General Public Health
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Item Effects of Maternal Health on Child Utilization of Dental Care among Medicaid and CHIP Participants: Results from the 2011-2012 National Survey of Children's Health (NSCH)(2015-03) Patel, Devang A.; Sadath, Mohammad; Deen, Briar; Rendon, Alexis; Lueke, Mark; Davis, Ann; Homan, SharonIntroduction: Understanding the preventive dental health care utilization of children is essential to reducing child dental disease rates in low income families. Previous studies have not examined the relationship between the mother’s health status and the child’s dental care utilization. The aim of this study is to examine the association between maternal health status and use of preventive dental care among children enrolled in Medicaid and CHIP programs. Methods: We conducted a cross sectional study of children enrolled in Medicaid and CHIP programs. A sample of 88,460 children was obtained from the 2011-2012 National Survey of Children’s Health (NSCH). We used multivariable logistic regression modeling (SAS 9.3) to estimate the adjusted odds ratio for having at least one dental visit in the past 12 months associated with self-reported maternal health. We statistically adjusted for child’s age, sex, maternal education, family structure, and parental satisfaction with the child’s health care provider. Results: Our key result is that children of mothers with excellent or very good health were 2.48 times more likely (95% CI 1.41-4.38) to have visited the dentist in the last year as compared to children of mothers with poor general health. There was a 45% reduction in access to dental health care when maternal health status decreased from excellent or very good status to good or fair health status. Conclusion: Our findings suggest that poor maternal health status decreases the likelihood that children will have an annual dental visit. Preventive dental outreach efforts and programs are needed to target these children.Item Relationship of Poor Oral Health to Depression in US Adults(2015-03) Rudraraju, Hemanth; Mandapati, Surendra R.; Vinjamuri, Gopi K.; Dhara, Prabodh K.; Homan, SharonPurpose: Oral health is a key component of the overall health of individuals. In 2012, an estimated 16 million adults in the U.S had at least one major depressive episode in the past year which represented 6.9 percent of all the U.S adults2. The purpose of this study is to examine the relationship between poor dental health and depression in US adults, adjusting for demographic and health risk variables. Methods: We analyzed data from 4949 adults participating in the National Health and Nutrition Examination Surveys (NHANES 2011-2012)1. Decayed Missing Filled Surfaces (DMFS) Index was used as a measure of oral health. Depression was measured as a subjective score based on answers to the Patient Health Questionnaire 9 (PHQ-9) designed by the United States Preventive Services Task Force. Ordinal logistic regression was performed to examine if depression was associated with poor oral health. We used SAS© 9.3 for the analyses. We adjusted for confounding variables including age, race, gender, smoking status, marital status and diet. Results: Poor dental health as measured by DMFS, is only weakly associated with depression. We estimated the adjusted odds ratio for depression in people with poor oral health to be 1.01 (95% CI: 1.00, 1.03; p= 0.4). Conclusion: There is a weak positive association between poor oral health and depression that is independent of age, race, gender, smoking status, marital status and diet.Item Use of 1,3,5–Trimethylbenzene in Unconventional Shale Gas Hydraulic Fracturing Operations and Potential for Water and Soil Contamination(2015-03) Patel, Tarang Mukeshbhai; Patel, Maulikkumar Natubhai; Rich, AlisaIntroduction and Objective: Hydraulic fracturing (fracking) of unconventional shale gas formations allows for extraction of natural gas in tight geologic formations. Large quantities of water, proppants and chemical additives are required during hydraulic fracturing. These chemicals have the potential to contaminate water and soil if not properly used and contained. The chemical’s unique characteristics increase the potential for human exposure from contaminated water, soil and bioaccumulation in fish. The objective of this study is to examine the use of 1,3,5-Trimethyl benzene (TMB) as a chemical additive in fracking and the potential for human ingestion. Methodology: A meta-analysis was performed and articles related to 1,3,5-TMB evaluated. Databases searched included Science direct, PubMed, Scopus, Web of Science, ACS ChemWorx and TOXNET. Keywords searched include 1,3,5-Trimethyl benzene, Mesitylene, soil and water contamination, runoff, ground, surface and drinking water, fish kills, fracking fluids and petroleum industry. Published articles dates ranged from 1993-2012. Inclusion criteria were chemical properties of 1,3,5-TMB (Mesitylene), TMB water concentration, substantiality of TMB in water and soil, use of TMB in hydraulic fracturing. Exclusion criteria were health effects of TMB, air pollution, aerosolization of TMB, and toxicology studies on animals. All the relevant abstracts were evaluated with 150 articles reviewed in full-text. Results: This study confirmed 1,3,5-TMB used as a chemical additive in hydraulic fracturing. Published studies showed high concentrations of 1,3,5-TMB present in produced water from oil and gas production discharge. Migration of 1,3,5-TMB from accidental spills, uncontained fluids on pad sites, and holding ponds was found to increase the potential for municipal water, surface and groundwater