General Public Health
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Item Health Champions for Health Equity, a Rapid Review(2023) Valdez, Alia; Vu, Patrick; Mahasamudram, Prathyusha; Phu, Daniel; Allsopp, Leslie C.Purpose This study aimed to synthesize existing knowledge from peer-reviewed literature on the usage of "health champions” in K-12 settings to improve health outcomes. Traditionally, community health initiatives aimed at K-12 students have been led by outside adults or appointed school leaders. While successful, one of the limitations frequently encountered was a disconnect between the leader and the target audience. To determine whether this issue could be addressed using peer-led interventions, a rapid literature review was conducted. Methods A Cochran Rapid Review was conducted due to time and resource constraints. A consultation with a research librarian generated a search strategy suitable for the scope of this project. Using databases ERIC, PubMed, and SCOPUS, an initial list of 602 articles was systematically reduced to 18 publications. The inclusion criteria included studies done in the United States in the past 10 years (2012-2022) to maintain relevance. After applying these criteria, an initial screening of the title/abstract and full-text analysis was performed to develop the final reference list. A data extraction tool was then used to yield the following results. Results The majority of health champions were students from their respective schools. Nutrition based interventions were the most common at the elementary school level. High school students had the widest array of interventions such as mental health improvement and tobacco usage reduction. Overall, peer health champions lead to better health intervention objective learning, more participation in the programs, and more student satisfaction. Conclusion Findings suggest that peer led interventions targeted at K-12 students are effective in improving participation in program activities. Students had more exposure to the learning material when the program utilized peer mentorship components which resulted in better objectives achievement. Additionally, having university or professional school students as mentors increased community involvement. Creating a working relationship between both K-12 educators and students from universities and higher education facilities is vital in building support for schools with limited resources.Item Suicidal Ideation Among High School Adolescents in the United States(2023) Flores, Claribel; Thompson, ErikaPurpose: Suicidal ideation represents thoughts or contemplations about death and suicide. Suicidal ideation has become a growing concern since suicide is the second leading cause of death among adolescents in the United States. The purpose of this analysis is to explore the epidemiology of suicidal ideation and the association between suicidal ideation and actual suicide attempts among high school adolescents in the U.S. Methods: The data source was the 2019 Youth Risk Behavior Surveillance System (YRBS). The sample size was 13,677. The primary variable was suicidal ideation measured from "During the past 12 months, did you ever seriously considered attempting suicide?” and categorized as yes or no. A secondary variable was actual attempt at suicide measured from "During the past 12 months, how many times did you actually attempt suicide? and categorized as yes or no. Demographics including sex, race/ethnicity, grade, and sexual orientation were also measured. The statistical analyses used were logistic regression, pairwise differences using t-tests, and chi-squares and p-values <0.05 were considered statistically significant. Data were obtained from the CDC YRBS Explorer tool. Results: Suicidal ideation decreased from 19.3% to 13.8% from 1999 to 2009. However, it increased from 13.8% to 18.8% from 2009 to 2019. Furthermore, females (24.1%), American Indian or Alaskan Native students (34.7%), bisexual students (48.5%), and those who had sexual contact with both sexes (58.9%) were significantly more likely to seriously consider attempting suicide compared to White students, heterosexual students and those with no sexual contact, respectively (p<0.05). Moreover, There was a significant association between seriously considering attempting suicide and attempted suicide (p<0.01). Among persons who considered suicide, 40.7% actually attempted suicide, compared to 59.3% who considered suicide and but did not attempt it. Conclusions: Due to the growing prevalence of suicidal ideation among high school adolescents, more research is needed to be done to create interventions that can help students who are experiencing suicidal ideation and prevent suicide attempts. Furthermore, these interventions should aim to target females, Asian Indian or Alaskan Native students, and LGBTQ+ students since suicide ideation was higher among these populations.Item The Intersection of Mental Health and Hypertension(2023) Nhpang, RoiSanPurpose: Mental health conditions such as depression and anxiety are serious public health issues globally. Likewise, hypertension is a significant public health issue across the globe and is the leading risk factor for chronic cardiovascular diseases and stroke. Several studies have reported the association between mental health conditions and chronic diseases such as hypertension and diabetes. This study aims to determine the association between mental health conditions and hypertension among adults living in the United States using data from the 2021 National Health Interview Survey (NHIS). Methods: Secondary data analysis of 2021 NHIS data was conducted to explore the association