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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]

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]

Approximately one-third of the veteran population suffers from post-traumatic stress disorder, a mental illness that is often co-morbid with social anxiety disorder. Student veterans are especially vulnerable as they struggle to adapt to a new, less structured lifestyle with few peers who understand their difficulties. To support mental health experts in the treatment of social anxiety disorder, this study utilized machine learning to detect anxiety in text transcribed from interviews with patients and applied topic modeling to highlight common stress factors for student veterans. We approach our anxiety detection task by exploring both deep learning and traditional machine learning strategies such as transformers, transfer learning, and support vector classifiers. Our models provide a tool to support psychologists and social workers in treating social anxiety. The results detailed in this paper could also have broader impacts in fields such as pedagogy and public health.1 [ABSTRACT FROM AUTHOR]

Alzheimer's disease (AD) is a devastating illness in elderly individuals, that currently has no known cure. Causal genetic factors only account for 1-2% of AD patients. However, other causal factors are still unknown for a majority of AD patients. Currently, multiple factors are implicated in late-onset AD, including unhealthy diet, physical inactivity, traumatic brain injury, chronic conditions, epigenetic factors, and environmental exposures. Although clinical symptoms of dementia are common to all races and ethnic groups, conditions that lead to dementia are different in terms of lifestyle, genetic profile, and socio-economic conditions. Increasing evidence also suggests that some elderly individuals age without cognitive impairments in their 60-90s as seen in rural West Texas, while some individuals progress with chronic conditions and cognitive impairments into their 60s. To understand these discriminations, we assessed current literature on demographic features of health in rural West Texas. This paper also outlines our initiated clinical study with a purpose of understanding the factors that allow some individuals to live without cognitive impairments at the age of 60-90 years, whereas others develop deficits in cognitive function around or above 60 years. Our ongoing study hopes to determine the factors that delay aging in some individuals by investigating various aspects including genetics, epigenetics, ethnicity, biology, culture, and lifestyle. This will be achieved by gathering information about participants' ethnographic profiles, cognitive assessments, blood-profiles, brain scans, and blood-based genomic analyses in relation to lifestyle. The outcomes of our study will provide insights into healthy aging in rural West Texas. [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]

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]

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]

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]

Background and Purpose. Internationalization is expanding its presence in higher education in the United States. Reflecting this trend that includes incorporating global perspectives in the curricula, physical therapist education programmes increasingly offer international opportunities such as International Service-Learning (ISL) to their students. Service-learning, a teaching strategy that integrates community service with structured learning activities, has gained broad acceptance in health professions education including physical therapy, and is therefore the focus of this paper. The specific purposes of this paper were to identify and analyse the commonalities that existed among established ISL programmes within physical therapist education programmes in terms of structures and processes, and to consider its broader implications for physical therapist education. Methods. A descriptive, exploratory study was performed using grounded theory. Snowball and purposive, theoretical sampling yielded 14 faculty members with experience in international service, international learning or ISL in physical therapist education programmes. Faculty were interviewed by phone. Interview transcriptions and course documents were analysed applying grounded theory methodology. Data from eight programmes which met the operational definition of established ISL were used to address the purposes of this paper. Results. Five phases of establishing an ISL programme were identified: development, design, implementation, evaluation, and enhancement. Although no single model exists for ISL in physical therapist education; commonalities in structures and processes were identified in each phase. However, attention to service objectives and outcomes is lacking. Conclusions. While analysis revealed that each programme shared commonalities and demonstrated differences in structures and processes compared with the other programmes, the study demonstrated a general lack of focus on formal community outcomes which raises ethical concerns. Future research and dialogue is warranted to explore ethics and good practice in ISL and other global health initiatives in physical therapy. This study may facilitate reflections and creative solutions by individual faculty and the profession. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

