Health Disparities

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    Potential Factors Affecting the Human Papillomavirus (HPV) Vaccination: Health Disparities Perspective Analysis
    (2019-03-05) Nair, Dr. Maya; Vishwanatha, Jamboor; Basha, Riyaz; Lamar, Ashley
    Potential Factors Affecting the Human Papillomavirus (HPV) Vaccination: Health Disparities Perspective Analysis Ashley Lamar, Maya Nair, Jamboor K Vishwanatha and Riyaz Basha Background Annually, 14 million people of all ages are infected with the Human Papillomavirus. Around 17,500 women and 9,300 men are affected by cancers related to HPV each year. Vaccinations are recommended for females aged 26 and under and for males under the age of 21. For both males and females, it is recommended that vaccination begins at aged 11 or 12. There are several factors that contribute to parent or guardian’s unwillingness to vaccinate their children. Our interest was to understand the association of HPV vaccination rates with race, sex, ethnicity, socioeconomic status, environment, or social factors. The other objective was to study characteristics specific to Texas that affect vaccination rates. Methods Information was gathered through review of literature and accessing the databases such as Center for Disease Control and Prevention (CDC) and National Immunization Surveys (NIS Teen data). The collected information/data were analyzed focusing on HPV knowledge, attitudes and cultural beliefs. Results Across the data sources investigated, women are shown to have higher vaccination rates than males. Non-Hispanic black males were found to be more likely to get vaccinated compared to their female counterparts. Groups of individuals with higher than a high school level education were shown to have lower HPV vaccination rates. The perception of the threat of HPV affected vaccination rates as well. Hispanic women were more likely to associate HPV with cancer, while their male counterparts associated HPV with infidelity. African Americans were seen to believe they had less of a chance of getting cervical cancer in comparison to White Americans. Socioeconomic status was shown to negatively affect HPV vaccination coverage, with adolescents below the poverty line having higher vaccination rates. Conclusion Overall, significant disparities exist in relation to HPV vaccination rates. The disparities experienced depend primarily on the maternal figure and are affected by age, race, sex, income, and education. Assessment of data specific to Texas area and comparing with the national trends is underway. There is significant room for improvement with HPV vaccination rates that need to be addressed in the community as well as the health care setting. Acknowledgement: This project is partially supported by a grant from the National Heart, Lung, and Blood Institute (#: R25HL125447) awarded to JKV.
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    Impact of race and socioeconomic status on breast cancer mortality in USA: A cross-sectional time-series analysis.
    (2019-03-05) Thyagarajan, Srikantha; Brenner, M. Harvey; Vishwanatha, Jamboor; Lakey, Desiree
    Purpose: Racial, ethnic, and socioeconomic (SES) disparities in incidence and mortality exist among all breast cancer types and stages, particularly between African American (AA), Caucasian American (CA), and Hispanic American (HA) women. The goal of our study is to investigate all three dimensions of SES to identify occupation, education, and income as predictors for breast cancer mortality among racial groups. Methods: A pooled cross-sectional time-series analysis is used to determine the statistical significance of the variables predicting age-adjusted breast cancer mortality in the 50 U.S. states from 1999-2015. Results: This study used beta coefficients, b, as indicators to determine the strength of the association between the dependent variables (race/ethnicity, income, education, and occupation) and breast cancer mortality. African American women showed the greatest statistical significance and strongest beta coefficient (p=0.000, b=0.061). Caucasian women exhibited a p-value of 0.007 and a beta of 0.037. The positive coefficients exhibited in both AA and CA women suggests that the probability of dying from breast cancer increases as the number of women in each racial group increases. The high beta coefficient shown in AA women illustrates a stronger relationship among this racial group, signifying the AA race alone may independently predict breast cancer death. Hispanic women demonstrated intermediate effects with statistical significance (p=0.004) and produced a negative beta coefficient (b=-0.057). The HA statistics illustrate an increase in this ethnic group would decrease breast cancer mortality, implying the presence of a protective factor. When analyzed independently, race or ethnic group alone showed significant relations to total age-adjusted breast cancer mortality, holding constant influences of education, income and employment. Also, under control were health care expenditures and lifestyle risks. Conclusion: This is the first breast cancer study to include all 50 U.S. states longitudinally and cross-sectionally to provide a large scale, population-based analysis. Additionally, this study is one of the first to consider all three dimensions of SES as predictors for breast cancer mortality. The results found that race and SES independently serve as strong predictors of breast cancer mortality, and when both are exhibited, the strength of the association is greater than having one characteristic alone.
