General Public Health

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    DIFFERENCES IN HEALTH BEHAVIORS BETWEEN MEDICAL SCHOOL FACULTY AND STAFF
    (2014-03) Ake, Stephen; Nejtek, Vicki A.; Talari, Deepika; Lovell, Andrew J.; Filipetto, Frank
    The 2012 National Gallup-Healthways survey found that physicians and nurses are healthier than other workers. However, objective data to adequately describe the health status in clinicians versus non-clinicians is lacking. We measured and compared physiological health indices and behaviors between medical school faculty and staff. Purpose (a): The 2012 National Gallup-Healthways survey using self-report phone interviews found that physicians and nurses are healthier than other workers. However, objective data to adequately describe the health status in clinicians versus non-clinicians is lacking. Here, we objectively measured and compared physiological health indices and behaviors between medical school faculty and staff. Methods (b): A prospective, cross-sectional pilot study was conducted to compare routine health and well-being between faculty and non-faculty medical school employees (n=69). Information about routine preventative health behaviors, inoculations, exercise, daily stress levels, and general life enjoyment were obtained. Subjects received $1 for completing all assessments. Data were analyzed using SPSS (version 19) and included analysis of variance to compare quantifiable variables and chi-square for categorical variables. All analyses were conducted using a 95% confidence level and an alpha level of 0.05 was used to determine statistical significance. Results (c): There were no statistically significant group differences between faculty and non-faculty staff in weekly exercise, daily stress levels, and general life enjoyment. 53% of staff exercised > 3 times/week than 25% of the faculty (p = 0.009). Based on the total population, 24% of combined faculty and staff did not receive a flu shot during the past 12-months (p = 0.026). More concerning was 25% of faculty and 78.6% of staff had not been TB tested in the past year. Significant differences emerged in faculty reporting higher levels of daily stress (p = 0.048), and lower overall levels of general life enjoyment than in non-faculty staff (p = 0.023). Conclusions (d): These data suggest that medical school faculty do not have better health outcomes or behaviors than non-faculty staff. Conversely, staff are significantly happier in life, exercise more often, and report less daily stress than faculty members. The data suggest that while faculty may take good care of others, they seem to put themselves at a higher risk for poor health outcomes. Further investigation is warranted.
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    WHAT REMINDERS DO PROBATIONERS WANT TO ASSIST WITH PROBATION AND TREATMENT GOALS?
    (2014-03) Spohr, Stephanie A.; Walters, Scott T.; Rodriguez, Mayra; Lerch, Jennifer; Taxman, Faye
    Purpose (a): The development of new web-based interventions provide increased opportunities for delivering text or email reminders around health behavior goals. The purpose of this study was to examine the role of text messaging and email reminders to assist probationers in reaching probation and substance abuse treatment goals. Methods (b): Sample consists of probationers (n=49) in Dallas and Baltimore participating in a randomized controlled trial of in person vs. computer interventions to increase probation compliance. Data from the computer arm were analyzed to determine probationer preference on goal content, timing and reminder method (text, email, or none). Reminder preferences were analyzed according to gender, risk level, age and ethnicity. Results (c): Overall, probationers set an average of 3.80 goals between probation-related (M=1.94, SD=1.03) and treatment-related (M=1.86, SD=1.21) goals. When given the option for electronic reminders, 47% (n=23) opted for no reminder, 24% (n=12) selected email reminder and 29% (n=14) selected text message reminder. Sixty percent of participants over age 35 selected electronic reminders compared to only 46% of those 35 and under. Low-moderate risk offenders (65%) were more willing to select electronic reminders than high risk offenders (35%) but there was no difference in the number of goals selected, (M=3.78, SD=2.06) and (M=3.81, SD=1.91) respectively. Conclusions (d): Persuasive technologies have not been utilized within a criminal justice sample. The use of electronic messaging provides a promising avenue for future behavioral change interventions. Information about probationer preferences for goal reminders, the method of delivery, and timing may help to increase the effectiveness of these interventions.
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    COLORECTAL CANCER SCREENING KNOWLEDGE AND BEHAVIOR IN RURAL TEXAS
    (2014-03) Desai, Krupa; Le, Carol Kim; Negem, Matt; Chiapa-Scifres, Ana; Bowling, John
    Colonoscopies can be an effective screening tool for colorectal cancers. Colorectal Cancer represents a significant challenge to many healthcare providers in rural populations. In spite of having successful screening tools developed and implemented in many primary care clinics in both urban and rural communities, it still remains the third most prevalent form of cancer. The study investigated the knowledge and insurance availability as potential barriers to this test from the patient’s perspective. Purpose (a): Colorectal Cancer (CRC) is the third most prevalent form of cancer. Colonoscopies/Sigmoidoscopies (C/S) can be an effective screening tool for CRC. The study investigated the relationship between knowledge and awareness of CRC, and the prevalence of C/S in a rural community. Methods (b): A survey was implemented and 360 individuals aged 18 to 93 years were recruited from Clifton and Cuero, Texas. Basic knowledge and awareness of CRC was divided into 3 categories: low, medium, and high. History of C/S was measured dichotomously as yes or no. Logistic regression was used to estimate the adjusted odd ratio (OR) and 95 % confidence interval (CI) between knowledge and awareness of CRC, and the prevalence of C/S after controlling for potential covariates (age, gender, race, education, insurance status, and income). Results (c): Results showed that those who had high and moderate level of knowledge and awareness of CRC were 6.38 (OR = 6.83, p = 0.004, 95% CI = 1.83-25.50) and 3.62 (OR = 3.62, p = 0.038, 95% CI = 1.073-12.209) times more likely to undergo C/S than those with low level of knowledge and awareness. As the age increased by one year, participants were 1.09 times (9 %) more likely to undergo C/S. Result were not significant for any other potential covariates. Conclusions (d): Our findings suggest that knowledge and awareness of CRC influence the prevalence of C/S. Health education programs should continue to promote C/S in rural communities to reach Healthy People 2020 goals.
