of the FPL. Age, severity of the CSHCN’s condition, sex, race, ethnicity, maternal education, insurance status / type, geographical region of the household, relationship of the respondent to the CSHCN, the total number of adults in the household, and the total number of kids in the household were all significant predictors of having received all needed care in at least one SES stratum for the four hypotheses. Analyses revealed there are disparities among SES strata for unmet health care needs for CSHCN.Item Variation in Hospital Utilization for Cardiovascular Surgical Procedures in Texas(2007-12-01) Kunte, Parag S.; Sejong Bae; Nuha Lackan; Karan SinghKunte Parag S., Variation in Hospital Utilization for Cardiovascular Surgical Procedures in Texas. Master of Public Health (Clinical Research), December 2007, 45 pp., 5 tables, references, 39 titles. Racial and ethnic differences in hospital utilization for cardiovascular surgeries have been studied for many years, but most of this research is limited to the Medicare or veteran population. The present study extends to the wider Tecas population including all insurance types, and includes non-Hispanic whites, non-Hispanic blacks, Hispanics, and others. This retrospective cross-sectional study examines racial/ethnic differences in the utilization of cardiac procedures. Results suggest that racial and ethnic differences in the utilization of cardiac procedures exist in Texas and are observed across all types of insurance.