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    Proviral DNA Integration in Human Peripheral Blood Mononuclear Cells: Biomarkers of HIV Associated Neurological Impairment
    (2019-03-05) Swanta, Naomi; Borgmann, Kathleen; Ghorpade, Anuja; Farrell, Molly
    Purpose: Historically, HIV decreased an individual’s survival due to opportunistic infections and malignancy. Since the introduction of antiretroviral therapy, many complications of HIV have declined. However, half of HIV+ individuals still experience cognitive impairments. These conditions are classified as HIV-associated neurocognitive disorder (HAND). This is a significant portion of the HIV population with issues maintaining daily functioning. While there are current objective measurements of disease progression with markers such as HIV viral load and CD4 cell counts, these have been found to be poor indicators of neuropsychometric performance. Therefore, there is a need for objective measures that could serve as prognostic biomarkers for the development HAND progression, stability or regression of disease. This could lead to further discovery of therapies and interventions for HAND. This research project focuses on peripheral blood mononuclear cells (PBMCs). The amount of HIV DNA integration may serve as a potential biomarker alone or in correlation with other inflammatory proteins from 121 male and female human subjects across three highly affected races. Methods:Enrolled participants enrolled underwent thorough evaluations, including a blood draw and full battery of neurocognitive functional tests. To determine the level of integrated of HIV, PBMCs were isolated from participant blood samples. Genomic DNA was isolated using DNAzol reagent. HIV DNA integration was then determined and quantified with a nested Alu-Gag PCR. Results: The levels of HIV DNA integration were correlated with measures of neurocognitive dysfunction and previously identified plasma biomarkers that are associated with neurocognitive dysfunction. The level of HIV DNA integration may serve as a prognostic biomarker of HIV-associated neurological impairment. Conclusions:These results may correlate with modifications of cellular function by the HIV DNA integration. Future directions will include self-report questionnaires regarding the participant’s perception of neurocognitive decline affecting their everyday living. Correlations between perception of neurocognitive impairment, discovered plasma, and HIV DNA integration biomarkers of neurocognitive decline could improve prognostic outcomes of HAND.
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    Comparative Microbiome Analysis of Breast Cancer Tissue in Black Non-Hispanic and White Non-Hispanic women.
    (2019-03-05) Thapa, Santosh; Vishwanatha, Jamboor; Thyagarajan, Srikantha
    Title: Comparative Microbiome Analysis of Breast Cancer Tissue in Black Non-Hispanic and White Non-Hispanic women. Background: Triple negative breast cancer (TNBC), abreast cancer disparity (BCD) with an especially aggressive subtype, is more prevalent among Black Non-Hispanic (BNH) women as compared to White Non-Hispanic (WNH) women.BNH women exhibit BCD as shown by higher level of mortality rate than WNH women. Studies have shown that the breast microbiota may have a major influence on breast carcinogenesis. Methods:We have characterized the microbiome of breast cancer and normal tissue samples from the same patients using 16S rRNA gene targeted sequencing. Two distinct breast tumor types were included in the study: TNBC and triple positive breast cancer (TPBC). The data were analyzed for microbiota composition, abundance, and diversity. Results:Our preliminary analysis revealed that both richness and evenness of the microbial community (as measured by alpha diversity metrics), of normal breast tissue was significantly different in comparison to the matched tumor breast tissue. The microbiota richness in BNH TNBC tumor was lower when compared to that of the matched normal breast tissue. In contrast, the microbial richness in WNH TNBC tumor was higher when compared to that of the matched normal breast tissue. The multivariate analysis of beta diversity revealed adistinct clustering of the microbial communities between BNH TNBC tumor and the matched normal tissue. Conclusions:Our findings demonstrated that BNH and WNH racial groups exhibit distinct alpha and beta microbial diversity patterns in normal and cancer breast tissue. Sponsor:Research reported in this publication was supported in part by the National Cancer Institute of the National Institutes of Health under Award Number R01CA220273 02 (to Dr. J.K. Vishwanatha)and by the National Institute On Minority Health and Health Disparities of the National Institutes of Health under Award Number S21MD012472 ( to J.K.Vishwanatha). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. IRB Project #: 2009-001 IBC/p/JV-2017-1
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    Do COPD Rates Differ by Veteran Status in Males 50-79 Years of Age?
