General Public Health
Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/21737
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Item 1,2,4-Trimethylbenzene (Pseudocumene) Formation of Photochemical Smog and Contribution to Atmospheric Greenhouse Gases (GHGs)(2015-03) Patel, Devang A.; Rich, Alisa A.Objective: To examine 1,2,4-Trimethylbenzene’s contribution to photochemical smog and affect cardiac and pulmonary disease. Introduction: 1,2,4-Trimethylbenzene, a chemical derivative of benzene, is an industrial solvent and easily volatilizes to the atmosphere. In the presence of other VOCs, it was found to contribute to formation of photochemical smog. Photochemical smog is known to exacerbate respiratory conditions, including asthma and may contribute to cardiac and pulmonary disease. This study examined 1,2,4-Trimethylbenzene in hydraulic fracturing fluids and produced water and its ability to contribute to atmospheric levels of GHGs and photochemical smog. Methods and Materials: A meta-analysis was performed and articles related to1,2,4-Trimethylbenzene evaluated. Databases searched include PubMed, Scopus, Web of Science, TOXNET and Science direct. Keywords 1,2,4-Trimethylbenzene, pseudocumene, Trimethylbenzene, atmospheric conversion, atmospheric degradation/reaction, hydraulic fracturing, and health effects. Published article dates ranged from 1994 – 2011. Inclusion criteria were chemical properties of 1,2,4-Trimethylbenzene, atmospheric degradation and reaction, and atmospheric sustainability, and health effects. Exclusion criteria were articles related to 1,2,4-Trimethylbenzene and water pollution, and animal toxicology studies. Articles meeting inclusion criteria were retrieved as full-text and examined. Results: This study confirmed high concentrations of 1,2,4-Trimethylbenzene in hydraulic fracturing fluids and produced water, and ability to aerosolize to the atmosphere from water and soil. Degradation of 1,2,4-TMB in the atmosphere by reactions with hydroxyl radicals are an indirect contributor to atmospheric GHG levels from hydroxyl radical scavenging, and may contribute to local/regional climate change. Slow atmospheric conversion of 1,2,4-TMB in the presence of ozone was found to occur with a half -life of more than 24 years, making it a candidate for long-range transportation. Conclusion: 1,2,4-Trimethylbenzene may be present in tanks and ponds in areas where hydraulic fracturing is occurring. The general public in close contact with these tanks and ponds may be exposed to 1,2,4-Trimethylbenzene in air and may experience adverse health effects.Item A Qualitative Analysis on the Effects of Social Support among Women of the Reentry Population(2015-03) Cantu, Katherine; Spence-Almaguer, Emily; Rohr, Danielle; Chhetri, ShlesmaPurpose: Promotion of positive social support through family reunification and mentorship through the Second Chance Mentoring (SCM) program reduces risk of recidivism among moderate-to-high risk incarcerated women. Methods: The SCM program is offered through a collaboration between Family Pathfinders and three partner organizations in Tarrant County. SCM provides assistance to women who have been incarcerated to support their successful reintegration in to the community. Information is collected during incarceration to determine the recidivism risk level using the Ohio Risk Assessment Scale (ORAS) scores. Participants are enrolled in 12 months of mentoring services upon their release from prison or jail. Post-release, Family Pathfinders uses progress notes to monitor SCM service activities and other information which may contribute to reentry success or failure. These progress notes were analyzed by the evaluation team at UNTHSC to code for different types and levels of support which may promote or reduce recidivism among women. Results: The initial analysis of a sample size made of 50 women indicates that those who actively engage in a mentoring relationship are more likely to seek assistance elsewhere in order to promote successful reentry. Women who have support of negative influences have more issues becoming self-sufficient and set minimal goals for behavior change by the end of the 12 month program. Conclusions: A mentoring relationship with women who pose a high risk of recidivism upon release provides a foundation for building additional supportive relationships. Ensuring a reliable support system to incarcerated women may increase the effectiveness of successful community reintegration.Item Adaptation of the CDC Evaluation Framework to Design the Evaluation of Reaching Teens, a Multi-Institutional, Region Wide Teen Resiliency Training Program(2015-03) Homan, Sharon; Spence-Almaguer, Emily; Gonzalez-Pons, KwynnPurpose: Mental Health Connection of Tarrant County (MHC) is a collaboration of public and private agencies working together to revolutionize the mental health service delivery system in Tarrant County, Texas. MHC is partnering with the American Academy of Pediatrics (AAP) on a multi-institutional region‐wide staff training program. This program, Reaching Teens, uses the teen resiliency curricula developed by Dr. Kenneth Ginsburg, a pediatrician specializing in Adolescent Medicine. The goals of reaching Teens are to develop a trauma‐informed workforce, improve system integration and increase the use of evidence-informed practices in youth behavioral care in Tarrant County. Our research purpose was to adopt the Centers for Disease Control and Prevention (CDC) evaluation framework to planning the evaluation of Reaching Teens. The CDC evaluation framework engages stakeholders in the evaluation with the goal of stimulating innovation that leads to improving outcomes and detecting program effects. Methods: We engaged agency stakeholders (Step 1), described the program using a logic model (Step 2), and focused the evaluation design on the issues most important to MHC and the organizational partners (Step 3). We conducted a baseline assessment of knowledge, attitudes and beliefs about teen resiliency and approaches for successfully working with adolescents in the mental health system. Results: Our results consist