between mental health conditions and hypertension among U.S. adults. Mental health conditions were determined using self-reported data on depression, and anxiety (whether or not they have even been told by a doctor or health professional if they had any type of depression or anxiety disorder). Hypertension was also determined by the self-report data by the participants who were diagnosed by a doctor or other health professional of ever having hypertension. Weighted multiple logistic regression models were conducted to measure the relationship between mental health conditions and hypertension. Models were adjusted for key covariates. Results: In the 2021 NHIS survey, approximately 55% (unweighted) of the participants were female. Among the different mental health conditions, depression was significantly associated with hypertension among U.S. adults, in which adults with depression are 1.443 times more likely to have hypertension than those without depression in 2021 (OR=1.443; 95% CL 1.311, 1.589). Whereas anxiety was found to not have a significant association with hypertension among U.S. adults in 2021(OR=1.051; 95% CL 0.947, 1.167) while controlling for covariates. The covariates measured include – serious psychological distresses, sex, educational levels, race, and ethnicity. Sex was also significantly associated with hypertension among U.S. adults in which males are 1.172 times more likely to have hypertension than women (OR= 1.172; 95% CL 1.106, 1.242). Conclusion: Depression was significantly associated with hypertension among US adults in 2021. Consistent with the results of previous studies, the result from this study indicates that men are more likely to have hypertension than women. The results from this study support the evidence of the intersection between chronic conditions and mental health, suggesting the need for primary healthcare providers to support mental health in patients seeking care for chronic disease.Item Assessing the impact of targeted continuing education training on improving dental hygienists’ HPV-related knowledge(2023) Farris, Alexandra; Neelamegam, Malinee; Cotter, Jane; Dickinson, Charlene; Johnson, Kaeli; Kline, Nolan; Thompson, Erika; Griner, StaceyBackground Human papillomavirus (HPV) is the most prevalent sexually transmitted infection in the United States and is attributable to various cancers. Approximately 70% of oropharyngeal cancer diagnoses are linked with an HPV infection. HPV vaccination is an effective prevention method that can protect against multiple high-risk strains including those directly associated with oropharyngeal cancer. Given the connection between HPV and oropharyngeal cancer and the frequency of dental visits compared to annual primary care visits, dental hygienists are uniquely positioned to help reduce the risk of HPV infection among their patients through vaccine education and promotion. The goal of this project is to evaluate the impact of a continuing education (CE) training on dental hygienists’ knowledge about HPV and the HPV vaccine. Methods This study used pre- and post-test survey design to collect data from dental hygienists. The CE training was presented at the Southwest Dental Conference on August 26th, 2022, in Dallas, Texas. Prior to the training, all attendees were asked to complete an online survey assessing their knowledge about HPV and the HPV vaccine. Knowledge questions included modes of transmission, types and sites of HPV-related cancers, and vaccine recommendations and indication. For example, "HPV is transmitted through skin-to-skin contact” was asked as a true or false question. With a total of 18 questions on the knowledge scale, participants were awarded 1 point per correct answer and no points for incorrect answers. Higher averages indicated higher knowledge, with 18 being the highest possible score. Following the 45-minute CE, participants completed a second online survey assessing their knowledge. Data were analyzed in SPSS using t-tests to assess for changes from pre-test to post-test. A p-value of <0.05 was considered statistically significant. Results While a total of 453 oral health providers were registered, only practicing dental hygienists (n=112) who had matched pre- and post-surveys were included in this analysis. Out of 18 items, the average number of correct responses pre-CE was 13.7 (SD=2.7), which was significantly higher following the CE (16.8 correct, SD=1.0; p<0.001). The item with the most significant knowledge increase pertained to the type of vaccine available for HPV (a virus-like particle vaccine, 39.1% pre-CE; 92.0% post-CE, p<0.001). Additional items with increases in knowledge included the various types of cancers directly linked to HPV such as anal cancer (54.9% pre-CE; 99.1% post-CE, p<0.001) and penile cancer (50.4% pre-CE; 97.3% post-CE, p<0.001). Conclusions The HPV vaccine is an FDA-approved form of cancer prevention, and the best predictor of HPV vaccination uptake is recommendation from a healthcare provider. The CE training resulted in increased knowledge regarding HPV-related cancers and the HPV vaccine, indicating a need for similar trainings that can help dental hygienists make stronger, more informed vaccination recommendations to their patients. Equipping dental hygienists with the most up-to-date knowledge, effective communication skills, and confidence to promote HPV vaccination among their patients could greatly reduce the number of missed clinical opportunities to recommend and refer for the HPV vaccine.Item Demographic Factors Associated with Parents’ Knowledge About Sexually Transmitted Infections(2023) Johnson, Kaeli; Kinard, Ashlyn; Lemuz, Tiffany; Terrillion, Ryan; Griner, StaceyPurpose: