College of Public Health
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Item A bias correction method in meta-analysis of randomized clinical trials with no adjustments for zero-inflated outcomes(John Wiley & Sons, Inc., 2021-09-03) Zhou, Zhengyang; Xie, Minge; Huh, David; Mun, Eun-YoungMany clinical endpoint measures, such as the number of standard drinks consumed per week or the number of days that patients stayed in the hospital, are count data with excessive zeros. However, the zero-inflated nature of such outcomes is sometimes ignored in analyses of clinical trials. This leads to biased estimates of study-level intervention effect and, consequently, a biased estimate of the overall intervention effect in a meta-analysis. The current study proposes a novel statistical approach, the Zero-inflation Bias Correction (ZIBC) method, that can account for the bias introduced when using the Poisson regression model, despite a high rate of inflated zeros in the outcome distribution of a randomized clinical trial. This correction method only requires summary information from individual studies to correct intervention effect estimates as if they were appropriately estimated using the zero-inflated Poisson regression model, thus it is attractive for meta-analysis when individual participant-level data are not available in some studies. Simulation studies and real data analyses showed that the ZIBC method performed well in correcting zero-inflation bias in most situations.Item A Case Study Analysis of the Healthcare Safety Net's Emergency Response Capabilities(2010-05-01) Barnes, Kirk T.; Lykens, KristineHealthcare safety net providers care for medically vulnerable populations on a daily basis. During disasters they play a crucial role in maintaining the continuity of healthcare services for individuals with chronic illness and limited resources whether they evacuate or remain. This study examines the roles and responsibilities of healthcare safety net providers in Louisiana, and their ability to assist in emergency response and recovery efforts. The research uses case study methodology to examine the roles and responsibilities of healthcare safety net providers during recent hurricane events. Roles examined include operating special needs shelters, mobile medical clinics, coordination of emergency resources and assisting medically vulnerable patients with the location of medications. The research will focus on the Health Resources and Services Administration (HRSA) funded programs in the State of Louisiana. Healthcare safety net programs included in the research include: Louisiana HIV/AIDS Program (Part B), Louisiana Primary Care Association, Louisiana Bureau of Primary Health Care, Louisiana Office of Rural Health, New Orleans and Baton Rouge HIV/AIDS programs (Part A), and Louisiana Maternal and Child Health Program. The research identifies multiple areas in which emergency response and recovery efforts could be enhanced through a greater integration with healthcare safety net providers.Item A Comparative Breast Cancer Study: Stage & Mortality in El Paso County's non-Hispanic white and Hispanic population(2003-05-01) Aravind, Raven; Hoverman, RusselAravind, Raven, A Comparative Breast Cancer Study: Stage & Mortality in El PasoCounty's non-Hispanic white and Hispanic population, 1990-2000. Master of Public Health (Epidemiology), May 2003, 17pp., 1 table, 3 figures, bibliography, 43 titles. This retrospective breast cancer study compares the stage of breast cancer diagnosis and mortality between Hispanic (HS) and non-Hispanic white women (NHW). The study includes 874 Hispanic women and 802 non-Hispanic white women diagnosed with breast cancer between January 1990 and December 2000 at the El Paso Cancer Treatment Center, El Paso Texas. The objectives of the study were: 1) to determine if this population of Hispanic women is being diagnosed at a later stage of breast cancer 2) to ascertain the relative survival of non-Hispanic white and Hispanic women 3) to verify if Hispanic women were being diagnosed at a younger age; and 4) to examine tumor size at diagnosis to determine if there is a need for more assertive screening measures in this population of women.Item A Comparative Study of Texas and Other States Regarding School Health Educator Qualifications(2009-05-01) Gonzalez, Rosa Emma; Lykens, KristineQualified school health educators are critical in educating the youth about diseases and disease prevention. The School Health Profiles, School Health Policies and Programs Study 2006, Texas Education Agency, and Texas