    (2019-03-05) Stellato, Jordan; Vogler, Kelli; Whorley, Jourdan; Holmes, Victor L.; Hartos, Jessica; Knutson, Kole
    Purpose: With little research that compares the rate of Chronic Obstructive Pulmonary Disease (COPD) status between the veteran population and the general population, the purpose of this study is to assess whether COPD rates differ by veteran status in males 50-79 years of age in the general population. Methods: This study was a cross sectional analyses using 2016 BRFSS data for males ages 50 to 79 in Arkansas (N=1,283), Montana (N=1,586), New Jersey (N=1,842), Tennessee (N=1,473), and West Virginia (N=1,854). Multiple Logistic Regression analyses were performed by state to determine whether COPD rates differed by veteran status when controlling for age, ethnicity, tobacco use, weight status, general health, asthma, income, education, and employment. Results: Across states, few participants reported having COPD (9-18%) and about one third were veterans (25-40%). After controlling for socioeconomic, demographic, and health influences, there was a significant consistent relationship between COPD and veteran status in three out of five states. There was also a significant consistent relationship between COPD and tobacco use, general health, and ever being diagnosed with asthma in five out of five states. Conclusion: The results found that in males ages 50-79, COPD rates were higher in veterans when compared to non-veterans. In addition, COPD was highly related to smoking, asthma, and general health. Providers should screen and treat COPD and any other health conditions to make sure they are managed properly. Most importantly, educate and refer smokers for treatment to assist with smoking cessation.
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    Examining Disparities in HPV Testing Knowledge among Women in the United States
    (2019-03-05) Galvin, Annalynn; Matthes, Sarah; Thompson, Erika; Garg, Ashvita
    Purpose: Human papillomavirus (HPV) is the cause of 99% of cervical cancers. In the US, HPV testing has recently been adopted as an option for cervical cancer screening in women over 30 years of age. Knowledge of HPV testing is important in influencing the acceptance of HPV testing among women. This study examined the association of sociodemographic covariates in relation to the knowledge of HPV testing among women in the United States. Methods: Women, ages 30 to 65 years, without hysterectomy, completed an online survey (N=812). The analytic sample was restricted to 507 women who were aware of HPV testing. The outcome, HPV testing knowledge, was calculated using a six-item validated scale. Sociodemographic covariates included: age, race, ethnicity, education level, income level, insurance status, relationship status, religious affiliation, and if previously had HPV vaccination. Multiple regression was used to identify variables that were uniquely associated with greater HPV testing knowledge using SAS 9.4. Results: The average age of women in the sample was 44 years, and there was a mean HPV testing knowledge score of 2.8 (out of 6). The multiple regression analysis revealed four independent correlates related to HPV testing knowledge. Lower knowledge was observed in older women compared to younger women (β = −.02, p = .01). Lower knowledge was also observed in women who did not have any health insurance (β = −.56, p = .02) or who did not know if they had ever received the HPV vaccination (β = −.83, p Conclusions: Findings from the study can be used to develop targeted prevention strategies and initiatives to improve HPV testing knowledge among women with HPV knowledge disparities. Improving HPV testing knowledge may promote uptake of this screening tool, and ultimately prevent cervical cancer morbidity and mortality.