Gender roles are usually discussed in the context of socialization, however, this can be extended to other facets of behavior, such as compliance with treatment of sexually transmitted infections (STI). Because of this, many times the burden of STI testing and relaying information to partners is left to women. Similarly, within traditional nuclear families, gender roles and norms create expectations for family members, but especially parents. For example, maternal roles often include tending to the children and home, while paternal roles usually include being a provider for the family. Though our current society continues to transform these gendered norms, some of these gender roles still linger. Because of this, it is expected to see these gender norms and roles reflected in knowledge about STIs. Other demographic factors such as race, age, and education level may have an impact on knowledge acquired about STIs. The purpose of this study was to explore the demographic factors, including gender, associated with parental knowledge of STIs. Methods: We recruited parents of children aged 10-17 (n=230) via Centiment, an online survey panel. We assessed STI knowledge using a 27-item validated knowledge scale that included true and false statements. The scale included questions about Chlamydia, Gonorrhea, Herpes Simplex Virus (HSV-2), Human Immunodeficiency Virus (HIV), Human Papillomavirus (HPV), and Hepatitis B. An example of a question included was Genital herpes is caused by the same virus as HIV. Parents indicated their response (true/false/don’t know) and answers were coded (incorrect/correct). Incorrect answers were coded as 0, correct answers were coded as 1, and "don’t know” responses were automatically considered incorrect. There were 27 possible points based on the validated scale. Demographic questions included gender, age, race, parental STI history, and highest level of education. Descriptive statistics, univariate, and bivariate analyses were conducted in SPSS. A p-value of p < .05 was considered statistically significant. Results: The average knowledge score was 12.5 (SD=6.2, range 0-27). Knowledge score was not correlated with parent age (p=.62) or child age (p=.43). There were no significant associations between knowledge and parent gender (p=.06), parent race (p=.70), parent education level (p=.47), child gender (p=.08), or child race (p=.59). However, 28% of parents reported a history of an STI, and knowledge score was significantly different among those with an STI history (14.5) compared to those without (11.6; p=.001). Conclusions: We noted a significant difference in STI knowledge based on STI history. This is expected as those who have had experience with STIs and STI treatment would have increased knowledge about them. However, average knowledge scores were low overall, with no significant differences across several different demographic factors. This emphasizes a need for better sexual education across the life course. This also displays a need for targeted interventions to increase STI awareness and knowledge among parents, in general. Future studies should assess the specific gaps in STI knowledge among older adults and how sexual education information can be disseminated to this age group.Item Decrease in Mental Health Among Adolescent Students(2023) Jones, Courtni; Thompson, ErikaBackground: Persistent feelings of sadness or hopelessness has increased among adolescent high school students over time. Lack of physical activity has been identified as a risk factor for persistent feelings of sadness or hopelessness. The purpose of this study was to understand the epidemiology of persistent feelings of sadness or hopelessness and its association with physical activity among adolescents. Methods: Data from the Youth Risk Behavior Survey (YRBS), 2019, consisted of N=13,677. The main variable analyzed was 'felt sad or hopeless’(yes/no)and the association variable was 'were not physically active at least 60 minutes/day on all 7 days of the week’ (yes/no). Demographic variables measured: sex, race/ethnicity, grade, and sexual orientation. Statistical analysis used: logistic regression model, chi-squared test, and t-test using the YRBS data explorer tool. Results: The current (2019) prevalence of feelings of sadness or hopelessness among adolescents is 36.7%, an increase from previous years. Rates for feelings of sadness and hopelessness were highest among these demographic groups: Females (46.6%), Bisexuals (68.2%), 12th Graders (39%), American Indians (45%), Sex with both sexes (74.4%). There was a significant association between feelings of sadness or hopelessness among adolescents and students who were not physically active at least 60 minutes/day on all 7 days of the week, p-value=<0.01. Adolescent students that were not physically active at least 60 minutes per day on all 7 days of the week were more likely to experience feelings of sadness or hopelessness (39.2%), compared to adolescent students who were physically active at least 60 minutes per day on all 7 days of the week (29%). Conclusion: There were differences observed in sex, race/ethnicity, grade-level, and sexual orientation among students that experience feelings of sadness or hopelessness. Lack of physical activity is associated with feelings of sadness or hopelessness. Although the role of lack of physical activity cannot be determined in the causation of poor mental health among adolescent students, future research should focus on examining why there are large differences between different demographics and how to combat that issue to improve mental health. In addition, more research should focus on