General Public Health

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    Major Mental Illness and Resources Available Tarrant County
    (2021) Singhal, Juhi; Wickramage, Pavithra; Desai, Shivani; Khowaja, Sanober; Blaydes, Rachel
    Major Mental Illness and Resources Available Tarrant County Introduction: High prevalence of mental illness leads to higher rates of death, disability, medical illness, incarceration, homelessness, unemployment, poverty, and violation of human rights. Significant barriers to those facing mental illness are the lack of access to care and the stigma of treatment. The three major mental illnesses that physicians encounter are schizophrenia, major depressive disorder, and bipolar disorder. All of these illnesses require life-long treatment. However, there are resources available in the Tarrant County area and at the national, state, and local levels to alleviate the mental illness care disparity. Available Resources: Although getting access to mental health care is still challenging, there are resources available at the national, state and local level. At the national level, there is the National Alliance on Mental Illness. Texas Health and Human Services is a resource available at the state level. Finally, at the local level in Tarrant County there is JPS Behavioral Health Clinic - Northeast, My Health My Resources (MHMR), and Crisis Respite and Residential Unit. Barriers: The goal of these organizations is to help those with serious mental health illnesses, however the eligibility and process required to access these resources may create barriers for some individuals. Conclusion: While several resources in Tarrant County are striving to close these significant gaps in access to behavioral health help, it is important to realize that more work needs to be done until mental illness is viewed as equivalent to physical illness.
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    Is the pill count or polyactive substance count a better estimate of polypharmacy in people living with HIV/AIDS?
    (2021) Tolulope Orimoloye, Helen
    Introduction: People with HIV/AIDS (PLWHA) now live longer due to the advent of antiretroviral therapy, but consequently are at an increased risk of age-related comorbidities. Increasing comorbidities have resulted in polypharmacy in PLWHA. Most studies define polypharmacy as the use of five or more medications simultaneously, but researchers have suggested that a definition based on the number of pharmacologically active ingredients (polyactive substances) may be a better indicator of polypharmacy. Typically, drugs for HIV/AIDS and other chronic diseases are combined into single doses to maximize adherence. Therefore, most pills used by PLWHA are a combination of two or more polyactive substances. However, due to limited literature, it is not clear by how much polypharmacy (defined by pill count) differs from that defined by polyactive substances. Objective: To compare polypharmacy in PLWHA by determining the difference between the pill count and the number of polyactive substances. Method: Medication records of 765 HIV patients from a study were obtained. Polypharmacy was defined as the use of five or more medications. Polyactive substance use was defined as the use of five or more pharmacologically active ingredients in medications. Result: The prevalence of polypharmacy using pill count at baseline was 78.3% at baseline, while the prevalence of polyactive substances was 92.16%. A paired T-test showed a mean difference of 2.15 with a standard deviation of 1.32 (p-value < 0.001) between polyactive substances and pill count. Conclusion: Among HIV patients, pill count underestimates the prevalence of polypharmacy compared to polyactive substance count.
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    (2021) LoParco, Cassidy; Zhou, Zhengyang; Seamster, Morgan; Litt, Dana M.; Lewis, Melissa
    Purpose. Using both alcohol and marijuana is risky, particularly when using both with overlapping effects. However, it is unclear how positive and negative affect are associated with simultaneous alcohol and marijuana use (SAM; using both with overlapping effect) and concurrent alcohol and marijuana use (CAM; defined in this study as using both substances in the past month without overlapping effect), and what role sex plays in these associations. Methods. Baseline data among past-year alcohol or marijuana users age 15–25 (N=417; mean age 21.2 (SD=2.7); 63.8% female) were used from a larger study. A logistic and an ordinal logistic regression model examined if sex moderated associations between positive/negative affect and past-month 1) CAM (yes/no) and 2) SAM use (ordinal categorical variable measuring occasions), respectively. Models controlled for age, sex, race, and ethnicity due to prior associations with outcomes. Results. Although the main effects of positive and negative affect were not associated with CAM or SAM use, the interactions suggest that with each increased unit of negative affect, males had a 7% (OR=1.07, 95% CI: 1.01–1.17) and 9% (OR=1.09, 95% CI: 1.01–1.17) higher odds of using CAM and higher level of SAM use, respectively. Females with higher levels of negative affect did not have higher odds of CAM or SAM use. Conclusions. Interventions aiming to decrease SAM/CAM use could target males who are experiencing high levels of negative affect. Future studies utilizing longitudinal data are needed to assess if causal associations between positive/negative affect, sex, and SAM/CAM use exist.
