Lifetime prevalence and risk factors for cancer in a Mexican American population with severe health disparities: The Cameron County Hispanic Cohort

Retrospective data from the Cameron Country Hispanic Cohort (1) were analyzed to assess the burden of cancer in the Mexican American population living in Brownsville TX. Data provided by the study participants for themselves and their parents and other extended relatives on cancer and related risk factors were used to determine both the prevalence of cancer and these risk factors as well as any associations between them. Lifetime incidence of cancer among the study participants was of 2.8%. Lifetime incidence of cancer among the parents of the study population was calculated for cancer in general and for specific cancer sites to determine the ranking of occurrence of each type of cancer. Some cancer types in this population were ranked higher than what would be expected when compared with national data from Hispanics in the U.S, these were: Liver cancer (3rd vs. 7th nationally in males and 6th vs. 13th nationally in females), stomach cancer (4th vs. 8th nationally in males and 5th vs. 11th nationally in females) and ovarian cancer (3rd vs. 8th nationally in females). A significant association with cancer was found for being born in the United States compared to being born elsewhere (O.R. 1.62, 95% C.I. 1.01–2.60) among study participants and the same association was also found between birth of parents in the United States regardless of gender for cancers in general (O.R. 1.38 95% C.I. 1.12–1.70), stomach cancer (O.R. 1.92 95% C.I. 1.01–3.67) and colorectal cancer (O.R. 2.93 95% C.I. 1.28–6.72). Having been born in the United States and having a family history of cancer was also found to be significantly associated with other risk factors for cancer such as obesity, diabetes and insulin resistance, both among the parents and the participant population, suggesting these interactions are complex. These high rates of cancer and particular prominence of less usual cancer such as liver and ovary in health disparities warrant evaluation of early detection strategies.^

Prevalence of HIV risk-related behaviors among undocumented Central American immigrant women in Houston, Texas, 2010

The primary aim of this dissertation research is to provide epidemiological data on HIV risk-related behaviors among undocumented Central American immigrant women living in Houston, Texas. Between February and May 2010, we used respondent driven sampling (RDS) to recruit 230 Guatemalan, Honduran, and El Salvadoran women, ages 18 to 50 years, living in Houston without a valid United States visa or residency papers. RDS is a probability-based sampling method that utilizes social networks to access members of hidden populations that lack a sampling frame. Participants completed an interview regarding their demographics, access to and utilization of healthcare services, HIV testing, and sexual behaviors. Data from this study were used 1) to describe the prevalence of sexual HIV risk-related behaviors among undocumented Central American immigrant women, comparing those who recently immigrated to the U.S. (within the past five years) to those with more established residency (of over five years); 2) to describe the prevalence of lifetime HIV testing and evaluate its associated factors in this target population; and 3) to describe the effectiveness of RDS to access members of this target population. ^ As described in Paper 1, there was a generally low prevalence of individual HIV risk-related behaviors (i.e., multiple, concurrent, convenience, and casual sexual partnerships) among the undocumented Central American immigrant women in this study. However, there was evidence of HIV risk due to unprotected sex with male partners who have concurrent sexual partnerships. We identified recent immigrants as the subpopulation at greatest risk, as they were significantly more likely than established immigrants to have multiple and/or concurrent sexual partners. As described in Paper 2, the lifetime prevalence of HIV testing was almost 70%. After adjusting for age, number of years living in the U.S., income security, and resource barriers, lifetime HIV testing was significantly associated with being from Honduras, having more than a sixth grade education, having a regular healthcare provider, and having knowledge of available healthcare resources. Finally, as described in Paper 3, RDS was an effective method for obtaining a diverse sample of Central American immigrant women in Houston. ^ This project is the first to use RDS to conduct an HIV behavioral survey among undocumented Central American immigrant women. Our results will inform the design of future research studies and the implementation of HIV prevention activities among undocumented Central American immigrants in the U.S.^

Physician perceptions of risk regarding mood disorders and pharmacological management during pregnancy: What is current practice?