understanding the role physical activity plays in mental health, and specific solutions for how it can be used as a tool to improve mental health among adolescent students.Item The Role of Pregnancy Intention in the Choice of Contraception Among U.S. Women of Reproductive Age: 2017-2019 National Survey of Family Growth(2023) Akpan, Idara N.; Yockey, Andrew; Galvin, Annalynn; Thompson, ErikaPurpose: Contraceptive use is an important aspect of women’s reproductive health. Long-acting reversible contraceptives (LARCs) such as the intrauterine device and hormonal implant, are known to be highly-effective methods to prevent an unintended pregnancy. Pregnancy intention may contribute to contraception use, and women who do not intend to get pregnant may opt for effective contraception methods. However, pregnancy intention is a behavioral factor that is subject to change based on circumstances. This study describes contraception use by pregnancy intention among a nationally representative sample of U.S. women aged 15-49 years. Methods: The study sample included women aged 15-49 years from the 2017-2019 National Survey of Family Growth (n=3025). The dependent variable was current contraception method at the time of interview, operationalized into four categories: LARCs (reference category), pill/ring/patch/injectable, barrier methods, and no contraception. Pregnancy intention (in the future or after a current pregnancy) was operationalized as intending, not intending, and don’t know/refused. The relationship between pregnancy intention and current contraception method was examined using weighted, multinomial logistic regression analyses, adjusting for race, age group, and type of current health insurance coverage. Results: The mean age of the women was 29.6 years (SD=8.4 years), and women identified as White (67.6%), Black (24.2%), and Other (8.2%). Less than a third (29.6%) of the women had a bachelor’s degree or higher, and a majority (58.4%) of women had private insurance. Overall, 22.1% were currently using LARCs and 15.7% were using no contraception. Compared to women intending to get pregnant, women not intending to get pregnant had lower odds of using pill/ring/patch/injectable (aOR=0.57; 95%CI=0.41, 0.80), barrier methods (aOR=0.54; 95%CI=0.40, 0.73), and no contraception (aOR=0.40; 95%CI=0.25, 0.64) versus LARCs. Women aged 20-29 years had lower odds of using pill/ring/patch/injectable (aOR=0.41; 95%CI=0.25, 0.67) and no contraception (aOR=0.43; 95%CI=0.24, 0.79) versus LARCs, compared with women aged 15-19 years. Older women within the age group 40-49 had higher odds of using barrier methods (aOR=1.98; 95%CI=1.05, 3.73) and significantly lower odds of using pill/ring/patch/injectable (aOR=0.32; 95%CI=0.18, 0.57) versus LARCs, compared with women aged 15-19 years. Compared to women with private insurance, women with public insurance (Medicaid/Children’s Health Insurance Program) had lower odds of using pill/ring/patch/injectable (aOR=0.50; 95%CI=0.35, 0.72) versus LARCs. Conclusions: Overall, women not intending to get pregnant were less likely to use pill/ring/patch/injectable and barrier methods compared to LARCs. As such, women who desire to prevent unintended pregnancy may opt for LARCs. Findings also show that a proportion of women not intending to get pregnant were not using any method of contraception, which highlights the need to examine reasons for no contraceptive use among this group of women. Given that pregnancy intention can be dynamic, preconception care should be accessible to women to support them in making informed decisions about their reproductive health. Moreover, there is need to examine factors that impact decision-making on contraception methods while accounting for pregnancy intention.Item Using the Model Aquatic Health Code to Grade the Safety of Swimming Pools in Houston, Texas(2023) Nguyen, Antoine; Arroyo, Miguel; Jones, Jennifer; Shenoi, RohitPurpose: Drowning and submersion injuries in the pediatric population are responsible for many unintentional deaths. Moreover, there are other associated injuries in young children such as water-borne diseases, falling, and diving injuries. The Model Aquatic Health Code (MAHC) developed by the CDC issues guidelines aimed to decrease disease, injury, and drowning events at aquatic facilities. Since no federal regulatory authority currently exists, there is wide variation in the inspection of aquatic facilities and implementation of the MAHC guidelines across state and local authorities. The aim of this study was to devise a grading system for swimming pools across the city of Houston by applying the MAHC guidelines to pool inspection data. The results may then inform measures to strategically provide pool operators and the public with safety information regarding swimming pools. Methods: A cross-sectional study of commercial swimming pools and spas in Houston was conducted in 2016 using routine inspection reports. Each public pool in Houston is required to undergo annual inspections. Private residential pools are not required to be inspected annually and such reports were excluded. The MAHC was used to develop a grading system that assigned points to commercial swimming pools and spas based on violations as detailed in inspection reports. Letter grades were assigned 95-100% (A); 85-94% (B); 75-84% (C); <75% (F-Fail) based on overall percentage of compliance with MAHC and projected onto a map of the city of Houston. Results: A total of 3107 commercial aquatic venues were inspected in Houston during 2016 with 3100 of these being located within the city of Houston. Each venue was graded for safety and had the following grade distribution: (A): 