Theses and Dissertations

Geographic Information System: A Targeted Approach to Syphilis Elimination

June Morrison-Jones M.A. — Fri, 17 May 2013 14:17:47 PDT

Morrison-Jones, June, Geographic Information System: A Targeted Approach to Syphilis Elimination. Master of Public Health, August 2000, 55 pp., 3 tables, 3 appendices, reference list, 25 titles. Syphilis is a sexually transmitted disease that has long caused a heavy public health and economic burden in the United States. With syphilis rates reaching their lowest recorded levels in the United States, Health officials are calling for an increased effort to eliminate the disease. In the United States, syphilis is also now extremely concentrated geographically, facilitating effective intervention. Most syphilis cases disproportionately affect a small portion of the population. African Americans who live below the poverty level, have limited access to health care, and have a number of social problems are also affected. This study examines the geographic distribution of syphilis and factors associated with syphilis transmission in Dallas County. The study used the techniques of geographic information system, principles of epidemiology, sociocultural linkages (race, ethnicity, and gender) between demographic factors and syphilis, to gain insights into the geographic distribution of syphilis among the affected groups, and intervention strategies for syphilis elimination were developed. These suggestions should assist the Dallas County Health Department in launching an effective syphilis elimination program. Results showed that zip codes with high incidence of cases were generally adjacent to each other. In addition, statistically significant results confirmed that poverty, minority-race ethnicity and geographic core areas are factors associated with the transmission of syphilis.

Genetic Engineering and the Food Supply

W. Russ Kennedy M.B.A., M.S. — Fri, 17 May 2013 14:17:46 PDT

As food sources high in the trees became inadequate, our predecessors climbed to the ground and through centuries of adaptation learned to stand upright and cultivate plants. Plant cultivation has been practiced for more than ten thousand years with continuous improvements made to crop plants to meet the growing food needs of human domesticated animal populations. Biotechnology has been practiced for thousands of years with fermentations of fruits and grains to make wine and beer and the use of yeast in baking. More recently, advances in molecular biology allow the analysis and manipulation of genetic material to achieve desired changes in the organism. Transgenics or genetic engineering is the process of identifying specific genetic defects or desirable traits and altering an organism’s DNA by addition or deletion of specific DNA sequences. Nearly 100 million acres (40 million hectares) were planted in transgenic crops in 1999. The largest acreages of more than 40 different transgenic crops grown were in cotton, corn, soybean and rapeseed. Fifty-five percent of all cotton, 50% of soybeans, and 33% of corn grown in the U.S. in 1999 were transgenic varieties. The large plantings stem from fairly straightforward manipulations of single genes, such as the transferring to corn and cotton genetic material from the bacterium Bacillus thuringiensis (Bt) which produces an insecticidal toxin or transferring to the soybean, corn, cotton, sugar beets, and canola a gene with resistance to herbicides, such as glyphosate. The American farmer is perceived to be the beneficiary of lowered production costs primarily through better weed and pest control and a reduction in pesticide use with accompanying environmental improvement. Agro-chemical companies, who for the most part have spearheaded research and development of these crops, became involved because they foresaw a declining market for pesticides. Another area of promise widely discussed in the scientific and popular press is the improvement of food quality and composition resulting from genetic engineering. Because plants and plant products provide much of the world’s food supply, it is only fitting that early applications of this technology be in this area. Recent estimates suggest that the market for transgenic seed has already reached several hundred million dollars per year and that more than 15 million hectares (37 million acres) were grown in the U.S. in 1998. Concerns of food risk to the food supply and environment that using transgenic methods present, although not always science based, have some merit and require careful scientific scrutiny.

Quality Assurance Review of the Department of Radiology's Processes at the Osteopathic Medical Center of Texas

Charles B.W. Mego — Fri, 17 May 2013 14:17:45 PDT

Mego, Charles B.W., Quality Assurance Review of the Department of Radiology’s Processes at the Osteopathic Medical Center of Texas. Master of Public Health, December 1999, 40 p.p., 4 illustrations, reference list. The Osteopathic Medical Center of Texas (OMCT), a 300 bed teaching hospital, must look at maximizing quality assurance measures in order to become more economically viable. A 24 hour final report turnaround time has been set as the gold standard in radiology departments world wide, compared to turn around times typically three or four times greater than the gold standard in OMCT’s radiology department. A retrospective and prospective approach were conducted over a period of six months to review the radiology process components. The draft report to signed report activity area, where report transcriptions are revised and signed by the radiologists takes up a majority of the process time with over 50% per patient case in both the retrospective and prospective approaches. The draft to signed area can be targeted for quality improvement, with possible implementation options such as voice recognition or retooling the five week rotation schedule.

Maternal Depression as Predictor of Repeat Child Unintentional Injury

Lisa Ruth Webster Krause M.P.H. — Fri, 17 May 2013 14:17:44 PDT

Webster Krause, Lisa Ruth, Maternal Depression as Predictor of Repeat Child Unintentional Injury. Master of Public Health (Community Health), December 2004, 39 pp., 4 tables, references 28 titles. Current literature supports maternal depression as a predictor of child unintentional injury. There have been conflicting results concerning mediating and other risk factors. This study aims to reexamine the link between maternal depression and the occurrence of repeat child unintentional injury in the home. Using the NHIS 2002 data maternal depression was found to predict child repeat unintentional injury in this national sample. It was found that the most predictive model of repeat unintentional injury in this national sample. It was found that the most predictive model of repeat child unintentional injury consisted of maternal depression and low-income. Since maternal depression and low-income have been identified as underlying determinants of child unintentional injury, they should be a priority in prevention efforts so as to more effectively reduce the occurrence of repeat unintentional injury among children in the home.

A Faith Based Approached to Cervical Cancer Screening in Latina and Vietnamese Women: Outcome Analysis

Robin Z. Perez B.S. — Fri, 17 May 2013 14:17:43 PDT

Perez, Robin Z., A Faith Based Approach to Cervical Cancer Screening in Latina and Vietnamese Women: Outcome Analysis. Master of Public Health (Health Management and Policy), May 2005, 34pp., 4 tables, 3 illustrations, bibliography, 6 titles. A secondary data analysis study of the cervical cancer screening collaboration hosted by the St. Joseph Health Care Trust through six area Catholic churches was conducted to describe a program that has been recognized as a best practice for serving minority communities in Texas. The objectives of the study were to list demographic characteristics associated with the screening participants; to review culturally sensitive programming and approaches to serving both Latina and Vietnamese women. The results of this study will assist in implementation of similar interventions. The conclusions demonstrate that interventions that are tailored to specific communities may influence program participants and increase screening turnout.

Characteristics of Primary Care Physicians Serving in Texas Medically Underserved Areas

Scott Bradley Lancaster B.A. — Fri, 17 May 2013 14:17:42 PDT

Lancaster, Scott Bradley, Characteristics of Primary Care Physicians Serving in Texas Medically Underserved Areas, 2005. Master of Public Health (Health Management and Policy), May 2006, 63 pp., 13 tables, bibliography, 59 titles. Primary care physician demographics were examined to determine if subgroups differed in choice of practice location in urban and rural Medically Underserved Areas (MUAs) in Texas. Compared with the overall proportion of physicians practicing in rural MUAs (8.8%), subgroups that significantly differed were Dos (13.5%), males (10.6%), general practitioners (19.4%), family physicians (12.4%), and graduates of medical school prior to or during 1960 (18.8%) and from 1961-1970 (11.2%). Compared with the overall proportion of physicians practicing in urban MUAs (23.2%), subgroups that significantly differed were females (25%), Blacks (29.7%), and Latinos (38.7). Binary logistic regression showed that Asian ethnicity, general practice specialty, and graduate year of 1961-1970 predicted MUA practice location. The statistically significant differences observed underscore the importance of further study to examine potential differences between rural and urban MUAs. Public policy that provides incentives for more equitable physician distribution should be based on sound research.

Epidemiology and Diagnostic Testing of Tuberculosis (Mycobacterium bovis) Infection in Ungulates in a Texas Zoo

Connie M. Hodges D.V.M., Ph.D. — Fri, 17 May 2013 14:17:41 PDT

Tuberculosis infection among ungulates with Mycobacterium bovis (M. bovis) in a Texas zoo resulted in epidemiological assessment and testing of 161ungulates because of concerns about the validity of tuberculosis infection in the zoo. Three intradermal tests and one serological test were used to assess M.bovis infection : 1)the comparative cervical tuberculin test (CCT) consisting of biologically balanced bovine purified protein derivative (PPD) and avian PPD; 2) the single cervical bovine PPD tuberculin (BPDD); 3) the Tuberculin-Mammalian (MOT) intradermal tuberculin; and 4) the serological blood tuberculosis test (BTB). All four tests were evaluated. Validity (i.e. sensitivity and specificity), positive predictive value (PPV), and negative predictive value (NPV) were measured. The MOT followed by the BPPD were the most sensitive tests, correctly identifying 100% and 67%, respectively of tuberculosis infected/exposed ungulates. The BTB test was the third order of recommendation followed by the combined CCT and BTB (CCT+BTB) tests, where a positive result in either test denoted a positive response. The CCT test ranked last, as this test had the lowest sensitivity and would have allowed tuberculosis infection to remain in the zoo.

Descriptive Study of Sexually Transmitted Diseases in Tarrant County, Texas from 1998 to 2000

Christine J. MacGrath B.A. — Fri, 17 May 2013 13:32:44 PDT

McGrath, Christine J., Descriptive Study of Sexually Transmitted Diseases in Tarrant County, Texas from 1998 to 2000. Master of Public Health, Epidemiology track, December 2001, 21 p.p., 3 tables, 1 illustration, references, 14 titles. Incidence rates of STDs in Tarrant County, Texas from 1998 to 2000 were assessed and compared with the rates in Texas and the United States, focusing on similarities and differences in gender, age and race/ethnicity. Data were obtained from the Tarrant County Public Health Department, the Texas Department of Health and the Centers for Disease Control and Prevention. The rates for gonorrhea and syphilis in Tarrant County were significantly higher than rates in Texas and the United States. The largest disparity was found among Blacks, followed by Hispanics and then< Whites, with those ages 15 to 24 years at the greatest risk. To increase awareness and reduce the burden of STDs, prevention programs need to be developed.

Prevalence of Hand, Finger, and Wrist Musculoskeletal Problems in Keyboard Instrumentalists: The University of North Text Musician Health Survey

Chong H. Pak B.S. — Fri, 17 May 2013 13:32:44 PDT

Pak, Chong H., Prevalence of Hand, Finger, and Wrist Musculoskeletal Problems in Keyboard Instrumentalists: the University of North Texas Musician Health Survey. Master of Public Health, May, 2000, 52 pp., 7 tables, references, 69 titles. Data were derived from the University of North Texas Musician Health Survey, involving keyboard instrumentalists. 455 keyboard instrumentalists were selected and musician type, daily playing time, gender, and age were examined as possible risk factors for musculoskeletal problems of the hand, finger, and wrist. Age was found to be a significant risk factor when all levels of pain were considered. Gender was found to be a significant risk factor for all levels of pain as well as severe pain. Musician type and daily playing time did not show statistical differences.

Transmissions of Mycobacterium tuberculosis in Dallas and Tarrant Counties: The Use of RFLP to Evaluate MTB Control Programs

Edward Donald Kosterman III, M.S., M.P.H. — Fri, 17 May 2013 13:32:43 PDT

KOSTERMAN, EDWARD DONALD; MASTERS OF PUBLIC HEALTH; MAY 19, 2001 TRANSMISSION OF Mycobacterium tuberculosis IN DALLAS AND TARRANT COUNTIES: THE USE OF RFLP ANALYSIS TO EVALUATE MTB CONTROL PROGRAMS; 108 PAGES; 3 TABLES; 39 REFERENCES Dallas and Tarrant Counties are adjacent, similar counties in North Central Texas. Each county manages MTB patients under similar contracts with the Texas Department of Health. In Dallas county culture positive patients MTB are treated with Selective Directly Observed Therapy. Patients with culture positive MTB in Tarrant county are treated with Universal Directly Observed Therapy. RFLP IS6110-based RFLP analysis revealed that more strains were clustered in Dallas county than Tarrant county. Significantly more drug resistant isolates and drug resistant isolates in clusters were observed in Dallas county. These results suggest that DNA typing methods may be used to assess the efficacy of MTB control programs in areas where traditional epidemiological analysis may be ineffective.

The Public Health Impact of Type 2 Non-Insulin Dependent Diabetes Mellitus in Asian Indians, Chinese and Japanese

Neetee Nadkarni B.A. — Fri, 17 May 2013 13:32:42 PDT

Nadkarni, Neetee A. The Public Health Impact of Type 2 Non-Insulin Diabetes Mellitus in Asian Indians, Chinese and Japanese. Master in Public Health (Community Health), August 2001, 22 pp, 4 tables, bibliography. The prevalence of type 2 non-insulin dependent diabetes mellitus (NIDDM) is increasing in Asians, especially among Asian, Indian, Chinese and Japanese populations. This increase will have a severe impact on the health and well being of these populations. In 1997, a health survey from the World Health Organization (WHO) found numbers of adults with NIDDM in Asian Indians, Chinese and Japanese populations to be first, second and fifth, respectively. According to the National Commisision on Diabetes, “it is not known how the course, the complications and mortality from diabetes among subgroups of the United States population compare with the same factors for persons with diabetes of the same ethnic origin in the homelands”. This review article focuses on the number and prevalence of NIDDM and risk factors contributing to the disease among these Asian sub-populations. This goal of this paper is to provide information to health and medical researchers, practitioners and community planners for use in public health interventions in the United States, India, China and Japan. The results of this paper direct attention to the migrant Asian Indian, Chinese and Japanese populations because the prevalence of NIDDM is increasingly rapid in these groups.

