Pathways to Health: Policy, Practices

and Partners

The 84th Annual Conference

Presented by the San Antonio Metropolitan Health District and Texas

Public Health Association

The Radisson Hill Country Resort & SpaMarch 5-7, 2008

San Antonio, Texas

Pathways to Health: Policy, Practices and Partners

WELCOME FROM THE PRESIDENTI am very pleased to welcome you to the Texas Public Health Association 84 th Annual Educational Conference.  This year, we have developed the program for those of you in the “grass roots” areas by looking at federal, state and local policies which serve as the guide for all public health partners.   We have excellent speakers who will update you on these policies and suggest practices which might be helpful to you as professionals in all areas of the state of Texas.  You will notice our proposed vision and mission of the association posted in various areas.  We want your feedback about these proposals to any executive board or governing council member. This association is for you and because it is for you, we would like to encourage you to share in the revision of the strategic plan by giving us your comments on the proposed vision and mission.  Again, welcome!  As an association, we are excited about our program, excited to see you here, and look forward to a good experience.

CONTINUING EDUCATION (Pick up your CEU paperwork at registration desk)Physicians-CME: Texas Department of State Health Services is accredited by the Texas Medical Association to provide continuing medical education for physicians. TDSHS designates this educational event for a maximum of 14.00 category 1 credits toward the AMA Physician’s Recognition Award. Each physician should claim only those hours of credit he/she actually spent in the educational event.

Nurses-CNE: The Texas Department of State Health Services, Continuing Education Service is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

A maximum of 14.00 continuing nursing education contact hours has been awarded by the DSHS CE service. Each nurse should claim only those hours of credit that he/she actually spent in the educational event.

Health Educators-CHES: Application for Category I continuing education contact hours for CHES has been made to the Texas Department of State Health Services, CE Service which has been designated as a provider of continuing education contact hours by the National Commission for Health Education Credentialing, Inc. The TDSHS CE Service has awarded a maximum of 14.00 contact hours.

Social Workers-SW: The Texas Department of State Health Services, under sponsor number CS3065, has been approved by the Texas State Board of Social Work Examiners to offer continuing education units to social workers. The CE Service has awarded a maximum of 14.00 continuing education credits.

Registered Sanitarians-RS: Certificate of Registered Sanitarians: The Texas Department of State Health Services is considered a sponsor of Registered Sanitarians according to the Texas Administrative Code, Title 25, Part 1, Chapter 265, Subchapter K, Rule §265.147. The PHW CE Service has awarded a maximum of 14.00 hours.

Certificate of Attendance: This activity was awarded 14.00 contact hours.

EXHIBITORS-Commercial and educational exhibitors will be located in the Rotunda of the hotel.Exhibits will be set up from Wednesday, March 5th 12:00 noon until Thursday, March 6th 6:30 p.m. Special events such as the grand opening “Wine and Cheese” and the President’s Reception will be held in the Exhibit area. Please visit the exhibits during these events!

PUBLIC HEALTH PRESENTATIONS-Abstracts on Public Health Education Materials (Projects designed to educate the public on a public health topic) Research Papers: (Original research of an empirical nature, conceptual or methodological issues or innovative techniques in a public health area) and Poster Presentations: (Original research of an empirical nature, conceptual or methodological issues or innovative techniques in a public health area) will be presented and/or displayed.

EVALUATIONS-Your feedback helps us to make each subsequent conference a meaningful, educational and fun experience for you. Please complete the evaluation and submit it prior to your departure.

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PRESIDENT’S RECEPTION- The Reception will be held Thursday, March 6th from 4:45-6:15 p.m. The following awards and recognition will be presented during the President’s Reception: Recognition of Officers, Governing Council and Committees, New Fellow Recognition, Exhibitor Recognition, Media Awards, Recognition of Immediate Past President, Outstanding Service Award, President’s Award, Jessie A Yoas Memorial Award, Thinking Progressively for Health (TPHA) Award, Honorary Life Member Award and James E. Peavy Memorial Award.

8:30 am-4:30 pm Conference Registration HOTEL LOBBY

8:30 -11:30 am Pre-Conference Workshop OFF SITEEvidence-Based Public Health Practice: Using Research and Data to Improve Your Programs, Helena M. Von Ville, Library Director, University of Texas School of Public Health, Houston, TX

9:30 – 11:30 am Pre-Conference Workshop AGARITA

Making the Connection between Housing and Health Sponsored by the Texas Public Health Training CenterSpeakers: Nancy M. Crider, MS, RN, University of Texas School of

Public Health, Houston and Brenda Reyes, MD, MPH, City of Houston Health and Human Services, Childhood Environmental Health

This training activity will discuss the increasing scientific evidence that links housing conditions to health and identify the root causes of housing related health problems such as asthma & allergies, lead poisoning, cancer and common preventable injuries. A holistic approach to identifying and resolving housing problems that are harmful to the health and well-being of children and families will be discussed. The “Seven Principles of Healthy Housing”, based on the National Center for Healthy Housing (NCHH), Essentials for Healthy Homes Practitioner Course, will be introduced.

1 – 3 pm Opening Assembly WESTOVER ASSEMBLY AUDITORIUM

1 – 1:45 pm Welcome by TPHA President Sandra Strickland, RN, DrPH, Mayor & Fernando A. Guerra, MD, MPH, FAAP, Director, San Antonio

Metropolitan Health District

1:45 – 2:45 pm Keynote Address- Forging an Enduring Partnership Between Public Health Academics and Practice in Texas, David L. Lakey, MD, Commissioner of Health, Texas Department of State Health Services, Austin

2:45 - 3 pm 2008 Texas Cardiovascular Health Promotion Awards Presentations by the Texas Council on CVD and Stroke

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3-3:15 pm Stretch break

3:15 – 4:45 pm Public Health Presentations WESTOVER ASSEMBLY AUDITORIUM

Moderator, Patricia Diana Brooks, MEd, MSIntentional Poisoning Exposures Reported to the Texas Poison

Control Center, Marcia Becker, MPH, Texas Department of State Health Services

Inpatient Admissions for Infection in Cancer Patients: Impact of an Aging Population, Catherine Cooksley, DrPH,

University of Texas M. D. Anderson Cancer Center

Public Health Presentations (Continued) WESTOVER ASSEMBLY AUDITORIUM

Following the Roadmap to Preparedness Data: Creating a Public Health Preparedness Dashboard, Catherine Pepper, MLIS, MPH, Centers for Disease Control & Prevention

Assessment of Evidence-based Prevention Practices within a Residency Based Family Practice Center, Linda Hook,

RN, MSN, Bexar County Hospital District dba University Health System

Hispanic Ethnicity & Foreign Nativity as Predictive Factors of Community Health Center Utilization as a Regular Source of Care, Erin K. Carlson, MPHGraduate Research Assistant, University of North Texas Health Science CenterSchool of Public Health, Department of Health Management and Policy

4:45 – 6:00 pm Opening of Exhibits & Posters (Wine & Cheese) SUNSPOT/FOYER AREA

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6:45 – 7:30 pm TPHA Governing Council MeetingAGARITA

6:30 – 7:30am Health Walk (meet in hotel lobby)HOTEL LOBBY

7 am-4 pm RegistrationHOTEL LOBBY

8 – 9 am GENERAL SESSION WESTOVER ASSEMBLY AUDITORIUM

Health Policy Case Study on Tobacco Steven R. Shelton, MBA, PA-C, Moderator, Assistant Vice President,

Division of Community Outreach, UTMB; Executive Director, East Texas AHEC.

He will present the case study on tobacco and will discuss health policy changes from the clinical perspective, and changes in health measures and outcomes.

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William M. Sage, MD, JD, University of Texas, School of Law, Vice Provost, Health Affairs, James R. Dougherty Chair for Faculty Excellence in Law. To discuss a few historical aspects of tobacco, agents of change, cite a few landmark policy changes, and identify medical/social ‘tipping points’ that influenced those changes.

