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Background: Cardiometabolic risk factors are related to the early onset of chronic health conditions. Purpose: To identify factors associated with perceptions about the severity of three interrelated cardiometabolic risks (i.e., high blood pressure, obesity, and cardiovascular disease) among U.S. college students. Methods: Data were analyzed from 1,361 college students using an internet-delivered survey. Linear regression models were fitted. Primary independent variables of interest were sex and cigarette smoking status. Results: Relative to nonsmokers, smokers perceived high blood pressure (B = -0.09, P = 0.001), obesity (B = -0.12, P < 0.001), and cardiovascular disease (B = -0.12, P < 0.001) to be significantly less severe. Across models, females perceived all three cardiometabolic risk factors to be more severe (P < 0.005). Relative to non-Hispanic whites, Hispanic and Asian/Pacific Islander students perceived all three cardiometabolic risk factors to be less severe (P < 0.002). Compared to normal weight students, overweight (B = 0.41, P = 0.039) and obese (B = -0.72, P < 0.001) students reported higher severity perceptions about obesity only. Discussion: There are discordances between perceived severity of interrelated cardiometabolic risks among college students by personal factors. Translation to Health Education Practice: Smoking prevention and cessation interventions are needed to educate college students about cardiometabolic risks associated with cigarette smoking, especially among male and minority students.

Background: The association of physical fitness with cognitive function in children and adolescents is unclear. The purpose of this ecological study was to describe the association between academic achievement, body mass index (BMI), and cardiovascular fitness (CVF) in a large sample of elementary, middle, and high school students in Texas. Methods: FITNESSGRAM® results for 2,550,144 students were matched with standardized composite academic test (TAKS) results from 2008 to 2009. Analyses were conducted on the percent of students meeting TAKS standards by BMI and CVF quintiles. Analyses of variance with Tukey adjustment examined differences between the most favorable 5th quintile (referent) and all other quintiles. Results: The prevalence of students meeting the TAKS standard was significantly higher in the highest fitness category for BMI and CVF compared to all other categories, regardless of sex or grade category (p?< 0.05). Linear modeling suggested a 5% increase in the prevalence of students meeting healthy BMI and CVF standards would result in a 2.25% and 0.65% increase in the prevalence of students meeting the TAKS standard (both p?< 0.05). Conclusion: Findings suggest a healthy BMI and CVF are associated with higher academic achievement, and the need for additional research examining the role of potential confounders and/or effect modifiers longitudinally.

Background: The US–Mexico border is a medically underserved region where survival disparities have been observed in adults diagnosed and treated for various malignancies. Studies examining survival disparities among children living in this region and diagnosed with cancer are lacking. The objective of this study was to evaluate the impact of border residence on survival among children with acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), and living near the Texas–Mexico border at the time of their diagnosis. The authors hypothesized that this group experiences inferior survival compared with patients with childhood leukemia living in nonborder areas. Methods: The authors conducted a retrospective survival analysis leveraging data from the Texas Cancer Registry. The study included patients aged birth to 19 years who were diagnosed with ALL or AML between 1995 and 2017. Cox proportional hazards models were used to evaluate the factors associated with the risk of death. Overall survival estimates were calculated using Kaplan–Meier methods. Results: During the study period, there were 6002 children diagnosed with ALL and 1279 diagnosed with AML. Inferior 5‐year overall survival was observed among children with ALL living along the border region compared with those living in nonborder areas (77.5% vs. 85.8%). In adjusted models, children with ALL living along the border experienced a 30% increased hazard of death versus children living in nonborder areas. In contrast, for children with AML, survival estimates did not vary by border versus nonborder residence. Conclusions: Living along the border was associated with inferior survival among children with ALL, but not among children with AML. Additional studies are urgently needed to identify the factors driving these disparities to effectively design multilevel interventions and influence state and national cancer control programs. The US–Mexico border is a medically underserved region of the United States in which cancer disparities have been observed for adults. In this work, the authors describe survival disparities observed in children diagnosed with leukemia living along the Texas–Mexico border region. [ABSTRACT FROM AUTHOR]

