Factors influencing hurricane evacuation among Hispanic population

The recent hurricanes of Katrina, Rita, and Dolly have brought to light the precarious situation populations place themselves in when they are unprepared to face a storm, or do not follow official orders to evacuate when a destructive hurricane is poised to hit the area. Three counties in southern Texas lie within 60 miles of the Gulf of Mexico, and along the Mexican border. Determining the barriers to hurricane evacuation in this distinct and highly impoverished area of the United States would help aid local, state, and federal agencies to respond more effectively to persons living here.^ The aim of this study was to examine intention to comply with mandatory hurricane evacuation orders among persons living in three counties in South Texas by gender, income, education, acculturation and county of residence. A questionnaire was administered to 3,088 households across the three counties using a two-stage cluster sampling strategy, stratified by all three counties. The door-to-door survey was a 73-item instrument that included demographics, reasons for and against evacuation, and preparedness for a hurricane. Weighted data were used for the analyses.^ Chi-square tests were run to determine whether differences between observed and expected frequencies were statistically significant. A logistic regression model was developed based on that univariate analysis. Results from the logistic regression estimated odds ratios and their 95 percent confidence intervals for the independent variables.^ Logistic regression results indicate that females were less likely than men to follow an evacuation order. Having a higher education meant more likelihood of evacuating. Those respondents with a higher affiliation with Spanish than English were more likely to follow the evacuation orders. Hidalgo County residents were less likely to evacuate than Cameron or Willacy Counties' residents. Local officials need to implement communication efforts specifically tailored for females, residents with less of an affiliation with Spanish, and Hidalgo County residents to ensure their successful evacuation prior to a strong hurricane's landfall.^

Exploring race/ethnicity as a risk factor for mortality in newborns following congenital heart surgery at a center of excellence

The purpose of this study was to determine if race/ethnicity was a significant risk factor for hospital mortality in children following congenital heart surgery in a contemporary sample of newborns with congenital heart disease. Unlike previous studies that utilized administrative databases, this study utilized clinical data collected at the point of care to examine racial/ethnic outcome differences in the context of the patients' clinical condition and their overall perioperative experience. A retrospective cohort design was used. The study sample consisted of 316 newborns (<31 days of age) who underwent congenital heart surgery between January 2007 through December 2009. A multivariate logistic regression model was used to determine the impact of race/ethnicity, insurance status, presence of a spatial anomaly, prenatal diagnosis, postoperative sepsis, cardiac arrest, respiratory failure, unplanned reoperation, and total length of stay in the intensive care unit on outcomes following congenital heart surgery in newborns. The study findings showed that the strongest predictors of hospital mortality following congenital heart surgery in this cohort were postoperative cardiac arrest, postoperative respiratory failure, having a spatial anomaly, and total ICU LOS. Race/ethnicity and insurance status were not significant risk factors. The institution where this study was conducted is designated as a center of excellence for congenital heart disease. These centers have state-of-the-art facilities, extensive experience in caring for children with congenital heart disease, and superior outcomes. This study suggests that optimal care delivery for newborns requiring congenital heart surgery at a center of excellence portends exceptional outcomes and this benefit is conferred upon the entire patient population despite the race/ethnicity of the patients. From a public health and health services view, this study also contributes to the overall body of knowledge on racial/ethnic disparities in children with congenital heart defects and puts forward the possibility of a relationship between quality of care and racial/ethnic disparities. Further study is required to examine the impact of race/ethnicity on the long-term outcomes of these children as they encounter the disparate components of the health care delivery system. There is also opportunity to study the role of race/ethnicity on the hospital morbidity in these patients considering current expectations for hospital survival are very high, and much of the current focus for quality improvement rests in minimizing the development of patient morbidities.^

Genome-wide algorithm for detecting CNV associations with diseases

SNP genotyping arrays have been developed to characterize single-nucleotide polymorphisms (SNPs) and DNA copy number variations (CNVs). The quality of the inferences about copy number can be affected by many factors including batch effects, DNA sample preparation, signal processing, and analytical approach. Nonparametric and model-based statistical algorithms have been developed to detect CNVs from SNP genotyping data. However, these algorithms lack specificity to detect small CNVs due to the high false positive rate when calling CNVs based on the intensity values. Association tests based on detected CNVs therefore lack power even if the CNVs affecting disease risk are common. In this research, by combining an existing Hidden Markov Model (HMM) and the logistic regression model, a new genome-wide logistic regression algorithm was developed to detect CNV associations with diseases. We showed that the new algorithm is more sensitive and can be more powerful in detecting CNV associations with diseases than an existing popular algorithm, especially when the CNV association signal is weak and a limited number of SNPs are located in the CNV.^

Parental acculturation and adolescent HPV uptake among Hispanics: Results from the California Health Interview Survey