An Evaluation of the Impact of Continuity of Care on Cost of Services in New and Renewing CHIP Enrollees

Brian Montague M.S. — Fri, 17 May 2013 13:32:42 PDT

Objective. To assess the impact of continuity of care as measured by enrollment history on the cost of services in Colorado’s state insurance program for children in low-income families, the Child Health Plan Plus. Design. A retrospective cohort study using data extracted from the eligibility/enrollment system and the claims payment system for inpatient and specialty services. All children enrolled in the program for at least 90 days and managed under the state managed-care network from its inception to April 1st of 2000 were included in the analysis (n-11841). Enrollees were separated into three enrollment groups: new members, renewing members, and members transition from a prior outpatient services group. The odds by enrollment groups: new members, renewing members, and members transition from a prior outpatient services program. The odds by enrollment group an average monthly claims greater than the 75th percentile amongst those with claims (n-2661) and the odds of presence of any claim in the full data set were compared means of a logistic regression model. In order to permit inferences regarding the total cost of care, all models included age group as a cofactor. Presence of chronic or congenital disease, ethnicity, primary language, urban residence, and the presence of multiple parents or caretakers were tested using univariate chi-square analysis and significant factors (p<0.1) were included as effects in the models. Results. All cofactors with the exception of ethnicity were significant in both models. Chronic disease status was associated with an increased risk of all claims. (OR=4.961, p<0.0001) and high claims (OR=9.639, p<0.0001). Renewal status was associated with a decreased risk of any claim (OR=0.921, p<0.0936) while rollover status was associated with both an increased risk of any claim (OR=1.157, p=0.0034) and a decreased risk of high claims (OR=0.731, p=0.0033). Residence in rural counties increased the risk of any claim (OR=0.0428, p<0.0001) and an increased risk of high claims (OR=1.472, p=0.0376). Conclusions. Enrollment history had a modest, though significant, effect on the presence of any claim and the specific presence of high claims. Rollover status was protective increasing utilization of the system overall but reducing the risk of high claims whereas renewal status only reduced the risk of utilization overall. The absence of multiple adults in the household showed a pattern consistent with episodic use of the system. Relative to urban residents, residents of rural counties were more likely to have used any service and less likely to have incurred high claims. This effect may be attributable to the transition of patients to HMO networks in urban counties. Linguistic or cultural barriers as reflected in primary language strongly decreased utilization, suggesting that these may be important barriers to address in outreach and member education.

The Effects of Cardiorespiratory Fitness and Body Mass Index on the Development of Osteoarthritis in Women

Supriya Hathwar M.S. — Fri, 17 May 2013 13:32:40 PDT

Hathwar, Supriya, The Effect of Cardiorespiratory Fitness and Body Mass Index on the Development of Osteoarthritis in Women, (ACLS 1970-1999). Master of Public Health (Epidemiology), May, 35 pp., 6 tables, references, 48 titles. Osteoarthritis (OA) of the hip and knee is one of the most important causes of pain and disability affecting nearly 21 million people in the United States. Obesity is one of the primary causes of secondary osteoarthritis especially of the hip and knee. (Felson, 1992). The aim of this prospective cohort study is to determine whether higher levels of CRF reduce the risk of development of OA in women across different body mass index (BMI) levels. The study population consisted of 3847 women, ages 20-87, examined at the Cooper Clinic, Dallas, Texas between 1970 and 1999. There were 379 cases of physician-diagnosed OA during 31,657 woman-years of follow-up. After adjustment for age, exam year and health status, obesity and overweight were found to be significant predictors of OA in women. At all levels of CRF, the odds of developing OA increase as weight increases. In the overweight category, the odds of developing OA are 80% higher among the low-fit women [OR=1.8,95% CI (1.1-3.1)], and 60% higher among the moderately fit women [OR=1.6,95%CI (1.0-2.3)] compared to high fit, normal weight women. In the obese category, the low-fit and the high fit women had the same odds of developing OA (OR=2.6), while moderately fit women had lower odds of developing OA (OR=1.7). These data suggest that CRF is not a consistent predictor for development of OA in women.

An Economic Analysis of Texas' Measles Vaccination Program: 1990-1996

Tammy O. MacDonald B.B.A. — Fri, 17 May 2013 13:32:40 PDT

In order to get the most benefit out of limited resources, public health departments must examine the costs and benefits of their activities to determine the most cost-effective method to allocate these scarce resources. The use of economic analysis can inform and help clarify upon which decisions are to be made. (CDC, 1996). The resources used to produce most goods and services in society are efficiently allocated through markets. However, markets can fail to efficiently provide goods and services that largely benefit individuals other than the consumer. The types of goods and services that public health departments provide often fall into that category. Cost-benefit analysis is one type of economic decision-making tool used when market forces are not in control Cost-benefit analysis (CBA) places a dollar value on the costs and benefits of each outcome so they can be compared. This type of economic analysis can then be taken one step further. An incremental or marginal analysis can determine changes in the relative costs and benefits’ resulting from increase or decreases in the amount of resources used in a program. Such an analysis should be part of the decision making process, so that scarce resources can be used efficiently. This paper examines not only the costs and benefits of the measles immunization program in Texas but also, the expansion of the program in the 1990’s. The most significant changes in Texas’ immunization program took place in 1994 as a result of the measles outbreak of 1989-1990. The years 1992, 1993, 1994 and 1996 were chosen for this analysis because of the difference in immunization rates, incidence rates and the level of State funding. This time period represents the most dramatic changes to these three areas. Since the measles vaccination was put into use in 1963, the number of measles cases in the United States has decreased dramatically. An average of 450 measles-associated deaths was reported each year between 1953 and 1963. (TDH, unpublished). Widespread use of the vaccine has led to a 95% reduction in measles compared with the pre-vaccine era. (TDH, unpublished). However, during 1989-1990, the number of measles cases and deaths rose sharply. During 1989, more than 18,000 cases and 41 deaths were reported. The largest number of reported cases since 1978 and the largest number of deaths in two decades in the U.S. (National Vaccine Advisory Committee, 1991). The major cause of the epidemic of 1989 and 1990 was a low vaccination rate among preschool children. (TDH, unpublished). The Centers for Disease Control and Prevention (CDC) estimates national measles vaccine coverage for 2-year-olds in 1985 was 61%, compared with 82% in 1991 and 1992. (CDC, 1994). The CDC has set a goal of 90% of 2-year-olds to be immunized against measles, mumps and rubella. Texas reported 11% of all measles cases in the U.S. between 1989 and 1990, although it only accounted for 7% of the total U.S. population (Schulte et al. 1996). This is likely due to the fact that immunization rates were low throughout the state. In 1989, only 66% of the children in Dallas and 58% in Houston were estimated to be immunized against polio, diphtheria, pertussis, tetanus, measles, mumps, and rubella by the age of two. Nationally, immunization rates were estimated to be 70% at the same time (Schulte et al., 1996). This paper will proceed as follows. Two benefit/cost studies will be outlined in the background section. These studies compare the total benefits and costs of current vaccination programs to no vaccination program. Then a history of Texas’ measles vaccination program will be discussed. It will explain how the measles outbreak of 1989-1990 brought about organizational and financial changes to the immunization program within the Texas Department of Health (TDH). In the method section, the disease costs and costs associated with a vaccination program are used to calculate a benefit/cost ratio. The changes in immunization rates and the associated marginal costs and benefits are then compared. The results of the CBA and marginal analysis indicate that the benefit to cost (B/C) ratios range from 17 to 30:1. After reaching an immunization rate of about 81%, marginal benefits become smaller and smaller while the cost of increasing the immunization rate rises. Finally, the results will be discussed and conclusions made as to the efficiency of Texas’ measles vaccination program. There is some evidence that the CDC’s goal to immunize 90% of 2-year-old children for measles may not the most efficient goal for Texas.

A Study of Pesticide Safety and Health Perceptions Among Tarrant County Pesticide Applicators

Robert A. Martinez B.S. — Fri, 17 May 2013 13:32:38 PDT

Pesticides have become an important part of our lives. We rely on them to help protect our crops from pest; they rid our homes of unwanted pests and help us make our lawns and public parks beautiful. Pesticides are also important to public health. They are a major source of vector control and help stop the spread of vector-borne disease. Even though we used them in our everyday lives, it is important to remember that pesticides are poisons, and that great care must be taken to ensure the safety of the public and safety of those who work with pesticides. This study looked at the safety knowledge and health perceptions among Tarrant County, Texas licensed applicators. Much research has been focused on the effects of pesticides on human health. Much of this research has been focus on the farmer applicator (Alavanja, 1999). This study focuses on applicators that work mostly in the urban areas of the County, as well as ranchers live in the County. These licensed urban applicators included those who work for city parks departments, golf courses, commercial applicators, lawn care service, pest control and some private ranchers. The Texas Pesticide Regulations require that a person may not use a restricted-use or state-limited use pesticides or herbicides unless licensed by the Texas Department of Agriculture (2000). Therefore the purpose of this study is to see if an association between health beliefs and pesticide safety knowledge exist. The reason it is important is because these people can have either a positive or negative impact on the safety of themselves and their crews. Acute pesticide poisoning is one of the biggest risks that applicators face. The state of Texas conducts an active surveillance of occupational-related pesticide poisonings. The Environmental Epidemiology and Toxicology Division at the Texas Department of Health (TDH) have had this system in place since 1985. TDH reported that 107 work related cases occurred during 1998, with 55 confirmed as occupational pesticide poisoning (1998). The most frequent symptoms reported were neuromuscular symptoms such as headaches, dizziness, confusion, irritability, and twitching muscles. Pyrethroids and pyrethins were the most commonly reported class of pesticides exposure (51%) followed by Organophosphates (25%), which are the most widely used form of insecticides, as well as herbicides and fungicides. Pesticide safety and the TDH surveillance system are two very important ways of informing pesticide applicators about the risk and what can be done to minimize that risk to themselves and their crew.

Effects of Osteopathic Manipulative Treatment on Osteoarthritis

Chau N. Pham D.O. — Fri, 17 May 2013 13:32:38 PDT

Osteoarthritis (OA) is the most prevalent form of arthritis in the United States. Of those 65 to 74 years old, 18 per 100 women and 8 out of 100 men will experience OA of the knee. (Towheed and Hochberg, 1997) The Center for Disease Control and Prevention (CDC) reported a high prevalence for disability for person > 65 years. Arthritis or rheumatism accounts for 7.2 million (17.1%) people ranking above back problems and heart disease. (CDC, 1994) The Framingham epidemiologic study of knee osteoarthritis estimated a 27% prevalence for those 44% of those >80 years. Nelson, Naimark, Anderson, Kazis, Castell & Meenan, 1987) This study uses the principles of Osteopathy to treat OA for the elderly as osteopathic manipulative treatment (OMT) specifically addresses the symptoms and signs of OA. The typical symptom of OA is pain stiffness “in and around a joint accompanied by limitation of function.” (Klippel, 1997) Pain from OA may originate from “periostitis at sites of bony remodeling; subchondral microfractures; irritation of sensory nerve endings in the synovium from osteophytes; periarticular muscle spasm; bony angina due to decreased blood flow and/or elevated intraosseous pressure; and synovial inflammation accompanied by release of prostaglandins, leukotrienes, and other cytokine.” (Klippel, 1997) Other symptoms include morning stiffness, gel phenomenon, buckling/instability. The signs of OA are bony enlargements, limitation of range of motion, crepitus, tenderness on pressure, pain, join effusion, malalignment and/or joint deformity. (Hazzard, 1999) Most often, pain and limitation of movement from OA cause signficiant changes in lifestyle for the older adult; functional independence is adversely affected. Decreased functional independence that affects the quality of life makes this the most debilitating illness in the 65 and older population. Studies have shown that patients with osteoarthritis of the hip and knee have comparable number of days with restricted activity as patients rheumatoid arthritis. (Towheed, 1997; Holman & Lorig, 1997). Treatment goals for managing osteoarthritic patients is to control pain subsequently minimizing functional limitation and disability. (Hazzard, 1999) To treat the above dysfunction, current treatments for OA include pharmacologic agents such as NSAIDs, analgesics, intra-articular steroid injections, topical analgesics; glucosamine sulfate and hyaluronic acid; nonpharmacologic measures include weight reduction, therapeutic ultrasound, acupuncture, transcutaneous electrical nerve simulation (TENS), physical therapy, pulsed electrical stimulation, orthotics, hydrotherapy, self management courses, and support groups. (Womheim, 1996; Zizic, 1995; Creamer, 1997; & McNoll, 199*) The primary objective of pharmacologic treatments is to decrease pain resulting in an increased functional capacity and improved quality of life. There are side effects and limitations to pharmacologic regimens. For example, the usage of NSAIDs in the treatment of the elderly can result in gastrointestinal bleeding. (McNoll, 1998) Non-pharmacologic treatments are viable alternatives in treating osteoarthritis; osteopathic manipulative treatment is such an alternative. A primary osteopathic principle dictates that structure and function are reciprocally inter-related. Any change from the “normal” is called somatic dysfunction. Specifically, somatic dysfunction is the altered or impaired function of related components of the somatic (body framework) system-skeletal, arthrodial, and myofascial structures and related vascular, lymphatic, and neural elements. (Greenman, 1989) OMT is used to return the body to its normal state by increasing symmetry and motion thereby improving body balance and reducing inflammation and pain by increasing fluid flow. When considering the physiological causes for OA of the knee coupled with the side effects from pharmacological treatment, health care providers must consider alternative treatments. The principles of osteopathy provide a logical spring board to meet that challenge. This present study provides a preliminary understanding of the efficacy of OMT for OA of the knee.

