General Public Health
Permanent URI for this collectionhttps://hdl.handle.net/20.500.12503/21627
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Item A Bigger View: US public TB prevention initiatives with a broader health systems perspective(2019-03-05) Miller, Thaddeus; Grebennikov, Sarah; Stockbridge, Erica L.; Hussain, AnushaBackground: Tuberculosis (TB) is a complex disease and persists as a greater threat than most understand. Responsibility for TB treatment and control has generally fallen to public health agencies. Unfortunately, important limitations to the public health sector’s of TB control are beginning to show. UNTHSC recently hosted a “systems thinking symposium” with the goal of helping public health authorities view their work in broader context. This project presents an analysis of industry perspectives on public TB control initiatives drawn from symposium discussions. Purpose: We analyzed 36 hours of discussions to better understand how CDC’s messaging around TB prevention and managing latent TB infection (LTBI) in particular is heard, accepted, and potentially acted on in various health care sectors. Methods: Approximately 30 participants from across the US healthcare system discussed how incentives and disincentives within their industry might affect TB-related public health initiatives. Discussion sessions focused on how at-risk patients self-identify and seek care; how providers identify potentially at-risk patients; how clinical evaluation is initiated and conducted; treatment initiation; and treatment completion. We analyzed discussion transcripts to identify industry perspectives, opportunities and barriers, and potential gaps in TB control initiatives. The unit of study was the program or industry represented by responses, not individual respondents, and the North Texas Regional IRB determined the project not to be human subjects research. Results: We identified the 15 most commonly used context appropriate words from a 78,604 word transcript. These were mapped to broad themes such as improving screening target populations, continuity of care, and potential roles of the non-public health sector. Notable barriers were identified within the clinical and managed care sectors, including consistent questioning of TB prevention as a priority activity, including potential risks, benefits, and the value proposition. Conclusions: CDC’s promotion of targeted LTBI screening and treatment, and TB prevention in general, is not well reflected in the attitudes of the non-public healthcare sector in our sample. Most health care professionals would choose not to prioritize LTBI due to the logistics of insurance and more urgent and emergent diseases. It may be important for CDC to consider who and how they target TB elimination messaging in order to enhance impact.Item Adolescent Health Data: Feelings of Depression and Marijuana Use(2019-03-05) Thompson, Erika; Davis, AmbrialeAdolescent Health Data: Feelings of Depression and Marijuana Use Objective The purpose of this study is to examine an association between feelings of depression and marijuana use amongst high school students in the United States. Methods Data were analyzed based on the Youth Risk Behavior Surveillance System (YRBS), 2017. SAS 9.4 was used to apply survey weighting procedures to the bivariate and logistic regression models as well as to calculate univariate and bivariate descriptive statistics, and crude and adjusted odds ratios for the outcome, exposure, and covariates (n=13,916). Outcome was measured as “During the past 12 months, did you ever feel so sad or hopeless almost every day for two weeks or more in a row that you stopped doing some usual activities” and operationalized by yes/no. Exposure was measured by ““during your life, how many times have you used marijuana” and operationalized as no if zero and yes if any other number. Results Students who had feelings of depression were more likely to have ever used marijuana (49.1%) than those who did not have feelings of depression (29.4%). Also, females were more likely to have experienced feelings of depression when compared to males, 67.2% and 32.8% respectively. High school students who ever tried marijuana had 2.46(95% CI:2.15-2.82) times the odds of feeling depressed compared to those who had never tried marijuana. Female students had 2.73(95% CI:2.37-3.13) times the odds of feeling depressed compared to male students. Black or African American, 0.83(95% CI:0.69-0.99), and 15 year old, 0.78(95% CI:0.64-0.96), students had less odds than whites and those 17 years and older respectively. Conclusions This study revealed that students who had feelings of depression were more likely to have ever used marijuana compared to students that did not. Race and age were protective factors for depression. Female students had almost three times the odds of feeling depressed than males. Results can inform future research surrounding attitudes of marijuana use among high school students with feelings of depression in order to prevent or delay marijuana use in this population.Item An Assessment of Obesity and Sleep Sufficiency Among Adolescents in the United States(2019-03-05) Thompson, Erika; Mayfield, LauraAn Assessment of Obesity and Sleep Sufficiency Among Adolescents in the United States Laura Mayfield, MPH Candidate, CHES Erika Thompson, PhD, MPH, CPH Purpose: Obesity is increasing among adolescents in the US, and understanding co-factors is needed. Insufficient sleep may contribute to obesity among adolescents. The purpose of this study was to assess the association between sufficient sleep and obesity among 9th-12th grade students in the United States. Methods: This study used the 2017 Youth Risk Behavior Surveillance System data (N=14,765). The sample was further restricted as a complete case analysis (N=10,350). The outcome was obesity, which was categorized