Background. The Centers for Disease Control and Prevention (CDC), the American Cancer Society (ACS), and the American College of Obstetricians and Gynecologists (ACOG) all recommend the HPV vaccine for girls 11-12. The vaccine has the potential to reduce cervical cancer disparities if it is used by populations that do not participate in screening. Evidence suggests that incidence and mortality are higher among Hispanic women compared to non-Hispanic white women because they do not participate in screening. Past literature has found that acculturation has a mixed effect on cervical cancer screening and immunization. Little is known about whether parental acculturation is associated with adolescent HPV vaccine uptake among Hispanics and the mechanisms through which acculturation may affect vaccine uptake.^ Aims. To examine the association between parental acculturation and adolescent HPV uptake among Hispanics in California and test the structural hypothesis of acculturation by determining if socioeconomic status (SES) and health care access mediate the association between acculturation and HPV vaccine uptake.^ Methods. Cross-sectional data from the 2007 California Health Interview Survey (CHIS) were used for bivariate and multivariate logistic regression analyses. The sample used for analysis included 1,090 Hispanic parents, with a daughter age 11-17, who answered questions about the HPV vaccine. Outcome variable of interest was HPV vaccine uptake (≥1dose). Independent variables of interest were language spoken at home (a proxy variable for acculturation), household income (percent of federal poverty level), education level, and health care access (combined measure of health insurance coverage and usual source of care).^ Results. Parents who spoke only English or English and Spanish in the home were more likely to get the HPV vaccine for their daughter than parents who only spoke Spanish (Odds Ratio [OR]: 0.55, 95% Confidence Interval [CI]: 0.31-0.98). When SES and health care access variables were added to the logistic regression model, the association between language acculturation and HPV vaccine uptake became non-significant (OR: 0.68, 95% CI: 0.35-1.29). Both income and health care access were associated with uptake. Parents with lower income or who did not have insurance and a usual source of care were less likely to have a vaccinated daughter.^ Discussion. Socioeconomic status and health care access have a more proximal effect on HPV vaccine uptake than parental language acculturation among Hispanics in California.^ Conclusion. This study found support for the structural hypothesis of acculturation and suggest that interventions focus on informing low SES parents who lack access to health care about programs that provide free HPV vaccines.^

Association of maternal sphinganine:sphingosine ratio and folate levels with neural tube defects along the South Texas border

Neural tube defects (NTDs) remain elevated in Hispanic women along the South Texas Border, despite folate supplementation and folate fortification of cereal products. Missmer et al. examined the relationships between fumonisins, a class of corn mycotoxin, and NTDs in Hispanic women who ate corn tortillas and found increased odds ratios with increasing exposure, as measured by serum sphinganine:sphingosine (sa:so) ratios. This study examined the interactions between categorized maternal serum folate levels and stratified sa:so ratios and the resultant odds ratios of NTDs, stratified by type (anencephaly and spina bifida). The hypothesis was that the above normal folate category would have lower odds ratios of NTDs at given sa:so ratio categories and that there would be a difference in odds ratio patterns for anencephaly and spina bifida. Methods. Data for 406 Hispanic women were obtained from the Missmer case-control study. Sa:so ratios were calculated and subjects were stratified into “below normal,” “normal,” and above normal range for folate. A logistic regression model was applied, controlling for BMI, serum B12, lab batch, and conception date. Results. While OR’s of NTDs increased for increasing sa:so ratios, OR’s for “above normal” folate were not decreased at any sa:so ratio and there was no statistically significant difference between OR’s of anencephaly and spina bifida. Conclusion. Folate does not appear to be protective against the potential teratogenic effect of fumonisins and did not differ in effect on OR’s of NTD by type. More research is necessary to determine the extent of fumonisin exposure in Hispanic women along the South Texas Border.^

Lifetime changes in body mass index and risk of breast cancer in minority women

Introduction: Obesity is an epidemic in the United States, especially among Hispanics and African-Americans. Studies of obesity and breast cancer risk and subtype have been conducted primarily in non-Hispanic whites. Obesity is inversely associated with premenopausal breast cancer, but both obesity and weight gain increase the risk of postmenopausal disease. Obesity has been associated with breast cancer subtype in many studies. Methods: To assess the association between changes in body mass index (BMI) over the lifetime, weight gain, and breast cancer in Mexican-American women, we conducted a case-control study using 149 cases and 330 age-matched controls. In a second study, we identified 212 African-American and 167 Mexican-American women with breast cancer in the ongoing ELLA Bi-National Breast Cancer Study, abstracted medical charts to classify tumors as ER+/PR+, HER2+, or ER-/PR-/HER2-, and assessed the association between lifetime changes in body mass index, weight gain, and breast cancer subtype. In both studies, growth mixture modeling was use to identify trajectories of change in BMI over the lifetime, and these trajectories were used as exposures in a logistic regression model to calculate odds ratios (OR). Results: There was no association between trajectories of change in BMI and breast cancer risk in Mexican-American women. In addition, BMI at ages 15 and 30 and at diagnosis was not associated with breast cancer. However, adult weight gain was inversely associated with breast cancer risk (per 5kg, OR=0.92, 95% CI: 0.85-0.99). The case-only analysis found no association between obesity at ages 15 and 30 and at diagnosis and breast cancer subtype. Further, there was no association between adult weight gain (defined as weight change from age 15 to time of diagnosis) and breast cancer subtype. Conclusions: Obesity was not associated with breast cancer risk in Mexican-American women, while adult weight gain reduced the risk independently of menopausal status. These results are contradictory of those in non-Hispanic white women and suggest that the etiology of breast cancer may differ by race/ethnicity. Further, obesity was not associated with breast cancer subtype in African-American and Mexican-American women, contrary to results in non-Hispanic white women. ^

The association of previous induced abortion with the subsequent pregnancy complication of placenta previa

