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Adolescence is a period of exploration of sexuality and of its integration into personality. Existing research on Latina adolescents, however, has been largely limited to disease and pregnancy prevention, ignoring the integration of sexual well-being with other aspects of health. Accordingly, this paper presents findings from a photovoice project with 11-12 year old Latina students, implemented to investigate topics related to cultural identity, gender and sexual health. The data were generated over a 12-week period in an urban middle school in Central Texas by 17 youth collaborators. Findings provide a platform for discussion of how Latina young people's ideas align with or diverge from current sexual health discourses within a racial/ethnic context. We highlight opportunities and constraints with regard to identifying sexual health needs from young Latina students' own perspectives, in an attempt to contribute to the body of literature on sexual health in middle school students, as well as the lessons learned through our efforts.

Bui, Craig, and Imberman assessed the impact of gifted and talented programs on student achievement using regression discontinuity and random assignment to gifted magnet schools. In both analyses, they found minimal impact of the gifted and talented programs on student achievement. This commentary addresses two concerns associated with the study. First, the studies provided no description of the gifted students in the analyses, and some evidence suggests that the students in the study may not match typical conceptions of giftedness. Second, the outcome measures (Stanford Achievement Tests) may not have aligned well with the intent of the gifted program in the school district. In addition, this commentary asked why and how economists study the impact of gifted education programs. It is recommended that those who study and practice gifted education seek common ground on the goals and measurable outcomes of gifted education programs in ways satisfying to both the field of gifted education and to policy evaluators.

Background: Drug overdose deaths in Texas have been accelerating in recent years with an increase of 33% in the 12 months leading up to December 2020. Accurate counts of nonfatal overdoses – including associated aspects of overdose, such as substances involved, demographic information, and reversal agents administered is critical to increase timely and adequate response to individuals and communities in need. Methods: Twenty semi-structured interviews were conducted with harm reduction workers across four Texas counties to understand existing methods of reporting overdoses, naloxone dissemination/administration, and recommendations for improving overdose surveillance. Interviews were transcribed and emergent themes were identified based on the a priori research goals. Results: Findings highlighted a variety of overdose data collection methods and tools among harm reduction organizations including Excel spreadsheet, web-based TONI application, notes on personal cell phones, and paper notes. Types of overdose data collected varied widely. Participants noted existing methods are suboptimal and that there is a need for a unified, statewide reporting system to improve overdose data capture. Participants also highlighted that overdose surveillance should include "hidden populations" of people who use drugs that are not currently counted in surveillance methods as a result of not interacting with the healthcare system. Conclusions: Texas lacks a unified overdose reporting system to capture critical data to inform overdose response and prevention efforts. Nontraditional reporters may be critical toward improving overdose syndromic efforts and capturing data among hard-to-reach populations. Harm reduction organizations are uniquely positioned to facilitate reporting among community gatekeepers and people who use drugs. [ABSTRACT FROM AUTHOR]

Mexican Americans (MA) are more likely to have cognitive impairment and dementia (CID), be diagnosed at an earlier age and live with CID longer, compared to non-Hispanic Whites (NHW). While studies have examined unmet needs of individuals with CID and their caregivers, few have focused on MA populations in the U.S. This paper examines the needs of community-residing individuals with CID and their caregivers in Nueces County, Texas, a county with one of the largest MA populations in the U.S., while exploring ethnic differences in needs identified. Using concept mapping, a mixed-method approach, qualitative input on perceived needs by informal caregivers and health professionals was collected. Participants then sorted and rated perceived needs. Using this information, multidimensional scaling and cluster analyses were conducted to map the relationship between perceived needs and determine their importance and priority. Five clusters were derived for caregivers and four for the health professionals. Themes across both caregivers and health professionals highlighted the need for specialized and team-based medical care, caregiver support and training, along with socio-economic and physical needs that help with day-to-day care of individuals with CID. Among caregivers, MA rated financial resources as more important and of higher priority compared to NHW. The health professionals' perspectives were aligned with those of all caregivers. By understanding the needs of caregivers and individuals with CID, we can help families deal with this disease and let caregivers thrive. This is especially important for minority populations like MAs. [ABSTRACT FROM AUTHOR]

Communication is at the foundation of safe and effective health care. When patients with limited English proficiency (LEP) have healthcare providers who do not speak their language, the communication barrier can lead to poor outcomes. Responding to the high number of Spanish-speaking individuals with LEP, a Doctor of Physical Therapy (DPT) program has integrated Spanish-language training in the curriculum. This paper describes their development and pilot testing of the Physical Therapy Spanish Proficiency Measure (PT-SPM). The PT-SPM was developed for English-Spanish bilingual faculty or clinicians to assess DPT students' clinically relevant Spanish communication. The PT-SPM has 11 total items with four subscales: verbal proficiency, aural proficiency, written proficiency, and cultural competence. Twenty-three pairs of DPT students and their bilingual clinical instructors were recruited for an interrater agreement study; each used the PT-SPM to independently rate the student's Spanish communication with Spanish-speaking patients with LEP in clinical settings. Cohen's weighted kappa was calculated to evaluate interrater agreement between the students and clinicians on item level, using linear incremental weights. The weighted kappa coefficients ranged from 0.35 (fair agreement) to 0.80 (substantial agreement). All weighted kappa coefficients were statistically significant. Two items had fair agreement; four items had moderate agreement, and five items had substantial agreement. These results support that the PT-SPM may have value as an assessment tool for DPT students in clinical settings. Educators in other health professions may consider adapting the PT-SPM. This paper contributes to the broader interprofessional dialogue about how to assess and improve patient-provider communication. [ABSTRACT FROM AUTHOR]

The research team developed a community-based, intergenerational intervention, the Spanish-language Healthy Buddy Program to alleviate transportation barriers experienced by Latinx older adults. College students were paired with Latinx older adults and helped them identify transportation- and health-related resources in their communities. During COVID-19, the program was implemented in Hillsborough County, Florida, and Dallas-Fort Worth Metroplex and San Antonio, Texas. This paper reports the study process and outcomes using quantitative and qualitative data collected in Texas (n = 25). Individual interviews indicated older adult participants were receptive to the program model and appreciated the roles student buddies played to help improve their mobility. [ABSTRACT FROM AUTHOR]

This paper explores culturally-related concerns that arose during a multi-year study of obsessive-compulsive disorder (OCD) along the U.S.-Mexico border and describes adaptations made to better connect the research process to study participants. The purpose of this exploration is two-fold: (1) to offer suggestions for culturally sensitive borderland mental health research; and (2) to enhance dialog focused on culture, mental health research and the U.S.-Mexico border. Systematic coding of the written record of weekly research team meetings identified six recurring cultural concerns: emotionally charged and poorly understood terminology; differing meanings of ethnicity and acculturation; quality of life—regional variation and uncertainty; overlap of research and care; hopeful but hesitant; and fatalism. We conclude that diligence in the initial planning phase of a study is only part of the challenge in doing culturally sensitive research. Equally important is an ongoing process of evaluation to make explicit cultural concerns that arise during research, as well as a readiness to implement culturally sensitive research adaptations. [ABSTRACT FROM AUTHOR]

Purpose: Meals on Wheel Central Texas (MOWCTX) provides meals to more than 5,000 home-bound older adults in the Austin area every weekday. The purpose of this paper is to examine the impact of client-volunteer interactions to assess the social benefits clients receive and ascertain if and how loneliness and social isolation are addressed. Design/methodology/approach: Observations of volunteer-client interactions, interviews with clients and surveys of clients were conducted to gain insight into clients' experiences with MOWCTX services. Findings: Qualitative analysis of observation and interview data revealed four non-tangible benefits clients received from MOWCTX: reduced physical risks when mobility issues are present, a daily safety check, opportunities for social contact and increased ability to maintain independence. Survey results supported these conclusions. Originality/value: This research examines the impact of volunteer-client relationships on the experience of loneliness and social isolation. [ABSTRACT FROM AUTHOR]