40.2%; (B): 0.5%; (C): 0%; and (F): 59.3%. The most frequent violations were related to swimming pool enclosures (18%) followed by self-closing gates (13.8%). The majority of swimming pools inspected were concentrated in southwest Houston. Conclusions: The MAHC guidelines may be used to appropriately assess and grade swimming pool safety in jurisdictions in which they have not yet been endorsed. Many jurisdictions vary in their regulation and implementation of policies regarding swimming pool safety. There may be a need for more jurisdictions to update their pool inspection criteria using MAHC guidelines. Further, injury prevention measures can be used to devise injury prevention measures based on the spatial distribution of safety violations.Item The Effect of Trusted News Sources on the Confidence in the Safety of COVID-19 Vaccination(2023) Alkhatib, Sarah A.; Luningham, Justin M.; Akpan, Idara N.; Taskin, Tanjila; Vishwanatha, Jamboor K.; Thompson, Erika L.Purpose: COVID-19 vaccination prevents severe disease manifestations; yet uptake has been suboptimal. Confidence in the safety and efficacy of the vaccine influences COVID-19 vaccination decisions. Exposure to information from a trusted news source can impact perceptions and may contribute to vaccine decisions. This study assessed the association between trusted news sources and confidence in the safety of COVID-19 vaccination among Texas adults. Methods: Participants were recruited through an online panel using quota sampling based on the racial and ethnic distribution of Texas in July 2022 (n=1089). The primary predictor variable was self-reported trusted news sources for COVID-19 related news (16 options), in which respondents were asked to endorse any news source they trusted, with options ranging from print media to cable news to local news. The outcome was confidence in the safety of the COVID-19 vaccine (not at all confident to very confident). Multinomial regression analyses were conducted to model confidence in COVID-19 vaccination and trusted news sources while controlling for education, age, gender, and self-reported race. Results: Through an initial descriptive analysis, Fox News, local cable TV programs, and news broadcasting from one’s home abroad were associated with lower confidence levels. After grouping those three sources as "top news sources” and assessing their effect on confidence through a multinomial model, it was found that individuals who trusted those top sources were significantly less likely to endorse "somewhat confident” (OR=0.59, 95%CI 0.4-0.89) or "very confident” (OR=0.41, 95%CI 0.27- 0.62) compared to being "not at all confident” in the safety of the COVID-19 vaccine. Conclusions: Study findings show that some trusted news sources contributed to participants having less confidence or no confidence in the safety of the COVID-19 vaccine. Public health initiatives should consider how to address vaccine confidence among the public given the diversity of information sources people rely on.Item Parenting styles and driving under the influence of cannabis among US adolescents(2023) Galindo, RebecaAbstract Objective: Access to cannabis and synthetic THC alternatives is increasingly widespread. Moreover, there is no federal minimum age for purchase, and inconsistencies between state laws. Some parenting behaviors are associated with substance use among their adolescent children. However, it is unclear whether certain types of parenting behaviors are associated with driving under the influence of cannabis (DUIC). The current study examines this association. Methods: We utilized cross-section data from the 2016-2019 National Survey on Drug Use and Health. The analytic sample (N=17,878) was comprised of adolescents aged 14 to 17 who had driven a car in the past 12 months. Parental warmth, monitoring, and conflict were recoded and measured ordinally. Weighted frequencies and multivariable analyses were conducted using SAS 9.4. Results: Multivariable regression results indicated significant associations between DUIC and all types of parenting behaviors measured: warmth (p<0.01), monitoring (p<0.001), and conflict (p<0.001). Each one unit decrease in parental warmth, monitoring, and conflict, was associated with an increase in the odds of DUIC by 16% (OR=1.16, 95% CI 1.035–1.30), 18.3% (OR=1.18, 95% CI 1.07–1.31), and 50% (OR = 1.50, 95% CI 1.24 – 1.82), respectively. Past cigarette (OR=4.72, 95% CI 3.89–5.73, p<0.0001), and alcohol use (OR=12.47 95%, CI 9.28–16.76, p<0.0001) are strongly associated with DUIC. Compared to White adolescents, Non-Hispanic Native-Americans had 2.10 times the odds (95% CI 1.19–3.67, p=0.03) and non-Hispanic Asians had 0.61 times the odds (95% CI 0.30–1.25, p=0.04) of adolescent DUIC). Adolescents aged 16 to 17 had greater odds of DUI (OR=2.96, 95% CI 2.12–4.12, p< 0.0001) compared to younger adolescents aged 14 to 15. Discussion: Our findings indicate adolescents with parents that engage in high warmth, high monitoring, and low conflict behaviors have decreased odds of DUIC. Past adolescent cigarette and alcohol use are also strong indicators of DUIC.Item Analyzing the Effectiveness of Wellness Resources Provided for Medical School Students(2023) Rama, Kush; Patel, Pooja; Adhikari, Pratichha; Ziller, RynnBackground: There exists well-documented evidence demonstrating that physicians and medical school students practicing preventative lifestyles are more likely to promote prevention to their patients, which is especially important given the escalation of chronic conditions in the United States. The arduous nature of medical school challenges the student’s ability to initiate or sustain healthy lifestyle