Placenta previa is alleged to be more common among women with a history of prior induced abortion. To investigate further whether there is a relationship between previous induced abortion and subsequent pregnancy complication of placenta previa, a matched case-comparison study was conducted comparing the reproductive histories of 256 women with placenta previa matched on age, date of delivery, and hospital with those of 256 women having normal deliveries and cesarean section deliveries without placental complications.^ Women with placenta previa had a twofold increase in the odds of having had one previous induced abortion (odds ratio 2.25) over women with no placental complications. Women with placenta previa and two or more previous induced abortions had a sevenfold increase in odds.^ The significant association of placenta previa and previous induced abortion remained after including gravida status, previous dilatation and curettage (D&C) status, previous spontaneous abortion, and race in a conditional logistic regression model. There is interaction between high gravidity and previous spontaneous abortion. Dilatation and curettage is associated with placenta previa primarily because women with abortion histories have also had a dilatation and curettage.^ Women who are seeking abortion and wish to have children later should be informed that there may be a longterm effect of developing placental complications in subsequent pregnancies. Women who have had at least one induced abortion or any dilatation and curettage procedure should be monitored carefully during any subsequent pregnancy for the risk of the complication of placenta previa. This knowledge should alert the physician or nurse-midwife to treat those women with a history of previous induced abortions as potential high risk pregnancies and could perhaps reduce maternal and fetal morbidity rates. ^

Burden of invasive pneumococcal disease in Harris County, Texas (2003--2010) and the implication for enhanced public health surveillance of isolates

Invasive pneumococcal disease (IPD) causes significant health burden in the US, is responsible for the majority of bacterial meningitis, and causes more deaths than any other vaccine preventable bacterial disease in the US. The estimated National IPD rate is 14.3 cases per 100,000 population with a case-fatality rate of 1.5 cases per 100,000 population. Although cases of IPD are routinely reported to the local health department in Harris County Texas, the incidence (IR) and case-fatality (CFR) rates have not been reported. Additionally, it is important to know which serotypes of S. pneumoniae are circulating in Harris County Texas and to determine if ‘replacement disease’ is occurring. ^ This study reported incidence and case-fatality rates from 2003 to 2009, and described the trends in IPD, including the IPD serotypes circulating in Harris County Texas during the study period, particularly in 2008 and 2010. Annual incidence rates were calculated and reported for 2003 to 2009, using complete surveillance-year data. ^ Geographic information system (GIS) software was used to create a series of maps of the data reported during the study period. Cluster and outlier analysis and hot spot analysis were conducted using both case counts by census tract and disease rate by census tract. ^ IPD age- and race-adjusted IR for Harris County Texas and their 95% confidence intervals (CIs) were 1.40 (95% CI 1.0, 1.8), 1.71 (95% CI 1.24, 2.17), 3.13 (95% CI 2.48, 3.78), 3.08 (95% CI 2.43, 3.74), 5.61 (95% CI 4.79, 6.43), 8.11 (95% CI 7.11, 9.1), and 7.65 (95% CI 6.69, 8.61) for the years 2003 to 2009, respectively (rates were age- and race-adjusted to each year's midyear US population estimates). A Poisson regression model demonstrated a statistically significant increasing trend of about 32 percent per year in the IPD rates over the course of the study period. IPD age- and race-adjusted case-fatality rates (CFR) for Harris County Texas were also calculated and reported. A Poisson regression model demonstrated a statistically significant increasing trend of about 26 percent per year in the IPD case-fatality rates from 2003 through 2009. A logistic regression model associated the risk of dying from IPD to alcohol abuse (OR 4.69, 95% CI 2.57, 8.56) and to meningitis (OR 2.42, 95% CI 1.46, 4.03). ^ The prevalence of non-vaccine serotypes (NVT) among IPD cases with serotyped isolates was 98.2 percent. In 2008, the year with the sample more geographically representative of all areas of Harris County Texas, the prevalence was 96 percent. Given these findings, it is reasonable to conclude that ‘replacement disease’ is occurring in Harris County Texas, meaning that, the majority of IPD is caused by serotypes not included in the PCV7 vaccine. Also in conclusion, IPD rates increased during the study period in Harris County Texas.^

Tuberculosis in HIV-infected individuals in Ho Chi Minh City, Vietnam

Early and accurate detection of TB disease in HIV-infected individuals is a critical step for a successful TB program. In Vietnam, the diagnosis of TB disease, which is based predominantly on the clinical examination, chest radiography (CXR) and acid fast bacilli (AFB) sputum smear, has shown to be of low sensitivity in immunocompromised patients. The sputum culture is not routinely performed for patients with AFB negative smears, even in HIV-infected individuals.^ In that background, we conducted this cross-sectional study to estimate the prevalence of sputum culture-confirmed pulmonary tuberculosis (PTB), smear-negative PTB, and multidrug-resistant TB (MDR-TB) in the HIV-infected population in Ho Chi Minh City (HCMC), the largest city in Vietnam where both TB and HIV are highly prevalent. We also evaluated the diagnostic performance of various algorithms based on routine available tools in Vietnam such as symptoms screening, CXR, and AFB smear. Nearly 400 subjects were consecutively recruited from HIV-infected patients seeking care at the An Hoa Clinic in District 6 of Ho Chi Minh City from August 2009 through June 2010. Participants’ demographic data, clinical status, CXR, and laboratory results were collected. A multiple logistic regression model was developed to assess the association of covariates and PTB. ^ The prevalence of smear-positive TB, smear-negative TB, resistant TB, and MDR-TB were 7%, 2%, 5%, 2.5%, and 0.3%, respectively. Adjusted odds ratios for low CD4+ cell count, positive sputum smear, and CXR to positive sputum culture were 3.17, 32.04, and 4.28, respectively. Clinical findings alone had poor sensitivity, but the combination of CD4+ cell count, sputum smear, and CXR proved to perform a more accurate diagnosis.^ This study results support the routine use of sputum culture to improve the detection of TB disease in HIV-infected individuals in Vietnam. When routine sputum culture is not available, an algorithm combining CD4+ cell count, sputum smear, and CXR is recommended for diagnosing PTB. Future studies on more affordable, rapid, and accurate tests for TB infection would also be necessary to timely provide specific treatments for patients in need, reduce mortality, and minimize TB transmission to the general population.^

