General Public Health

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    Oral Health Educational Needs Among HIV Health Care Providers in North Texas
    (2024-03-21) Garcia-Ponce, Alejandra; Teplitskiy, Nathaniel; McRae, Alison; Hodge, Crystal; Brosnan, Amanda; Neelamegam, Malinee; Allison, Waridibo; Griner, Stacey
    Purpose: Understanding connections between HIV and oral health is vital for providing comprehensive care to people with HIV (PWH). Due to compromised immune function associated with HIV, PWH are more susceptible to oral health disease and infections. In Texas, there is a need for improved access and provision of oral healthcare services for PWH, particularly amongst marginalized populations. The purpose of this study is to identify HIV/AIDS healthcare providers’ (HCPs) and non-clinical providers’ gaps in oral health knowledge and preferred educational strategies and models. Results can inform educational programming for providers, ultimately improving the quality of oral healthcare to PWH in North Texas. Methods: A targeted needs assessment (Qualtrics survey) was conducted among a sample of major HIV organizations in North Texas to assess the educational and training needs of their HCPs. The survey, administered in January 2024, featured multiple-choice and open-ended questions. Participants were presented with lists of topics based on existing programming and literature: (i) topics on oral health and HIV, such as oral microbiome and antiretroviral therapy; (ii) key populations, such as pregnant persons; and (iii) preferred learning models, such as workshops, webinars, and case studies. They were asked to select all topics of interest. Results: Of the 33 total responses, 8 were excluded due to incomplete surveys. The respondent’s credentials included DMD/DDS (n=4), MD/DO (n=1), PharmD (n=1), RN/NP (n=2), RDH (n=2), LSW/LPC (n=2). When prompted about general areas of interest within the HIV/AIDS care continuum, there was interest in learning about approaches to reduce patients lost to care, reduce HIV stigma in healthcare settings, and expand pre-exposure prophylaxis in routine oral care. Substance use disorder as it relates to HIV and oral healthcare was reiterated as an educational need. Specific educational gaps included oral manifestations of HIV (60%), HIV-related oral cancers (56%), and therapeutics such as antiretroviral therapy (48%) and other emerging treatments (48%). Clinical management of oral health conditions and HIV, dental implants and prosthetics, and innovations in diagnostics in the dental setting were other educational needs selected. Additionally, respondents indicated a need to learn more about specific key populations such as people living with substance use disorders (80%), people living without housing (76%), and transgender and gender diverse communities (64%). Pregnant persons, incarcerated persons, and aging populations were other groups of interest. Results indicate a significant preference for webinar (68%), seminar (52%), and workshop (44%) learning models. Podcasts (24%) and case studies (20%) were also selected often, but other major telementoring models (ECHO, self-paced learning and adapted community health clubs) did not receive the same preference. Conclusion: The results of this survey reveal knowledge gaps and oral healthcare needs among HCPs that should be addressed in order to enhance oral healthcare for PWH in North Texas. While synchronous educational methods like webinars and workshops were favored, HCPs may benefit from additional active learning models (e.g., ECHO) into their continuing education. By developing and implementing education on the identified topics, HCPs can advance efforts to end the HIV epidemic and ensure PWH receive comprehensive care, including addressing their oral health needs.
