General Public Health

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    The Association Between Enrollment in the Supplemental Nutrition Assistance Program and Household Food Security Status
    (2018-03-14) Rendon, Alexis; Thombs, Dennis; Hoff, Brandon
    Purpose: Food insecurity, or not having reliable access to nutritious food, is a problem that many U.S. families face today. The Supplemental Nutrition Assistance Program (SNAP) provides a monthly benefit to low-income individuals. Recent research has reported inconsistent findings about the effectiveness of SNAP in reducing food insecurity. This study examined the association between SNAP enrollment and household food security status. Methods: This cross-sectional study was conducted using data from the National Health and Nutrition Examination Survey (NHANES) 2013-2014. Logistic regression was used to model food security status predicted by SNAP participation while adjusting for the effects of age, gender, race/ethnicity, country of birth, education level, federal poverty ratio, and body mass index. All analyses were conducted using SAS 9.4 with appropriate survey weighting procedures. Results: Hispanics [OR = 2.189, (95% CI: 1.212 - 3.954), p p p p p p Conclusion: The measured demographic characteristics were consistent with existing literature and with conventional expectations; however, the finding that SNAP participation was positively associated with food insecurity was unexpected and inconsistent with the literature. Some research has suggested that the once-per-month distribution schedule of SNAP allows participants to deplete their benefits by the middle of the month, providing for a cyclical pattern of relative food security during the first half of the month and relative food insecurity during the last half of the month. Longitudinal research should be conducted to further analyze the strengths and limitations of SNAP as a tool to reduce food insecurity in the U.S and compare its effectiveness to other nutrition assistance programs.
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    Implementation of the HomeMeds Medication Management System in a Primary Care Setting
    (2018-03-14) Severance, Jennifer; Elrod, Shara; Chou, Evelyn
    Purpose: HomeMeds, an electronic medication management system, has been shown to prevent and reduce adverse effects of medications in the elderly by reconciling medications and looking at cardiovascular, psychotropic, nonsteroidal anti-inflammatory drug (NSAID), or duplication problems. The program was originally designed and tested for use in a home setting, but less is known about use in a primary care setting, and few studies can link the intervention to patient health outcomes. Methods: A retrospective analysis was performed on data from January – June 2017 of patients (n=300) 65 years and older in our electronic medication record (EMR) and from a Center for Disease Control (CDC) validated “Healthy Days” questionnaire administered by Meals on Wheels Inc (MOWI) of Tarrant County at a primary care geriatric clinic. The questionnaires examined physical and mental health and history of falls and hospitalizations, while the EMR provided Activities of Daily Living/Independent Activities of Daily Living (ADL/IADL) scores and demographic data. In addition to frequencies, odds ratios (OR) with 95% confidence intervals (CI) were estimated in a logistic regression analysis. Chi square tests compared groups. Results: The mean age was 77.63 years with 77% being female, and the mean number of medications per person was 11. Of those with alerts (n=210), the mean number of alerts per person was 2, with the most common being duplicate therapies (n=148) and 26% reported a fall history while 41% reported dizziness. The odds of reporting dizziness and a previous fall is 3.7 times higher compared to those without a previous fall. The odds of having a previous fall is 2.4 times higher for those reporting a lower health status (X2=8.433, df=1, p=0.004). Females had a higher proportion and were more likely to generate an alert than males (X2=5.679, df=1, p=0.017). The odds of having an alert are increased, but not statistically significant, for clients with low ADL/IADL scores and nonwhite (p=0.144, p=0.078, p=0.281). Conclusions: If patients are able to change or remove a medication predisposing them to dizziness, perhaps fall risk can be reduced. With the rising elderly population and the elderly’s increased frailty, this could be potentially life-saving. The primary care physician shortage and increasing elderly population make it more crucial than ever to improve patient health and HomeMeds is a feasible and relatively simple way to do just that.
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    Assessing Caregiver Health Literacy on HPV and the HPV Vaccine Based on Health Provider Communication
    (2018-03-14) Fernando, Shane PhD MS; Roane, Brandy Ph.D., CBSM; Whiting, Whitney; Ahmed, Syed; Hurt, Emily
    Abstract Purpose: HPV is an easily spread sexual infection that is a leading cause of cervical cancer and contributes to penile, anal and throat cancer. Despite the high success rate of the HPV vaccine in targeting high risk strains of HPV, the rate of use of the vaccine remains low. This project aims to assess patient literacy about HPV and better understand the misconceptions that keep individuals from becoming vaccinated. We will also examine the role of provider education. The goal is to also increase awareness about HPV and the vaccine. Methods: Surveys were administered to parents of pediatric patients recruited at the UNTHSC Patient Care Center. After consenting and completing the multiple choice surveys, participants were given a brief education session concerning questions in the survey about HPV and the vaccine. They were also given a handout ‘What you need to know about Human Papilloma Virus (HPV)’ to keep. 10 days later participants were contacted to complete the same “follow up survey” to determine retention of knowledge. Results: The number of participants that reported prior HPV education by a health care provider equaled the number that denied previous education. On HPV knowledge assessment questions, the number of participants that chose the correct/true statement varied by question and by self-reported HPV education. The group that reported HPV education did not show greater knowledge then the other group. Conclusion: The facts that there is more than one type of HPV and that there is no cure for HPV are less well known. Although participants demonstrated some correct basic knowledge about HPV and the vaccine, there is a lack of complete understanding regarding the magnitude of the disease and the long term consequences. Further work should be aimed at increasing education and exploring the correlation with vaccine acceptance.