Mood disorders are the most common form of mental illness and one of the leading causes of morbidity worldwide. Major depressive disorder and bipolar disorder have a lifetime prevalence of 16.2% and 4.4%, respectively. Women comprise a substantial proportion of this population, and an estimated 500,000 pregnancies each year involve women with a psychiatric condition. Management with psychotropic medications is considered standard of care for most patients with mood disorders. However, many of these medications are known human teratogens. Because pregnant women with mood disorders face a high risk of relapse if unmanaged, the obstetrician faces a unique challenge in providing the best care to both mother and baby. It has been suggested that many obstetricians overestimate the teratogenic risks associated with psychotropic medications, while concurrently underestimating the risks associated with unmanaged mood disorders. This may be due a knowledge gap regarding the most current teratogen information, and lack of official management guidelines. Therefore, the purpose of this study is to determine the current knowledge base of obstetricians regarding the teratogenic effects of common psychotropic medications, as wells as to capture current management practices for pregnant women with mood disorders. A total of 117 Texas obstetricians responded to a survey regarding teratogen knowledge and management practice. It was common for respondents to encounter women who disclose both having a mood disorder and taking a psychotropic medication during pregnancy. Many respondents did not utilize up-to-date drug counseling resources, and were unaware of or over-estimated the teratogenic risks of common medications used to treat mood disorders. Finally, many respondents reported wanting to refer pregnant patients with mood disorders to psychiatrists for co-management, but are reportedly restricted in doing so due to accessibility or insurance issues. This study demonstrates that there is a knowledge gap among obstetricians regarding the teratogenicity of common psychotropic medications utilized to manage a patient population they frequently encounter. Further, obstetricians have vastly different risk perceptions of these medications, resulting in various management approaches and recommendations. Future research should focus on establishing standard practice guidelines, as well as better accessibility to psychiatric services for pregnant women.

Back pain in migrant farmworker families and farmworker high school students from Starr County, Texas

Back symptoms are a major global public health problem with the lifetime prevalence ranging between 50-80%. Research suggests that work-related factors contribute to the occurrence of back pain in various industries. Despite the hazardous nature, strenuous tasks, and awkward postures associated with farm work, little is known about back injury and symptoms in farmworker adults and children. Research in the United States is particularly limited. This is a concern given the large proportion of migrant farmworkers in the United States without adequate access to healthcare as well as a substantial number of youth working in agriculture. The present study describes back symptoms and identifies work-related factors associated with back pain in migrant farmworker families and farmworker high school students from Starr County, TX. Two separate datasets were used from two cohort studies "Injury and Illness Surveillance in Migrant Farmworkers (MANOS)" (study A: n=267 families) and "South Texas Adolescent Rural Research Study (STARRS)" (study B: n=345). Descriptive and inferential statistics including multivariable logistic regression were used to identify work-related factors associated with back pain in each study. In migrant farmworker families, the prevalence of chronic back pain during the last migration season ranged from 9.5% among youngest children to 33.3% among mothers. Chronic back pain was significantly associated with increasing age; fairly bad/very bad quality of sleep while migrating; fewer than eight hours of sleep at home in Starr County, TX; depressive symptoms while migrating; self-provided water for washing hands/drinking; weeding at work; and exposure to pesticide drift/direct spray. Among farmworker adolescents, the prevalence of severe back symptoms was 15.7%. Severe back symptoms were significantly associated with being female; history of a prior accident/back injury; feeling tense, stressed, or anxious sometimes/often; lifting/carrying heavy objects not at work; current tobacco use; increasing lifetime number of migrant farmworker years; working with/around knives; and working on corn crops. Overall, results support that associations between work-related exposures and chronic back pain and severe back symptoms remain after controlling for the effect of non-work exposures in farmworker populations. ^