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    Consumer Needs for Long-Term Services and Supports and the Road to Improving the Texas No Wrong Door System
    (2024-03-21) Anaab, Esme; Murphy, Sara; Yockey, Robert; Severance, Jennifer
    Purpose: Long-term services and supports (LTSS) encompass a broad range of medical and personal care assistance needed by individuals who are unable to perform self-care tasks due to aging, chronic illness, or disability. The No Wrong Door (NWD) System is a statewide network that coordinates the system of access to long-term services and supports. As an offshoot of the person-centered planning movement, the NWD System is premised on ensuring that no matter where individuals first interact with the system, they are guaranteed comprehensive information, assessment, and services. The primary goal of this work is to identify strategies to optimize coordination between and awareness of the entry points of this system. The evaluation will help the Texas Health and Human Services Commission create a consumer-driven, cost-effective, and efficient system. Methods: Qualitative input was captured through listening sessions in five Texas cities (i.e. Amarillo, El Paso, Fort Worth, Pharr, and San Antonio) which were supplemented with a statewide survey launched in September 2023 to derive understanding from experiences with the NWD System. Target audiences included people with disabilities, veterans, adults aged 50 and over, family caregivers, and LTSS providers. Several tools (e.g., telephone, mail, and Internet) were utilized for increased survey accuracy and response rate. The survey was distributed in both English and Spanish, and a specific QR code and survey link was incorporated to track responses. Results: Of 4,185 survey respondents, 69% self-identified within the target group (excluding LTSS providers), and 61% expressed a need for LTSS in the past year. Of the 52% who applied for LTSS, 44% stated use of LTSS daily, and 14% weekly. The top three problems accessing LTSS include a confusing system, long wait times for services, and not knowing where to get help. 79% of consumers were unaware of the NWD System; 2% unsure. Of the 19% aware, 45% felt very or somewhat uninformed about the system in their community. The reasonability of time spent applying for services, ease of applying for services, and timeliness in handling service concerns were among the lowest-scoring statements regarding the system. Conclusions: Our results form the blueprint for facilitating access to care at the community and agency levels throughout Texas to ensure vulnerable populations obtain a high quality of life. Recommendations for the NWD system include effective community outreach and streamlined application processes for services and supports.
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    Assessing the Reliability of Current AI Platforms in Delivering Health Information Related to Crohn Disease, Ulcerative Colitis, and Colorectal Cancer
    (2024-03-21) Isa, Salman; Elchehabi, Sahar; Jafri, Faraz; Hoang, Long; Sharma, Mukesh; Hapuarachchi, Menalee; Gonzales, Gabriel; Lewis, Trina; Richardson, Justin; Nguyen, Elizabeth; Hyman, Charles
    Purpose In recent years, the advancements in artificial intelligence (AI) have revolutionized the way we seek and access health information. With more people turning towards AI for answers to their problems, it is important to question how safe it is to rely on AI for answers to health-related issues. We explored the accuracy of ChatGPT—a language model developed by OpenAI—and Gemini—Google’s AI platform—in providing health information related to Crohn disease, ulcerative colitis, and colorectal cancer. Methods We generated 10 questions relating to Crohn disease, ulcerative colitis, and colorectal cancer in relation to the social, psychological, economic, and physical aspects that patients with these diseases may face. Each query was remastered for each disease, resulting in 30 total questions which were posed to the two separate AI models. We then regenerated the responses for a total of three times ending up with 90 generated responses per AI model. We also measured the Flesch-Kincaid Readability scores for each response and analyzed the sentiment of the text using natural language processing and computational linguistics. The Centers of Disease Control and Prevention (CDC) recommend that medical information for the public be written at no higher than an eighth-grade reading level. Generated AI responses were evaluated by six gastroenterologist attendings and fellows for accuracy within the context of a patient seeking information. Sets were deemed inappropriate if any of the three responses contained inaccurate or misleading information, based on clinical judgment. Evaluators were blinded to model names and prices. Interrater agreement (94%) and reliability (κ score, 0.87) were ideal. The study was performed in July 2023. Results Of the 60 questions posed to the two different AI language models, 45% (n = 27) of the responses were found to be inaccurate. When the two AI models were compared, 43.33% (n = 13) of ChatGPT’s responses were accurate while 46.7% (n = 14) of Gemini’s responses were deemed accurate. ChatGPT also had a 13.20 average Flesch Kincaid Reading grade level and a 31.06 average Flesch Kincaid Readability score. Gemini’s responses received an average Flesch Kincaid Reading grade level of 8.34 and an average Flesch Kincaid Readability score of 56.92. ChatGPT’s average sentiment score was a 1.23 while Gemini’s average score was a 0.92. Conclusion While OpenAI’s ChatGPT and Google's Gemini platform can serve as valuable resources for information retrieval, they possess certain limitations when it comes to health-related information for Crohn disease, ulcerative colitis, and colorectal cancer. Importantly, both AI models in the study provided inappropriate responses to common patient questions regarding these conditions. Medical professionals should be aware of these limitations as they may lead to the spread of misinformation in populations with limited access to health care.