Objective: Healthcare spending in the US is $3.2 trillion. $1.1 trillion is attributed to hospital care, including emergency department (ED) visits and hospitalizations. There is a relationship between ED utilization, hospitalizations, and health literacy in the general population. Health literacy may play a role in frequent ED visits and hospitalizations in patients with sickle cell disease (SCD). The purpose of this paper is to describe the relationship among health literacy levels, annual hospital encounters, annual clinic visits, annual ED visits, and annual hospitalizations in 134 Black, non‐Hispanic adolescents aged 10–19 years with SCD. Design: This is a cross‐sectional, descriptive correlational study evaluating facilitators and barriers to health literacy and clinical outcomes in adolescents with SCD. Sample: Data were collected from 134 Black, non‐Hispanic adolescents with SCD at a large, tertiary care center in Texas. Measurements: The Newest Vital Sign and REALM‐Teen health literacy instruments were used to evaluate health literacy. Results: Contrasting previous studies evaluating the influence of health literacy on ED visits and hospitalizations in the general population, there were no significant relationships within this sample. Conclusions: This study gives insight into future research to evaluate other potential influences on ED utilization and hospitalizations in pediatric patients with SCD. [ABSTRACT FROM AUTHOR]

Background and Purpose: Intracranial pressure (ICP) monitoring is crucial to decision making for neurologically injured patients, yet measurement of ICP varies greatly among practitioners. Methods: Unblinded, nonrandomized, observational pilot study comparing ICP values collected using pen and paper (P&P), electronic medical record (EMR), and video data with continuous data acquisition (CDA) technology. Results: ICP values did not significantly differ between EMR and P&P records, despite an average of 16 minutes difference in reporting times. ICP values varied significantly when comparing CDA data to EMR or paper. Conclusion: The results of this pilot study put in to question the validity of ICP values that are recorded in the medical record, which has implications for patient care and research. [ABSTRACT FROM AUTHOR]

School nurses represent cost-effective investments in students' health and educational success. Alternative high schools (AHSs) serve an understudied population of youth who are at risk for school dropout and face numerous social inequities, heightening their risk for poor health outcomes. In this two-phase explanatory sequential mixed methods study, we examined school nurse staffing in Texas AHSs. Findings suggest Texas AHSs face understaffing for familiar reasons common across districts (e.g., lack of funding), but also reveal potential deeper inequities. Quantitative findings indicate 71% of Texas AHSs have some form of nursing support, most often an on-call or part-time nurse. Qualitative findings support and enrich this finding with insights into the negative consequences of not having a full-time nurse, indiscriminate approaches to staffing AHSs, and how AHSs can be the only school in the district without a full-time nurse. Altogether, our findings reveal opportunities to better support AHSs with adequate nursing support. [ABSTRACT FROM AUTHOR]

Background: Critical care nurses who care for postoperative cardiac surgery patients need such specialty knowledge as atrial electrograms (AEGs). An inadequate audit trail exists for psychometric performance of instruments to measure knowledge of AEGs. Objectives: The aim of this study was to revise a previously tested instrument and assess evidence for content validity (content validity index), internal consistency (Cronbach α), and stability (correlation coefficient, r) reliability against the a priori criterion of 0.80. Methods: The multiple-choice response, self-administered, paper-and-pencil instrument was revised to 20 items and named the Drake Atrial Electrogram Assessment Survey (DAEGAS). A panel of 6 AEG experts reviewed the DAEGAS for content validity evidence. The instrument was further revised to 19 items (13 knowledge and 6 AEG interpretation) and tested with 76 critical care nurses from the greater Houston metropolitan area. Results: The content validity index was 0.93. Cronbach α was.51, and test-retest r was 0.74. Cronbach α increased to.60 and r was 0.73 with removal of 3 items: 2 items with a negative item-total correlation and 1 item that was transitioned to a sample question. Discussion: Content validity evidence exceeded the a priori criterion. Internal consistency and stability reliability estimates did not meet the criterion, albeit the latter met the criterion recommended by psychometricians for a new instrument. Recommendations include further development of the DAEGAS to improve internal consistency estimates and testing for evidence of other forms of validity. Reliable and valid assessment of critical care nurse knowledge of AEGs will require improved psychometric performance of the DAEGAS. [ABSTRACT FROM AUTHOR]

BACKGROUND: Through the Texas Childhood Obesity Research Demonstration study, we implemented and evaluated a system‐oriented model of primary and secondary prevention approaches to mitigate obesity among low‐income Texas children aged 2 to 12 years. Primary prevention included implementing the Coordinated Approach To Child Health Early Childhood (CATCH EC) program in Head Start preschools. In this paper, we describe the methods and results of CATCH EC program process evaluation over 2 years of implementation. METHODS: We used a quasi‐experimental design with serial cross‐sectional data collected from Head Start centers across intervention and comparison catchment areas in Houston and Austin, Texas (intervention: N = 12 centers in 2012‐2013 [Year 1], N = 12 in 2013‐2014 [Year 2]; comparison: N = 13 centers in Year 1, N = 12 in Year 2). Process evaluation included center director and teacher surveys conducted in both years of implementation. We developed indices for implementation of CATCH EC and non‐CATCH health events at the centers. RESULTS: Implementation scores were higher among intervention centers as compared to comparison centers across both years of implementation, and these differences were statistically significant (p < .01). There was also high variability in program implementation in intervention centers across both years ranging from 55% to 95%. CONCLUSION: These implementation index strategies may inform future evaluation of preschool‐based obesity prevention program implementation. [ABSTRACT FROM AUTHOR]

Aims and objectives: The many negative effects of burnout have prompted researchers to better understand the factors contributing to it. The purpose of this paper is to add to this body of knowledge through the study of burnout among direct‐care workers in nursing homes. Background: Perhaps the factor most often associated with employee burnout is the level of staffing—insufficient staffing results in work overload and eventually employee burnout. A closer look at research findings suggests that there are many other factors also contributing to burnout. These range from those at the organisational level, such as availability of training and resources to individual characteristics such as self‐esteem and length of employment. Methods: A self‐administered survey instrument was completed by 410 direct‐care workers working within 11 nursing homes in the north Texas region. Regression analyses were performed, adjusting for clustering by nursing home. Beta coefficients and structure coefficients are reported. Burnout was measured through three dimensions: emotional exhaustion, depersonalisation and personal accomplishment. Results: Organisational, work design, interpersonal and individual characteristics were found to be associated with one or more dimensions of burnout. Conclusions: The analyses largely support previous research. Organisational variables of significance included the availability of resources to do the work, available training and fair pay. Work design variables of significance included adequate staffing. The individual characteristic, self‐esteem, appeared to have the strongest impact on burnout. Commitment to the organisation also had a large impact. Relevance to clinical practice: While the data do not allow for the testing of causal relationships, the data do suggest that providing adequate staffing, perceived fair pay, sufficient work resources (e.g., towels, gowns), management support and adequate training may result in less direct‐care worker burnout on the job. [ABSTRACT FROM AUTHOR]

