General Public Health
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Item A Comparison of Three Screening Tests in Detecting the Prevalence of Latent Tuberculosis Infection in Refugees by History of Residence in Refugee Camps(2016-03-23) Board, Amy; Carlson, Erin; Kolasani, BalajiPurpose: The purpose of this study was to examine residence in a refugee camp as a predictor of testing positive for latent tuberculosis infection (LTBI) according to each of three LTBI screening tests. Methods: Data were obtained from a study funded by the Centers of Disease Control and Prevention (CDC) through the Tuberculosis Epidemiologic Studies Consortium. Refugees presenting at Tarrant County Public Health in Fort Worth, Texas, from countries classified by CDC as having a medium or high risk of tuberculosis (TB) were eligible to participate. Participants were interviewed to obtain data on variables associated with LTBI and received three LTBI screening tests: QuantiFERON-TB Gold In-Tube (QFT), T-SPOT TB, and the tuberculin skin test (TST). The results of each screening test were used as the indicator variable for LTBI. Data analysis was conducted for each screening test result independently using logistic regression to adjust for potential confounders including age, gender, birth country, education, income, smoking, alcohol use, history of incarceration, and being a close contact to a TB case. Results: Of the 994 participants, twenty-six percent originated from medium-risk countries, 22% from high-risk countries in Africa, and 52% from high-risk countries in Asia. The odds of having LTBI for those who lived in a refugee camp compared to those who did not differed according to the screening test used, but was not significant for any of the three tests (QFT OR 0.843, 95% CI 0.568–1.252; T-SPOT OR 0.819, 95% CI 0.548–1.226; and TST OR 1.121, 95% CI 0.791–1.590). Conclusions: Among participants in our study, living in a refugee camp conferred no significantly increased risk of LTBI when adjusted for other predictive variables, independent of the type of screening test utilized.Item Public policy, private practice: Tuberculosis/latent tuberculosis infection (TB/LTBI) surveillance in the commercial healthcare sector(2016-03-23) Carlson, Erin; Miller, Thaddeus; Stockbridge, Erica L.Objective: To estimate the prevalence and explore the pattern of TB/LTBI testing and retesting in the commercially insured US population. Domestic TB elimination is a cornerstone of US public health policy, yet progress toward elimination has slowed. One reason for this is the lack of emphasis on identifying and addressing LTBI. Systematic efforts to find and treat persons with active TB or persons with LTBI have defaulted to local and regional public health departments but, given limited resources and murky mandates, LTBI surveillance and treatment by public health is inconsistent. At the same time, TB/LTBI testing is not uncommon in the private sector. Unleveraged synergies exist between the testing conducted by private healthcare providers and the surveillance conducted by public health departments. Understanding the patterns of TB/LTBI screenings conducted in the private sector is a crucial first step toward realizing this potential. Methods: De-identified paid medical claims for services rendered between 4/1/2010 and 3/31/2013 for a sample of 4 million people from the Optum Research Database were analyzed. People in the sample were ages/1/2010 and 3/31/2013. TB/LTBI testing via tuberculin skin testing (TST) and interferon gamma release assay (IGRA) was identified using CPT codes. The index TB/LTBI test per person was identified based on each individual’s first TST or IGRA with a service date between 6/2010 and 5/2011. Subsequent tests were identified based on service dates following the index test through 3/2013. Results: Of the 4 million people, 67,168 (1.68%) had an index TB/LTBI test between 6/2010 and 5/2011. TSTs were more common than IGRAs; 64,788 (96.5%) of index tests were TSTs and 2,355 (3.5%) were IGRAs. Of those with an index TST, 21,645 (33.4%) had another test on a later date. Retesting methods differed depending on how quickly retesting occurred. In patients with a retest within 30 days, 6.4% received an IGRA next instead of another TST, while 2.6% of patients who had a retest in [greater than] 30 days received an IGRA. Conclusion: Much TB/LTBI testing is conducted by providers outside of the US public health system. Data collected by commercial insurers can provide insight into TB/LTBI testing in this setting. These results indicate that TSTs are far more prevalent than IGRAs, but IGRAs are being used in practice for post-TST retesting when retesting is conducted shortly after initial testing.Item The Association of Body Mass Index, Body Image, and Body Satisfaction among African American Women(2016-03-23) Eke, Ikechukwu; Holmes, Esther J.; Kitzman-Ulrich, Heather; Dodgen, Leilani; Martinez Barrera, DanielAbstract The Association of Body Mass Index, Body Image, and Body Satisfaction among African American Women Purpose Obesity is a significant health issue in the United States, especially among African American (AA) women, and is associated with chronic diseases such as hyperlipidemia, hypertension, and diabetes. Barriers to weight loss among AA women may include having a more positive body image and body satisfaction. The purpose of this study was to determine if Body Mass Index (BMI) and waist circumference (WC) predict body perception and body image scores among AA women in the Better Me Within study, a randomized controlled trial evaluating a faith-enhanced diabetes