Roger D. Barker, MBA, RS, Director/Administrator, City of Waco-McLennan County Public Health District. To discuss how policy changes affected PHD mgmt & staff activities, operations, services, programming, enforcement, etc., and how PHD staff implemented policy changes at the community / public health level.

9:15 – 10:15 am GENERAL SESSION WESTOVER ASSEMBLY AUDITORIUM

Presidential Politics, Taxes and Wellness (Panel Discussion)Eduardo Sanchez, MD, MPH, Moderator, Professor, and Director,

Institute for Health Policy, School of Public Health, University of Texas Health Science Center at Houston

Paul B. Handel, MD, Chief Medical Officer, Health Care Service Corporation

William M. Sage, MD, JD, University of Texas, School of Law, Vice Provost, Health Affairs, James R. Dougherty Chair for Faculty Excellence in Law.

The burden of chronic disease is growing. 75% of medical care costs are attributable to chronic disease care. The medical model of care in the doctor’s office is but one piece of that process. Healthcare costs and health insurance are other pieces. The wellness model of individual-and community-based health literacy and education, prevention and self- management is a vital component. Is the current healthcare system well designed to deal with these issues? Are the presidential candidates talking about these issues? Are they thinking about anything other than insurance packages and benefits designs? Have

any of them considered the overall scheme, the big picture regarding health policy? What are their positions on health and the national mission for healthcare? This session will present a comparison of the presidential candidates’ positions on health/ wellness, and the implications for health policy. The panelists will also discuss the concept of wellness at the state and national level, as a continuation of last year’s session on Unhealthy Behaviors and Chronic Diseases, a True Threat to the Health of Texans

10:15 – 10:45 am Break WESTOVER ASSEMBLY AUDITORIUM

10:45 – 11:45 am GENERAL SESSION WESTOVER ASSEMBLY AUDITORIUM

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Texas Mental Health Transformation Initiative Sam Shore, Texas Department of State Health Services and Camille D. Miller, MSSW, President/CEO, Texas Health Institute

11:45 -12:45 pm Lunch on your own Past Presidents’ Lunch (meet in hotel restaurant)

Public Health Nursing Luncheon WESTOVER ASSEMBLY AUDITORIUM

Workforce Issues, Kathi Light, EdD, MSN, RN, Professor and Dean, University of the Incarnate Word (Pre-registration required)

1 – 3 pm CONCURRENT SESSIONS

Chronic DiseaseMEDIA ROOM

Facilitator-Jennifer Smith, MSHP Using What Works: Adapting Evidence-Based Programs to Fit Your Needs, Ginny Thompson, MPH, CHES, National Cancer Institute’s Cancer Information Service, MD Anderson Cancer Center.

Implementing Evidence-Based Programs in the Prevention & Control of Arthritis, Jeff Savage, BS, Director of Programs, Arthritis Foundation, Texas ChapterThe presentation will present information on the latest research to reduce pain and increase mobility for persons with arthritis and the current evidence-based programs developed that use physical activity and self-management as means to achieve those results that can be implemented in the community setting.

Objectives: Name evidence-based practices for major chronic disease conditions, and; Name one evidence-based practice that the participant will commit to introduce into their community or work program practices.

Environmental & Consumer HealthNANDINA

Facilitator-Janice Hartman, RS Food Imports Along the Texas-Mexico Border & DSHS

Manufactured Foods Inspections, Seri Essary, BS, RS, Manager, Foods Inspection South, Division for Regulatory Services, Texas Department of State Health Services, Austin

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Zoonotic Diseases in Texas (Dengue and Scrapie), Catherine Tull, DVM, Region 8, Texas Department of State Health Services, San Antonio

EpidemiologyAGARITA

Moderator, Patricia Diana Brooks, MEd, MS2007: Disasters in ReviewScott R. Lillibridge, MD, Texas A & M Health Science Center, School of Rural Public Health and Dennis M. Perrotta, PhD CIC, Texas A&M School of Rural Public Health, Houston, Texas, and Mary des Vignes-Kendrick, MD, MPH, Texas A & M School of Rural Public Health

The top 5 disasters of 2007 will be reviewed.  The panel will discuss key public health system elements of these disasters such as communication, information sharing, collaboration, response effectiveness and crisis leadership. The perspectives of these three distinguished public health practitioners, whose practice span the federal, state and local levels, will serve as the starting point for a facilitated and interactive discussion with audience participants.  How did public health fare in preparing and responding to these disasters in 2007?  This session will consider the critical public health preparedness competencies and how they were depicted in deciding the outcome of these disasters.

What do Epidemiologists Do?  Competencies for Applied Public Health Epidemiology Practice, Dennis M. Perrotta, PhD CIC, Texas A&M School of Rural Public Health, Houston, Texas

In order to improve the practice of epidemiology among public health agencies, a comprehensive list of competencies was created that defines the

discipline of applied epidemiology and describes what skills four different levels of practicing epidemiologists working in government public health agencies should have to accomplish required tasks.  The process and the competencies will be reviewed.

Health Policy LANTANA

Facilitator-Douglas H. Fabio, MHA Putting the “Force” Into the Public Health Workforce

Part A-Changes and Challenges in the Public Health Workforce, Rick Danko, DrPH, Texas Department of State Health ServicesObjective: Describe the composition of the Texas public health workforce, including gaps between needed and existing competencies.Part B-Making Public Health an Exciting and Lasting ProfessionJoan Hutton, BA, RN, CPC, The Hutton Group, Inc., Vero Beach, FLObjective: Relate how your organization can adapt creative strategies to recruit and retain critically needed professionals.Part C-Assuring the Next Generation of LeadersJoan Hutton, BA, RN, CPC, The Hutton Group, Inc., Vero Beach, FLObjective: Explain how to identify and energize future public health leaders through succession planning.

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Reactor Panel for Parts A-C above followed by questions and answers

Moderator: Douglas H. Fabio, MHAPanelists: Larry Johnson, MS, MBA, Abilene-Taylor County Public

Health District, Stephen Williams, MEd, MPA, City of Houston Department of Health and Human Services, Rick Danko, DrPH, Texas Department of State Health Services

Public Health Nursing WESTOVER ASSEMBLY AUDITORIUM

Facilitator- Alexandra Garcia, PhD, RNBest Practices in Health Promotion Programs for Kids

Lead Safe in San Antonio, Linda Kaufman, MSN, RN, CS, Environmental Health Nursing Program Manager, San Antonio Childhood Lead Poisoning Prevention Program, San Antonio Metropolitan Health District AND Myrna Esquivel, MS, Construction Specialist Supervisor, Lead-Based Paint Hazard Control Program, Neighborhood Services Department

School Health Practice: Treatment versus Prevention, A Cry for Help, Susan Franzetti, MSN, RN, Pflugerville Independent School District, Student Health Coordinator, After the presentation, participants will be able to describe the practice of school health in Texas, list 5 state-mandated areas of school health requirements and contrast differences between the traditional medical model of school health and the integration of public health concepts into school health practice.

A Statewide QA Children’s Immunization Program, Sandra Benavides-Vaello, BSN, MPAff, PhD(c), Director of Clinical Affairs, Texas Association of Community Health Centers This session addresses quality assurance in immunization programs.

