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PubMed2006

Emergency room use and access to primary care: evidence from Houston, Texas.

To cope with the rising number of uninsured, communities around the country are pursuing a variety of strategies to expand local health care safety nets. One measure that has been suggested to evaluate what is working is primary care-related emergency department (ED) visits. In this paper, we evaluate the applicability of this measure as an access indicator by examining its correlation with other indicators of medical under-service. We obtained ED visit data from safety net hospitals in Houston, Texas and applied the New York University ED Algorithm to estimate the rate of visits that were primary care-related. We then examined at the ZIP code level the correlation of primary care-related ED visits per 1,000 population with the federal government's Index of Medical Underservice (IMU), the poverty rate, and the uninsurance rate. Primary care-related ED visits were found to be weakly correlated with the IMU and strongly correlated with the rate of uninsurance and poverty. These findings suggest that the combination of this indicator with other measures of access could be used to monitor and evaluate local initiatives designed to expand care and coverage to the medically underserved.

Emergency Service, Hospital↗
PubMed1999

Preventing syphilis: lessons from a survey of two inner-city communities in Houston, Texas.

To develop a relevant, community-based prevention campaign, the authors examined, using street-intercept interviews, syphilis-related knowledge, circulation of information, and screening and treatment practices among four hundred residents of two inner-city communities in Houston, Texas, where syphilis case rates exceed city, county, and national averages. Although awareness of syphilis was near universal, one-fourth of the respondents thought syphilis was incurable, and a large proportion confused syphilis with other sexually transmitted diseases (STDs), mentioning discharge and burning or itching in the genital area as symptoms. Almost four out of five respondents were aware of free treatment and screening facilities in the local area, yet, less than two of five expressed the intention to get tested within the next month. Only 22 percent had seen or heard anything about syphilis in the past twelve months. The resultant prevention campaign is discussed along with implications for the development of comprehensive STD prevention and control campaigns in similar poor and underserved communities.

Adolescent↗
PubMed1979

A demographic study of disease due to Mycobacterium kansasii or M intracellulare-avium in Texas.

The number of patients reported th have disease due to Mycobacterium kansasii or M intracellulare-avium has increased in Texas from January 1967 to December 1976, in contrast to a decrease in tuberculosis. Presented is an analysis of 1,409 patients infected with M kansasii and 706 patients infected with M intracellulare-avium. The former group clustered in urban areas with more than twice the incidence compared to nonurban areas (P less than 0.001). The latter group was more diffusely distributed with approximately twice the incidence in nonurban areas compared to urban areas (P less than 0.001). The average age of the group infected with M kansasii was 50 years and of the group infected with M intracellulare-avium 58 years. In patients infected with M kansasii only, the average age was significantly higher for men than women. There was a male predominance in both groups, ie, 3:1 in M kansasii and 2:1 in M intracellulare-avium. Persons with Spanish surnames had a low incidence of disease due to M kansasii. No other racial or ethnic association was noted. The various factors involved in determining the atypical mycobacterial diseases are discussed.

Adolescent↗
PubMed1981

Usual interstitial pneumonia following Texas A2 influenza infection.

In two patients a documented Texas A2 influenza infection was associated with the development of interstitial pulmonary disease. One patient had an acute fulminating process resulting in respiratory failure and necessitating ventilatory assistance. Open lung biopsy revealed a histologic picture consistent with usual interstitial pneumonia (UIP). The other patient had a subacute course, and the pulmonary histology showed UIP with features of desquamative interstitial pneumonia. The influenza virus may have had an etiologic role in the development of the interstitial lung disease in our two patients.

Acute Disease↗
PubMed2002

Evaluating outcomes of HIV prevention programs: lessons learned from Houston, Texas.