This paper evaluates the effectiveness of community health workers/promotores (CHWs) in promoting cancer preventive behaviors in the 2011-2013 Education to Promote Improved Cancer Outcomes (ÉPICO) project. The ÉPICO project utilized CHWs to disseminate cancer education to predominately Spanish-speaking Hispanics living in colonias in the Lower Rio Grande Valley of Texas. The CHWs received training to become Texas-certified CHW instructors and specialized training in message tailoring, and they delivered more than 5000 units of resident education on cancer prevention/detection, treatment, and survivorship for breast, cervical, and colorectal cancer. Using panel data to examine overtime changes in cancer knowledge among Lower Rio Grande Valley residents, the evaluation found significant changes from baseline to both times 1 and 2. Additional individual-level analysis indicated that the increase in resident cancer knowledge was predicted by residents' perceptions of CHW credibility and intention to change their lifestyles. Multilevel analysis also showed that the increase in cancer prevention knowledge among residents was predicted by attributes of the CHWs who taught them. In particular, CHWs with higher education levels had the most impact on residents' increased knowledge over time. Unexpectedly, CHWs with more years of experience were less effective teachers than their early-career counterparts. [ABSTRACT FROM AUTHOR]

Communities across the United States are increasing efforts to find and count homeless youth. This paper presents findings and lessons learned from a community/academic partnership to count homeless youth and conduct an in depth research survey focused on the health needs of this population. Over a 4 week recruitment period, 632 youth were counted and 420 surveyed. Methodological successes included an extended counting period, broader inclusion criteria to capture those in unstable housing, use of student volunteers in health training programs, recruiting from magnet events for high risk youth, and partnering with community agencies to disseminate findings. Strategies that did not facilitate recruitment included respondent driven sampling, street canvassing beyond known hotspots, and having community agencies lead data collection. Surveying was successful in gathering data on reasons for homelessness, history in public systems of care, mental health history and needs, sexual risk behaviors, health status, and substance use. Youth were successfully surveyed across housing types including shelters or transitional housing (n = 205), those in unstable housing such as doubled up with friends or acquaintances (n = 75), and those who were literally on the streets or living in a place not meant for human habitation (n = 140). Most youth completed the self-report survey and provided detailed information about risk behaviors. Recommendations to combine research data collection with counting are presented. [ABSTRACT FROM AUTHOR]

Introduction: Pediatric patients account for 6-10% of emergency medical services (EMS) activations in the United States. Approximately 30% of these children are not transported to an emergency department (ED). Adult data in the literature reports higher hospitalization and complications following non-transport. Few studies discuss epidemiology and characteristics of pediatric non-transport; however, data on outcome is limited. Our primary aim was to determine outcomes of non-transported children within our urban EMS system before and during the COVID-19 pandemic. Our secondary objective was to explore reasons for non-transport. Methods: This was a prospective, descriptive pilot study. We compared EMS data for September 2019 (pre-COVID-19) to September 2020 (pandemic). Included were children aged 0-17 years who activated EMS and did not receive transport to the primary hospital for the EMS capture area. We defined outcomes as repeat EMS activation, ED visits, and hospital admissions, all within 72 hours. Data was obtained via electronic capture. We used descriptive statistics to analyze our data, chi square for categorical data, stepwise logistic regression, and univariate logistic regression to test for association of covariates with non-transport. Results: There were 1,089 pediatric EMS activations in September 2019 and 780 in September 2020. Non-transport occurred in 633 (58%) in September 2019 and 412 (53%) in September 2020. Emergency medical services was reactivated within 72 hours in the following: 9/633 (1.4%) in 2019; and 5/412 (1.2%) in 2020 (P = 0.77). Visits to the ED occurred in 57/633 (9%) in 2019 and 42/412 (10%) in 2020 (P = 0.53). Hospital admissions occurred in 10/633 (1.5%) in 2019 and 4/412 (0.97%) in 2020 (P = 0.19). One non-transported patient was admitted to the intensive care unit in September 2020 (<1%) and survived. Hispanic ethnicity, age >12 years, and fever were associated with repeat EMS activation. The most common reason for non-transport in both study periods was that the parent felt an ambulance was not necessary (47%). Conclusion: In our system, non-transport of pediatric patients occurred in >50% of EMS activations with no significant adverse outcome. Age >12 years, fever, and Hispanic ethnicity were more common in repeated EMS activations. The most common reason for non-transport was parents feeling it was not necessary. Future studies are needed to develop reliable EMS guidelines for pediatric non-transport. [ABSTRACT FROM AUTHOR]

Background: Coordinated, multi-component school-based interventions can improve health behaviors in children, as well as parents, and impact the weight status of students. By leveraging a unique collaboration between Texas AgriLife Extension (a federal, state and county funded educational outreach organization) and the University of Texas School of Public Health, the Texas Grow! Eat! Go! Study (TGEG) modeled the effectiveness of utilizing existing programs and volunteer infrastructure to disseminate an enhanced Coordinated School Health program. The five-year TGEG study was developed to assess the independent and combined impact of gardening, nutrition and physical activity intervention(s) on the prevalence of healthy eating, physical activity and weight status among low-income elementary students. The purpose of this paper is to report on study design, baseline characteristics, intervention approaches, data collection and baseline data.Methods: The study design for the TGEG study consisted of a factorial group randomized controlled trial (RCT) in which 28 schools were randomly assigned to one of 4 treatment groups: (1) Coordinated Approach to Child Health (CATCH) only (Comparison), (2) CATCH plus school garden intervention [Learn, Grow, Eat & Go! (LGEG)], (3) CATCH plus physical activity intervention [Walk Across Texas (WAT)], and (4) CATCH plus LGEG plus WAT (Combined). The outcome variables include student's weight status, vegetable and sugar sweetened beverage consumption, physical activity, and sedentary behavior. Parents were assessed for home environmental variables including availability of certain foods, social support of student health behaviors, parent engagement and behavior modeling.Results: Descriptive data are presented for students (n = 1369) and parents (n = 1206) at baseline. The sample consisted primarily of Hispanic and African American (53 % and 18 %, respectively) and low-income (i.e., 78 % eligible for Free and Reduced Price School Meals program and 43 % food insecure) students. On average, students did not meet national guidelines for vegetable consumption or physical activity. At baseline, no statistical differences for demographic or key outcome variables among the 4 treatment groups were observed.Conclusions: The TGEG study targets a population of students and parents at high risk of obesity and related chronic conditions, utilizing a novel and collaborative approach to program formulation and delivery, and a rigorous, randomized study design. [ABSTRACT FROM AUTHOR]

Cancer is the second leading cause of death in the U.S. Utilizing family health history in cancer prevention holds promise in lessening the burden of cancer. Nevertheless, family health history is underutilized in public health and preventive medicine. Community health workers, also known as lay health educators, are ideal candidates to offer basic cancer family history-based education and services to the general public. The authors developed the first cancer family history-based genomics training program in cancer prevention tailored for community health workers. This paper details the development and pilot testing findings of the training. Specifically, a multidisciplinary research team of geneticists, genetic counselors, health educators, community health workers, and community health worker instructors developed a 7-module, 6-hour, bilingual (English and Spanish) cancer family history-based training focusing on cancer family history-based risk assessment, lifestyle recommendations, and genetic evaluation and testing. The curriculum was based on an integrated theoretical framework, the National Comprehensive Cancer Network guidelines, the community health worker core competencies, and the 4MAT instructional model. The Texas Department of State Health Services approved and certified the curriculum with 2 delivery formats: in-person/face-to-face workshops and online training. A total of 34 community health workers completed the pilot training in person (n=17) and online (n=17) in 2018 and 2019. Participating community health workers' knowledge, attitudes, self-efficacy, and intention in delivering basic cancer family history-based genomics education and services significantly increased on the immediate post-test measures compared with their pretest data. Positive ratings and feedback were also reported by the community health workers. Findings from this pilot study suggest that wider training is warranted for educating more community health workers in the U.S. [ABSTRACT FROM AUTHOR]

