DigitalCommons@The Texas Medical Center

    A Comparison of Sociodemographic Correlates of Cigarette, Alcohol, and Energy Drink Consumption among High School Students in the United States, 2010-2015

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    OBJECTIVE: Despite growing awareness about the harmful physiological effects of energy drinks, especially among young people, there is little regulation governing the marketing and sale of these products to adolescents. Thus, in contrast to substances such as cigarettes and alcohol, energy drinks are readily available to adolescents, and widely consumed. It is not known if the easy availability of energy drinks has the effect of increasing usage of these substances among adolescents, and reducing sociodemographic differences in the consumption of energy drinks. In this study, we use pooled data (2010-2015) from the nationally representative Monitoring the Future survey (n=43,283), to compare consumption of energy drinks with other substance use, and to compare the sociodemographic correlates of energy drink consumption among high school students (10th and 12th grade) with those of cigarette and alcohol consumption. METHODS: Covariate-adjusted estimates for prevalence of consumption of energy drinks, cigarettes, and alcohol for each of different sociodemographic strata were obtained via logistic regression analysis. Additional analyses examined the extent to which socioeconomic disparities in prevalence of consumption of energy drinks are predicated by cigarette smoking and alcohol use. RESULTS: While the patterning of differences in energy drink use by sex, grade, race and parental education (as a measure of socioeconomic status) were similar to those seen in cigarette smoking and ever-use of alcohol, the magnitude of differences across subgroups varied across these behaviors. Racial/ethnic, socioeconomic and age differences were smaller in the case of energy drink use compared to alcohol or cigarette use. Gender differences were larger than in the case of cigarette smoking. In all cases, energy drink use were higher among students who were current users of alcohol or cigarettes, but there was little evidence that sociodemographic variables were differentially associated with energy drink use within these strata. CONCLUSIONS: Ready availability of energy drinks has resulted in elevated use of these products relative to cigarette smoking and alcohol, and some narrowing of socioeconomic differentials in use. Regardless of socioeconomic status, use of energy drinks is higher among current users of cigarettes and / or alcohol

    Persistent Complex Bereavement Disorder Symptom Domains Relate Differentially to PTSD and Depression: A Study of War-Exposed Bosnian Adolescents.

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    Persistent Complex Bereavement Disorder (PCBD) is a newly proposed diagnosis placed in the Appendix of the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as an invitation for further research. To date, no studies have examined the dimensionality of PCBD or explored whether different PCBD criteria domains relate in similar, versus differential, ways to other psychological conditions common to war-exposed bereaved youth, including symptoms of Posttraumatic Stress Disorder (PTSD) and depression. We evaluated the dimensionality of proposed PCBD B and C symptom domains, and their respective relations with measures of PTSD and depression, in 1142 bereaved Bosnian adolescents exposed to the 1992-1995 Bosnian civil war. Instruments included the UCLA PTSD Reaction Index, the Depression Self-Rating Scale, and the UCLA Grief Screening Scale (a prototype measure of PCBD symptoms). We investigated potential differences in grief, PTSD, and depression scores as a function of cause of death. We then examined hypothesized differential relations between PCBD B and C symptom domain subscales and selected external correlates, specifically measures of depression and the four-factor emotional numbing model of PTSD. Results of both analyses provide preliminary evidence of a multidimensional structure for PCBD in this population, in that the PCBD Criterion C subscale score covaried more strongly with each of the four PTSD factors and with depression than did PCBD Criterion B. We conclude by discussing theoretical, methodological, clinical, and policy-related implications linked to the ongoing study of essential features of PCBD

    Individual and psychosocial mechanisms of adaptive functioning in parentally bereaved children.

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    The authors examined factors theorized to contribute to adaptive functioning in 56 parentally bereaved children (age 7-13) who had lost their caregiver within the previous 6 months. Adaptive functioning, defined as falling below clinical threshold levels on all measures of depression, posttraumatic stress, anxiety, and internalizing/externalizing symptoms, characterized 57% of the sample. Linear mixed modeling revealed that children in the adaptive functioning group had lower mean scores on avoidant coping and higher mean scores on coping efficacy, religiosity, parental positive reinforcement, and parental empathy. Findings suggest that adaptive functioning following parental loss is related to both child-intrinsic factors and child-extrinsic factors

    Working With Faith-Based Communities to Develop an Education Tool kit on Relationships, Sexuality, and Contraception