3 - 3:15 pm Break and Visit Exhibits and PostersSUNSPOT/FOYER

Chronic Disease MEDIA ROOM

Facilitator-Jennifer Smith, MSHPPediatric Asthma: Bridging the Gap Between Acute and Chronic

Care,Charles G. Macias, MD, MPH, Associate Professor of Pediatrics, Director, Pediatric, Emergency Medicine Fellowship, Research Director, Section of Emergency Medicine, Baylor College of Medicine, This session will explore the gaps in the health care system that serve as barriers to

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improving the public health for children with asthma. Solutions through system changes will be addressed and best practices described to define ways to improve care for families with asthmatics while decreasing health care resource utilization.Reducing High Blood Pressure in the Hispanic Population through Clinical and Worksite Programs, Eva Dunn and Lourdes Rangel, Gateway Community Health CenterPediatric Asthma: Bridging the Gap Between Acute and Chronic

Care,Charles G. Macias, MD, MPH, Associate Professor of Pediatrics, Director, Pediatric, Emergency Medicine Fellowship, Research Director, Section of Emergency Medicine, Baylor College of Medicine, This session will explore the gaps in the health care system that serve as barriers to improving the public health for children with asthma. Solutions through system changes will be addressed and best practices described to define ways to improve care for families with asthmatics while decreasing health care resource utilization.Reducing High Blood Pressure in the Hispanic Population through Clinical and Worksite Programs, Eva Dunn and Lourdes Rangel, Gateway Community Health Center

3:15 – 4:45 pm Concurrent Sessions continued

Environmental & Consumer HealthNANDINA

Facilitator-Janice Hartman, RS Public Health Considerations of Methicillin-Resistant

Staphylococcus Aureus (MRSA), Bryan J. Alsip, MD, MPH, FACPM, San Antonio Metropolitan Health District

Environmental and Consumer Health Section Meeting-Janice Hartman, RS

EpidemiologyAGARITA

Moderator, Patricia Diana Brooks, MEd, MS Climbing the Money Tree: Locating Grants and Funding, Michelle

Malizia, MA National Library of Medicine at HAM/TMC Library

Health PolicyLANTANA

Facilitator- Hardy Loe, Jr., MD, MPH

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Workforce Implications of National Voluntary Accreditation of State and Local Health Departments; Current State of Implementation of the National Accreditation Program

Hardy Loe, Jr., MD, MPH.  Dr. Loe will outline the original work of the Exploring Accreditation Steering Committee, which established recommendations for the Voluntary Accreditation Program leading to the incorporation of the Public Health Accreditation Board in May 2007 and the hiring of Dr. Albert Gray as Executive Director. 

Richard S. Kurz, PhD, Professor and Dean, University of North Texas Health Science Center School of Public Health.   As a representative of a public health academic institution in Texas, Dr. Kurz will be in a position to discuss the teaching, research and technical assistance roles to be played in the new program.  In addition, Dr. Kurz brings important experience from his role as Co-Chair of the Accreditation Council for Local Health Departments in Missouri, the Missouri Institute of Community Health.  The state of Missouri began exploring accreditation in the 1990's and formalized its program in the Missouri Institute for Community Health in 2002. 

 Isaac Joyner, MPH, Bureau Chief for Health Planning, Houston Department of Health and Human Services.  As an experienced public health practitioner in a major health department in the state, Mr. Joyner will be able to identify and discuss the meaning and significance of accreditation in a metropolitan setting. 

Health Policy continuedLANTANA

Facilitator- Hardy Loe, Jr., MD, MPHHector Gonzalez, MD, MPH, Director of the City of Laredo Department of Public Health.  Dr. Gonzalez is in charge of a middle size health department and will speak to how accreditation in a department of that size affects these same issues.  Because of its location on the border of Mexico, the City of Laredo interacts routinely with international public health, so that these issues will also be of interest to the audience.

Fernando A. Guerra, MD, MPH, Director of the San Antonio Metropolitan Health District.  In addition to directing a large metropolitan health department in the state, Dr. Guerra brings two other perspectives that will be of interest to the audience.  He is a member of the Accreditation Planning Committee of the National Association of County and City Health Officials (NACCHO), and he is also a member of the National Public Health Accreditation Board, which is responsible for governing the new national accreditation program. In addition, the San Antonio Metropolitan Health District has been asked by NACCHO to conduct a self-assessment as part of their accreditation planning efforts. 

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Mike Czepiel, BBA, Senior Public Health Liaison, Regional and Local Health Services Division, Texas Department of State Health Services (TDSHS).   Mr. Czepiel, among other duties, serves as the focus for development of the State Agency's role in voluntary accreditation, with respect to the TDSHS role in providing local health services in cities and counties that do not have local public health departments as well as the Department's responsibilities to interact with local health departments throughout the state.

Bing Burton, PhD, Director, Denton County Health Department and Member of the Accreditation Committee of the Texas Association of Local Health Officials (TALHO).  TALHO is developing an initiative to assist Texas in the implementation of Voluntary Accreditation.  Toward that end the TALHO Board of Directors has invited representatives of the Missouri Community Health Institute to their retreat at the end of February as they work this out.  Dr.  Burton will report on this initiative to the audience.   

Public Health Nursing WESTOVER ASSEMBLY AUDITORIUM

Facilitator-Alexandra Garcia, PhD, RN

Best Practices in Health Promotion Programs for Adults

Your Health is in Your Hands: Developing a Topical Health Literacy / Education Campaign, Deborah Flaniken, East Texas Area Health Education Center, Session participants will review/discuss the elements of an effective topical health education campaign, using a pandemic flu model. Participants will use the model to collaboratively draft a pediatric obesity campaign.

Advances in Contraception, Janet Realini, MD, MPH, San Antonio Metropolitan Health District

4:45 – 6:15 pm President’s Reception & Awards PresentationsSUNSPOT/FOYER

6:30 – 7:15am Health Walk (Meet in Hotel Lobby)HOTEL LOBBY

8 am-1 pm Registration HOTEL LOBBY

8:30 – 9 am Breakfast WESTOVER ASSEMBLY AUDITORIUM

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9 – 11 am Closing General Session WESTOVER ASSEMBLY AUDITORIUM

Alzheimer’s Disease Consortium Panel DiscussionBobby Schmidt, MEd, RS, Moderator

Treatment in Alzheimer’s Disease, Rachelle Smith Doody, MD, PhD, Baylor College of Medicine, Houston

Neurodegenerative Disease: New Research and Therapy Strategies, Roger Rosenberg, MD, UT Southwestern Medical Center, Dallas

The Wisdom of Aging, Randolph Schiffer, MD, Texas Tech University, School of Medicine, Lubbock

Options for Care for Dementia Patients, Janice Knebl, DO, MBA, Dallas Southwest Osteopathic Physicians Endowed Chair in Clinical Geriatrics at the University of North Texas Health Science Center, Texas College of Osteopathic Medicine, Fort Worth

Texas Alzheimer’s Research Consortium Update, Stephen C. Waring, DVM, PhD, University of Texas Health Science Center, Lead Scientist for the Texas Alzheimer’s Research consortium

The session will offer the latest information on Alzheimer’s disease research, the diagnosis and treatment of Alzheimer’s disease, and innovations in care to improve the quality of life for individuals with Alzheimer’s disease and related disorders, their family members, and caregivers. The session will be presented by world-renowned authorities in Alzheimer’s research, treatment and care.

11 – 11:30 am Closing Remarks, Transfer of the Gavel and Incoming Presidents Remarks by Linda Hook, RN, MSN, (incoming President)

Public Health Presentations Awards-Patricia Diana Brooks, MEd, MS

11:30-12:30 pm 2009 Annual Education Conference Program PlanningLANTANA

The Texas Public Health Association extends its gratitudeto the following for their excellent work in contributing to the overall success of the

84th Annual Education Conference13

Sandra Strickland, RN, DrPH, Chair and TPHA PresidentFernando A. Guerra, MD, MPH, Host

San Antonio Metropolitan Health District Staff

Adriana Babiak-Vazquez, MPH, Second Vice-PresidentPatricia Diana Brooks, MEd,

MS, First Vice-PresidentJulio Allo, MPH, Epidemiology

Catherine Cooksley, DrPH, Website

Nancy Crider, Pre-conference

Mary desVignes-Kendrick, M.D, M.P.H, EpidemiologyDebra Edwards, MS, RNC, ONC, Continuing EducationDoug Fabio, MHA, Health

Policy

Deborah Flaniken, General Session

Alexandra Garcia, PhD, RN, Public Health NursingKarla Gutierrez, MPH,

EpidemiologyC. Lee Hamilton, Health

PolicyJanice Hartman, RS,

Environmental Linda Hook, RN, BSN, MSHP, President-Elect

Linda Kaufman, MSN, RN, CS, Public Health NursingHardy Loe, Jr., MD, Health

Policy/General Session

Amy Pearson, Continuing Education

Eduardo Sanchez, MD, MPH, General Session

Bobby Schmidt, General Session

Dan Smith, MEd, CHES, Continuing Education

Jennifer Smith, MSHP, Immediate Past President,

Chronic DiseaseCathy Troisi, PhD, Health

PolicyHelena VonVille, Pre-

conference

Special thanks to:

Silent Auction Contributors

Sponsors: University of Texas School of Public Health

for sponsoring the Public Health Presentations

Organon, a part of Schering-Plough

Advertisers:University of Texas School of Public Health

School of Public Health at the University of North Texas Health Science Center

Presenters and Moderators

Bryan Alsip, MD, MPH, FACPMSan Antonio Metropolitan Health District332 West CommerceSan Antonio, Texas 78205210- 207-8172bryan.alsip@sanantonio.gov

Roger D. Barker, MBA (HCA), RSWaco-McLennan County Public Health District225 West Waco DriveWaco, Texas 76707254- 750-5459

rogerb@ci.waco.tx.us

Marcia BeckerTexas Department of State Health Services1100 West 49th StreetAustin, Texas 78756512- 458-7287

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marcia.becker@dshs.state.tx.us

Sandra Benavides-Vaello, RN, MPAff, PhD©Texas Association of Community Health Centers5900 Southwest Parkway, Building 3Austin, Texas 78735512- 329-5959sbvaello@tachc.org

Patricia Diana Brooks, MEd, MSRetired7235 Sharpview DriveHouston, Texas 77074pdb879@yahoo.com

Bing Burton, PhDDenton County Health Department306 N. Loop 288, Suite 183Denton, Texas 76021940- 349-2900bburton@dentoncounty.com

Catherine Cooksley, DrPHUT MD Anderson Cancer Center1515 Holcombe Blvd. Unit 447Houston, Texas 77030713- 563-4304ccooksle@mdanderson.org

Nancy Crider, MS, RNTexas Public Health Training Center1200 Hermann Pressler DriveHouston, Texas 77054713- 500-9399nancy.m.crider@uth.tmc.edu

Mike Czepiel, BBATexas DSHS1100 West 49th StreetAustin, Texas 78756512- 458-7770michael.czepiel@dshs.state.tx.us

Rick Danko, DrPHTexas Department of State Health Services1100 West 49th StreetAustin, Texas 78756512- 458-7375

rick.danko@dshs.state.tx.us

Mary des Vignes-Kendrick, MD, MPHTexas A & M Health Science Center, School of Rural Public Health2121 West Holcombe Blvd, Suite 1111D, Houston, Texas 77030713- 677-7430mdkendrick@srph.tamhsc.edu

Rachelle Smith Doody, MD, PhD, Baylor College of MedicineOne Baylor Plaza, MS NB302Houston, Texas 77030713- 798-7416rdoody@bcm.edu

Eva DunnGateway Community Health Center, Inc.1515 Pecan StreetLaredo, Texas 78041956- 523-3671

Myrna Esquivel, MSLead-Based Paint Hazard Control Program, Neighborhood Services Department1400 South FloresSan Antonio, Texas 78204210- 207-6628myrna.esquivel@sanantonio.gov

Seri Essary, BS, RSTexas Department of State Health Services1100 West 49th StreetAustin, Texas 78756512- 834-6770seri.essary@dshs.state.tx.us

Doug Fabio, MHATarrant County Public Health1101 S. Main StreetFort Worth, Texas 76104817- 321-5316dfabio@tarrantcounty.com

Deborah FlanikenEast Texas AHEC/UTMB301 University Blvd

Galveston, Texas 77555409- 772-7884deborah.flaniken@utmb.edu

Susan Franzetti, MSN, RNPflugerville ISD16229 FM 973N #3Manor, Texas 78653512- 594-0127susan.franzetti@pflugervilleisd.net

Alexandra Garcia, PhD, RNUT School of Nursing3402 Larry LaneAustin, Texas 78722512- 474-7532agarcia@mail.nur.utexas.edu

Hector Gonzalez, MD, MPHCity of Laredo Department of Public Health2600 Cedar AvenueLaredo, Texas 78040956- 795-4920hgonzalez@ci.laredo.tx.us

Fernando A. Guerra, MD, MPHSan Antonio Metropolitan Health District, 332 W. CommerceSan Antonio, Texas 78205210- 207-8731fernado.guerra@sanantonio.gov

Paul B. Handel, MDHealth Care Service Corporation901 S. ExpresswayRichardson, Texas 75080972- 766-3333paul_handel@bcbstx.comJanice Hartman, RSTexas Department of State Health Services821 Brian DriveGrand Prairie, Texas 75052972- 264-2346hartwoman7@sbcglobal.net

Linda Hook, RN, BSN, MSHPUniversity Health System223 MackenzieNew Braunfels, Texas 78130210- 414-7578bhook3115@aol.com

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Joan Hutton, BA, RN, CPCThe Hutton Group, Inc., Vero Beach, FL1855 Bridgepointe Circle, Unit 23Vero Beach, Florida 32967772- 770-1787info@huttongrouphc.com

Larry JohnsonAbilene-Taylor County Public Health District850 N 6th StreetAbilene, Texas 79601325- 692-5600larry.johnson@abilenetx.com

Isaac Joyner, MPHCity of Houston Department of Health & Human Services8000 N. Stadium Drive 8th FloorHouston, Texas 77054713- 794-9286isaac.joyner@cityofhouston.net

Linda Kaufman, MSN, RN, CSSan Antonio Metropolitan Health District8210 Campobello DriveSan Antonio, Texas 78218210- 434-1079lkaufman@sanantonio.gov

Janice Knebl, DOTexas College of Osteopathic Medicine855 Montgomery AvenueFort Worth, Texas 76107817- 735-2200jknebl@hsc.unt.edu

Richard Kurz, PhDUNTHSC School of Public Health3500 Camp Bowie Blvd. EAD-749Fort Worth, Texas 76112817- 735-2323rkurz@hsc.unt.edu

David Lakey, MD

Texas Department of State Health Services1100 West 49th StreetAustin, Texas 78756512- 458-7375david.lakey@dshs.state.tx.us

Kathi Light, MSN, RNUniversity of the Incarnate Word, 4301 BroadwaySan Antonio, Texas 78209

Scott Lillibridge, MDTexas A & M Health Science Center, School of Rural Public Health2121 West Holcombe Blvd, Suite 1111, Houston, Texas 77030, 713- 677-7766lillibridge@srph.tamhsc.edu

Hardy Loe, Jr., MD, MPHConsultant, 1659 Harold Street, Apt. BHouston, Texas 77006713- 524-2682hardyloe@yahoo.com

Charles Macias, MD, MPHBaylor College of Medicine6621 Fannin Street, Suite A210, Houston, Texas 77030832- 824-5416cgmacias@texaschildrenshospital.org

Michelle Malizia, MANational Library of Medicine at HAM/TMC LibraryNN/LM/SCR 1133 John Freeman BlvdHouston, Texas 77030713- 799-7880michelle.malizia@exch.library.tmc.edu

Camille MillerTexas Health Institute8501 N. MoPac, Suite 420Austin, Texas 78759512- 279-3904cmiller@texashealthinstitute.org

Catherine Pepper, MLIS, MPHCenters for Disease Control & Prevention1600 Clifton Rd. NE, MS E-08Atlanta, GA 30333404- 639-6018cpepper@cdc.gov

Dennis Perrotta, PhDTexas A & M Health Science Center, School of Rural Public Health358 Gotier Trace RoadSmithville, Texas 78957512- 217-9042epidemic@prodigy.net

Lourdes RangelGateway Community Health Center1515 Pappas Street956- 523-3644lulur.gateway@tachc.org

Janet Realini, MD, MPHSan Antonio Metropolitan Health District332 West Commerce Street #303, San Antonio, Texas 78205210- 207-8850janet.realini@sanantonio.gov

Brenda Reyes, MD, MPHCity of Houston Health & Human Services8000 N. Stadium Drive, 2nd Floor, Houston, Texas 77054713- 794-9452brenda.reyes2@cityofhouston.net