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    “IS SKINNY HEALTHY”? : FOCUS GROUP FINDINGS AMONG AFRICAN AMERICAN WOMEN REGARDING BARRIERS TO WEIGHT LOSS
    (2014-03) Cole, Jennifer; Dodgen, Leilani; Kitzman-Ulrich, Heather; Lee, Jenny; DeHaven, Mark
    Focus group discussions among African American women and their perceptions of body image and how this impacts weight loss. Purpose (a): To examine how motivation and appearance is related to weight loss among African American (AA) women. Studies indicate AA women are more satisfied with their body and accept a larger body size. Yet, obesity rates leading to chronic disease are highest among AA women with nearly 60% considered overweight/obese. Methods (b): Focus groups were conducted with 51 AA women (mean age=45.6 years; 21% high school; 38% college; 62% full time employed). Social Cognitive Theory and Social Ecological Framework informed questions evaluating barriers and facilitators to weight loss. Classic content analysis identified themes related to motivation for weight loss and body appearance. Inter-rater reliability was adequate (K=0.65). Results (c): Motivation was mentioned 73 times and appearance 28 times. Prominent subthemes of motivation were lack of discipline, needing accountability, and excuses. Prominent subthemes for appearance were disconnection of obesity to health, acceptance of current size, and concern of losing desired shape. Concerns related to appearance may be related to motivation for weight loss in AA women such that preferences for appearance may interfere with motivation to adhere to weight loss behaviors. Conclusions (d): Research is needed to determine how to improve motivation for weight loss while considering AA women’s preferences for appearance.
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    MAXIMUM COST OF EFFICIENT WEIGHT-LOSS PROGRAMS FOR OVERWEIGHT AND OBESE POPULATIONS
    (2014-03) Park, Saehwan; Miller, Thaddeus L.
    To estimate economic and health benefit of different body-mass index reduction targets for overall overweight and obese populations as well as each age subgroup, we conducted a simulated trials over 10 years using Archimedes model based on representative sample of the US population. We also defined a Program-cost target measure to facilitate cost-effectiveness considerations in planning weight-loss programs. Our simulations predict that achieving weight loss targets would result in decreased cumulative for five obesity-related disorders, but that these benefits vary widely by subgroups and target effect. Older subgroups showed higher health benefit for the same BMI reduction target. Estimated PCT ranged from $18,119 to $99,893, with the highest PCT predicted for the subgroups (age 65-84) achieving sustained BMI reductions to 30 kg/m2, which implies the highest health value for the same cost. Our analysis predicts weight loss interventions targeted to high BMI elderly as the best relative value among the alternatives we considered. PCT is comprehensive enough for even academically untrained business/policy professionals to use, and may facilitate more CE evaluations and early stage program planning without the help of experts. Average costs of weight-loss interventions are much higher than PCTs estimated in this study, suggesting emerging smartphone/GPS-based exercise monitoring applications such as Nike+ Move® may be potentially efficient alternatives. Purpose (a): 1) To estimate economic and health benefit of different body-mass index (BMI) reduction targets for overall overweight and obese populations as well as each age subgroup 2) To define a Program-cost target (PCT) measure to facilitate cost-effectiveness considerations in planning weight-loss programs. Methods (b): Person-specific data from a representative sample of the US population (National Health and Nutrition Education Survey IV) was used to determine current population and characteristics of adults aged 30-84 years in the U.S. with BMI exceeding 25, and are candidates for different weight-reduction programs. We used the Archimedes modeling tool to create a simulated population matched to the current US population and simulate the 10-year aggregate effects of achieving three different weight-reduction targets among that population. We then compared economic and health benefits among different subgroups and reduction targets and to estimate the maximum intervention cost for which the program would remain cost effective. Results (c): Simulations predict that achieving weight loss targets would result in decreased cumulative for five obesity-related disorders, but that these benefits vary widely by subgroups and target effect. Predicted health benefits range from a net present value of 0.01 to 0.17 QALYs. Optimal relative results are predicted for programs that produce a sustained reduction of BMI level down to 25 kg/m2. Older subgroups showed higher health benefit for the same BMI reduction target. Estimated PCT ranged from $18,119 to $99,893, with the highest PCT predicted for the subgroups (age 65-84) achieving sustained BMI reductions to 30 kg/m2, which implies the highest health value for the same cost. Conclusions (d): We found substantial variation in program cost targets/value thresholds for weight loss/control interventions by population and effect; such investments will require careful targeting of interventions to appropriate populations. Our analysis predicts weight loss interventions targeted to high BMI elderly as the best relative value among the alternatives we considered. PCT is comprehensive enough for even academically untrained business/policy professionals to use, and may facilitate more CE evaluations and early stage program planning without the help of experts. Average costs of weight-loss interventions are much higher than PCTs estimated in this study, suggesting emerging smartphone/GPS-based exercise monitoring applications such as Nike+ Move® may be potentially efficient alternatives. CE of weight-loss interventions largely depend on population age and target BMI, which an optimal target should consider. Our PCT estimation showed that concentrating older subpopulations could maximize CE. Further studies should validate the statistical robustness of this approach and the practical bounds of its utility.