Risk factors for pediatric brain tumors are largely unknown. Identifying spatial clusters of these rare tumors on the basis of residential address may provide insights into childhood socio-environmental factors that increase susceptibility. From 2000–2017, the Texas Cancer Registry recorded 4305 primary brain tumors diagnosed among children (≤19 years old). We performed a spatial analysis in SaTScan to identify neighborhoods (census tracts) where the observed number of pediatric brain tumors was higher than expected. Within each census tract, the number of pediatric brain tumors was summed on the basis of residential address at diagnosis. The population estimate from the 2007–2011 American Community Survey of 0- to 19-year-olds was used as the at-risk population. p-values were calculated using Monte Carlo hypothesis testing. The age-standardized rate was 54.3 per 1,000,000. SaTScan identified twenty clusters, of which two were statistically significant (p < 0.05). Some of the clusters identified in Texas spatially implicated potential sources of environmental risk factors (e.g., proximity to petroleum production processes) to explore in future research. This work provides hypothesis-generating data for further investigations of spatially relevant risk factors of pediatric brain tumors in Texas. [ABSTRACT FROM AUTHOR]

This cross-sectional ecological study examined the relationship between neighborhood-level standard occupational groups in the USA and COVID-19 vaccine uptake using 774 census tract data, each consisting of approximately 1600 housing units. The neighborhood-level COVID-19 vaccination uptake data were retrieved from Harris County Public Health, Harris County, Texas. The standard occupational group data were from the US Census Bureau. We calculated the incidence rate ratios (IRRs) for vaccine uptake using bivariate and multivariable Poisson regression models. In the adjusted models, we found that the healthcare practitioner/technician (IRR: 1.008; 95% CI: 1.003–1.014; p = 0.001), business/management/legal (IRR: 1.011; 95% CI: 1.008–1.013; p < 0.001), computer/engineering/life/physical/social science (IRR: 1.018; 95% CI: 1.013–1.023; p < 0.001), and arts/design/entertainment/sports/media (IRR: 1.031; 95% CI: 1.018–1.044; p < 0.001) occupational groups were more likely to have received the full regimen of a COVID-19 vaccine. On the contrary, the building/installation/maintenance/repair (IRR: 0.991; 95% CI: 0.987–0.995; p < 0.001), construction/extraction/production (IRR: 0.991; 95% CI: 0.988–0.995; p < 0.001), transportation/material moving (IRR: 0.992; 95% CI: 0.987–0.997; p = 0.002), food preparation/serving related (IRR: 0.995; 95% CI: 0.990–0.999; p = 0.023), and personal care/services (IRR: 0.991; 95% CI: 0.985–0.998; p = 0.017) groups were less likely to have received the complete dose of a COVID-19 vaccine. White-collar workers were more likely to be vaccinated than blue-collar workers. We adjusted for age, sex, and race/ethnicity in the multivariable analysis. The low vaccine uptake among certain occupational groups remains a barrier to pandemic control. Engaging labor-centered stakeholders in the development of vaccination interventions may increase uptake. [ABSTRACT FROM AUTHOR]

Objectives: Lack of access to timely, accurate, and linguistically appropriate COVID-19 information has complicated the dissemination of evidence-based information and contributed to vaccine hesitancy among racial and ethnic minority groups in the United States. We developed community events that provided outreach, education, and access to COVID-19 vaccination to overcome vaccine hesitancy in these communities. Methods: Using spatial analysis techniques, we identified 3 communities with low vaccine uptake in Houston, Texas, in fall 2021; engaged 20 stakeholders from these communities via 4 focus groups to understand barriers to vaccination; and developed and implemented 3 COVID-19 vaccine education and outreach events tailored to the needs of these communities in January–March 2022. We used program evaluation surveys to assess attendee characteristics and satisfaction with the events. Vaccinated attendees also completed surveys on what motivated them to get vaccinated. Results: Two communities were predominantly Hispanic, and the third had an equal number of Black and Hispanic residents. Based on community stakeholder input, the study team organized 2 health fairs and 1 community festival featuring dialogue-based COVID-19 vaccine engagement in January and March 2022. Across the 3 events, a total of 865 attendees received COVID-19 education and 205 (24.0%) attendees received a COVID-19 vaccine or booster. Of 90 attendees who completed program evaluation surveys, 81 (90%) rated the outreach event as good or excellent. Of 145 attendees who completed postvaccination surveys, 132 (91%) endorsed ≥1 key program feature as motivating them to either get vaccinated or vaccinate their child that day. Conclusion: Community outreach events are important strategies for disseminating information, building trust, and facilitating COVID-19 vaccine uptake. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to review common natural disasters in Texas, along with their health effects on affected populations, in order to understand the benefit of integrating disaster research efforts into emergency response systems. The topic of natural disasters is important to address because many types of disasters in Texas are becoming more common or more intense. When disasters strike, all populations within the geographic area of impact feel the effects. Of the consequences following a disaster, the multitude of health effects are one of the most pressing to address. Immediate impacts include physical injuries, such as drownings and burns. Intermediate impacts include communicable diseases and starvation. Long-term impacts include chronic diseases and mental health disorders. To fully investigate these health effects, there needs to be a robust method of integrating disaster epidemiological studies into the immediate disaster emergency response. Disaster emergency response encompasses the actions of government and independent entities to provide immediate relief, such as provision of health services and allocation of resources, to groups and individuals impacted by natural disasters. Integration of disaster epidemiological research into the disaster emergency response could help fill in current gaps in knowledge, such as the long-term health effects of natural disasters on chronic disease and child development. [ABSTRACT FROM AUTHOR]