Firefighter Medical Surveillance/Duty Fitness Evaluation of Content and Reporting Format: Compliance with Federal and Other Recognized Standards

Rick H. Lin B.A. — Fri, 17 May 2013 12:22:42 PDT

Lin, Rick H, Firefighter Medical Surveillance/Duty Fitness Evaluation of Content and Reporting Format: Compliance with Federal and Other Recognized Standards. Master of Public Health (DO/MPH Dual Degree Track), May, 2001, 41 pp., 7 tables, bibliography, 11 titles. The University of North Texas Health Science Center analyzed data collected by the Public Health Preventive Medicine (PHPM) Clinic at the University of North Texas Health Science Center (UNTHSC) in the course of medical surveillance and duty fitness exams for the City of Rowlett, Texas, HAZMAT Team. Data was analyzed for content and reporting format to determine compliance with federal and other recognized standards. An aggregate report of continuous and categorical data was also created. The subjects were all firefighters in the City of Rowlett Fire Department, Rowlett, Texas. The data was collected from the results of physical exams performed on the members of this population between the period of 1-1-1996 and 12-31-1996. There were a total of sixteen subjects. (n=16) These firefighters are all HAZMAT Team members. The overall content of the medical surveillance and duty fitness examinations was evaluated. The compliance in content of medical history and physical examination to the recognized standards established by OSHA, EPA, and NFPA was examined. The physical characteristics and health of this population of firefighters is described based on the data collected. The result of the comparison shows that the UNTHSC PHPM Clinic’s forms for the history and medical exams did not completely incorporate the recognized standards. The content of the medical surveillance and duty fitness exams was in compliance with and often exceeded recognized standards.

Perceptions Regarding Tarrant County's Preparedness for a Bioterrorism Attack Involving Smallpox

Donald T. Michael B.S. — Fri, 17 May 2013 12:22:40 PDT

Michael III, Donald T., Perceptions Regarding Tarrant County’s Preparedness for a Bioterrorism Attack Involving Smallpox. Master of Public Health (Epidemiology), May 2003, 51 pp., 10 tables, bibliography, 26 titles. Perception and knowledge of risk of a bioterrorist attack are important factors in determining public response and anxiety level. A telephone survey of residents of Tarrant County, Texas was conducted to determine public perception regarding Tarrant County’s preparedness to respond to an intentional release of the smallpox virus as an act of terrorism. Although a low response rate limits the ability to generalize the findings of this survey, frequency and chi-squared analysis of survey responses revealed a public desire for more information about the county’s preparedness, access to smallpox vaccine, and identified a potential gap between objectively measured and public self-assessment of knowledge about bioterrorism and smallpox concepts. Increased efforts toward information dissemination and education of the Tarrant County community are needed to address these concerns.

Differences in the Rates of Cardiovasular Surgical Procedures in Men and Women with Coronary Heart Disease in the State of Texas

Matthew C. Moreland B.S. — Fri, 17 May 2013 12:22:38 PDT

Moreland, Mathew, Differences in the rates of cardiovascular surgical procedures between men and women with coronary heart disease in the state of Texas. University of North Texas Health Science Center, School of Public Health, February 2003, 19pp., 3 tables, references, 23 titles. Data for the Texas Health Care Information Council was analyzed to identify the difference in the rates of invasive cardiovascular procedures performed on men and women among 411 Texas hospitals with the diagnosis of coronary heart disease in 1999. In all, 150,361 cases were compared for differences between gender, race, age and type of invasive cardiovascular procedure using chi-square test. Frequencies were tabulated for age, race and gender. Invasive cardiac procedures were differentiated by type: coronary angiography and coronary revascularization. Between the ages of 45 and 79 women were more likely to have angiography performed than men in the same age group. However, young (30-44) and elderly (80+) men were more likely to receive angiographic procedures when presenting with the same symptoms as women. Also, men of all ages and races were more likely to receive revascularization procedures (PTCA, CABG) than women when presenting with coronary heart disease symptomology. Additionally, men between the ages of 35 and 49 received twice the number of revascularization procedures than women. These findings identified patterns of treatment with defined differences between gender which may be attributed to external factors versus a true gender bias.

Osteopathic Physicians in Primary Care, Texas 2003

Thaddeus L. Miller B.A. — Fri, 17 May 2013 12:22:37 PDT

Miller, Thaddeus L., Osteopathic Physicians in Primary Care, Texas, 2003. Master of Public Health (Health Management and Policy), December 2003, 62 pp., 11 tables, 4 illustrations, bibliography, 51 titles. Physician demographics were examined to determine if female osteopaths differ in choice of practice specialty and location in Texas. Taken relative to gender and medical degree type female osteopaths have the highest rate of primary care practice, with over 70% engaged in family or general practice, internal medicine, or pediatrics. Female osteopaths have an odds ratio 4 times greater than other physicians to practice primary care. Female osteopaths are also 2.5 times likelier than female allopaths to practice rural primary care. Male osteopaths are 2.3 times likelier than other physicians to practice rural primary care. Primary care osteopaths are 1.4 times likelier to practice rural primary care than allopaths. Policy intended to produce primary or rural primary care physicians should encourage medical school candidates to consider osteopathy.

Public Opinoin of the Uninsured: Who Are They? Can They Get Care? Should Insurance be Publically Provided

Rachel Miller B.S. — Fri, 17 May 2013 12:22:36 PDT

The United States is at the pinnacle of medical expertise and exploration. Many people from around the world come here to receive that outstanding care. Unfortunately, many of our own citizens are unable to enjoy that same privilege. With mounting technological and research costs, Health Maintenance Organizations, State-funded health insurance, and federally funded programs, such as Medicaid, are struggling to meet the expanding numbers of uninsured. The public is the driving force behind the policy debate in this country, and the debate over the uninsured may be lacking some very important information. It was the aim of this study to evaluate the public’s view of the uninsured. Meta-analysis was used to evaluate three questions regarding the public’s opinions of the status of the uninsured in the country to better understand the true perception held.

Spatial Analysis and Correlation of Air Pollution and COPD Mortality in Texas

Brian E. Long. B.A. — Fri, 17 May 2013 12:22:34 PDT

Long, Brian E., Spatial Analysis and Correlation of Air Pollution and COPD Mortality in Texas. Master of Public Health (Environmental Health), May 2002, 20 pp., 1 table, 2 figures, references, 8 titles. The goal of this research is to determine if there is an association between levels of air pollution emissions per square mile and the COPD mortality rates in the 254 Texas counties. Correlations were run comparing emissions densities of each county to its respective COPD mortality. The levels of emissions, when compared at the county level to COPD mortality rates show a positive correlation. A year-by-year analysis produced correlation coefficients as high as 0.331 (p<0.001). Emissions density is associated with increased COPD mortality. The association between air pollution and COPD mortality is higher among the black population than for the non-black population in Texas, and higher for females than males.

Geospatial and Molecular Clustering of Mycobacterium tuberculosis, Tarrant County, TX, 1993-2000

Patrick Kevin Moonan B.A. — Fri, 17 May 2013 12:22:34 PDT

Molecularly clustered cases are assumed to be the result of recent transmission of those in the cluster. An intervention that targets clustered cases with recent transmission, such as identifying contacts of active cases, could be effective as a programmatic control measure. The purpose of this study is to identify areas of recent transmission, whereby determining the contribution of geospatial and molecular clustering to the local tuberculosis morbidity. Tuberculosis cases due to recent transmission have important implications for tuberculosis control programs. They suggest that current methods of case-finding, investigations of susceptible contacts, and the provision of preventive therapy are ineffective in interrupting some transmission. This study utilized molecular strain characteristics and GIS technology to uncover geographical links to on-going transmission, where tradition public health surveillance methods are failing. Risk behaviors such as illicit drug use, crack-cocaine use, jail experience, and sexual relations with a prostitute were strongly associated with on-going transmission. Place factors, specifically where patients reside, was also found to be significantly associated for certain zip codes in Tarrant County. Cases in urban zip codes 76102 [OR=3.954; 95% CI=1.803, 8.671] and 76105 [OR=3.135; CI=1.254, 7.835] were strongly associated to infection with a clustered strain when compared to the rest of the county. The use of Geographical Informational Systems (GIS) technology and molecular strain typing provides a proactive approach that may be used to initiate traditional surveillance investigations. As an application utility, this project will be used to develop more effective means of tuberculosis control within Tarrant County.

Characterization of MRSA Infection at Childrens Medical Center, Dallas, January 2005-June 2005

Ngozi M. Okoro MBBS — Fri, 17 May 2013 12:22:31 PDT

Okoro, Ngozi M., Characterization of MRSA infection at Childrens Medical Center, Dallas, January 2005-June 2005. Master of Public Health (Epidemiology), May 2006, 33p., 14 tables, 10 illustrations, bibliography, 13 titles. MRSA infection is increasingly emerging in patients without the established risk factors hence the term CAMRSA. This study is a descriptive secondary data analysis from an ongoing study at UTSM/CMCD and describes the CMCD patients with MRSA infection. Data analysis showed a consistent increase in the incidence rate of the infection with slight female preponderance. Race distribution showed that blacks were the majority. Most children were less than 2years, used Medicaid, had superficial infections and community-acquired infections. All (100%) isolates were susceptible to Vancomycin and Linezolid while many (92.2%) were resistant to Erythromycin. The increasing incidence in CAMRSA infection remains a challenge for public health professionals and the resistant pattern a potential problem to the pharmaceuticals.

Does a Community Health Worker Program Work among Latino Communities?

Amanda Y. Medina M.A. — Fri, 17 May 2013 12:22:31 PDT

Medina, Amanda Y., Does a Community Health Worker Program Work among Latino Communities? Master of Public Health (Community Health), Dec 2003, 77 pp., 8 tables, 5 illustrations, bibliography, 70 titles. The study’s goal was to investigate if and what makes a community health worker (CHW) education program work among Latino participants. First, the author developed a conceptual model to explain why a CHW program might effectively reach Latino communities. Second, the study tested the effectiveness of a CHW program, Salud Para Su Corazon of North Texas, by examining participants’ self-reported healthy behaviors from before and immediately after education. Third, the study examined potential CHW program components that predicted healthy behavior scores. These findings showed that pledging to the program and positive program evaluations predicted participants’ scores. Past research and theories are in congruent with all these findings.

Evaluation of Mental Health Association of Tarrant County's School Based Mental Health Curriculum: Focus Group and Results

Anila K. Nanji-Bhai B.A. — Fri, 17 May 2013 12:22:29 PDT

Nanji-Bhai, Anila K., Evaluation of Mental Health Association of Tarrant County’s School Based Mental Health Curriculum: Focus Group and Results. Master of Public Health (Community Health), April 2005, 31 pp., references. There are presently numerous research findings that indicate the need for mental health education among the adolescent population within the United States. In the last decade, tragedies such as the Columbine school shooting, and most recently the Red Lake school shootings in Minnesota point to the fact that adolescents are facing mental pressures and need assistance. In this study, a mental health curriculum, developed by the Mental Health Association of Tarrant County, was examined through the use of focus groups. The group was asked to analyze and comment on the curriculum, as to the age-appropriateness, the “appeal,” and to suggest improvements or revisions. The qualitative data that was gathered was analyzed using NVivo. Results showed a strong opposition to this type of program being brought into the school setting. As the focus group sessions continued however, the curriculum was adapted based on the participants’ comments and suggestions. In the end, the curriculum was accepted by the participants as a program that would be welcomed in schools. Conclusions were that when the proposed curriculum was modified according to the focus group participants’ comments and suggestions; particularly concerning TEKS objectives, the curriculum became more acceptable and a viable opportunity for the school districts.

Rural Vs. Urban Residents and Obesity in Texas

Emeka J. Ohagi BSc., MSc., PhD — Fri, 17 May 2013 12:22:28 PDT

Ohagi, Emeka J., Rural vs. Urban Residents and Obesity in Texas. Master of Public Health (Health Informatics), May 2005, 52 pp., 3 tables, bibliography, 90 titles. Obesity in the United States has been described as an epidemic and Texas has been identified as one of the most obese states in the country. The purpose of this study is to examine obesity among Texas adults in order to determine if there are differences in obesity levels based on residence, and to explore the influence of other demographic, socioeconomic, health and behavioral factors on the distribution of obesity. Results indicate that urban and suburban dwellers are less likely than rural dwellers to be obese (adj. OR=0.64; 0.68, respectively). However, residents of frontier communities have slightly higher odds of obesity (adj. OR=1.09) than rural residents. Age was found to be an important factor in obesity. It is hoped that these and other results will facilitate appropriate channeling of public health response.

Integrating Public Health and Informatics into Undergraduate Medical Education: Utilization of an Innovative Bioterrorism Awareness Training Module

L. Charolette Lippolis B.A. — Fri, 17 May 2013 12:22:27 PDT

Lippolis, L. Charolette, Integrating Public Health and Informatics into Undergraduate Medical Education: Utilization of an Innovative Bioterrorism Awareness Training Module. Master of Public Health (Dual-Degree, DO/MPH), August 2003, 19 pp., 5 tables, references, 15 titles. On October 4, 2001, the first case of inhalation anthrax in U.S. history due to an intentional human act was diagnosed; convincing even the most skeptical American that bioterrorism is a real and present threat in this country. Despite its emergence as an important medical and public health issue, a serious deficit in bioterrorism preparedness training has been recognized throughout the medical community, particularly in undergraduate medical education. In the face of the established need for bioterrorism awareness training, an overriding issue facing medical educators is how to incorporate more information into already over-packed curricula. The sheer volume of medical knowledge is becoming too vast to be taught by “traditional methods”. Integration of multiple subject areas, using a variety of presentation formats, is the key to providing medical students with the breadth and depth of skills and knowledge necessary to become competent physicians in the 21st century. This paper describes a unique adaptable, bioterrorism awareness training module designed for preclinical medical students that is inexpensive and will easily integrate into a wide variety of existing curricula. This course serves not only to educate students about bioterrorism and weapons of mass destruction, but in addition will increase their understanding of the Public Health system and disease reporting requirements, while providing experience in utilizing on-line resources for knowledge acquisition. The format for this course is based upon educational data derived from two different bioterrorism preparedness training modules presented to the first year osteopathic medical students in the academic years 2001-02 and 2002-03.