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    Communities disproportionately affected from higher rates of unplanned teen births are in need of sustainable approaches to prevention strategies. One approach is to build the capacity of faith-based communities (FBCs) to address the sexual health needs of the surrounding community. However there is a need for comprehensive, user-friendly resources designed for FBCs that provide critical decision-making information related to pregnancy prevention inclusive of contraception. Using community-based, theoretical and practice-informed strategies, we developed a user-friendly sexuality education tool kit in five phases: (1) building relationships with faith leaders; (2) piloting educational sessions within churches; (3) gaining insight from participating faith leaders; (4) creating the tool kit; and (5) collecting feedback from training and implementation. Our findings suggest faith leaders remained motivated to overcome perceived barriers by their mission to serve their communities. A sexuality education tool kit that is respectful and guided by the input of FBCs can be a viable and innovative approach to address teen pregnancy

    Examining Patterns in AIDS-Related Hospitalizations Among African Americans in the United States From 2009-2014

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    The acquired immune deficiency syndrome (AIDS) epidemic exerts a substantial clinical burden in the United States. Of all races, African Americans disproportionately account for AIDS-related diagnoses and hospitalizations (Centers for Disease Control and Prevention [CDC], 2015a). This study used a descriptive, cross-sectional design by comparing patterns in hospital admissions for African Americans with an AIDS diagnosis among four regions of the United States from 2009-2014: (Northeast, Midwest, West, and South). First, we generated summary statistics for all African Americans living in the four regions and also for African Americans who fit the CDC-defined case definition of AIDS. Second, we summarized the total number of hospital admissions and the number of hospital admissions with an AIDS diagnosis for each region, from 2009-2014. We calculated percentages of hospital admissions with an AIDS diagnosis out of all hospital admissions for African Americans by year and region. Our findings indicated that, in 2009, the Northeast, Midwest, and West regions had 147,726, 130,680, and 70,990 admissions of African Americans, respectively, while the South region had 370,751 admissions. In 2014, the Northeast, Midwest, and West regions had 148,258, 156,442, and 65,855 admissions of African Americans, respectively, while the South region had 416,791 admissions. In 2009, the Northeast, Midwest, and West regions had 10,866, 10,368, and 5,577 admissions of African Americans with an AIDS diagnosis, respectively, while the South region had 33,388 admissions. In 2014, the Northeast, Midwest, and West regions had 11,079, 12,632, and 5,573 admissions of African Americans with an AIDS diagnosis, respectively, while the South region had 37,624 admissions. In 2009, the Northeast, Midwest, and West regions accounted for 18, 17, and 9 percent of hospital admissions with an AIDS diagnosis, respectively, while the South region accounted for 56 percent. In 2014, the Northeast, Midwest, and West regions accounted for 17, 19, and 8 percent of hospital admissions with an AIDS diagnosis, respectively, while the South region accounted for 56 percent. In conclusion, our findings indicated that the number of hospital admissions in this time period was the highest in the South region and the lowest in the West region. Future researchers should perform a formal analysis with statistical tests rather than just a count of hospital admissions to be able to determine statistically significant differences among the U.S. regions and years

    The Effect of Socio-Demographic Conditions on Vaccination Delinquency at the Elementary School Level

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    Objectives: To explore factors associated with Vaccine delinquency at the elementary school level. Methods: 2016 Vaccine coverage data for 155 Elementary schools in Houston is used to determine vaccination compliance. Logistic regression is performed with compliance as outcome variable and independent variables representing students’ socio-economic profile, Student outcome measures, Teachers’ education profile and School rank. Results: Lower Compliance is associated with African American students (OR) (0.23, p=0.01) and students with ESL (English as second language), (0.45, p=0.03). Higher compliance associated with gifted/talented students (28.17, p=0.08). Conclusions: Vaccine delinquency is higher among African American students and ESL students. Language might be a barrier to access Vaccination services. Parents’ motivation is important for high vaccination coverage at the elementary school level. Policy Implications: Multilingual communication materials towards vaccination services might increase vaccination compliance in schools. Schools with large populations of ESL

    Female invasive breast cancer mortality trends among Hispanic population in the United States from 1990 to 2012