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    2015 Dietary Guidelines Advisory Committee: A Review of the Literature Behind the National Guidelines and a Comparison to Fort Worth Nutritional Standings
    (2018-03-14) Kannappan, Anju
    Introduction: The 2015 Dietary Guidelines Advisory Committee (DGAC) is a joint effort between the U.S. Departments of Health and Human Services (HHS) and of Agriculture (USDA). Every five years the committee publishes a report containing dietary information and eating habits involving the American public. This study aims to review the literature utilized by the 2015 DGAC to describe the methods of data collection and selected results pertaining to the pediatric population. It will also present the results of the Youth Risk and Behavior Survey conducted amongst Fort Worth high school students to offer comparative data between local and national benchmarks of pediatric nutrition. Methods: A literature review was conducted using the DGAC’s published report index on the website. The primary results were retrieved from the 2007-2010 National Health and Nutrition Survey (NHANES) and the CDC’s Second National Report on Biochemical Indicators of Diet and Nutrition in the US Population. Dietary reference intakes for macro and micronutrients were taken from the Food and Nutrition Board and the Institute of Medicine’s reference manual. Statistics concerning Fort Worth’s population were taken from the Tarrant County Public Health Department and the 2016 FWISD Youth Risk and Behaviors Survey. Results: About 1/3 of children are expected to be obese. Concerning fruit intake, children ages 1 to 8 years meet recommended intakes, however average intakes of fruit are lowest among girls ages 14-18 years. Males and females on both national and local levels are receiving fewer servings of fruits and vegetables than advised, and their protein intake is on the lower end of the recommended range. Overall, all age groups and genders intake more sugar and saturated fats than recommended. Discussion: The target audience for the published Dietary Guidelines results are medical professionals who then work to translate the findings into usable resources for the public. One of the initiatives set forth by the USDA was MyPlate, an online tool that offers ideas for creating healthy eating recipes that encompass all necessary food groups and proper proportions. A local initiative in Fort Worth with similar focus is the Mobile Pantry program. Further studies can assess the success of such initiatives in fostering healthy eating among children.
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    Prescribing Practices Related to Concomitant Opioid and Benzodiazepine Use: A Focus Group
    (2018-03-14) Yuet, Cheng; Bullock, Katura; Pham, Kim; Tran, Trang; Halsey, Aaron
    Purpose: The Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) have issued warnings against the co-prescribing of benzodiazepines and opioids due to increased risk of drug overdose. Despite these warnings, benzodiazepines remain commonly prescribed with opioid containing products. The factors behind this practice are not well described. The objectives of this study were to evaluate provider perceptions in the following areas related to concomitant opioid and benzodiazepine use: prescribing practices, mitigation of patient risks, and issues not addressed by other agencies. Methods: This study was approved by the University of North Texas (UNT) Health Science Center in November 2017. Focus groups were conducted among providers at UNT Health clinics in Fort Worth, TX, to elicit opinions related to the co-prescribing of opioids and benzodiazepines. The study investigators co-identified themes after the focus groups. Open coding was performed for the initial thematic analysis, followed by selective coding upon theme identification. Descriptive statistics were used to characterize demographic information from study participants. Results: A total of 6 subjects were interviewed thus far; 3 (50%) males, 3 (50%) Asian, median age in years 39.5 (IQR 33-46.8), and median number of years in practice 12 (IQR 5.9-17.8). Four (67%) self-identified as attending physicians, and 2 (23%) self-identified as pharmacists. Major themes identified include “Providers are cognizant of risks of concomitant opioid and benzodiazepine therapy but may not have changed current practices,” “Common barriers to deprescribing therapy include patient preference and lack of resources (e.g., behavioral health),” and “Negative outcomes include adverse effects and inappropriate use.” Provider resources to mitigate patient risk include the Opioid Risk Tool, prescription monitoring programs, and practice-based quantity limitations. Additional data will be reported at the 2018 Research Appreciation Day. Conclusions: Preliminary results suggest that providers are aware of the risks associated with concomitant opioid and benzodiazepine therapy but face a number of challenges in tapering or discontinuing therapy. These findings may be used to impact trainee education and clinical practice. Final results and conclusions will be presented at the 2018 Research Appreciation Day.