contamination. Migration of 1,3,5-TMB in ambient temperature water was found to be possible due to its high concentration being used at fracking site. Conclusion: The use of 1,3,5-TMB as a chemical additive in hydraulic fracturing was confirmed in this study. Published literature supports the ability of 1,3,5-TMB to contaminate surface and ground water used as municipal water reservoirs. Bioaccumulation of 1,3,5-TMB in fish was found to be possible due to its low partition coefficient.Item Health Literacy Systems Approach: Empowering Healthcare Practitioners Through Education(2015-03) Wagner, Teresa; Carbajal-Diaz, Anissa; Linnear, Kim; Carlson, ErinProblem: Research indicates that limited health literacy can lead to adverse health outcomes due to patients’ inability to follow instructions regarding medications, labels and health messages especially in preventative care (Koh et al., 2012). Hypothesis: The Affordable Care Act (ACA) has mandated improved patient understanding of medical diagnoses through effective communication by providers. The purpose of this study was to determine if health literacy trainings can improve healthcare practitioners understanding and use of health literate communications. Materials and Methods: Context: Trainings were conducted at four healthcare organizations between December 18, 2013 and June 20, 2014. Site selection utilized a purposive convenience sample through community partner networking. Intervention/Instrument: Trainings engaged participants utilizing a variety of mediums to build capacity towards health-literate practices using the Health Literacy Universal Precautions Toolkit (HLUPT). Study Design: Knowledge levels of training participants were measured by a pre-test, post-test, and a follow-up survey consisting of closed-ended scaled items and open-ended items. Statistical Analysis: Univariate analyses offered descriptive statistics and bivariate analyses assessed mean score changes between pre- and post-tests both in SAS 12.1 using Wilcoxon Signed-Rank test (p = .001). NVivo software analysis of qualitative data assessed open-ended survey questions through coding and emergence of themes, sub-themes and frequency of response. Outcome Measures: Eighty-eight providers and staff members were trained at four healthcare entities. Eighty-eight pre- and post-test surveys and 29 follow-up surveys were collected with 37 pending. Results: Health literacy knowledge increased in 100% of participants and 75% increased knowledge in over half of the survey questions. Follow-up survey respondents demonstrated 100% retention of knowledge. Conclusions: The intervention showed that healthcare providers improved health literacy knowledge after a short, evidence-based training. The knowledge is retained at three months post-training. Future Implications: Despite knowledge increases, patient-centered care depends on improved health information and services. Longitudinal follow-up is needed on whether knowledge becomes integrated into clinical systems and improves compliance, patient outcomes and ultimately population health.Item Sudden Infant Death Syndrome in Texas: a Geospatial Analysis(2015-03) Hanich, Kristen M.; Oppong, JosephPurpose: to determine and explain the geospatial distribution of Sudden Infant Death Syndrome (SIDS) in Texas. The exact cause of SIDS is unknown, but it has been found to correspond to behaviors such as placing infants on their fronts to sleep, infants sleeping with soft bedding or toys in their crib, infants overheating, and exposure of infants to tobacco smoke. Geographic factors have by and large been de-emphasized in SIDS research, and as such represent a significant gap in the literature. However, factors such as temperature, demographics and socio-economic status may provide valuable insight into the underlying reasons behind the geographic distribution of SIDS in Texas. Methods: Standard Mortality Ratios (SMRs) were calculated for each county in order to categorize Texas counties as “high,” “average,” or “low” SIDS. The resulting data was examined in a Geographic Information System (GIS) in order to determine its spatial distribution. Demographic data was collected from the U.S. Census Bureau in order to descriptively analyze high and low SIDS counties, and T-tests were conducted in order to examine similarities and differences within and between these counties. Temperature data from the PRISM Climate Group was collected in order to examine the potential relationship between low temperature and SIDS deaths per 100,000. A linear model was created to describe this relationship. Results: 18 low and 54 high SIDS counties were identified by SMR. Low percentage of Hispanics and high percentage of vacant homes characterized the high SIDS group, while high percentage of Hispanics and low percentage of vacant homes characterized the low SIDS group. This difference was found to be significant at the p < 0.01 level. The temperature model was found to be significant at p < 0.05. This may be seen descriptively in that the high SIDS counties were clustered in the northeastern part of the state, where average temperatures are lower. Conclusions: the relationship between SIDS and low temperature may in part be explained by behavior. In cold weather, parents may be more likely to cover their infants with soft bedding, not realizing the danger. Additionally, certain elements of Hispanic culture might serve as a protective factor against SIDS. This may bear further investigation. Furthermore, vacancy rates have long been used as a proxy for urban decay, and might indicate poor housing conditions. This may act to create an environment which promotes SIDS.Item Impact of