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    Examining Fear of Missing Out (FoMO) as a Moderator of the Association Between Peak Drinks and Alcohol-Induced Blacking Out
    (2021) Lowery, Ashley; Zhou, Zhengyang; Astorga, Angeles; Litt, Dana M.; Lewis, Melissa
    Purpose: Heavy drinking remains a public health concern among adolescents and young adults due to adverse outcomes including blackouts. Moreover, studies have also linked heavy drinking to the Fear of Missing Out (FoMO). Further investigation into the relationship between FoMO and alcohol-induced blackouts is merited. Therefore, this study aims to examine whether FoMO moderates the association between peak alcohol consumption and experiencing alcohol-induced blackouts. Methods: Participants ages 15-25 (N = 233; Mean age = 21.54 (SD = 2.46); 36% male) completed both baseline and daily surveys as part of a larger EMA intervention study Zero-inflated Poisson model was fit to examine the interaction effect between FoMO and peak drinks on self-reported experiences of alcohol-induced blackouts, controlling for relevant covariates (i.e., age, biological sex). Results: Findings indicated the effect of peak alcohol consumption was moderated by FoMO on both the likelihood (log odds ratio = 0.048, p-value = 0.017) and average number (log incidence rate ratio = 0.296, p-value = 0.003) of alcohol-induced blackouts. Specifically, the effect of peak alcohol consumption on alcohol-induced blackouts was stronger for the average number of blackouts but weaker for the likelihood of experiencing any blackouts among those with higher level of FoMO. Conclusions: Findings support previous literature examining FoMO as a risk factor for experiencing alcohol-related harm among adolescents and young adults. Therefore, future research should seek to target FoMO cognitions as an additional way to reduce heavy drinking among adolescents and young adults.
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    Impact of Lifestyle Intervention using Family Central
    (2021) Banh, Debini; Lopez, Aimee; Robinson, Christina
    Chronic diseases due to preventative causes are becoming increasingly prevalent among Americans. The Pediatric Mobile Clinic provides free medical care and vaccines to uninsured children in underserved areas of Fort Worth. These underserved populations have health concerns that demonstrate the need for lifestyle medicine interventions that can promote healthful eating, physical activity, sleep, and other healthy behaviors in order to help prevent chronic disease while also improving the wellbeing of the family. Participants were placed into three groups that initially met once a month to discuss a Family Central topic (i.e Nutrition, Physical Activity, Tobacco Avoidance, Sleep, Stress Management, and Social Connection). Sessions were converted to a virtual platform due to the COVID-19 pandemic. Participants engaged in discussion on the topic of the week and created SMART goals. A general linear mixed-effects model was used to examine the impact of lifestyle intervention including health lifestyle education classes on participants' knowledge, attitude, and behaviors, and clinical outcomes. Due to the small sample size and the incomplete survey responses, the results were non-parametric. However, the survey responses showed that the Family Central sessions were highly effective in all participants in increasing awareness of good health behaviors and improving health status. The Family Central program is both important and necessary for improving the health behaviors of the community. With proper education and improved health behaviors, we will see reduced likelihood of chronic disease. We hope to see a positive impact as caregivers model the health behaviors for their children.
