General Public Health

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    Tuberculosis in Tarrant County
    (2020) Farooq, Ifrah; Qureshi, Sana; Nelson, Jacob; Javed, Madeeha; Charara, Fatima
    Purpose: Tuberculosis (TB) is a chronic bacterial infection, caused by mycobacterium tuberculae, that affects the lungs, brain, bones, and kidneys if not properly treated. TB management has improved tremendously since it's discovery in the 1880s. However, there are many socioeconomic factors that contribute to the disease's progression. The purpose of this study was to evaluate TB's mechanism of infection, current infection rates, and the resources available to the Tarrant County population. Methods: We conducted a literature study of resources specific to Tarrant County focusing on TB education, prevention, and elimination. Results: The International Standards for Tuberculosis Care have outlined the levels of care that should be sought by those who: have TB, are suspected of having TB, or are at increased risk of developing TB. Tarrant County has many resources available in accordance with these standards including Tarrant County Public Health Department, Tarrant County Public Health Refugee Program, and True Worth Place. These programs work to educate, screen, and provide referral services to residents, immigrants, and refugees. Conclusion: Since the discovery of this disease, there has been a growing effort to help the Fort Worth community. There are many programs available to those who have TB as well as those who are at risk. These programs are easily accessible and benefit people with limited access to healthcare due to income, education, or socioeconomic status. Although the prevalence of TB has decreased, this disease is still present in our community, and efforts should be made to further prevent its spread.
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    Childhood Autism Resources in Tarrant County
    (2020) Nguyen, Alexandra; Stedke, Alexandra; Fernandez, Jazmin; Mayerhofer, Jordyn; Yen, Kyle
    Purpose: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by persistent deficits in social communication, social interaction, and restricted patterns of behavior, interests, and activities. In 2014, the prevalence of ASD in the United States was about 1 in 59 children and was found across all racial and socioeconomic groups. Although the genetic causes of ASD remain unknown, risk factors include being male, exposure to specific drugs in utero, having other autistic family members, and being born prematurely. Our purpose was to discover available resources for those with ASD in Tarrant County. Methods: A literature search and review was conducted to determine the resources available specifically in Tarrant County to address the different needs of people with autism. Results: A variety of resources exists in Tarrant County for those diagnosed with ASD. These resources continue to grow in their importance and utilization especially as the rate of ASD continues to rise. The Autism Treatment Center (ATC), Hope Center for Autism, MHMR Tarrant County, and Easterseals are just a few organizations available to children with ASD and their families. The services offered include education, therapy, childcare, behavioral support, and outpatient rehabilitation. Certain eligibility requirements and barriers must also be overcome in order to benefit from these services, including age restrictions, transportation, and health insurance. Conclusion: As the rates of autism continue to rise, new resources are becoming increasingly important to this patient population. Tarrant County has several resources in place, however, there are still significant unmet needs.
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    Examining Tarrant County Resources for Attention Deficit and Hyperactivity Disorder
    (2020) Heinrich, Carl; Guerra, Alejandro; Reeves, Kirk; Zhou, Jason; Schmidt, Brendan
    Attention Deficit Disorder (ADD), known officially as Attention Deficit Hyperactivity Disorder (ADHD), is a highly prevalent behavioral disorder affecting about ten percent of children and adolescents between the ages of two and seventeen and is predominantly seen in males (2:1 predominance). The disorder is diagnosed clinically and may include inattention, hyperactivity, or a combination of these two aspects that can affect the child's daily life. ADHD is a disorder of particular concern because it often presents with an additional mental, emotional, or behavioral disorder and, more commonly, may severely impede the scholarly and social performance of persons it affects. We examined multiple resources in the Tarrant County area utilizing PubMed and local resource catalogues. Our resources were divided into three major categories: those that assist with diagnosis of ADHD, those that assist with treatment of ADHD, and those that support persons with ADHD. Additionally, multiple barriers to care were identified. We found that these resources, while freely available and easy to find, may present additional barriers to care including strict requirements for use, physical distance, and societal misconceptions. Along with addressing barriers to care, we also recommend increasing public awareness of these programs.