Roger Rosenberg, MDUT Southwestern Medical Center-Dallas5323 Harry Hines Blvd.Dallas, Texas 75390214- 648-3239roger.rosenberg@utsouthwestern.edu

William M. Sage, JD, MD

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University of Texas, School of Law727 East Dean Keaton StreetAustin, Texas 78705512- 232-7806wsage@law.utexas.edu

Eduardo Sanchez, MD, MPHInstitute for Health Policy, UTSPH313 East 12th Street, Suite 220Austin, Texas 78701512- 482-6164eduardo.sanchez@uth.tmc.edu

Jeff Savage, BSArthritis Foundation, Texas Chapter4300 MacArthur Ave, Suite 245Dallas, Texas 75209214- 826-4361jsavage@arthritis.org

Randolph Schiffer, MDTexas Tech University, School of Medicine, Lubbock806- 743-2249

Bobby Schmidt, MEdAlzheimer's Disease Program-Texas Department of State Health ServicesPO Box 149347Austin, Texas 78714512- 458-7111bobby.schmidt@dshs.state.tx.us

Steven Shelton, MBA, PA-CUTMB301 University BlvdGalveston, Texas 77555409- 772-7884steve.shelton@utmb.edu

Sam Shore, Mental Health Transformation Operations Director, DSHS909 W. 45th Street, Austin, TX 78756, 512-458-7135Sam.shore@dshs.state.tx.us

Jennifer SmithTexas Department of State Health Services1100 West 49th StreetAustin, Texas 78756512- 458-7111jennifer.smith@dshs.state.tx.us

Sandra Strickland, DrPHUniversity of the Incarnate Word508 Highway 90ECastroville, Texas 78009210- 829-3988strickla@uiwtx.edu

Ginny Thompson, MPH, CHESNational Cancer Institute's Cancer Information Service, MD Anderson Cancer Center1515 Holcombe Blvd, Unit 229Houston, Texas 77030713- 792-8091gthompson@mdanderson.org

Catherine Tull, DVMTexas Department of State Health Services, Region 87430 Louis Pasteur DriveSan Antonio, Texas 78229210- 949-2000catherine.tull@dshs.state.tx.us

Helena M. VonVilleThe University of Texas School of Public Health at Houston1200 Hermann Pressler RASE-119Houston, Texas 77030713- 500-9131helena.m.vonville@uth.tmc.edu

Stephen Waring, DVM, PhDUT School of Public Health1200 PresslerHouston, Texas 77030713- 500-9241stephen.c.waring@uth.tmc.edu

Stephen L. Williams, MEd, MPACity of Houston Department of Health & Human Services8000 N. Stadium Drive 8th FloorHouston, Texas 77054713- 794-9311stephen.williams@cityofhouston.net

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Exhibitors and Sponsors

Alzheimer's Disease ProgramDSHSBobby Schmidt, MEdPO Box 149347, Austin, Texas 78714512- 458-7111512- 458-7254bobby.schmidt@dshs.state.tx.us

Centers for Medicare & Medicaid ServicesMelissa Scarborough, MPH, CHES1301 Young Street, Room 714, Dallas, Texas 75202214- 767-4407/214- 767-6400melissa.scarborough@cms.hhs.gov

Channing Bete CompanySusann JohnsonOne Community Place, South Deerfield,MA 01373413- 665-6414/413- 665-7117jsmith@channing-bete.com

East Texas AHEC/UTMBDeborah Flaniken301 University Blvd, Galveston, Texas 77555409- 772-7884/409- 772-7886deborah.flaniken@utmb.edu

Environmental & Injury Epidemiology and Toxicology Branch-DSHSMaribel Garcia Valls1100 West 49th Street, Austin, Texas 78756512- 458-7269/512- 458-7222maribel.valls@dshs.state.tx.us

Glaxo SmithKline VaccinesChris Lowry512- 787-0708chris.lowry@gsk.com

Netsmart TechnologiesMichael Sheppard3500 Sunrise Highway, Suite D-122, Great River, NY 11739inquiry@ntst.com800-421-7503/631-968-2123

Nurse Oncology Education Program (NOEP)Lisa Watson7600 Burnet Road, Suite 440Austin, Texas 78757512- 467-2803/512- 467-0834lwatson@texasnurses.org

Organon, a part of Schering-PloughTamra Wilcoxson56 Livingston Avenue, Roseland, NJ 07068281- 250-2305/973- 325-5395t.wilcoxson@organonusa.com

Texas Health Steps-DSHSVelma Stille

7430 Louis Pasteur Drive, San Antonio, Texas 78209210- 949-2159/210- 949-2047velma.stille@dshs.state.tx.us

Texas Public Health Training CenterNancy Crider, MS, RN1200 Hermann Pressler Drive, Houston, Texas 77054713- 500-9399/713- 500-9397nancy.m.crider@uth.tmc.edu

Texas Vaccines for Children Program-DSHSAlma Chavez, AFIX ConsultantPO Box 149347, Austin, Texas 78714-9347512- 458-7284/512- 458-7288alma.chavez@dshs.state.tx.us

The Glenda Dawson Donate LifeTexas Registry-DSHSJoseph Struble1100 West 49th Street, Austin, Texas 78756512- 458-7111/512- 458-7238joseph.struble@dshs.state.tx.us

University of Texas-Health Science Center at HoustonIrmgard Willcockson, PhD7000 Fannin Suite 600, Houston, Texas 77030713- 500-3627/713- 500-3907irmgard.willcockson@uth.tmc.edu

University of Texas Health Science Center LibrariesJulie Gaines7703 Floyd Curl Drive MC 7940, San Antonio, Texas 78229210- 567-2464/210- 567-2490gaines@uthscsa.edu

University of Texas School of Public HealthStephanie Tamborello1200 Hermann Pressler, E-209, Houston, Texas 77054713- 500-9030/713- 500-9068stephanie.m.tamborello@uth.tmc.edu

UNT Health Science CenterSchool of Public HealthErin Carlson3500 Camp Bowie Blvd., Fort Worth, Texas 76112817- 735-5046/817- 735-2619ecarlson@hsc.unt.edu

US Army Reserve Physician RecruitingKeith Lehman2001 S. Hanley Road, Suite 540, St. Louis, MO 63144702- 572-4711/314- 646-8795keithl@goarmyreservedocs.com

Wyeth VaccinesClifford S. Pumphrey, Jr.727 Alendale Drive, Coppell, Texas 75019972- 897-0180/972- 393-3364pumphrec@wyeth.com

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Public Health Presentations

Papers

Intentional Poisoning Exposures Reported to the Texas Poison Control Center, Marcia Becker, MPH, CHES

Target audience: Educators, Health care providers, Public Health officials and practitioners as well as concerned public participants.

How the need was established: The need for research into intentional poisoning was established when it was recognized last spring that this was an area among intentional injuries/exposures that was increasing rather than decreasing in annual incidence for Texas. Recent publications confirm national trends as increasing intentional poisoning cases, particularly among female youth 15 to 19 years of age. Texas data indicate that females 20 to 29 years of age have the highest rate (7.4/100,000 population) for intentional poisoning exposures. These are serious events which resulted in 383 deaths from 2000 through 2006 in Texas. The majority of these exposures were determined to be intentional poisoning for suspected suicide.

Objectives: To determine who is at highest risk of intentional poisoning exposures in TexasTo determine what particular substances are involved in the intentional poisonings in TexasTo gain an understanding of the treatment and health outcomes of intentional poisonings in TexasTo increase awareness of this issue while addressing healthcare and educational resources needed to combat this increasing concern.

Inpatient Admissions for Infection in Cancer Patients: Impact of an Aging Population, Catherine D. Cooksley DrPH, Elenir B. C. Avritscher MD, MBA/MHA, Linda S. Elting, DrPH, Health Services Research Section, Division of Quantitative Sciences, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, Funded in part by the William Randolph Hearst Foundations

Target Audience: Epidemiologists, healthcare administrators, policy makers, nurses, physicians and other healthcare professionals

How need for research project was established: It is expected that improved life expectancies and the aging of the US population will present substantial financial and logistic challenges to future healthcare provision. Development of strategies to reduce the burden on healthcare providers and payers is essential to improve quality of life of seniors, control costs and prevent further stress on the healthcare system.