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    Examining Tarrant County Resources for Attention Deficit and Hyperactivity Disorder
    (2021) Heinrich, Carl; Schmidt, Brendan; Guerra, Alex; Reeves, Kirk; Zhou, Jason
    Purpose: Attention Deficit Hyperactivity Disorder (ADHD) is a highly prevalent behavioral disorder affecting about ten percent of children and adolescents between the ages of two and seventeen and is predominantly seen in males (2:1 predominance). The disorder is diagnosed clinically and may include inattention, hyperactivity, or a combination of these two aspects that can affect the child's daily life. ADHD is a disorder of particular concern because it often presents with an additional mental, emotional, or behavioral disorder and, more commonly, may severely impede the scholarly and social performance of persons it affects. Methods: We examined multiple resources in the Tarrant County area utilizing PubMed and local resource catalogues. Our resources were divided into three major categories: those that assist with diagnosis of ADHD, those that assist with treatment of ADHD, and those that support persons with ADHD. Additionally, multiple barriers to care were identified. Results: We found that these resources, while freely available and easy to find, may present additional barriers to care including strict requirements for use, physical distance, and societal misconceptions. Numerous resources exist in Tarrant County for both patients with ADHD and family members of those patients. Conclusions: These resources are readily accessible and provide beneficial lifestyle modifications for patients and families, specifically aimed at increasing quality of life by providing outlets such as diagnostic evaluations, accommodation testing, various therapy programs, and education for families. Along with addressing barriers to care, we also recommend increasing public awareness of these programs.
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    The Association of Pain and Sleep in Relation to Depressive Symptoms among Older Adults with Arthritis
    (2021) Zielke, Cameron; Peeri, Noah; Nguyen, Uyen-Sa
    Purpose: Data from 2013-2015 showed that arthritis affects 54.4 million adults in the US annually, most (59%) are 65 years or older. Chronic pain is a primary symptom of arthritis and may have widespread consequences on an individual's sleep and mental health. Research suggests that sleep and chronic pain may synergistically impact depression. However, to date no study has examined the joint effect that sleep and chronic pain may have on the development of depressive symptoms. Methods: We used data from the 2010-2016 waves of the Health and Retirement Study (HRS). The study included data from 7,310 individuals with arthritis and free of depressive symptoms at baseline (2010). We performed a multivariable-adjusted Cox proportional hazards regression to estimate the hazard ratio for the joint effect of pain and sleep disorder relative to having neither conditions on the development of depressive symptoms (CESD-R>=3). We calculated the relative excess risk due to interaction, comparing the joint effect with that of pain alone and sleep disorder alone. Analysis was further stratified by sex. Results: There is evidence of a synergistic effect of pain and sleep on risk of depressive symptoms adjusted-HR(95% CI):2.87(2.80,4.99) When stratified by sex a similar synergistic effect as observed in males. Conclusions: Findings from this study suggest that sleep and pain are synergistically linked to the development of depressive symptoms. Understanding the joint effect of pain and sleep on individuals' increased risk of depressive symptoms can help target treatment options for arthritis patients.
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    Utilization of Mental Health Prescription Claims in Texas Health Plan Members in Relationship to the Novel Coronavirus Pandemic
    (2021) Leytman, Michael; Guhad, Ahmed; Stahlnecker, Alvah; Rasu, Rafia; Xavier, Christy
    Objective: To evaluate the utilization of mental health disorder prescription claims in relationship to the novel coronavirus pandemic. Methods Design: Retrospective analysis of mental health utilization prescription claims between March 2020 to August 2020 compared to March 2019 to August 2019. Inclusion, ≥ 18 years of age, Prescription claims for anti-anxiety, anti-depressant, anti-psychotic/anti-maniac agents, Health Plan members filling prescriptions within the state of Texas. Exclusions, < 18 years old. Data Collection, Mail and Retail Pharmacy utilization claims data: March 2020 – August 2020 & March 2019 – August 2019, Gender, Fill date, Member age. Statistical Analysis, Chi-Square Test to identify a P-value for the primary endpoint Endpoints " Primary o Difference between the number of mental health utilization prescription claims between March 2020 to August 2020 compared to March 2019 to August 2019 " Secondary o Difference in utilization rate between men and women o Difference in age o Percentage of patients receiving Mail vs Retail claims (pre/post COVID) o Comparing public health infection rate data vs. prescription claim rate (pre/post COVID) Results: For all primary endpoints, statistical significance was observed with p-values < 0.001. Conclusion: Work-In-Progress, N/A ©2020 CVS Health and/or one of its affiliates. All rights reserved. This article contains proprietary information and cannot be reproduced, distributed or printed without written permission from CVS Health. Data use and disclosure is subject to applicable law, corporate information firewalls and client contractual limitations.
