General Public Health
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Item A Comparison of Three Screening Tests in Detecting the Prevalence of Latent Tuberculosis Infection in Refugees by History of Residence in Refugee Camps(2016-03-23) Board, Amy; Carlson, Erin; Kolasani, BalajiPurpose: The purpose of this study was to examine residence in a refugee camp as a predictor of testing positive for latent tuberculosis infection (LTBI) according to each of three LTBI screening tests. Methods: Data were obtained from a study funded by the Centers of Disease Control and Prevention (CDC) through the Tuberculosis Epidemiologic Studies Consortium. Refugees presenting at Tarrant County Public Health in Fort Worth, Texas, from countries classified by CDC as having a medium or high risk of tuberculosis (TB) were eligible to participate. Participants were interviewed to obtain data on variables associated with LTBI and received three LTBI screening tests: QuantiFERON-TB Gold In-Tube (QFT), T-SPOT TB, and the tuberculin skin test (TST). The results of each screening test were used as the indicator variable for LTBI. Data analysis was conducted for each screening test result independently using logistic regression to adjust for potential confounders including age, gender, birth country, education, income, smoking, alcohol use, history of incarceration, and being a close contact to a TB case. Results: Of the 994 participants, twenty-six percent originated from medium-risk countries, 22% from high-risk countries in Africa, and 52% from high-risk countries in Asia. The odds of having LTBI for those who lived in a refugee camp compared to those who did not differed according to the screening test used, but was not significant for any of the three tests (QFT OR 0.843, 95% CI 0.568–1.252; T-SPOT OR 0.819, 95% CI 0.548–1.226; and TST OR 1.121, 95% CI 0.791–1.590). Conclusions: Among participants in our study, living in a refugee camp conferred no significantly increased risk of LTBI when adjusted for other predictive variables, independent of the type of screening test utilized.Item Analyzing the Association between Adverse Childhood Experiences and an Increase in Body Mass Index among Adolescents (10-17 years)(2016-03-23) Sekhon, Vishaldeep; Chikani, Shalinkumar; Hilliard, Bethany; Hirpara, KomalPurpose: Adolescent obesity is a major public health concern in the United States1, 2. According to the CDC, more than 33% of children and adolescents are either overweight or obese1 . A major known risk factor for changes in BMI status is stress3 . Multiple risk factors, such as living in a food desert, race, and exposure to family and neighborhood stressors cause various emotional and physiological changes in the body, which can increase the risk of adolescent obesity3, 4, 5. Due to this, we use the socio-ecological model to understand intertwined risk factors of adolescent obesity3 . Based on biological and scientific evidence we hypothesized that adverse childhood experiences (ACEs) are associated with body mass index (BMI) status among adolescents aged 10-17 years. Methods: The secondary data analysis was done using the 2011-2012 National Survey of Children’s Health and conducted univariate, bivariate, and polytomous logistic regression to assess the relationship between ACEs and BMI while controlling for gender, federal poverty level, health insurance status, learning disabilities, and how often the studied family eats meals together. The estimation of adjusted odds ratio represents an adolescent having undergone at least one or more ACEs and its effect on BMI measured in three categories: underweight\normal weight, overweight and obese. Results: The odds of being overweight are 1.10 times higher (95% CI 0.94-1.30) for adolescents who are exposed to 1 ACE, while the odds of being overweight are 1.26 times higher (95% CI 1.08-1.47) for adolescents with 2 or more ACEs, with both odds ratios being compared to adolescents with normal BMI and no ACEs. The odds of being obese are 1.13 times higher (95% CI 0.96-1.33) for adolescents who are exposed to 1 ACE, while the odds of being obese are 1.43 times higher (95% CI 1.20-1.71) for adolescents with 2 or more ACEs, with both odds ratios being compared to adolescents with normal BMI and no ACEs. Conclusion: The study observed that increasing the number of ACEs adolescent experiences increases the odds of being overweight or obese. These results indicate that public health professionals should intervene at each level of the socio-ecological model in order prevent major fluctuations in adolescent BMI status.Item Cultural Diversity: Health Disparities in Tarrant County, TX(2016-03-23) Melville, Evan; Cushen, Spencer; Larrabee, Rachel; Severson, Samantha; Hallak, ErikaThe objective of our research was to evaluate health disparities among minority groups due to social behaviors, ability to receive care, and socioeconomic factors, within Tarrant County, Texas. Research on health distributions was conducted online through local and national government websites as well as through the Center for Disease control. Data then was extrapolated and analyzed by our team. No additional materials were utilized. Health disparities are more often noted in racial, ethnic, gender, and socioeconomic minority population groups. Risk factors for health disparities include behaviors, access to care, and socioeconomic factors. At 28.1% representation, Hispanics make up the largest ethnic minority group in Tarrant County. It is noted that Hispanics are at greater risk for DM2, obesity, and hypertension. Through the use of various Fort Worth community resource websites, a list of resources was compiled. The significance of our project was three fold: provide a list of community resources that deal with health disparities for the use of in-training healthcare professionals, to demonstrate to in-training healthcare professionals the ease at which a list like this can be developed, and to bring attention to the resources available in Tarrant county.Item Do Depression Rates Differ by SES Factors in Females Ages 25-45 from States with Varying Income Equality?