Women & Stress: Investigating the Female Stress Syndrome

Melissa Standord Oden LMSW, CLNH — Fri, 17 May 2013 12:22:26 PDT

Oden, Melissa Stanford, Women & Stress: Investigating the Female Stress Syndrome. Master of Public Health (Community Health), May 2006, 47 pp., bibliography. Research indicates that women experience long-term effects of stress that appear to be not only different from, but possibly more harmful than the long-term effects of stress in men. This situation creates the possibility of more chronic illness for women as well as the possibility for higher mortality rates. The purpose of this project is to investigate the effects of stress on professional women in Tarrant County based on meanings and interpretations women give to the stress they experience. It will also provide additional information about the effects of Female Stress Syndrome to contribute to the research literature on this topic.

Latino Immigrants in Fort Worth: Contributing Factors to Lack of Health Insurance and Their Impacton Utilization of Health Services

Jose J. Moreno — Fri, 17 May 2013 11:23:15 PDT

This quantitative research study consists of a secondary data analysis examining the factors contributing to the lack of health insurance in a group of Latino immigrants in Fort Worth, and the impact it has on their utilization for health care services. The data analyzed was previously collected to assess the needs for health insurance of Latino immigrants in Fort Worth. Bivariate analysis and multivariate logistic regression analysis methods of the sampled population were determine some of the main factors for lack of health insurance resulting in underutilization of health care service. Results of the study lacked the strong statistical association expected from the predictor variables, however, results of the study reveal areas where health care policies affect and may improve conditions of the immigrant population in Fort Worth, Texas.

Is an Enviormental Health Educational Intervention Sufficient to Change Behavior?: Perceptions from an Indigenous Lake Community in Guatemala

Carla Pezzia B.A. — Fri, 17 May 2013 11:23:12 PDT

Pezzia, Carla. Is an environmental health educational intervention sufficient to change behavior?: Perceptions from an indigenous lake community in Guatemala. Master of Public Health (Environmental Health), December 2006, 46 pp., 6 tables, 1 illustration, references, 18 titles. Traditional environmental health practices focus on education and exposure prevention, but the division between the biophysico-chemical and social environment keeps them from always being sufficient; human ecology seeks to bridge this division. The second leading cause of mortality in Guatemala is gastrointestinal infections, and San Pedro, Guatemala, provides an opportunity to study these infections utilizing a human ecological approach. Morbidity data were collected from the local health center, observations noted systematically, and both residents and tourists were interviewed regarding their perceptions of the community’s environmental health. Results found that residents who had no contact with tourists stated that, for gastrointestinal infections due to refuse in the streets, education alone would not be sufficient to reduce this problem; most felt some type of government intervention would be necessary. It is recommended that public health specialists enjoy a human ecological approach and refer to the community when designing an appropriate intervention.

Factors Associated with Multi-Drug Resistance among Patients with Streptoccus pneumoniae Ear Infections

Belinda A. Mendoza B. S. — Fri, 17 May 2013 11:23:12 PDT

Mendoza, Belinda A., Factors Associated with Multi-Drug Resistance among Patients with Streptoccus pneumoniae Ear Infections. Master of Public Health (Social and Behavioral Sciences), May 2004, 27 pp., 6 tables, 1 figure, references, 9 titles. Clinical trials play an important role in the development of new medical treatments. The purpose of this study is to describe patients participating in a clinical trial and at analyze the socio-demographic characteristics of patients with susceptible and multi-drug resistant Streptococcus pneumoniae ear infections. At the conclusion of this study, a socio-demographic description of clinical trial participants was obtained and the results were slightly younger than patients with susceptible S. pneumoniae ear infections and were more likely to attend day care.

Epidemiology of Cholera in Malawi, 2002-2003

Ella Nkhoma B.A. — Fri, 17 May 2013 11:23:09 PDT

Nkhoma, Ella, Epidemiology of Cholera in Malawi, 2002-2003. Master of Public Health (Epidemiology), August 2004, 33pp., 4 tables, 3 figures, bibliography, 24 titles. The objective of the present study was to characterize epidemic cholera in Malawi from 2002-2003. National and district-level surveillance records were used for the analyses in this study. The study employed Poisson regression, log-linear analysis, epidemic curve analysis, curve-fitting procedures and epidemic model simulations. District-level determinants of cholera mortality included various sociodemographic indicators. Significant two-way interactions were observed for age and district, with the oldest age group (65+) experiencing the highest risk of symptomatic cholera and residents of Nkhatabay districts also experiencing the most increased risk. Temporal analysis revealed the existence of secondary outbreaks and demonstrated the contribution of preexisting immunity to epidemic dynamics.

A Critical Review of the One Hour and the Eight Hour Standards for Ozone with an Overview of the Proceedings that Led to the Implementation of The New Standard for Ozone

Amruth A. Palla M.B.B.S. — Fri, 17 May 2013 11:23:08 PDT

Palla, Amruth R., A Critical Review of the One Hour and the Eight Hour Standards for Ozone with an Overview of the Proceedings that Led to the Implementation of The New Standard for Ozone; Master of Public Health (Environmental and Occupational Health), May 2004, 58 pp, 3 tables, 2 illustrations, 35 titles. With the increasing concern for human health and the recognition of the major role played by environment in the multi-factorial disease etiology, the various parameters established for maintaining the environmental constituents in the proportions desired for achieving a normal health status are taking an important position in the present day world. In 1997, during its review process the EPA found the exiting one-hour standards, for ozone to be insufficient to achieve the health friendly concentrations, and therefore proposed a new eight hour standard for this pollutant. The new standards proposed by the EPA were challenged by various other organizations and several proceedings have happened since then. The purpose of my thesis is to do a critical analysis of the advantages and the drawbacks of the two standards and to do an overview of the proceedings that have led to the implementation of the new standards.

Line-of-Duty Injury or Illness Incidence in an Air National Guard Unit

Michael F. Lorich B.S. — Fri, 17 May 2013 11:23:04 PDT

Lorich, Michael F., Line-of-Duty Injury or Illness Incidence in an Air National Guard Unit. Master of Public Health, DO/MPH track, May 2001, 31 p.p., 3 tables, 4 illustrations, reference list, addendum. Line-of-duty injuries or illnesses (LODs) suffered by members of Air National Guard units may demonstrate the status of unit safety, unit readiness and deployability, a potentially significant area of unit expenditures, and areas of needed health promotion. This descriptive pilot study was conducted at the unit commander’s request to determine an apparent doubling of the prevailing incidence of LODs over a recent quarterly period. Tracking of injuries and injured individuals was problematic. The vast majority of LODs were musculoskeletal in nature. Decreased fitness level (Identified as elevated body mass index (BMI)) among males and increased age were related to increased LODs. Recommendations were given to improve tracking, identify individuals at increased risk, provide pre-training assessment, and institute health promotion focused on musculoskeletal injuries.

Barriers to Women's Cardiovascular Risk Knowledge: A Tarrant County Study

Linda J. Liewer B.S.N. — Fri, 17 May 2013 11:23:03 PDT

Liewer, Linda J., Barriers to Women’s Cardiovascular Risk Knowledge: A Tarrant County Study. Master of Public Health (Health Management and Policy), May 2004, 71 pp., 19 tables, 6 illustrations, 36 references, 17 titles. Women’s death rate from cardiovascular disease is greater than the death rate from all cancers. Awareness and knowledge of a disease are key to dealing with it, yet many women are still unaware of their CVD risk. The purpose of this study is to identify the barriers to knowledge about cardiovascular disease risk in women in Tarrant County. Interviews with administrative personnel in 10 community organizations confirmed the lack of awareness of CVD. Barriers included: women in caregiver roles advocate effectively for their family members, but less effectively for themselves; physician communication with women regarding CVD is often suboptimal; women fear breast cancer far more than CVD; a program deficiency exists in Tarrant County; lack of a visible woman champion and heart disease is still seen as a man’s disease.

Income Inequality and Racial Disparities in Infant Mortality in Texas Counties

Syeda S. Jesmin M.A. — Fri, 17 May 2013 11:23:03 PDT

Jesmin, Syeda S., Income Inequality and Racial Disparities in Infant Mortality in Texas Counties. Master of Public Health (Health Services Research), May, 2004, 63 pp., 7 tables, 2 figures, references, 74 titles. This study provides an initial examination of predictors of differences of infant mortality between African-Americans and Whites. Guided by Wilkinson’s theory, it was hypothesized that income inequality among the population is a significant predictor of infant mortality disparities. A number of socioeconomic and health services variables were used in this study to control for the effects of income inequality on the dependent variable. Findings suggest that income inequality of a county is not a direct predictor of higher infant mortality of African-Americans than Whites. However, the association of inequality and IMR gap varies based on the metropolitan status of the county. Insurance status was found to have a negative effect on IMR gap, which implies the importance of including variables other than related to access (such as, quality of care) in future research.

Health Care Access Patterns in Relation to Ethnic/Racial and Health Insurance Status at an Osteopathic Hospital for 1998 through 2001

Charles B.W. Mego M.P.H. — Fri, 17 May 2013 08:33:15 PDT

Mego, III, Charles B.W., Health Care Access Patterns in Relation to Ethnic/Racial and Health Insurance Status at an Osteopathic Hospital for 998 through 2001. Doctor of Public Health (Social and Behavioral Sciences), December 2003, 106 p.p., 25 tables, 5 illustrations, references, 44 titles. The patient population of the Osteopathic Health System of Texas (OHST), an academic health center with a 256-bed teaching hospital, was analyzed for health care access as measured by health services utilization in 1998 through 2001. This study explored the question of whether there was less health care access among minorities than among the White non-Hispanic majority within the patient population at OHST. The Tarrant County population was compared to OHST’s population demographics. This assessment determined which Ethnic/Racial groups had the highest medical services utilization and their payment methods. Patient data obtained from the OHST’s Meditech database was analyzed using Epi-Info. White non-Hispanics made up over fifty percent of the Emergency Room (ER), Inpatient and Outpatient service utilization in 1998 through 2001. The Outpatient component made up just over fifty percent of the OHST’s patient. African-Americans were over represented in the ER, Inpatient, and Outpatient service components relative to the Tarrant County demographics for 1998 through 2001. The Hispanic ER Managed Care category increased 7% and confirmed a growth rate of 29% more ER Managed Care in 2001, as compared to 1998 (URR=1.29, [1.24-`.35], x2 = 142.49, p <.01). The Hispanic ER Medicaid category decreased 4.1% and indicated a reduced growth rate of 17% less ER Medicaid in 2001 as compared to 1998 (URR = 0.83, [0.79-0/87], x2 = 57.69, p,.01). The Hispanic Inpatient Managed Care category increased 13.2% and revealed a positive growth rate with 52% more Inpatient Managed Care in 2001 as compared to 1998 (URR=1.52, [1.44-1.61]. x2 = 224.92, p<.01). The Hispanic Inpatient Medicaid category decreased 14.4% and showed a reduced growth rate of 38% less Inpatient Medicaid in 2001 as compared to 1998 (URR=0.62, [0.59-0.66], x2=274.58, p<.01). The Hispanic and the Other groups relied heavily upon ER Self Pay, with a general decrease in Medicaid coverage and an increase in Managed Care. The Hispanic and Other groups have medical needs that are being neglected at OHST, and may lead to serious health problems that could be more costly if still treatable.

A Descriptive Analysis of Adolescent Pregnancy and Birth Outcomes in Tarrant County, Texas

Wilfred J. Omoloh B.S., M.S. — Fri, 17 May 2013 08:33:14 PDT

Omoloh, Wilfred, J., A Descriptive Analysis of Adolescent Pregnancy and Birth Outcomes in Tarrant County, Texas. Master of Public Health, August 14, 1999, 110 pp, 19 tables, reference list, 68 titles. A descriptive study of adolescent pregnancy and birth outcomes in Tarrant county, Texas between 1991 and 1995 was conducted to evaluate the effect of maternal age on infant birthweight and mortality among White, African American, and Hispanic adolescent mothers nineteen years and older. The age of the mother was not a significant predictor of infant birthweight and mortality, but mother’s ethnicity, weight gain, and gestational age were found to be strong predictors of infant birthweight and mortality. The Hispanic ethnic group came out much better than White and Black mothers but no difference between White and Black mothers regarding birthweight was found. The results from the data analysis demonstrated that teenage pregnancy may not be a serious problem in Tarrant County, Texas as was previously though.

Humanitarian and Technical Assistance to the Palestinian Health Sector: Donors' Policy and Behavior Analysis

Rami A. Hamarna R.Ph. — Fri, 17 May 2013 08:33:10 PDT

Hamarna, Rami A., Humanitarian and Technical Assistance to the Palestinian Health Sector: Donors’ Policy and Behavior Analysis. Master of Public Health (Health Management and Policy), December 2004, 170pp, 19 Tables, 41 Illustrations, bibliography, 104 titles. International assistance to the Palestinian health sector is reviewed in this thesis. Assistance to the health sector has been the major force towards developing a sound health infrastructure in the Palestinian territories. I argue that Palestinians are much like other recipients of aid for the health sector. This thesis explores the high aid dependence of Palestinians and the great influence of donors. I highlight that donors used aid conditionally, in its different forms, to intrusively interfere in Palestinian national planning and reform. Palestinians are no exception and they, like other countries, have been subject to relatively similar kinds of conditions. However, they were exceptional in the timing, in the great need for aid, and in the political context, which has impacted the effectiveness of the aid.