of: (1) a logic model and (2) baseline survey findings. The Reaching Teens logic model is a roadmap to guide the ongoing planning, program activities and evaluation. With stakeholders, we prioritized three program components: (1) staff development; (2) organizational capacity building; and (3) system‐wide collaboration. We identified key program outcomes: (1) engaging youth; (2) boundary-setting; (3) trauma-informed care; (4) commitment to “care” factor; (5) strengths-focussed; (6) resiliency; (7) job satisfaction; (8) system recognized for effective communication with youth; and (9) decreased turnover. Key baseline survey findings (n=438 staff participants from 15 agencies) are: high levels of job satisfaction (4.2 - 4.5, 5-point scale), congruence of personal and organizational values (3.3 - 4.0, 5-point scale), average teamwork in workplace (3.4 - 4.0, 5-point scale). Conclusion: The Reaching Teens logic model is a powerful tool to guide system-wide collaboration toward the goal of more effectively reaching adolescents in mental health care. There are three program components: staff development, building organizational capacity, and strengthening system-wide collaboration. Baseline levels of the outcome measures (job satisfaction, teamwork, and value congruity) are relatively high among participating staff; thus, it may be difficult to demonstrate program impact by increasing these scores post-intervention.Item Adverse Child Experiences and Their Effects on Child Behavior and Mental Health(2015-03) Pulvino, Steven; Mbise-Floyd, Lilian; Patel, Neha; Patel, Tarang; Davis, Ann; Homan, SharonBackground: The association between Adverse Child Exposures (ACEs) and risk for child mental health outcomes such as depression, anxiety problems, and behavior/conduct problems has not been thoroughly investigated for three age groups - ages 6 to 10 (elementary school), ages 11 to 13 (middle school), and ages 14 to 17 (high school). We examined the relationship of these three mental health outcomes with a variety of ACEs among children 6 to 17 years old. We also examined the prevalence of ACEs for each mental health outcome in order to better understand the nature of any influential exposures. Methods: National Survey of Children’s Health 2011-2012 dataset was used to investigate nine ACEs: socioeconomic hardship, divorce/separation of parent, death of a parent, parent served time in jail, witness to domestic violence, victim of neighborhood violence, lived with someone who was mentally ill or suicidal, lived with someone with an alcohol/drug problem, and treated or judged unfairly due to race/ethnicity. Total number of ACE exposures were categorized cumulatively into 5 classes: 0, 1, 2, 3, ≥4. They were then compared with the three child mental health outcomes: depression, anxiety problems, and behavior/conduct problems. Results: A dose response relationship was observed between each of the child mental health outcomes and the number of ACEs for the full model (where age groups are included as a co-variable). The odds for depression in the full model increases by 2.59, 3.08, 6.24, and 9.66 for those exposed to 1, 2, 3, or 4 or more ACEs respectively, when compared to those who had not been exposed to an ACE. Children with 1, 2, 3, or 4 or more ACEs were 2.01, 2.28, 2.88, and 5.45 times more likely to have anxiety problems, respectively. Children with 1, 2, 3, or 4 or more ACEs were 3.21, 3.80, 6.96, and 10.51 times more likely to have behavior/conduct problems, respectively. Conclusion: A dose response relationship was observed between the number of ACEs and risk of developing each of the examined child mental health outcomes (depression, anxiety problems, and behavior/conduct problems). Further examination of relationships between specific ACEs and the chosen mental health outcomes may help researchers identify significant or influential combinations of ACE risk factors.Item An Analysis of the Second Chance Mentoring Program among Female Offenders(2015-03) Cantu, Katherine; Spence-Almaguer, Emily; Rohr, Danielle; Chhetri, ShlesmaPurpose: To assess the effectiveness of the Second Chance Mentoring (SCM) program, which works to reduce the rate of recidivism among moderate-to-high risk incarcerated women. Methods: The SCM program offered through collaboration between Family Pathfinders and Cornerstone Assistance Network of Tarrant County provides assistance to successfully reintegrate incarcerated women into the community. Information is collected during the incarceration to determine the recidivism risk level using the Ohio Risk Assessment Scale (ORAS) scores. Participants are enrolled in 12 months of mentoring services with a matched mentor upon their release from prison. Post-release, data is submitted to Family Pathfinders on a regular basis by the mentors and agency. The participants are deemed successful if one does not recidivate, meaning the individual is not arrested and incarcerated on new charges within 12 months of their release from their most recent incarceration. Upon successful completion of SCM, data of the participants is collected from the Texas Criminal Justice system to obtain background information in the justice system. Results: Complete data profiles for the initial cohort were used. Of the 50 women who expressed some interest in the program, 29 complete profiles were provided between the justice system and community partners. These were then further investigated for successful and unsuccessful completion. Findings indicate that middle-aged women without the equivalent of a high-school diploma were more likely to be unsuccessful than compared to middle-aged women with a diploma/GED. Of those who were unsuccessful, 55% reported not having a place to live upon their release, where 89% of the successful women did have a place to live. Findings also suggest that the mentor relationship does contribute to less recidivism when 30% of those who were unsuccessful were not yet matched with a mentor before recidivating. Conclusions: The Second Chance Mentoring program provides sufficient support to reduce the risk of recidivism among moderate-to-high risk women. The promotion of social capital and encouragement to continue education through SCM allows for a successful reentry into the community.Item Areas for improvement to further reduce malaria burden in sub-Saharan Africa?