Understanding Associations Between Hurricane Harvey Exposure and Mental Health Symptoms Among Greater Houston-Area Residents.

OBJECTIVE: Hurricane Harvey made landfall on August 25, 2017 and resulted in widespread flooding in Houston and the surrounding areas. This study aimed to explore the associations between exposure to Hurricane Harvey and various mental health symptoms. METHODS: Self-reported demographics, hurricane exposure, and mental health symptomatology were obtained from residents of the greater Houston area through convenience sampling for a pilot study, 5 months after the storm from January 25-29, 2018 (N = 161). RESULTS: Increased hurricane exposure score was significantly associated with increased odds for probable depression, probable anxiety, and probable posttraumatic stress disorder after adjusting for other factors associated with mental health. No significant associations were found between demographic characteristics and risk of mental health difficulties. CONCLUSIONS: Mental health difficulties associated with exposure to Hurricane Harvey were still present 5 months after the storm. Future disaster response programs should focus on providing long-term mental health services to hurricane survivors.

Is Socioeconomic Advantage Associated With Positive Health Behaviors and Health Outcomes Among Asian Indians?

OBJECTIVE: The South Asian Health Needs Assessment was conducted to collect health status information on the rapidly growing Asian Indian (AI) community in the Houston area. Many were highly educated and reported high income levels, factors usually associated with better health outcomes. This study examined the relationship between socioeconomic advantage and the health behaviors and health outcomes of AIs. METHODS: We analyzed cross-sectional survey data from a convenience sample of 1416 AIs. Income was categorized as low, medium, and high. Descriptive statistics were generated by income categories and weighted multinomial regression analyses were conducted to examine the association of income with health behaviors and outcomes, adjusting for age, sex, health insurance, and years in the United States. RESULTS: Income was positively associated with better self-rated health, higher body mass index, moderate physical activity, having shingles vaccine, and cervical cancer screening. Income was inversely associated with perceived stress and heart disease. However, income was not significantly associated with alternative therapies, cigarette smoking, alcohol consumption, self-reported overweight/obesity, fruit and vegetable consumption, diabetes, high blood pressure, high cholesterol and screening for breast, prostate, and colon cancer. CONCLUSIONS: Socioeconomic advantage was not consistently associated with positive health outcomes or desired health behaviors among AIs. We speculate that other factors, including cultural beliefs and acculturation may also impact health behaviors and health outcomes in this group. Further studies examining the influence of these variables on health behaviors and health outcomes are warranted.

Chronic Health Conditions, Physical Activity and Dietary Behaviors of Bhutanese Refugees: A Houston-Based Needs Assessment.

Bhutanese refugees resettling in the U.S. face many challenges including several related to health and health care. Limited health literacy and the relatively complicated US health care system may contribute to health disparities as well. A health assessment was conducted on adult refugees in Houston, Texas to provide healthcare providers, community organizations, and stakeholders baseline data to plan programs and interventions. A convenience sample of 100 participants had a mean age of 38.37 years, 56 % where males, and almost 80 % did not have high school level education. High blood pressure (27 %), dizziness (27 %), and arthritis (22 %) were the commonly identified chronic health conditions and trouble concentrating (34 %) and fatigue (37 %) were also reported. Sixty-two percent of the respondents reported that they consume recommended servings of fruits and vegetables and 41 %reported that they were currently getting at least 20-30 min of aerobic exercise per day. The assessment concluded with recommendations on how better provide care and services for the refugees.

Characterizing urban vulnerability to heat stress using a spatially varying coefficient model.

Identifying and characterizing urban vulnerability to heat is a key step in designing intervention strategies to combat negative consequences of extreme heat on human health. This study combines excess non-accidental mortality counts, numerical weather simulations, US Census and parcel data into an assessment of vulnerability to heat in Houston, Texas. Specifically, a hierarchical model with spatially varying coefficients is used to account for differences in vulnerability among census block groups. Socio-economic and demographic variables from census and parcel data are selected via a forward selection algorithm where at each step the remaining variables are orthogonalized with respect to the chosen variables to account for collinearity. Daily minimum temperatures and composite heat indices (e.g. discomfort index) provide a better model fit than other ambient temperature measurements (e.g. maximum temperature, relative humidity). Positive interactions between elderly populations and heat exposure were found suggesting these populations are more responsive to increases in heat.