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    THE USE OF FOCUS GROUP RESEARCH TO EXPLORE COMMUNITY ATTITUDES TOWARD AIR QUALITY
    (2014-03) Allsopp, Leslie C.; Sterling, David A.; Franklin, Gillian; Adamie, Denise
    The purpose of this study is to explore community perspectives on air quality, through focus group research. North Central Texas is in nonattainment with National Ambient Air Quality Ozone Standards. One health impact of this is seen in Tarrant County’s asthma prevalence which is twice the national average. Community involvement is needed to address air pollution, but there is limited information about residents’ perspectives on these issues. The UNTHSC School of Public Health collaborated with the Fort Worth League of Neighborhood Associations to hold air quality focus groups. Three geographic clusters of neighborhood associations were identified which included a range of emission sources and diverse population demographics. One focus group was formed within each area. Questions were asked regarding air quality concerns, preferred methods for receiving and responding to information, and potential uses of information to improve air quality. Transcripts of the focus groups were reviewed by an advisory group from the Fort Worth League of Neighborhood Associations. Themes and keywords were identified and structured according to a social-environmental model. Mixed method content analysis is being conducted through NVivo. The initial analysis of the transcripts reveal a high concern regarding air pollution and toxic emissions, and an unmet need for air quality information from trusted sources. However, participants were uncertain of how they might use this information to improve air quality and reduce their exposure to pollutants. Focused information from trusted sources is needed by communities to support neighborhood level approaches to air pollution, and reduce exposure to airborne pollutants. Purpose (a): The purpose of this study is to explore community perspectives on air quality, through focus group research. Methods (b): North Central Texas is in nonattainment with National Ambient Air Quality Ozone Standards. One health impact of this is seen in Tarrant County’s asthma prevalence which is twice the national average. Community involvement is needed to address air pollution, but there is limited information about residents’ perspectives on these issues. The UNTHSC School of Public Health collaborated with the Fort Worth League of Neighborhood Associations to hold air quality focus groups. Three geographic clusters of neighborhood associations were identified which included a range of emission sources and diverse population demographics. One focus group was formed within each area. Questions were asked regarding air quality concerns, preferred methods for receiving and responding to information, and potential uses of information to improve air quality. Transcripts of the focus groups were reviewed by an advisory group from the Fort Worth League of Neighborhood Associations. Themes and keywords were identified and structured according to a social-environmental model. Mixed method content analysis is being conducted through NVivo. Results (c): The initial analysis of the transcripts reveal a high concern regarding air pollution and toxic emissions, and an unmet need for air quality information from trusted sources. However, participants were uncertain of how they might use this information to improve air quality and reduce their exposure to pollutants. Conclusions (d): Focused information from trusted sources is needed by communities to support neighborhood level approaches to air pollution, and reduce exposure to airborne pollutants.
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    PARENTAL INTENT TO VACCINATE YOUNG CHILDREN AGAINST THE FLU
    (2014-03) Komatz, Jared; Ramisetty-Mikler, Susie
    The objective of this study is to examine parental, child, and demographic factors that are associated with parental intention to vaccinate children against the flu and whether intention determines parental vaccinating behavior. These factors can be utilized to improve the efficacy of outreach programs and vaccination success rates. Purpose (a): Influenza is a preventable respiratory condition that affects over 3 million people every year. Young children are especially susceptible to complications from influenza. Daycare settings are highly vulnerable for infectious disease transmission. The objective of the study is to examine parental, child, and demographic factors that are associated with intent to vaccinate and whether intention determines parental vaccinating behavior. Methods (b): Parents of children 6 years and younger from 23 daycare centers in Tarrant County participated in a survey. Data on parental intent to vaccinate, education on flu vaccination, access to and utilization of health care, and health status of the child were collected. Analyses included bivariate and multivariate techniques to assess associations between predictors and outcomes. Results (c): Predictive factors associated with parental intent to vaccinate include physician discussion of benefits of flu vaccines (OR = 2.91, 95% CI (1.75, 4.83), p< 0.001), pediatric routine check-ups (OR = 10.01, 95% CI (2.50, 40.06) p< 0.001), medical insurance coverage, (OR = 9.41, 95% CI (2.87. 30.83) p< 0.001), health status of the child; “Excellent” (OR = 3.07, 95% CI (1.16, 8.11), p< 0.05) and “Good”(OR 5.50, 95% CI (1.92, 15.76), p< 0.01). Parental intention to vaccinate was predictive of positive vaccinating behavior (OR = 48.74, 95% CI (23.54, 100.88) p< 0.001). Conclusions (d): The study indicates that physician discussion of benefits of the flu vaccine, access to and utilization of health care, the child’s health status are important factors that may help in increasing parental intention to vaccinate their child against the flu. These factors can be utilized to improve the efficacy of outreach programs and vaccination success rates.
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    COMPARISON OF FREQUENTIST AND BAYESIAN TOLERANCE INTERVALS VIA SIMULATION
    (2014-03) Arora, Shivani; Aryal, Subhash
    Purpose (a): To compare via simulations frequentist and Bayesian methods for estimating the shape parameter of a gamma distribution and apply the estimates to construct gamma tolerance interval. Methods (b): We generated data for various sample sizes (10, 20, 50 and 100) from gamma distribution with shape parameter = 0.25 to 7 (with an increment of 0.25). The scale parameter was held constant at 1. We obtained parameter estimate for the shape parameter via maximum likelihood method, method of moments and Bayesian approach. Next, we constructed 95% tolerance interval separately using each of the parameter estimates and evaluated the coverage probability. Results (c): All three methods failed to consistently provide 95% coverage. The coverage probability for the Bayesian approach was closer to 95% compared to the other two methods. For sample size less than 20, the coverage was close to 95% for the Bayesian approach and the method becomes progressively conservative when sample size becomes larger. This was observed consistently for all values of the shape parameter. Conclusions (d): Tolerance intervals are frequently used in environmental monitoring programs. Most monitoring programs for groundwater use samples of size 8 or 20 and our study shows that the Bayesian approach performs adequately for sample sizes less than 20.