(2015-03) Lee, Ju Sung; Tak, Hyo Jung; Lee, Joon-HakIn 2012, sub-Saharan African countries account for 80% of all malaria cases worldwide. Malaria hampers their development both socially and economically. Global efforts to control malaria in sub-Saharan Africa have been placed in the past. In particular, since 2005, funding for Malaria control has increased dramatically.However, little is known about malaria incidence and mortality rate among sub-Saharan African countries overall. Only few studies investigated, and focused on a few countries in sub-Saharan Africa with limited attributing factors. We expect that national level operational intervention, malaria funding, and economic factors would be associated with reduction of malaria incidence and mortality. Our objectives are to assess progress of malaria control in sub-Saharan Africa overall and associated factors with malaria control. With data between 2005 and 2013 from World Malaria Reports and The World Bank, a dataset was constructed to associate reduction of malaria incidence and mortality rate with national economic factors, malaria funding, and malaria operational interventions. General Liner Model was used for the statistical analyses. Malaria incidence rate was inversely associated with GDP per capita (AME = -0.267, p-value = 0.004), but was positively associated with foreign aid per capita (AME = 0.158, p-value = 0.013)and ACT treatment courses delivered (AME = 0.069, p-value = 0.000). Malaria mortality rate was positively associated with foreign aid per capita (AME = 0.017, p-value = 0.016) and with increased number of ACT treatment courses delivered (AME = 0.073, p-value = 0.004). Increase of ODA per capita was associated with increase of distributed number of ITN/LLIN (AME = 6.601, p-value = 0.006). IRS (AME = 9.421, p-value = 0.001), and ACT (AME = 6.84, p-value = 0.064). In addition, increase of foreign aid per capita was positively associated with distributed number of IRS (AME = 4.070, p-value = 0.00). Economic growth and internal funding increase should be pursued for sustainable malaria control. Careful attention to utilizing operational intervention effectively and adequate education of its utilization is required. As the complicated malaria control can be achieved by multiple efforts, systematic strategies including education, operational management, adequate infrastructure, and cooperation between organizations should be taken into account.Item Associations between socioeconomic and demographic characteristics of ZIP codes and the availability of tobacco products(2015-03) Patel, Devang A.; Killion, Jordan; Gonzalez Pons, Kwynn; Rossheim, Matthew E.Objective: To examine associations between tobacco product availability and demographic and socioeconomic characteristics in ZIP codes. Introduction: The awareness of e-cigarette use has been increasing in U.S. population since its introduction in market. Research supports that female gender, less education population, lower income, and racial and ethnic minority status are associated with electronic cigarette use. It is important to understand the strategies employed by the cigarette retailers to attract the users in order to understand these disparities in use. Methods and Materials: We constructed a database using a variety of data sources. Demographic and economic data were obtained from the U.S. Census Bureau’s 2008-2012 American Community Survey 5-Year Estimates. Data on number of licensed tobacco retailers was identified retrieved from appropriate government agency within each state. Data on electronic cigarette retail availability was gathered from websites maintained by manufacturers. Results: Regression models were constructed to examine associations between the retail availability of tobacco products and the socioeconomic and demographic characteristics of ZIP codes. A number of socioeconomic and demographic variables were associated with the number of tobacco outlets, after adjusting for population size of ZIP codes. Conclusion: Understanding the geographic distribution of tobacco and electronic cigarette retailers is important to develop effective policies to control use and reduce/eliminate health disparities. To the investigators’ knowledge, this is the first known study to examine the retail availability of electronic cigarettes by the demographic and socioeconomic characteristics of populations.Item Concentration of Volatile Organic Compounds in Urban Cities Compared to Urban Areas Experiencing Natural Gas Extraction and Processing(2015-03) Shah, Ruchita P.; Shah, Mansi; Rich, AlisaObjective: The objective is to compare atmospheric concentrations of volatile organic compounds in urban areas of natural gas extraction as compared to areas without natural gas extraction. Introduction: Expansion of unconventional shale gas extraction and processing over the last decade has progressed significantly across the United States. Environmental concerns for what affect this energy expansion is having on air quality have been of great concern to many communities. Many of the VOCs present in natural gas and present in chemicals used in hydraulic fracturing are contributors to atmospheric greenhouse gas (GHG) levels and hazardous air pollutants (HAPs). Exposure to GHGs and HAPs are known to be a major factor in respiratory illnesses in humans. In this research, atmospheric volatile organic compound concentrations were compared in areas experiencing natural gas extraction and processing with urban area VOC concentrations. Material and Methods:Relevant articles were identified by a systematic search of reliable databases. Due to lack of literature for comparison of VOCs, all the study designs were included. Having difference in measurement unit, all the readings in different studies were converted to one common unit and compounds were compared. Results: Methodology of ambient air monitoring varied considerably