The Centers for Disease Control and Prevention (CDC) fund state and local health departments to contract with community-based organizations for HIV prevention tailored to the needs of populations at risk. In 1999, the CDC began requiring health departments to develop the capacity to evaluate the outcomes of these programs. The CDC requirements create the need for practical, low-cost methods of outcome monitoring that can be applied at the local level. We describe the development of a multisite evaluation of seven city health department funded (via CDC) HIV counseling programs in Houston, Texas. Initial findings indicate that (1) behavioral change information that reflects program objectives can be obtained through a brief survey; (2) community providers were not able, or were unwilling, to follow the evaluation protocol related to surveying their clients; (3) that asking clients to mail back posttest surveys resulted in low response; and (4) a one-contact intervention made establishing rapport, commitment, and/or trust difficult for evaluation purposes. These findings suggest areas for improvement, including providing staff training and/or better motivation to ensure protocol fidelity, considering the use of an external evaluator to conduct pre-post surveys, and developing a different design to evaluate one-shot interventions.

Adult↗
PubMed2006

Outcomes of Project Wall Talk: an HIV/AIDS peer education program implemented within the Texas State Prison system.

We report select outcomes from an evaluation of Project Wall Talk, a community-based, peer-led HIV prevention education program implemented in 36 Texas State prison units. Peer educators completed questionnaires prior to receipt of a 40-hour intensive training (N = 590) and at 9-month follow-up (N = 257). Students (N = 2506) completed questionnaires pre- and post-receipt of peer educator-led HIV education sessions. Peer educators and their students showed significant increases in HIV-related knowledge. Peer educators showed significant increases in assessment of their skills as educators. For both peer educators and students, significant differences in HIV-related knowledge were indicated across categories of prior educational level attained and race/ethnicity; no such differences were indicated at follow-up. Compared with baseline, a significantly greater proportion of peer educators reported ever having had an HIV test. After receiving peer-led education, a significantly smaller proportion of students reported they knew their HIV status and more indicated plans to take an HIV test. Additionally, in months 12 and 18 following program implementation, the numbers of HIV tests at the five units that implemented the peer education program were roughly twice that of five, matched comparison units without the peer education program. Based on peer educator reports, we projected that peer educators (N = 257) may have as many as 84,000 or more annual opportunities to share HIV-related knowledge with other prisoners outside the classroom.

Adult↗
PubMed2006

Adaptation and implementation of an evidence-based prevention counseling intervention in Texas.

HIV prevention counseling linked with testing has been shown to reduce high-risk behaviors and new sexually transmitted diseases in public clinic settings. However, few studies have been conducted evaluating the implementation of such models outside a research setting. This study sought to determine the extent to which the introduction of a standard protocol based on Project RESPECT improves the achievement of HIV prevention counseling goals of existing counseling and testing programs. Four prevention counseling programs contracting with the Texas Department of State Health Services completed a standardized 5-day training and implemented the protocols, counseling tools, and quality assurance (QA) procedures developed for the project. Introduction of the protocol was accomplished with existing program resources and significantly improved prevention counseling. Direct observation of counseling sessions demonstrated a significant improvement in attainment for eight of the nine counseling goals of initial sessions and for all counseling goals of follow-up sessions after the protocol was introduced. Client exit questionnaires reinforced this finding. Significant improvement was also found in use of counseling skills, with improvements in 6 of 10 skills observed in initial sessions and 4 of 10 skills in follow-up sessions. Challenges identified through semistructured interviews with counselors and supervisors included serving non-English-speaking and low-risk clients, mastery of the protocol, the amount of time required for QA, and implementation in settings with severe time constraints.

Counseling↗
PubMed2001

An unmatched case-control study of nearly lethal suicide attempts in Houston, Texas: research methods and measurements.

This article details the research methods and measurements used in conducting a population-based, case-control study of nearly lethal suicide attempts among persons aged 13-34 years, residing in Houston, Texas. From November 1992 to July 1995, we interviewed 153 case subjects presenting at one of three participating hospital emergency departments and used random digit dialing to identify 513 control subjects residing in the same catchment area in which cases were enlisted. Unlike most research in this area, this study was designed to extend our understanding of suicidal behavior and prevention activities beyond identification and treatment of depression and other mental illnesses. We discuss the overall strengths and weaknesses of our study design and conclude that this methodology is well suited for studying rare outcomes such as nearly lethal suicide.