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    UNMET PREVENTIVE DENTAL CARE NEEDS AMONG CHILDREN WITH SPECIAL HEALTHCARE NEEDS RESIDING IN THE MOUNTAIN STATES REGION
    (2014-03) Homan, Sharon; Roy, Anindita
    Abstract: Background: The Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau (MCHB) have defined the Children with special health care needs (CSHCN) as “...those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally”. These conditions include low birth weight, metabolic disorders, extreme poverty, child abuse, and air pollution. 1 The NS-CSHCN 2009-2010 is the second largest survey of the health and health care experiences of the special children population along with the state-level comparisons. Objective: To report the magnitude of unmet preventive dental care needs and factors associated among Children with Special Health Care Needs residing in the mountain states. The Mountain States region includes Arizona, Colorado, Montana, New Mexico, Nevada, Texas, Utah and Wyoming Methods: We used the National Survey of Children with Special Health Care Needs (NS-CSHCN) 2009-2010.As a part of telephone survey, 40242 families were interviewed and 372,698 children between 0 and 17 years were screened. In this study, the primary outcome of interest was unmet preventive dental care needs, defined as whether CSHCN were said to have needed preventive dental care but were unable to obtain it. We analyzed the association between predictors and unmet preventive dental care needs using chi-square test and multiple logistic regression. Results: Overall, 89.6 % of CSHCN residing in Mountain States region were reported as having a need for preventive dental care in the past 12 months. Of those CSHCN who needed preventive dental care, 9.8 % did not receive all of the care they needed. After adjusting for gender, non-English language interview and, mother’s education level, the results suggested that uninsured CSHCN had 6 times greater odds of having unmet preventive dental care needs as compared to CSHCN with both insurance (public and private); 26.4% of the parents reported that the cost was unaffordable; 18% reported “no insurance” and 7.6% answered lack transport facilities as causes of unmet preventive dental care needs. Conclusion: Uninsured children, poorer children, children from Hispanic families and children with greater limitations attributable to disability residing in Mountain States region had significantly greater odds of unmet preventive dental care needs. Children with a personal doctor or nurse were significantly less likely to have unmet dental care needs. ABBREVIATIONS: CSHCN, children with special health care needs; FPL, federal poverty level; area; MCHB, Maternal and Child Health Bureau. Purpose (a): To report the magnitude of unmet preventive dental care needs and factors associated among Children with Special Health Care Needs residing in the mountain states. The Mountain States region includes Arizona, Colorado, Montana, New Mexico, Nevada, Texas, Utah and Wyoming. Methods (b): We used the National Survey of Children with Special Health Care Needs (NS-CSHCN) 2009-2010.As a part of telephone survey, 40242 families were interviewed and 372,698 children between 0 and 17 years were screened. In this study, the primary outcome of interest was unmet preventive dental care needs, defined as whether CSHCN were said to have needed preventive dental care but were unable to obtain it. We analyzed the association between predictors and unmet preventive dental care needs using chi-square test and multiple logistic regression. Results (c): Overall, 90.4 % of CSHCN residing in Mountain States region were reported as having a need for preventive dental care in the past 12 months. Of those CSHCN who needed preventive dental care, 9.8 % did not receive all of the care they needed in the region as compared to 8.9% in the nation. After adjusting for gender, non-English language interview and, mother’s education level, the results suggested that uninsured CSHCN had 5 times greater odds of having unmet preventive dental care needs as compared to CSHCN with both insurance (public and private); 26.4% of the parents reported that the cost was unaffordable; 18% reported “no insurance” and 7.6% answered lack transport facilities as causes of unmet preventive dental care needs. Conclusions (d): Uninsured children, poorer children, children from Hispanic families and children with greater limitations attributable to disability residing in Mountain States region had significantly greater odds of unmet preventive dental care needs. Children with a personal doctor or nurse were significantly less likely to have unmet dental care needs.
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    SAMPLE SIZE DETERMINATION IN MIXED-EFFECTS ZERO INFLATED POISSON LONGITUDINAL DATA
    (2014-03) Aryal, Subhash; Anne, Sruthi; Vemulapalli, Abhilash
    To determine sample size for a mixed-effects zero-inflated Poisson regression model via simulation. Zero inflated Poisson data was simulated first and then a mixed-effects ZIP regression model was fitted to evaluate the significance of the time trend parameter using SAS software. Sample size was estimated to test the time trend parameter. Using simulation approach we determined sample size for testing both the Binomial and Poisson component separately as well as simultaneous testing of both the parameters. The results from Likelihood-Ratio-Test (LRT) indicate that different sample size estimates are required for the Binomial and Poisson components of model.We suggest zero inflated data can be best explained using ZIP model. It is recommended to use the larger of the two estimates from Binomial or Poisson model while designing any clinical study. Purpose (a): To determine sample size for a mixed-effects zero-inflated Poisson regression model via simulation. Methods (b): Zero inflated Poisson(ZIP) data was simulated first and then a mixed-effects ZIP regression model was fitted to evaluate the significance of the time trend parameter using SAS software. Sample size was estimated to test the time trend parameter.Results (c): Using simulation approach we determined sample size for testing both the Binomial and Poisson component separately as well as simultaneous testing of both the parameters. The results from Likelihood-Ratio-Test (LRT) indicate that different sample size estimates are required for the Binomial and Poisson components of model. Conclusions (d): We suggest zero inflated data can be best explained using ZIP model. It is recommended to use the larger of the two estimates from Binomial or Poisson model while designing any clinical study.