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    Policy Focused Implementation Mapping to Advance Equity and Best Practice in School Asthma Services
    (2024-03-21) Manohar, Ishaan; Roth, Hannah; Allsopp, Leslie
    Purpose: The goal of Dissemination and Implementation (D&I) science is to reduce the gap between best practices and those services widely implemented; D&I is key to improving health outcomes and equity. Pediatric asthma services exemplify the critical need for D&I, but application to advance best practices has been limited. Despite the availability of effective treatment, the CDC estimates that 44% of children with current asthma are poorly managed with entrenched disparities in adverse outcomes. Comprehensive school asthma programs with stocked quick-relief medication are shown to be effective. However, only 2% of Texas school districts have policies to permit this intervention. Further, before 2023, Texas legislation regarding stock albuterol was at sharp variance to national recommendations. In 2023, state-wide collaboration in Texas resulted in amendments that align policy with published recommendations. Asthma 411 is a model to advance comprehensive best practices in school asthma services including stock albuterol. It is currently adopted by 350 schools in North Central Texas. Implementation mapping is a multi-step process with systematic strategies to advance each stage of D&I. Producing implementation protocols and tools is a key element of the 5th step of the process. Policy-focused implementation mapping brings these approaches to legislative initiatives to maximize public health benefits and advance equity. The purpose of this study is to initiate policy implementation mapping for the guideline-based, Texas legislation passed in 2023 focusing on protocols and tools for implementation of the Asthma 411 model. Methods: Newly passed Texas legislation (SB 294 88R) was outlined and included categories of implementation mandates along with the specific requirements within each category. Each existing Asthma 411 implementation tool was independently assessed by two researchers and matched to corresponding legislative requirements. The researchers then identified mandates and guidelines that were not matched to any existing tool. Existing Asthma 411 tools that were matched to the new requirements, were also independently reviewed by two researchers to determine whether it was in alignment with policy or required modification. Discrepancies in researcher assessment were resolved by consensus review. New tools or modifications of existing tools were then drafted to create a preliminary, full suite of tools to support Task 4 of the implementation mapping process. Results: Researchers identified eight relevant categories within the new legislation. Nine existing tools were identified that require modification to align with new legislation and associated guidelines. Five new requirements in the new policy were identified that lack a tool or protocol to support the implementation of the new policy. Draft modifications and new implementation tools have been constructed. Conclusion: The resulting set of preliminary tools are uploaded to the Asthma 411 website where they are free and available for download. Free, online, on-demand professional development modules are being constructed for the use of these tools. Evaluation is ongoing. This work exemplifies the application of policy-focused implementation mapping to produce tools that support state-level best practices to improve asthma outcomes and advance equity. The process developed may be applied to the implementation of other school health policies.