prevention. Methods Baseline data were collected from 150 AA women (Means: Age = 48.5 ±11.7 years, BMI = 37.9±9.0, WC 42.7±5.9) to evaluate if the independent variables, BMI(kg/m2) and WC(cm), predict outcome variables including the Body Appreciation Scale score and the Pulver Figure Rating Scale (body discrepancy) score. Body discrepancy scores were determined by subtracting the scored ideal body shape from the scored current body shape. Linear regression controlling for education and age was used to evaluate the relationships. Results Greater WC predicted an increase in body appreciation (p0001), and a decrease in body discrepancy scores indicating more acceptance of current body size (ppp Conclusion Positive body image and perception among AA women with high BMI and WC may reduce motivation to participate in weight loss and dietary programs. Future research should evaluate other motivations to improve health in these high risk women.Item Metabolic Biomarkers of Allostatic Load in African-American Women(2016-03-23) Mandapati, Surendra; Dodgen, Leilani; Kitzman-Ulrich, Heather; Tan, MarissaIntroduction: The purpose of this study was to investigate risk factors of metabolic biomarkers of allostatic load in African-American women in the Better Me Within (BMW) program, a community-based participatory research study testing a faith-enhanced diabetes prevention program. Methods: Baseline health measures, psychosocial and demographic survey data were collected in 136 African-American women with a mean age of 49.3 years and mean body mass index (BMI) of 37.8 during baseline measurement for the BMW study at 7 churches in Dallas County over a period of 2 years. The metabolic biomarkers of high density lipoprotein (HDL), total cholesterol/HDL ratio, systolic blood pressure, diastolic blood pressure, glycosylated hemoglobin (HbA1C), triglycerides, and BMI were collected. The highest risk quartile of each biomarker was assigned a value of “1,” while all other values were assigned a “0.” All biomarker scores for each participant were summed for a maximum allostatic score of 7. A Poisson Regression was used to assess the relationship between allostatic load score and behavioral determinants of health (perceived stress, depression, and spiritual locus of health), controlling for age, income, and education level. Results: Regression model that included perceived stress, income, education, depression, spiritual locus of health, and age, found the main risk factor for higher allostatic load was low income level ( Discussion: Although no statistical significance was found in the relationship of the tested behavioral determinants of health and allostatic load, the significant association between low income and high allostatic load in this study of African-American women reinforces the known relationship of poverty and poor health outcomes in health disparities. Further investigation is needed to discover whether poverty mediates poor health or whether it is a proxy for experiences of poverty-related adversity, like childhood trauma, neighborhood poverty, and chronic stress.Item Cultural Diversity: Health Disparities in Tarrant County, TX(2016-03-23) Melville, Evan; Cushen, Spencer; Larrabee, Rachel; Severson, Samantha; Hallak, ErikaThe objective of our research was to evaluate health disparities among minority groups due to social behaviors, ability to receive care, and socioeconomic factors, within Tarrant County, Texas. Research on health distributions was conducted online through local and national government websites as well as through the Center for Disease control. Data then was extrapolated and analyzed by our team. No additional materials were utilized. Health disparities are more often noted in racial, ethnic, gender, and socioeconomic minority population groups. Risk factors for health disparities include behaviors, access to care, and socioeconomic factors. At 28.1% representation, Hispanics make up the largest ethnic minority group in Tarrant County. It is noted that Hispanics are at greater risk for DM2, obesity, and hypertension. Through the use of various Fort Worth community resource websites, a list of resources was compiled. The significance of our project was three fold: provide a list of community resources that deal with health disparities for the use of in-training healthcare professionals, to demonstrate to in-training healthcare professionals the ease at which a list like this can be developed, and to bring attention to the resources available in Tarrant county.Item Variation in Routine Check-Up Utilization by Working Age Adults: SES or Healthcare Access?(2016-03-23) LaMoure, Marissa; Hartos, Jessica PhD; Alvarez, SaschaPurpose: Healthy People 2020 aims to reduce health disparities by increasing the utilization of preventive services among American adults. The purpose of this study was to examine the relationships among socioeconomic status (SES), healthcare access, and routine check-ups in a representative sample of working-age adults. Methods: This cross-sectional analysis used 2013 BRFSS data for 35-54 year-old adults in New Jersey. Multiple logistic regression analyses were conducted separately for males and females to determine whether SES (income, education, and employment) and/or healthcare access (healthcare coverage and healthcare cost) predict routine check-up, while controlling for age, race/ethnicity, marital status, and general health. Results: The majority of participants reported having a routine check-up within the past year. None of the SES variables were related to routine check-ups for males or females in unadjusted or adjusted