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    FACTORS ASSOCIATED WITH INCREASED MOTIVATION FOR SUBSTANCE ABUSE TREATMENT AMONG PROBATIONERS
    (2014-03) Rodriguez, Mayra; Lerch, Jennifer; Walters, Scott; Taxman, Faye
    Purpose (a): Study examines the individual factors associated with motivation for substance abuse treatment among probationers. Methods (b): Preliminary data (N=103) was collected from MAPIT, a multi-site, randomized controlled trial to increase substance abuse treatment (SAT) compliance. Criminal history, HIV testing, and social support were assessed as potential predictors of motivation. The CJ CEST-Intake was used to measure motivation, desire for help (alpha=.73) and problem recognition (.88). Results (c): Nearly 40% had a court condition to attend substance abuse treatment, with 41% having attended SAT sometime prior in their lifetime. 24.3% tested positive for any illicit drug. 87% had ever been tested for HIV in their lifetime, 69% were tested in the past 12 months. 32% had ever tested positive for any STD. Desire for help was marginally associated with at least one night of homelessness in the last 90 days (F(1, 101)=3.3, p=.07), lifetime prior SAT (F(1, 101) = 43.43, p=.00), having ever tested positive for an STD (F(1, 100) = 5.30, p=.02), and testing positive for amphetamines at baseline (F(1, 91)= 4.39, p=.04). Increased problem recognition was associated with lifetime prior SAT (F(1, 100)=7.70, p=.01) and testing positive for opiates F(1, 89)= 5.28, p=.02). Having ever had a prior SAT improved both desire for help (B= .50) and problem recognition (B= .52). Conclusions (d): Information may be helpful in increasing treatment initiation and engagement. Prior SAT, positive for STDs, and drug use were associated with increased motivation. Prior treatment may be considered to assess treatment readiness.
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    Life Guard Rescues at Seattle Parks’ lake beaches
    (2014-03) Allen, John G.; Johnson, Leigh; Loewen, Ashlee; Martin, Ashley; Johnson, Valerie; Camp, Kathlene E.; Toale, Ashley; Rice, Margarita
    Purpose (a): This purpose of this project is to conduct an exploratory statistical analysis of Water Rescue/Assist Reports for nine fresh water beaches in King County, Washington, for the period 2008 to 2012. The nine beaches covered by the Water Rescue/Assist Report are East Greenlake Beach, Madison Beach, Madrona Beach, Magnuson Beach, Matthews Beach, Mount Baker Beach, Pritchard Beach, Seward Beach, and West Greenlake Beach. The project alternate hypothesis is: By describing and comparing data compiled from the Water Rescue/Assist Reports, public health leaders can make better decisions regarding water safety and can use the information for additional study. Methods (b): A total of 508 Water Rescue/Assist Reports reviewed for this analysis. The data from the reports were entered into and analyzed in Microsoft Excel. We reviewed lifeguard rescue records that collected data on: incident date and time of day; victim gender and age; parent availability during rescues for victims under age 18; victim symptoms after rescue; possible neck/back injuries; disposition to hospital; cause of incident; water depth; water temperature; park rules disobeyed; number of active and passive patrons present at time of rescue. The analysis included: age and gender based descriptive statistics; the ratio of lifeguards to patrons; water temperature correlated with rescue frequency; odds ratios and relative risks based on gender and age and the presence of a parent at the time of rescue. We searched records of the King County Medical Examiners deaths to identify drowning deaths occurring in Seattle Parks. Double entry was completed for each report to maximize data reliability. A data dictionary was developed as a guide for entering data and a blank Water Rescue/Assist Reports and was used as a reference to increase the speed of entering data.The analysis uses coded data to make data inferences using primarily descriptive statistics. Evaluations of non-coded or non-standardized report entries (such as water depth and number of guards on duty) was limited the “Other” category under “Accidents possible causes” in order to determine any possible trends based on information rescuers entered into the form. Results (c): Results: 508 rescues were completely recorded; an average of 11/park/year. Rescues steadily increased from beach opening at 11 AM and peaked at 5-7 PM when beaches closed. Most (65%) involved males; males outnumbered females between the ages of 7-50 years (RR=3.1, p5-10 feet deep; (29%) occurred in waters >10-15 feet deep.Most (65%) involved males; males outnumbered females between the ages of 7-50 years (RR=3.1, p<.05). Most (77%) rescues involved those 7-26 years of age; 55% were < 18 years. The greatest number of rescues involved those 7-10 years. Parents were on site for 90% of children <10 years of age. The most commonly listed causes were “overestimated ability”, “tired”, “waves”, and ”nonswimmer”. Drugs/alcohol were listed in 5% (28/503) of rescues. Half of rescues (51%, 236/ 462) rescues occurred in waters >5-10 feet deep; (29%) occurred in waters >10-15 feet deep. Conclusions (d): This exploratory analysis provides a snapshot of the data from the Water Rescue / Assist Reports filed from 2008-12. The data underscores some key points to be considered, including: most rescued victims were male; rescue frequency positively correlated with increasing levels of parental absence; swimmer overconfidence in their swimming abilities was the most common cause for rescues; more than 70% of rescues occurred in water depth exceeding 5 feet; the relative risk of rescues was twice what is was when there were fewer swimmers in the water as compared to more swimmers in the water. Public health leaders and others can use the information from these reports to better understand the factors involved with rescues and to conduct further study and develop effective policy.