dichotomously (obese, not obese) based on participants’ Body Mass Index. The exposure was sleep: those who got 8 or more hours of sleep on the average school night (sufficient sleep) and those who did not (insufficient sleep). Covariates included physical activity, sex, age, and race/ethnicity. All analyses were completed using survey- weighted procedures in SAS 9.4. A survey logistic regression model was used to calculate adjusted odds ratios and 95% confidence intervals modeling odds of obesity. Results: Among participants, 14.7% were obese and 74.5% had insufficient sleep. The association between sleep and obesity was not statistically significant (OR=0.91, 95% CI 0.76, 1.08). However, participants who were physically active for 60 minutes, 5 or more days each week, were less likely to be obese compared to participants who were not physically active, while controlling for sleep, sex, age, and race/ethnicity (OR=0.65, 95% CI 0.55, 0.76) Conclusions: Multiple factors are associated with obesity among American adolescents. Further research on obesity trends and associated factors is needed to help inform public health efforts to prevent and reduce obesity among adolescents. Keywords: YRBSS, Sleep, ObesityItem Application of an Interprofessional Team in Pediatric Nutritional Wellness(2019-03-05) Baker, Bryan; Farmer, David; Rew, Martha; Habiba, Nusrath; Muqueet, SameeraPurpose: Childhood obesity poses a significant health risk to children in the United States and has been increasing in recent years. Childhood obesity is associated with increased risk of hyperlipidemia, diabetes, and hypertension manifesting later in life. Early intervention is crucial in preventing these health problems. Therefore, it is important that parents receive early education on nutritional wellness as well as the most accurate information possible. A team-based application of health care delivery is one possible way of achieving this patient education. This study aims to evaluate patient satisfaction with the use of an interprofessional healthcare team in delivering nutritional wellness information to parents in an outpatient pediatric clinic. Methods: Patients were seen by a three member interprofessional team consisting of a Physician or Physician Assistant (PA), medical student or PA student, and dietetic intern. At the end of the visit, patients were given a survey to assess their satisfaction with the visit. The survey evaluated patient satisfaction with the interprofessional team with, how helpful and how likely they were to use the nutritional advice given to them during the visit, and their perception on whether the interprofessional team improved the quality of their visit. Patients were asked to rank these factors on a scale of 1-5 with 1 being unsatisfied and a 5 being highly satisfied. Results: Out of 95 patients, 96.8% rated their happiness with the interprofessional team as a 5/5; 95.7% rated the helpfulness of the nutritional advice 5/5; 94.7% rated their likelihood of utilizing the nutritional advice 5/5; 94.7% rated the improvement in the quality of their visit 5/5. Conclusions: Overall, patients were satisfied with the nutritional information they received from the interprofessional team and viewed being seen by a team as an improvement in the quality of their visit. Utilizing an interprofessional team has the potential to be an efficacious method of delivery of nutritional information to patients and improve wellness and prevention. In future studies, the likelihood of patients to implement this nutritional advice will be tracked via EMR and compared to groups that were not seen by an interprofessional team in order to assess the efficacy of team-based healthcare.Item Assessing the scope and equity of Medicare to determine policy improvements(2019-03-05) Chabot, Stephen; Parikh, Tiraj; Madina, Revanth; Gorrepati, Krishna; Guan, MaxAbstract Purpose: The purpose of this study was to determine the effectiveness of Medicare in providing universal access to equitable healthcare for those 65 and older. Medicare went through iterations to adapt to changes in medical practice, and today is organized into parts that cover hospital insurance, health insurance, and prescription drug coverage. It is funded by a combination of payroll taxes, premiums that beneficiaries pay, and general revenues. Methods: Through a literary analysis, we compiled data to illustrate a statistical presentation of Medicare’s current population and the disparities present within it. Results: 46% of Medicare recipients are age 65-74. 16% of recipients are under age 65 and qualify for Medicare for other reasons. Roughly 80% of recipients live in urban settings, in line with population demographics. Roughly half of recipients live with a spouse, almost 30% of beneficiaries live alone. 15% of recipients are under the poverty line, slightly higher than the United States census poverty rate of 12.7%. Despite widespread effectiveness, disparities are still present. There is a sizable difference in the coverage of white beneficiaries against their minority counterparts. Female beneficiaries outnumber male beneficiaries by a significant amount, despite a near equal gender ratio at the population level. Furthermore, while Medicare was designed for the aging, 65+ population, theexpenditure, due to the impact of end stage renal disease patients. Costs also rise as recipients’ ages increase, though the number of recipients in the upper echelons of age decrease. Medicare recipient numbers are expected to increase rapidly in the next decade, until 2030. At the same time, the number of recipients enrolled in Medicare Advantage continues to rise as well, in both absolute and relative terms, easing some of the government’s burden onto private contractors’ shoulders. Conclusion: An important question to answer is how much to spend on Medicare, and