Introduction Care coordination can improve healthcare quality and reduce costs. The objective of this study was to provide a qualitative understanding of the most helpful coordination services as experienced by patients receiving these services to reduce emergent hospital use. Methods Using case study methodology, we conducted focus group conversations with 51 care coordination patients and semi-structured interviews with 29 care coordinators at nine sites throughout Texas. The study team performed constant comparative analysis, beginning with start codes based on prior research. Results On average, focus group participants were 47 years old. The majority of participants reported a high school or General Equivalency Diploma level of education or less (84%), an annual income less than $14,999 (87%), and living with multiple chronic health conditions (60%). The majority (85%) of care coordinators reported backgrounds in nursing or social work. In our analysis, themes of what patients found most helpful fell under a broad social support framework (instrumental, informational, emotional, and advocacy) that care coordinators were uniquely situated to provide. Discussion Our paper adds to existing evidence by providing perspectives of patients with complex medical and non-medical needs about which care coordination services are most helpful. In this sample, patients with high needs describe reliance on professional sources, rather than their own social networks, to address several aspects of social support and to help meet non-health-related, as well as health-related needs. This can inform providers' approaches to treatment as well as program administrators' decisions about addressing and prioritizing services in care coordination programs. [ABSTRACT FROM AUTHOR]

The newly adopted Every Student Succeeds Act (U.S. Department of Education, 2015) requires that school districts use evidence-based practices for student outcomes. Evidence-based practices are practices supported by empirical research that demonstrates the effectiveness of the practice with a specific group of students. There are several evidence-based practices (e.g., picture task cards [PTC], video modeling) that teachers can implement to enhance the development of fundamental motor skills in children with autism spectrum disorder (ASD). The current study used an alternating treatment design to determine the impact of three types of motor performance instructional strategies (i.e., PTCs, ExerciseBuddy application [EB App], combination) on the motor performance of children with ASD. Six children (CA = 5 to 9 years) with ASD were purposively selected. The order of treatment was randomly selected and treatments were implemented for 15 min sessions three days a week for four consecutive weeks. Based on visual analysis of the data, the average of overlapping data between protocol conditions across participants approached 100%. Within the limitations of this investigation, no clear functional relation between PTCs, EB App, or combination instructional protocols and motor performance for children with ASD could be established. [ABSTRACT FROM AUTHOR]

BACKGROUND: Exposures to environmental contaminants can be influenced by social determinants of health. As a result, persons living in socially disadvantaged communities may experience disproportionate health risks from environmental exposures. Mixed methods research can be used to understand community-level and individual-level exposures to chemical and nonchemical stressors contributing to environmental health disparities. Furthermore, community-based participatory research (CBPR) approaches can lead to more effective interventions. OBJECTIVES: We applied mixed methods to identify environmental health perceptions and needs among metal recyclers and residents living in disadvantaged neighborhoods near metal recycling facilities in Houston, Texas, in a CBPR study, Metal Air Pollution Partnership Solutions (MAPPS). Informed by what we learned and our previous findings from cancer and noncancer risk assessments of metal air pollution in these neighborhoods, we developed an action plan to lower metal aerosol emissions from metal recycling facilities and enhance community capacity to address environmental health risks. METHODS: Key informant interviews, focus groups, and community surveys were used to identify environmental health concerns of residents. A diverse group from academia, an environmental justice advocacy group, the community, the metal recycling industry, and the local health department collaborated and translated these findings, along with results from our prior risk assessments, to inform a multifaceted public health action plan. RESULTS: An evidence-based approach was used to develop and implement neighborhood-specific action plans. Plans included a voluntary framework of technical and administrative controls to reduce metal emissions in the metal recycling facilities, direct lines of communication among residents, metal recyclers, and local health department officials, and environmental health leadership training. DISCUSSION: Using a CBPR approach, health risk assessment findings based on outdoor air monitoring campaigns and community survey results informed a multipronged environmental health action plan to mitigate health risks associated with metal air pollution. [ABSTRACT FROM AUTHOR]

An important gap in the literature is how clinicians feel about patient-centered technologies and how clinicians experience patient-centered technologies in their workflows. Our goal was to identify clinician users' perspectives on facilitators (pros) and barriers (cons) to using 1 digital texting innovation to promote family centered care during patients' hospitalizations. This qualitative study was conducted at a tertiary care center in Houston, consisting of 7 hospitals (1 academic hospital and 6 community hospitals), involving analyzation of 3 focus groups of 18 physicians, 5 advanced practice providers, and 10 nurse directors and managers, as well as a content analysis of 156 real-time alerts signaling family dissatisfaction on the nursing unit/floor. Thematic analysis methods were used. We selected these participants by attending their regularly scheduled service-line meetings. Clinician feedback from focus groups resulted in 3 themes as facilitators : (a) texting platforms must be integrated within the electronic medical record; (b) texting reduces outgoing phone calls; (c) texting reduces incoming family phone calls. Clinician feedback resulted in 3 themes as barriers : (a) best practice alerts can be disruptive; (b) real-time alerts can create hopelessness; and (c) scale-up is challenging. The analyzation of facilitators (pros) and barriers (cons) pertains only to the clinician's feedback. We also analyzed real-time alerts signaling family dissatisfaction (defined as "service recovery escalation" throughout this manuscript). The most common selection for the source of family dissatisfaction, as reflected through the real-time alerts was, "I haven't heard from physicians enough," appearing in 52 out of 156 alerts (33%). The second most common selection for the source of dissatisfaction was "perceived inconsistent or incomplete information provided by team members," which was selected in 48 cases (31%). Our findings indicate that clinicians value inpatient texting, not only for its ability to quickly relay updates to multiple family members with 1 click, but also because, when used intentionally and meaningfully, texting decreases family phone calls. [ABSTRACT FROM AUTHOR]

The article discusses the effectiveness of using the community-based participatory research (CBPR) principles with community health workers (CHW) in translating English to Spanish language CHW COVID-19 & Health Inequities Project Extension for Community Healthcare Outcomes (ECHO) program in South Texas. Other topics include the study on the effectiveness of the delivery of the CHWs of a diabetes education program.

The Butterfly Girls (BFG) Study is a culturally and developmentally appropriate online obesity prevention program for 8–10-year-old Black girls designed with key stakeholders in the Black community. This multi-methods investigation, conducted with parent–child dyads who participated in an outcome evaluation of the intervention, aimed to understand parent and child reactions to the program. We were particularly interested in understanding perceptions regarding its cultural and developmental appropriateness, relevance and acceptability. Program participation and survey data (demographics, parent and child write-in comments on process evaluation surveys) were analyzed. Participation data demonstrated high adherence in treatment and comparison groups. Descriptive statistics were calculated for survey data and highlighted the socioeconomic diversity of the sample. Post intervention surveys included two fill-in-the-blank questions for parents (n = 184 for question 1, n = 65 for question 2) and one for children (n = 32). Comments were analyzed using structured thematic analysis. The majority of the feedback from child participants was complimentary and many found the program relatable. Among the parent responses, the majority found the program to be beneficial in its educational nature and in promoting behavior change. This multi-methods analysis suggests that the BFG program was perceived as beneficial by parents while being culturally and developmentally appropriate and engaging for young Black girls, highlighting the importance of co-collaboration in program development. [ABSTRACT FROM AUTHOR]