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    Assessment of Food Insecurity Amongst HSC Patients Using the Hunger Vital Signs Screening Tool
    (2024-03-21) Brooks, Kate; Bui, Priya; Garcia, Joanna
    Purpose: The US Department of Agriculture (USDA) defines food insecurity (FI) as “lack of consistent access to enough healthy food for an active healthy life.” FI is associated with negative developmental and health outcomes in children and adults but is less often associated with the physical appearance of malnourishment in children. Because of this, the American Academy of Pediatrics recommends FI screening for all pediatric patients. The Hunger Vital Signs (HVS) screening tool was developed as an efficient and effective way to screen for FI in clinical settings. Since its development, the HVS has been found to be sensitive, specific, and valid as a screening tool for FI in all populations, as compared to the USDA’s 18-item Household Food Security Survey. This project aims to assess the prevalence and distribution of food insecurity within HSC’s patient population. Methods: As part of the check-in process, patients or their caregivers completed an HVS screening at each clinic visit. HVS asks if within the past 12 months, patients “worried whether our food would run out before we got money to buy more,” and if “the food we bought just didn’t last and we didn’t have money to get more,” and allows patients to answer along a 4-point scale. Patients who screened positive for FI then received in person or mailed resources from the clinic Social Worker, including various local food resources. The results of these screenings along with various patient demographics were then analyzed for various trends and distributions via Excel. Additionally, patients who screened positive for food insecurity were then provided resources by the clinic social workers, and results of these patients’ subsequent HVS screenings were followed to assess effectiveness of these resources. Results: Overall, 10.1% of patients screened positive for FI. Disparities across various factors were present, including percent FI amongst Asian patients of 6.1% compared to that of Native American patients of 15.5%. Additionally, patients from the UNT HSC Center for Older Adults showed only a 6.0% FI percentage. After intervention by the social work team, 40% of patients experiencing FI showed improvement on subsequent screenings. Conclusions: This study shows that food insecurity is a prevalent issue in our clinic’s patient population. Disparities across various factors were present, including ethnicity and clinic location, suggesting important areas for improved interventions. While 40% of food insecure patients showed improvement following intervention, several challenges were met regarding validation of this improvement data, emphasizing important areas for future research.
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    Perceived Advantages and Disadvantages of Clinical Trial Participation Among Minority communities: Results from a cross-sectional survey
    (2024-03-21) John, Sharon
    Authors: Sharon John,Marley Arnaud, Uyai Ibanga, Destiny Grisby, & Madison Townsend Institution worked with: University of Houston, Humana Institute Purpose: Research has shown that clinical trial results and safety may not be inclusive of minority populations (Nazha). The consequences include reduced generalizability of findings that might lead to adverse effects for unrepresented groups. Unrepresented clinical trials not tested with diverse populations could widen the gap within healthcare disparities. However, it is important to acknowledge and address the unethical practices of the past to understand the hesitancy of certain groups’ involvement. There is a need to evaluate the current perception of clinical trial involvement of minority groups and use the results to diversify clinical trial recruitment. This research explores the general population’s perspective on participating in clinical trials and evaluates results by separate racial groups. What are the perceived advantages and disadvantages of participating in clinical trials for minorities? Methods: The survey represents Black or African American, American Indian or Alaska Native, Hispanic or Latino, and Caucasian participation in the study. The inclusion criteria for participants are adult (18+) and English-speaking. The research study was conducted using an online cross-sectional and gathered a total of 736 respondents. Results: The data shows the differences in perceived advantages and disadvantages of participating in clinical trials between white, black, and other races. The Caucasian population is 1.7x times more likely than minority groups to consider participating in clinical trials as an advantage. The top three advantages of clinical trial participation for minoritized populations are: "doing something positive for self" with 34% agreement, "getting a cash stipend" with 34%, and doing something that will help others with 28%. The top three disadvantages of clinical trial participation for minoritized populations are: "having to arrange childcare" with 72% agreement, "experiencing side effects of treatment" with 63%, and "disrupting one's normal routine" with 65%. Conclusion: The collected data provides a detailed insight as to what each racial group and educational groups consider to be the three most prominent advantages and disadvantages of participating in medical research. Tailored outreach by addressing the disadvantages and advantages of participation is necessary for minority populations to build trust within medical research. Progression in clinical trial studies recruitment is vital to accurately reflect the diverse population of the U.S. Researchers could use the data to develop and apply these principles to potentially increase minority population participation in clinical trials and lessen the gap. Without this representation, the health disparities gap will continue to widen as minority groups are not considered potentially leading to increased adverse effects in the generation of new therapies. Mentors: Many thanks to our mentor Dr. Lauren Gilbert for her support and encouragement in our project work, the committed University of Houston College of Medicine, Humana Integrated Systems Sciences Institute Faculty and Staff including, Dr. Woodard, Dr. Adepoju, Dr. Beech, Dispensary of Hope, and the Community Research Advisory Board (CRAB).