how effective an increase in funding would be. For many, Medicare does not fully cover their health-related costs, and this is expected to worsen in the coming years. Since poverty is correlated with increased liability, targeting that group may present opportunities for improvement. Though outside the scope of Medicare, it is crucial to consider other programs that may work in tandem to achieve its goal of providing universal, equitable health care.Item Association between Cyber-Bullying and Weapons Carrying at School: Analysis of the 2017 Youth Risk Behavior Survey(2019-03-05) Thompson, Erika; Morris, KimberlyObjective: Previous research has found that victims of bullying are more likely to carry a weapon and say that it is “not wrong” to take a gun to school. Moreover, studies have shown that cyberbullying and traditional bullying are highly correlated. With the rate of online harassment nearly doubling from 2000 to 2010 further research is needed to study the link between cyberbullying and weapons carrying. The objective of this study was to examine the association between cyberbullying and weapons carrying at school among adolescents participating in the 2017 Youth Risk Behavior Survey (YRBS). Methods: The YRBS 2017 is a representative dataset for 9th through 12th graders in both public and private schools in the United States (N = 14,765). The analytic sample was restricted to a complete case analysis for the variables of interest (N = 13,944). The outcome variable was weapon carrying on campus (yes/no). Predictor variables included: cyberbullying, sex, grade, race/ethnicity, and bullying. A survey-weighted adjusted logistic regression model was estimated for the association between cyberbullying and weapons carrying using SAS 9.4. Results: 14.84% of students surveyed reported experiencing cyberbullying and 3.51% reported ever carrying a weapon on school ground. Students reporting weapons carrying were 74.7% male, 32.8% 11th graders, and 56.0% white; 27.7% reported experience bullying, and 22.2% cyberbullying. In the multivariable model predicting the outcome of weapon carrying on school grounds, exposure to cyberbullying, (Adjusted Odds Ratio (AOR) = 1.70, 95% CI: 1.27, 2.29), being a male student (AOR = 3.60, 95% CI: 2.91, 4.44), being in 11th(AOR = 2.29, 95% CI: 1.64, 3.19) or 12th(AOR = 1.97, 95% CI: 1.27, 2.64) grade and being bullied on school grounds (AOR = 1.56, 95% CI:1.21, 2.00) were significantly associated. Conclusions: Although a statistically significant correlation between cyberbullying and carrying a weapon on school grounds was found, results should be interpreted with caution due to the temporality of the data, and correlation between bullying and carrying a weapon on school grounds. Regardless, the results show that additional research is needed to investigate the affect cyberbullying has on eventual weapons carrying to ensure schools remain safe in the modern era.Item Autism Spectrum Disorder Service Utilization and Satisfaction in the DFW metroplex(2019-03-05) Miller, Haylie; Mupparapu, Shravan; Ganesh, AbhinayaPURPOSE The prevalence of Autism Spectrum Disorder (ASD) has risen rapidly to 1 in every 59 children. Being one of the fastest growing developmental disorders, the need for services outpaces availability for individuals with ASD. Texas is ranked 50th (out of the 51 states included) in providing community-based services for people with developmental disabilities. In order to make community- and state-level policy recommendations to address this issue, it is important to understand the specific landscape of met and unmet needs of individuals with ASD. By identifying gaps in service availability and use of services, policymakers, healthcare providers, and community advocates will be better equipped to design programs that facilitate access to appropriate and timely interventions. We aimed to identify patterns of service utilization among individuals with ASD and their families in the Dallas/Fort Worth (DFW) area, a large population center in northeast Texas. We predicted that service navigation and financial burden would be among the most difficult challenges caregivers faced. METHODS We conducted a cross-sectional study to assess the services used by individuals with ASD in the DFW area, and satisfaction with these services. We created the Autism Service Utilization and Satisfaction survey by combining new items with adaptations of two existing instruments, the Pathways in ASD and the Community Services Outcomes for Families and Children with ASD. The survey was delivered to caregivers of individuals with ASD and adult self-advocates with ASD using REDCap, an online secure project management service. The survey captured family demographics, services utilized (e.g., type, setting), and associated satisfaction. Preliminary analysis included 26 caregiver respondents. RESULTS Preliminary qualitative analysis revealed several notable trends in caregivers’ self-reports of the most challenging issues they faced after a diagnosis was made. Caregivers reported difficulty navigating services: 47% struggled to find the appropriate services for their child, 29% did not know where to start, and 24% had difficulty scheduling and maintaining appointments with providers. Overall, 29% reported that affording services and qualifying for help was one of their three most challenging issues. Additionally, 82% of caregivers affirmed that they identified a resource but could not pay for it, 67% were satisfied with the diagnostic services provided by their school district, and 71% were satisfied with education programs meeting the recipient’s behavioral and emotional needs. Finally, 88% either disagreed or were neutral about overall satisfaction with available services and providers. CONCLUSIONS Preliminary examination of responses suggests that caregivers in the DFW area have difficulty navigating their child’s diagnosis and case management. Participants confirmed our hypothesis that they were satisfied with the diagnostic and educational services the school provided; however, they had trouble paying for the services and qualifying for help through insurance and other means. This further emphasizes the importance of identifying resources that families are using, and where the gaps lie in their access to these resources. Data collection is ongoing through partnership with clinics, schools, and community organizations in the DFW community.Item Being Data Driven: Visualizing program data to aid stakeholder comprehension and decision-making in the TESSA project.