This paper examines the association between childhood trauma and gang membership. Specifically, this study compares histories of potentially traumatic events as assessed by the Childhood Trauma Questionnaire among a street-recruited random sample of Mexican American male gang members and a matched comparison group of delinquent youth. The gang and delinquent youth samples are then compared to normative samples of adolescent male psychiatric inpatients and male undergraduates. The findings show that gang members generally report experiencing lower levels of childhood trauma compared to those in the sample of delinquent youth. In fact, gang members' levels of childhood trauma more closely resemble those of the undergraduate sample. However, this analysis suggests that gang membership, and delinquency in general, may be associated with physical neglect. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Messages: Childhood trauma prevalence and delinquent youth comparison groups are rare in gang research., Childhood trauma rates (emotional, physical and sexual abuse) were found to be lower among a sample of gang-involved Mexican American males compared to non-gang delinquent youth., Levels of physical neglect should be assessed for in youth regardless of gang membership., Future research should focus on family-level sociocultural interventions that may be beneficial for gang-involved youth and trauma-informed interventions that may be particularly beneficial for delinquent youth in low-income communities. [ABSTRACT FROM AUTHOR]

Objectives: Following decades of mainstream bipartisan support, contraception has reemerged as a controversial political issue in the United States. At the same time, opposition to abortion has intensified. State legislatures across the country have enacted highly visible policies limiting access to family planning. Perhaps the most striking example occurred in 2011 in Texas, when legislators instituted unprecedented requirements on abortion providers and cut public funding for contraception by two thirds. Yet, despite popular interpretations of this phenomenon as a simple byproduct of increasing partisan divisions, little is understood about the factors underlying such policy shifts.Study Design: We fit Bayesian ideal-point models to analyze correlation patterns in record-vote data in the Texas House of Representatives in the 2003 and 2011 Legislatures. Both sessions had large Republican majorities and saw the passage of restrictive abortion bills, but they differed markedly with respect to public funding for contraception.Results: We demonstrate that variation in voting on family-planning issues cannot be fully attributed to partisanship in either session. However, the politics of abortion and contraception have converged over time, and - at least for Democrats - the correlation between constituency characteristics and voting behavior on family-planning legislation is markedly higher in 2011 than in 2003. These shifts have been partly driven by legislators from high-poverty, majority Latino districts near the US-Mexico border.Conclusions: Recent dramatic shifts in family-planning policy go beyond simple partisan divisions. As the politics of abortion and contraception have converged, policies that are increasingly hostile to reproductive health and that disproportionately affect low-income minority women have emerged.Implications: Recent shifts in family-planning policy restrict women's access to contraception and abortion, yet little research has examined why such shifts are occurring. This paper analyzes factors underlying voting behavior on restrictive policies in Texas. Identification of these factors helps us to better understand the current political climate surrounding our field. [ABSTRACT FROM AUTHOR]

This paper examines relationships between body weight, religion, and gender while controlling for relevant covariates and body mass index (BMI), a measure of physical/biological body type. Using data from the 2004 Survey of Texas Adults ( n = 1,504), we present results of ordered logistic regression models which indicate that religious factors work distinctly for men and women when controlling for BMI. While church attendance is associated with lower odds of overweight perceptions among women, it is religious salience that is associated with lower odds of self-reported excess weight in men. Implications for research which associates religious and physiological factors are discussed. [ABSTRACT FROM AUTHOR]

Brief and age-appropriate measures of trauma-related symptoms are useful for identifying children in need of clinical services. The current study examines the psychometric properties of the 23-item Child's Reaction to Traumatic Events Scale-Revised (CRTES-R). The CRTES-R includes subscales assessing hyperarousal, avoidance and intrusion. To date, no studies have examined the psychometric properties of this revised measure or cross-cultural differences in its factor structure. Two samples of (a) children (ages 6-21) who had experienced a hurricane in the USA or Grenada ( N = 135), and (b) Ugandan children (ages 8-17) who had experienced a variety of traumatic events ( N = 339) completed the CRTES-R in English or Lugandan. Confirmatory factor analysis supported an empirically adjusted model with three modified latent factors in both the English (χ/ df = 1.34, CFI = .90, RMSEA = .05) and Lugandan samples (χ/ df = 1.45, CFI = .93, RMSEA = .04). Although the analysis supported separate hyperarousal, avoidance and intrusion subscales, the items that loaded on each factor differed from the original CRTES-R subscales. The English version of the CRTES-R showed good concurrent validity with the Kauai Recovery Index measure of trauma symptoms. Those using the CRTES-R to assess children's experiences of the different symptom types should consider using the empirically-derived subscales described in this paper; however, those who wish to capture a broad spectrum of PTSD symptoms should consider using all the original CRTES-R items and calculating a total score. [ABSTRACT FROM AUTHOR]

