Addressing teenage pregnancy in rural areas: A case study from Liberty County, Texas

This study explores the issue of teenage pregnancy in a case study of Liberty County, a rural area in Texas with no public health department. It also describes the decision-making process and barriers faced in the beginning phases of adopting a sexual education program, and sets forth an implementation plan for two school districts on disseminating an evidence-based, comprehensive curriculum. Methods include a review of epidemiological data surrounding teenage pregnancy on the national, state, and county level; a literature review of factors related to teenage pregnancy and past interventions implemented in a rural community; a policy review of past and current bills in Legislature; and an analysis of barriers and decision making in implementing an evidence based program through qualitative observations, discussions with community members during meetings, presentations, and discussions. Results of this study indicate that there is a lack of research conducted in rural areas in the field of teenage pregnancy prevention and sexual education programs. Barriers experienced in Liberty County are shown to be consistent in scientific literature such as funding, logistical issues, and problems approaching the School Board in adopting a comprehensive sexual education program. This study fills a large gap in the literature on rural adolescents and attempts to analyze the process of decision-making in a rural area related to adoption of sexual education programming. In order to relieve this health disparity, further research should focus on rural areas to gain insight on the attitudes and behaviors of rural adolescents and beliefs among community stakeholders.^

Risk factors associated with first symptomatic infection of {\it Cryptosporidium parvum\/} in an infant population in Bilbeis, Egypt

Diarrhea disease is a leading cause of morbidity and mortality, especially in children in developing countries. An estimate of the global mortality caused by diarrhea among children under five years of age was 3.3 million deaths per year. Cryptosporidium parvum was first identified in 1907, but it was not until 1970 that this organism was recognized as a cause of diarrhea in calves. Then it was as late as 1976 that the first reported case of human Cryptosporidiosis occurred. This study was conducted to ascertain the risk factors of first symptomatic infection with Cryptosporidium parvum in a cohort of infants in a rural area of Egypt. The cohort was followed from birth through the first year of life. Univariate and multivariate analyses of data demonstrated that infants greater than six months of age had a two-fold risk of infection compared with infants less than six months of age (RR = 2.17; 95% C.I. = 1.01-4.82). When stratified, male infants greater than six months of age were four times more likely to become infected than male infants less than six months of age. Among female infants, there was no difference in risk between infants greater than six months of age and infants less than six months of age. Female infants less than six months of age were twice more likely to become infected than male infants less than six months of age. The reverse occurred for infants greater than six months of age, i.e., male infants greater than six months of age had twice the risk of infection compared to females of the same age group. Further analysis of the data revealed an increased risk of Cryptosporidiosis infection in infants who were attended in childbirth by traditional childbirth attendants compared to infants who were attended by modern childbirth attendants (nurses, trained midwives, physicians) (RR = 4. 18; 95% C.I. = 1.05-36.06). The final risk factor of significance was the number of people residing in the household. Infants in households which housed more than seven persons had an almost two-fold risk of infection compared with infants in homes with fewer than seven persons. Other risk factors which suggested increased risk were lack of education among the mothers, absence of latrines and faucets in the homes, and mud used as building material for walls and floors in the homes. ^

Birth defects among surviving children under seven years of age in Tianjin, China

Birth defects are a leading cause of infant mortality in the developed countries. They are also of increasing concern in many developing countries, such as China. However, prevalence and causes of birth defects in China are inadequately understood.^ The purpose of the present study was to estimated prevalence of birth defects in surviving children under seven years of age in Tianjin, China and investigate determinants of birth defects in the study area.^ The present study took place in Tianjin, China in 1986, involving 22,081 surviving children under seven years of age. Children with birth defects were ascertained through physical examinations by physicians during household visits and ascertainment of birth defects was verified through multiple sources. Of 22,081 surviving children, 524 had birth defects (23.7 per 1,000). The study noted a striking discrepancy in the prevalence of birth defects between urban and rural area. The prevalence of birth defects was 16.3 per 1,000 in the urban and 33.2 per 1,000 in the rural area.^ Using cases of birth defects ascertained from surviving children, a case-control study was carried out. The study observed that first-trimester maternal flu was associated with increased risk of both major and minor birth defects in children after controlling for other maternal factors (adjusted odds ratio (OR) = 8.7, 95% confidence interval (CI) = 4.3-17.3; OR = 3.6, 95% CI = 1.7-7.5). This association could be biased by different reporting of exposure between mothers of children with birth defects and mothers of children without defects. This study indicated that maternal flu was also associated with congenital heart defects and polydactyly after controlling for other maternal factors (adjusted OR = 32.3, 95% CI = 13.3-78.3; adjusted OR = 5.5, 95% CI = 1.1-27.7). The associations remained when affected controls (children with similar birth defects other than congenital heart defects or polydactyly) were used (adjusted OR = 4.3, 95% CI = 1.2-15.3; OR = 1.4, 95% CI = 1.4-7.9). A weak association between first-trimester vaginal bleeding and selected groups of birth defects was found in this study, but the association may be confounded by other factors. Maternal smoking during pregnancy was modestly associated with cleft lip with or without cleft palate (OR = 1.4, 95% = 0.4-4.9), but the association may be due to chance. Some major limitations in this study warrant caution in interpretation of the findings, especially the causal relation. ^