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    Does General Health Differ by Healthcare Access in Diabetic Females 30-50 Years of Age?
    (2018-03-14) Vaswani, Roma; Chua, Josh; Swartzentruber, Valerie; Holmes, Victor L.; Hartos, Jessica; Alarcon, Angela
    Purpose: Diabetes is one of the fastest growing epidemics requiring regular medical management, yet 12.6% of U.S. adults were without health coverage in 2015 (1,2). Our study aims to determine whether general health differs by healthcare access in diabetic females 30-50 years of age. Methods: This cross-sectional analysis used data from the 2015 BRFSS for females ages 30-50, from Louisiana, Mississippi, Oklahoma, and Tennessee. The relationship between general health to healthcare access and healthcare cost was analyzed using multiple logistic regression analysis controlling for weight status, comorbid conditions, age, ethnicity, marital status, income, education level, and state. Results: A high prevalence of participants reported having healthcare coverage (80%) and a moderate prevalence reported good or better overall general health (60%). There is a significant inverse relationship between healthcare cost and general health (OR=0.55, 95% CI=0.31, 0.97). There was no significant relationship between healthcare access and general health outcome. Additionally, relationships were shown between general health and comorbid conditions (OR=0.08, 95% CI=0.02, 0.27), income (OR=2.54, 95% CI=1.44, 4.45), and education level (OR=1.97, 95% CI=1.06, 3.66). Conclusions: Results show a significant relationship between healthcare cost, comorbidities, education, and income to participant’s general health. However, healthcare coverage was not significantly related to participant’s general health. Results may be utilized in primary care practice settings managing diabetic females aged 30-50. This population of patients should be screened for poor general health and additional comorbid conditions in low socioeconomic patient populations.
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    Effects of Cognitive Impairment on Hospitalizations in Heart Failure Patients
    (2018-03-14) Lykens, Kristine A.; Miller, Thaddeus; Nandy, Karabi; Bhatti, Megan
    Abstract Purpose: Heart failure (HF) is a major health problem in the United States (US) linked to poor survival rates, high rehospitalization rates and high healthcare cost. HF is positively associated with aging and its impact on US health and healthcare systems is expected to grow as the baby boomer generation enters their retirement years. The same is true for another chronic health risk, cognitive impairment. There is a clear, negative impact on prognosis and healthcare outcomes associated with cognitive impairment in HF patients, but less is known about how these affect systems outcomes such as overall hospitalization. We compared hospitalization patterns among aged HF patients with and without comorbid cognitive impairment to identify associated risks and outcomes. Methods: The data for this analysis will be obtained from the Medical Expenditure Panel Survey. MEPS is a survey that is conducted each year through the Agency for Healthcare Research and Quality (AHRQ) including both a household and an insurance component. MEPS provides relevant data including number of hospital discharges, diagnosis codes, etc. The sample is a stratified, cluster sample to ensure racial representation. Statistical analyses will be performed using SAS. Estimates of risk of hospitalization for patients with and without cognitive disorders will be calculated using self-response weights. Associated standard errors will be calculated using replicate weights obtained from MEPS. For the first question, differences in the distribution of risk for patients with and without cognitive disorders will be evaluated using weighted Chi-squared tests. A weighted logistic regression will be used to find factors associated with hospitalization risk by examining associations among demographic and other characteristics with the outcome. Goodness-of-fit of the model will be assessed using the Hosmer-Lemeshow test and a deviance test. Results and Conclusions: pending
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    Differences by Depression Severity Category in Cigarette Smoking Among Low-Income Housing Residents
    (2018-03-14) Mallampati, Rajesh; Barnett, Tracey E.; Livingston, Melvin D.; Rendon, Alexis
    Purpose: Smoking is especially prevalent in low-income groups with additional characteristics. Smoking prevalence is estimated to be 70% among homeless individuals and 77% among low-income substance users in treatment. Among the low-income and mentally ill, the smoking prevalence is 31.7%. The most common mental illness, depression, has been frequently studied as a comorbidity of smoking. Approximately 60% of individuals with depression are current or former smokers. This association has often been studied with a binary measure of depression, which may overlook the effects of depression severity on smoking behavior. Methods: This study used data collected from participants in subsidized housing enrolled in a health coaching intervention called “Mobile Community Health Assistance for Tenants” or “” The sample included 420 residents with a mental health condition. A zero-inflated Poisson regression was used to determine the association between smoking cigarettes and four levels of depression: minimal or none (PHQ9 ≤4), mild (PHQ9 5 - 9), moderate (PHQ9 10 - 14), and severe (PHQ9 ≥15). Results: The majority (73.3%) of individuals smoked an average of 7.5 cigarettes per day. In our population with a high prevalence of smoking and depression, when we controlled for depression severity, we found that those without depressive symptoms were more likely to smoke. Depression risk was significantly associated with both the likelihood of smoking (chi-sq=11.03, p=0.0116) and the number of cigarettes smoked among smokers (chi-sq=14.89, p=0.0019). Moderate depression severity resulted in increased odds of being a smoker (OR=2.16, 95%CI:[1.01,4.64]), but a decrease in the number of cigarettes smoked (RR=0.87, 95%CI:[0.77,0.99]). Conclusion: Further study is warranted to examine the relationship between depression severity and cigarette smoking.