Objective: To examine how the COVID‐19 Project ECHO program may have influenced the mental health of community health workers (CHWs) from South Texas. The program was designed around case‐based learning and mentorship to provide support to CHWs and help them gain expertise to provide services to their communities. Design: An explanatory sequential mixed methods pilot study. Sample: Fifteen CHWs who were enrolled in the program participated in this study. Measurements: The Center for Epidemiological Studies‐Depression (CES‐D) and the Perceived Stress Scale (PSS) were used to measure the differences pre‐ and post‐intervention. Qualitative description was used to explore the experiences of the participating CHWs. Results: The PSS post‐test mean (12.53) showed a statistically significant decrease from the pretest mean (17.01) (t (14 = 2.456, p =.028). The CHWs explained that the death of loved ones, feelings of isolation, and work‐related concerns influenced their mental health. CHWs expressed that the program provided them with emotional support and resources for their clients. Conclusions: The impact of the COVID‐19 pandemic on disadvantaged and medically underserved areas will be long‐lasting; therefore, the need is greater than ever for CHWs to receive mental health support and be able to connect communities with vital resources. [ABSTRACT FROM AUTHOR]

Objective: Examination of community resilience after Hurricane Harvey and -applicability of Neuman's systems model to the role of public health nurses in applying primary, secondary, and tertiary prevention strategies to communities susceptible to natural disasters. Design: Descriptive, exploratory study. Sample: A convenience sample (N = 1,470). Measurements: Hurricane Harvey Survey. Results: Respondents from seven counties in southeast Texas report previously experiencing a hurricane (80%) with no weather-related flooding (79%), adequate preparation (54%), failure to comprehend the potential severity of Hurricane Harvey (62%), damage to their homes (45%), and a 68% loss of personal belongings. Anxiety, frustration, disbelief, determination, and hopefulness were rated highest after the storm. Residents received updates from family and friends, social media, and online news reports regarding rising water, even though, in many cases, a mandatory evacuation was not officially announced. Only 35% of respondents reported being aware of resources available, possibly due to flooding or inaccessibility of typical resources (e.g., hospitals, shelters). Communicating through social networks (social media, family, and friends) provided avenues for arranging evacuations and assistance. Respondents report giving assistance to others and receiving assistance from family, friends, and their faith community. The majority of respondents reported that the community provided adequate services during the hurricane (59%), and they plan to stay in southeast Texas (70%). Conclusions: Southeast Texas residents demonstrated individual and community resilience which may be further supported with primary, secondary, and tertiary nursing interventions as illustrated by Neuman's systems model. The rise in positive emotional response traits demonstrates positive coping, which is consistent with resilience. Effective and timely communication through social networks provides an additional line of resistance to protect and promote the resilience of the community. The lack of medical resources indicates a break in the normal line of defense and an area for potential improvement with the utilization of mobile medical units to provide healthcare for areas not easily accessible during a disaster. Public health nurses are strategically positioned in the international community to lead prevention and recovery efforts by applying theory-based community interventions. [ABSTRACT FROM AUTHOR]

Immigrant rights have become increasingly contentious and partisan issues in the United States, and especially within the U.S. healthcare system. It is particularly essential to pay attention to Latinx immigrants—the largest immigrant and uninsured population in the United States. Latinx immigrants face many structural and legal challenges that may impact their biomedical healthcare access and treatment, creating a state of liminality or in-betweenness, especially when managing a chronic illness such as diabetes, hypertension, or arthritis. Using qualitative methods at a free healthcare clinic in Central Texas, the study reveals how the chronic illness narrative becomes inextricable from the immigrant narrative for this particular group, and how a unique 'dual-liminality' emerges from living with both an immigrant status and chronic condition. This study also introduces how Gloria Anzaldúa's theory of nepantla can be used to push existing understandings of migrant liminality in medical anthropology by reframing the experiences of U.S. Latinx immigrants with chronic illness as ones of opportunity. Nepantla functions as a novel theoretical lens to better understand how Latinx immigrants may regain agency in their chronic illness management and promote social change by helping others in similar situations. [ABSTRACT FROM AUTHOR]

Latino Day Laborers (LDL) experience high rates of occupational injury while navigating worksite hazards without adequate safety equipment or training. As such, LDL implement simple safety behaviors which may not reflect standardized labor safety practices. This study aims to demonstrate the validity of a scale measuring LDL safety practices. A 22-item scale was developed through qualitative analysis of interviews with LDL. We first validated our scale in a cross-sectional study with 149 LDL. After conducting exploratory and confirmatory factor analysis, a final 15-item safety practices scale emerged. Lastly, we cross-validated our scale with a second sample of 318 LDL. The EFA resulted in three distinct dimensions of safety practices: preparation safety, harm mitigation, and proactive communication. The CFA results from both samples supported a three-factor model. Our study provided evidence for a valid and reliable scale to measure the safety practices of LDL. [ABSTRACT FROM AUTHOR]

Aims: In recent years, studies have indicated that consumers of alcohol mixed with energy drink (AmED) are more likely to drink heavily and experience more negative consequences than consumers who avoid these beverages. Although researchers have identified a number of plausible hypotheses that explain how alcohol-energy drink co-ingestion could cause greater alcohol consumption, there has been no postulation about reverse causal relations. This paper identifies several plausible hypotheses for the observed associations between AmED consumption and greater alcohol consumption, and provides initial evidence for one such hypothesis suggesting that heavy drinking may be a determinant of AmED use.Method: Data collected from 511bar patrons were used to examine the plausibility of one of the proposed hypotheses, i.e., AmED is an artifact of heavy drinking. Associations between the consumption of an assortment of alcoholic beverage types and total alcohol consumption were examined at the event-level, to assess whether AmED is uniquely related with greater alcohol consumption.Results: Increased alcohol consumption was associated with greater odds of consuming most alcoholic beverage types; this association was not unique to AmED.Conclusions: Results support the overlooked hypothesis that AmED use is an artifact of heavy drinking. Thus, AmED consumption may be a consequence or marker of heavier drinking. Much of the existing research on alcoholic beverage types is limited in its ability to implicate any specific type of drink, including AmED, as a cause of increased alcohol consumption and related harm. More rigorous study designs are needed to examine causal relationships. [ABSTRACT FROM AUTHOR]

Advanced practice registered nurses are successful in improving quality outcomes and filling provider care gaps in long-term care. However, little is known about the nurse's transition to practice in this setting. A 12-month ethnography was conducted via participant-observation with nine advanced practice registered nurses in five long-term care facilities to understand practice environment influence on the nurses' transition and on the reciprocal influence of the nurse on the practice environment. Transition was fraught with uncertainty as documented by five themes: where's my authority, institutional acceptance, personal role fulfillment, provider relationships, and individual versus organizational care. These findings suggest that transition in this setting is complex, characterized by insecurity whether the individual is new to advanced practice or experienced. Transition in long-term care could be strengthened by formal programs that include clinical practice, reconceived mentorship for advanced practice registered nurses, and education designed to improve comfort and expertise with indirect care. [ABSTRACT FROM AUTHOR]

Background. The experiences of informal workers are often characterized by homelessness, social isolation, lack of access to health care, mental illness, and substance use. The aim of this study is to conduct an assessment of the health status and needs of informal workers at truck stops. Methods. This study took place at multiple Texas truck stops in 2017, where 25 informal male workers participated in a semi-structured interview and demographic survey. Recorded interviews were transcribed and coded, and a thematic analysis was conducted. Results. The primary themes were the following: (1) substance use; (2) mental illness; (3) criminal justice involvement; (4) lack of access to health care; and (5) lack of access to transportation. Conclusions. These findings support the need for health promotion programming at truck stops. Interventions at truck stops would need to be multifaceted to address the multiple layers of disenfranchisement and marginalization. [ABSTRACT FROM AUTHOR]