Objectives of research:

Estimate future cancer prevalence Estimate incidence of inpatient admissions for

infection among patients with cancer Project future incidence and economic burden of

infection in patients with cancer Describe resource utilization and costs

associated with such infections Examine impact of the aging U.S. population on

future hospital admissions for infection in patients with cancer

Background: Cancer patients are particularly susceptible to infections. As cancer prevalence increases due to an aging U.S. population (a 73% increase is expected by 2025), so will the population at risk for infections.

Methods: From the 2001 Texas discharge data, we identified all cancer patients’ hospitalizations which had pneumonia, bacteremia or wound infection as the admitting or principal diagnosis. We used 2003 Surveillance Epidemiology End Results (SEER) age-specific cancer prevalence estimates and 2006 and 2025 US census population projections to estimate future healthcare system burden (costs and total hospital bed days utilized) due to these infections. We inflated charges to 2006 US$ using Consumer Price Index for Medical Care and derived costs using 2006 Texas Medicare cost-to-charge ratios.

Results: Over 18,000 TX inpatients discharged in 2001 had a cancer diagnosis and a potentially preventable infection. Nationally, an estimated total of 318,164 cancer patients were hospitalized for infection in 2006 at a cost of $3.1 billion (B) (95% CI $2.8B, $3.4B) and utilizing a total of 2.3 million bed days. Assuming no change but the aging of the population, projected costs by 2025 could increase 45% to $4.5B (95% CI $4.1B, $4.9) with 27% more (3.4 million) hospital bed-days utilized.Conclusions: Implementing measures aimed at preventing serious infections in the vulnerable cancer population may reduce healthcare system burdens as the population ages and cancer prevalence rises.

Following the Roadmap to Preparedness Data: Creating a Public Health Preparedness Dashboard, Catherine Pepper, MLIS, MPH, Vipat Kuruchittham, PhD, Robert Lazo, MS, MS, Lisa Tuttle, Rebecca Petrie, MPH, Donald Ward, Sara Thrift, MLIS, Herman Tolentino, MD

Affiliation: Centers for Disease Control and Prevention, Atlanta, GA 30333; Maine Center for Disease Control, Augusta, ME, 04330

Target Audience: Preparedness and syndromic surveillance specialists, data managers, informaticians, IT specialists, public health administrators, disease surveillance specialists,

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epidemiologists, and others involved and interested in tools for data analysis, visualization, and reporting.

Objectives: 1. To identify and document all data elements

and processes that relate to preparedness, and create context mapping of information flow between stakeholders via business process analysis.

2. To develop a prototype graphical design for a preparedness dashboard, including data models (data flow diagrams and entity-relationship diagrams) of component systems.

Abstract: A dashboard is defined as a graphical user interface that organizes and presents information in a format that is easy to read and interpret.1 Dashboards have long been used as a tool in business to consolidate financial and performance reports into a streamlined visual display for management. Recently the dashboard concept has been modeled in the public health domain. Dashboards have been implemented by state and local health departments to provide access to various types and sources of information related to emergency, disaster, and bioterrorism preparedness.2 3 In response to a request from a state health department, we investigated the feasibility of integrating data from various sources into one desktop tool. Data collection was performed by structured interviews with key informants to ascertain their information needs and preparedness data accessed. In a “parallel design”4 session, participants drew their own dashboards, then discussed the components and designs they had incorporated. We subsequently created a prototype preparedness dashboard. The presentation illustrates the contribution of public health informatics5 to what may be ostensibly perceived as an “IT project,” particularly the need to approach such projects from a business process and organizational perspective, which requires the engagement of internal and external stakeholders for success.

References

Assessment of Evidence-Based Prevention

Practices within a Residency-based Family Practice Center, Linda Hook, RN, Norlynn Ripps, RN, Cathy White, RN, Graduate Students from the University of the Incarnate Word

Target Audience: Public health practitioners, nurses, and physicians

Need for Project: Requested by the agency to understand how to make improvements in efficiency

and effectiveness based on current literature regarding the concept of an integrated medical home.

Objective: To apply microsystem analysis in accessing the incorporation of Partnership for Prevention™ practices within a residency based family practice center.

Using recommendations from the Institute of Medicine Crossing the Quality Chasm (2001), and the Dartmouth College Assessing Your Practice “The Green Book” (2004), the project examined the coordination of patient care, the management of evidence-based knowledge and skills, the presence of multi-disciplinary teamwork, and the utilization of information technologies at a residency based family practice center.

The Center exists as a microsystem within a larger not-for-profit comprehensive health care system whose mission and core values are directed at respecting the dignity of the patients served. The Center’s diverse staff excels in the fundamental areas of medical practice including the use of the electronic medical records (EMR). A review of literature calls to action the need to change the current primary care paradigm from responding to episodic, acute, technology-driven activities of medical practice to implementing a holistic, integrated, anticipatory-based healthcare system (Cifuentes et al., 2005; Woolf, et al., 2005; Satcher, Nussbaum, Woolf, & Strange, 2006).

Clinical observations and review of 30 patient records revealed opportunities for implementing the Partnership for Prevention™ recommendations. Data revealed redundant processes in mandatory immunization reporting, inconsistent and varying proficiencies in EMR, and under-developed EMR templates incorporating Partnership for Prevention™ recommendations.

Hispanic Ethnicity and Foreign Nativity as Predictive Factors of Community Health Center Utilization as a Regular Source of Care, Erin K. Carlson, M.P.H. and Nuha A. Lackan, Ph.D. , University of North Texas Health Science Center, Fort Worth, TX

Target Audience: Policymakers, community stakeholders, and advocates for Hispanic immigrants and/or community health center expansion

Need for Research:Many Hispanics rely on the health care safety net for care. Approximately one-third of Hispanics are without health coverage and a growing portion of the Hispanic population are immigrants, presenting additional barriers to access and care. Community health centers (CHCs) are an integral part of the safety net for care to the rapidly growing Hispanic immigrant population. CHCs are consistently mentioned in literature as a means to improving access to care and health outcomes for Hispanic immigrants and are recognized for their culturally competent provision of care. However, little quantitative evidence is documented reporting the

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extent to which Hispanic immigrants utilize CHCs and the characteristics of the Hispanic immigrants who use CHCs. Empirical data is needed to inform community leaders who seek to expand access to health care to Hispanic immigrants about whether a CHC is a viable option in serving the needs of the population it is intended to serve. Results will inform current policy recommendations for CHC expansion as a means to improve health care for Hispanic immigrants.

Research Objective: This research describes the extent to which CHCs are utilized as a regular source of care among Hispanic immigrants compared to Hispanics of U.S. nativity and other racial and ethnic groups. This study also identifies the demographic characteristics of Hispanic immigrants who use CHCs.

Methods: The study analyzes nationally-representative 2001 Commonwealth Fund Health Care Quality Survey data (n=6,306). Univariate and bivariate analyses describe CHC utilization. Multivariate analyses model race, ethnicity, and U.S. nativity as predictors of CHC utilization.

Results: The subgroup of 209 Hispanics who used a CHC as their regular source of care was significantly associated with insurance status, age, income, poverty threshold, and education. Four-fifths reported annual incomes below $35,000. Nearly 62% were uninsured and 68% were under age 40. Finally, 70.8% were born outside the U.S.

CHC utilization was greater for foreign-born Hispanics than other racial/ethnic groups. One-third of foreign-born Hispanics reported using a CHC as a regular source of care. Multivariate analyses found that only foreign-born Hispanic and non-Hispanic white were significant ethnic/racial predictors of CHC use. Foreign-born Hispanics were more likely to use CHCs over another care source than any of the other five groups.