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    (2021) Seamster, Morgan; LoParco, Cassidy; Astorga, Angeles; Litt, Dana M.; Lewis, Melissa
    Purpose: Research indicates that young adults use alcohol and marijuana independently, or simultaneously (SAM; alcohol and marijuana use at the same time so that effects overlap) to cope with emotional distress (i.e., anxiety, depression). Given that behavioral willingness (i.e., openness) can be viewed as a predisposition to behavior, understanding mental health-related factors associated with willingness to engage in different types of substance use (i.e., alcohol, marijuana, SAM) may aid in identifying young adults at risk for harmful substance use. Methods: Participants ages 18-25 (N=363;60.1% female) completed baseline of a larger ecological momentary assessment study. Linear regression analyses controlling for age, gender, and past-month substance use examined associations between depressive and anxious distress and a willingness to engage in alcohol, marijuana, and SAM use. Results: Reports of higher depressive symptoms were associated with more willingness to use alcohol (B= 0.21, t = 2.85, p < .01) and engage in SAM use (B= 0.13, t = 2.25, p < .05). Anxious symptomology was associated with less willingness to use alcohol (B= -0.22, t = -2.99, p < .01), and more willingness to use marijuana (B= 0.15, t = 1.99, p < .05). Conclusions: Findings suggest that depressive and anxious distress are differentially associated with a willingness to engage in different types of substance use, depending on whether alcohol and marijuana are used independently or simultaneously. Therefore, targeted intervention strategies for young adults with depressive or anxious symptoms through early identification of willingness cognitions could prevent harmful substance use.
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    Physical Inactivity Among High School Students: A Public Health Concern of the 21st Century
    (2021) Deckard, Amber
    Purpose: Physical activity among school aged children is a leading public health concern with physical, mental, social, and financial implications. According to the Centers for Disease Control and Prevention (CDC), only 1 in 5 high school students meet the CDC's recommended 60 minutes of daily physical activity. The purpose of this report was two-fold to determine the prevalence of Texas high school students not meeting the CDC's physical activity recommendations and determine the relationship between the student's physical education class attendance. Methods: A web-based analysis was conducted utilizing the Youth Risk Behavior Surveillance System (YRBSS). Responses from individuals in 9th through 12th grade were included. YRBSS Analysis tools were utilized for performing a cross-tabulation and determining statistical significance within the variables of sex, race/ethnicity, grade level, and sexual identity with a (p< 0.05) significance level. Results: The majority of high school students do not meet the recommended minutes of physical activity. Females are more likely than males to not meet guidelines, and Black students and Hispanic students are more likely than White students to not meet guidelines. The relationship between the two measures were statistically significant in which students who did not attend physical education class were not meeting the CDC's recommendations either. Conclusion: Health disparities among students who do not meet physical activity recommendations were identified and need to be addressed. Adopting policies and allocating resources for longer physical education classes, more recreational activities, as well as ensuring safe environments for recreation are recommended next steps.