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    Are There Racial Differences in Hepatitis C Virus Infection among the Baby Boomer Birth Cohort? An Examination of the National Health and Nutrition Examination Survey (NHANES) from 2007-2016
    (2019-03-05) Sterling, David; Moore, Jonathan
    Background: Hepatitis C Virus (HCV) infection disproportionately affects those in the baby boomer birth cohort which includes those born between 1946 and 1964. Additionally, those who are African-American have an unequal burden of HCV infections and disease outcomes. Previous studies have found a relationship between race and HCV infection specifically within the baby boomer birth cohort. However, no study to our knowledge has investigated this relationship with data from a national sample using laboratory test results to identify HCV infection. Methods: Data from 2007 to 2016 were obtained from the National Health and Nutrition Examination Survey (NHANES), which included 3358 participants in this analysis. SAS 9.4 and G*Power were used for analysis and logistic regression was used for inferential analyses. Results: After controlling for selected covariates, Non-Hispanic Blacks had a higher odds of HCV infection compared to both Non-Hispanic Whites (aOR: 4.28 (95% CI: 1.87, 9.79)) and those of other races (aOR: 3.39 (95% CI: 1.38, 8.34)). Gender also remained significant in the multivariable analysis (p Conclusions: Race appears to be a significant predictor of HCV infection among baby boomers in the NHANES population. Programs interested in the prevention or improvement of Hepatitis C should focus on African-American baby boomers as an especially high-risk group. Due to the exclusion of those who are homeless and incarcerated in the NHANES data, future research needs to be conducted on baby boomers from these groups.
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    Is Free Effective? An Analysis of HPV Vaccines and Hispanic Caregivers in the Outpatient Setting
    (2019-03-05) Fernando, Shane PhD MS FRSPH; Tirloni, Adrianna
    Purpose: The Human Papillomavirus (HPV) is the primary cause of cervical cancer in the United States, with Hispanic women suffering disproportionately from cervical cancer incidence and mortality. While the HPV vaccine has shown great success in the prevention of cervical cancer, vaccination rates among Hispanics remain low nationwide. This study’s purpose was to identify barriers among Hispanic caregivers and different vaccination opportunities. Methods: A paper-based multiple-choice survey consisting of 32 questions were given to caregivers of patients from the UNT Health Science Center Department of Pediatrics, while they were in the waiting room. Upon survey completion, a brief education session was conducted on HPV and the HPV vaccine. Logistic regression, controlled for income and education, was performed to assess the relationship between vaccination intent and vaccination options among Hispanic caregivers. Results: Hispanic caregivers were more likely to pay $25 for an HPV vaccination (OR 1.793, p=0.093) than participate in a free vaccination program (OR 1.392 p=0.377) or the federally funded Vaccine for Children program (OR 1.394, p=0.349). As income increases, the likelihood of paying $25 for an HPV vaccination increases (OR 1.138, p=0.132). The inverse effect was observed as education increased (OR 0.725, p=0.077). Conclusions: The results showed that Hispanic caregivers were more likely to pay for their children’s HPV vaccinations than participate in a free or federally funded program. A priori literature identifies cost as a barrier to minorities, often suggesting providing free vaccines, contrary to study findings. Further research is needed to determine if results remain in diverse populations.
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    A Student-Run Clinic as an Approach to Refugee Health
    (2019-03-05) Miller, Dallas; Lin, Christine; Gee, Kelly; Chang, Shannon; Hughes, Jonathan
    Background: Texas is one of the top U.S. states for refugee resettlement, receiving 9% of the country’s refugees from October 2018 to February 2019 alone. The Congolese and Burmese comprise most of the refugee populations in Texas, holding 57% and 21% of state arrivals, respectively. Within Texas, Tarrant county is currently one of the top counties where refugees are resettled. Before a refugee resettled in the U.S., they must undergo a tedious resettlement process that consists of biographical data collection, medical and security screenings, and interviews. Once approved, refugees are assigned to a non-governmental organization that aids in the often difficult transition to their new lives in the U.S. Many challenges during the resettlement process may prevent the individual from obtaining adequate medical care. Language, cultural beliefs, and socioeconomic factors are the major barriers to accessing health care services resulting in the underutilization of resources. Access to community health resources is often also hindered by I-485 form processing times approaching 2 years. As a result, many refugees do not seek out care until medical emergencies arise. Refugee Health Initiative’s goal is to establish continuity of care by connecting refugees seen at our health clinics with pertinent healthcare resources. Case Information: From October 2018 to February 2019, we have held 4 clinics at 2 locations and have seen a total of 67 refugees, of which, 23 were males and 44 were females. The average age of patients seen was 41.73 years. While all were seen for a general screening, common co-occurring complaints included cold and flu symptoms, blood glucose screening, abdominal pain, headache, and dysuria. Patient medical histories included diabetes, hypertension, nephrolithiasis, hyperlipidemia, and hypothyroidism. Conclusions: Refugee experiences in the clinic setting reveal problems in navigating the health care system. Language barriers prevent many from understanding diagnoses and medications, while those who are unsure of their insurance status are often lost to follow-up. Although breakthroughs are being made in outreach, continued innovation in approaching these populations is essential in developing a relationship of trust with Western health care methods. The Refugee Health Initiative’s clinic has the potential to become an entry point of care that can improve health promotion and deconstruct cultural misunderstandings of the healthcare system.