(2019-03-05) Spence-Almaguer, Emily; Grace, Jessica; Chhetri, Shlesma; Prabhakar, PushanPurpose: Programs within the community gather large volumes of raw data on their target populations. Representing these data to stakeholders in a presentable format and customized to suit their varying needs poses a challenge. Data visualization may help streamline complex datasets for audiences. The Technology Enhanced Screening and Supportive Assistance (TESSA) project serves primary care clinics and interpersonal violence agencies in Tarrant County with a tablet-based screening and health advocacy component. The objective of this project is to determine the effectiveness of data dashboards for stakeholder decision-making from clinics and agencies. Methods: Data obtained from the TESSA project were visualized into dashboards using the software Tableau. Two dashboards were created based on the sources from which they were obtained (Computerized Intervention Authoring Software [CIAS] and FileMakerPro). These dashboards were then presented to the respective stakeholders from seven organizations and/or health systems for iterative feedback and also to aid in decision-making (e.g., referral process, client needs). Results: The two dashboards started with a baseline of what the evaluation team deemed necessary at the onset. The FileMakerPro dashboard details the interpersonal violence agency data and the health advocate encounters. The FileMakerPro dashboard went through multiple iterations based on stakeholder feedback before culminating in the current version. The CIAS dashboard, which details the primary care clinic data, had to be modified with a password protected feature to allow clinics to have online accessibility. The CIAS dashboards are also customized according to the individual clinics. Conclusion: Data visualization in the form of dashboards have helped influence stakeholder decision-making in the TESSA project. These findings are evident from the multiple iterative processes and feedback received from the stakeholders regarding the respective dashboards. Data visualization serves as an essential tool in breaking down complex streams of data into more digestible formats for community collaborators.Item Break a Sweat, Mend Your Mind: Exercise and Mood Among Adolescents(2019-03-05) Thompson, Erika; Harrison, SamanthaPurpose: The prevalence of depression in adolescents is rising, and regular exercise has been reported to have a decreasing effect on incidence of depressed mood in meta-analyses of adult interventions. There is a need to explore this association among adolescents. The purpose of this study was to examine the association between exercise and mood among United States adolescents responding to the Youth Risk Behavior Survey (YRBS) 2017. Methods: YRBS is a nationally representative sample of 9th through 12th grade students (N=14,765), and was restricted to an analytic sample (N=10,789). The outcome of interest was depressed or low mood (yes/no to feeling sad or hopeless in the past 12 months), and the exposure was physical activity (yes/no to being physically active for at least 60 minutes on five or more days in the past week). Covariates included: age, sex, race/ethnicity, physical education class attendance, sports team participation, and hours of sleep. SAS version 9.4 was used to perform survey-weighted descriptive estimates and crude and adjusted logistic regression models. Results: Overall, 47.5% of participants reported being physically active, and 31.3% reported feeling sad or hopeless in the last year. Respondents who reported physical activity were less likely to have reported feeling sad or hopeless when compared to those who were not physically active (OR=0.68, 95%CI 0.59, 0.79). When adjusting for age, sex, race/ethnicity, physical education class attendance, sports team participation, and hours of sleep, the association was no longer statistically significant (aOR=0.93 95%CI 0.80, 1.10). Conclusions: While an association between exercise and depressed mood was not observed in this cross-sectional study, further research is needed into the risk and protective factors for depression in adolescents due to the rising prevalence of the disorder.Item Bullying Involvement and Adverse Childhood Events: Should We be Concerned?(2019-03-05) Maskey, Smriti; Nandy, Rajesh Dr.; Shrestha, NisthaPURPOSE: Bullying is one of the public health priorities in the United States. While most of the current literature focuses on the relationship between school environment and bullying involvement, research shows that adverse child events play an important role in developing bullying behavior. Hence the aim of this study is to examine if adverse child events increase the likelihood of bullying involvement among children aged 6-17 years. METHODS: The National Child Health Survey (NCHS) data from 2016 was used in this study. The survey included a total of 50,212 participants, who were chosen by the household at random. Eight questions from the NCHS 2016 survey related to adverse childhood experiences were used for this study. The bullying involvement was studied in terms of being bullied and bullying others. RESULTS: A