BACKGROUND: Parental Medicaid eligibility has been shown to be linked to positive academic and school outcomes for children. However, the impact of adult Medicaid expansion on children's school absenteeism is largely unexplored in the literature. The aim of this study was to examine whether Medicaid expansion for adults under the Affordable Care Act (ACA), affected school absenteeism of children. METHODS: This study used data from the National Survey of Children's Health 2016 to 2017 and the difference‐in‐differences method. RESULTS: The decrease in the predicted probability of missing 11 or more school days in Louisiana, after Medicaid expansion, among school‐going children from low‐income families, was greater by 18 percentage points (p =.007), as compared to the decrease in the predicted probability of missing 11 or more school days in the neighboring nonexpansion states of Texas and Mississippi. CONCLUSION: The positive impacts of Medicaid expansion are not limited to adults, but also extend to children's school absenteeism. [ABSTRACT FROM AUTHOR]

Purpose: It has been well documented that a significant number of children with developmental language disorders (DLDs) also exhibit challenging behaviors. In this study, a new intervention (Play and Language [PAL]) was developed through a research collaboration between a speech-language pathologist and a play therapist. The purpose of this clinical focus article is to describe child play therapy techniques and how these, along with early language intervention techniques, may positively impact preschool children’s general communication and behavior. Method: Students in a communication sciences and disorders program were trained to use a combination of child therapy techniques and language facilitation procedures in the PAL approach. Five preschool children, who displayed DLD and challenging behaviors, participated in a 2-week daily intensive intervention. Pre- and postintervention data for general communication and behavior skills were collected through parent report and language sample data. Student clinician and parent surveys were collected to assess the feasibility of conducting the new intervention and the parentobserved outcomes and satisfaction. Results: A majority of the children who participated in the study increased their intelligibility and number of different words. Fewer than half increased their sentence length. These same children decreased their challenging behaviors, with 11 of 14 behaviors being reduced to normal levels. All parents reported satisfaction with their child’s results. In addition, students trained to provide the intervention reported high levels of satisfaction with the training to implement PAL and that they were confident in providing the intervention techniques. Conclusion: Together, our exploratory data provide preliminary and limited evidence that combining play therapy and language facilitation techniques may improve general communication skills and decrease challenging behaviors within the same intervention. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to understand nursing leaders' experience during the pandemic. Background: COVID‐19 is a public health crisis that affects every nation in the world. Methods: Purposeful sampling was used to recruit 28 leaders in a large health care system. Data were collected via semi‐structured audiotaped interviews. Results were analysed using hermeneutic phenomenology. Results: The structure in which leaders worked was described as: from the day‐to‐day grind to derailment and from manning the hospital to manning the frontlines. Five phenomenological themes were as follows: embodied leadership, navigating differently, trusting and earning trust, being the calm voice and envisioning the future. Conclusion: Disaster policies and procedures are needed that will alleviate leadership angst, maximize nursing resources, heighten trust and enhance communications. Implications for Nursing Management: In 2020, we witnessed a previously inconceivable media and public focus on the value of nursing care. Leaders can use this pivotal moment in time as a catalyst towards securing the support needed in planning for the next pandemic. [ABSTRACT FROM AUTHOR]

In this study the authors examined how maternal health workers (MHWs) perceive the health risks of extreme heat exposure to pregnant women and fetuses. The authors conducted interviews with 12 MHWs (including midwives and doulas) in El Paso, Texas. Using qualitative analysis, the researchers identified numerous themes. Although heat was not communicated as a major health risk, participants expressed some concern with growing heat exposure and communicated standard protective measures. While all participants were familiar with some heat illness symptoms, they were generally unaware of their clients' vulnerability. MHWs' minimal heat-risk knowledge leaves pregnant women and developing fetuses at risk of preventable harm. [ABSTRACT FROM AUTHOR]

Background: Perinatal care nurses are well positioned to provide the education and support new fathers need to navigate the transition to fatherhood and to encourage positive father involvement from the earliest hours of a child's life. To effectively serve fathers in perinatal settings, it is important to understand the attitudes, beliefs, and behaviors of healthcare providers that may encourage and engage them, or alternatively alienate and discourage them. Methods: This qualitative study involved structured interviews with ten NICU and postpartum nurses from hospitals in two large Texas cities. The interview protocol was designed to elicit descriptive information about nurses' attitudes and beliefs, sense of efficacy and intention for working with fathers, as well as their father-directed behaviors. Nurses were recruited for the study using a purposive sampling approach. Interviews were conducted by telephone and lasted approximately 25 to 35 min. Data were analyzed using a qualitative descriptive approach. Results: Overall, study participants held very positive subjective attitudes toward fathers and father involvement. Nevertheless, many of the nurses signaled normative beliefs based on race/ethnicity, gender, and culture that may moderate their intention to engage with fathers. Participants also indicated that their education as well as the culture of perinatal healthcare are focused almost entirely on the mother-baby dyad. In line with this focus on mothers, participants comments reflected a normative belief that fathers are secondary caregivers to their newborns, there to help when the mother is unavailable. Conclusions: Nurse attitudes and practices that place mothers in the role of primary caregiver may be interpreted by fathers as excluding or disregarding them. Further research is needed to validate the results of this small-scale study, and to assess whether and how provider attitudes impact their practices in educating and engaging fathers in newborn care. [ABSTRACT FROM AUTHOR]

Introduction: The use of mobile health technology has the potential to increase healthcare accessibility, promote self-management, provide education materials, and support self-monitoring of biometrics. This may be of particular benefit to those living in the community with chronic neurological conditions. The purpose of this research was to characterize perspectives of individuals with brain injury or stroke, their care partners, and neuro-rehabilitation clinicians to inform the design of mobile health app-based interventions that address the need for ongoing community-based health-related professional support. Methods: Individuals with stroke or traumatic brain injury, their care partners, and clinicians were recruited from a large university hospital with a specialized neuro-rehabilitation program. Data were collected via semi-structured focus groups and were examined using descriptive statistics and content analysis. Results: Five consistent themes emerged: (a) all-in-one app with customized features; (b) communication with healthcare providers; (c) cognitive strategies; (d) app accessibility; and (e) user education. The clinician focus group reiterated these consumer focus group themes, with one additional theme: (f) logistics of clinician time and effort to provide effective app-based services to patients. Conclusions: Results have directly informed the ongoing development of a community-based mobile health app intervention, and may also inform the content and design of future mHealth technological development in this population. [ABSTRACT FROM AUTHOR]