Texas has the highest rates of hepatocellular carcinoma (HCC) in the United States. Exposure to toxicants may play a role in liver disease. Several mechanisms of arsenic carcinogenesis have been proposed, however, the evidence in human populations is limited to associations between HCC and ingestion of arsenic-contaminated drinking water. Through an ecological study, we examined associations between ambient arsenic and HCC incidence rates. Primary outcome was HCC incidence rates based on Texas Cancer Registry (TCR) data. Primary exposure of interest was the simulated census-tract level estimate of arsenic exposure concentration (EC) from the U.S. Environmental Protection Agency 2011 National Air Toxics Assessment (NATA). We analyzed the association between the arsenic EC and HCC using the negative binomial Poisson regression model separately for six study groups that were based on race/ethnicity and sex. We adjusted the main analyses for selected characteristics. Texas has 5265 census tracts and TCR reported 18,235 new ≥20 years old HCC diagnoses between 2007 and 2015. We observed significant differences along racial-ethnic and sex groups while accounting for socioeconomic deprivation, urban/rural residency, and senior residents' health insurance status. Census tracts with the highest arsenic EC had elevated rates of HCC among NH black men (Quintile 5 vs. Quintile 1: IRR = 2.18, 95% CI: 1.66–2.86), NH black women (Quintile 5 vs. Quintile 1: IRR = 1.72, 95% CI: 1.33–2.22) and NH white men (Quintile 5 vs. Quintile 1: IRR = 1.38, 95% CI: 1.24–1.54). The associations in the remaining study groups were either inconsistent or attenuated. Our finding suggests a potential inhalation pathway for the Arsenic-HCC association; however, the ecological nature of our study precludes the interpretation of a causal link between exposure to aerial arsenic and HCC. This finding needs to be further examined in cohort studies. • Arsenic in the air may contribute to increase in liver cancer diagnosis. • Neighborhood concentration of arsenic in air varies across racial-ethnic groups. • Neighborhoods with highest arsenic concentration had elevated rates of HCC. • Disparity along racial-ethnic and sex lines for the arsenic-HCC association. • A potential inhalation pathway for the Arsenic-HCC association. [ABSTRACT FROM AUTHOR]

In an effort to understand factors influencing the implementation and outcomes of the Safe Routes to School (SRTS) program in Texas, interviews were conducted in 2014 with 34 community- and state-level stakeholders involved in the 2007 SRTS grant program. Participants were asked a series of multiple-choice and open-ended questions about SRTS program planning, implementation, and sustainability. Transcribed responses were organized and grouped according to thematic elements using standard qualitative methods. Results indicate the SRTS program was perceived as beneficial by providing funds for both infrastructure and education projects. Although most community representatives reported accomplishments toward planned goals (improved infrastructure and perceived increase in active commuting), many had significant challenges including lack of communication and up-front funding, and difficulty navigating the regulatory process. Future SRTS programs should be structured to be more compatible with community-based needs and limitations, provide adequate underlying infrastructure and resources, and include at least partial funding up-front. [ABSTRACT FROM AUTHOR]