THE OCCURRENCE OF GROUP G STREPTOCOCCUS IN THE DOMESTIC CAT: COMPARISON OF THE PHYSIOLOGICAL PROPERTIES OF GROUP G STREPTOCOCCUS ISOLATED FROM HUMANS AND CATS

The occurrence of group G streptococci in cats and evaluation of the recovered organisms as potential human pathogens was investigated. Throat swabs were obtained from 89 cats (47 males and 42 females) and vaginal swabs from 39 female cats. Eighty-three of the examined cats were housed in individual cages at a University Animal Care Facility. Six cats, 2 mature males, 2 mature females and 2 young females were family pets in a rural area. Beta-hemolytic streptococci were recovered from 33 (37%) of the 89 cat throats cultured, and 27 (30.3%) were identified as group G. More males (34%) than females (24%) had throat cultures positive for group G. From the 39 vaginal cultures examined, 24 (61.5%) contained beta-hemolytic streptococci and 23 (58.9%) were identified as group G streptococci. Streptococci were not recovered from the vaginal cultures of the 5 females under 6 months of age.^ Thirty one group G streptococci isolated from cats were compared with 37 isolates of group G obtained from humans (health status or site of origin unknown). More group G cat isolates (81%) produced deoxyribonuclease (DNase) than did the human isolates (36%). The proportion of cat throat and vaginal isolates producing DNase was the same. Production of nicotinamide adenine dinucleotide glycohydrolase (NADase) by group G isolates of human origin was 70%, cat throat isolates 53% and cat vaginal isolates 37%. The Serum Opacity Factor was present in 73% of the cat throat isolates of group G, 43.7% of the cat vaginal isolates and 58.6% of the human isolates. Possession of an anti-phagocytic factor (M protein like substance) demonstrated by the ability to multiply in fresh human blood was greater in the group G from cat throats (46.7%) than from cat vagina (37.5%) or from the human isolates (13.5%). Many of the biochemical characteristics of the group G streptococci of cat origin were more similar to the biochemical characteristics of group A streptococci, than to the characteristics of group G of human origin. The group G streptococci, found in a large number of cats, could be potential human pathogens, as their physiological and biological characteristics are very similar to those of group A, a known human pathogen. ^

Prevalence of symptoms of neurotoxicity and potential occupational pesticide and solvent exposures among high school students in Starr County, Texas: A pilot study

Numerous harmful occupational exposures affect working teens in the United States. Teens working in agriculture and other heavy-labor industries may be at risk for occupational exposures to pesticides and solvents. The neurotoxicity of pesticides and solvents at high doses is well-known; however, the long term effects of these substances at low doses on occupationally exposed adolescents have not been well-studied. To address this research gap, a secondary analysis of cross-sectional data was completed in order to estimate the prevalence of self-reported symptoms of neurotoxicity among a cohort of high school students from Starr County, Texas, a rural area along the Texas-Mexico border. Multivariable linear regression was used to estimate the association between work status (i.e., no work, farm work, and non-farm work) and symptoms of neurotoxicity, while controlling for age, gender, Spanish speaking preference, inhalant use, tobacco use, and alcohol use. The sample included 1,208 students. Of these, the majority (85.84%) did not report having worked during the prior nine months compared to 4.80% who did only farm work, 6.21% who did only non-farm work, and 3.15% who did both types of work. On average, students reported 3.26 symptoms with a range from 0-16. The most commonly endorsed items across work status were those related to memory impairment. Adolescents employed in non-farm work jobs reported more neurotoxicity symptoms than those who reported that they did not work (Mean 4.31; SD 3.97). In the adjusted multivariable regression model, adolescents reporting non-farm work status reported an average of 0.77 more neurotoxicity symptoms on the Q16 than those who did not work (P = 0.031). The confounding variables included in the final model were all found to be factors significantly associated with report of neurotoxicity symptoms. Future research should examine the relationship between these variables and self-report of symptoms of neurotoxicity.^