Individual and Parental Determinants on the Developmental of Attention Deficit Hyperactivity Disorder(2015-03) Panchal, Hardik; Patel, Riddhi; Homan, SharonPurpose: To assess the effects of low birth weight, maternal and paternal mental and emotional health status, and time spent for viewing television or playing video games per day in the development of Attention Deficit Disorder (ADD) /Attention Deficit Hyperactivity Disorder (ADHD). Methods: The National Survey of Children’s Health (2011-2012) data was used for the analysis of 65,680 children from 6 to 17 years of age. Multivariate logistic regression technique was applied to find the association between low birth weight, time spent for viewing television or playing video games per day, maternal and paternal mental and emotional health status and ADD/ADHD controlling for age, gender and poverty level. Results: As compared to female children, male children had 2.5 times higher odds of developing ADD/ADHD. Age was also significantly associated with ADD/ADHD. Children of mothers with fair or poor mental and emotional health status had 1.8 times higher odds of developing ADD/ADHD as compared to children of mothers with excellent or very good mental and emotional health status. In addition, children whose father had fair or poor and good mental and emotional health status had 1.5 times increased odds of having ADD/ADHD as compared to children whose father had excellent or very good mental and emotional status. Conclusion: Parental mental and emotional health had significant association with the development of ADHD in their children. Six to seventeen years of age children whose mother or father had poor mental and emotional health conditions were more likely to have ADD/ADHD.Item The Association Between Severity of Non-Cognitive Disability and Self-Reported Worsening Memory(2015-03) Teigen, Kari J.; Cannell, Brad J.; Bouldin, Erin; Akhtar, Wajiha; Andresen, ElenaObjectives: To estimate the proportion of Floridians with long-term, non-cognitive disability using a population-representative sample of adults aged 18 and older. Secondarily we estimate the association between long-term, non-cognitive disability and self-reported worsening memory, and the association between severity of non-cognitive disability and self-reported worsening memory. Methods: Using the 2009 Florida Behavioral Risk Factor Surveillance System (BRFSS) we measured the relationship between non-cognitive disability and worsening memory using multivariable logistic regression analysis weighted to account for the complex sampling design of the BRFSS. We also estimated the adjusted odds ratio association between worsening memory and disability severity, classified according to the types of assistance needed. Results: Among adults with no disability during or prior to the last year, only 6% reported worsening memory. These percentages increased to 15%, 26%, and 38% as severity of disability related limitations increased. In an adjusted logistic regression model odds of worsening memory increased significantly with severity of disability related limitations. Discussion: These results highlight the association between non-cognitive disability and subsequent increased odds of worsening memory, independent of several other known risk factors, and that there is a dose-response association with disability related limitations.Item Ethyl Benzene (EB) Exposure and Potential Health Effects From Natural Gas Extraction in Urban Areas (Urban Drilling)(2015-03) Ilouga, Obioma I.; Osunkoya, Oluwafunlayo; Rich, Alisa L.Objective: To examine the presence of ethyl benzene (EB) in ambient air in residential areas experiencing natural gas extraction and processing (E&P) and identify potential health impacts. Background: Residential communities affected by “urban drilling” have raised concerns about potential health effects from exposure to toxic chemicals. This study examines ethyl benzene (EB) in ambient air in residential communities experiencing E&P operations and potential health impacts from EB exposure. Natural gas processing occurring at pad sites located in residential areas were identified as potential sources of EB emissions. Methodology: A meta-analysis was performed and articles related to health effects from EB exposure evaluated. Databases searched included: Pub-Med, Scopus, Science direct and TOXLINE. Keywords were ethyl benzene, health effects, occupational exposure, natural gas and ambient air. Initially, 500 articles on the health effects of EB were selected. Publication dates ranged from 1967 to 2014. Inclusion criteria were occupational exposure, health effects, ambient air and toxicological animal studies. Exclusion criteria were soil and groundwater contamination, and EB exposure from other sources like cigarette smoke. Retrieved abstracts were evaluated for relation to study focus. Fifty articles were selected and reviewed as full text. Results: Occupational studies of EB exposed workers in natural gas and petrochemical industries, confirmed multi-system toxic effects. Animal studies supported the findings. Adverse health effects included respiratory, cardiovascular, reproductive, hematologic, digestive/liver, excretory and endocrine impairment. Ambient air monitoring studies confirmed elevated levels of EB in residential communities experiencing urban drilling. Conclusion: Communities where natural gas E&P operations are occurring may experience occupational-like exposure to EB and elevated risk of adverse health effect when compared to other areas. Current literature on health effects from EB exposure is lacking and limited to occupational studies. Future studies examining occupational-like