analyses, but the variables for healthcare access were. Routine checkups were 3.53 times more likely for males and 3.77 times more likely for females with healthcare coverage, and 1.41 times less likely for males and 1.47 times less likely for females (OR=.68; 95% CI=.51, .91) with healthcare cost barriers. Conclusions: These findings suggest that healthcare access, not SES, is related to routine check-ups in a representative sample of working aged adults. Therefore, increasing utilization of preventative services among American working age adults may be tied to expanding healthcare coverage and/or providing widespread access to reduced or no cost routine checkups.Item Effect of Having a Quality Medical Home on School Attendance for Children with Asthma(2016-03-23) Lockwood, Laura; Hirpara, Juhi; Makwana, Bhavik; Animashaun, MoriamPurpose: Understanding the concept of a quality medical home is important when it comes to ensuring the health of those with asthma. Previous studies have not examined the relationship between having a quality medical home and school absenteeism in children with asthma. The objective of this study it to estimate the effect of having a medical home on missing more than 11 days of school among children with asthma. Methods: Secondary data analysis of the 2011-12 National Survey of Children’s Health (NSCH) was conducted. A total of 95,677 child-level interviews were completed. However, 6,623 surveys were analyzed for children ages 6-17 with current asthma. We estimated the frequencies of potential confounders (individual, family, and clinical measures) by missed school days. We used SAS Proc Surveylogistic to model the (1) effect of having a quality medical home; and (2) individual medical home subcomponents on missing 11 or more school days, adjusting for confounding variables. Results: Our key result is that children who did not have a quality medical home were 1.7 times more likely (95% CI: 1.2-2.3) to miss 11 or more school days than the children who had a quality medical home. We also found that children who did not have a usual source of sick care, which was a subcomponent of having a quality medical home, were 2.2 times more likely (95% CI: 1.2-4.0) to miss 11 or more school days than the children who had a usual source of sick care. Conclusions: From statistical analysis, it can be inferred that having a quality medical home will significantly decrease the chances of missing 11 or more school days. Interventions should be implemented to educate parents of children with asthma on the importance of having a quality medical home. Quality healthcare is essential to adequate asthma management which in turn can affect a child’s ability to regularly attend school.Item What’s the Agreement between Self-Reported and Biochemical Verification of Drug Use? A Look at Permanent Supportive Housing Residents in Ft. Worth(2016-03-23) Walters, Scott; Livingston, Melvin D.; Suzuki, Sumihiro; Rendon, AlexisPeople who are chronically homeless are nearly seven times as likely to use illicit drugs, compared to the general population. We evaluated the validity of self-reported drug use in a sample of previously homeless people housed in permanent supportive housing programs in Ft. Worth. We used data from 345 clients who completed a baseline assessment prior to participating in a health coaching intervention. Self-reported drug use and saliva drug tests were compared to determine the positive predictive value for amphetamines/methamphetamines (47.1% agreement), cocaine (43.8% agreement), and marijuana (69.7% agreement) drug tests. Exclusively relying on self-reported drug use may not be a valid measure of drug use in this population. However, we also found instances where people self-reported recent drug use that was not captured by the saliva drug test. In general, amphetamine/methamphetamine and cocaine use was adequately captured by the biological test, while marijuana use was best captured by a combination of self-report and biological data. Assessments of drug use among permanent supportive housing residents should not rely exclusively on self-reported measurements of drug use.Item Is Our Community Trauma-Informed?(2016-03-23) Gonzalez-Pons, Kwynn; Spence-Almaguer, Emily MSW, PhD; Thomas, Patsy; Hagan, Nancy; Mandy, FanniPurpose: The Mental Health Connection (MHC) of Tarrant County supports the incorporation of Trauma-Informed Care (TIC) practices for all organizations serving trauma survivors. Trauma-informed organizations are able to respond to signs of trauma using specific policies, practices, procedures, and knowledge aimed at preventing re-traumatization (SAMHSA, 2015). The MHC conducted a survey regarding the current state of TIC incorporation within various organizations in order to gauge the community’s current ability to provide comprehensive trauma-informed care. The purpose of this study was to determine how effectively the principles of TIC were implemented in the MHC’s organizations. Methods: The MHC TIC survey was administered to 495 participants, representing over 60 organizations. The survey prompted employees to report the level of TIC implementation in various areas of their organization. Response frequencies were determined and composite variables were created for five key areas: policy, leadership, organization structure, training, and finance. Within each category, the top, moderate, and lowest progress items were identified to determine which aspects of TIC were implemented effectively and which could be improved. Responses relating to the participants’ confidence levels and most recent TIC trainings were further