(2016-03-23) Le, Christian; Lord, David; Miller, Marcus; Uhlig, Michael; Hartos, Jessica PhDPurpose: Research shows that depression is related to socioeconomic status (SES); however, few studies have focused specifically on depression and SES in females during young- to mid-adulthood, which would have important ramifications on parenting, work productivity, and interpersonal relationships. Therefore, the purpose of this study was to assess whether depression rates differ by SES factors in representative samples of females ages 25-44 years from states with varying levels of income inequality. Methods: This cross-sectional analysis used 2013 BRFSS data for females ages 25 to 44 years from Louisiana, New Hampshire, New York, and Utah. The relationship between SES variables (income, education, and employment) and depression was assessed using multiple logistic regression while controlling for demographic and psychosocial variables. Results: About 19-31% of females reported depression across all four states. In adjusted analyses, none of the SES variables were related to depression across all four states. However, after adjusting for all variables in the model, both low general health and being a smoker were related to depression in each state. Conclusions: This study found that SES was not related to depression in representative samples of females ages 25 to 44 years across four states after controlling for other demographic and psychosocial variables. However, health status and smoking status were related to depression in all four states. Practitioners should assess mental health status in patients from this target group who have low general health and/or are smokers, and vice versa.Item Effect of Having a Quality Medical Home on School Attendance for Children with Asthma(2016-03-23) Lockwood, Laura; Hirpara, Juhi; Makwana, Bhavik; Animashaun, MoriamPurpose: Understanding the concept of a quality medical home is important when it comes to ensuring the health of those with asthma. Previous studies have not examined the relationship between having a quality medical home and school absenteeism in children with asthma. The objective of this study it to estimate the effect of having a medical home on missing more than 11 days of school among children with asthma. Methods: Secondary data analysis of the 2011-12 National Survey of Children’s Health (NSCH) was conducted. A total of 95,677 child-level interviews were completed. However, 6,623 surveys were analyzed for children ages 6-17 with current asthma. We estimated the frequencies of potential confounders (individual, family, and clinical measures) by missed school days. We used SAS Proc Surveylogistic to model the (1) effect of having a quality medical home; and (2) individual medical home subcomponents on missing 11 or more school days, adjusting for confounding variables. Results: Our key result is that children who did not have a quality medical home were 1.7 times more likely (95% CI: 1.2-2.3) to miss 11 or more school days than the children who had a quality medical home. We also found that children who did not have a usual source of sick care, which was a subcomponent of having a quality medical home, were 2.2 times more likely (95% CI: 1.2-4.0) to miss 11 or more school days than the children who had a usual source of sick care. Conclusions: From statistical analysis, it can be inferred that having a quality medical home will significantly decrease the chances of missing 11 or more school days. Interventions should be implemented to educate parents of children with asthma on the importance of having a quality medical home. Quality healthcare is essential to adequate asthma management which in turn can affect a child’s ability to regularly attend school.Item Effect of Low Birth Weight and Preterm Birth on Incidence of Autism Spectrum Disorder(2016-03-23) Killion, Jordan; Nagavalli Aarigapudi, Nagavalli; Kavali, Hasini; Ghadge, NitinEffect of Low Birth Weight and Preterm Birth on Incidence of Autism Spectrum Disorder Purpose: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that affects the social, communication, and developmental abilities of a person (CDC, 2015). There are still a lot of unknowns regarding ASD, however it is hypothesized that low birth weight and preterm birth are risk factors for ASD. This study was done to assess if there was any association between low birth weight (LBW) and preterm birth on the presence of ASD in children 2-17 years old. Methods: Secondary data analysis was done on the 2011-2012 NSCH survey, which had 95,677 child-level NSCH interviews completed nationally. 1,850 individual interviews were collected per state and the results were weighted to represent a national population of children ages 0-17 in each state. The sample was restricted to exclude children below the age of 2. A multivariable logistic regression model was done to see if there was a relationship between the presence of ASD and preterm birth and LBW, A second multivariate logistic regression model was done examining the presence of ASD with only preterm birth. Both models were statistically adjusted for gender, age of the child, maternal physical health, maternal mental health, race/ethnicity, health insurance, household income and type of insurance. Results: The key findings from this study were that preterm birth had a significant association with the presence of ASD, but LBW did not have any statistical significance. Children who were born preterm had a 2.045 [95% CI 1.491-2.806] greater odds of being diagnosed with ASD than