habits even with the various resources available. Several interventions have been created to address medical student wellness; however, there remains a discrepancy in the literature regarding the effectiveness of these resources long-term. Student burnout, which is defined as emotional exhaustion, is still a prevalent issue in the medical profession. Medical schools must emphasize the importance of program evaluations to address the issues that contribute to poor medical student wellbeing. Goal:To create a simple and inexpensive survey that can track the effectiveness of wellness resources that medical students use over the long-term. Methods: A survey that could be implemented at a single point in time or a yearly fashion was developed. The survey was created to collect information on wellbeing markers, resources used, and basic demographic information. The wellness questionnaires used were the WHO-5 Wellbeing Index, Modified Maslach Burnout Inventory (M-MBI), International Physical Activity Questionnaire Short Form (IPAQ-SF), Single Item Sleepy Quality Scale (SQS), and the nutritional questionnaire section from the American Association of Family Medicine’s (AAFP) Lifestyle Assessment Form. The effectiveness of the wellness resources will be assessed in three ways. First, a question will be asked regarding the user’s opinion about the value of the resource to their wellness. Second, the students with poor wellbeing will be identified, and the prevalence of usage of that resource will be documented. Third, the wellbeing markers will be compared to students who use the resource versus students who do not use the resource. Propensity score matching will be used to reduce the confounding variables associated with demographic information and academic factors (average grades, amount of time spent studying in a day, etc.). The data will be collected through Qualtrics and analyzed using IBM SPSS Version 29.0. The first round of the survey will be distributed to first- and second-year medical students between the dates of February 1st -15th. Subjects will be recruited through verbal announcements at the end of mandatory lectures. Discussion and Future Implications: Due to the numerous wellness programs at medical schools, it can be difficult to assess their efficacy because of the time and resources needed. The survey design is built to help medical schools track the performance of their wellness resources in a quick and affordable manner. The data from this survey can help guide decisions about how medical schools can improve the quality of their wellness resources. It is important for medical schools to continue to evaluate their wellness initiatives over the long-term so that they can adapt to the evolving needs of their students.Item Cannabis and its effect on health outcomes and behaviors of UNTHSC graduate students(2023) Shah, Mauli; Arvay, Andrew; Mire, Emily; Griner, StaceyPurpose: The rate of cannabis usage is high among graduate students. According to the reference data of the National College Health Assessment survey of Spring 2022, 42.4% of graduate students reported cannabis use sometime in their life. Cannabis use is often linked with the use of alcohol, tobacco, and other drugs but there is limited research on its relationship to mental health outcomes such as anxiety, depression, and stress among graduate students. There is also limited information about the effect of cannabis use on academic success, which is often a significant concern among graduate students. The purpose of this study was to assess the associations of cannabis use with health outcomes and behaviors among graduate students. Method: The National College Health Assessment (NCHA) survey data collected by the Office of Care and Civility of UNTHSC were analyzed after approval from the Institutional Review Board. Variables included were cannabis use (ever used or never used), anxiety (ever diagnosed or never diagnosed), depression (ever diagnosed or never diagnosed), tobacco use (ever used and never used), alcohol consumption (ever consumed or never consumed), stress (no, low, moderate, high), and if cannabis use has affected academic performance in the past years (yes or no). A descriptive analysis using Chi-square tests and Fisher’s Exact tests were conducted using RStudio, with a p-value of <0.05 being considered significant. Results: In total, 32.2% of graduate students on the UNTHSC Campus reported non-medicinal use of cannabis sometime in their life. A total of 29% of cisgender men, 33% of cisgender women, and 50% of transgender/gender non-conforming graduate students on campus reported using cannabis ever in their life. Statistically significant associations were found between the use of cannabis and anxiety (p=0.0003), cannabis use and depression (p=0.006), cannabis use and alcohol use (p<0.0001), and cannabis use and tobacco use (p<0.0001). No significant associations were noted between cannabis use and stress (p=0.76) and the influence of cannabis use on academics (p= 0.27). Conclusion: We noted that cannabis use was associated with mental health outcomes and other substance use among this sample of graduate students. The results from this analysis will guide the Office of Care and Civility to develop future health programming on campus with a more holistic approach. Moreover, mental health outcome numbers are high among graduate students on the UNTHSC campus, and programming or awareness campaigns for cannabis might be effective in addressing mental health outcomes as well. However, since this study is a cross-sectional study, we cannot comment on causation, but future work may benefit from further exploring these relationships