analyzed. Results: The results indicated that the top policy, organizational structure, and training items were better implemented than the top leadership and finance items. Within policy, 64% of respondents reported that confidentiality measures were effectively implemented. Furthermore, the difference in the mean response for policy items was significant at the 90% confidence level between those who did and did not participate in TIC training. Those who participated in TIC training were also significantly (95% confidence level) more confident in their ability to provide TIC than those who did not participate. Conclusions: The results demonstrated that employees who participated in TIC training were more confident in their ability to provide trauma-informed care than those who did not receive training. Apart from highlighting the importance of TIC training, the respondents reported areas where participating organizations were excelling, as well as areas of improvement. Overall, the study reinforces the importance of TIC training and avenues for further item implementation that will aid organizations in becoming fully trauma-informed.Item Oral Health Status Among Drug Abusers(2016-03-23) Kolasani, Balaji; Nandy, Rajesh PhD; Mallampati, RajeshAbstract Purpose- To evaluate oral health status among drug abusers. Methods- We used data National Health and Nutritional Examination Survey (NHANES) data of 2011-2012 to examine the relationship between oral health and drug abuse. Drug abuse data included people who are using or used marijuana, cocaine, methamphetamine, heroin and injected drugs. Presence of decayed teeth, missing teeth which are not replaced and periodontal status are used as indicators of oral disease. We used SAS® 9.4 for our analysis. Logistic regression model was used to analyze the relationship while adjusting for demographic variables. Results- A total of 4116 participants from 18 to 69 years were used for our analysis purposes. Total number of drug users are 1916. No significant relation was detected between oral health and drug abuse (OR=0.942, 95% CL= 0.756, 1.176). Conclusion- Among the participants of our study which included 1916 drug abusers no significant difference in oral health status was observed.Item Analyzing the Association between Adverse Childhood Experiences and an Increase in Body Mass Index among Adolescents (10-17 years)(2016-03-23) Sekhon, Vishaldeep; Chikani, Shalinkumar; Hilliard, Bethany; Hirpara, KomalPurpose: Adolescent obesity is a major public health concern in the United States1, 2. According to the CDC, more than 33% of children and adolescents are either overweight or obese1 . A major known risk factor for changes in BMI status is stress3 . Multiple risk factors, such as living in a food desert, race, and exposure to family and neighborhood stressors cause various emotional and physiological changes in the body, which can increase the risk of adolescent obesity3, 4, 5. Due to this, we use the socio-ecological model to understand intertwined risk factors of adolescent obesity3 . Based on biological and scientific evidence we hypothesized that adverse childhood experiences (ACEs) are associated with body mass index (BMI) status among adolescents aged 10-17 years. Methods: The secondary data analysis was done using the 2011-2012 National Survey of Children’s Health and conducted univariate, bivariate, and polytomous logistic regression to assess the relationship between ACEs and BMI while controlling for gender, federal poverty level, health insurance status, learning disabilities, and how often the studied family eats meals together. The estimation of adjusted odds ratio represents an adolescent having undergone at least one or more ACEs and its effect on BMI measured in three categories: underweight\normal weight, overweight and obese. Results: The odds of being overweight are 1.10 times higher (95% CI 0.94-1.30) for adolescents who are exposed to 1 ACE, while the odds of being overweight are 1.26 times higher (95% CI 1.08-1.47) for adolescents with 2 or more ACEs, with both odds ratios being compared to adolescents with normal BMI and no ACEs. The odds of being obese are 1.13 times higher (95% CI 0.96-1.33) for adolescents who are exposed to 1 ACE, while the odds of being obese are 1.43 times higher (95% CI 1.20-1.71) for adolescents with 2 or more ACEs, with both odds ratios being compared to adolescents with normal BMI and no ACEs. Conclusion: The study observed that increasing the number of ACEs adolescent experiences increases the odds of being overweight or obese. These results indicate that public health professionals should intervene at each level of the socio-ecological model in order prevent major fluctuations in adolescent BMI status.Item Exploring Compassion Fatigue and Satisfaction Among Refugee Leaders in the DFW Area(2016-03-23) Raines-Milenkov, Amy DrPH; Kwentua, Victoria; Berg, ElyssaPurpose: Compassion fatigue describes the secondary traumatic stress seen in those working with others that have experienced trauma. It can lead to chronic fatigue, anxiety, irritability, and eventually burnout. Compassion fatigue has been studied in numerous helper and caregiver roles, such as social workers, nurses, and child protection caseworkers. However, research has not been conducted to investigate the presence of compassion fatigue within refugee populations or to understand how compassion fatigue may affect community leaders in this high-risk population. This study will explore the behavioral, emotional and physical effects of working with refugees among refugee leaders. Methods: In-depth qualitative