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    Association of Nutritional Label Literacy and Eating Habits in Adult Population of Rural Texas
    (2018-03-14) Clark, Leslie; Fraser, Jordan; Moore, Kalee; Pham, "Kat" Dung; Mamun, Md Abdullah; Abraham, Stacy; Coffey, Danielle
    ASSOCIATION OF NUTRITION LABEL LITERACY AND EATING HABITS IN ADULT POPULATION OF RURAL TEXAS Purpose: The Nutrition Facts panel (NFP) (nutrition labels on food packaging) is one of the best ways to disseminate nutritional information at the point-of-purchase to help reduce total calorie intake and sodium, saturated fat, trans fat, cholesterol, and added sugar consumption. Purpose of this study was to examine the association between the ability to interpret nutrition labels correctly and eating habits in the adult population in rural Texas. Methods: A total of 121 adult subjects were recruited from five primary care clinics located in rural Texas. Data on nutrition label literacy and dietary practice were collected using the Newest Vital Sign and the NHANES Dietary Screener Questionnaire, respectively. Univariate analyses and regression analyses were carried out to estimate the strength of association between nutrition label literacy and eating habits. Results: About one-fifth of the subjects had very low nutrition label literacy. Only two-thirds of the subjects were able to calculate the percentage daily value of calories in a single serving. After adjusting for the demographic variables, higher educational level (OR = 3.53), higher income (OR = 5.10), and lower amount of added sugar consumption (OR = 1.14) were found significantly associated with a higher level of nutrition label literacy. Conclusions: Adult population in rural Texas had difficulty in interpreting nutrition label correctly. This study supported the hypothesized linkage between the ability to interpret nutrition labels and healthy eating practices. Revision of the NFP to reduce complexity and account for varying levels of literacy should be considered for future nutrition labels.
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    Is alcohol use related to high cholesterol in premenopausal women aged 40-51 years old?
    (2018-03-14) Lueg, Holli; Moore, Jessica; Stafford, Patricia; Hartos, Jessica; Homeyer, Sydnee
    Purpose: Alcohol use and cholesterol are related in men and postmenopausal women but relations between alcohol use and cholesterol are unclear for premenopausal women. The purpose of this study was to determine whether alcohol use was related to cholesterol in women aged 40-51 years old. Methods: This cross-sectional analysis used 2015 data from the Behavioral Risk Factor Surveillance System (BRFSS) for females aged 40-51 years old from Louisiana, Michigan, Nevada, and Tennessee. Multiple logistic regression analysis was used to assess the relationship between high cholesterol and alcohol use while controlling for high blood pressure, diabetes, weight status, daily fruit and vegetable intake, physical activity, tobacco use, age, and ethnicity/race. Results: Across states, approximately one-third of women reported being diagnosed with high cholesterol (25-36%) and about half reported any alcohol use (36-55%). The results of adjusted analysis indicated that high cholesterol was not significantly related to alcohol use in three of four states. However, high cholesterol was significantly related to blood pressure in all four states with moderate to large effect sizes, and to weight status and tobacco use in three of four states with moderate to large effect sizes. Conclusion: The results of this study indicate that high cholesterol is not related to alcohol use in females aged 40-51 years old, but is moderately to highly relate to high blood pressure, weight status, and tobacco use. For premenopausal women in a primary care setting, about one-third may have high cholesterol, and because high cholesterol, high blood pressure, overweight or obese, and smoking are moderately to highly related, it is recommended to screen for all four if symptoms of any are present and educate and treat as comorbid conditions.
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    Is Arthritis a Risk Factor for Kidney Disease in Females Ages 65 and Older?