EB exposures in residential communities experiencing urban drilling are recommended.Item Determining Effective Collection and Identification Measures of Estradiol in African-American Women(2015-03) Askew, Jasmun; Dodgen, Leilani; Kitzman-Ulrich, HeatherPurpose: Estrogen is important for overall health and reproduction, and has been linked to obesity. Currently, estrogen is time and cost intensive to measure. The purpose of this research was to establish a more cost-effective way to measure estradiol in community based settings, and to determine a methodology for collection and identification of peak estradiol levels. Methods: Four saliva samples, medication information, and previous menstrual cycle history from 61 premenopausal and postmenopausal African-American women were collected over a 4-6 week time period. The saliva samples were analyzed by an independent laboratory to identify levels of estradiol (E2). A primary sample was defined as the sample that was collected on or most closely aligned with day 13 of the menstrual cycle when estradiol peaks. A secondary sample was identified if a primary sample was not aligned with day 13 of the menstrual cycle. The secondary sample was determined by projecting the next menstrual cycle period. A secondary sample and the average of all samples were calculated to determine the best method for identifying peak estradiol levels. Results: Using this protocol, for the premenopausal subjects, 56.3% of their primary samples were equal to their peak estradiol sample, and 37.5% of their average estradiol samples were equal to their peak sample. Only 6.3% of the participants’ secondary samples were equal to their peak level. For the postmenopausal women, 73.9% of the participants’ average samples were equal to or ≤ .03 of their peak estradiol sample. Conclusion: This data suggests that this modified protocol demonstrates preliminary ability to identify peak estradiol levels in a community setting in a cost-effective and time efficient manner.Objective: To examine the presence of ethyl benzene (EB) in ambient air in residential areas experiencing natural gas extraction and processing (E&P) and identify potential health impacts. Background: Residential communities affected by “urban drilling” have raised concerns about potential health effects from exposure to toxic chemicals. This study examines ethyl benzene (EB) in ambient air in residential communities experiencing E&P operations and potential health impacts from EB exposure. Natural gas processing occurring at pad sites located in residential areas were identified as potential sources of EB emissions. Methodology: A meta-analysis was performed and articles related to health effects from EB exposure evaluated. Databases searched included: Pub-Med, Scopus, Science direct and TOXLINE. Keywords were ethyl benzene, health effects, occupational exposure, natural gas and ambient air. Initially, 500 articles on the health effects of EB were selected. Publication dates ranged from 1967 to 2014. Inclusion criteria were occupational exposure, health effects, ambient air and toxicological animal studies. Exclusion criteria were soil and groundwater contamination, and EB exposure from other sources like cigarette smoke. Retrieved abstracts were evaluated for relation to study focus. Fifty articles were selected and reviewed as full text. Results: Occupational studies of EB exposed workers in natural gas and petrochemical industries, confirmed multi-system toxic effects. Animal studies supported the findings. Adverse health effects included respiratory, cardiovascular, reproductive, hematologic, digestive/liver, excretory and endocrine impairment. Ambient air monitoring studies confirmed elevated levels of EB in residential communities experiencing urban drilling. Conclusion: Communities where natural gas E&P operations are occurring may experience occupational-like exposure to EB and elevated risk of adverse health effect when compared to other areas. Current literature on health effects from EB exposure is lacking and limited to occupational studies. Future studies examining occupational-like EB exposures in residential communities experiencing urban drilling are recommended.Item H. Pylori and Thyroid Hormone Levels: A Cross-sectional Study of Adults Participating in the National Health and Nutrition Examination Survey (NHANES III).(2015-03) Hall, Lauren; Felini, MarthaPurpose: Helicobacter pylori (H. Pylori) bacteria produce a strong inflammatory response in the body. It is hypothesized that strong immune responses to H.pylori can enhance systemic inflammation and produce an autoimmune response against the thyroid. Epidemiologic studies have assessed an association between H. pylori infection and autoimmune thyroid diseases, but with conflicting results and small study populations. Using a large, nationally representative US population, we investigated whether there is an observable association between H. pylori infection and levels of serum thyroid hormones (T4 and TSH) and anti-thyroglobulin antibodies. Methods: We analyzed cross-sectional data from the most recent National Health and Nutrition Examination Survey III (1988-1994) containing serum H. pylori and thyroid hormone levels. H. pylori infection status was determined by detection of antibodies. Chi-square and t-tests were used to assess differences by H. pylori status. Multivariable linear regression models were used to quantify the association between T4, TSH, and anti-thyroglobulin antibodies separately, while adjusting for age, sex, race/ethnicity, and BMI. Results: Among 5848 adults studied, the prevalence of H. Pylori infection was 32.8%. Mean