Background: Latinx children in the United States are at high risk for nature-deficit disorder, heat-related illness, and physical inactivity. We developed the Green Schoolyards Project to investigate how green features-trees, gardens, and nature trails-in school parks impact heat index (i.e., air temperature and relative humidity) within parks, and physical activity levels and socioemotional well-being of these children. Herein, we present novel methods for a) observing children's interaction with green features and b) measuring heat index and children's behaviors in a natural setting, and a selection of baseline results.Methods: During two September weeks (high temperature) and one November week (moderate temperature) in 2019, we examined three joint-use elementary school parks in Central Texas, United States, serving predominantly low-income Latinx families. To develop thermal profiles for each park, we installed 10 air temperature/relative humidity sensors per park, selecting sites based on land cover, land use, and even spatial coverage. We measured green features within a geographic information system. In a cross-sectional study, we used an adapted version of System for Observing Play and Recreation in Communities (SOPARC) to assess children's physical activity levels and interactions with green features. In a cohort study, we equipped 30 3rd and 30 4th grade students per school during recess with accelerometers and Global Positioning System devices, and surveyed these students regarding their connection to nature. Baseline analyses included inverse distance weighting for thermal profiles and summing observed counts of children interacting with trees.Results: In September 2019, average daily heat index ranged 2.0 °F among park sites, and maximum daily heat index ranged from 103.4 °F (air temperature = 33.8 °C; relative humidity = 55.2%) under tree canopy to 114.1 °F (air temperature = 37.9 °C; relative humidity = 45.2%) on an unshaded playground. 10.8% more girls and 25.4% more boys interacted with trees in September than in November.Conclusions: We found extreme heat conditions at select sites within parks, and children positioning themselves under trees during periods of high heat index. These methods can be used by public health researchers and practitioners to inform the redesign of greenspaces in the face of climate change and health inequities. [ABSTRACT FROM AUTHOR]

Objective: To develop a questionnaire to measure food nutrition, food expenditures and time spent in food-related activities; and to assess the association between diet quality, time spent in food-related activities and food expenditures using data from a pilot study.Design: Cross-sectional study. Multiple linear regression models were used to analyse participants' survey response behaviours and the relationship between food nutritional quality and time and money expenditures.Setting: Online survey using Qualtrics software in a public university located in West Texas, USA.Participants: Faculty and staff aged 18 years and older from a public university located in West Texas, USA.Results: Combining questions from three survey instruments that collect data on food nutrition, food expenditures and time spent in food-related activities resulted in a thirty-page survey instrument. The median completion time of the survey instrument was about 30 min. Preliminary results suggest that time and money expenditures are associated with food quality but that their role is small relative to sociodemographic characteristics such as race and gender.Conclusions: Time and money expenditures are associated with food quality but their role is small relative to sociodemographic characteristics such as race and gender. [ABSTRACT FROM AUTHOR]

Purpose: Intracameral antibiotic in cataract surgery has shown level I evidence as prophylaxis for postoperative endophthalmitis. Not much is known if one should also use topical antibiotics after intracameral injection. The purpose of the study was to determine efficacy of intracameral antibiotic with and without postoperative topical antibiotic in reducing the incidence of acute endophthalmitis after cataract surgery in rural India.Methods: A.prospective comparative, non-randomized interventional study was designed in 15 rural centres in India. The study recruited 40,006 patients (n = 42,466 eyes), who underwent cataract surgery (phacoemulsification/small incision cataract surgery), and received intracameral antibiotic (cefuroxime/moxifloxacin). Postoperative topical antibiotic prescription was left to the choice of the treating physician, but they were encouraged not to use it in uneventful surgeries. Primary outcome measure was occurrence of acute clinical endophthalmitis within 6 weeks of surgery. Statistical analysis was done using STATA software v13.1 (StataCorp, Texas); P value of <0.05 was considered statistically significant.Results: In the study, 17,932 (42%) eyes received intracameral cefuroxime (ICC) and 24,534 (58%) eyes received intracameral moxifloxacin (ICM). Topical antibiotic was not prescribed to 17,855 (42%) eyes - 5723 (32%) eyes in ICC group and 12,132 (68%) eyes in ICM group. Acute clinical endophthalmitis occurred in 15 (0.035%) eyes - 1 / 3515 (0.028%) eyes and 1 / 2231 (0.045%) eyes that received and did not receive topical antibiotic, respectively. The difference in occurrence of endophthalmitis with/without topical antibiotics in each group (ICC: 0.016% and 0.017%; P = 0.958; ICM: 0.040% and 0.058%; P = 0.538) was not significant (P = 0.376).Conclusion: Supplementing intracameral antibiotic with topical antibiotic postoperatively did not impact the occurrence of acute post cataract surgery endophthalmitis in rural India. [ABSTRACT FROM AUTHOR]

Background and Aims: Between 2007 and 2016, pregnancy‐associated mortality resulting from overdose more than doubled in the United States. This study explored the circumstances surrounding maternal opioid‐related morbidity and mortality, using the life‐course theory as a sensitizing framework to examine how each participant's life‐course contributed to her substance use, relapse, recovery or overdose. Design A mixed‐methods study using semi‐structured, in‐depth face‐to‐face interviews and focus groups were conducted. Setting: Texas, United States. Participants: Women who had relapsed into opioid use or experienced a 'near‐miss' overdose and family members of women who had died during the maternal period due to opioid overdose were interviewed (n = 99). Measurements A socio‐demographic questionnaire captured participants' ethnicity, age, marital status, medical and mental health history and employment status. The Stressful Life Events Screening Questionnaire—revised (SLESQ‐R) assessed life‐time exposure to trauma. Findings Women reported histories of abuse and loss of a loved one through homicide or suicide. Participants indicated that limited social support, interpersonal conflict with their partner and unaddressed mental illness made recovery more challenging. Additionally, losing their children through the child welfare system was described as punitive and placed them at greater risk for relapse and overdose. Conclusions: A life‐course theory approach to examining maternal opioid‐related morbidity and mortality in Texas, United States reveals the complex needs of women at risk for opioid use relapse and overdose and the significant role of previous traumatic experiences. [ABSTRACT FROM AUTHOR]

Globally, 830 women die daily from preventable postpartum issues. Little research exists on health literacy's role in maternal morbidity and mortality. This study examined new moms' perception of postpartum education in Texas using the Integrated Model of Health Literacy. Twenty-one postpartum women underwent semi-structured interviews. We assessed their ability to access, understand, appraise and apply information based on postnatal education. Participants identified gaps in consistency and usability including too much information, lack of time to read and lack of cultural sensitivity especially about postpartum depression (PPD). Findings suggested a need for standardized, concise, health literate and culturally sensitive postpartum education. [ABSTRACT FROM AUTHOR]

Importance: Slowing myopia progression could decrease the risk of sight-threatening complications.Objective: To determine whether soft multifocal contact lenses slow myopia progression in children, and whether high add power (+2.50 D) slows myopia progression more than medium (+1.50 D) add power lenses.Design, Setting, and Participants: A double-masked randomized clinical trial that took place at 2 optometry schools located in Columbus, Ohio, and Houston, Texas. A total of 294 consecutive eligible children aged 7 to 11 years with -0.75 D to -5.00 D of spherical component myopia and less than 1.00 D astigmatism were enrolled between September 22, 2014, and June 20, 2016. Follow-up was completed June 24, 2019.Interventions: Participants were randomly assigned to wear high add power (n = 98), medium add power (n = 98), or single-vision (n = 98) contact lenses.Main Outcomes and Measures: The primary outcome was the 3-year change in cycloplegic spherical equivalent autorefraction, as measured by the mean of 10 autorefraction readings. There were 11 secondary end points, 4 of which were analyzed for this study, including 3-year eye growth.Results: Among 294 randomized participants, 292 (99%) were included in the analyses (mean [SD] age, 10.3 [1.2] years; 177 [60.2%] were female; mean [SD] spherical equivalent refractive error, -2.39 [1.00] D). Adjusted 3-year myopia progression was -0.60 D for high add power, -0.89 D for medium add power, and -1.05 D for single-vision contact lenses. The difference in progression was 0.46 D (95% CI, 0.29-0.63) for high add power vs single vision, 0.30 D (95% CI, 0.13-0.47) for high add vs medium add power, and 0.16 D (95% CI, -0.01 to 0.33) for medium add power vs single vision. Of the 4 secondary end points, there were no statistically significant differences between the groups for 3 of the end points. Adjusted mean eye growth was 0.42 mm for high add power, 0.58 mm for medium add power, and 0.66 mm for single vision. The difference in eye growth was -0.23 mm (95% CI, -0.30 to -0.17) for high add power vs single vision, -0.16 mm (95% CI, -0.23 to -0.09) for high add vs medium add power, and -0.07 mm (95% CI, -0.14 to -0.01) for medium add power vs single vision.Conclusions and Relevance: Among children with myopia, treatment with high add power multifocal contact lenses significantly reduced the rate of myopia progression over 3 years compared with medium add power multifocal and single-vision contact lenses. However, further research is needed to understand the clinical importance of the observed differences.Trial Registration: ClinicalTrials.gov Identifier: NCT02255474. [ABSTRACT FROM AUTHOR]