    (2018-03-14) Gathright, Kristen; Carey-Woodard, Katharyn; Bonsness, Joseph; Hartos, Jessica; Manz, Amanda
    Purpose: Previous research has shown a relationship between kidney disease and arthritis, however, the results are not specific to a gender or age group. Thus, the purpose of our study was to determine whether arthritis is a risk factor for kidney disease in females aged 65 and older. Methods: This cross sectional analysis used data from the BRFSS 2015 survey for females aged 65 and older from Arizona, Kentucky, Oregon and West Virginia. Multiple logistic regression analysis was used to assess the relationship between kidney disease and arthritis, while controlling for weight status, high blood pressure, diabetes, heart disease, high cholesterol and ethnicity. Results: Few of the target population reported having a lifetime diagnosis of kidney disease (6-8%). The majority of the target population reported having a lifetime diagnosis of arthritis (51-64%). After controlling for extraneous factors, kidney disease was significantly related to arthritis in two of the four states with moderate to large effect sizes. Kidney disease was also significantly related to high blood pressure, heart disease, and diabetes in all four states. Conclusions: Arthritis was significantly related to kidney disease in females aged 65 and older in two of four states and to high blood pressure, heart disease, and diabetes in all four states. Female patients age 65 and older who have been diagnosed with arthritis or kidney disease should be screened for the other disease. Providers should educate patients on early signs and symptoms of these diseases. Providers should also screen patients for kidney disease and educate patients on early symptoms when patients have high blood pressure, heart disease, and diabetes.
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    For general physical health, is heavy alcohol use related to stroke diagnosis in middle aged women?
    (2018-03-14) Timciuc, Laura; McGrade, Samantha; Hartos, Jessica; Lee, Andrew
    Introduction: Stroke and alcohol have been linked in previous research, none have focused on middle aged women. The purpose of this study was to assess whether heavy alcohol use is related to stroke diagnosis in middle aged women. Methods: This cross-sectional analysis used 2015 BRFSS data for middle aged women, ages 45-64, from Missouri, Louisiana, and Michigan. Multiple logistic regression analysis assessed the relationship between heavy alcohol use and stroke diagnosis while controlling for education level, ethnicity/race, tobacco use, weight status, high blood pressure, and diabetes. Results: A small percentage of the participants reported ever being diagnosed with stroke (4-6%) and about one-fourth reported heavy alcohol use (21-32%). Results of adjusted analysis indicated that heavy alcohol use was inversely related to stroke in Louisiana (AOR=0.18, 95% CI= 0.04, 0.78) and Michigan (AOR=0.38, 95% CI=0.18, 0.79) but not in Missouri. Furthermore, stroke was significantly related to education level in Missouri and Michigan, and high blood pressure in Louisiana and Michigan. Conclusion: Overall, heavy alcohol use was found to be significantly and inversely related to stroke diagnosis in middle aged women in two out of three states. Since this data was from a population based study, the results may generalize to patients in the primary care setting. As a result of the inverse relationship, practitioners should only assess middle aged women for stroke if symptoms are present because of the low prevalence in this population. Additionally, because one in four participants reported heavy alcohol use, standard screening and patient education about the health risks associated with excessive drinking should continue to occur.
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    A comparison of treatment acceptance and adherence rates among two populations at high risk to develop tuberculosis in Tarrant County, Texas
    (2018-03-14) Miller, Thaddeus; Taskin, Tanjila
    Background: After decades of declining incidence rates, progress toward US tuberculosis (TB) elimination goals has begun to stall and perhaps even reverse. In light of this alarming trend, the strategic approach to TB control has begun to place more emphasis on carefully targeted surveillance for and treatment of latent TB infection (LTBI). Approximately 13 million people in the US have LTBI, and both LTBI and active TB are much more prevalent among homeless persons, refugees, and immigrants from high burden settings. Without treatment, 5-10% of persons with LTBI will develop active TB during their lifetime, and most ([greater than] 85%) US patients with recent incident TB have a prior history of LTBI. Still, LTBI is an asymptomatic condition that can be difficult to diagnose, and treatment acceptance and adherence are critical barriers to related prevention efforts. A 2012 report estimated that treatment acceptance and completion rates in the US were only 26% and 53%, respectively, and these vary widely by population.For instance, adherence is 7.2 times higher among the refugee population compared to the homeless population, however, the treatment completion rate is low for both. Local public health departments (PHD) are ultimately responsible for the protection of their catchments through TB surveillance, outpatient treatment, and prevention activities. A complete understanding of how patient characteristics may influence treatment acceptance and adherence is critical to successfully implementing risk targeted TB control strategies at the local level. Purpose: We analyzed acceptance and adherence for refugee and homeless patients offered treatment for diagnosed LTBI in Tarrant County Public Health’s TB and Refugee Clinic. Understanding factors associated with accepting and completing LTBI treatment in these high-risk populations inform public health action at the local level and contributes to individual and community health protections. Methods: We examined LTBI treatment acceptance and adherence among homeless and refugee research subjects in an urban public health clinic in Tarrant County, Texas during January 2013 to December 2016. Our retrospective analysis used deidentified local data collected as part of a larger project by the CDC’s Tuberculosis Epidemiologic Studies Consortium. We used multiple logistic regression and chi-square to compare outcomes while controlling for demographic, clinical, and other factors. Results: To be calculated. Conclusions: Will be complete soon.