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    Analyzing Sound Levels Produced by a Choral Ensemble During a Choral Concert Event
    (2020) Taylor, Meghan
    Purpose: Efforts to quantify the sound levels produced by instrumental ensemble-based instructional activities and understand the role of the conductor in these activities has a robust history. However, these factors have not been widely studied in choral ensemble-based instructional activities. Additionally, the World Health Organization's current estimation that 1.1 billion young people are at risk for noise-induced hearing loss, there is a need for investigating sound levels produced by choral ensembles. The purpose of this study was to quantify and compare the sound characteristics associated with a choral concert event. Methods: This study examined the UNT A Cappella Choir's spring concert event in the Winspear Performance Hall. Sound measurements were taken using two noise dosimeter microphones; one microphone was positioned downstage and another in the choir loft. An aggregate view database and a time series database were created to analyze the data collected during each aspect of the choral event. Results: Obtaining temporal sound measurements during this type of activity is possible regardless of microphone placement. Variability in the sound measurements revealed that the ensemble was able to sing more musically while reducing their overall risk. Conclusion: This research presents a novel understanding of the conductor's role in a choral ensemble-based instructional activity for reducing the risks associated with NIHL. Additionally, this research determined that temporal views of sound can be obtained from multiple vantage points in the room, making it easier for researchers to unobtrusively obtain this data during these events.
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    Major Mental Illness and Resources Tarrant County
    (2020) Desai, Shivani; Blaydes, Rachel; Wickramage, Pavithra; Khowaja, Sanober; Singhal, Juhi
    Introduction: Mental Illness is a global issue that affects over 1 billion individuals. High prevalence of mental illness leads to higher rates of death, disability, medical illness, incarceration, homelessness, unemployment, poverty, and violation of human rights. Significant barriers to those facing mental illness are the lack of access to care and the stigma of treatment. The three major mental illnesses that physicians encounter are schizophrenia, major depressive disorder, and bipolar disorder. All of these illnesses require life-long treatment. However, there are resources available in the Tarrant County area and at the national, state, and local levels to alleviate the mental illness care disparity. Resources: Although getting access to mental health care is still challenging, there are resources available at the national, state and local level. At the national level, there is the National Alliance on Mental Illness. Texas Health and Human Services is a resource available at the state level. Finally, at the local level in Tarrant County there is JPS Behavioral Health Clinic - Northeast, My Health My Resources (MHMR), and Crisis Respite and Residential Unit. Barriers: The goal of these organizations is to help those with serious mental health illnesses, however the eligibility and process required to access these resources may create barriers for some individuals. Conclusion: While several resources in Tarrant County are striving to close these significant gaps in access to behavioral health help, it is important to realize that more work needs to be done until mental illness is viewed as equivalent to physical illness.
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    Establishing an Performing Arts Health Workshop for Secondary Fine Arts Teachers in Texas
    (2020) Surve, Sajid; Hoverson, Roger; Chesky, Kris; Taylor, Meghan
    Purpose: The purpose of this project is to develop a consensus-based workshop for fine arts educators in Texas to meet state mandates requiring the inclusion of health-related concepts during classroom instruction. Methods: The Texas Center for Performing Arts Health partnered with Denton Independent School District (DISD) to establish the City of Denton as the epicenter for innovation, research, and education in performing arts health. Musician-Researchers, fine arts administrators, and six music educators from DISD developed a professional development workshop for secondary fine arts educators. Our partnership with DISD allowed this project to expand to serve 100 fine arts educators in the district including music, dance, and theater during a 2-day workshop. Through this workshop, our organization presented current research about performing arts health, facilitated group discussions, and worked to develop best-practices for including performing arts health content in fine arts classrooms across DISD. Results: We assessed these educators' attitudes and knowledge about performing arts health-related information and used this feedback to inform the next phases of our project. We found that these educators offered appreciation for the content given but expressed the need for deliverables that could be implemented into their classrooms post-workshop. Conclusion: The feedback we received can be categorized into three main areas of growth: 1) there is need for novel performing arts health-related resources, 2) increased communication and 3) collaboration among current stakeholders and performing arts health professionals must develop a deeper understanding of the fine arts classroom context.