children who were not born preterm. The covariate gender was also shown to be highly associated with ASD. Males had 4.529 [95% CI 3.464-5.923] times greater odds of being diagnosed with ASD than females. Conclusion: The results show that preterm birth was associated with the manifestation of ASD. There was no correlation between LBW and ASD found. The results also indicate that males are more frequently diagnosed with ASD than females. These results can be used to help show the importance of adequate prenatal care to help reduce the prevalence of preterm births, which can hopefully help to reduce the prevalence of ASD.Item Exploring Compassion Fatigue and Satisfaction Among Refugee Leaders in the DFW Area(2016-03-23) Raines-Milenkov, Amy DrPH; Kwentua, Victoria; Berg, ElyssaPurpose: Compassion fatigue describes the secondary traumatic stress seen in those working with others that have experienced trauma. It can lead to chronic fatigue, anxiety, irritability, and eventually burnout. Compassion fatigue has been studied in numerous helper and caregiver roles, such as social workers, nurses, and child protection caseworkers. However, research has not been conducted to investigate the presence of compassion fatigue within refugee populations or to understand how compassion fatigue may affect community leaders in this high-risk population. This study will explore the behavioral, emotional and physical effects of working with refugees among refugee leaders. Methods: In-depth qualitative interviews were conducted with refugee leaders working with refugees in the DFW area. Each participant completed a demographic questionnaire, a comprehensive interview and Professional Quality of Life Scale: Compassion Satisfaction and Compassion Fatigue Version 5 (ProQOL). The ProQOL questionnaire is a validated tool used to assess compassion fatigue. Results: Nine refugee leaders, representing six refugee groups, completed the demographic questionnaire, interview and ProQOL questionnaire. Participants reported a high level of compassion satisfaction (mean = 44.2), a low level of burnout (mean = 18.9), and a varied level of secondary traumatic stress. Refugee leaders reported a reliance on faith and a compulsion to help others due to their refugee experience as factors that outweighed the cost to their family wellbeing, physical and emotional health. Conclusions: Refugee leaders are highly resilient. They are often recruited by health care organizations, researchers and resettlement agencies to provide services and information to other refugees. These findings have implications for organizations to provide training on self-care practices and support services.Item Exploring the Relationship between Socioeconomic status and C-Reactive protein levels in the US population using NHANES Survey Data(2016-03-23) Morrissey, Katherine; Li, Furong; Mandapati, Surendra; Aryal, Subhash; Robledo, Candace; Obinwa, UdokaExploring the Relationship between Socioeconomic status and C-Reactive protein levels in the US population using NHANES Survey Data Abstract Background Several studies have examined the impact of socioeconomic status on health and its overall quality. Low socioeconomic status has been associated with a higher prevalence of chronic health conditions, mortality from coronary heart disease, stroke, diabetes and subclinical markers of disease risk. An elevated Plasma C-Reactive Protein (CRP) is one of such markers, signaling an increased risk for atherosclerotic cardiovascular disease and sub clinical stages of pulmonary dysfunction. Various studies have been carried out on the association between CRP levels and Socioeconomic status. However, most studies did not consider how factors like acute and chronic health conditions along with health behaviors relates with the socioeconomic difference in CRP levels. In addition, many of the study samples in the previous studies were not representative of the socioeconomic diversity of the United States. In this study, we explored the relationship between socioeconomic status and C-Reactive protein levels in the US population, taking account of health indicators and behavioral factors. Methods We used the National Health and Nutrition Examination Survey (NHANES) dataset from 2001 to 2006. The survey includes interviews, clinical examinations and laboratory test data. Demographic factors (age, ethnicity and poverty), health/immunity indicators (recent illness, leucocyte count, asthma, chronic bronchitis and rheumatoid arthritis) and behavioral risk factors (obesity, current smoker, heavy drinking and exercise) were examined in this study to see how they predict the socio economic variation in CRP levels. Blood samples from a total of 13,708 adults who were over 20 years were assayed for CRP. Pregnant women (888) and participants who did not have income data (1006) were excluded from the study. For our analysis, CRP were divided into three categories: moderate (1.01 – 3.0 mg/L), high (3.01 – 10.0 mg/L) and very high ([greater than] 10 mg/L). First, bivariate analysis was done to display the characteristics of the study population by poverty status. T-tests and Chi-square tests were used for continuous and categorical variables respectively. Multinomial logistic regression was then used to obtain the relative odds of having a CRP level that is above normal in relation to poverty. Results The mean levels of CRP and blood leucocyte count were higher for subjects in poverty. Subjects in poverty were more likely to be female and of a younger age. People in poverty had a higher prevalence of recent illness, asthma, chronic bronchitis, and rheumatoid arthritis. They also reported a higher prevalence of obesity, current smoking, heavy drinking and as well as less exercise. As age increased, the odds of all CRP levels compared to the normal increased. Obesity had the