Genetic variants in the mammalian target of rapamycin (mTOR) signaling pathway as predictors of survival and clinical response in women with ovarian cancer

Background. The mTOR pathway is commonly altered in human tumors and promotes cell survival and proliferation. Preliminary evidence suggests this pathway's involvement in chemoresistance to platinum and taxanes, first line therapy for epithelial ovarian cancer. A pathway-based approach was used to identify individual germline single nucleotide polymorphisms (SNPs) and cumulative effects of multiple genetic variants in mTOR pathway genes and their association with clinical outcome in women with ovarian cancer. ^ Methods. The case-series was restricted to 319 non-Hispanic white women with high grade ovarian cancer treated with surgery and platinum-based chemotherapy. 135 SNPs in 20 representative genes in the mTOR pathway were genotyped. Hazard ratios (HRs) for death and Odds ratios (ORs) for failure to respond to primary therapy were estimated for each SNP using the multivariate Cox proportional hazards model and multivariate logistic regression model, respectively, while adjusting for age, stage, histology and treatment sequence. A survival tree analysis of SNPs with a statistically significant association (p<0.05) was performed to identify higher order gene-gene interactions and their association with overall survival. ^ Results. There was no statistically significant difference in survival by tumor histology or treatment regimen. The median survival for the cohort was 48.3 months. Seven SNPs were significantly associated with decreased survival. Compared to those with no unfavorable genotypes, the HR for death increased significantly with the increasing number of unfavorable genotypes and women in the highest risk category had HR of 4.06 (95% CI 2.29–7.21). The survival tree analysis also identified patients with different survival patterns based on their genetic profiles. 13 SNPs on five different genes were found to be significantly associated with a treatment response, defined as no evidence of disease after completion of primary therapy. Rare homozygous genotype of SNP rs6973428 showed a 5.5-fold increased risk compared to the wild type carrying genotypes. In the cumulative effect analysis, the highest risk group (individuals with ≥8 unfavorable genotypes) was significantly less likely to respond to chemotherapy (OR=8.40, 95% CI 3.10–22.75) compared to the low risk group (≤4 unfavorable genotypes). ^ Conclusions. A pathway-based approach can demonstrate cumulative effects of multiple genetic variants on clinical response to chemotherapy and survival. Therapy targeting the mTOR pathway may modify outcome in select patients.^

Frequencies and risk factors for bisphosphonate-related osteonecrosis of the jaw in cancer patients: A matched case-control study

Bisphosphonates represent a unique class of drugs that effectively treat and prevent a variety of bone-related disorders including metastatic bone disease and osteoporosis. High tolerance and high efficacy rates quickly ranked bisphosphonates as the standard of care for bone-related diseases. However, in the early 2000s, case reports began to surface that linked bisphosphonates with osteonecrosis of the jaw (ONJ). Since that time, studies conducted have corroborated the linkage. However, as with most disease states, many factors can contribute to the onset of disease. The aim of this study was to determine which comorbid factors presented an increased risk for developing ONJ in cancer patients.^ Using a case-control study design, investigators used a combination of ICD-9 codes and chart review to identify confirmed cases of ONJ at The University of Texas M. D. Anderson Cancer Center (MDACC). Each case was then matched to five controls based on age, gender, race/ethnicity, and primary cancer diagnosis. Data querying and chart review provided information on variables of interest. These variables included bisphosphonate exposure, glucocorticoids exposure, smoking history, obesity, and diabetes. Statistical analysis was conducted using PASW (Predictive Analytics Software) Statistics, Version 18 (SPSS Inc., Chicago, Illinois).^ One hundred twelve (112) cases were identified as confirmed cases of ONJ. Variables were run using univariate logistic regression to determine significance (p < .05); significant variables were included in the final conditional logistic regression model. Concurrent use of bisphosphonates and glucocorticoids (OR, 18.60; CI, 8.85 to 39.12; p < .001), current smokers (OR, 2.52; CI, 1.21 to 5.25; p = .014), and presence of diabetes (OR, 1.84; CI, 1.06 to 3.20; p = .030) were found to increase the risk for developing ONJ. Obesity was not associated significantly with ONJ development.^ In this study, cancer patients that received bisphosphonates as part of their therapeutic regimen were found to have an 18-fold increase in their risk of developing ONJ. Other factors included smoking and diabetes. More studies examining the concurrent use of glucocorticoids and bisphosphonates may be able to strengthen any correlations.^