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    Association of Tobacco Use and Suicidal Ideation among Adults with Metal Health Issues
    (2024-03-21) Nhpang, RoiSan
    Purpose: People with mental health disorders are at higher risk of tobacco use. Studies have demonstrated higher prevalence of tobacco use among people with mental health disorders. We aimed to examine the association between tobacco use and suicidal ideation (SI) among adults with major depressive episode (MDE) and serious psychological distress (SPD) using data from the 2021 National Survey on Drug Use and Health (NSDUH). Methods: Weighted multiple logistic regression modeling and descriptive analyses were conducted on a representative sample of 47,291 from the US general population. Respondents were classified as having past-year SI if they answered yes to SI or suicide planning in the past year. Past-year SPD was defined as a score of 13 or higher on the K6 scale of nonspecific psychological distress. MDE was defined based on the diagnostic criteria from DSM-5. Self-reported data on the use of tobacco products was used. Models were adjusted for sex, age category, and race/ethnicity. Results: Tobacco use was significantly associated with SI among adults with past-year MDE and SPD after accounting for covariates. Among adults with past-year MDE, individuals using/having used tobacco products were more likely to have SI (aOR 1.474; 95% CL 1.107, 1.962). Among adults with past-year SPD, adults using/having used tobacco products were more likely to have SI (aOR= 1.268; 95% CL 1.031, 1.558) compared to adults with no tobacco use history. Conclusion: Findings suggest the need to screen tobacco use as a risk factor in suicidal risk factors among adults with mental health disorders.
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    ADHD Management in Adolescents and its Impact to Lower Incidence of Risky Sexual Behavior
    (2024-03-21) Gillespie, Amelia; Brosnan, Amanda; Griner, Stacey
    Background: Attention-deficit/hyperactivity disorder (ADHD) is a neurological condition that is recognized by an ongoing pattern of inattention with or without hyperactivity and impulsivity that interferes with functioning or development. In 2020, it was reported that ADHD affects 9.6% of children ages 6-11 and 13.6% of adolescents ages 12-17. Therapies that include medications and/or interventions can aid in reducing symptoms and improving functioning. ADHD can be associated with sexual health outcomes such as higher rates of sexually transmitted infections and elevated rates of risky sexual behavior, like condomless sex. Adolescents with ADHD have an earlier age of intercourse, more lifetime sexual partners, higher rates of pregnancy, and higher rates of lifetime STIs. However, few studies have investigated sexual health promotion for those diagnosed with ADHD. Purpose: The purpose of the present study is to explore current literature examining the relationship between ADHD and risky sexual behavior among adolescents. Methods: A literature review process was conducted using PubMed and Google Scholar. The reference list of the relevant articles was screened for titles and abstracts containing the keywords: Attention-deficit hyperactivity disorder, ADHD, risky sexual behaviors, STI, Sexually Transmitted Infections, Syphilis, Chlamydia, human papillomavirus, herpes, sexually transmitted diseases. The retrospective search was limited to articles in English, from 2010 or later, and included the keywords listed above in the title or abstract. Articles reviewed included qualitative and quantitative studies and systematic reviews. Results: In current literature, the incidence of risky sexual behavior has been shown to decrease with either stimulant medication therapy or behavioral therapy for comorbid psychiatric disorders like substance abuse. There are varying conclusions in published literature giving attributes of lowering risky sexual behavior through drug intervention and others to behavioral therapy. These different conclusions of effective therapy come from our limited current understanding of ADHD and the vast array of patient circumstances, such as the varying severity of ADHD, other psychiatric symptoms, and other behavioral influences in the patient's life. Through these studies, we can conclude that patient-centered approaches are pivotal in addressing risky sexual behaviors. Conclusion: These results indicate that ADHD symptoms can be managed with stimulant medication; however, psychiatric therapy shows a promising effect on decreasing risky sexual behavior among adolescents with ADHD, especially for those presenting with psychiatric comorbidities. To decrease risky sexual behavior and its consequences, medication alone may not be effective for most adolescent patients with ADHD, and early intervention for adolescents with ADHD is essential. By translating these findings into clinical care, we can move toward reducing the negative sexual health outcomes experienced by adolescents with ADHD.