Adolescent↗
PubMed1998

Evaluation of a bicycle helmet giveaway program--Texas, 1995.

OBJECTIVE: To determine the effect of a bicycle helmet giveaway program on helmet use among children. METHODS: In 1995, a bicycle helmet giveaway program was conducted in two rural towns in Texas. Helmets were given to all 403 school children in kindergarten through grade 8. Helmet education, a bicycle rodeo, and incentives to increase helmet use were part of the program. Observations of helmet use were made before the helmet program began and after the program at several intervals throughout the school year and during the summer. A self-reported survey questionnaire was administered to children in grades 4 through 8 before the helmet program began and at several intervals during the school year to determine their attitudes about helmet use, safety perceptions, and peer pressure. A questionnaire also was administered to the parents of these children to determine attitudes and bicycle helmet use among parents. RESULTS: Helmet use increased from 3% before the giveaway to 38% at the end of the school year, 7 months later. However, during the subsequent summer, helmet use decreased to 5%. Helmet use among 7th- and 8th-grade students was 0% at all observations periods after the giveaway. Even though 96% of all students thought that helmet use increased riding safety and 68% thought helmets should be worn at all times when riding, only 25% thought that their friends would approve of helmet use. Most parents also believed that helmets increased riding safety and should be worn, but only 23% reported always wearing one when riding a bicycle. CONCLUSIONS: Bicycle helmet giveaway programs can increase helmet use temporarily, but they may not be sufficient to sustain it. This program was not effective among 7th- and 8th-grade students.

Adolescent↗
PubMed2005

Epidemiology of pediatric tuberculosis using traditional and molecular techniques: Houston, Texas.

OBJECTIVE: To investigate the transmission dynamics of pediatric tuberculosis (TB) by analyzing the clinical characteristics with the molecular profiles of Mycobacterium tuberculosis isolates during a 5-year period. METHODS: A retrospective review of a prospective population-based active surveillance and molecular epidemiology project was conducted in private and public pediatric clinics within Houston and Harris County, Texas. The study population consisted of patients who had pediatric TB diagnosed from October 1, 1995, through September 30, 2000. Cases and potential source cases (PSC) were interviewed using a standardized questionnaire. Available Mycobacterium tuberculosis isolates from cases and PSCs were characterized and compared by IS6110 restriction fragment length polymorphism, spoligotyping, and genetic group assignment. Clinical characteristics were described, and molecular characterizations were compared. Data were analyzed by using EpiInfo 6.02b and SAS 8.2. RESULTS: A total of 220 (92%) of 238 pediatric TB cases were included. Epidemiologic and clinical findings were consistent with previous studies. Molecular profiles from 3 cases did not match the profile of PSC. Four previously unknown PSCs were identified using molecular techniques. Fifty-one (71.8%) of 71 isolates matched at least 1 other Houston Tuberculosis Initiative TB database isolate and were grouped into 33 molecular clusters. Cases were more likely to be clustered when the patients were younger than 5 years, identified a source case, or were US born. CONCLUSIONS: Traditional contact tracing may not always be accurate, and molecular characterization can lead to identification of previously unrecognized source cases. Recent transmission plays a significant role in the transmission of TB to children as evident by the high degree of clustering found in our study population.

Adolescent↗
PubMed1998

A case-control study of human papillomavirus and cervical squamous intraepithelial lesions (SIL) in Harris County, Texas: differences among racial/ethnic groups.