Given disproportionate burden of physical inactivity among US Hispanics and emerging interests in the potential role of the built environment on physical activity, we tested the hypothesis that residing in a more walkable block group is associated with increased physical activity in a cohort of Mexican-American adults. 10,183 Mexican-American adults from Houston, TX, USA were studied. Physical activity was assessed through self-report. Geographical information systems were used to create a 'walkability index' (WI). We examined the relationship between WI and physical activity using regression models. Findings for the entire study population suggested a direct association between neighborhood walkability and physical activity that approached statistical significance (High WI vs. Low WI: OR = 1.16; 95 % CI 0.95-1.40). Furthermore, participants who lived in a higher WI neighborhood were more likely to meet physical activity guidelines in 2 groups: (1) men whose recreational physical activity included walking (High WI vs. Low WI: OR = 5.43; 95 % CI 1.30-22.73) and (2) men whose only recreational physical activity was (High WI vs. Low WI: OR = 9.54; 95 % CI 1.84-49.60). Our findings suggest gender differences in the association between the built environment and physical activity in Mexican-American adults. Attempts to encourage walking among Mexican-American adults may be easier in high-walkability neighborhoods than in low-walkability neighborhoods. [ABSTRACT FROM AUTHOR]

Background Empirical evidence of the relationship between safety concerns and walking to school (WTS) is growing. However, current research offers limited understanding of the multiple domains of parental safety concerns and the specific mechanisms through which parents articulate safety concerns about WTS. A more detailed understanding is needed to inform environmental and policy interventions. This study examined the relationships between both traffic safety and personal safety concerns and WTS in the U.S. Methods This cross-sectional analysis examined data from the Texas Childhood Obesity Prevention Policy Evaluation (T-COPPE) project, an evaluation of state-wide obesity prevention policy interventions. All study data were from the survey (n = 830) of parents with 4th grade students attending 81 elementary schools across Texas, and living within two miles from their children's schools. Traffic safety and personal safety concerns were captured for the home neighborhood, en-route to school, and school environments. Binary logistic regression analysis was used to assess the odds of WTS controlling for significant covariates. Results Overall, 18% of parents reported that their child walked to school on most days of the week. For traffic safety, students were more likely to walk to school if their parent reported favorable perceptions about the following items in the home neighborhood environment: higher sidewalk availability, well maintained sidewalks and safe road crossings. For the route to school, the odds of WTS were higher for those who reported "no problem" with each one of the following: traffic speed, amount of traffic, sidewalks/pathways, intersection/crossing safety, and crossing guards, when compared to those that reported "always a problem". For personal safety in the en-route to school environment, the odds of WTS were lower when parents reported concerns about: stray or dangerous animals and availability of others with whom to walk. Conclusions Findings offered insights into the specific issues that drive safety concerns for elementary school children's WTS behaviors. The observed associations between more favorable perceptions of safety and WTS provide further justification for practical intervention strategies to reduce WTS barriers that can potentially bring long-term physical activity and health benefits to school-aged children. [ABSTRACT FROM AUTHOR]

Background: Active travel to and from a transit station may provide significant amounts of physical activity and improve health. The ease with which people can traverse the distance to the transit station may impede or support active travel. Therefore, transit stations that have features that are supportive of utilitarian physical activity would be desirable. This study aimed to characterize the built environment surrounding new light rail transit (LRT) stations in the City of Houston, Texas.Methods: In 2014, we used a series of systematic protocols and a standardized environmental audit instrument, the Analytic Audit Tool, to collect data on segments (streets) that surround 22 LRT stations that were being newly built. Using Geographic Information System (GIS), we assembled all the segments that intersect a 0.25-mile circular buffer around each station for the audit exercise. Several 3- to 4-member teams of trained auditors completed the audit exercise on a subset of these identified segments. Our analysis were descriptive in nature. We provided the frequency distributions of audited features across the study area. We also followed an original algorithm to produce several composite index scores for our study area. The composite index score is indicative of the prevalence of physical activity friendly/unfriendly features in the study area.Results: In all, we audited a total of 590 segments covering a total of 218 US Census blocks, and eight City of Houston super neighborhoods. Findings suggest the environment around the new LRT stations may not be supportive of physical activity. In general, the audited segments lacked land use integration; had abandoned buildings, had uneven sidewalks; were not bike-friendly, had minimal presence of public-recreational facilities that would support physical activity; and had significant physical disorder. Notably, certain attractive and comfort features were frequently to usually available.Conclusions: Current findings, which will be compared to follow-up audit data, can be useful for future researchers and practitioners interested in the built environment around LRT stations. [ABSTRACT FROM AUTHOR]