interviews were conducted with refugee leaders working with refugees in the DFW area. Each participant completed a demographic questionnaire, a comprehensive interview and Professional Quality of Life Scale: Compassion Satisfaction and Compassion Fatigue Version 5 (ProQOL). The ProQOL questionnaire is a validated tool used to assess compassion fatigue. Results: Nine refugee leaders, representing six refugee groups, completed the demographic questionnaire, interview and ProQOL questionnaire. Participants reported a high level of compassion satisfaction (mean = 44.2), a low level of burnout (mean = 18.9), and a varied level of secondary traumatic stress. Refugee leaders reported a reliance on faith and a compulsion to help others due to their refugee experience as factors that outweighed the cost to their family wellbeing, physical and emotional health. Conclusions: Refugee leaders are highly resilient. They are often recruited by health care organizations, researchers and resettlement agencies to provide services and information to other refugees. These findings have implications for organizations to provide training on self-care practices and support services.Item Improving Lives of Most Vulnerable: The Relationship between Diet, Physical Activity, and Quality of Life among Permanent Supportive Housing Residents(2016-03-23) Suzuki, Sumihiro; Spence-Almaguer, Emily LSW, PhD; Walters, Scott PhD; Chhetri, ShlesmaBackground: Chronic homelessness is a complex public health concern in the United States. People experiencing chronic homelessness are much more likely to suffer from mental illness and substance use, and to be overweight or obese (Tsai & Rosenheck, 2013; Tsemberis, Kent, & Respress, 2012). Housing First is an approach to place people who are chronically homeless into Permanent Supportive Housing (PSH) (Rog el at., 2014). There is clear evidence PSH programs increase housing retention and, reduce healthcare and criminal justice costs (Tsemberis & Eisenberg, 2014; McLaughlin, 2010). However, becoming housed does not necessarily improve a person’s overall quality of life (QOL) (Wolf et al., 2001). Improvement in diet and physical activity may be one way to improve QOL among vulnerable populations (Blissmer et al., 2006). However, this association has not been explored among PSH residents. The purpose of this study was to explore the patterns of change and relationship between diet, physical activity and QOL among PSH residents enrolled in a health coaching program. Method: We used data collected during baseline and follow up interviews from m.chat – a health coaching program for PSH residents in Fort Worth. The program utilizes motivational interviewing and wellness incentives to help people achieve health goals. Specifically, we examined demographic characteristics, diet, physical activity and overall QOL from 230 participants enrolled in the m.chat program. Paired t-test and mixed model analysis was performed utilizing SPSS software. Results: We found a significant improvement in the total QOL scores from baseline to follow-up. A random intercept model showed a positive association between change in diet and the improvement in QOL. Physical activity was not significantly related to improved QOL; however, there was large variation in the physical activity data. Conclusion: This study is the first to look at changes in QOL among PSH residents enrolled in a health coaching program. Interventions that encourage diet and physical activity may improve overall QOL among PSH residents.Item Relationships between a motivation to exercise and exercise activity levels in adolescents(2016-03-23) Roane, Brandy PhD; Mott, Kacee; Morrissey, Katherine; Escarsega, PhillipIntroduction: Prior literature shows a positive relationship exists between motivation to exercise and weight loss. Adolescents are a prime population to study health behaviors such as physical exercise and other obesity-related factors due to the many developmental changes occurring and increasing autonomy. This shouldering of responsibility for their health likely shifts motivation to a more prominent factor in sustaining healthy behaviors such as physical activity. The current analysis compares motivation to exercise and the impact it has on engaging in physical activity (PA). The hypothesis was teens who claimed higher motivation to exercise would subsequently evidence increased activity levels the next week compared to teens who did not exhibit high motivation to exercise. Methods: Participants were 35 normal weight to obese teens (mean grade=10th, mean age=15.3 yrs, 77% females, 23% Hispanic). After obtaining consent and assent, teens completed questionnaires assessing sleep and health behaviors. Included was the 19-item Behavioral Regulation in Exercise Questionnaire (BREQ2) to assess their motivation to engage in PA (scale:0-4/item; mean=27.1, SD=10). Stadiometer and digital scale measured height and weight (BMI %tile calculated). One week later teens completed additional assessments including the Past Week Modifiable Activity Questionnaire for Adolescents (MAQAPW) which provided data on # of activities engaged in; days/wk of sedentary behavior, light PA, moderate-vigorous PA, and all PA; total minutes/wk of PA; and min/day of PA. Data were from a larger prospective study assessing teen’s sleep and health. Regression analyses examined BREQ2 as a predictor of self-reported PA with sex, grade, age, and BMI %tile as covariates. Results: Analyses showed BREQ2 predicted the frequency teens engaged in moderate-vigorous PA (29%=none, 34%=1-2 days, 31%=3-5 days, 6%=6-7 days; beta=0.476, P=0.006) and days/week they engaged in PA (mean=2.83 days; beta=0.413, P=0.048). No other PA variables were significant. Conclusions: Motivation appears to increase how frequent teens engage in PA as well as how often they engage in moderate-vigorous PA. These two aspects of PA have been shown to protect against obesity. Further exploration into factors that both enhance and reduce motivation to engage in PA would be beneficial to reduce risk of obesity. Such findings would also assist with obesity interventions.Item Reduction of Malaria Mortality in the country of Chad, Sub-Sahara Africa from 2013 to 2014.