T4, TSH, and anti-thyroglobulin antibodies differed by H.pylori status (p <0.05), but remained within the wide reference values. H. pylori infection was a significant predictor of higher T4 and anti-thyroglobulin antibodies, particularly in younger persons (<40 years of age). Conversely, a significant inverse association was observed for TSH. Similar differences were observed for the higher risk cytotoxin associated gene A H.pylori strain. Conclusions: Our findings suggest that H. pylori eradication may be important before abnormal thyroid levels can return to normal.Item Self-Selected Sleep Duration and Its Impact on Next Day Physical Activity in Teens(2015-03) Requa, Spencer; Roane, Brandy; Morrissey, Katherine; Mott, Kacee; Graves, ShelbyIntroduction: While previous research shows increased obesity and obesity markers in children with shortened sleep durations, there is a scarcity of research exploring the effects sleep may have on teens’ physical activity levels. The paucity of research conducted so far is conflicting with some studies showing shorter sleep durations were associated with decreased physical activity while others indicate that longer sleep durations are associated with decreased physical activity. A clear need exists for additional exploration into the connection between sleep and physical activity. The hypothesis of the current analyses was that increased actigraph-measured nighttime sleep duration will predict higher rates of next day moderate-to-vigorous physical activity. Methods: Participants were 29 normal to obese teens (mean BMI=25.1) in grades 9-12 (mean grade=10th, mean age=15.4 yrs, 73% female, 23% Hispanic) who were relatively healthy and reported sleepingassent, teens’ height(cm) and weight(kg) were assessed with a stadiometer and digital scale, which allowed for the calculation of BMI. During the study week, teens followed a self-selected schedule while wearing an actigraph to record their sleep/wake schedule. Night sleep duration (NSD) was equal to the sleep duration recorded by the actigraph during the night sleep period. Teens also completed 3 Previous Day Physical Activity Recalls (1 weekend, 2 weekdays) assessing activities engaged in the previous afternoon-evening (1500-2300). The % time engaged in moderate-vigorous physical activity (MVPA) was calculated (total time spent engaged in MVPA divided by total time spent not sleeping). These data were from a larger prospective study assessing sleep and health in teens. Multiple regression analyses examined NSD as a predictor of MVPA% with grade, race, BMI, and sex as covariates for weekdays and weekends. Results: Teens slept an average of 392.5 min/night (SD=77 min) on weekdays and 506.4 min/night (SD=85 min) on weekends. Multiple regression analyses found that NSD was not a significant predictor of MVPA% on week days (adjusted R2=-0.15, p=0.944) or weekends (adjusted R2=-0.06, p=0.226). Conclusions: NSD was not predictive of next day MVPA%, which may have been due to the small sample size and subjectively assessed physical activity. Further research should examine the connection between sleep and physical activity using objectively measured physical activity data collected throughout the day and in a larger sample.Item Perinatal and Neonatal Determinants of the Development and Severity of Autism Spectrum Disorder(2015-03) Patel, Riddhi; Panchal, Hardik; Herell, Maggie; Khalili, Leila; Homan, Sharon; Davis, AnnObjective: Demonstrate the potential effects of breastfeeding, low birth weight, maternal age at the time of childbirth and birth order on the development and severity of Autism Spectrum Disorders (ASD). Methods: We analyzed data from the National Survey of Children’s Health (2012), for 19,957 children aged two to five years. Using multivariate logistic regression, we estimated the association between breastfeeding status, maternal age at the time of childbirth, birth weight and birth order and ASD, adjusting for age, gender, race and poverty level. In addition, we examined the influence of these factors on severity of ASD using ordinal logistic regression. Results: Children with low birth weight had twice the odds for ASD. Children with higher birth order had three times higher odds for ASD. Breastfed children had decreased odds for a severe form of ASD, as compared to those who were never breastfed or breastfed for less than six months. Children born to of mothers aged 25-30 years had higher odds for severe ASD, as compared to children born to mothers under 20 years at childbirth. Higher birth order children had a small (1%) decreased odds of severe ASD. Conclusion: Children with lower birth weight and higher birth order were more likely to have ASD. Children who were breastfed for six or more months had decreased risk for severe ASD. Children of mothers 25 to 30 years were more likely to have more severe form of ASD than children of younger mothers.Item Areas for improvement to further reduce malaria burden in sub-Saharan Africa?