Presence of three pesticides in rural drinking water sources in Kenya

A cross-sectional study on the use of three pesticides and their presence in drinking water sources was conducted in Githunguri/Kiaria community between January 1994-March 1995. The main objective of the study was to determine the extent to which some of the pesticides used by the Githunguri/Kiaria agricultural community were polluting their drinking water sources. Due to monetary and physical limitations, only DDT, its isomers and metabolites, carbofuran and carbaryl pesticides were identified and used as surrogates of pollution for the other pesticides.^ The study area was divided into high and low lying geographic surface areas. Thirty-four and 38 water sampling sites were randomly selected respectively. During wet and dry seasons, a total of 144 water samples were collected and analyzed at the Kenya Bureau of Standards Laboratory in Nairobi. Gas chromatography was used to analyze samples for possible presence of DDT, its isomers and metabolites, while high pressure liquid chromatography was used to analyze samples for carbofuran and carbaryl pesticides.^ Six sites testing positively for DDT, its isomers and metabolites represented 19.4% of the total sampled sites, with a mean concentration of 0.00310 ppb in the dry season and 0.0130 ppb in the wet season. All the six sites testing positively for the same pesticide exceeded the European maximum contaminant limit (MCL) in the wet season, and only one site exceeded the European MCL in the dry season.^ Those sites testing positively for carbofuran and carbaryl represented 5.6% of the total sampled sites. The mean concentration for the carbofuran at the sites was 2.500 ppb and 1.590 ppb in the dry and wet seasons respectively. Similarly, the mean concentration for carbaryl at the sites was 0.281 ppb in the dry season and 0.326 ppb in the wet season.^ One site testing positively for carbofuran exceeded the European MCL and WHO set limit in the wet season, while one site testing positively for the same pesticide exceeded the USA, Canada, European and WHO MCLs in the dry season. Similarly, one site which tested positively for carbaryl pesticide exceeded the European MCL in both seasons.^ Out of the 2,587 community members in the study area, 333 (13%) were exposed through their drinking water sources to the three pesticides investigated by this study. As a public health measure, integrated pest management approaches (IPM), protection of the wells and education of the community is necessary to minimize the pollution of the environment and safeguard the drinking water sources from pollution by the pesticides. ^

Feeding practices and their associations with diarrhea incidence in a cohort of rural Egyptian infants

A study was conducted in 4 villages in Bilbeis, Egypt, to document the infant feeding practices and identify their determinants, and examine the associations between feeding practices and diarrhea incidence in infants. A cohort of 152 infants were followed from birth with twice-weekly home visits to record feeding practices and diarrheal illness. Cross-sectional information was obtained about child birth; early neonatal feeding practices; and the socioeconomic, demographic, and water and sanitation characteristics of study families.^ Prelacteal fees were given to 60% of the infants. Nineteen percent of the infants were wet nursed at least once during the first week of life. Breast-feeding prevalence declined from 100% among infants aged less than 12 weeks to 84% among those aged 44-47 weeks. The prevalence of exclusive breast-feeding among breast-fed infants was 38% in those aged less than 4 weeks, increased to 54% in age period 4-7 weeks, and then declined rapidly to 4% in age period 24-27 weeks. The patterns and determinants of consumption by breast-fed infants of specific supplements were examined in detail.^ Between birth and age 47 weeks, the diarrhea incidence rate per person-year among breast-fed infants (6.84 episodes) was identical to the rate among all infants (6.89 episodes). In age period 0-11 weeks, the diarrhea incidence rate among breast-fed infants receiving supplements was 1.3 times (95% confidence interval: 0.9-2.0) higher than the rate among those exclusively breast-fed. In other age periods, diarrhea incidence was generally nonsignificantly higher among exclusively breast-fed infants than among those partially breast-fed and those completely weaned.^ Both univariate and multivariate analyses were done to examine the associations between diarrhea incidence and the consumption by breast-fed infants of specific supplements. After multivariate adjustment, supplements that showed significant, borderline, or suggestive positive associations with diarrhea incidence were cereal-water, cheese, raw vegetables, and 'other' foods. Significant, borderline, or suggestive negative associations were observed between diarrhea incidence and the intake of fresh animal milk, and potatoes.^ To reduce the risk of diarrhea, indiscriminate use of supplements among Bilbeis infants aged less than 12 weeks should be strongly discouraged. While mothers in this area should be educated about methods of safer preparation, handling, storage, and administration of all weaning foods, their attention should be particularly drawn to the 4 foods that were found to be positively associated with diarrhea incidence among infants in this study. ^

FEASIBILITY OF CORRELATING INCIDENCE OF DIARRHEA WITH CHARACTERISTICS OF RURAL EGYPTIAN HOUSEHOLDS BY MEANS OF AN ENVIRONMENTAL SURVEY