Legislature Online were used to compare Texas with other states in terms of school health educator qualifications, continuing education, and who teaches health education in schools. Texas should model policies that states, such as Alabama, Georgia, Hawaii, Minnesota, New Jersey, Rhode Island, Utah, West Virginia, and the District of Columbia, have implemented. These states have polices in place that require health education teachers to obtain the Certified Health Education Specialist credential (CHES). The National Commission for Health Education Credentialing requires CHES to obtain health specific continuing education training.Item A Comparative Study on the Differences in Policies Contributing to Childhood Obesity in the United States and Child Malnutrition in Sub-Saharan Africa(2010-05-01) Akuoko, Mathias K.; Lykens, KristineChildhood obesity in the United States has reached an epidemic state. Child malnutrition in Africa has reached an epidemic state. The objective is: To analyze the policies that have contributed to childhood obesity in the United States and malnutrition in Sub-Saharan Africa. Data: Trust for America’s Health; for childhood obesity. Database by Dr. Lykens and colleagues for child malnutrition. Analysis performed on childhood obesity and malnutrition. Findings: Public policies have contributed to this wide nutritional disparity in these two areas. Recommendations: The policies that have contributed to these can also serve as an avenue to reverse them; Africa should learn from the West to improve food security.Item A Comparison of Medicare Prospective Payment Systems on P.T.C.A. and Stent Outcomes in an Urban Hospital(2001-05-01) Compton, Ben H.; Mains, Doug A.; Hilsenrath, P. E.Compton, Ben H., A Comparison of Medicare Prospective Systems on P.T.C.A. and STENT Outcomes in an Urban Hospital. Master of Public Health (Health Services Administration), May 2001, 57 pp., 10 tables, 1 graph, bibliography, 51 titles. To determine if differences in outcomes exist between Medicare prospective payment systems when doing percutaneous transluminal coronary angioplasty (PTCA) or STENT surgeries. From January 1999 and December 2000, 146 Medicare patients were identified with 35 being outpatient and 111 inpatient. A separate group of 1-day inpatients was used as a comparison for the outpatient group. Results from the comparison reveal that in the three groups, the majority of patients were white, non-Hispanic males who were about 70 years of age. The 1-day inpatient group had the highest profit of all three with about $3,000 while the inpatient group broke even. The outpatient group had no in-hospital deaths or complications while all three had equal amounts of comorbidities. The conclusion is that losses will probably occur if PTCA and STENTs are done outpatient. Possible solutions are moving to an inpatient setting or determining which costs can be reduced in the outpatient setting.Item A Computational Modeling Study of COVID-19 in Bangladesh(The American Society of Tropical Medicine and Hygiene, 2020-11-02) Khan, Irtesam Mahmud; Haque, Ubydul; Kaisar, Samiha; Rahman, Mohammad SohelThe COVID-19 pandemic has spread globally. Only three cases in Bangladesh were reported on March 8, 2020. Here, we aim to predict the epidemic progression for 1 year under different scenarios in Bangladesh. We extracted the number of daily confirmed cases from March 8 to July 20, 2020. We considered the suspected-infected-removed (SIR) model and performed a maximum likelihood-based grid search to determine the removal rate (). The transmission was modeled as a stochastic random walk process, and sequential Monte Carlo simulation was run 100 times with bootstrap fits to infer the transmission rate (beta) and R t. According to the simulation, the (real) peak daily incidence of 3,600 would be followed by a steady decline, reaching below 1,000 in late January 2021. Thus, the model predicted that there would still be more than 300 cases/day even after a year. However, with proper interventions, a much steeper decline would be achieved following the peak. If we apply a combined (0.8beta, 1.2) intervention, there would be less than 100 cases by mid-October, only around five odd cases at the beginning of the year 2021, and zero cases in early March 2021. The predicted total number of deaths (in status quo) after 1 year would be 8,533 which would reduce to 3,577 if combined (0.8beta, 1.2) intervention is applied. We have also predicted the ideal number of tests that Bangladesh should perform and based on that redid the whole