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    Pick a Card: An Autonomy-Building Exercise to Promote Healthy Lifestyle Behaviors
    (2018-03-14) Cantu Anguiano, Katherine; Dodgen, Leilani; Spence-Almaguer, Emily; Velarde, Elizabeth
    Purpose: Providing options can be beneficial to participant success by promoting a greater sense of autonomy about individual changes which promote health. Developed with the goal to guide participants of a social-network based women’s wellness intervention, health behavior cards were created using health and wellness evidence-based information. The purpose of this research was to develop a tool to allow program participants the flexibility and autonomy to make choices regarding individual behavior changes. Methods: Using evidence-based literature, health behaviors were chosen to align within the 5 domains guiding SHE Tribe (Me, Mind, Mater, Move, and Meet). For each behavior, evidence in the literature was found supporting the effectiveness to improve health. The behavior and evidence were then incorporated on the card, for example, “Skip the salt and try adding spices, herbs, and seasonings to your food. Less sodium (salt) can help lower your risk for high blood pressure.” This tool provides participants choices for their health behaviors, but also a rationale for why it would be beneficial to consider adopting. Results: This process resulted in the creation of a 54-card deck of health behavior changes. Through participation in SHE Tribe, participants will receive the cards with the objective of to prompt participants’ reflection and goal-setting as they go through the program. The cards can also be used after the program has ended. After the first gathering, participants receive custom feedback with scores associated in each of the 5 domains. In addition to the feedback, the cards will allow participants to tailor the program to their needs. Used as a way to identify small yet achievable changes toward a healthier lifestyle, the cards can be used in 2 ways. Whether guided by a facilitator to help participants reflect on their health and identify potential health changes through discussion, or used individually, the cards will serve as a tool to continue exploring small, but positive, health behaviors. Conclusion: Having choices is necessary to strengthen motivation and empowers program participants to make their own meaningful health changes. A deck of cards that includes 54 empirically-supported health behaviors supports individuals’ capacity to select behaviors that best meet their needs and lifestyle. By setting goals with the use of the cards, self-efficacy is increased making changes to health behaviors more likely to be achieved.
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    Does Alcohol Misuse Differ by Gender and Veteran Status in Adults Ages 25 and Older?
    (2018-03-14) Goodell, Haley; Van Noy, Aubry; Kotulek, Shelby; Diver, Thomas; Hartos, Jessica; Zarker, Kourtney
    Purpose: There are conflicting findings across previous studies regarding prevalence of alcohol use, binge drinking, and heavy drinking between veteran males and females, and compared to civilians. The purpose of this study was to assess whether alcohol misuse differs by gender and veteran status in adults 25 and older. Methods: Data from the 2015 BRFSS for Maine, Montana, Oregon, South Carolina, and Alaska for veteran and non-veteran males and females ages 25 and older were used in this cross sectional analysis. Multiple logistic regression analysis was used to assess the relationship between alcohol misuse (use, binge, heavy) and veteran status by gender after controlling for age, education level, income level, marital status, race, depression, and smoking status. Results: For adults ages 25 and older, about half (44-59%) reported alcohol use, and about one-tenth reported binge drinking (10-15%) or heavy drinking (5-7%) in the past 30 days. After controlling for demographic and lifestyle factors, alcohol use and binge drinking were directly related (small to moderate effect sizes) to gender and veteran status, with males, both veteran and non-veteran, showing more than female non-veterans in Maine, Montana, Oregon, South Carolina, and Alaska. There was no overall pattern across states for heavy drinking. Conclusion: Overall, alcohol use, binge drinking, and heavy drinking were related to gender and veteran status. Binge drinking and heavy drinking were also related to smoking. For veteran and non-veteran adults ages 25 years and older in a primary care setting, a moderate prevalence of alcohol use may be expected, while a low prevalence of binge drinking, heavy drinking, and smoking may be expected. Although these prevalences may be low, standard of care is to automatically screen for alcohol use and smoking in all patients, both veteran and non-veteran. Therefore, in a primary care setting if signs of binge or heavy drinking are present, providers should consider a more in depth screen for alcohol misuse. Additionally, if signs of either alcohol misuse or smoking are present, providers should consider a more in depth screen for both. Patient education and referrals for alcohol misuse treatment programs and/or smoking cessation counseling should be provided to patients as needed.