logistic regression analysis was conducted after adjusting for all the variables of interest. Presence of adverse childhood events such as past racial or ethnic discrimination showed a statistically significant increase in the tendency to be victims of bullying others (OR=2.30, CI=2.00-2.60). History of the child experiencing domestic violence showed an increase in the tendency of bullying others (OR=2.05, CI=1.71-2.46) and the tendency of being bullied (OR=1.76, CI=1.55-2.00). History of living with mentally ill caregiver showed a protective effect against being bullied (OR=0.54, CI=0.50-0.60) & bullying others (OR=0.66, CI=0.55-0.73). CONCLUSION: The results indicate that the presence of adverse childhood events increases the likelihood of bullying involvement. More research should be conducted to strengthen this relationship. In order to address bullying at large, screening for adverse childhood events should be conducted and counseling should be provided.Item Developing Tuberculosis Prevention Strategies via Interdisciplinary Systems-Thinking: Latent Tuberculosis Infection Risk Recognition and Care(2019-03-11) Chhetri, Shlesma; Dhakal, Eleena; Stockbridge, Erica L.; Miller, Thaddeus; Jose, RoslinBackground: Tuberculosis (TB) remains a threat to public health, both globally and within the US. An estimated 80% of active TB cases in the US are from reactivation of latent TB infection (LTBI). Reactivation is preventable with proactive, targeted LTBI screening and treatment but public health agencies lack the capacity to mitigate this threat. Recent guidelines recommend that LTBI-related services be rendered by private sector healthcare providers. In order to identify systemic barriers to appropriate LTBI-related care in the private sector and brainstorm new strategies to facilitate this care, UNTHSC hosted an LTBI Systems Thinking Symposium. Aims: 1) To identify barriers and facilitating factors that influence patient and provider recognition of LTBI risk and subsequent care-seeking or care-recommending behavior, as articulated by symposium participants. 2) To determine whether the factors identified by attendees varied by attendee profession. Methods: Thirty healthcare and public health professionals were divided into 6 interdisciplinary groups. Participants identified barriers to care and opportunities to facilitate care by discussing each step in the LTBI care continuum. We used Grounded Theory approach to code participants’ distinct ideas. Each open code was systematically categorized into axial codes by two independent coders. A third coder calculated inter-coder reliability; the two coders agreed 80% of the time. Coders collaborated on the remaining 20% to create a final list of axial codes, which were further categorized into selective themes. Results: Barriers (78%) to targeted LTBI screening and treatment were mentioned more frequently than strategies to facilitate care (22%). The top three barriers were lack of awareness among patients, lack of ideal testing tools, and lack of health insurance among high-risk persons. Facilitators included increasing patient awareness, health insurance that covers LTBI services, community outreach, and population-level health communication. Variations in perceived barriers and facilitating factors based on the industries our participants represented were observed. Conclusion: Both patient and health systems-related factors present barriers to the initial identification of LTBI in the private sector healthcare setting, but there are opportunities to overcome these barriers. The facilitating factors identified by symposium participants can serve as beacons for prevention strategies and future health policies.Item Dissemination and Implementation of School-Based Asthma Initiatives: The Asthma 411 Pilot(2019-03-05) Aryal, Subhash; Sterling, David; Spence-Almaguer, Emily; Allsopp, Leslie C.Purpose: The dissemination and implementation (D&I) of evidence based practices (EBIs) has been identified as one of the most critical barriers to improvement of the public’s health. The Asthma 411 EBI was developed, implemented and evaluated in St. Louis, MO from 2002-2008; Asthma 411 was disseminated, adapted, and piloted in Fort Worth, TX from 2013-2015. The evaluation of the pilot was designed to examine processes and outcomes of the program’s dissemination, inform ongoing expansion, and identify approaches that may support dissemination of other school health EBIs. Methods: In 2013, an engaged process was used to retain core components of Asthma 411 while adapting peripheral program elements. The pilot was implemented in one elementary (n=567) and 1 middle school (n=791). Three service categories were included: 1) access to rescue medication through standing orders; 2) support for enhanced school asthma services; and 3) support for communication with parents and health care providers to support comprehensive, prevention oriented care. Data collected included 1) school day EMS calls one year prior and both years of the program, 2) logs of aggregated nursing services, 3) individual level school absence and demographic data, 4) availability of medication provided through existing policies, and 5) informal interviews. Results: The pilot was positively received by schools and parents. During the pre-implementation year, there were 19 asthma-related EMS calls from the pilot schools. During the two years of the pilot, school day, asthma-related EMS calls were eliminated. Across the two year study, there was an increase in documented asthma self-management education, use of Asthma Control Tests, proportion of students with asthma that have authorization for rescue medication, and documented efforts to communicate with parents and health providers. Evaluation of absences was limited by the lack of pre-implementation data, small numbers, large variance, and short duration. Between year 1 and year 2, the gap between unadjusted, weighted absences among students with and without asthma was reduced 1.1 day. However, this difference was not seen in a fully adjusted negative, binomial regression analysis which provided a modeled mean difference of 1.28 absence days between children with and without asthma (95%CI 1.10, 1.50, p = .002) during year one, and 1.24 days (95% CI 1.07, 1.47, p = .006) in year two. Conclusions: The Asthma 411 case study identifies important characteristics of interventions, interventionists, contextual factors, and processes that may support effective dissemination of school based health initiatives. More research is needed to clarify impacts on absenteeism, and to determine if observed benefits are sustained.Item Does Alcohol Misuse Differ by Veteran and Gender Status in Adults 25 to 75 Years of Age?