Association of Leukemia and Other Selected Diseases with Occupational Exposure to Welding

Hilda Oralia Mendoza B.S. — Fri, 17 May 2013 08:33:08 PDT

MENDOZA, HILDA ORALIA. ASSOCIATION OF LEUKEMIA AND OTHER SELECTED DISEASES WITH OCCUPATIONAL EXPOSURE TO WELDING. Master of Public Health (Epidemiology). May, 2003. Exposure to carcinogens is an established risk factor for cancer development. Welders are chronically exposed to cardinogens. In this study, the relationship between occupational exposure to welding and mortality from leukemia, lymphoma, Hodgkin’s disease, melanoma, lung cancer, or myocardial infarcation was examined. Files from ORISEWDS, Comprehensive Epidemiologic Data Resource, U.S. Department of Energy were utilized to develop a working file including 416,686 records from employees of one or more Oak Ridge, nuclear plant facilities. Neither welding exposure length, radiation exposure, nor smoking were included in this study. Results show higher adjusted ratios (OR) for leukemia, lymphoma, and Hodgkin’s disease for employees occupationally exposed to welding as compared to employees on-occupationally exposed to welding. OR’s for lung cancer and myocardial infarction were also higher for welders than non-welders.

HIV Related Risk Behaviors: A Comparitive Study of Urban, Suburban, and Rural U.S. Adolescents

Godavari D. Patil Ph.D. — Fri, 17 May 2013 08:33:07 PDT

Godavari D. Patil, HIV Related Risk Behaviors: A Comparative Study of Urban, Suburban, and Rural U.S. Adolescents. Masters of Public Health (Biostatistics), August 2006, 120 pp., 29 tables, References, 209 titles. This explorative study YRBS 2003 data provides the prevalence of HIV-related risky sexual behaviors and predictors of such behaviors across gender, race/ethnicity, and metro status (N=15, 214) during 2003. Overall, more urban male adolescents engaged in health-compromising behaviors. A significant association was found between gender, race/ethnicity, and metro status and sexual behaviors and associated risk behaviors such as alcohol, drug use, and mental health indicators. These associated risk behaviors were not only associated among themselves and with sexual behaviors variables but also turned out to be responsible predictor variables for HIV related sexual risk behaviors. Minority groups especially black adolescents were at higher risk of contracting HIV infection as having multiple sexual partners was highest (8 fold) among black adolescents compared to mixed & other race, and Hispanic adolescents. Suburban adolescents were nearly two times more likely that rural and urban adolescents to having multiple partners. Results indicated that younger the age more the involvement in sexual and other risky behaviors.

Barriers to Health Care Access Among Vietnamese Refugees in Tarrant County, Texas.

Tuan D. Le — Fri, 17 May 2013 08:33:04 PDT

Le, Tuan D., Barriers to Health Care Access among Vietnamese Refugees in Tarrant County, Texas. Master of Public Health (Health Management & Policy), May 2004, 88 pp., 17 tables, 11 illustrations, bibliography, 56 titles. The refugee community is the most vulnerable community due to existing medical conditions without proper treatment and many barriers in accessing the health care system, including different language, cultural conflict, legal restrictions, and socioeconomic status. The purpose of this study is to determine the nature of these barriers that keep the Vietnamese refugees from accessing the health care system in Tarrant County. The study found that 45.8% have no health insurance, 17.4% received Medicaid, 53.7% have no primary care physician, and 57.14% of Vietnamese elderly refugees, who have been living in the U.S. between seven and ten years, and have lost SSI and Medicaid. These findings are significant at p<.001. Vietnamese refugees perceived factors that kept them from accessing the health care system as major barriers, including language (14%), legal issues (17%), misunderstanding of the medical system (15%), lack of insurance (14%), and different culture (11%). These results may assist social service providers, health care providers, and policy activists to enhance their services and advocate for legal issues, in order to remove these barriers and help refugees to access health care better.

Dietary Quality In The United States: An Evaluation Of Tim American Diet Using Tim Mediterranean Diet Index

Laura Jean LaFontaine B.S., M.B.A. — Fri, 17 May 2013 08:33:03 PDT

LaFontaine, Laura Jean, Dietary Quality in the United States: An Evaluation of the American Diet Using the Mediterranean Diet Index. Master of Public Health (Epidemiology), December 2003, 69 pp., 10 tables, 3 figures, reference list, 92 titles. Mediterranean Diet Index (MDI) score is positively associated with increased longevity in diverse populations. High scores are characterized by high intake of fruit, vegetables, legumes, fish, and grains; low intake of meat and dairy; moderate alcohol intake; and high monounsaturated to saturated fat ratio. Dietary quality 7,772 individuals ages 2 and older in the NHANES 1999-2000 sample was assessed using the MDI. Mean MDI scores were low overall and across all population groups. Highest mean scores (3.03-3.13) were observed in children 2-3 and adult men; lowest scores (2.76-2.77) were observed in adolescents. High scores were associated with foreign-born status, higher education level, increasing age in adults, and decreasing age in children.

Epidemiological Modeling of a Bioterrorism Event in a Noncombat Environment

Christopher J. Perkins D.O. — Fri, 17 May 2013 08:33:02 PDT

Perkins, Christopher J., Epidemiological Modeling of a Bioterrorism Event in a Noncombat Environment. Master of Public Health (Biomedical Sciences), July, 1999, 60 pp., 8 tables, 4 illustrations, references, 31 titles. The challenge to government, medical and public health officials is to advocate for American citizens the safest environment possible to live and work. A threat to the safety of all Americans has initiated preparations from national, state, and local jurisdictions in an attempt to counter the probability of biological terrorism. Bioterrorism is not only a threat to humans but also a threat to the nation’s water and food supplies. Epidemiological Modeling of a Bioterrorism Event demonstrates the importance in preparations to reduce the number of casualties and fatalities. Using Epidemiological Modeling of bioterrorism events will aid public health and medical personnel in the planning and initiation of appropriate public health actions and medical therapies should such events occur.

An Evaluation of an Interdisciplinary House Calls Program For the Frail Homebound Elderly

Jennifer L. Johs B.A. — Fri, 17 May 2013 08:33:01 PDT

Johs, Jennifer L. An Evaluation of an Interdisciplinary House Calls Program For the Frail Homebound Elderly. Master of Public Health (Biomedical Sciences), May, 1999, 57 pp., 4 tables, references, 66 titles. The current study compared utilization markers of 87 frail elderly homebound patients prior to and subsequent to enrollment in an interdisciplinary, physician-led house calls program, as well as measured efforts to increase documentation of advance directives. After enrollment in the program the number of hospital admissions (p=0.047) and emergency department visits (p=0.030) were significantly decreased. The number of admissions to skilled nursing facilities (p=0.023) was also reduced, as was length of stay in skilled nursing facilities (p=0.018). The prevalence of advance directives increased from 26% to 74% (p<0.001) subsequent to enrollment. Patients who died were more likely to die at home (19) than in the hospital (6). All patients who died at home had documented advance directives.

Enhancing the nutritional status of an older population: an educational intervention to improve the nutrition knowledge of persons over 60 living in a rural Texas community

Bridget M. Lane M.S., R.D. — Fri, 17 May 2013 08:32:58 PDT

Lane, Bridget M., Enhancing the nutritional status of an older population: an educational intervention to improve the nutrition knowledge of persons over 60 living in a rural Texas community. Master of Public Health (Health Administration), May, 2002, 61 pp., 8 tables, references, 41 titles. A four session nutrition education promotion program was developed and implemented for a group of seniors in a rural Texas community to enhance the nutritional status of persons over 60 through educational intervention to improve nutrition knowledge. Nutrition knowledge was measured using pre-tests and post-tests (before and after short-term nutrition education). No statistically significant differences were observed between pre/post test results, although there was a directional improvement in several aspects of test performance. Nutrition education programs that can effectively translate healthy dietary recommendations into understandable concepts can result in improvements in nutrition knowledge, and possibly have a positive influence on dietary behaviors and health markers.

A Mixed Methods Approach to the Definition of Family Health Promotion Practices for Mexican Sonoran Mothers

Maria Martha Montiel-Carbajal — Wed, 15 May 2013 14:19:09 PDT

Montiel-Carbajal, Maria M., A Mixed Methods Approach to the Definition of Family Health Promotion Practices for Mexican Sonoran Mothers. Doctor of Public Health (Social and Behavioral Sciences), December 2006, 143 pp., 14 tables, 1 illustration, bibliography, 55 titles. The purpose of this research was to study the family health promotion practices of a sample of Mexican mothers living in the state of Sonora Mexico through a concurrent mixed method approach that included (1) a qualitative component with face to face and in-depth interviews, investigator observations, and analysis of content; (2) a quantitative component consisting of statistical analysis of data from selected selections of the National Survey for the Evaluation of Health Services 2002-2003. For the qualitative component 15 mothers, with mean age of 40 years, mean years of education of 10 years, living with their families were selected to form a purposive sample, and assigned to one of three groups: married working mothers, non-married working mothers, or married non-working mothers. The qualitative component was naturalistic and descriptive using semi-structured interviews with the mothers, and individual questionnaires to collect demographic and housing information. The quantitative component used the survey responses provided by the database of the National Survey for the Evaluation of Health Services 2002-2003, from 404 female adults age 18 and older, living in the urban zone of Sonora. The qualitative component showed that mothers conceptualize the health status of the family as a priority. The specific practices they use depend on the set of external resources and internal strengths of the family in order to overcome the physical, environmental, relational, or economic barriers they found to the promotion of health practices. The participants also reported being unsatisfied with the access and quality of the social health care system. The data from the quantitative component showed that Mexican Sonoran women living in the urban area reported having good health and felt satisfied with their health status; their satisfaction with the social health care system was fair. The group of non-married working mothers was detected to be more at risk for cardiovascular diseases due to a greater proportion of smokers and drinking paired with low amount of exercise. The results provided valuable information to formulate health promotion programs and future policies to be implemented with the target population.

The Geography of the Risk Factors for Type 2 Diabetes in Fifth-Grade School Children in Fort Worth, Texas: Spatial Associations with Obestiy and Fast Food Restaurants

Catherine A. Pepper M.L.I.S. — Wed, 15 May 2013 14:19:08 PDT

Pepper, Catherine A. The Geography of the Risk Factors for Type 2 Diabetes in Fifth-Grade Schoolchildren in Fort Worth, Texas: Spatial Associations with Obesity and Fast Food Restaurants. Master of Public Health (Public Health Informatics), May 2006, 48pp., 3 tables, 5 illustrations, bibliography, 47 titles. In examining risk for Type 2 Diabetes Mellitus (T2DM) in Fort Worth elementary schools, the investigator answered the following questions: What is the geographical distribution of risk for T2DM in Fort Worth elementary schoolchildren? How is that related to the prevalence of obesity? To what extent is the spatial concentration of fast food restaurants a factor in the risk for diabetes and obesity prevalence in this population? The investigator also makes policy recommendations regarding the prevention of diabetes in children. Statistical and spatial analysis of data, provided from a previous study at UNTHSC that assessed overweight and risk for T2DM in elementary school children in the Fort Worth Independent School District, was used to assess the association between risk of diabetes in children and proximity to fast food restaurants. Geographic Information Systems (GIS) analysis was applied to the data to determine if such an association could elucidated.

Radiation Treatments in Women Suffering From Advanced Breast or Cervical Cancer Pain: Is it Underutilized for Palliation?

Sonnia B. Oliva B.S.N., M.B.A. — Wed, 15 May 2013 14:19:07 PDT

Oliva, Sonnia B., Radiation Treatments in Women Suffering From Advanced Breast or Cervical Cancer Pain: Is It Underutilized For Palliation? Doctor of Public Health (Social and Behavioral Sciences), May 2005, 43 pp., 3 tables, 4 figures, references, 39 titles. The research is to study if radiation treatments are under-utilized in metastatic breast and cervical cancer for palliative therapy and to explore the usage of various radiation-therapy modalities that are currently being used for women with these diagnoses. Studies indicate that radiation treatments specifically external beam radiation and radiopharmaceutical therapy for painful metastatic bone disease are the most effective at relieving bone pain. Studies find that breast cancer is known to be a cancer associated with bone metastasis, and literature review supports the conclusion that cervical cancer may also present with bone metastasis. The literature review includes the pervasiveness of pain suffering, issues surrounding why it is so difficult to treat pain, how cancer causes pain, and past study results of radiation effectiveness for bone metastases. The study population is secondary data attained from the Surveillance Epidemiology and End Results (SEER) Program and included 65 years of age and older with Stage IV breast or cervix uteri cancers. The total sample analyzed included 6,505 breast cancer cases and 758 cervix uteri cancer cases. Logistic regression of data found that women with Stage IV breast cancer compared to women with a diagnosis of Stage IIIB breast cancer are 30% less likely to have radiation with a p-value of less than .001. A diagnosis of cervix uteri cancer of Stage IV was also found to be significant with a women being 57% less likely to have radiation compared to a diagnosis of Stage IIIB cervix uteri cancer. The results of this study support the underutilization of radiation in Stage IV breast and cervical cancers for palliative purposes. The World Health Organization’s model of resource allocation in cancer care recommended palliative, symptom-modifying therapy simultaneously with disease-modifying therapy. In summary, this study provides the first known population-based data on radiation utilization of invasive breast and cervix uteri cancers controlling for age, marital status and race/ethnicity in the United States.