Latino Teen Pregnancy in Texas: Prevalence, Prevention, and Policy

Texas is home to over one million Latino teens who are at risk for negative reproductive health outcomes, such as teen pregnancy and STIs. Teen pregnancy disproportionately impacts the health of Latino teens in Texas and places them at risk of continued high rates of poverty, school dropout, and unemployment unless Texas makes a concerted effort to reduce its teen pregnancy rate. The birth rate among Latina girls is astonishing: 98 per 1000 Latinas (aged 15-19) are giving birth. This translates to over 32,000 births each year among Latina teens, costing almost $98 million in direct medical expenditures and well over $638 million if other costs are included. Most teens become sexually experienced while they are of school age, which translates to an estimated 414,583 sexually experienced Latino students attending Texas public schools. Of these Latino youth, 237,466 report being currently sexually active, and 89,000 report having had four or more sexual partners in their lifetime. While causes of teen pregnancy are complex, the solutions to teen pregnancy are known. Texas needs an effective, comprehensive approach to address the sexual health needs of Texas Latino youth that includes: statewide implementation and monitoring of evidence-based sex education for middle school and high school students, access to reproductive health services for students who are already sexually experienced, and widespread training on adolescent sexual health for teachers, service providers, and parents. By tackling teen pregnancy, we can positively impact the future and well-being of not only Latinos, but of all Texans, and subsequently can contribute to the social and economic success of Texas.

The prevalence, health risks, and consequences of asthma among adult residents in Texas

Based on asthma prevalence data collected from the 2000 BRFSS survey, approximately 14.7 million U.S. adults had current asthma, accounting for 7.2% of the total U.S. population. In Texas alone, state data extrapolated from the 1999-2003 Texas BRFSS suggested that approximately 1 million Texas adults were reporting current asthma and approximately 11% of the adult population has been diagnosed with the illness during their lifetime. From a public health perspective, the disease is manageable. Comprehensive state-specific asthma surveillance data are necessary to identify disparities in asthma prevalence and asthma-control characteristics among subpopulations and to develop targeted public health interventions. The purpose of this study was to determine the relative importance of various risk factors of asthma and to examine the impact of asthma on health-related quality of life among adult residents of Texas. ^ The study employed a cross-sectional study of respondents in Texas. The study extracted all the variables related to asthma along with their associated demographic, socioeconomic, and quality of life variables from the 2007 BRFSS data for 17,248 adult residents of Texas aged 18 and older. Chi-square test and logistic regression using SPSS were used in various data analyses on weighted data, adjusting for the complex sample design of the BRFSS data. All chi-square analyses were carried out using SPSS's CSTABULATE command. In addition, logistic regression models were fitted using SPSS's CSLOGISTIC command. ^ Risks factors significantly associated with reporting current asthma included BMI, race/ethnicity, gender, and income. Holding all other variables constant, obese adults were almost twice as likely to report current asthma as those adults who were normal weight (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.25 to 2.53). Other non-Hispanic adults were significantly more likely to report current asthma than non-Hispanic Whites (OR, 2.43; 95% CI, 1.38 to 4.25), while Hispanics were significantly less likely to report current asthma than non-Hispanic Whites (OR, 0.38; 95% CI, 0.25 to 0.60), after controlling for all other variables. After adjusting for all other variables, adult females were almost twice as likely to report current asthma as males (OR, 1.97; 95% CI, 1.49 to 2.60). Adults with household income of less than $15,000 were almost twice as likely to report current asthma as those persons with an annual household income of $50,000 or more (OR, 1.98; 95% CI, 1.33 to 2.94). In regards to the association between asthma and health-related quality of life, after adjusting for age, race/ethnicity, gender, tobacco use, body mass index (BMI), exercise, education, and income, adults with current asthma compared to those without asthma were more likely to report having more than 15 days of unhealthy physical health (OR, 1.84; 95% CI, 1.29 to 2.60). ^ Overall, the findings of this study provide insight and valuable information into the populations in Texas most adversely affected by asthma and health-related consequences of the disease condition. Further research could build on the findings of this study by replicating this study as closely as possible in other asthma settings, and look at the relationship for hospitalization rates, asthma severity, and mortality.^

Disparities in asthma prevalence: The influence of sociodemographic and workplace factors

