Texas public health journal最新文献

Background: Asymptomatic and pre-symptomatic infections may play a significant role in the spread of COVID-19 but determining prevalence of these infections in the general population is labor intensive.

Purpose: This approach describes an innovative surveillance strategy using teams of medical students and emergency medical technicians (EMTs). Medical students represent a highly trained but underutilized workforce in the pandemic response.

Methods: A household-level sampling frame generated a population-weighted representative sample of households in San Antonio, Texas. Households were included if an English or Spanish-speaking adult (≥18yo) answered the door and was willing to participate; excluded if household members had past or present COVID-19 symptoms or close contact with confirmed COVID-19 infection. Interdisciplinary teams of medical or medical/public health dual degree students paired with EMTs conducted a survey and instructed participants on how to self-administer nasal swabs among 502 community members without symptoms of COVID-19 from June 1-6, 2020, weeks prior to a community case surge.

Results: Of 502 participants, median age was 52 years and average household size was 3.1. Only 40% reported no medical risk factors for COVID-19 complications. Hypertension (23.6%) and diabetes (13.4%) were the most common pre-existing medical conditions; 29% of respondents reporting feeling at risk for SARS-CoV-2 during daily outside-of-the-home activities. All 502 SARS-CoV-2 PCR tests were negative, suggesting a prevalence range of 0%-1.2%.

Public health significance: It is unlikely that pre-symptomatic and asymptomatic COVID-19 infections in households without existing COVID-19 infections played a major role in the propagation of the epidemic at this point in time. While community-wide testing of individuals without symptoms of COVID-19 may be low yield in the context of low prevalence of symptomatic cases of COVID-19, medical students provided valuable support for community-based surveillance at a time when public health infrastructure was severely taxed.

Significance: Youth use of e-cigarettes is reaching 'epidemic proportions,' even as combustible tobacco use is declining. Comparison of risk factors that are uniquely associated with e-cigarette and combustible tobacco use among adolescents is warranted.

Methods: Six waves of data from the Texas Adolescent Tobacco and Marketing Surveillance (TATAMS) study (n=3907; N=461,069; 2014-2017) were used in this analysis. A random intercept logistic regression model was used to compare intrapersonal, interpersonal, and environmental risk factors for use of both products based on the Social Ecological Model.

Results: Risk factors that were significantly associated with both past 30-day use of e-cigarette and combustible tobacco products over time included past 30-day use of marijuana and alcohol, social acceptability of product use, having friends and family members who used the products, and male gender. Increasing age, worse academic performance, higher sensation seeking score, higher recall of social media promotion in the past 30 days, and lower positive affect score were associated with past 30-day use of combustible tobacco only. White race was associated with past-30 day use of e-cigarettes only.

Conclusion: Involving peers and parents in preventive interventions designed to reduce uptake of these products is paramount, as is the need to address other substance use, like alcohol and marijuana. Efforts should also be made to create a social climate that makes tobacco use (e-cigarettes and combustible products) less acceptable and desirable.

The Hispanic population is underserved and underrepresented in health care. Epidemiological studies are cmcial for providing insight to identify disparities and unmet eye health needs in this vulnerable group. The purpose of our study is to examine the prevalence of ocular conditions in the elderly Hispanic population in North Texas and identify the frequency in which these conditions were undiagnosed. This study was ancillary to the Health and Aging Brain study among Latino Elders (HABLE). Seventy-three HABLE participants (aged > 50 years) underwent neuropsychological evaluation and an eye health screening at the University of North Texas Health Science Center study site. Descriptive analyses were performed for prevalence of ocular conditions, as well as a comparison of self-reported conditions and ocular Endings. Our results suggest the prevalence patterns for undetected ocular disease in the Hispanic population of North Texas are comparable with the epidemiological trends for this population group in other concentrated areas in the United States.

Background: The existence of racial and ethnic disparities in leg amputations rates is well documented. Despite this, approaches to addressing these alarming disparities have been hampered by the inability to identify at-risk individuals in a region and design targeted interventions. We undertook this study to identify small geographic areas in which efforts focused on high-risk individuals with peripheral artery disease (PAD) could address disparities in leg amputation rates.

Methods: We used de-identified Texas state admission data to identify PAD-related admissions associated with an initial revascularization (leg angioplasty or leg bypass) or an primary leg (above-ankle) amputation between from 2004 through 2009.

Results: 21,273 major initial procedures were performed in Texas from 2004 through 2009 for PAD-related diagnoses, including 16,898 revascularizations and 4,375 leg amputations. A multivariate logistic regression demonstrated that an initial leg amputations done without revascularization was significantly associated with, among other variables: people categorized as black (odds ratio [OR] 1.79) or Hispanic (OR 1.42); those with Medicaid coverage (OR 1.89); and those treated at low volume hospitals (OR 1.78; p<0.001 for all). Four geographic regions were identified with significantly higher risk-adjusted leg amputation rates. Of the 349 Texas hospitals performing major procedures, 72 (21%) reported no revascularization procedures during the six year period studied.

Conclusions: Prevention efforts directed at specific geographic areas may be more likely to reach at-risk people with PAD and thereby reduce leg amputations disparities in Texas. Such efforts might also find strategies to direct patients toward higher volume centers with higher revascularization rates.