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    A Matter of Balance Fall Prevention Program Delivery to Underserved Populations
    (2021) Khan, Amal; Quach, Shanon; Rivera, Solymar; Severance, Jennifer
    Purpose: Falls are the leading cause of injuries in older adults. A Matter of Balance (AMOB) is a national evidence-based fall prevention program. However, there is a lack of implementation to underserved populations. This study investigates the impact of cross-sector partnership delivery of AMOB on 1) access to serve underserved older adults in Tarrant County, Texas and 2) older adults' confidence in their ability to manage falls. Methods: Area Agency on Aging, Sixty and Better, University of North Texas Health Science Center, and Medstar collaborated to deliver AMOB in Tarrant County zip codes with the most emergency calls for falls in older adults. 354 older adults voluntarily participated and were surveyed for demographics and self-rated confidence in their ability to manage falls using the Falls Efficacy Scale (FES). Results: The average age was 78 ± 8.33 and most participants were female and white non-Hispanic. 49% of the programs were in hotspot zip codes and 31% of the participants were from hotspot zip codes. 53% of the participants completed the program and 48% of those who did not complete was due to COVID-19. Confidence in managing falls (t=-8.222, p< 0.001) increased significantly with program completion. Conclusions: AMOB was effective in increasing confidence in managing falls for individuals who completed the program. Using zip code data is helpful in planning outreach, but less than half of the participants were in the desired areas. To address access barriers, stakeholder groups that represent underserved communities should be included.
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    Factors associated with HPV vaccination intention among U.S. 27-45-year-olds
    (2021) Moore, Jonathan; Garg, Ashvita; Galvin, Annalynn; Kasting, Monica; Wheldon, Christopher; Thompson, Erika L.
    Introduction: HPV vaccination recommendations now include shared clinical decision-making for adults aged 27-45 years. We investigated how knowledge, attitudes, and beliefs were associated with likelihood of asking a healthcare provider about the HPV vaccine and the likelihood of getting the HPV vaccine among adults ages 27-45 years old. Methods: A cross-sectional survey was distributed to U.S. adults between 27-45 years old between April-May 2020 (n=691). Outcomes of interest included likelihood of asking their provider about the HPV vaccine and likelihood of getting the HPV vaccine. Covariates included demographic factors, knowledge, attitudes, and beliefs. Adjusted models were estimated for each outcome variable using a log function and Poisson distribution. Results: Likelihood of asking their provider about the HPV vaccine was significantly associated with perceived likelihood of benefitting from the vaccine (aOR=2.45, 95% CI: 1.69-3.57). Likelihood of receiving the vaccine was associated with HPV vaccine attitudes (aOR=1.04, 95% CI:1.01-1.07), perceived effectiveness against HPV infection (aOR=4.03, 95% CI=1.20-13.53), and perceived likelihood of benefitting from the vaccine (aOR=4.31, 95% CI=2.64-7.03). Conclusions: These findings suggest increasing positive vaccine attitudes, perceived effectiveness, and perceived likelihood of benefitting from the vaccination are important factors in facilitating a shared clinical decision for HPV vaccination. Understanding factors associated with likelihood of discussing and receiving the HPV vaccine among 27-45-year-olds is important to implement guidelines for shared clinical decision-making.
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    Mapping Out Maternal Mortality
    (2021) Kade, Laura
    Purpose: The rising maternal mortality (MM) rate in the United States is a pressing concern that mandates immediate action. One of the highest state-level MM rates belongs to Texas, where almost 80% of deaths are deemed to be preventable. Biomedical approaches have previously been prioritized, but the issue is unfolding to be much more complex. To better understand MM in Texas, it is necessary to identify the multidisciplinary teams involved in prevention efforts and how they are linked. Methods: A web-based search of the terms "maternal mortality" and "maternal mortality in Texas" was conducted via Google, Google Scholar, and PubMed to identify organizations involved in pregnancy care and MM prevention efforts. The systems thinking approach was used to map out organizational connections. Results: Ten prominent organizations were identified at the international (2), national (4), and state (4) level that conducted a range of functions such as surveillance, research, recommendations, funding, and advocacy. Higher rates of collaborative work were observed among state level organizations, where a partnership was identified. Inconsistencies across all organizational levels, in regard to the MM definition and tracking, resulted in duplicate analyses and misclassification errors. Dismissal of national level recommendations at the state level led to deficits in protective services. Conclusion: While all of the organizations provided vital services to combat MM, a lack of standardization suggested that the full scope of MM is unknown. Additionally, further expansion of interrelations, and a reduction of counterintuitive practices is needed to make a greater impact on MM.