Racial and Ethnic Differences in Cardiovascular Disease Risk Factors in U.S. Older Women: Findings from the Behavioral Risk Factor Surveillance Survey

Anita K. Kurian M.B.B.S., M.P.H. — Wed, 15 May 2013 14:19:06 PDT

Kurian, Anita K., Racial and Ethnic Differences in Cardiovasular Disease Risk Factors in U.S. Older Women: Findings from the Behavioral Risk Factor Surveillance Survey, 2003 & 2004. Doctor of Public Health (Clinical Research), August 2006, 118 pp., 55 tables, 14 illustrations, references, 69 titles. Objectives- The study sought to determine if there were any significant racial and ethnic differences in six modifiable cardiovascular disease risk factors in women aged 65 years and older. It also examined the dynamic relationships of race/ethnicity, socioeconomic status and cardiovascular risk factors. Methods- Data were extracted from the merged 2003 & 2004 Behavioral Risk Factors Surveillance Survey (BRFSS). Prevalence estimates and 95% of each of the six cardiovascular disease risk factors considered (Hypertension, Diabetes, Obesities, Hypercholesterolemia, Smoking, and No leisure-time physical activity) were calculated by race/ethnicity. Multinomial (for indicator outcomes) and multiple logistic regression analyses (for binary outcomes) were performed. Path analysis was performed to assess the complex pathways by which race/ethnicity and socioeconomic status (SES) were associated with cardiovascular disease risk factors. Results- Of the 77,492 survey respondents included in the sample, there were 68,251 whites, 4,912 blacks, 3,656 Hispanics and 673 AIANs. The odds of the cardiovascular risk factors were higher in race/ethnicity minority women (non-Hispanic black, Hispanic, American Indian Alaskan Native) compared to white women aged 65 years and older. Socioeconomic status was found to be a moderator rather than a mediator of the relationship between race/ethnicity and cardiovascular disease risk factors. The re-specified model with the behavioral risk factors (smoking and no leisure-time physical activity) as mediators was deemed a good fit to the data. Age, race/ethnicity, SES, smoking and leisure-time physical activity were found to have significant direct, indirect and total effects on cardiovascular disease risk factors. Conclusions- There is a need to find better ways to measure race/ethnicity, and future research should consider the impact of more fundamental determinants of CVD risk factors. Area-based measures, such as neighborhood conditions, should also be given consideration for influencing these risk factors. Identification of potential mediating and moderating factors in these pathways (for example, sense of personal control or social support) will help clinicians and public health professionals to develop culturally sensitive intervention or prevention programs specifically targeted toward risk burdens in each of these populations.

Epidemiologic Assessment of a Targeted Tuberulosis Screening and Treatment Program Based on Geographic and Molecular Clustering

Patrick Kevin Moonan M.P.H. — Wed, 15 May 2013 14:19:05 PDT

Moonan, Patrick K., Epidemiologic Assessment of a Targeted Tuberculosis Screening and Treatment Program Based on Geographic and Molecular Clustering. Doctor of Public Health (Disease Prevention and Control), August 2005, 93 pp., 12 tables, 7 illustrations, bibliography, 148 tables. One of the primary goals of the tuberculosis elimination strategy is to interrupt the transmission of mycobacterium tuberculosis (TB). The most effective way to accomplish this goal is to identify and treat individuals who have active tuberculosis. However, even in highly effected tuberculosis control programs, M. tuberculosis continues to be transmitted to others, largely because most transmission occurs before diagnosis and initiation of therapy. Under the current recommendations, testing should be targeted at specific high-risk populations. While a strategy of targeted testing and treatment of persons most likely to develop tuberculosis is attractive, it is uncertain how best to accomplish this goal. This is the first study to assess the use of geographic and molecular surveillance in guiding a targeted tuberculosis screening and treatment of active tuberculosis and latent tuberculosis infection that monitors potential transmission in a defined high risk geographic area. The results of this geographically targeted program demonstrate significant yield for discovering active cases, latent tuberculosis infection, and recent transmission (TST converters). In this setting, geographically targeted screening identified as many as 19.8 tuberculosis cases per 1,000 persons screened and as many as 292.4 latent tuberculosis infections per 1,000 persons screened. Additionally, successful treatment of these individuals reduced the number of both cases and latent infection identified. Over a three-year period the case detection rate, latent infection detection rate, and TST conversion rate was reduced by 335%, 171% and 285% respectively.

The Impact of Race, Ethnicity, and Income on Dental Utilization

Kyeung Oak Maresh B.S. — Wed, 15 May 2013 14:19:03 PDT

Kyeung, Oak Maresh. The Impact of Race, Ethnicity, and Income on Dental Utilization Master of Public Health (Biostatics), May 2004, 29 pp., 5 tables, 43 references. Objective To determine if there is a difference in access to dental care services among the difference race/ethnic groups, to ascertain if dental care access differs according to income levels, and to look at the utilization patterns of dental care services. Methods The study data is public use data provided by the Medical Expenditure Panel Survey. The data for this study consisted of the 1999 Full Year Consolidated (Medical Expenditure Panel Survey) household component and the 1999 dental visits (HC-033B). Chi-square tests were performed to determine if there was a significant association (p<0.05) between each variable and the probability of dental care visits. Multiple logistic stepwise regression was performed to identify each predictor associated with dental care service. Results This study confirmed that minority ethnic groups access fewer dental care services than do non-Hispanic Whites. It also confirmed the second hypothesis that there is a positive relationship between income levels and access to dental care services. Conclusion The result of this study furthers our understanding of race/ethnicity and socioeconomic status in relation to dental care access. They may also help to raise consciousness of dental care utilization and provide basic information to set up efficient prevention strategies increasing dental care utilization among minority racial/ethnic groups and those of low socioeconomic status.

Asthma Mortality and Toxic Release in Texas - An Ecological Study 1980-2001

Sreeram Maddipatla — Wed, 15 May 2013 14:19:02 PDT

Maddipatla, S., Asthma Mortality and Toxic Release in Texas - An Ecological Study 1980-2001. Master of Public Health (Environmental Health) April 2004, 97 pp., 4 tables, bibliography, 94 titles. There is a lack of literature examining how the spatiotemporal trend of asthma may have impacted different ethnic/racial compositions of Texans. The present study sought to evaluate the geographic-temporal variations in asthma mortality in Texans over a 22-year period, retrospectively, and examine whether the trend of environmental Toxic Release Inventory (TRI) concentrations and their spatiotemporal persistence might place an uneven burden on particular racial groups. The study concentrates on the time period between 1980-2001 and first evaluates geographic excess of asthma mortality in different racial groups at the county level and characterizes the excess burden by spatiotemporal variations. After this assessment, the impact of TRI on asthma mortality over this period of time is analyzed. Based on these two analyses, this would identify which racial/ethnic groups in which Texas regions might have been affected the most by regarding mortality over time, and suggested priority geographic areas for policy intervention. At the end of this study, it could be said that there might be an association between the TRI release and increased asthma mortality in the Black male population.

The Effects of a School-Based Intervention on the Physical Activity Behaviors of Latino High School Students

Eva Pena B.S. — Wed, 15 May 2013 14:19:00 PDT

Pena, Eva, The Effects of a School-Based Intervention on the Physical Activity Behaviors of Latino High School Students. Master of Public Health (Community Health), May 2004, 66 pp., 5 tables, 2 illustrations, 6 titles. The study was to determine if a culturally appropriate school-based intervention increases self-reported levels of physical activity (PA) in 9th grade Latinos. A culturally appropriate intervention could help Latino youth adopt and maintain PA. Students from two primarily Latino schools served as subjects. Experimental students received a modified form of Salud Para Su Corazon, a Latino community-based cardiovascular health initiative. Questions from CDC’s YRBSS were used to measure PA changes. A 3-way mixed model ANOVA was used investigate the effect of pre-post, treatment, and gender on self-reported days of participation in moderate (M) and vigorous (V) PA. Students reported increased M and V PA at the post-test compared to the pre-test. The experimental students tended to report greater increases in V PA following intervention compared to controls. Males reported higher levels of V PA than females. Results suggest some potential effect on student PA behaviors as a result of the intervention.

Do Social Factors Influence the Severity of Diabetes among Hispanics in Fort Worth?: A Cross-Sectional Study

Neda Zandi Moayad — Wed, 15 May 2013 14:18:58 PDT

Neda Zandi Moayad, Do social factors influence the severity of Diabetes among Hispanics in Fort Worth? A cross-sectional study. Doctor of Public Health, May 2004, 91 pp., 5 tables, bibliography, 99 titles. The Latino population is the fastest growing ethnic group in Texas, representing more than 35% of the total population. There is evidence that diabetes among Latinos has increased considerably in recent years. The prevalence of type II diabetes in Latinos ages 45-74 is three times higher than in the non-Latino whites of the same age group. The goal of this research was to assess the importance of selected potential prognostic factors to severe type II diabetes in Latino patients. Among other findings, the results of this study show that family history of diabetes, place of birth and having spent childhood in Mexico, preferring Spanish as the spoken language, having been educated in Mexico, receiving food stamps, smoking, being overweight and obsess, acculturation and low family cohesiveness were associated with severe diabetes. These findings indicate that level of family cohesiveness and acculturation and other variables might be predictors of diabetes severity.

The Effects of Media Exposure on Alcohol Consumption Patters within the African American Population

Vanessa G. Miller B.A., B.S., M.S., A.P.R.N. — Wed, 15 May 2013 14:18:53 PDT

Miller, Vanessa G., The Effects of Media Exposure on Alcohol Consumption Patterns within the African American Population. Doctor of Public Health (Health Management and Policy), May 2005, 206 pp., 62 tables, 8 illustrations, references, 77 titles. Objectives- The study examined the role of media exposure on alcohol consumption patterns in the African American population. In studying the role of media exposure, the study also examined the role of ethnicity, mood/affect, socio-demographic factors and religion on alcohol consumption patterns in this population. Methods- Secondary analysis of the General Social Survey (GSS), 1972-2002 cumulative data file was used to provide quantitative estimates of the relationship between media exposure, ethnicity, mood/affect, socio-demographic factors, and religiosity as predictors of alcohol consumption. Path analysis was used to determine the direct and indirect effects of these concepts on alcohol consumption patterns. Results- Watching television and reading the newspaper were significant predictors of alcohol use. Watching television had a positive effect on alcohol use; but only in the absence of religiosity. When religiosity was present, as indicated by religious affiliation and attendance at religious services, watching television had a significant negative effect on alcohol use. Reading the newspaper had a negative effect on alcohol use; but this effect was not very significant. Watching TV also had a significant positive effect on alcohol abuse. Reading the newspaper had an effect on alcohol abuse but this effect was not significant. IN the presence of religiosity, neither watching TV nor reading the newspaper had a significant effect on alcohol abuse. The effects of religiosity could also be seen on the relationships between alcohol consumption and socializing patterns, age, sex, ethnicity, and income. The year of the GSS survey had a significant positive effect of television viewing and a significant negative effect on reading the newspaper. Race did not have a significant effect on alcohol use or abuse. Conclusion- This research has significant policy implications, as it indicates that exposure to media, thus exposure to advertising, had an effect on alcohol consumption. Religiosity appeared to act as a protective mechanism against the adverse effects of media exposure, as they relate to alcohol consumption. This research provides support for the implementation of more faith-based initiatives to combat substance abuse (especially alcohol abuse). It also sets the foundation for additional research on the effects of advertising on alcohol consumption, looking at the media revolution of the 21st century.

The Role of Health Literacy When Analyzing Functional Health Status: A Look a the 2003 National Assessment of Adult Literacy

Merly Mathew B.S. — Wed, 15 May 2013 14:18:50 PDT

Mathew, Merly. The Role of Health Literacy When Analyzing Functional Health Status: A Look at the 2003 National Assessment of Adult Literacy. Master of Public Health (Community Health), May 2007, 45 pp., 4 tables, bibliography, 36 titles. U.S. Adults with low health literacy have been found to have poor health status and poor knowledge of medical conditions when compared with those with adequate health literacy skills. This research focused on the relevance of the health literacy skills of U.S. adults age 50 and above, when analyzing their functional health status. Secondary data was obtained from public data files that are available from the NCES (National Center for Education Statistics) website. The research is organized as follows: introduction, review of literature, methodology, results, discussion and implications. The findings established a relationship between health literacy and functional health status, and confirmed the need to focus on creating a health literate America.

An Analysis of Texas Hospitals: Assessing the Association between Charity Care, Uncompensated Care, & Community Benefits

Marcus J. Mitias B.A., M.B.A. — Wed, 15 May 2013 14:18:49 PDT

Mitias, Marcus J. An Analysis of Texas Hospitals: Assessing the Association between Charity Care, Uncompensated Care, & Community Benefits. Master of Public Health (Health Management & Policy), May 2007, 47 pp., 5 tables, 11 illustrations, references, 45 titles. The question of whether not-for-profit hospitals are meeting their charitable obligations is once again starting to intensify. Congress is calling for increased scrutiny of not-for-profit hospitals. Similarly, pressure is mounting in Texas where the not-for-profit hospital sector struggles to justify the contributions they make to the community. This cross-sectional study examines the county level association between charity care, uncompensated care expenditures, and community benefits, and hospital structure, and the number of uninsured. Descriptive and multi-linear regression analyses are used to compare hospital charity care and uncompensated care expenditures in Texas. Results indicate the number of uninsured is significantly associated with charity care expenditures and uncompensated care expenditures.

Health Risk Associated with Microbial Contamination in Healthcare Facilities

Eboni D. Palmer — Wed, 15 May 2013 14:18:48 PDT

Palmer, Eboni D., Health Risk Associated with Microbial Contamination in Healthcare Facilities. Master of Public Health (Occupational Health Practice), July 2007, 96 pp., 20 tables, 8 illustrations, bibliography, 140 titles. This study developed a model assessing the risk associated with indoor microbial contamination in health care facilities. A semi-quantitative model resulting in numerical scores was used to describe the severity of risk associated with given levels of contamination. The hospital used in this study had problems with water intrusion. There were 99 locations from 3 air handler unit (AHU) service area locations examined. The final results produced a health risk rating for all three AHUs of medium risk. There is an increased risk of adverse health outcomes due to exposure from environmental microbial contamination. Immunocompromised patients and patients with allergies are not protected from the risk of developing a nosocomial infection or allergic reaction. Remediation of the contaminated areas must be performed in order to reduce the risk.