(2019-03-05) Siegel, Jerome; Hartos, Jessica; Ashworth, Kelly; Burns, Justin; Boulom, AnitaPurpose. Historically, alcohol misuse has been a problem among veterans. The purpose of this study was to examine whether alcohol misuse differs by veteran and gender status in adults 25 to 75 years of age in the general population. Methods. This cross-sectional study used data from the 2016 Behavioral Risk Factor Surveillance System for adults 25-75 year olds in Alaska (N=2443), Arizona (N=8319), Montana (N=4754), South Dakota (N=4580), and Wyoming (N=3572). Ordered logistic regression by state was used to assess whether alcohol misuse differs by veteran and gender status when controlling for physical and mental health status, tobacco use, education, employment, income, race and marital status. Results. Across five states, there were low levels of excessive alcohol use (21-26%) and few veteran males (12-15%) and veteran females (1-2%). After controlling for health and socioeconomic factors, results showed that veteran and non-veteran males were more likely to use alcohol than non-veteran females (moderate effect sizes). In addition, alcohol use was highly related to physical health (moderate effect sizes) and smoking status (small effect sizes), and inversely related in age 65-75 (moderate effect sizes). Conclusion. Results of our analysis revealed a significant relationship between alcohol misuse and gender and veteran status across five states. Alcohol use was also related to smoking and good physical health in all 5 states. Providers in a primary care setting may expect a low prevalence of alcohol use in adults 55 to 75 years of age, but alcohol use screening should continue for all patients. Patients and with risk factors of alcohol misuse, that smoke tobacco, and are in good physical health, especially males, should undergo further detailed screening for moderate to high levels of alcohol use and educational materials and referrals should be made available.Item Does Alcohol Use Differ by Metropolitan Status in Females Ages 25-44?(2019-03-05) Dainty, PA-S, Mackenzie; Weise, PA-S, Lauren; Dempsey, PA-S, Bethany; Hartos, Jessica; Thompson, MSPAS, PA-C, Feroza; Story, PA-S, SarahPurpose: Alcohol use can lead to serious health concerns and even death, but findings are inconsistent regarding whether risk differs by where people live. The purpose of this study was to determine whether alcohol use differs by metropolitan status in female adults ages 25-44. Methods: This cross-sectional analysis used data from the 2016 Behavioral Risk Factor Surveillance System (BRFSS) for females ages 25-44 in California (N=271), Colorado (N=428), Florida (N=1109), New York (N=1456), and Texas (N=482). Ordered logistic regression analysis was used with combined state data to assess the relationship between alcohol use and metropolitan status while controlling for demographic and health-related factors. Results: Across states, almost half of participants reported alcohol use (49-65%), about one-fifth reported excessive alcohol use (14-26%), few were smokers (8-20%) and about half reported mental health issues in the past 30 days (38-52%). Metropolitan status varied among urban (12-54%), suburban (24-51%), and rural (5-42%) residents. Adjusted results indicated that metropolitan status, current smoking, and mental health status were significantly related to alcohol use. Conclusion: Overall, alcohol use differed by metropolitan status in female adults ages 25-44, with urban women reporting drinking more than their rural counterparts. In a primary care setting, providers may expect half of young adult females to drink alcohol, half to have mental health issues, and few to be smokers. Providers need to be aware that current smokers and those with mental health issues are more likely to report alcohol use. Because alcohol use is related to metropolitan status, providers should screen for alcohol use in every woman aged 25-44, and especially those from urban areas. They should also include screening for smoking and mental health status when any of these factors are present, and provide education and referrals to substance abuse programs and mental health counseling as necessary.Item Does Mental Health Differ by Obesity in Younger, Middle Aged, and Older Females?