Exploration of genetic susceptibility to pancreatic cancer: A GWAS approach

Pancreatic cancer is the 4th most common cause for cancer death in the United States, accompanied by less than 5% five-year survival rate based on current treatments, particularly because it is usually detected at a late stage. Identifying a high-risk population to launch an effective preventive strategy and intervention to control this highly lethal disease is desperately needed. The genetic etiology of pancreatic cancer has not been well profiled. We hypothesized that unidentified genetic variants by previous genome-wide association study (GWAS) for pancreatic cancer, due to stringent statistical threshold or missing interaction analysis, may be unveiled using alternative approaches. To achieve this aim, we explored genetic susceptibility to pancreatic cancer in terms of marginal associations of pathway and genes, as well as their interactions with risk factors. We conducted pathway- and gene-based analysis using GWAS data from 3141 pancreatic cancer patients and 3367 controls with European ancestry. Using the gene set ridge regression in association studies (GRASS) method, we analyzed 197 pathways from the Kyoto Encyclopedia of Genes and Genomes (KEGG) database. Using the logistic kernel machine (LKM) test, we analyzed 17906 genes defined by University of California Santa Cruz (UCSC) database. Using the likelihood ratio test (LRT) in a logistic regression model, we analyzed 177 pathways and 17906 genes for interactions with risk factors in 2028 pancreatic cancer patients and 2109 controls with European ancestry. After adjusting for multiple comparisons, six pathways were marginally associated with risk of pancreatic cancer ( P < 0.00025): Fc epsilon RI signaling, maturity onset diabetes of the young, neuroactive ligand-receptor interaction, long-term depression (Ps < 0.0002), and the olfactory transduction and vascular smooth muscle contraction pathways (P = 0.0002; Nine genes were marginally associated with pancreatic cancer risk (P < 2.62 × 10−5), including five reported genes (ABO, HNF1A, CLPTM1L, SHH and MYC), as well as four novel genes (OR13C4, OR 13C3, KCNA6 and HNF4 G); three pathways significantly interacted with risk factors on modifying the risk of pancreatic cancer (P < 2.82 × 10−4): chemokine signaling pathway with obesity ( P < 1.43 × 10−4), calcium signaling pathway (P < 2.27 × 10−4) and MAPK signaling pathway with diabetes (P < 2.77 × 10−4). However, none of the 17906 genes tested for interactions survived the multiple comparisons corrections. In summary, our current GWAS study unveiled unidentified genetic susceptibility to pancreatic cancer using alternative methods. These novel findings provide new perspectives on genetic susceptibility to and molecular mechanisms of pancreatic cancer, once confirmed, will shed promising light on the prevention and treatment of this disease. ^

Predicting smokeless tobacco cessation in a blue -collar population

The use of smokeless tobacco products is undergoing an alarming resurgence in the United States. Several national surveys have reported a higher prevalence of use among those employed in blue-collar occupations. National objectives now target this group for health promotion programs which reduce the health risks associated with tobacco use.^ Drawn from a larger data set measuring health behaviors, this cross-sectional study tested the applicability of two related theories, the Theory of Reasoned Action (TRA) and the Theory of Planned Behavior (TPB), to smokeless tobacco (SLT) cessation in a blue-collar population of gas pipeline workers. In order to understand the determinants of SLT cessation, measures were obtained of demographic and normative characteristics of the population and specific constructs. Attitude toward the act of quitting (AACT) and subjective norm (SN) are constructs common to both models, perceived behavioral control (PBC) is unique to the TPB, and the number of past quit attempts is not contained in either model. In addition, a self-reported measure was taken of SLT use at two-month follow-up.^ The study population was comprised of all male SLT users who were field employees in a large gas pipeline company with gas compressor stations extending from Texas to the Canadian border. At baseline, 199 employees responded to the SLT portion of the survey, 118 completed some portion of the two-month follow-up, and 101 could be matched across time.^ As hypothesized, significant correlations were found between constructs antecedent to AACT and SN, although crossover effects occurred. Significant differences were found between SLT cessation intenders and non-intenders with regard to their personal and normative beliefs about quitting as well as their outcome expectancies and motivation to comply with others' beliefs. These differences occurred in the expected direction, with the mean intender score consistently higher than that of the non-intender.^ Contrary to hypothesis, AACT predicted intention to quit but SN did not. However, confirmatory of the TPB, PBC, operationalized as self-efficacy, independently contributed to the prediction of intention. Statistically significant relationships were not found between intention, perceived behavioral control, their interactive effects, and use behavior at two-month follow-up. The introduction of number of quit attempts into the logistic regression model resulted in insignificant findings for independent and interactive effects.^ The findings from this study are discussed in relation to their implications for program development and practice, especially within the worksite. In order to confirm and extend the findings of this investigation, recommendations for future research are also discussed. ^

Desintegración vertical en la industria del automóvil en España: un caso de estudio = Vertical disintegration in the automotive industry in Spain: a case study