A1C Testing and its Sociodemographic Predictors: Implications for Diabetes Self-management Programs.

BACKGROUND: One of the Healthy People (2020) goals related to the glycated hemoglobin (HbA1C) test is to increase the percentage of adults (aged 18 years and older) with diabetes who have had an HbA1C test at least twice in the past 12 months from 64.6% percent in 2008 to 71.1% by 2020. However, Texas has historically trailed behind several other states in achieving this goal. Targeted interventions for demographic subgroups of population could be a strategy to increase testing. However, little is known about the sociodemographic predictors of A1C test. METHOD: Texas Behavioral Risk Factor Surveillance System (BRFSS) data (2011 and 2012) were used to identify sociodemographic predictors of having had at least one A1C test in the past 12 months among diabetic patients. The sociodemographic predictors examined included age, sex, race/ethnicity, marital status, educational attainment, insurance status, whether or not the respondents had a primary care physician, and age when diabetes was diagnosed. A logistic model was developed to predict the membership. RESULTS: Multivariate logistic regression indicated that insurance status and educational attainment are predictors of adherence to an annual A1C test. Those with insurance were nearly 3 times more likely than those without insurance to report adherence to annual A1C test (odds ratio [OR] = 2.82, 95% confidence interval [CI], 1.47-5.42, P = .002), when controlled for all other sociodemographic variables. Likewise, those with more than college-level education were also nearly 3 times more likely than those with less than high school level education to report adherence (OR = 2.74, 95% CI, 1.27-5.89, P = .010). CONCLUSION: Population-based diabetes management programs should consider educational attainment level and insurance status of individuals when developing interventions to increase the rate of adherence to A1C testing recommendation among diabetic patients. Targeting interventions toward individuals with less than high school education and ensuring that diabetic individuals have some form of health insurance coverage may be helpful.

Disaster preparedness of linguistically isolated populations: practical issues for planners.

In the absence of culturally and linguistically appropriate disaster preparedness plans, several linguistically isolated and culturally diverse population groups are disproportionately disadvantaged in the United States. The communication gap poses challenges to emergency preparedness planners and response personnel in predisaster communication and postdisaster response efforts. Houston Department of Health and Human Services aimed to develop practical recommendations for local emergency response personnel so as to improve dissemination of emergency information and equitable delivery of services to linguistically isolated communities in the greater Houston area. Sixteen focus group discussions were conducted among linguistically isolated immigrant populations living in the greater Houston metropolitan area who primarily spoke one of the Spanish, Chinese, Vietnamese, and Somali languages. Our questions focused on general knowledge and understanding of disasters and explored experiences during Houston's most recent disaster, Hurricane Ike. We found that (a) understanding of disaster and preparedness is contextual, (b) awareness of preparedness needs and actual plans among LIPs is inadequate, and (c) word of mouth is the preferred information source for linguistically isolated groups. Disaster preparedness plans of a given jurisdiction should reflect the culturally and linguistically appropriate components addressing the needs, concerns, context-based knowledge or awareness, and perceptions of linguistically isolated populations.

Determinants of fruits and vegetables consumption among persons with doctor-diagnosed chronic diseases.

OBJECTIVE: The objective of this study was to examine the factors associated with fruits and vegetables consumption pattern among persons with doctor-diagnosed chronic diseases. METHOD: The authors examined cross-sectional, random-digit-dialed health survey data collected in 2008 in Houston, Texas, a city with a diverse ethnic population. The survey sample, which was designed to represent all households with telephones, was drawn using standard list-assisted random-digit-dialing methodology from telephone exchanges that serve the study area. A total of 1001 households were interviewed, and data obtained were subjected to both bivariate and multivariate analyses. RESULTS: Findings from this study indicate that fruits and vegetables consumption for persons with single chronic disease was significantly predicted (R (2) = 0.83) by the participants' age, educational level, and insurance status. None of the covariates considered in the study were significant predictors of fruits and vegetables consumption pattern among persons who had multiple chronic diseases. But when the subpopulation with any number of chronic diseases was considered, only gender (P < .05) and marital status (P < .001) were noted as the significant predictors of fruits and vegetables (R (2) = 0.34). CONCLUSION: More public health efforts are needed to make individuals with chronic diseases aware of the importance of consumption of fruits and vegetables. Clinicians and health care professionals should be encouraged to emphasize the importance of consumption of fruits and vegetables in their routine practice to the patients with chronic disease(s), especially to those who are unmarried and male.