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    Factors Affecting the Spatial-temporal Distribution of Tuberculosis in Texas - 2012-2016
    (2018-03-14) Princewill, Nimitariye
    1) Purpose Tuberculosis (TB) is a chronic disease that mostly affects the respiratory system. It is among the top 10 causes of death worldwide, according to the World Health Organization (WHO), even though a preventable disease. In Texas, data from the Texas Department of State Health Services (DSHS) reveals that TB remains a relatively significant disease. Several risk factors have been linked to a predisposition of TB infection. Such risk factors include HIV/AIDS and other immunodeficiency states (e.g. diabetes), alcohol abuse, poverty, etc. The objective of this study is to determine the geographical distribution of TB in Texas and to assess how HIV/AIDS prevalence and median household income correlate with the spatial pattern of TB in the state. 2) Methodology TB prevalence rates for the years 2012-2016 were obtained for all counties in Texas from the Texas Department of State Health Services (DSHS) while prevalence rates for HIV/AIDS were obtained from Texas Ranking Data. Median household income was used as an indicator of SES; the data was obtained from Texas Ranking Data. Temporal-spatial variations in TB and HIV/AIDS prevalence were analyzed using ArcGIS. Multiple linear regression models were used to regress TB prevalence on HIV/AIDS and median household income. 3) Results TB prevalence in the state has been relatively low in the last five years at about a mean of 4.5 per 100,000. Counties in the south of the state have had the highest burden of the disease. HIV/AIDS prevalence was found to be positively correlated with TB prevalence, adjusting for demographic factors. 3) Conclusion Even though the average TB prevalence in the state is low, preventive measures should still be promoted, especially among vulnerable populations, to maintain the low rates. HIV/AIDS prevention efforts should also be intensified because a successful HIV/AIDS program (resulting in low prevalence rates) will ultimately lower TB prevalence.
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    Effects of the Motion Wellness System on balance, coordination, strength and quality of life in older adults: a survey study
    (2018-03-14) Chan, Ryan; Rodriguez, Nicole; Najera, Yoshio; Bugnariu, Nicoleta L.
    PURPOSE: The purpose of this study is to investigate the benefits of the Motion Wellness Platinum Systems equipment, the patterns of usage of the equipment, and the related factors facilitating and impeding usage of the equipment. METHODS: The study will take place over a one year period, November 1, 2016-October 31, 2017. Data will be collected from users aged 55 and older at all 3 Motion Wellness System sites in Fort Worth and Arlington. Surveys will be collected for a duration of 6 months with an average data collection of 2 hours per site visit. Number of users during the data collection visits at each site and total number of users of the equipment over the period of data collection will be recorded, regardless of whether people agree to complete the survey or not. RESULTS: During the data collection period, in 36.5 hours of data collection, only 5 users matched the targeted age group and agreed to complete a survey. Fifty-one people used the equipment, mostly consisting of children who were accompanied by adults less than the age of 55. Through the survey, factors that facilitated usage included newspaper/magazine advertisements informing the community about the installation of the Motion Wellness System. Factors that impeded usage included the presence of too many children using the equipment and participants’ lack of transportation. CONCLUSION: The awareness or cultural acceptance of adult playgrounds is not as strong in the western civilization as it is in Asian countries. Lack of advertisement about the Motion Wellness System and the benefits of exercise within the area possibly resulted in the less-than-expected turnout. Location is another limitation to this study. The initial proposal stated to construct equipment near senior centers where older adults can freely use the system and perhaps even participate in group exercises using the system. Even if older adults wanted to “play” on the playground, they were likely to shy away in presence of the children, the majority of users. In addition, during the first month of data collection, the frequent rain and occasional high temperatures discouraged outdoor activities. Overall, the benefits of the Motion Wellness System, the patterns of usage, and the factors facilitating and impeding usage are inconclusive due to the small sample size in this study.