We investigated the effect of chronic medical conditions including obesity on self-reported disability and mobility in Mexican Americans aged 75 or over using data from the Hispanic Established Population for the Epidemiological Study of the Elderly (Hispanic EPESE) Wave 5 (2004-2005). Disability was assessed with a modified version of the Katz activities of daily living (ADL) scale and mobility was assessed with the Rosow Breslau scale of gross mobility function. The percentage of participants needing assistance with ADLs were as follows: 26.7% for transferring from a bed to chair, 26.6% for walking across a small room, 17.9% for dressing, 16.3% for using a toilet, 14.3% for grooming, and 8.2% for eating. Fifty percent reported limitation in the ability to walk ½ a mile and walking up and down stairs. Multivariate logistic regression analysis after controlling for all covariates showed that arthritis, diabetes, stroke, and obesity were significantly associated with any ADL limitation, walking up and down stairs, and walking 1/2 mile. Prevention of obesity and chronic medical conditions will help increase functional independence in this population.

Introduction: Rural residence is associated with later stage of breast cancer diagnosis in some but not all prior studies. The lack of a standardized definition of rural residence may contribute to these mixed findings. We characterize and compare multiple definitions of rural vs. non-rural residence to provide guidance regarding choice of measures and to further elucidate rural disparities in breast cancer stage at diagnosis.

Methods: We used Texas Cancer Registry data of 120,738 female breast cancer patients ≥50 years old diagnosed between 1995-2009. We defined rural vs. non-rural residence using 7 different measures and examined their agreement using Kappa statistics. Measures were defined at various geographic levels: county, ZIP code, census tract, and census block group. Late-stage was defined as regional or distant disease. For each measure, we tested the association of rural residence and late-stage cancer with unadjusted and adjusted logistic regression. Covariates included: age; patient race/ethnicity; diagnosis year; census block group-level mammography capacity; and census tract-level percent poverty, percent Hispanic, and percent Black.

Results: We found moderate to high levels of agreement between measures of rural vs. non-rural residence. For 72.9% of all patients, all 7 definitions agreed as to rural vs. non-rural residence. Overall, 6 of 7 definitions demonstrated an adverse association between rural residence and late-stage disease in unadjusted and adjusted models (Adjusted OR Range = 1.09-1.14).

Discussion: Our results document a clear rural disadvantage in late-stage breast cancer. We contribute to the heterogeneous literature by comparing varied measures of rural residence. We recommend use of the census tract-level Rural Urban Commuting Area Codes in future cancer outcomes research where small area data are available.

Providing breast cancer screening services in rural areas is challenging due to the fractured nature of healthcare delivery systems and complex reimbursement mechanisms that create barriers to access for the under- and uninsured. Interventions that reduce structural barriers to mammography, like patient navigation programs, are effective and recommended, especially for minority and underserved women. Although the literature on rural healthcare is significant, the field lacks studies of adaptive service delivery models and rigorous evaluation of evidence-based programs that facilitate routine screening and appropriate follow-up across large geographic areas.

Objectives: To better understand how to implement a decentralized regional delivery "hub & spoke" model for rural breast cancer screening and patient navigation, we have designed a rigorous, structured, multi-level and mixed-methods evaluation based on Glasgow's RE-AIM model (Reach, Effectiveness, Adoption, Implementation, and Maintenance).

Methods and design: The program is comprised of three core components: 1) Outreach to underserved women by partnering with county organizations; 2) Navigation to guide patients through screening and appropriate follow-up; and 3) Centralized Reimbursement to coordinate funding for screening services through a central contract with Medicaid Breast and Cervical Cancer Services (BCCS). Using Glasgow's RE-AIM model, we will: 1) assess which counties have the resources and capacity to implement outreach and/or navigation components, 2) train partners in each county on how to implement components, and 3) monitor process and outcome measures in each county at regular intervals, providing booster training when needed.

Discussion: This evaluation strategy will elucidate how the heterogeneity of rural county infrastructure impacts decentralized service delivery as a navigation program expands. In addition to increasing breast cancer screening access, our model improves and maintains time to diagnostic resolution and facilitates timely referral to local cancer treatment services. We offer this evaluation approach as an exemplar for scientific methods to evaluate the translation of evidence-based federal policy into sustainable health services delivery in a rural setting.

Purpose: The purpose of this study is to describe the county-level geographic distribution of human papillomavirus (HPV) vaccine coverage among young women aged 18-26 in Texas using multilevel, small area estimation.

Methods: Multilevel (individual, county, public health region) random-intercept logit models were fit to HPV vaccination data (receipt of ≥ 1 dose Gardasil®) from the 2008 Behavioral Risk Factor Surveillance System and a number of secondary sources. Using the parameters from the final model, we simulated HPV vaccine coverage in each county.

Results: Indirect county-level estimates ranged from 1.9-23.8%, with a weighted state average of 11.4%. The counties with the highest and lowest coverage estimates were Orange County, TX and Webb County, TX respectively. Significant correlations were observed between HPV vaccination and age, Hispanic ethnicity, and the percentage of uninsured at the county and public health region levels.

Conclusions: Small area analyses have been used in a variety of settings to assess a variety of health outcomes, and as shown in this study, can be used to highlight geographic disparities and opportunities for intervention in HPV vaccine coverage.

The goal of this study was to quantify the burden of cervical cancer in Texas and provide information about the health care needs of survivors. Data from multiple sources including the Texas Cancer Registry, Behavioral Risk Factor Surveillance System, and Texas Medicare claims were used in this effort. In 2009, there were over 100,000 cervical cancer survivors in Texas. Our descriptive analysis revealed that these women consumed less fruit and vegetables, were more often smokers, and had worse physical and mental health than women without a history of cancer. Survivors aged 65 and older cost Medicare over $15 million in inpatient, outpatient, and hospice care in 2009 alone, or $9,827 per cervical cancer survivor - nearly a third more than the average Medicare enrollee in Texas that year. Providers and public health practitioners can play an integral role in reducing the human and economic burden of cervical cancer in Texas through smoking cession and healthy lifestyle counseling for survivors, recommending the HPV vaccine to males and females aged 9-26, and continuing to offer cervical cancer screening for women up to age 65.