The quality and quantity of illicit methamphetamine has recently increased due to introduction of a new precursor, 1-phenyl-2-propanone (P2P). This paper updates the problems associated with methamphetamine use. Methamphetamine-using clients ( N = 222) entering a Texas program participated in computer-assisted interviews in 2010 and 2011 about routes of administration, other drugs used, severity of dependence, mental and physical health, perceived risks and benefits of use, family history, and abuse and neglect experienced as children and adults. Special needs of this population include therapies for trauma, gender-focused counseling, safe housing, and prevention messages to discourage use of the drug. [ABSTRACT FROM AUTHOR]

Military service itself has been documented as a positive turning point in enlistees' life trajectories. However, for the veteran population with psychiatric disorders, resources other than the GI Bill, such as supported education psychiatric rehabilitation programs, may be as important or more important to their post-service outcomes. Methods: This paper examines new clinical developments in supported education for veterans with PTSD and related disorders, utilizing systematic literature review methodology. Results: Five reports were retrieved which provide psychiatric rehabilitation practice guidance or examine supported education programs targeted to veterans in the current combat era who are suffering from PTSD or polytrauma. Level of evidence is predominantly descriptive. Conclusions and Implications for Practice: While the extant literature suggests applicability of available supported education models to the prevalent mental disorders in this current veteran population, high quality studies are needed to investigate their effects for this population. Current trends in military mental health programs and the civilian recovery movement suggest that supported education programming for veterans of this current combat era must incorporate resilience theory-based concepts and approaches and avoid diagnostically-driven and restrictive eligibility criteria. [ABSTRACT FROM AUTHOR]

This paper describes HIV testing behaviors among undocumented Central American immigrant women living in Houston, Texas, USA. Respondent driven sampling was used to recruit participants for an HIV behavioral survey. HIV testing items included lifetime history of testing, date and location of the most recent test, and reason for testing. Multivariate logistic regression was used to assess the demographic, behavioral, and structural characteristics associated with testing. The lifetime prevalence of HIV testing was 67%. Half of those who tested did so within the past 2 years and almost 80% received their most recent test in a healthcare setting. The primary reason for testing was pregnancy. Lifetime testing was associated with being from Honduras, having over a sixth grade education, having a regular healthcare provider, and having knowledge of available healthcare resources. Our results suggest that expanding access to healthcare services may increase the prevalence of HIV testing in this population. [ABSTRACT FROM AUTHOR]

Findings from previous research linking sedentary time with cardiometabolic risk factors and body composition are inconsistent, and few studies address population groups most vulnerable to these compromising conditions. The purpose of this paper was to investigate the relationship of sitting time to cardiometabolic risk factors and body composition among African American women. A subsample of African American women (N = 135) completed health and laboratory assessments, including measures of blood pressure, resting heart rate, cholesterol, triglycerides, glucose, body mass index, body fat, sitting time, and demographics. Simultaneous, adjusted regression models found a positive association between weekend sitting time and glucose and an inverse association between weekly sedentary time and cholesterol (ps < .05). There were no significant associations between sedentary behavior and body composition. The unexpected relationship between sedentary time and cholesterol suggests that the relationship of sedentary behavior to cardiometabolic risk factors may depend on existing characteristics of the population and measurement definition of sedentary behavior. Results suggest distinctly different relationships between weekend and weekday sitting time, implicating a need for careful measurement and intervention that reflects these differences. [ABSTRACT FROM AUTHOR]

We sought to determine whether computerized physician order entry (CPOE) improves the induction agent turnaround time on the labor and delivery unit (L&D) compared with paper-based order entry (PBOE). We conducted a retrospective study of singleton, term pregnancies admitted to L&D for induction of labor. Outcomes of women who delivered 3 months before or 3 months after universal CPOE implementation were compared including induction agent turnaround time. The induction agent turnaround time was significantly shorter in the CPOE group ( N = 83) compared with PBOE group ( N = 71) [71 (range 8 to 411) versus 100 (2 to 442) minutes, P = 0.004]. There were no differences in cesarean section rate or length of hospital stay. After controlling for time of day of induction, induction agent, and type of order entry, CPOE continued to significantly decrease the induction agent turnaround time by 25 minutes ( P = 0.042). CPOE improved the process of induction of labor and efficiency of care of pregnant women. [ABSTRACT FROM AUTHOR]