simulation. The outcome, though worse, would be manageable with interventions according to the simulation.Item A Cost Analysis of Tuberculosis and its Prevention in Tarrant County, Texas(2007-05-01) Miller, Thaddeus L.; McNabb, Scott; Hilsenrath, Peter; Pasipanodya, JotamMiller, Thaddeus L. A Cost Analysis of Tuberculosis and its Prevention in Tarrant County, Texas. Doctor of Public Health (Health Management and Policy), May 2007, 232 pp., 29 tables, 2 illustrations, bibliography, 274 titles. Tuberculosis cost has been incompletely described as the cost arising from acute illness and treatment. The societal cost of tuberculosis arises from infection, suspicion of infection, acute and preventive responses, the sequalae of illness (including acute morbidity, drug induced hepatitis, mortality, and disability), and the compounding effects of transmission. This societal cost in unknown however the variable portion of this cost is equivalent to the savings made possible by averting tuberculosis, This study measured the societal cost of tuberculosis in Tarrant County, Texas, for the year 2002. Societal costs were estimated as the sum of known or estimated expenditures and health losses related to tuberculosis and discounted at 3%. Current and future costs will accrue to an estimated net $33.9 2002 USD million for the year 2002 in Tarrant County, Texas. An average of 1.4 QALYs net of 3% social discount were lost per incident case. The greatest burdens of tuberculosis, when analyzed by either cost or health quality, can be averted only by case prevention. Forty-three and 44% of societal cost was generate by secondary transmission and chronic impairment associated with pulmonary tuberculosis. Neither factor is routinely considered in discussions of tuberculosis cost. Acute treatment, hospitalization and direct medical care account for only 2.4% of societal cost. Any intervention that prevents one tuberculosis case will prevent at least a net $295,182 (2002 USD) and individual health quality losses averaging 1.4 net QALYs.Item A Critical Review of the One Hour and the Eight Hour Standards for Ozone with an Overview of the Proceedings that Led to the Implementation of The New Standard for Ozone(2004-05-01) Palla, Amruth A.Palla, Amruth R., A Critical Review of the One Hour and the Eight Hour Standards for Ozone with an Overview of the Proceedings that Led to the Implementation of The New Standard for Ozone; Master of Public Health (Environmental and Occupational Health), May 2004, 58 pp, 3 tables, 2 illustrations, 35 titles. With the increasing concern for human health and the recognition of the major role played by environment in the multi-factorial disease etiology, the various parameters established for maintaining the environmental constituents in the proportions desired for achieving a normal health status are taking an important position in the present day world. In 1997, during its review process the EPA found the exiting one-hour standards, for ozone to be insufficient to achieve the health friendly concentrations, and therefore proposed a new eight hour standard for this pollutant. The new standards proposed by the EPA were challenged by various other organizations and several proceedings have happened since then. The purpose of my thesis is to do a critical analysis of the advantages and the drawbacks of the two standards and to do an overview of the proceedings that have led to the implementation of the new standards.Item A cross-sectional study of latent tuberculosis infection, insurance coverage, and usual sources of health care among non-US-born persons in the United States(Wolters Kluwer Health, Inc., 2021-02-19) Annan, Esther; Stockbridge, Erica L.; Katz, Dolly; Mun, Eun-Young; Miller, Thaddeus L.ABSTRACT: More than 70% of tuberculosis (TB) cases diagnosed in the United States (US) occur in non-US-born persons, and this population has experienced less than half the recent incidence rate declines of US-born persons (1.5% vs 4.2%, respectively). The great majority of TB cases in non-US-born persons are attributable to reactivation of latent tuberculosis infection (LTBI). Strategies to expand LTBI-focused TB prevention may depend on LTBI positive non-US-born persons' access to, and ability to pay for, health care.To examine patterns of health insurance coverage and usual sources of health care among non-US-born persons with LTBI, and to estimate LTBI prevalence by insurance status and usual sources of health care.Self-reported health insurance and usual sources of care for non-US-born persons were analyzed in