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    The effects of sexual health education programming on health literacy of sexual minority youth
    (2024-03-21) Jampani, Navya
    Purpose: Sexual health education programming has always been a politically-charged topic that has once again come under the spotlight with the recent passing of bills in multiple states that restrict classroom education of sexual health. This literature review seeks to understand how these bills could affect the health of young people who go through grade school without proper sexual health education, especially students who identify as LGBTQ. Methods: This study was a literature review. Articles were found on various databases including PubMed, ERIC, and CINHAL using the same key search terms. Articles published within the last 10 years were reviewed and included based on their relevance to the research question. The variety of databases allowed for perspectives from the education, medical, and social stakeholders. Results: A total of 15 articles were included and thoroughly examined. Across the articles, it was found that state requirements widely vary, creating disparity between student who live in different states. Some states were found to require the portrayal of LGBTQ relationships as socially unacceptable or to not include them at all. It was found that these policies did not match public opinion, with many articles finding that states that mandated abstinence-only education (AOE) programs had over 80% of constituents favoring comprehensive sexual education (CSE). Schools that delivered CSE saw lower rates of homophobia and bullying, and dating violence while AOE programs were found to deliver medically inaccurate information. Formal sexual health education during adolescence was also found to create a solid base of sexual health knowledge that persists into adulthood, showing that adolescence is an important time to impart sexual health education as it may be the only such education individuals receive throughout their lifetime. It was also found that exclusion of the LGBTQ population in sexual health education, which many states are now mandating, led them to perceive the content as not relevant to them, leading to decreased use of screening tests for STIs and cancer. Conclusion: Across the articles, it was found that the largest issue facing the quest for effective sexual health education is a lack of standardization across the country. The consensus among existing research is that medically accurate, inclusive, and early sexual health education paves the way for safer school environments and healthier students. Despite this research, the federal government leaves the specifics of sexual health education programming to state and local governments. There is also a glaring lack of research regarding the long-term impact of sexual health programming on students’ health literacy, their ability to understand new health concepts and make the best decisions for their life following graduation.
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    Role of Patient-Provider Relationship in Overall Health and Well-being of Older LGBTQ Adults
    (2024-03-21) Hwang, Jimin; Neelamegam, Malinee; Nhpang, RoiSan
    Purpose: LGBTQ aging encompasses the experiences and challenges encountered by lesbian, gay, bisexual, transgender, and queer individuals as they progress through life. LGBTQ individuals face unique obstacles related to their sexual orientation, gender identity, and the historical context in which they have lived. To effectively meet the specific needs of LGBTQ older adults, it's crucial to offer culturally sensitive healthcare and social support within nurturing healthcare communities. We aim to explore how the doctor-patient relationship impacts the overall well-being of LGBTQ seniors. Methods: A secondary analysis of the AARP survey titled "Maintaining Dignity: Understanding Challenges of Older LGBT Americans," was done. The online survey was conducted between October 27 and November 12, 2017, among adults aged 45 and older who identified as LGBTQ. Data analysis was conducted on SAS statistical analysis software. Descriptive statistics were completed to determine survey participant characteristics. Logistic regression was conducted to assess the association between the patient-provider relationship and overall health after adjusting for demographics and chronic health conditions. Results: Participants were predominantly white (67.08%), between ages 45-54 years (34.6%) and 55-64 years (34.1%). The majority of the participants self-identified as gay (43%) or lesbian (43%). Most participants described their overall health as "good" or better (85.5%), 71.93% informed their physician about their sexual identity (71.93%) and described their physician-patient relationship as open and honest (71.43%). The patient-provider relationship influenced the overall self-reported health status in our study population. Compared to those who had open and honest discussions with their healthcare providers, individuals with difficult relationships with their providers were less likely to have good overall health (OR 0.098, 95% CI 0.032, 0.298). Conclusion: In conclusion, the well-being of older LGBTQ adults is significantly influenced by the quality of their relationship with their healthcare providers, emphasizing the crucial role of fostering supportive patient-provider connections and highlighting the imperative for healthcare professionals to be knowledgeable and compassionate in their care of LGBTQ patients.