En los años recientes se ha producido un rápido crecimiento del comercio internacional en productos semielaborados que son diseñados, producidos y ensamblados en diferentes localizaciones a lo largo de diferentes países, debido principalmente a los siguientes motivos: el desarrollo de las tecnologías de la información, la reducción de los costes de transporte, la liberalización de los mercados de capitales, la armonización de factores institucionales, la integración económica regional que implica la reducción y la eliminación de las barreras al comercio, el desarrollo económico de los países emergentes, el uso de economías de escala, así como una desregulación del comercio internacional. Todo ello ha incrementado la competencia a nivel mundial en los mercados y ha posibilitado a las compañías tener más facilidad de acceso a potenciales mercados, así como a la adquisición de capacidades y conocimientos en otros países y a la realización de alianzas estratégicas internacionales con terceros, creando un entorno con mayor incertidumbre y más exigente para las compañías que componen una industria, y que tiene consecuencias directas en las operaciones de las compañías y en la organización de su producción. Las compañías, para adaptarse, ser competitivas y beneficiarse de este nuevo escenario globalizado y más competitivo, han externalizado partes del proceso productivo hacia proveedores especializados, creando un nuevo mercado intermedio que divide el proceso productivo, anteriormente integrado en las compañías que conforman una industria, entre dos conjuntos de empresas especializadas en esa industria. Dicho proceso suele ocurrir conservando la industria en que tiene lugar, los mismos servicios y productos, la tecnología empleada y las compañías originales que la conformaban previamente a la desintegración vertical. Todo ello es así debido a que es beneficioso tanto para las compañías originales de la industria como para las nuevas compañías de este mercado intermedio por diversos motivos. La desintegración vertical en una industria tiene unas consecuencias que la transforman completamente, así como la forma de operar de las compañías que la integran, incluso para aquellas que permanecen verticalmente integradas. Una de las características más importantes de esta desintegración vertical en una industria es la posibilidad que tiene una compañía de adquirir a una tercera la primera parte del proceso productivo o un bien semielaborado, que posteriormente será finalizado por la compañía adquiriente con la práctica del outsourcing; así mismo, una compañía puede realizar la primera parte del proceso productivo o un bien semielaborado, que posteriormente será finalizado por una tercera compañía con la práctica de la fragmentación. El principal objetivo de la presente investigación es el estudio de los motivos, los facilitadores, los efectos, las consecuencias y los principales factores significativos, microeconómicos y macroeconómicos, que desencadenan o incrementan la práctica de la desintegración vertical en una industria; para ello, la investigación se divide en dos líneas completamente diferenciadas: el estudio de la práctica del outsourcing y, por otro lado, el estudio de la fragmentación por parte de las compañías que componen la industria del automóvil en España, puesto que se trata de una de las industrias más desintegradas verticalmente y fragmentadas, y este sector posee una gran importancia en la economía del país. En primer lugar, se hace una revisión de la literatura existente relativa a los siguientes aspectos: desintegración vertical, outsourcing, fragmentación, teoría del comercio internacional, historia de la industria del automóvil en España y el uso de las aglomeraciones geográficas y las tecnologías de la información en el sector del automóvil. La metodología empleada en cada uno de ellos ha sido diferente en función de la disponibilidad de los datos y del enfoque de investigación: los factores microeconómicos, utilizando el outsourcing, y los factores macroeconómicos, empleando la fragmentación. En el estudio del outsourcing, se usa un índice basado en las compras externas sobre el valor total de la producción. Así mismo, se estudia su correlación y significación con las variables económicas más importantes que definen a una compañía del sector del automóvil, utilizando la técnica estadística de regresión lineal. Aquellas variables relacionadas con la competencia en el mercado, la externalización de las actividades de menor valor añadido y el incremento de la modularización de las actividades de la cadena de valor, han resultado significativas con la práctica del outsourcing. En el estudio de la fragmentación se seleccionan un conjunto de factores macroeconómicos, comúnmente usados en este tipo de investigaciones, relacionados con las principales magnitudes económicas de un país, y un conjunto de factores macroeconómicos, no comúnmente usados en este tipo de investigaciones, relacionados con la libertad económica y el comercio internacional de un país. Se emplea un modelo de regresión logística para identificar qué factores son significativos en la práctica de la fragmentación. De entre todos los factores usados en el modelo, los relacionados con las economías de escala y los costes de servicio han resultado significativos. Los resultados obtenidos de los test estadísticos realizados en el modelo de regresión logística han resultado satisfactorios; por ello, el modelo propuesto de regresión logística puede ser considerado sólido, fiable y versátil; además, acorde con la realidad. De los resultados obtenidos en el estudio del outsourcing y de la fragmentación, combinados conjuntamente con el estado del arte, se concluye que el principal factor que desencadena la desintegración vertical en la industria del automóvil es la competencia en el mercado de vehículos. Cuanto mayor es la demanda de vehículos, más se reducen los beneficios y la rentabilidad para sus fabricantes. Estos, para ser competitivos, diferencian sus productos de la competencia centrándose en las actividades que mayor valor añadido aportan al producto final, externalizando las actividades de menor valor añadido a proveedores especializados, e incrementando la modularidad de las actividades de la cadena de valor. Las compañías de la industria del automóvil se especializan en alguna o varias de estas actividades modularizadas que, combinadas con el uso de factores facilitadores como las economías de escala, las tecnologías de la información, las ventajas de la globalización económica y la aglomeración geográfica de una industria, incrementan y motivan la desintegración vertical en la industria del automóvil, desencadenando la coespecialización en dos sectores claramente diferenciados: el sector de fabricantes de vehículos y el sector de proveedores especializados. Cada uno de ellos se especializa en unas actividades y en unos productos o servicios específicos de la cadena de valor, lo cual genera las siguientes consecuencias en la industria del automóvil: se reducen los costes de transacción en los productos o servicios intercambiados; se incrementan la relación de dependencia entre fabricantes de vehículos y proveedores especializados, provocando un aumento en la cooperación y la coordinación, acelerando el proceso de aprendizaje, posibilitando a ambos adquirir nuevas capacidades, conocimientos y recursos, y creando nuevas ventajas competitivas para ambos; por último, las barreras de entrada a la industria del automóvil y el número de compañías se ven alteradas cambiando su estructura. Como futura línea de investigación, los fabricantes de vehículos tenderán a centrarse en investigar, diseñar y comercializar el producto o servicio, delegando el ensamblaje en manos de nuevos especialistas en la materia, el contract manufacturer; por ello, sería conveniente investigar qué factores motivantes o facilitadores existen y qué consecuencias tendría la implantación de los contract manufacturer en la industria del automóvil. 