Although we know a great deal about the percentage of youth who drink alcohol, we know very little about the specific brands they choose to drink. This information gap needs to be addressed if public health officials are to develop more effective interventions. Unfortunately, there are no national youth surveys that collect data on alcohol brand consumption. In this paper, we describe the development and pilot testing of what we believe to be the first comprehensive, Internet-based youth survey of brand-specific alcohol use. We used online advertising in 3 U.S. cities to recruit a convenience sample of 241 respondents, ages 16 to 18 years. We used Craigslist, a network of online communities that features local classified advertisements, to recruit the sample. We used SurveyGizmo, an online software program for designing Internet surveys, collecting data, and performing basic analysis, to survey these respondents about their brand-specific alcohol consumption patterns. The survey instrument assessed each respondent's 30-day drinking history, including the frequency of consumption for each alcohol brand. Using Internet survey technology, we were able to collect information on 366 brands and still have respondents complete the instrument quickly and easily. The total number of brands consumed in the past 30 days ranged from 1 to 18, with a median of 4 brands. The top 5 brands consumed were beer brands, as were eleven of the top 15 brands. The remaining 4 brands in the top 15 included 3 brands of flavored alcoholic beverages and 1 brand of mixed drink. Among the top 15 alcohol brands consumed during heavy drinking episodes were 8 brands of beer, 4 brands of flavored alcoholic beverages, 2 brands of wine, and 1 brand of mixed drink. This pilot study helps establish the feasibility of including brand-specific questions on federal or other national youth alcohol surveys. [ABSTRACT FROM AUTHOR]

The national Demonstration to Maintain Independence and Employment (DMIE) projects examined whether providing comprehensive and coordinated health and employment services could help people with significant mental, physical and/or chronic health issues remain employed and independent of government benefits. Four states implemented interventions using different models that shared a person-centered approach. This paper describes how DMIE interventions were defined and implemented, compares models developed by states, and identifies factors that facilitated and/or limited their success. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of an evaluation of the psychometric properties of the Health Beliefs Related to Cardiovascular Disease Scale designed to measure beliefs related to cardiovascular disease risk and diet and exercise in adults with diabetes. Background. Heart attack and stroke are 2-4 times more common among adults with diabetes than those without diabetes. To reduce this risk for patients with diabetes, understanding beliefs about cardiovascular disease risk and risk-reduction strategies is important. Methods. Item development for the 25-item self-report Likert scale was guided by literature review, expert panel review and focus-group feedback. It consists of four subscales, measuring four constructs of the Health Belief Model: perceived susceptibility and severity of cardiovascular disease and benefits and barriers to diet and exercise. A convenience sample of 178 adults with self-reported type 2 diabetes completed the survey between August 2006 and March 2007; 42 participants completed it again 2-3 weeks later to evaluate test-retest reliability. Results. The instrument has more than one dimension, with the best fit identified using a two-factor model specifying the Benefits and Susceptibility subscale items, rather than the four-factor solution as predicted. The Susceptibility and Benefits subscales demonstrated stable factor structure and acceptable reliability (a = 0.93 and a = 0.82 respectively). The Barriers and Severity items demonstrated unstable factor structure and poor internal consistency (a = 0.70 and a = 0.61 respectively). Conclusion. Only the Susceptibility and Benefits subscale items can be used in their current form. The Barriers and Severity items need further refinement including revised wording with clearer focus and evaluation with a larger, more diverse sample. [ABSTRACT FROM AUTHOR]

A medical statistician's routine professional activities are likely to have important ethical consequences. This is due in part to the fact that good medical practice and scientifically valid medical research both require as precursors high quality statistical design and data analysis. In this paper I discuss various ethical issues that I have encountered while working as a biostatistician at M.D. Anderson Cancer Center. I describe particular experiences and the ethical issues involved. Topics include medical decision making, benefit-harm trade-offs, safety monitoring, adaptive randomization, informed consent, and publication bias. [ABSTRACT FROM AUTHOR]