(2015-03) Lee, Ju Sung; Tak, Hyo Jung; Lee, Joon-HakIn 2012, sub-Saharan African countries account for 80% of all malaria cases worldwide. Malaria hampers their development both socially and economically. Global efforts to control malaria in sub-Saharan Africa have been placed in the past. In particular, since 2005, funding for Malaria control has increased dramatically.However, little is known about malaria incidence and mortality rate among sub-Saharan African countries overall. Only few studies investigated, and focused on a few countries in sub-Saharan Africa with limited attributing factors. We expect that national level operational intervention, malaria funding, and economic factors would be associated with reduction of malaria incidence and mortality. Our objectives are to assess progress of malaria control in sub-Saharan Africa overall and associated factors with malaria control. With data between 2005 and 2013 from World Malaria Reports and The World Bank, a dataset was constructed to associate reduction of malaria incidence and mortality rate with national economic factors, malaria funding, and malaria operational interventions. General Liner Model was used for the statistical analyses. Malaria incidence rate was inversely associated with GDP per capita (AME = -0.267, p-value = 0.004), but was positively associated with foreign aid per capita (AME = 0.158, p-value = 0.013)and ACT treatment courses delivered (AME = 0.069, p-value = 0.000). Malaria mortality rate was positively associated with foreign aid per capita (AME = 0.017, p-value = 0.016) and with increased number of ACT treatment courses delivered (AME = 0.073, p-value = 0.004). Increase of ODA per capita was associated with increase of distributed number of ITN/LLIN (AME = 6.601, p-value = 0.006). IRS (AME = 9.421, p-value = 0.001), and ACT (AME = 6.84, p-value = 0.064). In addition, increase of foreign aid per capita was positively associated with distributed number of IRS (AME = 4.070, p-value = 0.00). Economic growth and internal funding increase should be pursued for sustainable malaria control. Careful attention to utilizing operational intervention effectively and adequate education of its utilization is required. As the complicated malaria control can be achieved by multiple efforts, systematic strategies including education, operational management, adequate infrastructure, and cooperation between organizations should be taken into account.Item Concentration of Volatile Organic Compounds in Urban Cities Compared to Urban Areas Experiencing Natural Gas Extraction and Processing(2015-03) Shah, Ruchita P.; Shah, Mansi; Rich, AlisaObjective: The objective is to compare atmospheric concentrations of volatile organic compounds in urban areas of natural gas extraction as compared to areas without natural gas extraction. Introduction: Expansion of unconventional shale gas extraction and processing over the last decade has progressed significantly across the United States. Environmental concerns for what affect this energy expansion is having on air quality have been of great concern to many communities. Many of the VOCs present in natural gas and present in chemicals used in hydraulic fracturing are contributors to atmospheric greenhouse gas (GHG) levels and hazardous air pollutants (HAPs). Exposure to GHGs and HAPs are known to be a major factor in respiratory illnesses in humans. In this research, atmospheric volatile organic compound concentrations were compared in areas experiencing natural gas extraction and processing with urban area VOC concentrations. Material and Methods:Relevant articles were identified by a systematic search of reliable databases. Due to lack of literature for comparison of VOCs, all the study designs were included. Having difference in measurement unit, all the readings in different studies were converted to one common unit and compounds were compared. Results: Methodology of ambient air monitoring varied considerably from locations. Among analysis of over 100 concentrations, only 7 compounds were collected in urban studies which include Acetone, Benzene, Chloroform, 1, 2 dichloroethane, Ethylbenzene, Tetrachloroethane and Styrene. Concentration of VOCs was found to be 70% higher in urban areas experiencing natural gas extraction. Conclusion: VOCs are found to be higher due to natural gas extraction process in urban areas. Greenhouse and HAPS are pervasive and responsible for adverse health and environmental effects. Our future studies are focused on consistent monitoring of HAPS and other chemicals.Item An Analysis of the Second Chance Mentoring Program among Female Offenders(2015-03) Cantu, Katherine; Spence-Almaguer, Emily; Rohr, Danielle; Chhetri, ShlesmaPurpose: To assess the effectiveness of the Second Chance Mentoring (SCM) program, which works to reduce the rate of recidivism among moderate-to-high risk incarcerated women. Methods: The SCM program offered through collaboration between Family Pathfinders and Cornerstone Assistance Network of Tarrant County provides assistance to successfully reintegrate incarcerated women into the community. Information is collected during the incarceration to determine the recidivism risk level using the Ohio Risk Assessment Scale (ORAS) scores. Participants are enrolled in 12 months of mentoring services with a matched mentor upon their release from prison. Post-release, data is submitted to Family Pathfinders on a regular basis by the mentors and agency. The participants are deemed successful if one does not recidivate, meaning the individual is not arrested and incarcerated on new charges within 12 months of their release from their most recent incarceration. Upon successful completion of SCM, data of the participants is collected from the Texas Criminal Justice system to obtain background information in the justice system. Results: Complete data profiles for the initial cohort were used. Of the 50 women who expressed some interest in the program, 29 complete profiles were provided between the justice system and community partners. These were then further investigated for successful and unsuccessful completion. Findings indicate that middle-aged women without the equivalent of a high-school diploma were more likely to be unsuccessful than compared to middle-aged women with a diploma/GED. Of those who were unsuccessful, 55% reported