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    Health Disparities in the United States with a Focus on Tarrant County
    (2019-03-05) Thomas, Andrew; Scribner, Jacob; Tomasco, Olivia; Brodrick, Ashley; Carson, Madeline
    Abstract Purpose: Health disparities across racial, socioeconomic, gender, and age groups are well documented across the United States. This study seeks to review health disparity data and provide resources addressing these disparities on the local, state, and national level, with a focus on socioeconomic status, access to care, and insurance coverage. Methods: Sources such as Data USA, United States Department of Agriculture (USDA), and Healthy People 2020 were used to gather information regarding specific health disparities and resources available to combat the growing disparities. Results: Resources in Tarrant county promoting the health and well-being of the community include organizations such as the Mercy Clinic and the Healthy Tarrant County Collaboration. The state of Texas is also helping to promote healthier individuals by providing Medicaid and CHIP (Children’s Health Insurance Program). However, Texas voted to not expand their Medicaid coverage, leaving a group uninsured which is now known to be called the Medicaid gap. Programs on the national level include the Affordable Care Act of 2010, WIC, and the Healthy People 2020 campaign, all of which strive to improve access to care and insurance coverage. Conclusion: This gap can be closed and better quality of care can be provided by increasing awareness, promoting currently available resources, conducting further research, and by addressing influential factors that lead to health disparities.
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    A Robust Model for A Sustainable Diverse Healthcare Community - The Center for Diversity and International Programs, UNT Health Science Center
    (2019-03-05) Jones, Harlan; Basha, Riyaz; Vishwanatha, Jamboor; Nair, Maya
    About CDIP The Center for Diversity and International Program’s (CDIP) objectives are to broaden partnerships (local, national and international), unify institutional pipeline programs, innovate education and training, and lead diverse constituencies to opportunities in biomedical/behavioral science research and Health Professional career paths. CDIP’S programs A pipe line of programs from “K-12” to “healthcare professionals” are offered by CDIP K – 12 Outreach Stimulate and broaden student’s awareness of biomedical and health professional careers paths by exposing students to clinical and laboratory research environments at UNTHSC. Undergraduate Summer Research Internships Various undergraduate summer research programs at UNTHSC are funded through numerous sources. Participants are created with minority and non-minority-serving institution partners across USA. Graduate and Health Professional Student Training Programs Supports short term and dual degree research training for underrepresented students in health professions. Faculty Grant Writing and Professional Development Provide research and mentoring to underrepresented graduate and heath professional students, post-docs and junior faculty. CDIP’S structure The main pillars of CDIP are constituted with (1) Texas Center for Health Disparities (TCHD): A National Institute of Minority Health and Health Disparities (specialized Center of Excellence in Health Disparities (U54) was announced in 2017. (1) Research (2) Education and Training and (3) Outreach (2) National Research Mentoring Network (NRMN): Develop a culture of mentoring relationships, and more broadly the research workforce. (3) Diversity Training Programs: The plan includes a variety of programs that reach out to students from K-12, through college, and into graduate school and health care professions. (4) Texas Minority Health, Education Research and Outreach: Supports PhD scholars, junior faculty development and scholarship for senior faculty. Impact of CDIP CDIP has pioneered inter professional collaboration at institutional and national levels. 801 students and 201 faculty members from various colleges/schools at UNT Health Science Center and partnering institutions across the nation participated in various programs offered by CDIP and benefiting their educational or professional career. Such collaboration resulted in more than 200 publications and $24.76 Million in research funding. In summary, CDIP functions are in full alignment with the mission of ‘One University’.