combination with markers for LTBI using 2011-2012 National Health and Nutrition Examination Survey (NHANES) data for 1793 sampled persons. A positive result on an interferon gamma release assay (IGRA), a blood test which measures immunological reactivity to Mycobacterium tuberculosis infection, was used as a proxy for LTBI. We calculated demographic category percentages by IGRA status, IGRA percentages by demographic category, and 95% confidence intervals for each percentage.Overall, 15.9% [95% confidence interval (CI) = 13.5, 18.7] of non-US-born persons were IGRA-positive. Of IGRA-positive non-US-born persons, 63.0% (95% CI = 55.4, 69.9) had insurance and 74.1% (95% CI = 69.2, 78.5) had a usual source of care. IGRA positivity was highest in persons with Medicare (29.1%; 95% CI: 20.9, 38.9).Our results suggest that targeted LTBI testing and treatment within the US private healthcare sector could reach a large majority of non-US-born individuals with LTBI. With non-US-born Medicare beneficiaries' high prevalence of LTBI and the high proportion of LTBI-positive non-US-born persons with private insurance, future TB prevention initiatives focused on these payer types are warranted.Item A Descriptive Analysis of Adolescent Pregnancy and Birth Outcomes in Tarrant County, Texas(1999-08-01) Omoloh, Wilfred J.; Ramirez, Gilbert; Rene, AntonioOmoloh, Wilfred, J., A Descriptive Analysis of Adolescent Pregnancy and Birth Outcomes in Tarrant County, Texas. Master of Public Health, August 14, 1999, 110 pp, 19 tables, reference list, 68 titles. A descriptive study of adolescent pregnancy and birth outcomes in Tarrant county, Texas between 1991 and 1995 was conducted to evaluate the effect of maternal age on infant birthweight and mortality among White, African American, and Hispanic adolescent mothers nineteen years and older. The age of the mother was not a significant predictor of infant birthweight and mortality, but mother’s ethnicity, weight gain, and gestational age were found to be strong predictors of infant birthweight and mortality. The Hispanic ethnic group came out much better than White and Black mothers but no difference between White and Black mothers regarding birthweight was found. The results from the data analysis demonstrated that teenage pregnancy may not be a serious problem in Tarrant County, Texas as was previously though.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 Meta-Analysis of the Effects of Chromium on Fasting Blood Glucose, HBA1c, Triglycerdies, LDL-C and HDL-C in Type 2 Diabetes and Impaired Glucose Tolerance(2002-05-01) Evans, Jill E.; Urrutia-Rojas, Ximena; Mains, Doug A.Evans, Jill E., A meta-analysis of the Effects of Chromium on Fasting Blood Glucose, HbA1c triglycerides, LDL-C, and HDL-C in Type 2 Diabetes and Impaired Glucose Tolerance. Master of Public Health, May, 2002, 35 pp., 4 tables, 4 figures, references cited, 23 titles. Objective: To assess the magnitude of chromium’s effect of trivalent chromium (picolinate or chloride) or yeast in type 2 diabetics or subjects with impaired glucose tolerance. Efforts were taken to combine studies with similar doses and treatment periods. Sensitivity analysis was performed. Outcomes Measured: Fasting blood glucose (FBG), HbA1c, triglycerides, high-density cholesterol (HDL-C), and low-density cholesterol (LDL-C). Effect sizes were converted to appropriate units and were reported as “effect size equivalents”. Results: The magnitude of effect of chromium on FPG and HbA1c was negative and generally increased with dosage and duration. Statistically significant effects were observed for typical doses (150-250μg/day) for both outcomes at 1.5-3 months duration, and for HbA1c at 4-6 months; and high dosage (1000 μg/day) at 1.5-3 and 4-6 months for both outcomes. For triglycerides at the typical dose, statistically significant effects (p=0.00) were observed at 1.5-3 months. There was no effect on LDL-C. HDL-C increased with increasing duration of chromium supplementation, with the exception of the 4-6 month duration. Statistically significant effects (p=0.00) were observed for typical dosage at 1.5-3 months. For the studies using yeast with GTF activity, the effect size equivalent for FPG and triglycerides was significantly lowered (p [less than] 0.001 and p=0.00 respectively). When the study using yeast with no GTF activity was included, the pooled fixed effect size equivalent was smaller, yet remained significant. HDL-C was significantly increased (p=0.00). Sensitivity analysis yielded similar results. Conclusion: Meta-analysis of chromium showed