Predictors of Complicated Staphylococcus Aureus Bacteremia: A Retrospective Validation Study

Pramod Krishnamurthy M.D. — Wed, 15 May 2013 14:18:47 PDT

Krishnamurthy, P., Predictors of Complicated Staphylococcus aureus Bacteremia (SAB): A Retrospective Validation Study. Master of Public Health (Epidemiology), April 2008, 57 pp, 9 tables, 1 illustration, bibliography, 39 titles. SAB often has a complicated clinical course and it is important to identify those at risk for complications to guide management. We conducted a validation study of a clinical prediction tool that uses a scoring system to predict the likelihood of developing complicated SAB. Chapter I is a review of background literature and rationale for our study. Chapter II has sections describing the study design, methods, eligibility criteria, statistical analysis and a summary of the results. We observed significantly higher complications among patients with SAB in our validation study. The prediction tool is not a valid predictor of complicated SAB and we recommend better prediction models to accurately predict complications of SAB.

Measurement of Health Care Professional Concordance with the National Asthma Education and Prevention Program Guidelines for the Management of Asthma

Jeannette Adetokunbo Oshitoye Ph.D., M.S.A.S., M.P.A. — Wed, 15 May 2013 14:18:46 PDT

Asthma is a widely prevalent chronic disease affecting children in the United States. Prior studies show that blacks are more likely to die from asthma than other racial groups. Despite this fact, blacks are less likely to receive the recommended medication to appropriately treat their asthma. Because of the disparity in treatment, this study was conducted to determine if minorities were receiving information recommended by the NAEPP Guidelines. Logistic regression was used to determine the receipt of instructional information. Results show that males are less likely; and those below the age of 17 are more likely to receive the information.

Assessment and Identification of Areas for Improvement of a Local Health Department Food Safety Program

Ann Marie Harris B.S. — Wed, 15 May 2013 14:18:45 PDT

Harris, Ann Marie. Assessment and Identification of Areas for Improvement of a Local Health Department Food Safety Program. Master of Public Health (Environmental Health), May 2008, 14 pp. 1 table, 1 figure, references, 14 titles. The Fort Worth Public Health Department (FWPHD) established a standardized assessment to compare compliance rates for risk factors contributing to foodborne illness. The FWPHD identified significantly higher compliance rates in four out of six risk factors. Risk factors posing the greatest risk for out of compliance observations included threats from contaminated equipment and chemical/other hazards. Fast food establishments had a significantly greater risk for contaminated equipment (OR=1.81; CI=1.27, 2.58). Chemical/other hazards was the only risk factor with a higher overall out of compliance rate than the FDA. The FWPHD can now accurately track the effectiveness of training and education programs for food handlers, consumer health specialists, and the overall inspection process.

Evaluating the Sustainability of THE NORTH TEXAS SALUD PARA SU CORAZON PROGRAM: Effects of the Program on Promotores and the Partner Organizations

Elham Rastegar Kourosh B.S., M.S. — Wed, 15 May 2013 14:18:44 PDT

Kourosh, Elham R., Evaluating the Sustainability of the NORTH TEXAS SALUD PARA SU CORAZON PROGRAM: Effects of the Program on Promotores and the Partner Organizations. Doctor of Public Health, May 2008, 117 pp., 1 table, bibliography, 47 titles. In the light of the rapid growth of the Latino population in Texas, the need for culturally and linguistically appropriate health promotion programs for Latinos is becoming apparent. It is essential that these programs address CVD prevention for this population, since the results of an assessment conducted by the City of Fort Worth in 1998 confirmed that the Latino population in the area is heavily burdened by CVD risk factors such as diabetes and lack of physical activity. It is also important, in light of limited resources for health promotion, that the community health impacts of such programs be sustainable. The purpose of this research was to evaluate the sustainability of the North Texas Salud Para Su Corazon program, by examining two major elements of the program for sustainability: (1) the professional development and work-related experiences of the promotores who participated during the 3 years of operation of the program, and (2) the continuation of the activites that were supported by the network of community partner organizations during the initial period. North Texas Salud Para Su Corazon was a heart health promotion program which trained and mobilized promotores in the Fort Worth area from 2001 to 2004. Guided interviews with a key informant (project director), 14 promotores, and nine partner organization representatives were analyzed using qualitative methods and showed that project activities and effects endured beyond the funding period of the project. Promotores continued to disseminate heart health information after the end of the project, and organizational structures are evolving to support promotora activities, enabling the health effects of the project to continue in the community. Recommendations were made for further support of these activities and included university sponsored studies of the promotores’ work, annual conferences and award ceremonies highlighting their service, and the development of funding for continuous education and job creation programs involving promotores in the health care sector.

Religiosity and Sexually Transmitted Diseases: How Past and Present Religiosity Affect the Odds of Having a Sexually Transmitted Diseases

Rachel Jackson B.S. — Wed, 15 May 2013 14:18:42 PDT

Jackson, Rachel S. Religiosity and Sexually Transmitted Diseases: How Past and Present Religiosity Affect the Odds of Having a Sexually Transmitted Disease among Young Adults. Master of Public Health (Community Health), May 2008, 73 pp., 7 tables, 2 figures, bibliography, 57 titles. The purpose of this study was to determine if and how religiosity among American adolescents affects their odds of developing an STD by young adulthood. Using the National Longitudinal Study of Adolescent Health, the odds of developing an STD were calculated based on past religiosity (religiosity score at Wave I), present religiosity (religiosity score at Wave III), and continued religiosity (religiosity score at Wave III adjusted for Wave I religiosity score). It was determined that religiosity, both past and present, impact the odds of developing an STD, but that the direction and magnitude of this relationship varies by race and religion.

Effects of Cardiorespiratory Fitness on Serum Ferritin Concentration and Type 2 Diabetes: Evidence from the Aerobics Center Longitudinal Study (ACLS)

Tuan D. Le M.D., M.P.H. — Wed, 15 May 2013 14:18:41 PDT

Le, Tuan D., Effects of Cardiorespiratory Fitness on Serum Ferritin Concentration and Type 2 Diabetes: Evidence from the Aerobics Center Longitudinal Student (ACLS). Doctor of Public Health (Clinical Research). May 2008, 114 pp., 12 tables, 8 figures, bibliography, 68 titles. Recent studies suggest that an elevated serum ferritin concentration is considered an independent factor associated with increased risk of type 2 diabetes and cardiorespiratory fitness (CRF) is inversely associated with diabetes. Using secondary data from Aerobics Center Longitudinal Study at the Cooper Institute, Dallas, Texas, the author explored the association between serum ferritin levels and diabetes, CRF and diabetes, and the effect of CRF on the association between serum ferritin levels and diabetes. A cross-sectional study and a longitudinal cohort study were used. In the cross-sectional study, an increased CRF level found to be associated with a decreased serum ferritin concentration and a lowered prevalence of type 2 diabetes. Participants with high ferritin levels and high triglyceride levels were 1.89 and 1.57 times more likely to have diabetes respectively. Overweight or obese individuals were 1.35 to 1.40 times more likely to have diabetes. Participants with a family history of diabetes were 3.69 times more likely to have diabetes. Participants in the highest CRF quintile levels were 40% and 15% less likely to have type 2 diabetes among persons with normal and high blood glucose, respectively. In the prospective cohort study, it was found that serum ferritin might predict the development of type 2 diabetes in males and high serum ferritin concentration levels. The incidence rate among males increased with serum ferritin quartile (ptrend<0.05). A reduction of serum ferritin concentration was associated with a reduction of diabetes risk in those participating in physical activity. It suggests physicians might use patients’ serum ferritin concentrations as a marker for predicting risk for new-onset diabetes and patients should be encouraged to participate in physical activities.

Predictors for the Severity of Asthma in the Hospital Setting. An Epidemiologic Study Based on Hospital Records from the Texas Health Care Information Council

Marco Marruffo M.D., S.C.P, M.P.H. — Wed, 15 May 2013 14:18:39 PDT

Marruffo, Marco, Predictors for the Severity of Asthma in the Hospital Setting. An Epidemiologic Study Based on Hospital Records from the Texas Health Care Information Council. Doctor of Public Health (Epidemiology), May 2005, 118 pp., 40 tables, 3 figures, bibliography, 62 titles. The purpose of this research was to identify and assess prognostic factors for severity and risk of death among 27,383 hospitalized asthma patients in the state of Texas during 2002, by using the public available Texas Hospital Inpatient data, collected by The Texas Health Care Information Council (TCHIC)(TCHIC, 2002). Data was analyzed by means of multinomial logistic regression using minor risk as the reference group. Among other results severe asthma cases were 20% more likely to be females, 20% more probability to have HIV/AIDS, 5.5 times more chance to be obese, 4.2 times more likely to have esophageal reflux, 1.7 times more likely to be hypertensive, and 11.8 times more likely to have diabetes as compared to those without severe asthma (p<0.001). Obese were 2.8, diabetics 3.3, those with urinary tract infection 2.3, those with fever 3.1 and those with congestive heart failure 7.5 times more likely to have major risk of death due to asthma (p<0.001). The results of this study can be used to identify high risk groups to plan and applied control measures for tertiary prevention of severity and death due to asthma.

A Comparative Study of Three Methods to Enhance the Collection of DNA from Plant Material

Alea D. Ausmer — Mon, 13 May 2013 15:34:00 PDT

Simplifying Medical Terminology in Interpreted Medical

Josue Carmona — Mon, 13 May 2013 15:33:59 PDT

An Assessment of Formal Education in Breast feeding or human lactation for Health Professionals In Texas

Olga L. Zasova — Mon, 13 May 2013 15:33:58 PDT

Autism: Association Between Autism and Parenting Stress

Simon D. Banini — Mon, 13 May 2013 15:33:57 PDT

Factors Associated with Difficulty in Using the Community Based Services among Children with Special Health Care Needs

Sreelakshmi Talasila — Mon, 13 May 2013 15:33:57 PDT

Psychiatric Emergency Services Utilization in Tarrant County, Texas, 2000-2007

Sarah K. Brown — Mon, 13 May 2013 15:33:56 PDT

Expression of CSI and 2B4 in Human Lupus Erythematosus and Transcriptional Regulation of CSI Gene

Jongrok Kim — Mon, 13 May 2013 15:33:55 PDT

Appropriate Delivery Of Care In American Patients With Hepatocellular Carcinoma: A Systematic Review

Debra Tan — Mon, 13 May 2013 15:33:53 PDT

Objective: To assess and provide in-depth analysis of appropriate delivery of care in patients with hepatocellular carcinoma (HCC) based on time of diagnosis within Americans in the United States. Design: Meta-analysis of retrospective cohort studies describing receipt of appropriate treatment utilization and delivery of care for HCC. Results: Among all twenty-three included studies, a total of 7,986 of 17,286 (44.4%, 95% CI 43.7-45.1%) patients received overall treatment. Of 48,200 patients with HCC, only 10,518 (21.8%, 95% CI 21.5-22.2%) patients received curative treatment and 6,810 of 11,776 (57.8%, 95% CI 56.9-58.7%) patients who were within early stage HCC received curative treatment. Conclusion: HCC treatment is underutilized in the United States. Although the pooled treatment rate for early HCC patients receiving curative treatment is somewhat better, only about four-sevenths receive appropriate care. There are significant socio-demographic disparities with the lowest treatment rates in non-Caucasians and non-private insurance patients.

A Cost Analysis of Tuberculosis and its Prevention in Tarrant County, Texas

Thaddeus L. Miller M.P.H. — Mon, 13 May 2013 15:33:47 PDT

Miller, Thaddeus L. A Cost Analysis of Tuberculosis and its Prevention in Tarrant County, Texas. Doctor of Public Health (Health Management and Policy), May 2007, 232 pp., 29 tables, 2 illustrations, bibliography, 274 titles. Tuberculosis cost has been incompletely described as the cost arising from acute illness and treatment. The societal cost of tuberculosis arises from infection, suspicion of infection, acute and preventive responses, the sequalae of illness (including acute morbidity, drug induced hepatitis, mortality, and disability), and the compounding effects of transmission. This societal cost in unknown however the variable portion of this cost is equivalent to the savings made possible by averting tuberculosis, This study measured the societal cost of tuberculosis in Tarrant County, Texas, for the year 2002. Societal costs were estimated as the sum of known or estimated expenditures and health losses related to tuberculosis and discounted at 3%. Current and future costs will accrue to an estimated net $33.9 2002 USD million for the year 2002 in Tarrant County, Texas. An average of 1.4 QALYs net of 3% social discount were lost per incident case. The greatest burdens of tuberculosis, when analyzed by either cost or health quality, can be averted only by case prevention. Forty-three and 44% of societal cost was generate by secondary transmission and chronic impairment associated with pulmonary tuberculosis. Neither factor is routinely considered in discussions of tuberculosis cost. Acute treatment, hospitalization and direct medical care account for only 2.4% of societal cost. Any intervention that prevents one tuberculosis case will prevent at least a net $295,182 (2002 USD) and individual health quality losses averaging 1.4 net QALYs.

Is There a Relationship Between Impulsiveness, Risk Perception, Alcohol Problems, Race/Ethnicity, and Alcohol-Related Injury Type?

Cara Hamann B. S. — Mon, 13 May 2013 15:33:44 PDT

This cross-sectional study examined the associations between impulsiveness, risk perception, alcohol problems, race/ethnicity and alcohol-related intentional injury of 1504 White, Black, and Hispanic trauma patients from the emergency department at a Level 1 Trauma center in Dallas, Texas. After controlling for race/ethnicity, age, gender, education, marital status, drug use, and annual frequency of heavy drinking, injury-related alcohol problems within the past 12 months (OR= 1.10, 95% CI 1.02-1.18) had a moderate effect on intentional injury. Impulsiveness (total score, motor, and non-planning) and alcohol problems (total score, physical, interpersonal, social responsibility, and injury) had moderate effects on intentional injury in univariate analyses, but these effects became null in multivariate analyses. Race/ethnicity had a large effect on injury type in all models considered in the study, with Blacks (estimated ORs ranged from 3.06 to 3.54, 95% CIs ranged from 2.08 to 5.18) and Hispanics (estimated ORs ranged from 2.29 to 2.47, 95% CIs ranged from 1.61 to 3.52) having greater odds of intentional in jury in comparison to Whites in univariate and multivariate analyses. Overall, race/ethnicity and injury-related alcohol problems were the only variable of interest that showed effects on intentional injury. Lack of significant results may be partially explained the use of ICD-9 codes to categorize injury type. Future studies should address limitations and alternatives of using ICD-9 codes to evaluate psychological and behavioral factors.