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    Overview of National and Local Resources for Osteoporosis
    (2020) Momin, Shahana; Soomro, Zara; Ozguc, Fatma; Nemati, Rojin; Seemann, Amanda
    INTRODUCTION: Osteoporosis is a bone disease characterized by low bone mass density and bone fragility. This disease affects postmenopausal women due to hormonal fluctuations, aging, disease processes, or medications. 50% of women and 25% of men will break a bone due to osteoporosis. In Tarrant County, the incidence of osteoporosis has increased 2.8% since 2012. Risk factors include age, family history, smoking, excessive alcohol use, sedentary lifestyle, diet, and several clinical conditions such as thyrotoxicosis, hypogonadism, malabsorption disorders, and autoimmune diseases. Diagnosis is achieved by bone density scans (DXA/DEXA scans), which is recommended for all women over 65 years and men over 70 years. Medications for osteoporosis include bisphosphonates which inhibit bone resorption. Behavioral modifications and underlying diseases should be addressed as well. METHODS: A literature review was conducted regarding available resources at the national and local levels. The majority of resources found were at the national level and included programs run by the National Osteoporosis Foundation and National Institutes of Health (NIH). RESULTS: National programs included support hotlines, risk calculators, and lifestyle modification recommendations. The Tarrant County Public Health Classes was the only local resource, but it was directed towards all chronic diseases, not just osteoporosis. CONCLUSION: There is a substantial amount of online resources available for osteoporosis support, but more personalized education and support is needed. Patients with osteoporosis will benefit more from customized care since individual factors must be considered. Additionally, enhanced preventative efforts, especially for girls and young women, should also be considered.
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    Protective behavioral strategies are more helpful for avoiding alcohol-related problems for college drinkers who drink less
    (2020) Li, Xiaoyin; Walters, Scott; Mun, Eun-Young
    Purpose: Many health providers recommend that college students should use protective behavioral strategies (PBS) (e.g., setting drinking limits) to reduce negative consequences. This recommendation is derived from previous research showing that PBS can help reduce alcohol-related harm. However, more research is needed to determine whether PBS are equally protective across different demographic groups when college drinkers increase their alcohol consumption. This study examined race, gender, and alcohol use level as moderators of the association between PBS and alcohol-related problems among college students. Methods: A total of 12,011 participants (87.7% White, 61% Women) from 12 studies were selected from Project INTEGRATE that combined individual participant data from 24 intervention studies for college students. Complex samples hierarchical regressions were conducted using Mplus. Alcohol use, alcohol-related problems, and PBS use were continuous variables that were measured or estimated in latent variable modeling. Results: Moderation analyses suggested that the protective association between PBS and alcohol-related problems was greater for those who drank less. This moderated effect did not differ across men and women or across racial groups. Conclusions: Greater use of PBS may not always be beneficial for lowering alcohol problems, especially among heavier drinkers or during heavy drinking situations. College drinking prevention programs should ensure that students are aware of the limits of PBS as a harm reduction strategy for alcohol problems. Findings from this study provide evidence for public health efforts to reduce alcohol use "across the board" in addition to promoting PBS among student drinkers.
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    A Review of Resources and Accessibility for Alcohol Addiction in Tarrant County
    (2020) Ajaykumar, Sharanya; Bourgin, Sarah; Mahajan, Anisha; Sahu, Shweta; Hussain, Sumera
    Purpose: Alcoholism is a disorder that affects 14.4 million adults, ages 18 and older. Therefore, an understanding of alcoholism, its impact on the population, and resources available is crucial to help those suffering from this disease. This study serves as a systematic review of resources available to those suffering from alcoholism at a national, state, and local level with an emphasis on resources within Tarrant County, Texas. Methods: Online scientific archives were used to collect statistics on rates of alcoholism, associated behaviors, and options for treatment for those afflicted. Preliminary research for publicly available resources was done through Google. We chose to conduct our research in this manner to parallel the search behavior of those seeking treatment for alcoholism. We searched colloquial phrases such as "resources for alcohol addiction, Tarrant County" and "alcoholics anonymous Tarrant County" to compile our resources. Results: A plethora of resources are available to those seeking help to combat alcoholism or in need of withdrawal assistance at Tarrant County and beyond. Some of these resources include the National Association of Alcoholism and Drug Abuse Counselors, Alcoholics Anonymous, the Recovery Resource Council, MHMR Tarrant County, Mesa Springs, and Community Addiction Treatment Services. Conclusions: A number of resources are available to those suffering from alcoholism. These resources span a variety of services tailored across age, socioeconomic status, and insurance providers. However, as alcoholism becomes increasingly prevalent within society, the most significant barrier to receiving treatment is a lack of resources due to overcrowding.