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    Examining Reasons for Intent to Discontinue and Remove LARCs: National Survey of Family Growth 2017-2019
    (2021) Poleon, Suprena; Thompson, Erika L.
    Background Long-acting reversible contraception (LARC) are highly-effective forms of contraception, which can reduce the risk of unintended pregnancy. Despite LARCs effectiveness, women may desire to discontinue this method. This study will examine reasons for intent to discontinue and remove LARCs among US women aged 15-49 from 2017-2019. Methods The National Survey of Family Growth2017-2019 was utilized with a sample of 6141 female respondents. Descriptive statistics for intention to discontinue LARCs, difficulty removing LARCs, and reasons for LARC discontinuation and removal were examined. Rao-Scott chi-square tests were conducted in SAS. Results Overall, 22.9% of women reported ever using LARCs. Among LARC users, most women (81.2%) reported using LARC in the past 10-years. Among these women, 63.9% intended to discontinue LARCs, and 11.5% had difficulty removing LARCs. Reasons for wanting to discontinue LARCs include decided to get pregnant (15.9%), side effects (29.6%), LARC complications (19.3%), and LARC expiration (26.8%). Primary reasons reported for difficulty removing LARCs included: complications (68.3%), discouragement by provider (6.8%), provider's inability to remove (4.9%), removal not covered by insurance (3.8%), and could not get removed (3.7%). Conclusion Given that women who use a LARC method rely on providers to remove this contraceptive method, understanding the reasons for discontinuation and difficulties encountered are needed. Findings from this nationally representative sample identified provider-level and system-level barriers for LARC removal. In order to respect the reproductive autonomy of LARC users method for pregnancy prevention, these barriers must be overcome.
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    A Non-Parametric Alternative to The Cochran-Armitage Trend Test in Genetic Case-Control Association Studies: The Two-sided Jonckheere's Test
    (2021) Manning, Sydney E.; Xing, Chao; Ku, Hung-Chih; Zhou, Zhengyang
    Purpose: In genetic association studies with case-control design, standard practice is to perform the Cochran-Armitage (CA) trend test under the assumption of additive genetic model. The CA trend test is a parametric statistical test, and under the null hypothesis of no association between the genetic variant and disease, the test statistic asymptotically follows a chi-square distribution with 1 degree-of-freedom. However, when the sample size and/or variant minor allele frequency are small, asymptotic properties may not hold, which can lead to reduced statistical power in detecting genetic associations. Methods: To improve statistical power in this case, we consider the two-sided Jonckheere's test, which is a rank-based nonparametric test. By not imposing assumptions on the distributions of the data, it is expected to have better statistical power than parametric tests for small sample sizes and/or rare variants. We conducted extensive simulations to compare the statistical power between the CA trend test and the two-sided Jonckheere's test under various scenarios. Results: We found for small sample size (e.g., n=200) and low minor allele frequency (e.g., p=0.05), the two-sided Jonckheere's test outpowered the CA trend test for all genetic models ranging from recessive to dominant. Conclusion: This finding provides an alternative to the CA trend test in genetic association studies under these circumstances. With higher statistical power from the two-sided Jonckheere's test, genetic epidemiologists will be able to detect more genetic associations for complex diseases, which may lead to better prevention and treatment strategies.