from locations. Among analysis of over 100 concentrations, only 7 compounds were collected in urban studies which include Acetone, Benzene, Chloroform, 1, 2 dichloroethane, Ethylbenzene, Tetrachloroethane and Styrene. Concentration of VOCs was found to be 70% higher in urban areas experiencing natural gas extraction. Conclusion: VOCs are found to be higher due to natural gas extraction process in urban areas. Greenhouse and HAPS are pervasive and responsible for adverse health and environmental effects. Our future studies are focused on consistent monitoring of HAPS and other chemicals.Item Determining Effective Collection and Identification Measures of Estradiol in African-American Women(2015-03) Askew, Jasmun; Dodgen, Leilani; Kitzman-Ulrich, HeatherPurpose: Estrogen is important for overall health and reproduction, and has been linked to obesity. Currently, estrogen is time and cost intensive to measure. The purpose of this research was to establish a more cost-effective way to measure estradiol in community based settings, and to determine a methodology for collection and identification of peak estradiol levels. Methods: Four saliva samples, medication information, and previous menstrual cycle history from 61 premenopausal and postmenopausal African-American women were collected over a 4-6 week time period. The saliva samples were analyzed by an independent laboratory to identify levels of estradiol (E2). A primary sample was defined as the sample that was collected on or most closely aligned with day 13 of the menstrual cycle when estradiol peaks. A secondary sample was identified if a primary sample was not aligned with day 13 of the menstrual cycle. The secondary sample was determined by projecting the next menstrual cycle period. A secondary sample and the average of all samples were calculated to determine the best method for identifying peak estradiol levels. Results: Using this protocol, for the premenopausal subjects, 56.3% of their primary samples were equal to their peak estradiol sample, and 37.5% of their average estradiol samples were equal to their peak sample. Only 6.3% of the participants’ secondary samples were equal to their peak level. For the postmenopausal women, 73.9% of the participants’ average samples were equal to or ≤ .03 of their peak estradiol sample. Conclusion: This data suggests that this modified protocol demonstrates preliminary ability to identify peak estradiol levels in a community setting in a cost-effective and time efficient manner.Objective: To examine the presence of ethyl benzene (EB) in ambient air in residential areas experiencing natural gas extraction and processing (E&P) and identify potential health impacts. Background: Residential communities affected by “urban drilling” have raised concerns about potential health effects from exposure to toxic chemicals. This study examines ethyl benzene (EB) in ambient air in residential communities experiencing E&P operations and potential health impacts from EB exposure. Natural gas processing occurring at pad sites located in residential areas were identified as potential sources of EB emissions. Methodology: A meta-analysis was performed and articles related to health effects from EB exposure evaluated. Databases searched included: Pub-Med, Scopus, Science direct and TOXLINE. Keywords were ethyl benzene, health effects, occupational exposure, natural gas and ambient air. Initially, 500 articles on the health effects of EB were selected. Publication dates ranged from 1967 to 2014. Inclusion criteria were occupational exposure, health effects, ambient air and toxicological animal studies. Exclusion criteria were soil and groundwater contamination, and EB exposure from other sources like cigarette smoke. Retrieved abstracts were evaluated for relation to study focus. Fifty articles were selected and reviewed as full text. Results: Occupational studies of EB exposed workers in natural gas and petrochemical industries, confirmed multi-system toxic effects. Animal studies supported the findings. Adverse health effects included respiratory, cardiovascular, reproductive, hematologic, digestive/liver, excretory and endocrine impairment. Ambient air monitoring studies confirmed elevated levels of EB in residential communities experiencing urban drilling. Conclusion: Communities where natural gas E&P operations are occurring may experience occupational-like exposure to EB and elevated risk of adverse health effect when compared to other areas. Current literature on health effects from EB exposure is lacking and limited to occupational studies. Future studies examining occupational-like EB exposures in residential communities experiencing urban drilling are recommended.Item Effects of Maternal Health on Child Utilization of Dental Care among Medicaid and CHIP Participants: Results from the 2011-2012 National Survey of Children's Health (NSCH)(2015-03) Patel, Devang A.; Sadath, Mohammad; Deen, Briar; Rendon, Alexis; Lueke, Mark; Davis, Ann; Homan, SharonIntroduction: Understanding the preventive dental health care utilization of children is essential to reducing child dental disease rates in low income families. Previous studies have not examined the relationship between the mother’s health status and the child’s dental care utilization. The aim of this study is to examine the association between maternal health status and use of preventive dental care among children enrolled in Medicaid and CHIP programs. Methods: We conducted a cross sectional study of children enrolled in Medicaid and CHIP programs. A sample of 88,460 children was obtained from the 2011-2012 National Survey of Children’s Health (NSCH). We used multivariable logistic regression modeling (SAS 9.3) to estimate the adjusted odds ratio for having at least one dental visit in the past 12 months associated with self-reported maternal health. We statistically adjusted for child’s age, sex, maternal education, family structure, and parental satisfaction with the child’s health care provider. Results: Our key result is that children of mothers with excellent or very good health were 2.48 times more likely (95% CI 