The Relationship Between Adolescent Suicide and Income Inequality

Lauraless Harris M.P.A. — Mon, 13 May 2013 15:33:38 PDT

Harris, Lauralee. The Relationship Between Adolescent Suicide and Income Inequality. Doctor of Public Health (Social and Behavioral), December 2007, 52 pp., 22 tables, 4 figures, references, 43 titles. Suicide is the third leading cause for adolescents in the United States. This study is an attempt to provide a tool for targeting suicide prevention efforts using measures of income inequality. Income inequality measurements included the Gini coefficient and housing value as a percent of median value of single family homes. The study included youth ages 13-21 who committed suicide in Tarrant County, Texas during a ten-year period. Analysis was conducted at the zip code level and included suicide rates, housing value, gender, ethnicity and age. Hypotheses were: there is a positive relationship between the Gini coefficient and suicide rates; there is a relationship between suicide and the median value of housing in the zip code; these relationships will be stronger for males than females. Results of regression analysis showed a positive linear relationship between the Gini coefficient and suicide, though it did not reach the .05 level of significance. The relationship was stronger for males than females. The relationship was stronger for Hispanics and Blacks than for Whites. Frequencies for the relationship between percent of median home value and suicide indicated suicides clustering within 20% +/- of the median for the zip code. Analyses of variance did not show a relationship between percent of median home value and age, gender or ethnicity. These findings do not support the use of Gini coefficient as a predictor for adolescent suicide, but do provide some support for focusing prevention efforts on youth who are near the median income within their zip code. Recommendations are made for further research into the relationship of adolescent suicide and income inequality and for strategies to minimize the effects of relative deprivation.

Variation in Hospital Utilization for Cardiovascular Surgical Procedures in Texas

Parag S. Kunte — Mon, 13 May 2013 15:33:37 PDT

Kunte Parag S., Variation in Hospital Utilization for Cardiovascular Surgical Procedures in Texas. Master of Public Health (Clinical Research), December 2007, 45 pp., 5 tables, references, 39 titles. Racial and ethnic differences in hospital utilization for cardiovascular surgeries have been studied for many years, but most of this research is limited to the Medicare or veteran population. The present study extends to the wider Tecas population including all insurance types, and includes non-Hispanic whites, non-Hispanic blacks, Hispanics, and others. This retrospective cross-sectional study examines racial/ethnic differences in the utilization of cardiac procedures. Results suggest that racial and ethnic differences in the utilization of cardiac procedures exist in Texas and are observed across all types of insurance.

Are the Disaster Preparedness Plans in the Largest Cities in the States Adequate for Disabled & Elderly Populations?

Stephanie K. Hall — Mon, 13 May 2013 15:33:36 PDT

Hall, Stephanie K, Are the Disaster Preparedness Plans in the Largest Cities in the Unites States Adequate for Disabled & Elderly Populations? Master of Public Health (Community Health), May 2007, 36 pp., 10 tables, 1 map, reference, 15 titles. This study seeks to compare urban disaster plans in the 25 largest U.S. cities. The focus of this study involves two populations that are often neglected or dealt with last: elderly and disabled. Therefore, the largest US cities should have a comprehensive disaster preparedness plan that includes evacuation & transportation; sheltering and health services; and legal considerations for both the disabled & elderly populations. The data reported in this study was gathered from each city Office of Emergency Management website. The data was analyzed to determine which cities have disaster preparedness plans that consider the disabled and again populations. Results indicate many cities are not prepared.

An Exploratory Study of the Influence of Language and Ethnic Concordance on Hispanic Patients' Trust in their Healthcare Providers in Tarrant County

Isela Macias B.A. — Mon, 13 May 2013 15:33:35 PDT

Macias, Isela. An Exploratory Study of the Influence of Language and Ethnic Concordance on Hispanic Patients’ Trust in Their Healthcare Providers in Tarrant County. Master of Public Health (Health Interpreting & Health Applied Linguistics), August 2007, 76 pp., 8 tables, references, 57 titles. There is a scare number of Spanish-speaking, Hispanic physicians to serve a growing Spanish-speaking Hispanic population. A survey and interview were conducted in a primary health clinic with fifty-two Spanish-speaking Hispanic patients. The Introduction (Chapter 1), included the problem and purpose; Literature Review (Chapter 2), analyzed supporting literature; Methodology (Chapter 3), described data process; Results (Chapter 4), reported the findings; and Conclusions and Recommendations (Chapter 5), included the decision. Spanish-speaking Hispanics in the study had more trust in Spanish-speaking Hispanic physicians than in non-Hispanic physicians who did not speak Spanish. More studies should include Spanish-speaking Hispanics and focus on differences in acculturation and the patient-physician relationship.

Disability-Adjusted Life Years Lost Due to Adult Pulmonary Tuberculosis in Tarrant County, 2005-2006: An Analysis of the Role of Post Tuberculosis Impairment

Jotam Garaimunashe Pasipanodya M.D., M.H.S.M. — Mon, 13 May 2013 15:33:32 PDT

Pasipanodya, Jotam G. Disability-Adjusted Life Years lost due to adult pulmonary tuberculosis in Tarrant County, 2005-2006: An analysis of the role of post tuberculosis impairment. Doctor of Public Health (Health Management and Policy), May 2008. 145 pages, 18 tables, 11 illustrations, 135 references. Pulmonary impairment after tuberculosis treatment (PIAT) is not yet incorporated in assessing burden of tuberculosis. Previous global and national TB burden estimates therefore did not fully reflect the consequences of surviving tuberculosis disease. This study was conducted to assess burden of TB in Tarrant County, Texas, using Disability-Adjusted Life Years (DALY). DALY is a composite measure of premature mortality and disability that equates years of healthy life lost. DALY, stratified by gender and race were calculated for 118 adult TB subjects seen between July 2005 and October 2006. Years of Life Lost (YLL) were calculated from the difference between standard life expectancy and age at death from TB, summed across county population. Years Lived with Disability (YLD) were derived from age and gender-specific disease incidence weight-adjusted for impairment levels; using disability weights obtained from literature. Three percent discount rate per year was used. One hundred and eighteen subjects lost 444.25 DALY during the study period. Years of life lost to premature mortality (YLL) contributed 159.62 (36%) and years of life lived with disability (YLD) contributed majority of total DALY. Pulmonary impairment after tuberculosis (YLD PIAT) contributed 234.6 (53%), while YLD Acute contributed only 50.03 (11 %) of total DALYS. Contrary to previous estimates; disability contributes more than mortality to TB burden in areas with low TB adult and child mortality. PIA T contributes significantly to TB burden, but was previously unrecognized. These findings suggest that the greatest health savings will be achieved through strategies to prevent tuberculosis from developing rather than strategies to shorten treatment once it has developed.

Body Image, Depressed Mood, Weight Concerns, and Risky Sexual Behaviors Among Female Adolescents

Khiya J. Marshall M.P.H. — Mon, 13 May 2013 15:33:25 PDT

Marshall, Khiya J., Body Image, Depressed Mood, Weight Concerns, and Risky Sexual Behaviors among Female Adolescents. Doctor of Public Health (Social and Behavioral Sciences), May 2006, 75 pp., 17 tables, bibliography, 90 titles. Adolescence is a time of self-discovery and growth, both emotionally and physically, particularly for adolescent females. The literature lacks specific research pertaining to female adolescent females. The literature lacks specific research pertaining to female adolescent’s body image and other concerns and their association with risky sexual behaviors. Using secondary data from the 2003 Dallas Youth Risk Behavior Survey (YRBS; 9th-12th grade), this study explored the relationship between body image, having a depressed mood, and weight control behaviors and how these may translate into risky sexual behaviors among Dallas Independent School District (DISD) adolescent females. Most respondents were African American and Hispanic. The main hypotheses were: a) African American and Hispanic adolescent females will be more likely to have a depressed mood, an unrealistic body image, or weight control behaviors compared to Caucasian adolescent females; and b) Adolescents with unrealistic body image, depressed mood, and weight control behaviors will be more likely to engage in risky sexual behaviors, regardless of race or ethnicity. As hypothesized, more African American and Hispanic adolescents had a depressed mood, and more Hispanics had an unrealistic body image compared to Caucasians. The hypothesis that depressed mood and unrealistic body image would be significant predictors of engaging in risky sexual behaviors was corroborated only for depressed mood. Engaging in weight control, although hypothesized as not a significant predictor, was a significant predictor for using alcohol/drugs before his last sexual intercourse. School-based sexual education programs that target adolescent females in DISD should focus on abstinence or consistent condom use if sexually active, weight control behaviors, and depressed mood and its implications.

Hispanic Female Adolescents at Risk for Suicide and the Use of Illicit Drugs

Cecily Luncheon M.D., M.P.H. — Mon, 13 May 2013 15:33:24 PDT

Luncheon, Cecily. M.D., M.P.H. Hispanic Female Adolescents at Risk for Suicide and the Use of Illicit Drugs. Doctor of Public Health, Fall 2006, 88 p.p., 31 tables, bibliography, 77 titles. This study examines the hypothesis that Latina adolescents in high school who were at risk for suicide are more likely to use illicit drugs than Non-Latinas in high school who are at risk for suicide. Data was analyzed from the 2003 Centers for Disease Control and Prevention Youth Risk Behavioral Survey. A national sample of 9th-12th grades students participated in a self-administrated questionnaire at school. The study who conducted based on 6,826 Hispanic/Latinas, black, non-Hispanic and white, non-Hispanic female adolescents. Three at risk for suicide, nine frequent illicit drugs and three controlling variables were chosen to conduct the study. Chi-square test assessed the significant of difference between races and binary logistic regression models were utilized to estimate the association between at risk for suicide and drug use. Among the three race/ethnicities who were at risk for suicide, Hispanic/Latinas had the highest drug use prevalence. The first logistic regression model that seriously consider attempting suicide were associated with Latinas (OR= 1/0.68 [95% CI, 1/0.53-1/0/87]), suburban youth (1.28 [1.02-1.63]), marijuana (1.79 [1.49-2.16]), inhalants (2.58 [1/46-3.28]), and steroids without MD’s prescription (1.98 [1.32-2.99]). The second logistic regression model established that those who made a suicide plan were associated with Latinas (OR=1/0.66 [95% CI, 1/0.48-1/0.91]), marijuana (1.40 [1.00-1.95]), inhalants (3.18 [2.05-3.79]), methamphetamines (2.21 [1.42-3.76]), and used a needle to inject any illegal drug (4.24 [1.29-12.66]). While the third logistic regression model found that attempted suicide were associated with Latinas (OR= 1/0.67 [95% CI, 1/0.48-1/0.94]), 11th and 12th grades (0.66 [0.46-0.94]) and (0.40 [0.27-0.60]), marijuana 2.50 [1.99-3.16]), cocaine (1.67 [1.09-2.58]), inhalants (2.69 [1.89-3.82]), methamphetamines, taken steroids without MD’s prescription (1.95 [1.12-3.40]) and used a needle to inject any illegal drug (4.30 [1.16-15.87]). Greater awareness about the physical and mental health status of Latinas are needed to ensure that good mental health programs are available for Latina adolescents.

Characterization of Health Status and Modifiable Risk Behavior of United States Adults Using Chiropractic Care as Compared to General Medical Care

Harrison Tatandam Ndetan B.Sc., M.Sc. — Mon, 13 May 2013 15:33:22 PDT

Ndetan, Harrison Tatandam, B.sc., M.Sc., Characterization of Health Status and Modifiable Risk Behavior of United States Adults Using Chiropractic Care as Compared to General Medical Care. Master of Public Health (Biostatistics), August 2007; 25 pp., 8 tables, 1 appendix, 49 titles. This study characterizes typical conditions of chiropractic patients and explores how chiropractic influences modifiable behavioral risk factors in the U.S. data from the Sample Adult Core component of the 2005 National Health Interview Survey (NHIS) was analyzed using SAS9.1.2. Statistical analyses included logistic regression, chi squared, and t test analyses. There were 31,428 respondents. Males comprised 43.79%. Those who saw/talked to chiropractors (DC’s), within the past 12 months were 8.73%. Among these 21.37% did not see the general medical doctor (MD). There was no significant difference in the smoking and alcohol consumption status of respondents who saw/talked to DC’s than MDs. DC patients were more likely to be physically active [OR=1.45(1.20, 1.75)] and less likely to be obese [OR=0.74(0.59-0.92)] than MD patients. Patients with acute migraine, neck, and low back pains were more likely to see DC’s but patients with arthritis and chronic conditions were more likely to see MDs.

"Is it as Simple as ABC?" -- Applying Uganda's ABC Approach Amongst the Dinka Ethnic Group of Southern Sudan

Nyebol B. Madut B.S. — Mon, 13 May 2013 15:33:17 PDT

Madut, Nyebol B., “Is it as simple as ABC? – Applying Uganda’s ABC approach amongst the Dinka ethnic group of Southern Sudan. Master of Public Health (Health Management and Policy), December 2007, 127 pp, 23 figures, 23 tables, bibliography, 157 titles. The purpose of this thesis is to explore those activities than can potentially result in a constructive balance of A, B and C activities, which could translate into an effective HIV prevention strategy for Southern Sudan’s largest ethnic group, the Dinka. In other words, the objective of this paper is to examine the local cultural context of southern Sudan’s largest ethnic group, as well as the state of the AIDS epidemic in areas populated by the Dinka; and then determine which public health and/or health management and policy strategies will prove to be the most effective in tailoring an appropriate mix of ABC activities.