highest odds ratio (Moderate 2.81; 95% CI: 2.41 – 3.29; High 5.88; 95% CI: 4.96 – 6.96; Very high 8.51; 95% CI: 7.03 – 10.30) for CRP above normal levels. The odds of having very high CRP level was also increased for people with chronic bronchitis and rheumatoid arthritis. Controlling for the demographic factors, health indicators and behavioral factors, living in poverty increased the odds of very high CRP levels by 36% when compared to those not living in poverty. Conclusion Socioeconomic status is related to higher CRP levels, and this relationship is noteworthy at very high CRP levels. People who have low indicators of health and immunity are more likely to be in poverty and to have a very high CRP level. We found that the line depicting CRP level for those in poverty and above poverty crossed as age increased. Further studies need to be carried out on this subject to examine if there is an interaction effect between CRP levels and poverty at different age groups.Item Filling in the gaps: identification of lost opportunities for TB prevention(2016-03-23) Miller, Thaddeus; Crowley, PatrickPurpose: We reviewed current and historic clinical and other records for patients being treated for active TB to identify if and how such records suggest potential opportunities for TB prevention. New or expanded knowledge of how individual and population determinants of health interact with TB risk will allow more efficient and effective development and targeting of strategies against that risk. US public health authorities concur that much or all TB is preventable, whether by primary (prevention of onset by reducing exposure to risk) or secondary (preventing occurrence by treatment to reduce risk) means. Prevention requires a multifactorial approach to address each of the biological, clinical, environmental, social, behavioral, and system determinants of health that together allow TB risk to be avoided entirely or identified and mitigated. Robust treatment of active TB in the US has led to declining TB incidence rates, and many prevention activities take place in various settings. Still, incident TB’s rate of decrease is flattening and new incident TB cases continue to occur. We assume that every newly incident TB patient indicates a missed opportunity for prevention. By identifying factors that led to current TB patients “falling through the cracks” in our otherwise successful public TB prevention programs, we hope to facilitate progress toward the domestic elimination of this serious public health threat. Methods: In a convenience sample from June to July, 2015 we obtained consent for participation from patients under treatment by the Tarrant County Public Health Department Tuberculosis Clinic (TCPH-TBC) for confirmed active TB.. Consenting participants were asked to sign records releases for clinical and other records from TCPH-TBC as well as all other known current and prior health providers. Each record obtained was reviewed by the research fellow and abstracted into a research dataset of standardized elements for analysis for missed opportunities. We defined these as evident clinical risks for the development of active TB disease prior to onset of disease. The study was determined to be exempt status research by UNTHSC’s Office of Research Compliance, IRB # 2015-068. Results: Approximately half (16/33) of all patients in TB treatment at TCPH-TC during the study period consented to take part in the study. Current TCPH-TC administrative or clinical records were obtained for 14 (87.5%) of participants; we obtained at least one historic provider record for another 8 (50%) participants. Among the 14 participants with record reviews , 11 (78.6%) were foreign-born. Insurance status could be identified for 12 (85.7%) participants with records for review,. Most were insured (8/12 or 66.6%) by public or commercial insurance (4 with Medicare/Medicaid, and 4 with commercial insurance). A total of 12 missed opportunities for TB prevention prior to onset of disease (.86/patient analyzed) were identified from available patient records. Conclusions: Retrospective review of available administrative and clinical records of patients treated for TB is a potentially useful and efficient means to identify and target prevention opportunities prior to disease onset. However, the wide-spread, long-term implementation of such efforts require more investigation, as does application of these data to public health efforts.Item Identifying Provider and Patient Barriers to the Implementation of (MeTree) Family Health History Clinical Decision Support (FHH CDS) Tools(2016-03-23) Cross, Deanna; Fulda, Kimberly; Espinoza, Anna; Zhang, Julia; Mallaiah, JanhaviObjective: The purpose of this study was to determine healthcare provider and patient barriers in the implementation of a FHH CDS tool. Background: The University of North Texas Health Science Center (UNTHSC) in collaboration with Duke University and other sites around the country is currently conducting an implementation-effectiveness study to investigate MeTree implementation. MeTree, a Family Health History Clinical Decision Support (FHH CDS) tool is a patient facing tool that provides disease risk-stratification to both patients and providers. In previous studies, several perceived barriers for the use of this type of tool were identified including limited time during a patient visit and a lack of patient knowledge to provide family health history. This is especially true in regard to primary care clinics that cater to underserved populations. Methods: Family Medicine providers from three primary care clinics were identified and recruited. Eligible patients of consented providers were invited to participate in the study via recruitment letters. Registration information was obtained from interested patients, and unique study IDs were assigned by