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    Comparison of renal function estimation in transgender adults
    (2020) Howard, Meredith; Yuet, Cheng; Jann, Michael; Gaviola, Marian; SoRelle, Jeffrey; Tran, Nicholas
    Purpose: Renal function assessment typically relies on equations such as Cockcroft-Gault (CG) or Modification of Diet in Renal Disease (MDRD) which consider age, weight, sex, and serum creatinine (SCr). In transgender patients, sex assigned at birth and hormone therapy (HT) may influence renal function estimation. The purpose of this study is to compare renal function estimation among transgender patients with or without HT to identify the most accurate equation. Methods: In this retrospective, matched, case-control study, patients >18 years from a transgender clinic with at least one SCr measurement were included as cases. Cases were matched to a sex assigned at birth and a transition gender control based on age and weight. Comparisons of SCr and CrCl as calculated using CG and MDRD between cases and controls, sex, and HT were completed. Results: 248 matches were included in the initial analysis. Of transgender cases, 148 (60%) were transgender women. Between matched pairs, there was no significant difference in SCr or CrCl estimation using CG or MDRD, regardless of sex assigned at birth. Transgender women taking HT significantly affected SCr (p< .01) and CrCl estimation using MDRD (p< .01), but not CG (p=.21). Transgender men taking HT had significant differences in SCr and CrCl estimation based on CG and MDRD calculations (p< .01). Conclusion: Among transgender patients receiving HT, discrepancies in renal function estimates may occur based on equation type and HT use. Clinicians should exercise prudence utilizing renal function estimates to adjust renally-excreted medications in this population.
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    Qualitative Analysis On HIV/AIDS Clinical Trial Recruitment Marketing Practices in the DFW MSA
    (2020) Dapoz, Anthony; Chishimba, Ryan
    Few studies have been conducted regarding marketing techniques of clinical trials, while those conducted focus on a particular strategy's effectiveness with no comparative analysis to other existing techniques available. Fewer studies focus on HIV/AIDS clinical trial recruitment practices, with no standardized report given on which practices show more favorable recruitment rates. Data collection was carried out in two parts: literature review of HIV/AIDS clinical trials and (U.S.-wide and Dallas Fort-Worth Metropolitan Statistical Area (DFW)). The literature review was used to create a summary of currently utilized marketing techniques used in the HIV/AIDS clinical trial, which directed data collection on recruitment techniques from Clinical trials meeting inclusion criteria were queried for recruitment marketing practices conducted via protocols and statistical analysis plans (SAPs) provided via Comparison of U.S. wide techniques to DFW recruitment techniques were to be conducted afterwards. The search of clinical trials was conducted via a U.S.-wide search and a regional DFW search. 45 of the 113 U.S.-wide clinical trials that provided protocols and SAPs met inclusion criteria. Of the 45 clinical trials that met inclusion, none of them were from the DFW. This quantitative analysis enabled the determination and documentation of the suggested best clinical trial recruitment practices. However, it did not successfully compare and contrast between recruitment strategies being utilized nationally to those utilized locally by organizations in the DFW. Further investment into national clinical trial registries would allow more detailed analysis for future studies.
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    Emergency Relief Efforts in North Texas
    (2020) Tierney, Emma; Ahmed, Ibrahim; Calcagno, Alexa; Vachon, Brad; Bibb, Patrick; Powell, Jake
    Purpose: The aim of this study was to provide a comprehensive literature review of modern disasters, the challenges they pose to healthcare, and the architecture of the modern response to them. The study also used available resources to analyze the current state of preparedness for the Dallas-Fort Worth (DFW) area. Methods: A literature review was conducted using PubMed, MEDLINE, Scopus, and Excerpta Medical Database (EMBASE). Because there is no current literature directly comparing DFW to the national and international levels, we used local government websites to compile a list of resources. Results: Healthcare safety nets (HSN) for emergency situations are set in place at local, state, and national levels to provide immediate aid and to prevent future disasters. Examples for North Texas include: The North Central Texas Council of Governments, The Texas Department of Public Safety, and The Federal Emergency Management Agency. Benefits from HSNs during disasters include increased hygiene, decreased hospital congestion, and improved psychosocial care for community members. However, HSNs face barriers to reach patients without adequate access to information and addressing patient needs efficiently during disaster situations. To address these barriers, HSNs perform tabletop exercises to gather key personnel, review emergency protocols, and discuss roles and responsibilities during mass emergencies. Conclusion: Such preparations improve the efficiency of communication channels between first responders, local hospitals, and regional/state emergency programs and facilitate improved care for disaster scenarios.