1.41-4.38) to have visited the dentist in the last year as compared to children of mothers with poor general health. There was a 45% reduction in access to dental health care when maternal health status decreased from excellent or very good status to good or fair health status. Conclusion: Our findings suggest that poor maternal health status decreases the likelihood that children will have an annual dental visit. Preventive dental outreach efforts and programs are needed to target these children.Item Electronic Goal Reminders and Subsequent Substance Use and Treatment Initiation in Probationers(2015-03) Spohr, Stephanie A.; Walters, Scott; Taxman, FayeObjective: The opportunities to influence behavior through the use of electronic goal reminders have not been examined in a criminal justice population. The purpose of this study was to assess probationer preferences for short-term goals from a web-based program and evaluate the role of voluntary electronic reminders (e.g., text messaging, email) in achieving early treatment and probation tasks. Methods: We used data from drug-involved offenders (n=76) participating in a clinical trial of a 2-session motivational computer program. As part of the program, participants could choose to receive text or email reminders about their probation and treatment goals for the next month. Poisson regression models were utilized to evaluate goal and reminder selection in relation to days of substance use and days of treatment attendance at two months. Results: The most common goals were related to treatment, probation, relationships, and reappraisal. Forty-five percent of probationers elected to receive electronic goal reminders at Visit 1 with a slight increase at Visit 2 (49%). Probationers who opted to receive electronic goal reminders at Visit 1 selected significantly more goals on average (M = 4.4, SD = 2.1) than probationers who did not want reminders (M = 3.4, SD = 1.8), (t = 2.41, p = .019). Reminder selection and total number of goals selected significantly predicted days of substance use and treatment attendance at two month follow-up. Probationers who opted not to receive electronic reminders and those who only selected to receive reminders at one visit had more days of substance use compared to those who received reminders at both visits, 1.66 and 2.31 times respectively. Probationers who chose not to receive electronic reminders attended 56% fewer days of treatment compared to those who received reminders at both visits. Conclusions: People’s choice of short-term goals and reminders can provide advance notification of the likelihood of substance use and treatment initiation. Probation systems might use such information to triage probationers to a higher level of service, before problems have emerged.Item Ethyl Benzene (EB) Exposure and Potential Health Effects From Natural Gas Extraction in Urban Areas (Urban Drilling)(2015-03) Ilouga, Obioma I.; Osunkoya, Oluwafunlayo; Rich, Alisa L.Objective: To examine the presence of ethyl benzene (EB) in ambient air in residential areas experiencing natural gas extraction and processing (E&P) and identify potential health impacts. Background: Residential communities affected by “urban drilling” have raised concerns about potential health effects from exposure to toxic chemicals. This study examines ethyl benzene (EB) in ambient air in residential communities experiencing E&P operations and potential health impacts from EB exposure. Natural gas processing occurring at pad sites located in residential areas were identified as potential sources of EB emissions. Methodology: A meta-analysis was performed and articles related to health effects from EB exposure evaluated. Databases searched included: Pub-Med, Scopus, Science direct and TOXLINE. Keywords were ethyl benzene, health effects, occupational exposure, natural gas and ambient air. Initially, 500 articles on the health effects of EB were selected. Publication dates ranged from 1967 to 2014. Inclusion criteria were occupational exposure, health effects, ambient air and toxicological animal studies. Exclusion criteria were soil and groundwater contamination, and EB exposure from other sources like cigarette smoke. Retrieved abstracts were evaluated for relation to study focus. Fifty articles were selected and reviewed as full text. Results: Occupational studies of EB exposed workers in natural gas and petrochemical industries, confirmed multi-system toxic effects. Animal studies supported the findings. Adverse health effects included respiratory, cardiovascular, reproductive, hematologic, digestive/liver, excretory and endocrine impairment. Ambient air monitoring studies confirmed elevated levels of EB in residential communities experiencing urban drilling. Conclusion: Communities where natural gas E&P operations are occurring may experience occupational-like exposure to EB and elevated risk of adverse health effect when compared to other areas. Current literature on health effects from EB exposure is lacking and limited to occupational studies. Future studies examining occupational-like EB exposures in residential communities experiencing urban drilling are recommended.Item Family History Information in Dallas/Fort Worth: What We’re Not Telling Patients(2015-03) Gregorio, Dave; Cross, DeannaPurpose: Patients can be empowered to assess their own family health history (FHH) by providing accurate information that: (1) explains the importance of FHH in the context of heritable conditions and (2) outlines how to take an accurate FHH. The aim of this study is to assess the quality of information provided to patients regarding FHH prior to a clinical encounter in the Dallas/Fort Worth area. Methods: FHH information from local health organizations was collected throughout the Dallas/Fort Worth area. Information was included if published by a local health organization (or national organization with local offices) and FHH was discussed in the capacity of health risk assessment. The information was categorized based on source into the following groups: local electronic, national electronic, print, and health fair. Each source was further assessed for quality of information by a series of questions following the Genetics in Primary Care Institute (GPCI) guidelines for taking FHH and disease-specific questions based on familial risk guidelines. The percentage of positive “Yes” answers is tabulated for each category and assessment question. Results: A search for local information on FHH was conducted between June, 2014 and December, 2014. Information on FHH was provided by 48% (25/52) of outlets searched. 