study coordinators at UNT Health Science Center. Registered patients received an email link to e-consent and complete the family health history online using the MeTree software. A printed copy of the risk report generated on completion of MeTree was delivered to the primary care provider to be reviewed at their next clinical appointment. Results: To date, patients of two Family Medicine providers were invited to participate in the study. Of the 2711 who were invited, 92 patients registered (response rate 3.39%) and 11 patients completed MeTree (completion rate 11.9%). Qualitative information collected through in-person discussions with providers indicated a preference of integration of the risk stratification report into the electronic medical record (EMR) system versus a printed copy of the report. Patient barriers included lack of access to a computer and internet. Conclusion: Provider engagement in implementation of new clinical decision support tools is imperative for identifying barriers as well as providing potential solutions for these barriers.Item Improving Lives of Most Vulnerable: The Relationship between Diet, Physical Activity, and Quality of Life among Permanent Supportive Housing Residents(2016-03-23) Suzuki, Sumihiro; Spence-Almaguer, Emily LSW, PhD; Walters, Scott PhD; Chhetri, ShlesmaBackground: Chronic homelessness is a complex public health concern in the United States. People experiencing chronic homelessness are much more likely to suffer from mental illness and substance use, and to be overweight or obese (Tsai & Rosenheck, 2013; Tsemberis, Kent, & Respress, 2012). Housing First is an approach to place people who are chronically homeless into Permanent Supportive Housing (PSH) (Rog el at., 2014). There is clear evidence PSH programs increase housing retention and, reduce healthcare and criminal justice costs (Tsemberis & Eisenberg, 2014; McLaughlin, 2010). However, becoming housed does not necessarily improve a person’s overall quality of life (QOL) (Wolf et al., 2001). Improvement in diet and physical activity may be one way to improve QOL among vulnerable populations (Blissmer et al., 2006). However, this association has not been explored among PSH residents. The purpose of this study was to explore the patterns of change and relationship between diet, physical activity and QOL among PSH residents enrolled in a health coaching program. Method: We used data collected during baseline and follow up interviews from m.chat – a health coaching program for PSH residents in Fort Worth. The program utilizes motivational interviewing and wellness incentives to help people achieve health goals. Specifically, we examined demographic characteristics, diet, physical activity and overall QOL from 230 participants enrolled in the m.chat program. Paired t-test and mixed model analysis was performed utilizing SPSS software. Results: We found a significant improvement in the total QOL scores from baseline to follow-up. A random intercept model showed a positive association between change in diet and the improvement in QOL. Physical activity was not significantly related to improved QOL; however, there was large variation in the physical activity data. Conclusion: This study is the first to look at changes in QOL among PSH residents enrolled in a health coaching program. Interventions that encourage diet and physical activity may improve overall QOL among PSH residents.Item Individualized Education Programs and their Effects on Preventive Medical, Dental and Vision Care(2016-03-23) Patel, Gunjanbhai; Patel, Nayan; Espinoza, Alex; Sasser, Lauren; Homan, Sharon; Mistry, JayAbstract Purpose: Individualized Education Programs (IEPs) are designed to help children with disabilities to progress through general education and transition into the adulthood. The IEP is an opportunity to increase health awareness and advocate for preventive health for the child who is at an increased risk for multiple health problems such as obesity and oral health problems. The aim of this study is to examine the exposure to IEP and its association with three preventive health outcomes--preventive medical care, preventive dental care, and preventive vision care—for disabled youth from 6-17 years of age. Methods: Using the National Survey of Children’s Health 2011-2012 dataset, we conducted a cross-sectional study of children ages 6-17. 65,480 children were categorized into two categories: those with an IEP and those without. We then compared the association between IEP exposure and the three preventive health outcomes in three separate models utilizing logistic regression. Results: At a significance of α=0.05, children with an IEP are 31% more likely to receive preventive medical care and 35% more likely to receive preventive vision care when compared to children without an IEP. In contrast, children with an IEP are 8% less likely to receive preventive dental care, though this was not significant at α=0.05. Conclusion: The results of this study appear to justify the role of IEPs in improving health outcomes for children with disabilities. The continuation of these programs and further integration of health education could prove to be pivotal in shaping the life-course of children with disabilities as they transition to more independent roles after exiting the school system.Item Internalizing Behaviors in Hispanic Boys Predict Overweight/Obese Status(2016-03-23) Franks, Susan; Fulda, Kimberly; Habiba, Nusrath; Namuduri, AnuradhaBackground: Obesity has been a troubling trend among Hispanic youth. Emotional eating has been described as the consumption of comfort food to cope with negative emotions, which in turn can contribute to weight gain. Negative emotions can lead to internalizing (feeling worthless, sad, withdrawn) and externalizing (bullying, arguing, disobeying, stubbornness) behaviors. Studies