to determine causality.Item Use of Electronic Vapor Products and its association with Feelings of Depression(2023) Pradhan, Sushaili; Thompson, ErikaUse of Electronic Vapor Products and its association with Feelings of Depression Authors: Sushaili Pradhan, Erika L. Thompson Background: Electronic vapor products (EVPs) are the second most common form of youth substance use. EVPs were principally a means of harm reduction or cessation for smokers of cigarettes made of combustible tobacco, but this new tendency is emerging in teenagers and youths as a coping mechanism for feelings of sadness, hopelessness, stress, anxiety, or depression. There is a need for continued assessment of EVP use among adolescents. The aim of the study was to understand the epidemiology of current use of EVPs among adolescents in the U.S. and identify the association between depression and current EVPs use. Methods: Data from the Youth Risk Behavior Surveillance System – 2019 was used. Students from grades 9 through 12 were sampled (n = 13,677) to obtain information on trends and sociodemographic disparities related to the use of EVPs. Variables included "During the past 12 months, did you ever feel so sad or hopeless almost every day for two weeks or more in a row that you stopped doing some usual activities” and operationalized as yes/no and, "During the past 30 days, on how many days did you use an electronic vapor product?" (Response: 0 days, 1 or 2 days, 3 to 5 days, 6 to 9 days, 10 to 19 days, 20 to 29 days, and All 30 days) and operationalized as "no” EVP use for 0 days and "yes” for other options. ” Demographic variables included grade, sexual orientation (sexual identity and sex of sexual contact), and race/ethnicity. The associations were analyzed using t-tests and chi-square tests, with a 0.05 level of significance. Result: Among high school students, 32.7% (95% CI: 30.7–34.8%) reported use of EVPs. Non-Hispanic-Whites were more likely to use EVPs as compared to NH-Black, Hispanic/Latinos and Asian (p-value <0.001). 9th graders were less likely than other grades (10th, 11th, and 12th) to be using EVPs currently (p-value=0.001). Bisexuals (34.5%) and gay, lesbian, or bisexual (34.1%) students used EVPs at a higher rate than heterosexual students (32.1%), but there was no statistically significant difference between them. Among high school students who reported feeling sad or hopeless, 43.5% (95% CI: 40.8–46.2) were currently using EVPs, compared to 73.5% (95% CI: 71.6 - 75.4) who did not feel sad or hopeless and were not using EVPs currently. Conclusion: A difference was observed in the use of EVPs based on race/ethnicity and grade level, while no significant differences were observed for EVP use and sexual identity. Moreover, feeling sad or hopeless was associated with the current use of EVPs. Additional research is needed to disentangle the relationship between EVP use and mental health among adolescents, especially as mental health is a growing concern among youth in the United States.Item Gaps in the Knowledge of Sexually Transmitted Infections in Young Adults: A Review of the Literature(2023) Rice, Elliana; Johnson, Kaeli; Gill, Lily; Navid, Daniel; Griner, StaceyPurpose Almost half of the 26 million sexually transmitted infections (STI) occur in young adults, although they are only 25% of the sexually active population in the US. Common STIs include chlamydia, gonorrhea, syphilis, genital herpes, Hepatitis B (HBV), Human Immunodeficiency Virus (HIV), and Human Papillomavirus (HPV). STIs are often associated with adverse health outcomes if left untreated, such as pelvic inflammatory disease, infertility, and ectopic pregnancies in women. The high rates of STIs in young adults, ages 18-25, may be due in part to a lack of knowledge about screening recommendations, symptoms, and available services for care. Because knowledge is a key factor associated with the prevention of STIs, the purpose of this study is to explore the current literature related to STI knowledge among young adults and identify the gaps in knowledge. Methods A literature review process was conducted using the following electronic databases: PubMed, Scopus, Medline, ScienceDirect, WILEY, EbscoHost. In addition to database search, the reference lists of the relevant articles were screened for titles and abstracts containing the keywords. The keywords used included: STI, STD, sexually transmitted infection, sexually transmitted diseases, knowledge, awareness, health literacy, health attitudes, information literacy, primary prevention, and secondary prevention. This retrospective search was limited to: (i) articles written in English, (ii) studies conducted in the United States, (iii) articles addressing genital herpes, HBV, HIV, HPV, chlamydia, or gonorrhea in the title or abstract, and (iv) included young adults 18-25 years old as participants. We excluded syphilis in the STI category, and the final search resulted in 41 articles that included qualitative and quantitative studies and systematic reviews. Results Gaps in the knowledge of STIs in young adults was subset into five categories: prevalence, transmission, symptoms, treatment and prevention, and testing services. Young adults lack awareness about the high STI rate in their age group, transmission factors such as skin-skin contact, or oral/genital sex, and that STIs can be asymptomatic. Many young adults have misconceptions about HPV vaccines, pre-exposure prophylaxis for HIV prevention, and condom use. Two of the most important factors to the success of STI prevention in programming are the promotion of self-efficacy and the reduction of stigma around STIs. Self-efficacy is defined as the "belief in one’s own ability to execute a particular behavior related to a specific domain of functioning.” A high level of self-efficacy in college students is one of the best predictors of STI and HIV testing and condom use. Additionally, higher levels of STI knowledge have been correlated with less stigma surrounding the diseases. Conclusion Understanding what the specific gaps are in young adults’ STI knowledge can guide college and community programs in narrowing their focus to provide complete education concerning STIs. Specifically, more programs should implement effective theory-based approaches, including those that focus on improving self-efficacy of STI prevention and treatment and decreasing the stigma around these diseases. Addressing these specific points among young adult populations may have a role in reducing the rates of STIs and preventing the adverse health outcomes.Item Quality Improvement Project: Advanced Care Planning in Rural Family Practice Clinics(2023) Rogers, Joshua; Ratliff, SarahIntroduction: Advanced Directives ensure patient’s autonomy at the end of life. This project’s purpose was to assess the outcomes of integrating discussions in patients over 65 with an educational resource discussing Advance Care Planning (ACP) and analyzing the change over one year in a family practice clinic with intervention vs. a family practice clinic without intervention. Methods: Data was collected at two family practice clinics. In Fall 2021, patients at clinic 1 were provided patient education on ACPs and provided resource material. Clinic 2 did not have this intervention take place. All patients 65 years or older were eligible for this study. A chart review was performed on each patient during the study period to determine if an ACP had been created within the last 5 years. Results: During the study period, a total of 167 patients were eligible. 64 at B&W Healthcare and 103 at Family Health Clinic. At the clinic with intervention, 89% of the eligible patients had an updated ACP within the past 5 years in Fall 2022, compared to the 9.7% at the clinic lacking intervention. Conclusion: This project demonstrated how the lack of documented ACP and the need for ACP education among those 65 years and older in rural family practices can be addressed in primary care visits. Future interventions should involve EMR flags to identify those who lack an updated ACP. The goal of discussing ACPs is to have an ongoing conversation to exchange, deliberate, and clarify values and responsibilities. This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U1QHP28735. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the Health Resources and Services Administration or the U.S. Department of Health and Human Services.Item Opioid Crisis Breakdown in Tarrant County(2023) Conley, Mark; Judd, DallinPurpose: It is undisputed that opioids, while they have inherent medicinal value, can be abused recreationally leading to devastating effects. According to the CDC, Texas had the 6th most related deaths from opioids in 2019[1]. There were 3136 opioid related deaths in 2019 in the state of Texas [1]. It has been noted by physicians that Tarrant County in particular has seen a high incidence. The purpose of this research was to quantify the data surrounding opioid use in Tarrant County. Data from the National Institute on Drug Abuse shows that overdose deaths from opioids have risen steadily across the country in the last decade with a sharper increase in the last few years [2]. Methods: Using a database from the Texas Department of State Health Services we identified all calls, visits, and deaths related to opioid use [3]. The following metrics were used: Total opioid related deaths in Tarrant County and opioid deaths filtered by age, sex, race, education status, and marital status in Tarrant County. Total emergency department (ED) visits and ED visits per 100,000 population and per 100,000 ED visits in Tarrant County. The type of opioid related to each ED visit in Tarrant County was quantified as well. Finally, poison center opioid-related calls were totalled in Tarrant County. Results: Out of 254 counties in the state of Texas, Tarrant County recorded the 5th highest number of opioid related deaths in 2019, with 75 total deaths and a rate of 8 per 100,000 population. These opioid related deaths were most focal in the age range of 18-44 (72%). Of the total deaths, 65% of them were white and 68% were male. Of note, 70% of the users who died were not married, while 30% were married. Of these deaths, the most significant portion were by non-heroin opioids (34%), followed by heroin users (15%). In addition, in 2019 there were 244 poison center calls related to opioids. Finally, in 2019 there were a total of 774 ED visits related to opioids, with a rate of 87.5 visits per 100,000 ED visits. Conclusions: As indicated in the results, both the state of Texas and Tarrant County have been negatively impacted by the epidemic rise in opioids. Texas has sought to alleviate some of the disparities, and funding was received by the U.S. government. Beginning in May 2017, under the Texas targeted Opioid Response Program, Texas has received over $280 million in federal funding to address the opioid crisis [4]. However, the data presented in the case report (objective opioid related outcomes in 2019) demonstrates that more needs to be done. In response to the high prevalence of deaths, emergency room visits, and opioid related calls, it is critical that Texas mounts a proportional response. This response may be both systemic and individualistic as people are educated on the effects of opioids and what they can do to prevent negative outcomes.