(2016-03-23) Rich, Alisa PhD; Njesada, NdolembaiReduction of Malaria Mortality in the country of Chad, Sub-Sahara Africa from 2013 to 2014. 1. Objective: The purpose of this study is to show the effectiveness of a malaria net distribution program with multi-faceted activities including multiple forms of communication, early diagnosis and treatment in the reduction of malaria mortality in Chad from 2013 - 2014. 2. Material/Background and Methods Malaria is a parasitic disease caused by the Plasmodium parasite transmitted through infected mosquitoes bites (anopheles). The parasites multiply rapidly in a human’s liver and then infect red blood cells. Symptoms including headache, fever, vomiting and vertigo appearing within 10 to 15 days after a mosquito bite. Worldwide, cases of malaria are estimated at 198 million (2013). Approximately 584,000 deaths occurred mostly in African children. This equates to a child dying of malaria every minute in Africa. Despite the alarming number of cases, the mortality rate since 2000 has fallen by 47% globally with a 54% decrease in the African Region. In the Country of Chad, 27% of all morbidity and 19% of all mortality are due to malaria. The database from the United Nations Development Program (UNDP-CHAD) and communication activities of STOP PALU CHAD from 2013 and 2014 were examined. 3. Results Confirmed cases of malaria increased by 27.28% from 2013 – 2014, primarily due to increased awareness and early detection. The mortality rate fell by 69 cases/1000 (1881 in 2013, 1729 in 2014) according to records from health facilities. Studies show in the African region many malaria cases are underreported. 4. Conclusion A multi-faceted malaria awareness and prevention campaign was shown to be effective in reduced mortality of children in Sub-Sahara Africa. The incidence of malaria continues to be underreported due to lack of awareness, health care facilities and access to facilities. Results show combined efforts are necessary to educate people in rural communities in reporting to health care facilities, when symptomatic, for proper diagnosis and treatment.Item The Challenges of a Second Chance: Exploring the Role of Social Support among Females who were Previously Incarcerated(2016-03-23) Cantu, Katherine; Chhetri, Shlesma; Spence-Almaguer, Emily MSW, PhD; Rohr, Danielle; Andrews, Alita R.Objective: The incarceration rate for women in the United States has increased by 31% in the last decade (Minton, 2012). Community reentry following incarceration is a complex process, leading to approximately 45% of women recidivating (Brown, 2010). Upon release, women are in need of comprehensive services including empowerment programs with opportunities to achieve self-sufficiency (Richie, 2001). However, studies show providing housing, employment and treatment alone are not sufficient in addressing recidivism, fortifying the need for additional support systems (Adritti & Few, 2008; Makarios, Steiner, & Travis, 2010). The Second Chance Mentoring program (SCM) coordinated by Family Pathfinders of Tarrant County provides re-entry mentoring services for formerly incarcerated females. Volunteer mentors focus on providing support during this integral transition. This study aimed to evaluate the effectiveness of the social support triangular relationship between mentors, mentees, and the SCM staff members. Methods: This study utilized a mixed method design using secondary data from 58 women enrolled in the SCM program between 2010-2015. Individual case notes, risk scores, and data related to recidivism were analyzed using qualitative and quantitative methods. Textual data were coded using content analysis procedures to investigate key themes from progress notes. Data associated with recidivism were analyzed using SPSS. Qualitative and quantitative findings were triangulated in iterative cycles to develop an understanding of variable/theme interactions. Results: Using the Ohio Risk Assessment System (ORAS), the level of family/social support and their attitudes towards crime reflect that 44.6% of the participants reported low social support with criminal activity, 37.5% had moderate levels of social support, and 18% had high social support with criminal activity. Additionally, ORAS yielded a score based on peer associations and their attitudes towards crime, resulting in: 53.8% with high peer association risk, 46.2% of moderate risk, none of the sample had positive associations. Through qualitative data analysis, the triangular relationship between the participants, mentors, and staff members was examined to assess supportive influences associated with varying levels of risks and needs. Conclusion: The results indicate that the triangular relationship serves an important role in addressing the needs of reintegrating women, and staff members provide a strong scaffolding influence. Navigating a complex system of internal and external barriers requires both strong social support and tangible resources.Item Research Gap in Identifying the Relationship