Conclusions: Hispanic immigrants were twice as likely to use a CHC as a regular care source compared to another care source. U.S.-born Hispanics, non-Hispanic immigrants, and non-Hispanic minorities were not significantly associated with CHC. CHCs provide well-utilized care to Hispanic immigrants. Policymakers seeking to increase care for Hispanic immigrants should consider expanding CHC capacity.

Posters

Uninsurance, the Local Safety Net and Preventable Hospitalizations in Harris County, Texas, YF Lee and JM Swint, University of Texas School of Public Health, Houston, Texas (Student Travel Scholarship Recipient)

In 2004 the Harris County (Texas) uninsurance rate was in excess of 30% and 75% of the demand for

primary care from the safety net population was not met. Our objective was to examine how the uninsurance rate and local safety net may affect access to primary care for Harris County. The data from this study were collected from the Texas Health Care Information Collection, Census 2000 and Project Safety Net.

The applied methodology was small area analysis, with ZIP Codes as the unit of analysis. The outcome examined was the preventable hospitalization rate for non-elderly adults in the safety net population for each ZIP Code. Preventable hospitalizations are often used as an indicator of lack of access to care. Patient Quality Indicators, with the exception of low birth weight, were used as our inclusion criteria for preventable hospitalizations in this study.

The preliminary results suggest that an increase in the uninsurance rate was strongly associated with an increase in preventable hospitalizations. However, this significant association diminished as the poverty, education, and non-whites covariates were added to the model. There was not a statistically significant association between the existence of local safety net clinics and preventable hospitalizations.

Cost Drivers of Texas Medicaid Perinatal Care, Jimmy Blanton, MPAff, David Lynch, MA, Judy Devore, PhD, Cheryl Bowcock, MPH, Judy Temple, MSSW, and Gary Rutenberg, PhD

Target audience: Public health administrators, related professionals

Summary: Since SFY 2000, perinatal diagnoses have maintained a stable share of overall Medicaid spending for inpatient hospitalization. In SFY 2000, pregnancy and childbirth accounted for 65% of hospitalizations and 43% of expenditures, remaining the same through SFY 2006. However, during this same six year period, Medicaid spending for perinatal inpatient care increased by about $175 million. An estimated $50 million additional dollars were spent for professional fees associated with these hospital stays. While this spending growth is proportional to increases for other types of inpatient care, examination of hospital claims for pregnancy and childbirth shows that almost all of the additional expenditures are due to three specific cost drivers:1) an increase in the number of non-citizen residents whose maternal and infant health care costs were paid for by Medicaid, 2) An increase in the rate of newborns delivered via cesarean section, and 3) An increase in the Medicaid reimbursement rate for neonates born with extreme immaturity or respiratory distress syndrome.

Gender and Age Differences in Blood Utilization and Length of Stay in Radical Cystectomy: A Population Based Study, Marylou Cárdenas-Turanzas*, M.D. Dr. P.H., Catherine Cooksley, Dr. P.H., Ashish M. Kamat, M.D., Curtis A Pettaway, M.D., Linda S. Elting, Dr. P.H.

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Names and affiliations of authors: M. Cárdenas-Turanzas, C. Cooksley and L. Elting.Health Services Research, Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd. Unit 447, Houston, TX 77030, USA.

AM. Kamat and CA. Pettaway Department of Urology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd. Unit1373, Houston, TX 77030, USA.

*Presenter

Purpose: Radical cystectomy is a major surgical procedure associated with significant blood loss and lengthy hospital stays. This surgical procedure is more challenging in women than men due to anatomical based differences. We evaluated resource utilization and complication rates of patients undergoing radical cystectomy or exenteration using the Texas Hospital In-patient Discharge Data Collection.

Materials and Methods: Retrospective study of 1493 patients, 35 years of age or older, who underwent radical cystectomy for bladder cancer from January 2000 to December 2003. We evaluated blood product charges, length of stay, and complication rates during hospitalization.

Results: In this sample, 24% of the patients (n = 356) were women. Overall, women had significantly increased blood product charges and length of stay compared to men, $1392.87 vs. $718.21 (p < 0.001) and 12.72 vs. 11.64 (p = 0.03), respectively. During hospitalization, 26 of the patients died. No differences in mortality or complication rates were observed between men and women.

Multivariate analysis showed that female sex (p < 0.001) and age (p = 0.003) were independent predictors of increased blood product charges. Multivariate analysis showed that female sex (p = 0.015), age (p = 0.003) and Charlson’s comorbidity index > 2 (p = 0.05) were predictors of longer length of stay.

Conclusions: Women and older patients with bladder cancer are at risk of increased blood products utilization and length of hospital stay after a radical cystectomy. Future research should focus on improving postoperative outcomes for these vulnerable patients.

Human Papillomavirus Vaccine Knowledge and Attitudes in Texas – Texas BRFSS, 2007, Rebecca A. Wood, MSHP; Michelle L. Cook, MPH

Target Audience: Epidemiologists, researchers, public health administrators, physicians and other public health professionals interested in HPV vaccination knowledge and attitudes in Texas.

Background/Need: The first vaccine to protect against four types of human papillomavirus (HPV) most commonly associated with causing cervical cancer was licensed by the Federal Drug Administration in June of 2006. The Advisory Committee on Immunization Practices recommends the routine vaccination of 11-12 year old females with three doses of quadrivalent HPV vaccine. Limited data have been collected on the knowledge and attitudes of men and women concerning HPV vaccination recommendations.

Objectives: To examine the knowledge of and attitudes toward the new HPV vaccine in Texas.

The Heath Resources and Services Administration and Harris County Hospital District, Health Care for the Homeless Program: Working Together to Impact the Plight of the Homeless in Harris County, Princess D. Jackson, MS, Wanda I. De Mello, MBA, Co-Authors: Kevin Bartlett, RN, MSN, Marion Scott, RN, MSN, Susan Spalding, MD

Target Audience: Health Care for the Homeless Program Administrators, Public Health Officers, Community health Centers Administrators, and other Public health Professionals.

Objectives of Project: To identify factors impacting the homeless population ability to access health care services and effective strategies to increase the awareness and use of existing health care services for the target population.     

How need for research of project was established: Health Resources and Services Administration (HRSA) Office of Performance Review (OPR) conducts performance reviews to assure organizations receiving HRSA funds are successfully accomplishing their programs goals and objectives. In 2007, the Dallas Regional Division of the OPR conducted a performance review with the HCHP to identify the successes and challenges faced by the organization in increasing access to health services to homeless individuals and families in a large metropolitan area in the United States. In addition, there is a need to address limitations within the service delivery system so strategies can be developed to improve and increase access of health care service to the homeless.

Abstract: The Health Resources and Services Administration (HRSA), Dallas Regional Division (DRD) Office of Performance Review (OPR) conducted a performance review with Harris County Hospital District – Health Care for the Homeless Program (HCHP) to address the successes and challenges faced by the organization in increasing access to the homeless population in Harris County.  A protocol was developed to collect quantitative and qualitative data to analyze factors that impacted the program’s service delivery of healthcare to the

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population. The OPR findings indicated the following: independently operated shelters’ policies impact the homeless’ ability to give priority to their medical needs, revitalization of the downtown area has forced the homeless to move out and away from traditional service provider networks, and homeless individuals and families migrating to the city or not living in shelters are unaware of the health care services available for them. Given these findings, the following strategy was recommended: increase communication and partnerships between shelters, agencies and government officials to promote the increase of healthcare services through outreach efforts.Introduction:

The HRSA OPR plays a central role in achieving HRSA’s mission by reviewing and enhancing the performance of HRSA supported programs within communities and States. The purpose of OPR performance reviews is to improve the performance of HRSA supported programs by working collaboratively with grantees to measure program performance, analyze the factors impacting performance and identify effective strategies to improve performance. In 2007, the Dallas Regional Division (DRD) OPR conducted a performance review with Harris County Hospital District – Health Care for the Homeless Program (HCHP) to measure the organization’s impact in providing health care services to the homeless. The program began operations in 1988 and provides preventive and primary care, oral health and social and support services to homeless individuals and families. HCHP provides services in eleven health clinics in homeless shelters, two medical mobile units, one dental unit, and a day center to its target population. HCHP reports 100% of their clients are below the 200% Federal Poverty Level (FPL). The population served is approximately 52% African-American, 24% White, 13% Hispanic, and 11% other. Mental disorders, hypertension, diabetes mellitus and asthma are the most common medical diagnoses seen in the homeless population receiving services through the HCHP.