a significant reduction in FBG, HbA1C, triglycerides, and LDL-C, while increasing HDL-C in the groups studied. The best available evidence suggests that chromium has a dose and duration-dependent effect on these outcomes.Item A Mixed Methods Approach to the Definition of Family Health Promotion Practices for Mexican Sonoran Mothers(2006-12-01) Montiel-Carbajal, Maria Martha; Lurie, SueMontiel-Carbajal, Maria M., A Mixed Methods Approach to the Definition of Family Health Promotion Practices for Mexican Sonoran Mothers. Doctor of Public Health (Social and Behavioral Sciences), December 2006, 143 pp., 14 tables, 1 illustration, bibliography, 55 titles. The purpose of this research was to study the family health promotion practices of a sample of Mexican mothers living in the state of Sonora Mexico through a concurrent mixed method approach that included (1) a qualitative component with face to face and in-depth interviews, investigator observations, and analysis of content; (2) a quantitative component consisting of statistical analysis of data from selected selections of the National Survey for the Evaluation of Health Services 2002-2003. For the qualitative component 15 mothers, with mean age of 40 years, mean years of education of 10 years, living with their families were selected to form a purposive sample, and assigned to one of three groups: married working mothers, non-married working mothers, or married non-working mothers. The qualitative component was naturalistic and descriptive using semi-structured interviews with the mothers, and individual questionnaires to collect demographic and housing information. The quantitative component used the survey responses provided by the database of the National Survey for the Evaluation of Health Services 2002-2003, from 404 female adults age 18 and older, living in the urban zone of Sonora. The qualitative component showed that mothers conceptualize the health status of the family as a priority. The specific practices they use depend on the set of external resources and internal strengths of the family in order to overcome the physical, environmental, relational, or economic barriers they found to the promotion of health practices. The participants also reported being unsatisfied with the access and quality of the social health care system. The data from the quantitative component showed that Mexican Sonoran women living in the urban area reported having good health and felt satisfied with their health status; their satisfaction with the social health care system was fair. The group of non-married working mothers was detected to be more at risk for cardiovascular diseases due to a greater proportion of smokers and drinking paired with low amount of exercise. The results provided valuable information to formulate health promotion programs and future policies to be implemented with the target population.Item A nonparametric alternative to the Cochran-Armitage trend test in genetic case-control association studies: The Jonckheere-Terpstra trend test(PLOS, 2023-02-03) Manning, Sydney E.; Ku, Hung-Chih; Dluzen, Douglas F.; Xing, Chao; Zhou, ZhengyangIdentifications of novel genetic signals conferring susceptibility to human complex diseases is pivotal to the disease diagnosis, prevention, and treatment. Genetic association study is a powerful tool to discover candidate genetic signals that contribute to diseases, through statistical tests for correlation between the disease status and genetic variations in study samples. In such studies with a case-control design, a standard practice is to perform the Cochran-Armitage (CA) trend test under an additive genetic model, which suffers from power loss when the model assumption is wrong. The Jonckheere-Terpstra (JT) trend test is an alternative method to evaluate association in a nonparametric way. This study compares the power of the JT trend test and the CA trend test in various scenarios, including different sample sizes (200-2000), minor allele frequencies (0.05-0.4), and underlying modes of inheritance (dominant genetic model to recessive genetic model). By simulation and real data analysis, it is shown that in general the JT trend test has higher, similar, and lower power than the CA trend test when the underlying mode of inheritance is dominant, additive, and recessive, respectively; when the sample size is small and the minor allele frequency is low, the JT trend test outperforms the CA trend test across the spectrum of genetic models. In sum, the JT trend test is a valuable alternative to the CA trend test under certain