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    HEALTHCARE ACCESS AND SATISFACTION WITH CARE BY INSURANCE TYPE AMONG CHILDREN WITH SPECIAL HEALTH CARE NEEDS: A SUMMARY REPORT AND KEY FINDINGS FROM NEW MEXICO
    (2014-03) Homan, Sharon; Bashyal, Richa; Akinyede, Oyinade; Roy, Anindita
    Purpose (a): This article reports new findings from the 2009-2010 National Survey of Children with Special Health Care Needs (NS-CSHCN) regarding parental opinion on access to health care and satisfaction with care according to insurance type. The report highlights descriptive summary comparing findings from the state of New Mexico, one of the eight states of the Mountain States Genetics Regional Collaborative (MSGRC), to the entire mountain state region and to the nation. The focus is on New Mexico because demographically the state of New Mexico is found to be the underprivileged state in terms of its socioeconomic status. Methods (b): Data on 40,242 children included in the NS-CSHCN were used to create the baseline descriptive for the entire nation. A sub group for the MSGRC“REGION” was created with 6,334 observations, which included data from 8 states1. Finally, the analysis was narrowed down to only New Mexico to study the association between health care access and satisfaction with care by insurance type and impact of language barrier. Results (c): According to this national survey, 13.8% of children under age 17 in New Mexico have special healthcare needs compared to 15.1% nationwide1. The respondents are 50% more likely to be Hispanics and approximately 30% are living below the 100% Federal Poverty Level compared to the region and the nation. Families covered by public insurance expressed lower level of satisfaction with care thereby utilizing low quality of care as compared to those who are privately insured. Additionally, parents of Hispanic children whose household language is not English were almost 5 times more likely than their counterparts to go without a usual source of care. Conclusions (d): The findings indicate that those who are publicly insured expressed lower level of satisfaction with care compared to those who are privately insured. In addition, language barrier is another leading cause of diminished access to usual source of care. These conclusions suggest that the coverage of public insurance certainly needs to be revised in order to deliver high quality care for CSHCN targeting non-English speaking Hispanic households with low socio-economic status.
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    COMPARING ATTITUDES AND OUTCOMES OF THE AFFORDABLE CARE ACT'S READMISSION REDUCTION PROGRAM IN TEXAS RURAL AND URBAN HOSPITALS
    (2014-03) Khan, Shamyal H.; Chiapa-Scifres, Ana
    Purpose (a): Section 3025 of the Affordable Care Act, The Readmission Reduction Program, which outlines penalties to participating hospitals with high readmission rates in certain diagnoses, began the Federal fiscal year (FY) of 2012 and has been met with mixed criticism as to its fairness as well as its results. Penalties asserted to participating hospitals under this policy will rise from 1% of Medicare reimbursement dollars (FY 2012) to eventually 3% (FY 2015) with limited data suggesting improved quality of care as a result of implementation. Prior data is conflicting if readmission rates are a positive, negative, or even contributory to outcomes on the national scale. This project sought to determine if readmission rates had gone down in participating Texas hospitals and what the attitudes are at hospitals concerning the readmission rate as a measure of quality of care. Furthermore, we sought to review possible discrepancies between rural and urban facilities. Methods (b): Hospitals were approached among a qualifying list with the intent of gathering a sample size of 25. A cross-sectional survey was provided to participating hospitals inquiring about the following: readmission rates as a factor for quality of care, protocol for discharge instructions, average length of stay increases, penalties assessed by Medicare, and Medicare reimbursements as significant income (25%) to the hospital. Results (c): Preliminary data is being gathered and indicates that while attitudes remain ambiguous an increased focused on readmission rates have driven readmission down. Readmission rate as a factor of quality of care remains undetermined.
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    CARBON DISULFIDE AS A CONTRIBUTOR TO FORMATION OF CARBON DIOXIDE IN THE ATMOSPHERE FROM NATURAL GAS EXTRACTION AND PROCESSING OPERATIONS
    (2014-03) Rich, Alisa L.; Patel, Jay T.
    Climate change is occurring due to increased levels of greenhouse gases (GHG) in the atmosphere. Man is contributing to atmospheric GHG levels from industrial processes. Natural gas extraction and processing operations may be contributing to increased levels of GHGs in the atmosphere. Carbon disulfide, a chemical emitted during natural gas extraction and processing, has been found to be a contributor to formation of CO2. This study is the first to identify CS2 as a contributor to CO2 levels and the four mechanisms of action by which CS2 may contribute CO2 to the atmosphere. Purpose (a): This study is one of the first to identify the presence of CS2 and other sulfide compounds in emissions from unconventional shale gas extraction and processing, and the mechanisms by which it contributes CO2 to the atmosphere. This study also identifies COS, CO and SO2 as additional greenhouse gas (GHG) contributors from CS2 breakdown. The purpose of this study is to examine the different mechanisms by which CS2 and associated sulfide compounds can form CO2 and their ability to contribute to GHG atmospheric levels. Methods (b): A literature review was performed correlating CS2 emissions and production of CO2 in natural gas emissions. Databases searched included MEDLINE, TOXLINE, and PubMed. Current research has not identified CS2 as a contributor to CO2 levels in the atmosphere from natural gas extraction and processing operations. No paper was found that recognized all four potential mechanisms of CO2 formation or identified the potential for COS and SO2 to be contributors to CO2 formation. Results (c): Atmospheric conversion of CS2 was shown to result in the formation of CO2, COS, CO and SO2. Emissions from unconventional shale gas extraction and processing were shown to be a source for CS2 in the atmosphere. The mechanisms for GHG formation was found to occur through combustion, photolysis and hydrolysis of CS2. Conclusions (d): The contribution of CO2, COS, CO, and SO2 in the atmosphere from natural gas emission of CS2 may be underestimated. Future calculations of atmospheric GHGs levels may consider what contribution CS2 from natural gas emissions is making to GHG levels in the atmosphere.