Between Breastfeeding and Early Childhood Caries in The United States: A Systematic Review(2016-03-23) Shah, Dishani; Rich, Dr. Alisa PhD, MPH; Raiyani, ChandniObjective: To demonstrate the current research deficit, involving the association between breastfeeding and early childhood caries in the United States (U.S), as compared to other countries through a systematic review. Method: The PubMed database was searched for previously conducted studies relating to the effect of breastfeeding on occurrence of early childhood caries (ECC). Keywords used included “Breastfeeding” “Dental caries” and “dental decay”. Results were further narrowed by searching keywords “Breastfeeding” and “Early childhood caries”. PubMed search resulted in 355 articles published from 1890-2015, and of that 59 articles were selected for the review. References cited in the articles were also selected. Articles were retrieved and categorized according to the country where research study was conducted. Results: Studies conducted in U.S. contributed to only 5% (n=3) in comparison to Brazil, which led the research marathon at 17% (n=10). Research studies conducted in Asia (n=22), Europe (n=12), and Africa (n=7), contributed approximately 67% collectively. 53% of the studies found significant relationship between either prolonged breastfeeding ([greater than] 12 months) or nocturnal breastfeeding and early childhood caries, while 15% were inconclusive. Conclusion: Study results indicate a clear gap in the research conducted in the U.S. investigating association between breastfeeding and early childhood caries when compared internationally. Although many studies have found significant association, it is a highly complex relationship and additional research needs to be done for the U.S. population involving children from different racial, ethnic, educational and socioeconomic background to reach definitive conclusions and decrease the burden of dental caries.Item Filling in the gaps: identification of lost opportunities for TB prevention(2016-03-23) Miller, Thaddeus; Crowley, PatrickPurpose: We reviewed current and historic clinical and other records for patients being treated for active TB to identify if and how such records suggest potential opportunities for TB prevention. New or expanded knowledge of how individual and population determinants of health interact with TB risk will allow more efficient and effective development and targeting of strategies against that risk. US public health authorities concur that much or all TB is preventable, whether by primary (prevention of onset by reducing exposure to risk) or secondary (preventing occurrence by treatment to reduce risk) means. Prevention requires a multifactorial approach to address each of the biological, clinical, environmental, social, behavioral, and system determinants of health that together allow TB risk to be avoided entirely or identified and mitigated. Robust treatment of active TB in the US has led to declining TB incidence rates, and many prevention activities take place in various settings. Still, incident TB’s rate of decrease is flattening and new incident TB cases continue to occur. We assume that every newly incident TB patient indicates a missed opportunity for prevention. By identifying factors that led to current TB patients “falling through the cracks” in our otherwise successful public TB prevention programs, we hope to facilitate progress toward the domestic elimination of this serious public health threat. Methods: In a convenience sample from June to July, 2015 we obtained consent for participation from patients under treatment by the Tarrant County Public Health Department Tuberculosis Clinic (TCPH-TBC) for confirmed active TB.. Consenting participants were asked to sign records releases for clinical and other records from TCPH-TBC as well as all other known current and prior health providers. Each record obtained was reviewed by the research fellow and abstracted into a research dataset of standardized elements for analysis for missed opportunities. We defined these as evident clinical risks for the development of active TB disease prior to onset of disease. The study was determined to be exempt status research by UNTHSC’s Office of Research Compliance, IRB # 2015-068. Results: Approximately half (16/33) of all patients in TB treatment at TCPH-TC during the study period consented to take part in the study. Current TCPH-TC administrative or clinical records were obtained for 14 (87.5%) of participants; we obtained at least one historic provider record for another 8 (50%) participants. Among the 14 participants with record reviews , 11 (78.6%) were foreign-born. Insurance status could be identified for 12 (85.7%) participants with records for review,. Most were insured (8/12 or 66.6%) by public or commercial insurance (4 with Medicare/Medicaid, and 4 with commercial insurance). A total of 12 missed opportunities for TB prevention prior to onset of disease (.86/patient analyzed) were identified from available patient records. Conclusions: Retrospective review of available administrative and clinical records of patients treated for TB is a potentially useful and efficient means to identify and target prevention opportunities prior to disease onset. However, the wide-spread, long-term implementation of such efforts require more investigation, as does application of these data to public health efforts.Item The Association of Low-Income and Food Insecurity on Chronic Disease: NHANES 2005-2012(2016-03-23) Raiyani, Chandni; Yang, Mei; Spohr, Stephanie; Aryal, Subhash; Rudraraju, HemanthPurpose: Food