We conducted a case-control study of the association between SIL and HPV among whites (W), African Americans (AA), and Hispanics (H) in Harris County, Texas. Cases were identified at M.D. Anderson Cancer Center Colposcopy Clinic. Controls were identified among women obtaining routine Pap screening at two Harris County Health Department Clinics. HPV was detected by a PCR-based fluorescent assay. Dichotomous and polytomous logistic regression models were used to estimate adjusted odd ratios (AOR) and 95% confidence intervals (CI) for SIL among racial/ethnic groups and grade of disease. Prevalence of HPV infection was 64% in low grade SIL (LSIL), 84% in high grade SIL (HSIL), and 19% in controls. Risk of SIL was higher in H than in W and AA, AOR 29.5 (12.4-70.5), 15.3 (6.0-33.8), and 5.8 (2.6-12.6), respectively. Similarly, racial/ethnic differences were observed for both LSIL (AOR = 16.6, 7.7, and 4.3, respectively) and HSIL (AOR = 78.6, 34.6, and 14.2, respectively). Findings support the association between SIL and HPV and differences in the strength of the association with LSILs and HSILs. Data also suggest a higher risk for H and a lower risk for AA.

Adult↗
PubMed2000

Urinary fluoride excretion by children 4-6 years old in a south Texas community.

This study evaluated urinary fluoride excretion by school children 4-6 years old who were living in a south Texas rural community that had concentrations of fluoride in drinking water supplies generally around the optimal level. We took supervised collections of urine samples in the morning and afternoon at school, and parents of the participating students collected nocturnal samples. We recorded the beginning and end times of the three collection periods and then determined the urinary volume and urinary flow for each of the periods. We measured urinary fluoride concentrations and calculated the urinary excretion rate per hour. The children had breakfast and lunch provided at the school, where the drinking water contained 1.0-1.3 milligrams/liter (mg/L) fluoride. Fluoride concentrations in the tested household water supplies, from wells, ranged from 0.1 to 3.2 mg/L fluoride. The children's average urinary fluoride concentrations found for the day were similar to those for the night, with means ranging from 1.26 mg/L to 1.42 mg/L. Average excretion was 36.4 micrograms/h in the morning, 45.6 micrograms/h in the afternoon, and 17.5 micrograms/h at night. The lower nocturnal excretion rates are easily explained by low urinary flow at night. Based on the 15 hours of urine collected, the extrapolated 24-hour fluoride excretion was 749 micrograms. In conjunction with similar studies, the data from this study will help in developing upper limits for urinary fluoride excretion that are appropriate for avoiding unsightly fluorosis while providing optimal protection against dental decay.

Age Factors↗
PubMed2001

Attitudes and beliefs about environmental hazards in three diverse communities in Texas on the border with Mexico.

OBJECTIVE: Since communicating risk related to environmental hazards has consistently presented a challenge to government agencies and industries, our objective was to better understand the attitudes and beliefs of three communities, so as to help agencies and industries develop better risk communication interventions. METHODS: We explored attitudes and beliefs about environmental risks in three diverse communities in Texas on the border with Mexico, in the county of El Paso. During the summer of 1995, using a door-to-door survey, we interviewed 147 individuals, using a questionnaire based upon an existing instrument. Interviews were conducted in three very different areas of the county: semirural low-income, urban low-income, and suburban upper-income. We randomly selected specific sections in each of the three communities for inclusion in the sample. We assessed attitudes and beliefs about regulations and experts, risk and hazards, and how to address environmental issues. RESULTS: Attitudes and beliefs varied among the three communities, especially in the assessment of riskiness of various hazards. In general, there was mistrust of government agencies and of industries, a strong feeling that the environment can be improved, and a lack of understanding about what actions individuals might take to improve the environment. DISCUSSION: Agencies need to find ways to increase their credibility with the public, and they should assess communities in order to understand the attitudes of the residents.

Attitude to Health↗
PubMed2006

Physical activity and overweight among adolescents on the Texas-Mexico border.