suggest these may precede obesity in children with poor socioeconomic status. The aim of this study was to examine these behaviors in relation to weight in under served Hispanic children. Hypotheses: Overweight children (OW) will have higher internalizing or externalizing behaviors as compared to normal weight children (NW). Methods: Subjects included Hispanic youths (117 males, 116 females) ages 10-14. Subjects were classified into NW (n=85) and OW (n=148) based on BMI percentile. Parents completed a 1-5 Likert scale survey of social-emotional behaviors. Responses were summed to arrive at scores for Internalizing (INT) and Externalizing (EXT) behaviors. Relationships between INT, EXT, age, and BMI percentile were examined for boys and girls separately using Spearman correlation. Logistic regressions were conducted to ascertain the effects of significantly associated variables on the likelihood that subjects would be OW. Results: For boys, BMI percentile was associated with INT (rs=.180, p=.053) and age (rs=.215, p=.020). Girls showed no significant correlations. Logistic regression for boys using INT and age was significant (X2=10.570, p=.005). Increasing age in boys was significantly associated with an increased likelihood of being OW (OR= 1.439, CI=1.056 – 1.961). The Wald criterion indicated that increases in INT approached significance in predicting OW (p=.069). EXT was not significant for boys. Regression models for girls were not significant. Conclusion: Internalizing behaviors increased for boys who were overweight or obese, especially with increasing age. This trend was not significant in girls. These data contradict previous literature suggesting Hispanic girls are at higher risk for obesity due to increased internalizing behaviors. Future research should broaden the scope of internalizing behaviors that may place children at risk for obesity. Acknowledgments: This study was supported by intramural grants, and the study was approved by the IRB at the University of North Texas Health Science Center.Item Is Our Community Trauma-Informed?(2016-03-23) Gonzalez-Pons, Kwynn; Spence-Almaguer, Emily MSW, PhD; Thomas, Patsy; Hagan, Nancy; Mandy, FanniPurpose: The Mental Health Connection (MHC) of Tarrant County supports the incorporation of Trauma-Informed Care (TIC) practices for all organizations serving trauma survivors. Trauma-informed organizations are able to respond to signs of trauma using specific policies, practices, procedures, and knowledge aimed at preventing re-traumatization (SAMHSA, 2015). The MHC conducted a survey regarding the current state of TIC incorporation within various organizations in order to gauge the community’s current ability to provide comprehensive trauma-informed care. The purpose of this study was to determine how effectively the principles of TIC were implemented in the MHC’s organizations. Methods: The MHC TIC survey was administered to 495 participants, representing over 60 organizations. The survey prompted employees to report the level of TIC implementation in various areas of their organization. Response frequencies were determined and composite variables were created for five key areas: policy, leadership, organization structure, training, and finance. Within each category, the top, moderate, and lowest progress items were identified to determine which aspects of TIC were implemented effectively and which could be improved. Responses relating to the participants’ confidence levels and most recent TIC trainings were further analyzed. Results: The results indicated that the top policy, organizational structure, and training items were better implemented than the top leadership and finance items. Within policy, 64% of respondents reported that confidentiality measures were effectively implemented. Furthermore, the difference in the mean response for policy items was significant at the 90% confidence level between those who did and did not participate in TIC training. Those who participated in TIC training were also significantly (95% confidence level) more confident in their ability to provide TIC than those who did not participate. Conclusions: The results demonstrated that employees who participated in TIC training were more confident in their ability to provide trauma-informed care than those who did not receive training. Apart from highlighting the importance of TIC training, the respondents reported areas where participating organizations were excelling, as well as areas of improvement. Overall, the study reinforces the importance of TIC training and avenues for further item implementation that will aid organizations in becoming fully trauma-informed.Item Metabolic Biomarkers of Allostatic Load in African-American Women(2016-03-23) Mandapati, Surendra; Dodgen, Leilani; Kitzman-Ulrich, Heather; Tan, MarissaIntroduction: The purpose of this study was to investigate risk factors of metabolic biomarkers of allostatic load in African-American women in the Better Me Within (BMW) program, a community-based participatory research study testing a faith-enhanced diabetes prevention program. Methods: Baseline health measures, psychosocial and demographic survey data were collected in 136 African-American women with a mean age of 49.3 years and mean body mass index (BMI) of 37.8 during baseline measurement for the BMW study at 7 churches in Dallas County over a period of 2 years. The metabolic biomarkers of high density lipoprotein (HDL), total cholesterol/HDL ratio, systolic blood pressure, diastolic blood pressure, glycosylated hemoglobin (HbA1C), triglycerides, and BMI were collected. The highest risk quartile of each biomarker was assigned a value of “1,” while all other values were assigned a “0.” All biomarker scores for each participant were summed for a maximum allostatic score of 7. A Poisson Regression was used