insecurity is a household level economic and social condition of limited or uncertain access to adequate food leading to hunger. It is estimated that 14% of the U.S population will experience food insecurity at any given point during the year. Between 5-6% of Americans are severely food insecure in which meals are skipped with disruptions in eating patterns. The purpose of this study is to evaluate the association of food insecurity and chronic disease among low-income individuals who are particularly at risk for food insecurity. Methods: Data from four NHANES cohorts from 2005-2012 combining eight years of data collection (n = 40,790). The sample was restricted to adults between the ages of 18-65, with income levels below 200% of the federal poverty level guidelines (FPL). The NHANES survey utilizes the Food Security Survey Module (FSSM) which is a validated questionnaire developed by the USDA to measure food security. The dependent variables consisted of a self-reported measures and clinical/laboratory indicators of three forms of chronic disease: hypertension, hyperlipidemia and diabetes. All analyses were conducted in SAS 9.3 for complex survey analysis. Results: Food insecurity was significantly associated with age, race, education level, income, health insurance, and current health status. Crude adjusted models found a significant positive association between food insecurity and hypertension (OR = 1.62, 95% CI 1.40, 1.86), hyperlipidemia (OR = 1.26, 95% CI 1.06, 1.49), and diabetes (OR = 1.92, (95% CI 1.55, 2.37). Additionally, among the most severely food insecure there was a highly significant association between food insecurity and both self-reported and clinical hypertension, (OR = 1.84, 95% CI 1.52, 2.22 and OR = 1.69, 95% CI 1.39, 2.05 respectively). Among adults already diagnosed with disease, food insecurity was associated with inadequate control of diabetes (OR = 1.57, 95% CI 1.14, 2.15) but not hypertension or hyperlipidemia. Conclusion: Food insecure adults were associated with increased cardiovascular risk factors. Given the importance for a healthy diet for disease prevention and health promotion it will be important for policymakers to increase access to affordable, nutritious foods in low-income neighborhoods. Additionally, increased access and utilization of federal food assistance programs such as SNAP (Supplemental Nutrition Assistance Program) can also address the large number of food insecure Americans.Item Why did Mrs. X Die? Multi-Level Influences on Health and Healthcare among a Refugee Woman following Resettlement in Tarrant County(2016-03-23) Raines-Milenkov, Amy; Baker, Eva; Lopez, Tania; Wurie, Neneh; Anderson, Ralph; Kwentua, VictoriaPurpose Hepatitis B virus infection (HBV) is a significant global health problem. Two billion people around the world have contracted the disease, and almost four million cases are a part of the refugee population. Although screening is mandatory before and after resettlement in the U.S., HBV status can still go undetected. There are several challenges working against the refugee population when it comes to health that result in increasing rates of HBV-related morbidity and mortality. The present study examines the case of a refugee woman who died from liver cancer less than four years after resettlement in Tarrant County. The case study illustrates how multi-level influences prevented her from receiving adequate and timely care. Methods The patient's medical records, UNTHSC Building Bridges Initiative’s case files, and medical case management files were reviewed for the study. The Building Bridges Initiative (BBI) is a UNTHSC program funded by the Cancer Prevention and Research Institute of Texas (CPRIT). The program uses lay health educators from the refugee community to conduct free educational workshops, health screenings, and connect medical case management to the community. Results Analysis of the patient’s records revealed missed opportunities to address the patient’s liver cancer and HBV status. Upon initial entry into the medical system, the patient had a 7.3 cm mass in her liver and tested positive for Hepatitis B. Despite subsequent appointments and numerous visits to the E.R. for abdomen pain, two years passed before doctors addressed the mass again. At this time, she was near the end of her pregnancy and the mass had grown. Following pregnancy, a surgery was scheduled. Lack of insurance and community members advising the patient against chemotherapy may have impacted her decision to miss multiple oncology consultations and follow-up appointments after the surgery. She enrolled in BBI four months before she passed way. In those months, she attended Hepatitis B educational sessions which helped bring her into care again. She then agreed to chemotherapy for comfort, and started palliative care. Conclusion Each source of evidence provided a unique perspective to the experience of Mrs. X in the U.S. health system. Though records supported a gap in the health care system, the case also revealed a possible lack of understanding of the severity of the illness, or the patient’s inability to advocate for herself in the system. Had BBI, or similar advocacy and navigation services, been in place and accessed at the time of initial diagnosis, perhaps the outcome might have been different for Mrs. X. In this case, medical case management was necessary to navigate the health care system, improve Mrs. X’s understanding of her condition, and improve communication between Mrs. X and the system. Without personnel to advocate on their behalf, refugees like Mrs. X get lost in the health care system.