1.1. ABSTRACT In recent years there has been a rapid growth of international trade in semi-finished products designed, produced and assembled in different locations across different countries, mainly due to the following reasons: development of information technologies, reduction of transportation costs, liberalisation of capital markets, harmonisation of institutional factors, regional economic integration, which involves the reduction and elimination of trade barriers, economic development of emerging countries, use of economies of scale and deregulation of international trade. All these factors have increased competition in markets at a global level and have allowed companies to gain easier access to potential markets and to the acquisition of skills and knowledge in other countries, as well as to the completion of international strategic alliances with third parties, thus creating a more demanding and uncertain environment for these companies constituting an industry, which has a direct impact on the companies' operations and the organization of their production. In order to adapt, be competitive and benefit from this new and more competitive global scenario, companies have outsourced some parts of their production process to specialist suppliers, generating a new intermediate market which divides the production process, previously integrated in the companies that made up the industry, into two sets of companies specialized in that industry. This process often occurs while preserving the industry where it takes place, its same services and products, the technology used and the original companies that formed it prior to vertical disintegration. This is because it is beneficial for both the industry's original companies and the companies belonging to this new intermediate market, for various reasons. Vertical disintegration has consequences which completely transform the industry where it takes place as well as the modus operandi of the companies that are part of it, even of those who remain vertically integrated. One of the most important features of vertical disintegration of an industry is the possibility for a company to acquire from a third one the first part of the production process or a semi-finished product, which will then be finished by the acquiring company through the practice of outsourcing; also, a company can perform the first part of the production process or a semi-finish product, which will then be completed by a third company through the practice of fragmentation. The main objective of this research is to study the motives, facilitators, effects, consequences and major significant microeconomic and macroeconomic factors that trigger or increase the practice of vertical disintegration in a certain industry; in order to do so, research is divided into two completely differentiated lines: on the one hand, the study of the practise of outsourcing and, on the other, the study of fragmentation by companies constituting the automotive industry in Spain, since this is one of the most vertically disintegrated and fragmented industries and this particular sector is of major significance in this country's economy. First, a review is made of the existing literature, on the following aspects: vertical disintegration, outsourcing, fragmentation, international trade theory, history of the automobile industry in Spain and the use of geographical agglomeration and information technologies in the automotive sector. The methodology used for each of these aspects has been different depending on the availability of data and the research approach: the microeconomic factors, using outsourcing, and the macroeconomic factors, using fragmentation. In the study on outsourcing, an index is used based on external purchases in relation to the total value of production. Likewise, their significance and correlation with the major economic variables that define an automotive company are studied, using the statistical technique of linear regression. Variables related to market competition, outsourcing of lowest value-added activities and increased modularisation of the activities of the value chain have turned out to be significant with the practice of outsourcing. In the study of fragmentation, a set of macroeconomic factors commonly used for this type of research, is selected, related to the main economic indicators of a country, as well as a set of macroeconomic factors, not commonly used for this type of research, which are related to economic freedom and the international trade of a certain country. A logistic regression model is used to identify which factors are significant in the practice of fragmentation. Amongst all factors used in the model, those related to economies of scale and service costs have turned out to be significant. The results obtained from the statistical tests performed on the logistic regression model have been successful; hence, the suggested logistic regression model can be considered to be solid, reliable and versatile; likewise, it is in line with reality. From the results obtained in the study of outsourcing and fragmentation, combined with the state of the art, it is concluded that the main factor that triggers vertical disintegration in the automotive industry is competition within the vehicle market. The greater the vehicle demand, the lower the earnings and profitability for manufacturers. These, in order to be competitive, differentiate their products from the competition by focusing on those activities that contribute with the highest added value to the final product, outsourcing the lower valueadded activities to specialist suppliers, and increasing the modularity of the activities of the value chain. Companies in the automotive industry specialize in one or more of these modularised activities which, combined with the use of enabling factors such as economies of scale, information technologies, the advantages of economic globalisation and the geographical agglomeration of an industry, increase and encourage vertical disintegration in the automotive industry, triggering co-specialization in two clearly distinct sectors: the sector of vehicle manufacturers and the specialist suppliers sector. Each of them specializes in certain activities and specific products or services of the value chain, generating the following consequences in the automotive industry: reduction of transaction costs of the goods or services exchanged; growth of the relationship of dependency between vehicle manufacturers and specialist suppliers, which causes an increase in cooperation and coordination, accelerates the learning process, enables both to acquire new skills, knowledge and resources, and creates new competitive advantages for both; finally, barriers to entry the automotive industry and the number of companies are altered, changing their structure. As a future line of research, vehicle manufacturers will tend to focus on researching, designing and marketing the product or service, delegating the assembly in the hands of new specialists in the field, the contract manufacturer; for this reason, it would be useful to investigate what motivating or facilitating factors exist in this respect and what consequences would the implementation of contract manufacturers have in the automotive industry.