Importance: To inform the design and implementation of targeted interventions to reduce the future burden of human papillomavirus (HPV)-related cancers in Texas, it is necessary to examine the county and health service region (HSR) levels of (1) the proportion of children and teenagers aged 9 to 17 years who initiated and were up to date for HPV vaccination series and (2) HPV-related cancer incidence rates (IRs)., Objective: To evaluate temporal trends and geospatial patterns of HPV vaccination initiation and up-to-date status as well as HPV-related cancer rates at county and HSR levels in Texas., Design, Setting, and Participants: This population-based cross-sectional study used data from the Texas Immunization Registry, the National Cancer Institute's Surveillance, Epidemiology, and End Results Program database, and Texas Department of State Health Services annual population counts from 2006 to 2022. The analysis of HPV vaccination rates was conducted among children and teenagers aged 9 to 17 years; the analysis of HPV-related cancer rates was conducted among adults aged 20 years and older. Data were extracted between June and July 2023 and statistical analysis was performed from February to April 2024., Main Outcomes and Measures: HPV vaccination initiation and up-to-date status rates and HPV-related cancer IR at county and HSR levels., Results: A total of 32 270 243 children and teenagers (65.8% female individuals and 34.2% male individuals) and 22 490 105 individuals aged 20 years and older (50.7% female individuals and 49.3% male individuals) were included. The mean 2021 to 2022 county-level HPV vaccination series initiation estimates ranged from 6.3% to 69.1% for female and from 7.0% to 77.6% for male children and teenagers aged 9 to 17 years. County-level vaccination up-to-date estimates were generally lower compared with those of initiation estimates and ranged from 1.6% to 30.4% for female and from 2.1% to 34.8% for male children and teenagers. The pattern of HPV vaccination rates stratified by sex were similar across counties and HSRs. The age-adjusted annual HPV-related cancer IR by county for years 2016 to 2020 ranged from 0 to 154.2 per 100 000 for female individuals and from 0 to 60.1 per 100 000 for male individuals. The counties located in North Texas, HSRs 2/3 and 4/5N, had lower HPV vaccination rates and higher IRs of HPV-related cancers for both female and male individuals compared with other regions., Conclusions and Relevance: In this study, the incidence of HPV-related cancers varied widely across the counties and HSRs of Texas. More counties in North Texas, HSRs 2/3 and 4/5N, had higher IRs of HPV-related cancers and a lower proportion of HPV vaccination rates than counties in other regions. Designing and implementing targeted interventions to increase uptake and completion of HPV vaccination series across counties with low HPV vaccination rates may help to reduce future the burden of HPV-related cancers.

Background: Few studies have evaluated social determinants of outcomes disparities for children with acute lymphoblastic leukemia (ALL). We investigated the association of area deprivation index (ADI), a measure of neighborhood socioeconomic disadvantage, with overall survival (OS) among children and adolescents with ALL., Procedure: We obtained demographic and clinical data, geocoded addresses at diagnosis, and vital status on all Texas children diagnosed with ALL from 1995 to 2011 (N = 4104). Using the US Census Bureau 2010 geography, we computed ADI scores for all census tracts in Texas and grouped the tracts into quartiles: least, third-most, second-most, and most disadvantaged. We mapped children to ADI quartiles based on residence at diagnosis, and estimated OS using Cox regression adjusting for sex, race/ethnicity, age, and metropolitan/nonmetropolitan residence., Results: Five-year OS ranged from 89% (95% confidence interval [CI] 87-91%) for children in the least disadvantaged tracts to 79% (95% CI 76-81%) for children in the most disadvantaged tracts (P = 4E-7). An elevated hazard ratio (HR) for death was observed for children in the most disadvantaged tracts (HR 1.57, 95% CI 1.23-2.00), and trends toward increased mortality were observed in the third-most and second-most disadvantaged tracts (HR 1.23, 95% CI 0.97-1.57 and HR 1.27, 95% CI 0.99-1.62, respectively). In stratified analyses, area disadvantage was more strongly associated with OS in males than females., Conclusions: Neighborhood socioeconomic disadvantage is associated with inferior OS in this analysis of over 4100 children with ALL, highlighting the substantial contributions of social-environmental factors to childhood cancer survival. This association was stronger in males than females., (© 2020 Wiley Periodicals LLC.)