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    Introduction: Analyzing trends in breast cancer mortality can ensure a precise characterization of changes over time and can be important in public health decision making. Most reported trends are limited to incidence and mortality rates among Whites and Blacks, without categorization regarding tumor clinical characteristics. This study analyzed breast cancer mortality trends among different race-ethnic groups using various approaches such as partitioning rates by factors associated at the time of diagnosis; taking into consideration age, cohort and period effects; and by evaluating geographical variations. Methods: Incidence and mortality data from 1990 to 2012 of female invasive breast cancer among women aged 18-84 years in United States (U.S.) was provided by the National Cancer Institute. The following analyses were conducted: (1) calculation of incidence based mortality (IBM) rates by estrogen receptor (ER) status according to race-ethnicity; (2) examination of temporal trends using age-period-cohort (APC) analysis on incidence and mortality rates; and, (3) spatiotemporal analysis of the county level age-standardized breast cancer mortality rates to identify significant geographical areas with higher risk. Results: IBM rates for ER+ tumors increased while those of ER- tumors decreased among all race-ethnic groups. APC analysis showed that race-ethnic disparities were largely among the ER- tumors and temporal trends of the ER+ tumors were similar across the race-ethnic groups, with identical effects across the various birth cohorts. Geographical variation in the breast cancer county-level mortality rate was mostly explained by age-standardization and county level risk factors, although the effect of these factors was greater in rural areas of western U.S. Conclusion: Temporal trends in the IBM rates were more reflective of the recent changes in the incidence trends of female invasive breast cancer. Trends of ER+ tumors were similar across all race-ethnic groups suggesting a common risk factor for the persistent increase in the incidence and mortality of these tumors. Spatial analysis shows that the higher mortality risk in certain rural counties of western U.S. might be due to poor survival than an elevated incidence and the need for better health care access in these medically underserved areas. These results might explain the observed ethnic and geographic variations in breast cancer mortality, and in turn, could support a stronger theoretical basis for public health policy

    Head Start since the War on Poverty: Taking on New Challenges to Address Persistent School Readiness Gaps

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    This article explores Head Start’s overall effectiveness in improving school readiness outcomes and its potential to reduce gaps in these outcomes in light of changing program goals, resource and funding capacity, and the demographic changes in the low-income child population it serves. Although not an explicit goal of the Head Start program, we assess whether and how the program can address reducing school readiness gaps between children of different racial and ethnic backgrounds and income groups. Because of changing policy priorities and targeting vulnerable groups of children with diverse needs, meeting Head Start goals within funding constraints can be challenging. Yet, as we will show in this paper, the program has successfully adapted to its changing environment, and despite the evolving nature of its goals and populations served, it has managed to demonstrate a favorable impact on children. Future research on tailored programming, program implementation and impacts on specific groups of children is needed to help Head Start further improve its ability to address persistent school readiness gaps

    Assembling data for use of the ITHIM (integrated transport and health impact modeling) tool for Houston, Texas

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    Houston, Texas is implementing changes to the built environment in the forms of new rail lines and shared use pathways. The use of these new systems can improve public health via the benefit of transport-related physical activity, or active transport. These outcomes can be measured using modeling tools such as the Integrated Transport and Health Impact Model (ITHIM). ITHIM models population-level changes of chronic disease burden using secondary data sets tied to the geographical region of interest. We assembled an ITHIM iteration for Houston and documented the process and assembly results. Through this calibration we uncovered the limitations of the Houston model and challenges facing future versions such as acquiring key data and management of data that may or may not meet the requirements set by ITHIM developers. We concluded that our federal data were easy to use and attain, but recommend setting aside significant time to acquire and manage local and state data and establish contacts at partner agencies

    The impact of the Texas DSRIP program on preventable hospitalizations in southeast Texas

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    The adoption of Medicaid Section 1115 waiver was undertaken to improve healthcare access and reform healthcare programs especially for the uninsured and needy populations in Texas. The waiver aims at developing infrastructure and the redesigning healthcare delivery system to improve quality of care. The Delivery System Reform Incentive Payment (DSRIP) waiver pool, one of the two funding pools of the waiver has four categories of which a metric of the fourth category, preventable hospitalizations was analyzed for eight Category 4 conditions stipulated by the program. The Texas Healthcare Information Collection (THCIC) database was used for performing both a time series regression analysis and an interrupted time series regression analysis with preventable hospitalizations as the dependent variable and time and DSRIP program covariates as independent variables, respectively, specific to the nine counties located in southeast Texas for both sets of DSRIP- and non-DSRIP hospitals. The impact of the program on eight Category 4 conditions was examined for the duration of 22 pre-post quarterly time periods in southeast Texas for both DSRIP and non-DSRIP hospitals. It was detected that the preventable hospitalization rate decreased in DSRIP hospitals and the DSRIP program may have improved the health of the population in southeast Texas
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