to assess the relationship between allostatic load score and behavioral determinants of health (perceived stress, depression, and spiritual locus of health), controlling for age, income, and education level. Results: Regression model that included perceived stress, income, education, depression, spiritual locus of health, and age, found the main risk factor for higher allostatic load was low income level ( Discussion: Although no statistical significance was found in the relationship of the tested behavioral determinants of health and allostatic load, the significant association between low income and high allostatic load in this study of African-American women reinforces the known relationship of poverty and poor health outcomes in health disparities. Further investigation is needed to discover whether poverty mediates poor health or whether it is a proxy for experiences of poverty-related adversity, like childhood trauma, neighborhood poverty, and chronic stress.Item Oral Health Status Among Drug Abusers(2016-03-23) Kolasani, Balaji; Nandy, Rajesh PhD; Mallampati, RajeshAbstract Purpose- To evaluate oral health status among drug abusers. Methods- We used data National Health and Nutritional Examination Survey (NHANES) data of 2011-2012 to examine the relationship between oral health and drug abuse. Drug abuse data included people who are using or used marijuana, cocaine, methamphetamine, heroin and injected drugs. Presence of decayed teeth, missing teeth which are not replaced and periodontal status are used as indicators of oral disease. We used SAS® 9.4 for our analysis. Logistic regression model was used to analyze the relationship while adjusting for demographic variables. Results- A total of 4116 participants from 18 to 69 years were used for our analysis purposes. Total number of drug users are 1916. No significant relation was detected between oral health and drug abuse (OR=0.942, 95% CL= 0.756, 1.176). Conclusion- Among the participants of our study which included 1916 drug abusers no significant difference in oral health status was observed.Item Public policy, private practice: Tuberculosis/latent tuberculosis infection (TB/LTBI) surveillance in the commercial healthcare sector(2016-03-23) Carlson, Erin; Miller, Thaddeus; Stockbridge, Erica L.Objective: To estimate the prevalence and explore the pattern of TB/LTBI testing and retesting in the commercially insured US population. Domestic TB elimination is a cornerstone of US public health policy, yet progress toward elimination has slowed. One reason for this is the lack of emphasis on identifying and addressing LTBI. Systematic efforts to find and treat persons with active TB or persons with LTBI have defaulted to local and regional public health departments but, given limited resources and murky mandates, LTBI surveillance and treatment by public health is inconsistent. At the same time, TB/LTBI testing is not uncommon in the private sector. Unleveraged synergies exist between the testing conducted by private healthcare providers and the surveillance conducted by public health departments. Understanding the patterns of TB/LTBI screenings conducted in the private sector is a crucial first step toward realizing this potential. Methods: De-identified paid medical claims for services rendered between 4/1/2010 and 3/31/2013 for a sample of 4 million people from the Optum Research Database were analyzed. People in the sample were ages/1/2010 and 3/31/2013. TB/LTBI testing via tuberculin skin testing (TST) and interferon gamma release assay (IGRA) was identified using CPT codes. The index TB/LTBI test per person was identified based on each individual’s first TST or IGRA with a service date between 6/2010 and 5/2011. Subsequent tests were identified based on service dates following the index test through 3/2013. Results: Of the 4 million people, 67,168 (1.68%) had an index TB/LTBI test between 6/2010 and 5/2011. TSTs were more common than IGRAs; 64,788 (96.5%) of index tests were TSTs and 2,355 (3.5%) were IGRAs. Of those with an index TST, 21,645 (33.4%) had another test on a later date. Retesting methods differed depending on how quickly retesting occurred. In patients with a retest within 30 days, 6.4% received an IGRA next instead of another TST, while 2.6% of patients who had a retest in [greater than] 30 days received an IGRA. Conclusion: Much TB/LTBI testing is conducted by providers outside of the US public health system. Data collected by commercial insurers can provide insight into TB/LTBI testing in this setting. These results indicate that TSTs are far more prevalent than IGRAs, but IGRAs are being used in practice for post-TST retesting when retesting is conducted shortly after initial testing.Item Pyriproxyfen prenatal exposure to pregnant women and increased potential for hormone disruption and morphological abnormalities in the fetus(2016-03-23) Shah, Taksh; Rich, Dr. Alisa PhD, MPH; Tiwari, SwetaBackground: Pyriproxyfen is an insecticide used to kill ticks, fleas, mosquitoes, and cockroaches. Reports support pyriproxyfen used in drinking water in Brazil as a juvenile toxic growth regulator/hormone analog preventing maturation of mosquito larvae. Fetal exposure to pyriproxyfen has been associated with increased incidence of microcephaly in Brazil. Objective: The aim of this study is to assess if pyriproxyfen exposure to pregnant women has the potential to alter normal fetal development, sexual and physical maturation. Methods: A systematic review of databases (PubMed, Scopus and Google Scholar) resulted in 2080 publications related to pyriproxyfen. Cross referencing pyriproxyfen and pregnancy resulted in 116 publications since 2010. Search narrowed using keywords pyriproxyfen, pregnancy, drinking water, and birth defects (44 references). Adverse effects from pyriproxyfen exposure in fish, reptiles