Communication strategies to improve HIV treatment adherence.

Although antiretroviral therapy has increased the survival of HIV-positive patients, traditional approaches to improving medication adherence have failed consistently. Acknowledging the role of communication in health behavior, we conducted a qualitative study to learn about patients' HIV treatment adherence experiences and to identify which communication strategies might influence adherence. Findings indicate that five constructs--cultural beliefs/language, stigma, cues to action, self-efficacy, and mood state--are potentially modifiable by improved communication. Results will be used to create a direct marketing campaign targeted to HIV-infected patients.

Prenatal Care Barriers in an Inner-city Neighborhood of Houston, Texas.

The objective of this qualitative pilot study was to explore barriers to prenatal care among women (aged 17 to 30 years) with pregnancy experience who resided in an underserved and predominantly African American neighborhood in Houston, Texas. The authors conducted 5 focus group discussions with, and collected demographic information from, the 32 participants. Discussions were audiotaped, transcribed, and analyzed manually. The data analysis suggested 5 key barriers to prenatal care services among the study populations: unplanned pregnancy, lack of information, lack of support system (eg, lack of emotional and instrumental support from family members), psychosocial challenges (eg, emotions and stress-related to the condition of pregnancy), and economic hardships (eg, lack of money to maintain healthy pregnancy and basic needs). Addressing the causes of unplanned pregnancy, such as low risk perception, behavior-related causes, and attitude toward pregnancy, may be helpful to improve the utilization of prenatal care by underserved women.

Disparities in fruits and vegetables consumption in houston, Texas: implications for health promotion.

BACKGROUND: The consumption of the recommended amount of fruits and vegetables is believed to help prevent nutrient deficiency disorders and lower the risk of several chronic diseases. Information on the disparity of fruit and vegetable consumption may be useful in designing targeted health promotion programs for increasing fruit and vegetable consumption. The objective of this pilot study was to examine disparities in fruit and vegetable consumption among Houston residents based on sociodemographic characteristics. METHODS: The authors conducted bivariate and multivariate analyses to examine the associations between sociodemographic characteristics and fruit and vegetable consumption using a random digit dialing (RDD) health survey data (N = 1001) collected in Houston, Texas. RESULTS: Bivariate analysis showed that there were significant associations between fruit and vegetable consumption and education (P < .01); race/ethnicity (P < .001); marital status (P < .001); and employment status (P < .05). Multivariate analysis indicated that fruit and vegetable consumption pattern could be significantly (P ≤ .05) predicted by gender, race, and marital status. Respondents who were of other race category were less likely than whites to consume fruits and vegetables, while married respondents and women were more likely to consume fruits and vegetables compared to the unmarried and men, respectively. IMPLICATIONS: Health promotion programs aimed at increasing the consumption of fruits and vegetables should consider developing targeted intervention for men, people with less formal education, minority race/ethnicity, people who are unemployed, and those who are unmarried.

Community-based participatory research in disaster preparedness among linguistically isolated populations: a public health perspective.

Working with linguistically isolated immigrants on public health issues poses a set of methodological challenges unique to this population. We used community-based participatory research (CBPR) techniques to investigate the disaster preparedness needs of four linguistically isolated population groups in Houston, Texas (Vietnamese, Chinese, Somali, and Spanish-speaking) in partnership with community-based organizations and community researchers. As a local health department conducting CBPR, we witnessed various challenges, including: engaging and using interpreters versus using community researchers; translating focus group questions from English to other languages; recruiting participants from linguistically isolated populations; and handling issues of community power, data collection, and data reliability. In this article, we discuss these challenges, strategies used, and the outcomes of our approaches in the broader context of CBPR.