OBJECTIVE: To investigate differences in associations between physical activity and overweight for students in two adjacent areas on the border between Mexico and the United States of America: students in the city of Matamoros, Mexico, and Mexican-American students in the Lower Rio Grande Valley (LRGV) area of southern Texas. Since the extremely high prevalence of overweight among Mexican-American adolescents is well-recognized, we wanted to determine whether overweight has become a problem among Mexican adolescents as well. METHODS: Students from 6 schools (n = 653), representing 11% of the ninth-grade students in Matamoros during 2002-2003, and students from 13 high schools (n = 4,736), representing 22% of the ninth-grade students in the LRGV during 2000-2001, completed questionnaires. Polytomous logistic regression was performed to estimate the risk of being at risk for overweight (> or = 85th percentile to < 95th percentile of body mass index (BMI) for age and sex) and the risk of being overweight (> or = 95th percentile of BMI-for-age and sex) versus normal weight that were associated with measures of physical activity. For simplicity, the classification of normal weight also included underweight. RESULTS: A higher percentage of adolescents in the LRGV were at risk of overweight (17%) in comparison with adolescents from Matamoros (15%). The percentages of LRGV and Matamoros adolescents who were overweight were identical (17%). LRGV adolescent boys (OR = 0.87, 95% CI = 0.77-0.98) who participated in team sports were less likely to be at or above the 85th percentile of BMI-for-age and sex. Although of borderline significance, Matamoros and LRGV adolescent boys who participated in physical education classes were less likely to be at risk for overweight. Among neither the Matamoros students nor the LRGV students were any of the various other physical activity categories or levels associated with being at risk for overweight or being overweight. CONCLUSIONS: Nearly one-third of the students in both Matamoros and the LRGV are at risk for overweight or are overweight. Implementation of interventions on healthful dietary choices and participation in physical education classes and sports teams are essential for reducing the extremely high prevalence of overweight among students on both sides of the Texas/Mexico border.

Adolescent↗
PubMed2000

Population dynamics of Bemisia argentifolii (Homoptera: Aleyrodidae) on spring collard and relationship to yield in the lower Rio Grande Valley of Texas.

Seasonal population dynamics of the silverleaf whitefly, Bemisia argentifolii Bellows & Perring [formerly known as the sweetpotato whitefly, B. tabaci (Gennadius) Biotype "B"], was investigated on collard (Brassica oleracea L. variety acephala) during spring 1998 and 1999 in the Lower Rio Grande Valley of Texas. Yield loss caused by whitefly was determined by using insecticides to suppress whitefly populations to a low level. Although B. argentifolii populations of adults and immatures fluctuated greatly from April to June during the two seasons, the relative values were similar. Adult whiteflies first appeared on the plants in early April, increased rapidly within the month, peaked in May, and declined at the end of the season in early or mid-June. Whitefly eggs appeared on plants soon after adults were found, but high numbers of eggs were observed on foliage until late May 1998 and mid- and late May 1999. Nymphs and pupae increased slowly before June 1998 and increased early in May 1999. Whitefly population levels appeared to be positively associated with the availability and the growth of host plants until plant maturation, afterward being negatively related with plant quality in the late season. Temperature, rainfall, and natural enemies were not key factors in regulating population dynamics during the two seasons. Collard plants with heavy infestations of whiteflies were unmarketable because of the damage caused by honeydew and sooty mold on the foliage. Application of a combination of fenpropathrin (Danitol) and acephate (Orthene) not only significantly reduced the whitefly infestation levels but also reduced plant foliar damage, resulting in marketable foliage with six to seven times greater yield and higher quality compared with the untreated plants.

Animals↗
PubMed2001

The Ivomec SR Bolus for control of Boophilus annulatus (Acari: Ixodidae) on cattle in South Texas.