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    Comparative study on the accessibility of opioid dependence treatment in Dallas and Tarrant counties and emergency department encounters linked to an opioid overdose
    (2020) Fleming, Marc; Roberts-Lagrone, Tyrane; Njoku, Collins
    Purpose: Opioid dependency is an emerging health crisis nationwide that affects the Dallas/Fort Worth (DFW) community. There is limited research on the availability of opioid use dependency (OUD) treatment. Our study's objective was to examine the success rate of reaching a licensed OUD provider. Methods: Through the Substance Abuse and Mental Health Services Administration (SAMHSA) website, Texas-waivered providers who were listed to offer medication-assisted opioid dependence treatment were contacted to confirm availability. Providers were contacted during regular business hours between October and December 2019 using a standardized script simulating a patient seeking treatment. The data collected from 235 providers contacted in Dallas and Tarrant counties were compared to opioid-related emergency department (ED) visits found on the Texas Department of State Health Services website in 2014 and 2017. Results: In 2014 there were 308 (11.4%) opioid-related ED visits in Dallas and 228 (8.4%) in Tarrant out of the 2700 ED visits in Texas reported. In 2017 there were 962 (10.5%) in Dallas and 833 (9.1%) in Tarrant out of 9121 visits. Of the 137 providers in Dallas, and the 98 in Tarrant listed on the SAMHSA website who responded, 76 (55.4%) in Dallas and 53 (54.1%) in Tarrant offered OUD treatment. Conclusion: More licensed OUD providers are necessary due to increasing rates of opioid overdoses. These numbers suggest that despite an increase in opioid-related ED visits there is a lack of providers who are truly available to treat people who are dependent on opioids in DFW.
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    An Assessment of Texas Human Papillomavirus Vaccination Rates
    (2020) Thompson, Erika; Hoff, Brandon
    Purpose: Previous studies have demonstrated significant differences in Human papillomavirus (HPV) vaccine rates between different regions of the US. However, an analysis of geographic variation of HPV vaccine uptake among different areas of Texas has not been investigated yet. This study examines the geographical variation in HPV vaccine rates within Texas. Methods: This cross-sectional study was conducted using data from the National Immunization Survey and Teen, 2017 (N=20,949). Logistic regression was used to model provider-verified HPV vaccination up-to-date status predicted by area of residence within Texas, while adjusting for the effects of sex, race/ethnicity, maternal education level, household income, and type of health insurance. Results: Approximately 42% of adolescents in Texas were up-to-date on the HPV vaccine, compared to 52% of adolescents in the US as a whole. Adolescents who lived in El Paso County [OR = 2.79, (95% CI: 1.86, 4.18)] or the City of Houston [OR = 2.04 (95% CI: 1.30, 3.21)] were more likely to be up-to-date on the HPV vaccine than adolescents who lived in other areas of Texas. Conclusion: The results of this study indicate a difference in HPV vaccine rates across different areas of Texas. Most previous research on regional differences among US adolescents attributed much of the variation to state-level policies. The results of this study suggest that there may be other factors contributing to HPV vaccine disparity within Texas and further research should be conducted to elucidate these factors.