73 sources were included for analysis. 53% came from websites of local health organizations, 16% came from print resources, 11% came from health fairs, and 19% came from national health organizations. Of these sources, 22% were general FHH information and 88% were disease specific. Information from health fairs had the greatest proportion of guideline components (18.8%) and local electronic sources had the fewest components (12.4%). Printed information had a greater percentage of guideline components (15.5%) than electronic (14.6%). General FHH information was more likely to have guideline components (24.3%) than disease specific information. Conclusions: Difficulty in obtaining information on FHH was noted with less than half of potential resource sites providing FHH information. Few sources provided all components recommended by GPCI guidelines and differences in the quality of information between source categories (electronic vs. print) were found. Sharing FHH with a provider was only recommended 59% of the time. Here we have demonstrated a clear need for health organizations to provide FHH information to patients.Item Genetic Service Shortage Areas in the Mountain States Region: What Is Needed?(2015-03) Dokpesi, Philip; O'Meara, Stephanie; Jegede, Opeyemi; Kaye, Celia; Homan, SharonPurpose: The mission of the Mountain States Genetics Regional Collaborative (MSGRC) is to ensure access to exemplary genetic and newborn screening services in the eight states of the region (Arizona, Colorado, Montana, Nevada, New Mexico, Texas, Utah and Wyoming). The purpose of this research is to identify and map shortage areas for genetics services in the mountain states region. Methods: We mapped the Health Professional Shortage Areas (HPSAs) in MSGRC counties, using the HRSA-designated primary medical care shortage areas. We overlaid on this map the estimated number of birth defects in 2014, as a proxy for the pediatric caseload for geneticists. A contact list of all (53) genetics providers in the region was developed. Each provider organization was contacted to establish the number of physicians seeing genetics patients, genetics counselors, and patients, geographic practice area, and insurance types accepted. Results: Mapping birth defects and genetics providers is a useful method for estimating genetics services shortages, and geographically displaying areas of unmet need. There are genetics health shortage areas in multiple rural and frontier areas in the eight mountain states. Conclusion: The Mountain States have multiple genetics healthcare shortage regions. New advances in telegenetics may address some of these shortages, but it is expected that the rural and frontier areas will continue to have significant shortage areas.Item Geographic Disparity in Health Insurance(2015-03) Master, Hiral; Fulda, KimberlyPurpose: The purpose of this study is to identify factors associated with having adequate health insurance for children with special health care needs (CSHCN) differ by geographic region. Methods: The proposed analysis was conducted on the 2009-2010 databases of the NS-CSHCN using SAS which accounted for complex survey weighting and sampling design. The analysis included examining the overall distributions of variables using means and frequencies. Distributions of variables were examined for those who had any kind of health insurance and those who did not. Differences in whether having health insurance or not by region were analyzed using chi-square test and logistic regressions were performed. Odds ratios and 95% CIs were examined. Results: Out of total population, 10110 were insured for entire year while 919 were insured at some point during the year. Education level, family structure and financial condition of the family have significant effect on the insurance status of CSHCN. Based on chi square analysis, education level of the household had significant effect on insurance status of CSHCN in northeast and south and west region while family structure, number of missed school days of CSHCN, Family financial burden was significant for all region. Odds ratio obtained from logistic regression where individuals who were uninsured was used as reference. Thus, odds of having insurance were higher in individuals with higher education in all the regions. Odds of CSHCN being insured was significantly lesser in northeast, south for Hispanics while was significantly higher in west for blacks compared to white non- Hispanics. Odds of CSHCN being insured was significantly lesser in midwest, south in family consisted of only mother and was significantly lesser in northeast in family consisted of parent stepfamily when compared to either biological or adopted parents. Odds of CSHCN being insured was significantly higher in midwest if child’s problems never affected ability to do compared to those where their ability was usually affected. Odds of CSHCN being insured was significantly higher in midwest, northeast, south in family with no financial burden compared to who had financial burden. Conclusion: Policies should be directed to increase the educational awareness, focus on Hispanic groups for insurance, expand the insurance plans that will accommodate the families having financial burden.Item H. Pylori and Thyroid Hormone Levels: A Cross-sectional Study of Adults Participating in the National Health and Nutrition Examination Survey (NHANES III).