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    Health disparities in age of first concern and age of diagnosis for children with ASD, ADHD, and ASD+ADHD are evident in a national sample
    (2018-03-14) Patterson, Rita; Miller, Haylie; Thomi, Morgan
    Background: Autism Spectrum Disorder (ASD) is diagnosed in 1 out of 68 children. Individuals with ASD commonly meet criteria for comorbid conditions such as Attention Deficit-Hyperactivity Disorder (ADHD). Although previous diagnostic guidelines (DSM-IV) did not permit clinicians to assign co-occurring diagnoses of ASD+ADHD, this became allowable in 2013 (DSM-V). Due to this change and a high prevalence of ASD+ADHD, it is important for researchers and clinicians to be aware of groups vulnerable to delayed or incomplete diagnosis. Objective: Assess the impact of race, ethnicity, sex, poverty level, and diagnosing provider type on age of first concern and age of final diagnosis in children diagnosed with Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD), and ASD+ADHD. Hypothesis: We predicted that age of first concern would vary by sex, race, poverty level, identifier of first symptoms, and comorbidities. We also predicted that age of final diagnosis would vary by sex, race, poverty level, identifier of first symptoms, and provider type. Method: Data were extracted from the CDC Survey of Pathways to Diagnostics and Services (SPDS) and the National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome (DTAT). Parents/guardians of 5,959 children aged 3-17 completed the surveys; in the current sample, 2,966 cases were from DTAT and 2,993 were from SPDS. The datasets were recoded and merged for analysis. We used a series of ANOVAs to assess differences in the variables of interest, grouped by demographics (sex, race, poverty level), identifier of first concerns, previous and current co-morbid conditions, and provider type. Results: Age of first concern was significantly impacted (p Conclusion: Specific combinations of demographic factors increase vulnerability for later diagnosis. These findings suggest that provider- and patient-centered education is needed to increase surveillance in at-risk populations.
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    Does the Relationship Between Depression and Physical Activity Differ by Gender in Young Adults Ages 25-34?
    (2018-03-14) Kinne, Hannah; Cawood, Amanda; Clark, Marilyn; Hartos, Jessica; Sarradet, Charis
    Purpose: Depression has become a significant health concern in the United States and has been linked to physical activity in previous research; however, there is insufficient research on the relationship between physical activity and depression between genders in young adults ages 25-34. The purpose of this study was to determine whether the relationship between physical activity and depression differs by gender in young adults ages 25-34. Methods: This cross-sectional analysis used 2015 data from the Behavioral Risk Factor Surveillance System (BRFSS) for males and females ages 25-34 from Maine, Oregon, Rhode Island, and Vermont. Multiple logistic regression analysis was used to assess the relationship between depression and physical activity, while controlling for age, ethnicity/race, income level, weight status, tobacco use, alcohol use, and activity limitations. Results: Across states, about one-fourth of young adults reported ever having been diagnosed with depression or dysthymia (25-29%) or being highly active (22-36%). After controlling for demographic factors, socioeconomic status, and psychosocial factors, depression was not significantly related to physical activity in males or females in ME, OR, or VT. However, depression was significantly related to activity limitations in both males and females in all four states, and significantly related to tobacco use in females in ME, OR, and RI. Conclusions: Overall, depression was not significantly related to physical activity in males or females ages 25-34. However, depression was significantly related to activity limitations in both males and females in all four states as well as tobacco use in females in three of the four states. This study was limited by an inability to obtain information on duration, extent, or prior treatment of depression in participants. Although the prevalence of depression may be low to moderate in primary care, it is recommended that providers screen all young adults for depression if they present with depressive symptoms and refer to a mental health clinic for treatment. Additionally, providers should screen all young adults with depression for activity limitations as well as young adult females with depression for tobacco use, and vice versa, and provide education, treatment, and referrals as needed.
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    Using Machine Learning Technique to Explore Factors Associated with Change in Quality of Life Among Permanent Supportive Housing Residents
    (2018-03-14) Nandy, Karabi; Nandy, Rajesh; Walters, Scott; Mamun, Md Abdullah
    Purpose: The purpose of this study was to identify predictors of change in the overall quality of life (QOL) at 6-months, compared to baseline, among permanent supportive housing residents with a history of chronic homelessness and mental illness. Methods: Data were collected at baseline and 6-month using 18 questionnaires, encompassing over 100 variables on 457 adults. The short version of the Quality of Life Enjoyment and Satisfaction Questionnaire was used to measure QOL. We used a machine learning technique for dimension reduction to achieve a final predictive model for QOL. We used a two-step approach: first, using a machine learning technique called random forest (RF) for dimension reduction by eliminating unimportant variables, and then using a model selection technique in multiple linear regression (MLR) framework with the reduced set obtained from RF to propose a final model. In the process, we highlighted the utility of RF as a means of exploring the fullness of a dataset in order to identify factors associated with improvement in QOL. We captured the linear relationships only in the final predictive model. Results: The mean improvement in QOL score at 6-months was 4.24 (SD=13.52, effect size=0.31). Significant predictors of the change in QOL were one’s baseline QOL (estimate=-0.32, p Conclusion: QOL is a multifaceted concept that encompasses various constructs ranging across physical health, psychological state of mind, social circumstances, environmental factors, etc. We hope that future interventions addressing QOL in this vulnerable population will benefit from our findings. Methodologically, we illustrate the benefit of using machine learning techniques in behavioral/social experiments to leverage “big data” and conduct comprehensive analyses.