When Hereford heifers infested with Boophilus annulatus (Say) were treated with a single Ivomec SR Bolus, the concentration of ivermectin in the serum of the treated cattle reached a maximum of 8.8 +/- 0.9 ppb at 2 wk posttreatment. The single bolus treatment resulted in 84.4% control of standard engorging B. annulatus females on treated cattle over the 20-wk trial. Although fewer engorged ticks were collected from the sentinel heifers exposed in the treated pasture than those in the control pasture at weeks 4, 10, and 16 posttreatment, none of the differences was statistically significant. Each exposure of sentinel cattle found free-living ticks in both the treated and control pastures, indicating the infestation was not eliminated by the treatment. When the trial was repeated using two Ivomec SR Boluses/heifer, the concentration of ivermectin in the serum of the treated cattle reached a maximum level of 31.2 +/- 3.9 ppb at week 13 posttreatment. The use of two boluses/heifer resulted in 99.6% control of standard engorging B. annulatus females over the 20-wk trial. No ticks were found on sentinels placed in the treated pasture after week 9 posttreatment, an indication that the treatment had eliminated the free-living population in the treated pasture. From these studies, we conclude that a single Ivomec SR Bolus is incapable of sufficient control of B. annulatus to meet the rigid requirements of the Cattle Fever Tick Eradication Program in South Texas. Although two boluses per animal did eliminate the ticks from treated heifers and the pasture they were in, the treatment would not be sufficiently efficacious for mature cattle (>400 kg) for it to be useful in the program.

Animals↗
PubMed2003

Early-season colonization patterns of the boll weevil (Coleoptera: Curculionidae) in Central Texas cotton.

It is commonly believed that colonization of early-season cotton, Gossypium hirsutum L., by overwintered boll weevils, Anthonomus grandis grandis Boheman, is concentrated on field margins. However, supporting experimental evidence is not available. In 1999 and 2000, we examined colonization patterns of overwintered boll weevils in Central Texas cotton on the bases of adult collections by a pneumatic sampler and hand collections of abscised infested squares. Samples were taken from sites arranged in a grid that extended inward >70 m from the field margin. Adults were collected from shortly after seedling emergence until the flowering stage, and infested squares were collected during the one-third grown square stage. Despite numerical trends, the numbers of adult weevils collected were not significantly different between years or sexes, or among plant phenological stages. Field-to-field variation among collections was considerable and likely prevented detection of differences among these factors. Spatial patterns represented by adult weevil and infested square collections were examined by logistic regressions fitted to the respective probabilities of weevil detection at each designated sample site. Although we observed trends for slightly decreased probability of weevil detection with increased distance from the field margin, these trends were too weak to be demonstrated statistically. Our results indicate the boll weevil does not consistently exhibit a strong edge-oriented colonization pattern, and that management tactics that are predicated on these patterns, such as border sprays, should be used with caution.

Animals↗
PubMed2005

Leptodictya tabida (Hemiptera: Tingidae): a potential threat to sugarcane production in Lower Rio Grande Valley of Texas.

Areawide surveys and replicated cultivar trials were conducted in 2001 and 2002 in sugarcane (Saccharum spp.) fields in the Lower Rio Grande Valley of Texas to assess the distribution and incidence of the sugarcane tingid Leptodictya tabida (Herrich-Schaeffer). L. tabida was found in all fields surveyed during both years, infesting 60 and 68% of the plants, respectively. The average percentage of leaves infested was 11% in 2001 and 15% in 2002. In 2001, 'CP70-1133' was the most infested, 'CP72-1210' was the least infested, and intermediate infestation levels were evident in 'CP70-321' and 'TCP87-3388'. In 2002, however, TCP87-3388 and CP70-321 were more heavily infested, and CP71-1240 and CP71-1405 were the least infested. Mean densities of L. tabida recovered per plant varied between 1.2 bugs on CP72-1210 and 5.1 on CP70-1133 in 2001, and in 2002, from zero bugs on CP71-1240 and CP71-1405 to 5.3 on CP72-1210. In the cultivar trials, cultivar differences also were evident in both plant and leaf infestation levels, and the proportion of immatures to total L. tabida populations; 'HoCP91-555' had the lowest L. tabida infestations and 'NCo-310' had the greatest levels in both years. Although >5000 L. tabida from the field were collected and kept in the laboratory, no parasitoids were found. The distribution of the infestations during the surveys and in the field trial evaluations suggested that L. tabida populations have been spreading in sugarcane across the Lower Rio Grande Valley. Potential varietal resistance mechanisms are discussed.

Animals↗