Bases metodológicas para un sistema de apoyo a la selección de especies en la restauración de la vegetación

RESUMEN El apoyo a la selección de especies a la restauración de la vegetación en España en los últimos 40 años se ha basado fundamentalmente en modelos de distribución de especies, también llamados modelos de nicho ecológico, que estiman la probabilidad de presencia de las especies en función de las condiciones del medio físico (clima, suelo, etc.). Con esta tesis se ha intentado contribuir a la mejora de la capacidad predictiva de los modelos introduciendo algunas propuestas metodológicas adaptadas a los datos disponibles actualmente en España y enfocadas al uso de los modelos en la selección de especies. No siempre se dispone de datos a una resolución espacial adecuada para la escala de los proyectos de restauración de la vegetación. Sin embrago es habitual contar con datos de baja resolución espacial para casi todas las especies vegetales presentes en España. Se propone un método de recalibración que actualiza un modelo de regresión logística de baja resolución espacial con una nueva muestra de alta resolución espacial. El método permite obtener predicciones de calidad aceptable con muestras relativamente pequeñas (25 presencias de la especie) frente a las muestras mucho mayores (más de 100 presencias) que requería una estrategia de modelización convencional que no usara el modelo previo. La selección del método estadístico puede influir decisivamente en la capacidad predictiva de los modelos y por esa razón la comparación de métodos ha recibido mucha atención en la última década. Los estudios previos consideraban a la regresión logística como un método inferior a técnicas más modernas como las de máxima entropía. Los resultados de la tesis demuestran que esa diferencia observada se debe a que los modelos de máxima entropía incluyen técnicas de regularización y la versión de la regresión logística usada en las comparaciones no. Una vez incorporada la regularización a la regresión logística usando penalización, las diferencias en cuanto a capacidad predictiva desaparecen. La regresión logística penalizada es, por tanto, una alternativa más para el ajuste de modelos de distribución de especies y está a la altura de los métodos modernos con mejor capacidad predictiva como los de máxima entropía. A menudo, los modelos de distribución de especies no incluyen variables relativas al suelo debido a que no es habitual que se disponga de mediciones directas de sus propiedades físicas o químicas. La incorporación de datos de baja resolución espacial proveniente de mapas de suelo nacionales o continentales podría ser una alternativa. Los resultados de esta tesis sugieren que los modelos de distribución de especies de alta resolución espacial mejoran de forma ligera pero estadísticamente significativa su capacidad predictiva cuando se incorporan variables relativas al suelo procedente de mapas de baja resolución espacial. La validación es una de las etapas fundamentales del desarrollo de cualquier modelo empírico como los modelos de distribución de especies. Lo habitual es validar los modelos evaluando su capacidad predictiva especie a especie, es decir, comparando en un conjunto de localidades la presencia o ausencia observada de la especie con las predicciones del modelo. Este tipo de evaluación no responde a una cuestión clave en la restauración de la vegetación ¿cuales son las n especies más idóneas para el lugar a restaurar? Se ha propuesto un método de evaluación de modelos adaptado a esta cuestión que consiste en estimar la capacidad de un conjunto de modelos para discriminar entre las especies presentes y ausentes de un lugar concreto. El método se ha aplicado con éxito a la validación de 188 modelos de distribución de especies leñosas orientados a la selección de especies para la restauración de la vegetación en España. Las mejoras metodológicas propuestas permiten mejorar la capacidad predictiva de los modelos de distribución de especies aplicados a la selección de especies en la restauración de la vegetación y también permiten ampliar el número de especies para las que se puede contar con un modelo que apoye la toma de decisiones. SUMMARY During the last 40 years, decision support tools for plant species selection in ecological restoration in Spain have been based on species distribution models (also called ecological niche models), that estimate the probability of occurrence of the species as a function of environmental predictors (e.g., climate, soil). In this Thesis some methodological improvements are proposed to contribute to a better predictive performance of such models, given the current data available in Spain and focusing in the application of the models to selection of species for ecological restoration. Fine grained species distribution data are required to train models to be used at the scale of the ecological restoration projects, but this kind of data are not always available for every species. On the other hand, coarse grained data are available for almost every species in Spain. A recalibration method is proposed that updates a coarse grained logistic regression model using a new fine grained updating sample. The method allows obtaining acceptable predictive performance with reasonably small updating sample (25 occurrences of the species), in contrast with the much larger samples (more than 100 occurrences) required for a conventional modeling approach that discards the coarse grained data. The choice of the statistical method may have a dramatic effect on model performance, therefore comparisons of methods have received much interest in the last decade. Previous studies have shown a poorer performance of the logistic regression compared to novel methods like maximum entropy models. The results of this Thesis show that the observed difference is caused by the fact that maximum entropy models include regularization techniques and the versions of logistic regression compared do not. Once regularization has been added to the logistic regression using a penalization procedure, the differences in model performance disappear. Therefore, penalized logistic regression may be considered one of the best performing methods to model species distributions. Usually, species distribution models do not consider soil related predictors because direct measurements of the chemical or physical properties are often lacking. The inclusion of coarse grained soil data from national or continental soil maps could be a reasonable alternative. The results of this Thesis suggest that the performance of the models slightly increase after including soil predictors form coarse grained soil maps. Model validation is a key stage of the development of empirical models, such as species distribution models. The usual way of validating is based on the evaluation of model performance for each species separately, i.e., comparing observed species presences or absence to predicted probabilities in a set of sites. This kind of evaluation is not informative for a common question in ecological restoration projects: which n species are the most suitable for the environment of the site to be restored? A method has been proposed to address this question that estimates the ability of a set of models to discriminate among present and absent species in a evaluation site. The method has been successfully applied to the validation of 188 species distribution models used to support decisions on species selection for ecological restoration in Spain. The proposed methodological approaches improve the predictive performance of the predictive models applied to species selection in ecological restoration and increase the number of species for which a model that supports decisions can be fitted.