Asthma is a serious and continuing health problem that affects millions of Americans. Our study was conducted in response to this serious health problem and for purposes of addressing the issue of potential health disparities as outlined in Healthy People 2010. Data from sub-populations of subjects who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999-2004 were used to complete the following specific aims: (1) to update nationally-based estimates of the prevalence of current and lifetime (ever) asthma among adults in the United States (U.S.) and describe by gender the relationships between potential risk factors (e.g., sociodemographics and lifestyle) and asthma; (2) to describe demographic characteristics among working adults in the U.S. and update estimates of the prevalence of asthma in this sub-population, stratified by occupation and industry; and 3) to determine the utility of adapting a population-based Job Exposure Matrix (JEM) for classifying workplace exposures to asthmagens. ^ Our findings suggest the prevalence of asthma among U.S. adults is continuing to rise, with women having a higher prevalence of asthma than men. Living below the poverty threshold, obesity, and prior history of smoking remain important determinants of asthma. Our study also adds to the increasing evidence that health care workers (HCWs) and those employed in education remain at high risk and that appropriate evaluation and control measures need to be implemented. Over 78% of HCWs and 71% of teachers in our study were females suggesting that further exploration of gender-specific risk factors of asthma in working populations is needed. ^ Our study also addressed the feasibility of adapting a population-based asthma-specific JEM to NHANES (1999-2004). We were not able to apply the asthma-specific JEM due to the broad occupational categories within NHANES. This represents a missed opportunity to examine the association between workplace exposures and asthma in U.S. working adults. However, we have identified steps that may be implemented in future population-based studies that would allow the asthma-specific JEM (and other population-based job exposure matrices) to be used in future studies of the U.S. working population.^

Prevalence and risk factors of asthma and work -related asthma among U.S. adults: Data from the Third National Health and Nutrition Examination Survey, 1988--1994

This cross-sectional analysis of the data from the Third National Health and Nutrition Examination Survey was conducted to determine the prevalence and determinants of asthma and wheezing among US adults, and to identify the occupations and industries at high risk of developing work-related asthma and work-related wheezing. Separate logistic models were developed for physician-diagnosed asthma (MD asthma), wheezing in the previous 12 months (wheezing), work-related asthma and work-related wheezing. Major risk factors including demographic, socioeconomic, indoor air quality, allergy, and other characteristics were analyzed. The prevalence of lifetime MD asthma was 7.7% and the prevalence of wheezing was 17.2%. Mexican-Americans exhibited the lowest prevalence of MD asthma (4.8%; 95% confidence interval (CI): 4.2, 5.4) when compared to other race-ethnic groups. The prevalence of MD asthma or wheezing did not vary by gender. Multiple logistic regression analysis showed that Mexican-Americans were less likely to develop MD asthma (adjusted odds ratio (ORa) = 0.64, 95%CI: 0.45, 0.90) and wheezing (ORa = 0.55, 95%CI: 0.44, 0.69) when compared to non-Hispanic whites. Low education level, current and past smoking status, pet ownership, lifetime diagnosis of physician-diagnosed hay fever and obesity were all significantly associated with MD asthma and wheezing. No significant effect of indoor air pollutants on asthma and wheezing was observed in this study. The prevalence of work-related asthma was 3.70% (95%CI: 2.88, 4.52) and the prevalence of work-related wheezing was 11.46% (95%CI: 9.87, 13.05). The major occupations identified at risk of developing work-related asthma and wheezing were cleaners; farm and agriculture related occupations; entertainment related occupations; protective service occupations; construction; mechanics and repairers; textile; fabricators and assemblers; other transportation and material moving occupations; freight, stock and material movers; motor vehicle operators; and equipment cleaners. The population attributable risk for work-related asthma and wheeze were 26% and 27% respectively. The major industries identified at risk of work-related asthma and wheeze include entertainment related industry; agriculture, forestry and fishing; construction; electrical machinery; repair services; and lodging places. The population attributable risk for work-related asthma was 36.5% and work-related wheezing was 28.5% for industries. Asthma remains an important public health issue in the US and in the other regions of the world. ^