not having a place to live upon their release, where 89% of the successful women did have a place to live. Findings also suggest that the mentor relationship does contribute to less recidivism when 30% of those who were unsuccessful were not yet matched with a mentor before recidivating. Conclusions: The Second Chance Mentoring program provides sufficient support to reduce the risk of recidivism among moderate-to-high risk women. The promotion of social capital and encouragement to continue education through SCM allows for a successful reentry into the community.Item Meeting Healthcare Needs of Children with Autism Spectrum Disorders: Family Centered Medical Home Matters(2015-03) Davis, Ann M.; Homan, SharonPurpose: The prevalence of Autism Spectrum Disorders (ASD) has increased over the past decade. Children with ASD have complex healthcare needs that may be best served in a family-centered medical home (FCMH) model. A family-centered medical home provides effective primary health care that is accessible, family-centered, continuous, comprehensive, coordinated, compassionate and culturally competent. We examined whether having a FCMH increased the likelihood that children with ASD receive the therapy, mental health care, preventive services and specialty care they need. Methods: We conducted a cross-sectional national study of 3025 children (3 to 17 years) with parent-reported ASD. We analyzed data from the 2009-10 National Survey of Children with Special Health Care Needs (NS-CSHCN). We estimated the impact of having a medical home on receiving needed medical and non-medical therapy, mental health care, preventive services and specialty health care. Using the Andersen Model of Health Care Utilization as our conceptual framework, we fit hierarchically well formulated logistic regression models consisting of predisposing (P), enabling (E) and health need (N) variables as predictors of receiving needed healthcare services. We estimated the increased likelihood (odds ratio) of receiving needed services when the child has a FCMH versus no FCMH, adjusting for the P, E and N variables. Results: Only half of children with autism (51.8%) had healthcare that is considered part of a FCMH. Children with a FCMH were more likely to report receiving needed specialty care (OR=4.068, 95%CI 2.20-7.52), therapy (OR=1.754 95% CI 1.18 – 2.60) and mental health care (OR=2.74 95% CI 1.55 – 4.84). Having a FCMH was not significantly associated with receiving needed preventive health services. Each model was adjusted for predisposing factors (age, gender, race, family structure), enabling factors ( household education, poverty level, adequacy of current insurance, receipt of early intervention services, age at diagnosis) and need ( severity level, difficulty communicating). Conclusions: Having a FCMH significantly increased the likelihood that the healthcare needs of children with ASD were met, adjusting for relevant predisposing, enabling and need variables.Item Genetic Service Shortage Areas in the Mountain States Region: What Is Needed?(2015-03) Dokpesi, Philip; O'Meara, Stephanie; Jegede, Opeyemi; Kaye, Celia; Homan, SharonPurpose: The mission of the Mountain States Genetics Regional Collaborative (MSGRC) is to ensure access to exemplary genetic and newborn screening services in the eight states of the region (Arizona, Colorado, Montana, Nevada, New Mexico, Texas, Utah and Wyoming). The purpose of this research is to identify and map shortage areas for genetics services in the mountain states region. Methods: We mapped the Health Professional Shortage Areas (HPSAs) in MSGRC counties, using the HRSA-designated primary medical care shortage areas. We overlaid on this map the estimated number of birth defects in 2014, as a proxy for the pediatric caseload for geneticists. A contact list of all (53) genetics providers in the region was developed. Each provider organization was contacted to establish the number of physicians seeing genetics patients, genetics counselors, and patients, geographic practice area, and insurance types accepted. Results: Mapping birth defects and genetics providers is a useful method for estimating genetics services shortages, and geographically displaying areas of unmet need. There are genetics health shortage areas in multiple rural and frontier areas in the eight mountain states. Conclusion: The Mountain States have multiple genetics healthcare shortage regions. New advances in telegenetics may address some of these shortages, but it is expected that the rural and frontier areas will continue to have significant shortage areas.Item A Qualitative Analysis on the Effects of Social Support among Women of the Reentry Population(2015-03) Cantu, Katherine; Spence-Almaguer, Emily; Rohr, Danielle; Chhetri, ShlesmaPurpose: Promotion of positive social support through family reunification and mentorship through the Second Chance Mentoring (SCM) program reduces risk of recidivism among moderate-to-high risk incarcerated women. Methods: The SCM program is offered through a collaboration between Family Pathfinders and three partner organizations in Tarrant County. SCM provides assistance to women who have been incarcerated to support their successful reintegration in to the community. Information is collected during incarceration to determine the recidivism risk level using the Ohio Risk Assessment Scale (ORAS) scores. Participants are enrolled in 12 months of mentoring services upon their release from prison or jail. Post-release, Family Pathfinders uses progress notes to monitor SCM service activities and other information which may contribute to reentry success or failure. These progress notes were