(2015-03) Hall, Lauren; Felini, MarthaPurpose: Helicobacter pylori (H. Pylori) bacteria produce a strong inflammatory response in the body. It is hypothesized that strong immune responses to H.pylori can enhance systemic inflammation and produce an autoimmune response against the thyroid. Epidemiologic studies have assessed an association between H. pylori infection and autoimmune thyroid diseases, but with conflicting results and small study populations. Using a large, nationally representative US population, we investigated whether there is an observable association between H. pylori infection and levels of serum thyroid hormones (T4 and TSH) and anti-thyroglobulin antibodies. Methods: We analyzed cross-sectional data from the most recent National Health and Nutrition Examination Survey III (1988-1994) containing serum H. pylori and thyroid hormone levels. H. pylori infection status was determined by detection of antibodies. Chi-square and t-tests were used to assess differences by H. pylori status. Multivariable linear regression models were used to quantify the association between T4, TSH, and anti-thyroglobulin antibodies separately, while adjusting for age, sex, race/ethnicity, and BMI. Results: Among 5848 adults studied, the prevalence of H. Pylori infection was 32.8%. Mean T4, TSH, and anti-thyroglobulin antibodies differed by H.pylori status (p <0.05), but remained within the wide reference values. H. pylori infection was a significant predictor of higher T4 and anti-thyroglobulin antibodies, particularly in younger persons (<40 years of age). Conversely, a significant inverse association was observed for TSH. Similar differences were observed for the higher risk cytotoxin associated gene A H.pylori strain. Conclusions: Our findings suggest that H. pylori eradication may be important before abnormal thyroid levels can return to normal.Item Health Behavior Changes Among First Year Medical Students a Pre- and Post- Analysis(2015-03) Kalra, Kyle; Sori, Ermias; Castillo, Marisa; Stone, Chelsea; Trammell, Randall; Fulda, Kimberly; Smith, Michael L.Background: Entering medical students begin their journey into medicine with the desire of being a healthcare professional whose healthy habits serve as a model for their patients. In truth, the high stress of the academic environment of medical training makes students vulnerable to poor health behaviors. Research has shown that there is a correlation between high stress environments and poor health behaviors. This study is a follow-up to that research. Hypothesis: We hypothesized that first year medical students consumption of energy drinks is associated with less positive health behaviors upon reassessment during medical school. Methods: The study involved the administration via Qualtrics of two surveys to the Texas College of Osteopathic Medicine Class of 2018. The pre-survey, was distributed during the 3rd week of class which was completed by 135 students when there were no impending exams. The participation in the survey was voluntary, and the subjects were recruited by the following methods: announcement in class, announcement on social media, and announcement via email to the Class of 2018. The survey was re-administered during the last 2 weeks of the semester, and it was completed by 99 students. Data analyses of the two surveys only included the students who completed both surveys (n=49). To compare pre- and post- variables of typical hours per sleep in a 24-hour day, days per week exercised (≤2 days or ≥3 days), changes in reported GI symptoms, and whether the subject consumed energy drinks in the past month (yes or no), the nonparametric McNemar’s test was used. An alpha level of less than .05 was considered significant. The Perceived Stress Scale between pre- and post-measurement surveys were compared with a dependent sample T-test. Results: 63% of the students were male and 37% were females ranging from ages 22-41 with a mean age of 25.3+3.6. General trends included an increase in energy drink consumption, reported headaches/palpitations and GI symptoms, and decrease in sleep hours per day. Statistically, there was a significant increase in energy drink consumption (from 26.5% at pre-test to 42.9%, p=0.008), and an increase in gastrointestinal symptoms (from 16.3% at pre-test to 34.7%, p=0.012). Conclusion: An increase in energy drink consumption and gastrointestinal symptoms supports our hypothesis that first year medical students consumption of energy drinks is associated with less positive health behaviors.Item Health effects from Exposure to Benzene and Benzene Related Compounds in Residential Communities Experiencing Natural Gas Extraction and Processing Operations(2015-03) Orimoloye, Helen T.; Rich, AlisaAdvancement of natural gas extraction into urban areas across the United States has raised concern for a potential increase in exposure to volatile organic compounds, including air toxics, to the public. Benzene is a primary chemical of concern (COC) due to its classification as a known human carcinogen. Ambient air sampling performed in an earlier study found elevated levels of benzene and 17 benzene related compounds in residential areas where natural gas extraction and processing operations were occurring. Benzene is present in geologic rich formations and released during pyrolysis and venting of fuels. Drilling within city limits has increased the potential for human exposure. The evolution of this study began, as the health effects of exposure to natural gas well emissions are increasingly visible in our society. Study Objective: The main purpose of this study was to determine the health effects that results from exposure to benzene and benzene related compounds in residents of and workers in natural gas extraction sites; To also determine the routes of exposure and the distance that benzene can travel from the point source of generation, and to make recommendations of ways to reduce benzene exposure. Methods: A meta-analysis was conducted and identified all published articles related to benzene and benzene related compounds, and health effects of benzene in residents of natural gas extraction plants and occupational workers. Databases comprehensively searched included: MEDLINE, TOXLINE, PubMed, Scopus, Web of Knowledge, and the Clinical Trials Registry. Reference lists of reports and reviews were also searched. The authors of