Few, if any studies, have attempted to identify the specific environmental factors associated with the incidence of diarrheal disease and to rank these by their contribution to the total incidence of diarrheal illness. Potentially those factors with the greatest contribution are the variables on which intervention could be expected to have the greatest impact on the incidence of diarrhea.^ In 317 rural Egyptian households participating in a longitudinal study of diarrheal disease, selected environmental characteristics were observed and recorded on a questionnaire. Characteristics of the environment were classified into seven categories including water usage, proximity of animals to the house, waste management, food preparation area, toilet area, the household structure and hygiene. The variables from each of the seven major groupings most associated with the incidence of diarrhea in infants were selected through the application of stepwise multiple regression. Each area was then ranked by the portion of the incidence of diarrhea in infants that each composite group of area-specific variables alone would explain. The groups of household structure and water usage variables were found to be more associated with the incidence of diarrhea in infants than variables describing the toilet area, proximity to animals or others. It was also found that 24.7% of the total variance in incidence of diarrheal illness was explained by environmental variables. ^

AN ASSESSMENT OF AFLATOXIN B1, AND OTHER SELECTED VARIABLES, IN A RURAL ENVIRONMENT AND ASSOCIATED CANCER RISK (TEXAS)

A study to assess possible exposure to carcinogenic metabolites (aflatoxins) from a mold Aspergillus flavus has been made in a rice producing area of Brazoria County, Texas. One hundred samples of unmilled rice were analyzed by thin-layer chromatography (TLC) for the amount of aflatoxin produced by the mold during rice growth and storage. Two well water samples and two rice elevator dust samples were also checked for possible aflatoxin content. The mortality rates from gastrointestinal and urinary tract cancers in the rice-growing part of the county were compared with mortality rates in the nonrice-producing areas of the same county.^ This study was an outgrowth of an earlier investigation by Cech and co-workers in Brazoria County which focused on environmental differences, specifically on the quality of drinking water in the former residences of decedents from primary liver cancer. It also compared subjects who died from other causes. The author of this dissertation participated in this phase of the overall investigation by performing some of the chemical analyses and by preparing synographic maps of water quality, and thus, part of those results from the early phase is also included in this manuscript.^ No aflatoxin was detected by TLC methods. However, when extracts of rice dust were checked for mutagenesis by the Ames Salmonella-microsome assay as a supplement to the TLC analysis, the result suggested that these dusts might have contained mutagenic material. The age-adjusted mortality rates in the rice-growing area were higher than those in the comparison area for both male and female gastrointestinal tract cancer and for male urinary tract cancer, but the differences were not statistically significant. ^

Pediatric asthma incidence in Texas and associations with ambient ozone levels in an urban area an analysis using Medicaid claims data

Few recent estimates of childhood asthma incidence exist in the literature, although the importance of incidence surveillance for understanding asthma risk factors has been recognized. Asthma prevalence, morbidity and mortality reports have repeatedly shown that low-income children are disproportionately impacted by the disease. The aim of this study was to demonstrate the utility of Medicaid claims data for providing statewide estimates of asthma incidence. Medicaid Analytic Extract (MAX) data for Texas children ages 0-17 enrolled in Medicaid between 2004 and 2007 were used to estimate incidence overall and by age group, gender, race and county of residence. A 13+ month period of continuous enrollment was required in order to distinguish incident from prevalent cases identified in the claims data. Age-adjusted incidence of asthma was 4.26/100 person-years during 2005-2007, higher than reported in other populations. Incidence rates decreased with age, were higher for males than females, differed by race, and tended to be higher in rural than urban areas. With this study, we were able to demonstrate the utility of MAX data for estimating asthma incidence, and create a dataset of incident cases to use in further analysis. ^ In subsequent analyses, we investigated a possible association between ambient air pollutants and incident asthma among Medicaid-enrolled children in Harris County Texas between 2005 and 2007. This population is at high risk for asthma, and living in an area with historically poor air quality. We used a time-stratified case-crossover design and conditional logistic regression to calculate odds ratios, adjusted for weather variables and aeroallergens, to assess the effect of increases in ozone, NO2 and PM2.5 concentrations on risk of developing asthma. Our results show that a 10 ppb increase in ozone was significantly associated with asthma during the warm season (May-October), with the strongest effect seen when a 6-day cumulative lag period was used to compute the exposure metric (OR=1.05, 95% CI, 1.02–1.08). Similar results were seen for NO2 and PM 2.5 (OR=1.07, 95% CI, 1.03–1.11 and OR=1.12, 95% CI, 1.03–1.22, respectively). PM2.5 also had significant effects in the cold season (November-April), 5-day cumulative lag: OR=1.11, 95% CI, 1.00–1.22. When compared with children in the lowest quartile of O3 exposure, the risk for children in the highest quartile was 20% higher. This study indicates that these pollutants are associated with newly-diagnosed childhood asthma in this low-income urban population, particularly during the summer months. ^