(2019-03-05) Torre, Jacob; Zeitz, Erica; Fuller, Aleksandra; Hartos, Jessica; Shropshire, MichellePurpose: Although the relationship between mental health and obesity has been well studied, it has not been researched by age groups. The purpose of this study is to examine the relations between mental health and obesity among younger, middle aged, and older adult female age categories in the general population. Methods: The cross-sectional analysis used 2016 data from the Behavioral Risk Factor Surveillance System (BRFSS) for females from Arkansas, Louisiana, Mississippi, and Tennessee. Multiple logistic regression was used by state to assess the relationship between obesity and mental health in females of different age groups while controlling for race, education level, income level, employment status, marital status, general health, health conditions, tobacco use, alcohol use, and physical activity. Results: The majority of participants in all age groups reported good mental health (younger: 49-56%; middle aged: 57-59%, older: 71-82%), and less than half of participants across age groups were obese (younger: 29-41%; middle aged: 38-49%; older: 27-35%). In the adjusted analyses, mental health did not differ by weight status across states and age groups. However, a moderate inverse relationship was found between good mental health and number of health conditions across all age groups. Conclusion: The results of this study indicate that obesity is not related to mental health in females in different age groups in the general population, but is moderately to highly related to number of health conditions. For female patients in a primary care setting, it is recommended to screen for mental health when 2 or more health conditions are present, regardless of the patient’s age, and educate and treat as comorbid symptoms.Item Early detection of influenza outbreaks: an application of a Bayesian online change point detection algorithm with optimal hyperparameter estimation using the CDC Influenza-Like Illness Surveillance Network (ILINet) data(2019-03-05) Suzuki, Sumihiro; Liu, JialiangIntroduction Each year, the incidence of influenza (flu) and its financial costs are substantial in the United States (US). The Centers for Disease Control and Prevention (CDC) indicates that approximately 25 million people in the US were infected with influenza during the 2015-2016 flu season, leading to 11 million flu-related medical visits, and 12,000 flu-associated deaths. Although flu outbreaks occur every year, the timing and severity of these outbreaks vary from year to year. A critical component in averting the spread of the flu and its adverse consequences is early detection of imminent flu outbreaks. The earlier the detection, the more time there is to implement proactive prevention strategies against the spread of the disease. However, under the current gold standard for flu surveillance, the US Outpatient Influenza-Like Illness Surveillance Network (ILINet) conducted by the CDC, flu activity is estimated and monitored based on clinical and laboratory data. As such, there is always a delay of up to three weeks between the occurrence of the outbreak and dissemination of this information. Thus, there is an urgent need for improving and strengthening the flu surveillance system to provide timely outbreak information for guiding public health decisions that seek to prevent and control the disease. Purpose To test the feasibility for early detection of imminent flu outbreaks by applying a Bayesian online change point detection (BOCPD) algorithm with optimized hyperparameter estimation to the CDC’s ILINet data. Method CDC ILINet data from the week of 1/16/2010 through 4/29/2017 (N = 380 weeks) were used in the analysis. The CDC ILINet data consist of weekly number of people seeking medical attention with symptoms of influenza-like illness (ILI). Change points were detected using the BOCPD algorithm with a 1-year (52 weeks) rolling window. That is, instead of using a constant set of hyperparameters for the machine learning process, new hyperparameters were used every week when detecting change points, where the new hyperparameters were estimated using the data from the previous 52 weeks. CDC declares flu outbreaks using ILINet data when the percent of ILI during that week exceeds a predetermined threshold. For each season, the first change point that satisfied the following conditions was considered informative in early detection of the subsequent outbreak: (1) its percent of ILI visit was higher than that of the last change point, (2) its percent of ILI visit was less than the predetermined CDC threshold for an outbreak, and (3) the relative change between its percent of ILI and the CDC threshold was less than 50%. Results Except for the 2011-2012 flu season, we were able to detect the imminent outbreak, on average, 6 weeks prior to the actual outbreak. Conclusion Results suggest that the BOCPD algorithm may be effective in detecting flu outbreaks weeks prior to the start of the outbreak.Item Examining Willingness and Intentions to Drink Alcohol as Predictors of Protective Behavioral Strategies(2019-03-05) Lowery, Ashley; Leon, Marcela; Galvin, Annalynn; Litt, Dana M.; Lewis, Melissa; LoParco, CassidyPurpose: Willingness and intentions are components of the Prototype Willingness Model (PWM), which predicts adolescent and young adult health-risk behaviors. However, research has yet to examine intentions and willingness as predictors of health-protective behaviors, such as alcohol-related protective behavioral strategies (PBS). PBS are behavioral strategies to reduce the amount of alcohol consumed or risk for negative consequences. Longitudinal and daily-level findings have shown PBS to be associated with alcohol-related consequences. As such, we hypothesized that willingness and intentions to drink any alcohol or engage in heavy-episodic drinking (4+ women, 5+ men) will be associated with subsequent PBS use. Methods: A total of 1,034 participants (mean age 19.5, 45% male) completed longitudinal data as part of a larger experimental study. Linear regressions controlling for age and sex were used to test all models. Results: Study findings indicated that the harm reduction PBS subscale was significantly predicted by intentions of heaviest drinking day (ß = 0.027, t = 2.261, p Conclusions: Willingness and intentions, the primary components of the PWM, were shown to predict the health-protective behaviors of alcohol-related PBS. A targeted intervention among those who are more willing to drink may promote the use of PBS, which in turn may reduce alcohol-related consequences.Item Factors Associated with Electronic Cigarette Use in a Population-Based Sample in the US.