this paper determined the suitability of the articles by evaluating all related title/abstracts. Articles found relevant were retrieved as full texts and thoroughly reviewed. Health effects of benzene exposure were analyzed based on organ system. Results: Results revealed that exposure to benzene can lead to multiple health effects affecting multiple systems. Health effects can be short term and long term. The health effects were prevalent amongst residents of natural gas extraction sites and people with occupational exposure to benzene. Routes of exposure to benzene are; inhalation, ingestion and dermal. It is metabolized extensively in the liver and can be stored for long periods in adipose tissue and bone marrow. It is excreted in the urine via the kidneys as phenols. Residents in communities experiencing natural gas extraction have higher cases of anemia, leukemia (Acute Myeloid Leukemia, Acute Lymphoid Leukemia), and non- Hodgkin’s lymphoma, which is explained by the hematotoxic effect of benzene. Several studies report that benzene affects the reproductive system, Central nervous system and respiratory system. Recommendations and Conclusion: Use of environmentally friendly hydraulic fracturing chemicals should be encouraged. Residential areas and especially schools should be protected from industrial mining operations. Children exposed to emissions from natural gas extraction/processing should be tested regularly through bio monitoring of urine and blood. Future studies should be done on the effects of benzene exposure to children. Through this study we were able to establish that there is an association between benzene exposure and natural gas drilling in residential communities and the health effects can be debilitating to children, women and workers.Item Health Literacy Systems Approach: Empowering Healthcare Practitioners Through Education(2015-03) Wagner, Teresa; Carbajal-Diaz, Anissa; Linnear, Kim; Carlson, ErinProblem: Research indicates that limited health literacy can lead to adverse health outcomes due to patients’ inability to follow instructions regarding medications, labels and health messages especially in preventative care (Koh et al., 2012). Hypothesis: The Affordable Care Act (ACA) has mandated improved patient understanding of medical diagnoses through effective communication by providers. The purpose of this study was to determine if health literacy trainings can improve healthcare practitioners understanding and use of health literate communications. Materials and Methods: Context: Trainings were conducted at four healthcare organizations between December 18, 2013 and June 20, 2014. Site selection utilized a purposive convenience sample through community partner networking. Intervention/Instrument: Trainings engaged participants utilizing a variety of mediums to build capacity towards health-literate practices using the Health Literacy Universal Precautions Toolkit (HLUPT). Study Design: Knowledge levels of training participants were measured by a pre-test, post-test, and a follow-up survey consisting of closed-ended scaled items and open-ended items. Statistical Analysis: Univariate analyses offered descriptive statistics and bivariate analyses assessed mean score changes between pre- and post-tests both in SAS 12.1 using Wilcoxon Signed-Rank test (p = .001). NVivo software analysis of qualitative data assessed open-ended survey questions through coding and emergence of themes, sub-themes and frequency of response. Outcome Measures: Eighty-eight providers and staff members were trained at four healthcare entities. Eighty-eight pre- and post-test surveys and 29 follow-up surveys were collected with 37 pending. Results: Health literacy knowledge increased in 100% of participants and 75% increased knowledge in over half of the survey questions. Follow-up survey respondents demonstrated 100% retention of knowledge. Conclusions: The intervention showed that healthcare providers improved health literacy knowledge after a short, evidence-based training. The knowledge is retained at three months post-training. Future Implications: Despite knowledge increases, patient-centered care depends on improved health information and services. Longitudinal follow-up is needed on whether knowledge becomes integrated into clinical systems and improves compliance, patient outcomes and ultimately population health.Item Impact of Individual and Parental Determinants on the Developmental of Attention Deficit Hyperactivity Disorder(2015-03) Panchal, Hardik; Patel, Riddhi; Homan, SharonPurpose: To assess the effects of low birth weight, maternal and paternal mental and emotional health status, and time spent for viewing television or playing video games per day in the development of Attention Deficit Disorder (ADD) /Attention Deficit Hyperactivity Disorder (ADHD). Methods: The National Survey of Children’s Health (2011-2012) data was used for the analysis of 65,680 children from 6 to 17 years of age. Multivariate logistic regression technique was applied to find the association between low birth weight, time spent for viewing television or playing video games per day, maternal and paternal mental and emotional health status and ADD/ADHD controlling for age, gender and poverty level. Results: As compared to female children, male children had 2.5 times higher odds of developing ADD/ADHD. Age was also significantly associated with ADD/ADHD. Children of mothers with fair or poor mental and emotional health status had 1.8 times higher odds of developing ADD/ADHD as compared to children of mothers with excellent or very good mental and emotional health status. In addition, children whose father had fair or poor and good mental and emotional health status had 1.5 times increased odds of having ADD/ADHD as compared to children whose father had excellent or very good mental and emotional status. Conclusion: Parental mental and emotional health had significant association with the development of ADHD in their children. Six to seventeen years of age children whose mother or father had poor mental and emotional health conditions were more likely to have ADD/ADHD.