were also retrieved. Results: Reports confirmed adverse developmental defects such as microcephaly, skin and eye toxicity in infants with pyriproxyfen exposure. Animal studies confirm malformations including bilateral gynandromorphism, eye and skin toxicity, endocrine and immunological disruption. Pyriproxyfen effectively interferes with reproductivity in mosquitoes and aquatic organisms through morphological changes in an endocrine system, sex organs, and secondary sexual behavior. Conclusion: Prenatal exposure to pyriproxyfen is associated with morphological abnormalities affecting fetal development. Studies support the plausible connection between congenital malformations in infants (as seen in ecological studies) and pyriproxyfen exposure in drinking water. Reproductive malformations (ambiguous genitalia, gynandromorphism, intersex) are voluntary reporting unless associated with CAH, and, therefore, may be unrecognized and underreported. Recommendations include the elimination of pyriproxyfen in drinking water sources.Item Reduction of Malaria Mortality in the country of Chad, Sub-Sahara Africa from 2013 to 2014.(2016-03-23) Rich, Alisa PhD; Njesada, NdolembaiReduction of Malaria Mortality in the country of Chad, Sub-Sahara Africa from 2013 to 2014. 1. Objective: The purpose of this study is to show the effectiveness of a malaria net distribution program with multi-faceted activities including multiple forms of communication, early diagnosis and treatment in the reduction of malaria mortality in Chad from 2013 - 2014. 2. Material/Background and Methods Malaria is a parasitic disease caused by the Plasmodium parasite transmitted through infected mosquitoes bites (anopheles). The parasites multiply rapidly in a human’s liver and then infect red blood cells. Symptoms including headache, fever, vomiting and vertigo appearing within 10 to 15 days after a mosquito bite. Worldwide, cases of malaria are estimated at 198 million (2013). Approximately 584,000 deaths occurred mostly in African children. This equates to a child dying of malaria every minute in Africa. Despite the alarming number of cases, the mortality rate since 2000 has fallen by 47% globally with a 54% decrease in the African Region. In the Country of Chad, 27% of all morbidity and 19% of all mortality are due to malaria. The database from the United Nations Development Program (UNDP-CHAD) and communication activities of STOP PALU CHAD from 2013 and 2014 were examined. 3. Results Confirmed cases of malaria increased by 27.28% from 2013 – 2014, primarily due to increased awareness and early detection. The mortality rate fell by 69 cases/1000 (1881 in 2013, 1729 in 2014) according to records from health facilities. Studies show in the African region many malaria cases are underreported. 4. Conclusion A multi-faceted malaria awareness and prevention campaign was shown to be effective in reduced mortality of children in Sub-Sahara Africa. The incidence of malaria continues to be underreported due to lack of awareness, health care facilities and access to facilities. Results show combined efforts are necessary to educate people in rural communities in reporting to health care facilities, when symptomatic, for proper diagnosis and treatment.Item Relationships between a motivation to exercise and exercise activity levels in adolescents(2016-03-23) Roane, Brandy PhD; Mott, Kacee; Morrissey, Katherine; Escarsega, PhillipIntroduction: Prior literature shows a positive relationship exists between motivation to exercise and weight loss. Adolescents are a prime population to study health behaviors such as physical exercise and other obesity-related factors due to the many developmental changes occurring and increasing autonomy. This shouldering of responsibility for their health likely shifts motivation to a more prominent factor in sustaining healthy behaviors such as physical activity. The current analysis compares motivation to exercise and the impact it has on engaging in physical activity (PA). The hypothesis was teens who claimed higher motivation to exercise would subsequently evidence increased activity levels the next week compared to teens who did not exhibit high motivation to exercise. Methods: Participants were 35 normal weight to obese teens (mean grade=10th, mean age=15.3 yrs, 77% females, 23% Hispanic). After obtaining consent and assent, teens completed questionnaires assessing sleep and health behaviors. Included was the 19-item Behavioral Regulation in Exercise Questionnaire (BREQ2) to assess their motivation to engage in PA (scale:0-4/item; mean=27.1, SD=10). Stadiometer and digital scale measured height and weight (BMI %tile calculated). One week later teens completed additional assessments including the Past Week Modifiable Activity Questionnaire for Adolescents (MAQAPW) which provided data on # of activities engaged in; days/wk of sedentary behavior, light PA, moderate-vigorous PA, and all PA; total minutes/wk of PA; and min/day of PA. Data were from a larger prospective study assessing teen’s sleep and health. Regression analyses examined BREQ2 as a predictor of self-reported PA with sex, grade, age, and BMI %tile as covariates. Results: Analyses showed BREQ2 predicted the frequency teens engaged in moderate-vigorous PA (29%=none, 34%=1-2 days, 31%=3-5 days, 6%=6-7 days; beta=0.476, P=0.006) and days/week they engaged in PA (mean=2.83 days; beta=0.413, P=0.048). No other PA variables were significant. Conclusions: Motivation appears to increase how frequent teens engage in PA as well as how often they engage in moderate-vigorous PA. These two aspects of PA have been shown to protect against obesity. Further exploration into factors that both enhance and reduce motivation to engage in PA would be beneficial to reduce risk of obesity. Such findings would also assist with obesity interventions.