Objective: There are concerns that some non-profit organisations, financed by the food industry, promote industry positions in research and policy materials. Using Freedom of Information (FOI) requests, we test the proposition that the International Life Sciences Institute (ILSI), one prominent non-for profit in international health and nutrition research, promotes industry positions.Design: U.S. Right to Know filed five FOI from 2015 to 2018 covering communications with researchers at four US institutions: Texas A&M, University of Illinois, University of Colorado and North Carolina State University. It received 15 078 pages, which were uploaded to the University of California San Francisco's Industry Documents Library. We searched the Library exploring it thematically for instances of: (1) funding research activity that supports industry interests; (2) publishing and promoting industry-sponsored positions or literature; (3) disseminating favourable material to decision makers and the public and (4) suppressing views that do not support industry.Results: Available emails confirmed that ILSI's funding by corporate entities leads to industry influence over some of ILSI activities. Emails reveal a pattern of activity in which ILSI sought to exploit the credibility of scientists and academics to bolster industry positions and promote industry-devised content in its meetings, journal and other activities. ILSI also actively seeks to marginalise unfavourable positions.Conclusions: We conclude that undue influence of industry through third-party entities like ILSI requires enhanced management of conflicts of interest by researchers. We call for ILSI to be recognised as a private sector entity rather than an independent scientific non-profit, to allow for more appropriate appraisal of its outputs and those it funds. [ABSTRACT FROM AUTHOR]

Infancy and toddlerhood are critical stages for the development of habits that can lead to future obesity, and caregivers have an important influence on these habits. We conducted this qualitative semistructured interview study to explore the feeding practices of Latinx mothers of young children who are at risk for childhood obesity in order to identify targets for obesity prevention. We interviewed Latinx mothers (N = 14) of a child ages 6–18 months with a weight‐for‐length ratio > 85th percentile at the time of recruitment. Two researchers independently read through the interviews, identified sections of the interviews pertaining to feeding, and used constant comparative methods to identify the following common themes: mothers overwhelmingly reported permissive feeding styles, driving overfeeding and frequent night‐time feeding. Mothers expressed some difficulty with transitioning to solid foods and reported desiring to feed their child healthy foods by minimizing juice and giving vegetables. Paediatricians and WIC staff were viewed by mothers as trustworthy sources of nutrition information. Most identified a connection between their child's weight and diet, but many lacked the insight or capacity to change their current practices. The mothers in our study provide insight into factors that may predispose young children to obesity and thus potential avenues to support these families. Healthcare providers can better serve them by giving clear, actionable advice on healthy feeding practices for their child, while understanding constraints that may make healthy habits difficult to implement. Paediatricians should be honest about their child's weight status early on to allow time for intervention. [ABSTRACT FROM AUTHOR]

Background: Human milk is the preferred source of infant nourishment; yet, acceptance of human milk as the norm for infant feeding is debated. In the United States there is a disparity in breastfeeding rates, which are significantly lower in African Americans compared to Whites. Multiple variables appear to influence breastfeeding, including the male partner. Objectives: To assess and compare breastfeeding exposure, attitude, and knowledge between African American and White college males with no biological children. A second objective was to explore the relationship between breastfeeding variables and educational attainment, academic major, and sibling presence. Methods: A subset of responses from a larger cross-sectional survey were analyzed. African American and White collegiate males aged 18–40 years without biological children were included in the study. The questionnaire included demographic, exposure, attitude, and knowledge items. Results: A total of 117 African American and 713 White males were included and represented all academic colleges on campus. African American participants documented less exposure to breastfeeding, a more positive attitude, and similar poor knowledge scores compared to their White counterparts. Sibling presence was linked with exposure, and exposure was linked to attitude. Both African American and White science majors scored higher on all factors than humanities or business majors. Conclusions for Practice: Breastfeeding exposure influences males' attitudes toward breastfeeding. Future research should consider types of exposure to identify the sources most influential. Furthermore, tailoring breastfeeding interventions to increase exposure and knowledge in core wellness courses may improve attitudes and social acceptance among collegiate males. [ABSTRACT FROM AUTHOR]

Background: Among Latinas with breast cancer, residence in an ethnic enclave may be associated with survival. However, findings from prior studies are inconsistent.Methods: The authors conducted parallel analyses of California and Texas cancer registry data for adult (aged ≥18 years) Latinas who were diagnosed with invasive breast cancer from 1996 to 2005, with follow-up through 2014. Existing indices applied to tract-level 2000 US Census data were used to measure Latinx enclaves and neighborhood socioeconomic status (nSES). Multivariable Cox proportional hazard models were fit for all-cause and breast cancer-specific survival adjusted for year of diagnosis, patient age, nativity (with multiple imputation), tumor stage, histology, grade, size, and clustering by census tract.Results: Among 38,858 Latinas, the majority (61.3% in California and 70.5% in Texas) lived in enclaves. In fully adjusted models for both states, foreign-born women were found to be more likely to die of breast cancer and all causes when compared with US-born women. Living in enclaves and in neighborhoods with higher SES were found to be independently associated with improved survival from both causes. When combined into a 4-level variable, those in low nSES nonenclaves had worse survival for both causes compared with those living in low nSES enclaves and, in the all-cause but not breast cancer-specific models, those in high nSES neighborhoods, regardless of enclave status, had improved survival from all causes.Conclusions: Applying the same methods across 2 states eliminated previously published inconsistent associations between enclave residence and breast cancer survival. Future studies should identify specific protective effects of enclave residence to inform interventions. [ABSTRACT FROM AUTHOR]

Modern communities face escalating threats from natural disasters. Thus, the resilience of incident management teams (IMTs) during adverse events becomes crucial to protect lives and physical systems. However, prior studies have only partially highlighted factors related to IMT resilience. To provide a holistic understanding of the resilience of the IMTs, this study conducted semi-structured interviews with 10 experienced IMT personnel during Hurricane Harvey. Thematic analysis revealed six characteristics of resilient IMTs during a hurricane event: (i) establishing a common operating picture, (ii) adopting and adapting plans and protocols, (iii) proactive, re-prioritizing, and unconventional decision-making, (iv) enhancing resourcefulness and redundancy, (v) learning for improved anticipation and response readiness, and (vi) inter-organisational relationship to promote IMT functions. As an empirical investigation of the resilience of the IMTs, the findings inform future endeavours for developing incident information technologies and strategies to harmonise pre-established plans with adaptive actions in the field and fostering capabilities to learn from incidents. Practitioner summary: Resilient incident management teams establish a common operating picture; effectively adopt and adapt plans and protocols; make decisions in an unconventional and anticipatory fashion; constantly re-prioritize goals and tasks; enhance resourcefulness and redundancy; continuously learn skills for improved anticipation and response readiness; and exhibit good inter-organisational coordination and planning skills. [ABSTRACT FROM AUTHOR]