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    Assessing Accessibility to Domestic Violence Resources within Tarrant County: A Community-Based Study of Prevalence, Barriers, and Proposed Solutions
    (2020) Das, Siddharth; Bhachawat, Neal; Siddiqui, Umar; Nguyen, Jacqueline; Katamaneni, Varun
    Purpose: Intimate partner violence is a common issue affecting 1 in 4 women and 1 in 10 men in the U.S. Tarrant county has a higher incidence rate of 1 in 3 women. It is important to understand the impact of abuse on individuals and evaluate the accessibility of resources available. In this study, we aim to perform a systematic review of the resources available to people at a national, state, and local level. Methods: Our study determined which resources at the national, state, and local levels were most likely sought out by domestic violence victims from Tarrant county. From database searches, we selected and inquired various resources about those who sought their services and the barriers that victims typically face. Results: Locally, victims are able to access the following: National Domestic Violence Hotline, National Resource Center on Domestic Violence, Texas Family Violence Program, Texas Council on Family Violence, Freedom House, and SafeHaven. The interplay of national, state, and local programs depends on local entities providing a strong structure for support and referral. For example, SafeHaven is often overwhelmed by those seeking temporary housing, who are then discouraged to seek out further programs or services. Conclusion: Despite the various resources offered to victims, there are many barriers such as distance, finances, social, and cultural factors that can hinder a victim's accessibility to these resources. The significance of these barriers is ultimately the social and health ramifications on victims: increased possibility of emotional distress and disease.
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    Detecting Alcohol Consumption Among Homeless Individuals Using Ecological Momentary Assessment, Transdermal Sensors, And Timeline Follow Back Methods
    (2020) Li, Xiaoyin; Mun, Eun-Young; Businelle, Michael; Lineberry, Shelby; Tan, Zhengqi; Walters, Scott
    Purpose: The present study examined the extent to which self-reported measures of alcohol use from ecological momentary assessment (EMA) among homeless drinkers corresponded with estimates from a transdermal alcohol sensor (SCRAM) and self-reported timeline follow-back (TLFB) recall measures. Methods: Participants were 63 homeless adults who were receiving services at a homeless shelter in Dallas, TX. Participants' alcohol consumption data were collected via EMA, SCRAM sensor, and a TLFB recall measure at the 4-week follow-up. For each assessment approach, we created two daily alcohol use variables: any use (1= alcohol use positive or 0 = alcohol use negative) and alcohol use quantity. We analyzed data using multilevel models, calculated intraclass correlation coefficients for inter-rater agreement, and estimated pairwise correlations and means across all three assessment methods. Results: Across the three assessment methods, the intraclass correlation coefficient for inter-rater agreement was 0.81 for any alcohol use and 0.76 for alcohol use quantity, indicating excellent agreement. Furthermore, the EMA assessed the quantity of alcohol used was highly correlated with SCRAM peak transdermal alcohol concentration estimate, whereas TLFB had low to modest correlations with EMA and SCRAM measures of alcohol use quantity. Conclusions: Compared with a transdermal alcohol measure, EMA is a valid measure of alcohol use among homeless drinkers. Given the substantial day-to-day variation in alcohol consumption and the ease of EMA compared to biological measures, EMA-based measures of alcohol consumption may be an important tool for clinical research, especially among underserved populations.
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    Knowledge, attitudes, and beliefs about contraception and pregnancy among women experiencing homelessness: A theory-informed systematic review
    (2020) Thompson, Erika; Spence, Emily; Garg, Ashvita; Galvin, Annalynn
    Purpose: Women comprise 39% of people experiencing homelessness, and the number of individual women experiencing homelessness has increased by 3% since 2017. Women who are homeless experience unintended pregnancy at considerably higher rates compared to the general U.S. population. The purpose of the systematic review was to summarize pregnancy prevention and contraception knowledge, attitudes, and beliefs among women experiencing homelessness. Methods: Per protocol, qualitative and quantitative articles published before September 2019 were identified with PubMed, EBSCOHost, and Embase. Inclusion criteria were peer-reviewed articles; U.S.-based observational studies; measured knowledge, attitudes, and beliefs related to contraceptive use for avoiding pregnancy; and sampled women experiencing homelessness. Results were aggregated and thematically analyzed within the context of the Information-Motivation-Behavioral Skills model. Results: After an initial search result of 407 articles, 7 articles met inclusion criteria. Many women reported past use of contraception, but consistency, type, and preferences varied between studies. Despite most women understanding where to get contraception, many had misconceptions about how various contraception methods worked. Personal experience with contraception and dislike of side effects were salient personal motivational factors influencing contraceptive use, as well as the power and social dynamics in their relationship with their partners, peers, and health care providers. Numerous shelter-related and clinic-related contraception barriers were identified that uniquely affected this population. Conclusion: With this consolidated information provided by a systematic review, future interventions can promote theory-informed, non-coercive contraception decision-making with better access to preferred contraception methods for women experiencing homelessness.