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    AN EVALUATION OF DIABETES KNOWLEDGE AMONGST TYPE 2 DIABETICS, HIGH RISK, AND LOW RISK DIABETIC POPULATIONS IN A RURAL COMMUNITY
    (2014-03) Riezenman, Ariel R.; Mendoza, Irwin; Chiapa-Scifres, Ana; Bowling, John
    Purpose (a): It has been predicted that 1 of 3 adults in the US will have diabetes by 2050. Most Texas rural communities lack adequate healthcare professionals and resources to serve their residents. The assessment of diabetes knowledge in a rural community identifies groups that may benefit from diabetes education in efforts to prevent diabetes and its associated medical complications. Methods (b): A cross-sectional study was performed within Guadalupe County at hospital and clinical settings. A consent and 24-item survey was provided to each participant. Data abstracted from 122 individual surveys were analyzed on SAS. Participants were classified as either having type 2 diabetes or being of high/low risk for type 2 diabetes. Risk status was based on the number of diabetes risk factors outlined by the National Diabetes Informational Clearinghouse. Diabetes exposure was determined by either having diabetes or knowing someone with diabetes, such as a family member or friend. Diabetes knowledge was categorized based on number of correct questions: poor (poor (<8), average (9-16), good (17-24). Results (c): Participants had an average age of 43 years, were predominantly white (63.87%), and female (61.34%). The average number of correct responses from the diabetes knowledge questionnaire was 12.38 (±3.43), with majority of participants having average diabetes knowledge, 78.15%. Independent sample t-tests were conducted to compare the average number of correct responses from the diabetes knowledge questionnaire and both diabetes exposure and age. Specifically, those with diabetes exposure had a significantly higher average number of correct responses (M = 12.69, SD = 3.23) when compared to participants not exposed to diabetes (M = 9.27, SD = 3.88), t (117) = -3.28, p = 0.001. Similarly, the average number of correct responses was significantly different between participants aged 18 to 25 (M = 10.87, SD = 3.13) and those aged 26 and older (M = 13, SD = 3.28), t (113) = -3.10, p = 0.003. A one-way ANOVA noted a significant effect for risk status on average number of correct responses, F (2, 118) = 5.14, p=0.007. Post hoc analysis using the Tukey HSD test indicated that the average number of correct response for those with diabetes (M = 13.7, SD = 2.69) was significantly different from those at low risk (M = 11.29, SD = 3.85). However, those at high risk (M = 12.68, SD = 3.02) did not differ significantly from either those at low risk or those with type 2 diabetes. A one-way ANOVA showed no significant effect for gender on average number of correct responses, F (2, 118) = 1.78, p=0.173. Conclusions (d): Overall, this study supports targeted diabetes education for persons aged 18-25 years, regardless of gender, in rural communities due to their lower levels of diabetes knowledge compared to persons aged 26 and older. Through diabetes awareness programs and health education classes, diabetes prevention and future medical complications may be reduced in rural settings.
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    AN ACADEMIC-COMMUNITY-CLINIC PARTNERSHIP TO REDUCE WEIGHT IN HISPANIC YOUTH: FIT FOR HEALTH
    (2014-03) Nguyen, Dawn; Waverka, Rachael; Kitzman-Ulrich, Heather; Wilson, Don
    FIT for Health is a family-based weight management program taught by medical and graduate students delivered in a neighborhood clinic that includes behavioral skills, self-monitoring and a social networking website. Purpose (a): To develop an academic-community partnership, FIT for Health, to deliver a weight management program to low-income underserved communities who experience obesity related health disparities. Methods (b): Families with an overweight child (N=12; mean age = 11.8 (SD=2.1) years, 83% female, 100% Hispanic, mean BMI% = 96.3) were recruited by medical staff in a neighborhood clinic. Results (c): Youth maintained their weight over the 9-week program and demonstrated a small decrease in BMI percentile (96.3 to 96.0). The program demonstrated high satisfaction with an 84% attendance rate and 100% of families reporting enjoyment of the program, 89% were happy with their progress, and 100% felt they did a good job getting healthier. In addition, 78% of volunteer students reported an increase in knowledge about delivering community-based health promotion programs. Conclusions (d): The FIT academic-community-clinic model is a novel, cost-effective, and promising health promotion program that can provide resources to underserved low-income, ethnic minority families along with opportunities for students to participate in community-based health promotion.