(2019-03-05) Garg, Ashvita; Wan, Bingchun; Nandy, Ph.D., Karabi; Peeri, NoahFactors Associated with Electronic Cigarette Use in a Population-Based Sample in the US. Noah C. Peeri1 Ashvita Garg1 Bingchun Wan1 Karabi Nandy1 1University of North Texas Health Science Center, School of Public Health, Department of Biostatistics and Epidemiology, Ft. Worth, TX Purpose Electronic cigarettes (e-cigarettes) are lithium-ion battery powered devices that deliver nicotine vapor by heating a coil immersed in a solution of nicotine, propylene glycol, or some other humectant, delivering nicotine and flavor to the users’ lungs. They are often marketed as devices for cessation of traditional cigarette smoking. However, they are not considered an entirely safe option because they contain nicotine, lead, volatile organic compounds, and known carcinogenic agents. This work examined the prevalence and patterns of electronic cigarette use in a recent population-based sample of the US. Methods Utilizing data from the 2017 Behavioral Risk Factor Surveillance Survey (BRFSS), 529,714 participants aged 18 and older were included in the analysis. E-cigarette user status was defined as current, former and never. Weighted multinomial logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results Prevalence of current, former and never users of e-cigarette were 3.2%, 12.3% and 84.5%, respectively. Females had higher odds of being current e-cigarette users, compared to being former (OR: 1.17; 95% CI: 1.06,1.30) and never users (OR:1.52; 95% CI:1.38,1.67). Older age was associated with higher odds of current use, with a significantly increasing trend with age (ptrend Conclusions Utilizing data from a cross sectional nationally representative sample of the united states, we identified factors associated with current, former and never users of e-cigarette. This information could inform intervention strategies for groups at highest risk of e-cigarette use.Item Factors Associated with Medication Adherence Among Persons in Permanent Supportive Housing(2019-03-05) Nandy, Karabi , PhD; Nandy, Rajesh , PhD; Walters, Scott , PhD; Khan, MahbubaPurpose: Nonadherence to medication is associated with poor health outcomes, worsening of disease and frequent hospitalization. People living in permanent supportive housing (PSH) may be at greater risk of medication nonadherence because of a history of chronic homelessness, increased prevalence of mental disorders and other vulnerabilities. Understanding factors associated with medication nonadherence in this vulnerable population may help alleviate an important deficiency in their life and advance them towards stability. The objective of this study was to estimate the prevalence of medication adherence among PSH residents and to identify factors associated with low medication adherence. Methods: Adult PSH residents voluntarily participated in the mobile community health assistance for tenant (m.chat) project during 2014-2017 in Fort Worth, Texas. The Morisky medication adherence scale was used to classify participants as having low, medium or high adherence to medication. Self-reported data on demographic variables, alcohol consumption, quality of life, substance use, and depression were collected. Multinomial logistic regression was used to identify factors associated with participants’ levels of medication adherence. Results: A total of 598 participants were included in the sample. The prevalence of low, medium and high medication adherence were 54.5%, 29.9%, and 15.6%, respectively. In unadjusted analyses, binge drinking (p-value=0.001), quality of life (p-value Conclusion: A majority of PSH residents were in the low medication adherence category. To better address the issue of medication noncompliance, intervention programs may want to target PSH residents who have depression, binge drinking habit, and have a poor quality of life.Item Late Night Social Networking Use and the Associations with Adolescent and Young Adult Sleep Quality, Substance Use, and Anxiety(2019-03-05) LoParco, Cassidy; Galvin, Annalynn; Leon, Marcela; Lewis, Melissa; Litt, Dana M.; Lowery, AshleyPurpose: Research has shown social networking site use to be associated with adolescent and young adult health and risk behavior generally, but less is known about whether late night use is related to health and well-being. The purpose of this study is to examine late night use (between the hours of 11pm and 5am) of specific social networking site platforms (Snapchat, Instagram, Facebook) in relation to sleep quality, substance use (alcohol, marijuana), and anxiety. Methods: Adolescents and young adults ages 15-20 (mean age of 18.39, (SD = 1.32), 47% male) completed a survey from which the current data are drawn as part of a larger experimental study (N=306). Linear regressions were carried out, controlling for age, sex, education status, race, alcohol and marijuana use, and anxiety in all models. Results: Findings indicated that past week late night use of Instagram was associated with fewer hours of sleep at night on average (t = -2.02, p t = 3.44, pt = 2.11, p t = 2.78, p t = -2.12, p all p-values [greater than] .05). Finally, linear regression results indicated that past week late night use of Snapchat was positively associated with past month anxiety (t = 2.102, p Conclusions: Together, these findings contribute to the growing literature supporting the association between social media use and various aspects of well-being in adolescents and young adults. The present findings suggest that late night social networking site use by platform is an important factor that warrants further investigation in the context of adolescent and young adult sleep, substance use, and anxiety. IRB #: 2018-009