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    Understanding Postpartum Depression through System Thinking
    (2020) Ajoku, Brittany
    Purpose: Postpartum depression (PPD) is a lingering and potentially debilitating condition that affects 8-20% of women in the United States. The consequences of untreated PPD include disruption of relationships and societal contributions, adverse impact on the development of her infant, and significant costs to the healthcare system. Due to the adverse consequences of untreated PPD, it is important to use a system thinking approach to understand complexity of the condition and how organizations can play unique roles in preventing and treating PPD. Methods: By using a web-based search with the search terms "postpartum depression" AND "resources" OR "organizations", 10 organizations that prevent and treat PPD were identified. These organization were then organized in a system map by the type of social support they provide. Results: Most organizations provided social support through informational support, either to solely clinicians or to clinicians and providers. The remaining organizations included organizations provided social support in the form of emotional support and instrumental support. Organizations that provided informational support often served as the foundation for guidelines for organizations that provided other kinds of support. Conclusion: Most organizations that address the complexity of PPD with social support align with secondary and tertiary level of prevention. Moving forward, more organizations are needed to focus on primary prevention.
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    Sexarche and Its Association to Future Contraceptive Use
    (2020) Lewis, Melissa; Litt, Dana M.; Smith, Madison
    This study examined the association of sexarche with perceived descriptive norms for condom use, and willingness to have sex without the use of condoms or dental dams. Data on sexarche, perceived descriptive norms for condom use, and willingness to have sex without contraceptives were assessed at baseline among 402 participants from a study examining an intervention to reduce sexual risk taking (Lewis et al., 2018). Controlling for birth sex and current age, linear regressions were used to analyze the association among sexarche, perceived descriptive norms, and willingness to have sex without the use of condoms, or dental dams. The age of oral sexarche was not associated with descriptive norms for using condoms or dental damns during oral sex, t = 0.72, p = .47, β = - .04. However, the younger people were at oral sexarche, the more willing they were currently to have oral sex without a condom or dental dam, t = -2.94, p < .01, β = - .13. Penile-vaginal sexarche is associated with descriptive norms for using condoms, t = -2.56, p < .05, β = - .13, such that the younger people were penile-vaginal sexarche, the more they perceive others to use condoms during sex. The younger people were at penile-vaginal sexarche, the more willing they were to not use a condom, t = -2.51, p < .05, β = - .12. This study is useful in understanding sexarche as a factor in sexual risk-taking cognitions and suggests interventions to reduce risky cognitions before sexarche.
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    Correlates of Cervical Cancer Screening Among U.S. Women: Findings from the National Health Interview Survey
    (2020) Thompson, Erika; Galvin, Annalyn; Garg, Ashvita
    Purpose: While cervical cancer rates have declined dramatically, the Healthy People 2020 goal for cervical cancer screening has not been reached. This study examined factors associated with up-to-date cervical cancer screening among women in the US. Methods: This study utilized data from the 2018 National Health Interview Survey (N=10,714 women, aged 21-70), with the main outcome as cervical cancer screening in the last 5 years (yes/no). Weighted logistic regression modeling estimated the association between cervical cancer screening and predictor variables. Results: Prevalence of up-to-date cervical cancer screening was 78.4%. Compared to White women, women from other races were less likely to receive a screening (aOR=0.71; 95%CI: 0.57, 0.88), and Black women were more likely (aOR=1.49; 95%CI: 1.19, 1.88). Hispanic women had higher odds of cervical cancer screening compared to non-Hispanics (aOR=1.58; 95% CI: 1.26, 1.99). Women between the ages of 20-29, who are divorced/widowed/separated or are not married, who have not talked to their healthcare providers recently, or who have not received HPV vaccination had lower odds of cervical cancer screening. Additionally, women who did not use the internet to search for health information (aOR=0.55; 95%CI: 0.48, 0.63) had lower odds of cervical cancer screening. Conclusion: Findings can inform targeted interventions to improve cervical cancer screening uptake and reduce cervical cancer mortality. Further studies should explore the barriers to cervical cancer screening among women who did not receive cervical cancer screening.