analyzed by the evaluation team at UNTHSC to code for different types and levels of support which may promote or reduce recidivism among women. Results: The initial analysis of a sample size made of 50 women indicates that those who actively engage in a mentoring relationship are more likely to seek assistance elsewhere in order to promote successful reentry. Women who have support of negative influences have more issues becoming self-sufficient and set minimal goals for behavior change by the end of the 12 month program. Conclusions: A mentoring relationship with women who pose a high risk of recidivism upon release provides a foundation for building additional supportive relationships. Ensuring a reliable support system to incarcerated women may increase the effectiveness of successful community reintegration.Item Family History Information in Dallas/Fort Worth: What We’re Not Telling Patients(2015-03) Gregorio, Dave; Cross, DeannaPurpose: Patients can be empowered to assess their own family health history (FHH) by providing accurate information that: (1) explains the importance of FHH in the context of heritable conditions and (2) outlines how to take an accurate FHH. The aim of this study is to assess the quality of information provided to patients regarding FHH prior to a clinical encounter in the Dallas/Fort Worth area. Methods: FHH information from local health organizations was collected throughout the Dallas/Fort Worth area. Information was included if published by a local health organization (or national organization with local offices) and FHH was discussed in the capacity of health risk assessment. The information was categorized based on source into the following groups: local electronic, national electronic, print, and health fair. Each source was further assessed for quality of information by a series of questions following the Genetics in Primary Care Institute (GPCI) guidelines for taking FHH and disease-specific questions based on familial risk guidelines. The percentage of positive “Yes” answers is tabulated for each category and assessment question. Results: A search for local information on FHH was conducted between June, 2014 and December, 2014. Information on FHH was provided by 48% (25/52) of outlets searched. 73 sources were included for analysis. 53% came from websites of local health organizations, 16% came from print resources, 11% came from health fairs, and 19% came from national health organizations. Of these sources, 22% were general FHH information and 88% were disease specific. Information from health fairs had the greatest proportion of guideline components (18.8%) and local electronic sources had the fewest components (12.4%). Printed information had a greater percentage of guideline components (15.5%) than electronic (14.6%). General FHH information was more likely to have guideline components (24.3%) than disease specific information. Conclusions: Difficulty in obtaining information on FHH was noted with less than half of potential resource sites providing FHH information. Few sources provided all components recommended by GPCI guidelines and differences in the quality of information between source categories (electronic vs. print) were found. Sharing FHH with a provider was only recommended 59% of the time. Here we have demonstrated a clear need for health organizations to provide FHH information to patients.Item Electronic Goal Reminders and Subsequent Substance Use and Treatment Initiation in Probationers(2015-03) Spohr, Stephanie A.; Walters, Scott; Taxman, FayeObjective: The opportunities to influence behavior through the use of electronic goal reminders have not been examined in a criminal justice population. The purpose of this study was to assess probationer preferences for short-term goals from a web-based program and evaluate the role of voluntary electronic reminders (e.g., text messaging, email) in achieving early treatment and probation tasks. Methods: We used data from drug-involved offenders (n=76) participating in a clinical trial of a 2-session motivational computer program. As part of the program, participants could choose to receive text or email reminders about their probation and treatment goals for the next month. Poisson regression models were utilized to evaluate goal and reminder selection in relation to days of substance use and days of treatment attendance at two months. Results: The most common goals were related to treatment, probation, relationships, and reappraisal. Forty-five percent of probationers elected to receive electronic goal reminders at Visit 1 with a slight increase at Visit 2 (49%). Probationers who opted to receive electronic goal reminders at Visit 1 selected significantly more goals on average (M = 4.4, SD = 2.1) than probationers who did not want reminders (M = 3.4, SD = 1.8), (t = 2.41, p = .019). Reminder selection and total number of goals selected significantly predicted days of substance use and treatment attendance at two month follow-up. Probationers who opted not to receive electronic reminders and those who only selected to receive reminders at one visit had more days of substance use compared to those who received reminders at both visits, 1.66 and 2.31 times respectively. Probationers who chose not to receive electronic reminders attended 56% fewer days of treatment compared to those who received reminders at both visits. Conclusions: People’s choice of short-term goals and reminders can provide advance notification of the likelihood of substance use and treatment initiation. Probation systems might use such information to triage probationers to a higher level of service, before problems have emerged.