circumstances with higher statistical power, which could lead to better detection of genetic signals to human diseases and finer dissection of their genetic architecture.Item A Path Analysis of Body Mass Index, Body Image, and Unhealthy Dietary Behavior as Contributors to Suicidal Behavior in Female Adolescents(2004-05-01) Rorie, Michele Taylor; Balcazar, Hector; Lurie, Sue; Rene, Antonio A.Rorie, Michele Taylor, A Path Analysis of Body Mass Index, Body Image and Unhealthy Dietary Behavior as Contributors to Suicidal Behavior in Female Adolescents. Doctor of Public Health (Social and Behavioral Sciences), May 2004, 120 pp., 17 tables, 6 illustrations, references, 106 titles. Objectives- This study examined the pattern and magnitude of relationships between body mass index, body image, unhealthy dietary behaviors, and suicidal behavior among a sample of White, African American, and Hispanic adolescent females. Methods-This study employed secondary analysis of the 2001 Youth Risk Behavior Survey public-use dataset to provide quantitative estimates of the causal connections between body mass index, body image, dietary behaviors, and suicidal behavior. A sample (n=5,218) of White, African American, and Hispanic adolescent females aged 14-17 were selected for analysis. This cross-sectional study involved public high school students in grades 9-12. The variables/constructs BMI, Body Image, and Dietary Behavior were examined using a path analysis to determine the magnitude of effects on Suicidal Behavior in adolescent females. Results- The path coefficients were obtained for the path model using multiple regression equations, which took direct and indirect effects into account. The Female Adolescent Model (n= 5,218) yielded an R2 = .27. This meant that 27% of the variance in Suicidal Behavior was explained by BMI, Body Image, and Dietary Behavior. When race/ethnicity was analyzed separately, different values were observed. The White Adolescent Female Model (n=2,768) had an R2=.32. The Black or African American Model (n=1,206) had an R2=.23, and the Hispanic or Latino Model (n=1,224) had an R2=.27. Conclusion- The basic state of what is an actual fact about a person (i.e. weight) does not cause an increase of harmful or destructive behavior. The person’s beliefs drive intention as it was demonstrated through the immergence of significant indirect pathways from BMI through Body Image and Dietary Behavior to Suicidal Behavior. The path analyses for the three racial groups suggest that there are varying degrees of influence among BMI, Body Image, Dietary Behaviors, and Suicidal Behaviors.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.; Rene, Antonio A.; Fairchild, Thomas J.; Blakley, SallyWilliams, 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 Social Vaccine for HIV/AIDS: Investing in Our Future Through Curriculum-Based Education in Tanzania: A Conceptual Implementation Model(2009-05-01) Tenende, Tunu; Lykens, KristineAn estimated 10 million young people worldwide are living with HIV with a yearly incidence of 2 million in the 15-24 year old population. This is nearly half of all new cases that are being reported. Worldwide roughly 39.5 million people are dying of Acquired Immune Deficiency Syndrome (AIDS) or are infected with the Human Immuno-deficiency Virus (HIV). Of these 39.5 million people, 24.7 million live in Africa; a strong majority in resource scarce countries. In Tanzania alone there are 1.4 million people living with HIV making the percentage of people with HIV at 6.2%. With other prevention efforts that have been underway in the past few years, we have thus far been able to see a drop in people affected from 7.0% to what is now current at 6.2%. With an understanding that the country is capable of making stride in lowering incidence which will ultimately lower prevalence down the line, focus on the countries youth has been an avenue to explore. Though there are studies that have looked into prevention methods and even more specifically have looked into curriculum-based prevention programs, there have not been any that focus on a comprehensive approach that includes seeking governmental support and mandating a change in the curriculum to focus on HIV/AIDS education. Based on literature review of components that can influence the development, implementation and incorporation of an HIV/AIDS prevention program in Tanzania, this paper concludes that a curriculum-based HIV/AIDS prevention program is the most effective and efficient manner to reach the community and bring about the biggest change.