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    ASSOCIATION BETWEEN PERFLUORONONANOIC ACID (PFNA) AND THYROID HORMONE LEVELS IN THE U.S. POPULATION: A CROSS-SECTIONAL STUDY OF NHANES DATA, 2007-2008
    (2014-03) Hall, Lauren R.; Cannell, Brad J.; Felini, Martha
    PFNA is found in a wide array of consumer products, food, water, and air. Levels of PFNA in the environment continue to increase, and can accumulate over a lifetime. Thyroid hormones are responsible for regulating major processes of the human body. Decreasing levels of thyroid hormones could potentially interfere with essential metabolic processes. Results of this study help researchers better understand the levels of serum PFNA found in the U.S. general population, and adds to the growing body of knowledge of PFNA in relation to thyroid hormone levels. Purpose (a): Perfluorinated chemicals (PFCs) are widely used in many consumer products and have been linked with thyroid hormone disruption. Most studies have focused on perfluorooctonoic acid (PFOA) and perfluorooctane sulfonate (PFOS) exposures and thyroid hormone levels, but perfluoronananoic acid (PFNA) has shown to be associated with thyroid hormone levels in animal studies. More human studies are needed to assess PFNA in relation to thyroid hormone levels. We assessed the association between serum PFNA levels and serum thyroid hormone levels (T3, T4, and TSH) in the adult U.S general population. Methods (b): We analyzed data from the 2007-2008 National Health and Nutrition Examination Survey (NHANES) for participants 20 years of age and older. Sex-specific multivariable linear regression models were used to assess the association between perfluorononanoic acid (PFNA) and thyroid hormone measures of triiodothyronine (T3), thyroxine (T4), and thyroid stimulating hormone (TSH), separately, while adjusting for age, race, and BMI. Results (c): Higher concentrations of PFNA were found in males (males = 1.95 ng/mL and females = 1.60 ng/mL). There were statistically significant negative relationships with PFNA and T3 (p = 0.0013) and T4 (p = 0.0381) among males, after adjustment for age, race, and BMI, indicating that gender may be an effect modifier. Conclusions (d): PFNA is associated with decreasing T3 and T4 levels in males. However, there have been no consistent findings of an association between PFNA levels and thyroid hormone levels in previous studies. More evidence and research is needed to determine specific implications of PFNA exposure and thyroid function.
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    WHAT ARE THE NEEDS OF PERMANENT SUPPORTIVE HOUSING RESIDENTS? A SURVEY OF CASE MANAGERS IN TARRANT COUNTY
    (2014-03) Marshall, Brittany; Walters, Scott; Spence-Almaguer, Emily; Abraham, Stacy
    This research served as a pilot study to help us develop a program for homeless persons in Tarrant County to improve their quality of life. Purpose (a): Permanent Supportive Housing (PSH) is used as a method of reducing homelessness and its associated costs. The insight of case managers is integral to determine factors that may facilitate or inhibit the health and quality of life of PSH residents in Tarrant County. Methods (b): An online survey was conducted with PSH case managers (n=24) to assess the percentage of PSH residents affected by various health and wellness domains, barriers to improving health, and potential motivational levers. Data was analyzed using SPSS. Results (c): Case Managers reported that clients were most affected by poor mental health (74%), poor social support (69%) physical health (64%) and substance abuse (46%). Case managers identified furniture, transportation, and food as their clients’ top needs. Case managers believed clients were somewhat motivated to work on improving social support, physical and mental health, and poor nutrition. Approximately 60% of case managers believed their clients were not at all or a little motivated to work on improving medication adherence and substance abuse issues. Conclusions (d): Findings will guide the development of the Interactive Community Health Assistance for Tenants (iCHAT), which aims to reduce alcohol and drug use, reduce symptoms of depression, and improve quality of life amongst PSH residents.
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    THE FAMILY-CENTERED MEDICAL HOME AND PARENTAL REPORT OF ACCESS TO SUPPORTIVE HEALTHCARE SERVICES AMONG CHILDREN WITH AUTISM SPECTRUM DISORDER, NATIONAL SURVEY OF CHILDREN WITH SPECIAL HEALTHCARE NEEDS
    (2014-03) Davis, Ann M.; Brown, Lindsey M.; Suzuki, Sumihiro
    Purpose (a): Autism Spectrum Disorder (ASD) is diagnosed among 1 in 88 children in the United States. These children have complex healthcare needs that may be well served in a family-centered medical home (FCMH) model. FCMHs provide comprehensive medical care that encourages partnerships between patients, families, and healthcare providers in effort to facilitate care that is accessible, compassionate, and family-centered. The primary purpose of this research was to examine the associations between having a FCMH and impact on access to supportive healthcare care for families with a child with ASD. Although multiple studies have examined effects of FCMH on children with special healthcare needs, few have specifically examined the relationship for ASD children. Methods (b): Data was obtained from the 2009-2010 National Survey of Children with Special Healthcare Needs (CSHN), a national telephone survey of households with children identified as special needs. Unadjusted and adjusted multivariate logistic regression was performed to determine the association between report of having a FCMH and report of unmet needs for healthcare or health services, respite care, communication equipment when needed, family support services, respite care, mental healthcare, and report of frustration with access to health-related services. Results (c): The study population consisted of 3,055 children (age 0-17) with parent reported ASD. The majority of the study population was between the ages of 6-11 (46.4%), male (80.6%), non-Hispanic white (72.1%), and had mild ASD (49.1%). About one quarter (23.1%) have care that is considered part of a FCMH. Those with a FCMH were less likely to report having an unmet healthcare or health service need (OR=0.170, 95%CI 0.117-0.245), having an unmet therapy need (OR=0.115,95%CI 0.068-0.194) and parent-reported frustration with coordination of care (OR=0.147,95% CI 0.089-0.240). Having a FCMH was not significantly associated with receipt of communication equipment when needed (OR=0.526, 95% CI 0.210-1.315) or receipt of respite care when needed (OR=1.281,95% CI 0.771-2.128) when adjusting for age, gender, race, ethnicity, type of insurance, having a usual source of care, primary spoken language, poverty level and state of residence. Conclusions (d): The FCMH was positively associated with improved access to supportive healthcare for families with a child with ASD. Future studies should examine this population to determine reasons behind the lack of usage.