One of the measures selected for the review was the number of unduplicated homeless users receiving services through HCHP over the past four years. This performance measure was selected because it reflects the grantee’s efforts and HCHP goal of improving the health status and outcomes for homeless individuals and families by improving access to primary health care, mental health services, and substance abuse treatment. Moreover, the number of patients utilizing HCHP services is a significant indicator to measure the organization’s efforts in meeting healthcare needs and impact of services provided to this population.

Methodology: The OPR process focuses on the selection of performance measures that reflect the organization’s ability to measure its effectiveness in terms of effort and outcome. When measures are chosen, quantitative data is collected which will demonstrate the history of the program’s actual performance and compare the trend with the grantee’s projected performance. Qualitative data is

gathered by a series of telephone and face-to-face interviews that take place over a 12-week period. Interviews are semi-structured and designed to support disclosures to take place in a non-threatening setting. The discussion oriented atmosphere is created to build trust and elicit honest answers from the participants. The focus of the discussions is to identify the restricting factors facing HCHP’s ability to increase access to health care for their target population. A root cause analysis is conducted of the restricting factors so systemic challenges can be identified and strategies developed that highlight the benefits of using a community wide approach to confront the issue. Throughout the process, the review team shared all data collected during the interviews with the organization’s stakeholders to promote transparency and trustworthiness.

Findings and Recommendations: The performance review process findings indicated policies of the shelters, which are independently operated, hinder the organization’s ability to give priority to the population’s medical needs. Likewise, the revitalization of the downtown Houston area has caused the homeless to move away from traditional service provider networks, which are usually located in metropolitan downtown areas. Lastly, because of the transient nature of the population, homeless individuals and families are not aware of the community’s variety of health care services available to them.

At the conclusion of the review, the following recommendations were suggested as methods to increase access to healthcare services to homeless individuals and families: First, increase communication with the shelters to educate, coordinate services and partner so the collaboration is successful for all stakeholders. Second, host meetings with the Coalition for the Homeless of Houston/Harris County, local advisory councils, city officials, police departments and associations involved in the improvement of Harris County to expand networking opportunities between the various local, city and county representatives so outreach activities in non-traditional service areas can be increased. Third, contact the National Law Center on Homelessness and Poverty. This agency assist organizations in implementing constructive alternative solutions to benefit all stakeholders involved with service delivery to the homeless population. Keep Infants Sleeping Safely (KISS), Paola Tovar Kurth, MBA & Jann Rodriguez Carter, RN.

Objectives: To conduct newborn safe sleep training in 75% of Bexar County hospital’s Maternal-Child Units. Adoption of safe sleep practices in 50% of nurseries that participated in training, witnessed through open crib post intervention observations.

Target audience: Newborn nursery, labor and delivery and post-partum staff.

Need for Education: Despite a major decrease since 1992 in Sudden Infant Death Syndrome (SIDS) and the “Back to Sleep” campaign, more than 4,500

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infants still die suddenly of no obvious cause in our country each year. Bexar County post-neonatal infant mortality rate is about 150% of the national average.

Abstract: Studies suggest that instituting new sleep recommendations in the nursery, as well as in the media that surrounds new parents, is likely to discourage parents from using the side position, propping, and/or swaddling at home (1,2). Maternal-Child hospital staff participated in training discussing (a.) research-based safe sleep practices, (b.) death statistics for the County and (c.) the importance of modeling correct positioning of newborns and creating a safe sleeping environment during the first 24-48 hours to help educate parents on the risk factors of SIDS. Surveys of newborn sleep environment and position in the crib were conducted in nurseries that agreed to the intervention. Observations were conducted in three stages: prior to the intervention, midcourse and at the end of project year 1. Educational materials for staff and parents were distributed at all hospitals that participated in the intervention.

Bibliography:Colson ER, Joslin SC. Changing nursery practice gets inner-city infants in the supine position for sleep. Arch Pediatr Adolesc Med. 2002;156:717–720.Willinger M, Ko CW, Hoffman HJ, Kessler RC, Corwin MJ. Factors associated with caregivers’ choice of infant sleep position, 1994–1998:the National Infant Sleep Position Study. JAMA. 2000;283:2135–2142.

Disparities in Access to Health Care among Children in the U.S. after SCHIP (1997 to 2005), Alicia C. Guerrero, M.P.H. & Stephanie McFall, Ph.D.

Target Audience: Disparities researchers, state and national health policy makers, child health care advocates.

Need for Research: Much of the literature on disparities in access to health care among children has focused on measuring disparities at a single point in time and with a focus on race/ethnic groups. This study examines change in income and racial/ethnic disparities in access to care over time within the child population. The period of change that will be examined coincides with implementation of major policy initiatives to enhance access to care for children, the State Children’s Health Insurance Program (SCHIP). The Relative Index of Inequality (RII) and the Population Attributable Risk (PAR) are two measures that will be used to quantify the change in disparities. These health inequalities measures use more information about the distribution of the disparities in the population to quantify the problem so comparisons aren’t limited to extreme groups (rich versus poor) or limited to just two groups (poor versus non-poor). The RII is a linear regression based estimate and thus can measure the access to care differences among ‘rich’

and ’poor’ income groups while taking into account the variation that occurs for income categories between these extremes when plotted appropriately. The PAR estimates the proportion of differences in access to care ‘attributable’ to being from a disadvantaged social group.

Figure 1. Scatterplot of the percent of Children Uninsured by the relative Income group position based on % of Federal Poverty Threshold, 1997-98 vs. 2004-05

Research Objectives1) Use the Relative Index of Inequality (RII) and the Population Attributable Risk (PAR) to measure income and race/ethnicity disparities (respectively) in access to health care among children. 2) Using the RII and PAR, quantify the change in disparities in health insurance coverage and having a usual source of health care (access to care) after health insurance coverage became available through the SCHIP.

Abstract: The objective of the research was to determine if there was a decrease in disparities in access to care for children across income and race/ethnicity groups after SCHIP. The study used four years of data from the National Health Interview Survey to depict disparities prior to SCHIP (1997-1998) and six years after SCHIP (2004-2005). Access was measured by health insurance coverage and having a usual source of care. The Relative Index of Inequality (RII) and Population Attributable Risk (PAR) were used to measure and quantify the change in disparities. Based on these measures, there was a substantial decrease in income disparities in both health insurance coverage and having a usual source of care following SCHIP. There was also a considerable decrease in non-Hispanic Black disparities in both access to care indicators. .However, among Hispanic children there was no change in health insurance disparities and a slight increase in disparities in having a usual source of care. While there were great improvements in income disparities in access to care coinciding with the introduction of the SCHIP program, continuing progress in reducing race/ethnicity disparities may depend on continuation of the SCHIP program or similar targeted health coverage programs.

Hospitals and Environmental Variation in Texas Nonprofit Hospital Organizational Policies Regarding Charity Care, Mary Kathryn Martin, “Kate”

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0.00 0.20 0.40 0.60 0.80 1.00

Relative SE Grp Position (Income)

% U

nins

ured

1997-1998 2004-2005 Linear (1997-1998) Linear (2004-2005)

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Target audience: Safety Net Providers

How need for research or education project was established: Approximately 25 percent of Texas residents are uninsured. Nonprofit hospitals are part of the safety net for persons who are indigent, low-income and uninsured. Texas was the first state to enact legislation (1993) specifying a percentage of revenues that tax-exempt hospitals must dedicate to community benefits. This “quid pro quo” of providing community benefits in exchange for tax exemption has become controversial. Hospitals use charity care to determine community benefits and meet Texas Health and Safety Code, §311.04610. This paper is the first review of charity care eligibility policies.

Objectives of research or education project:Hospitals designated by state and federal governments as tax-exempt organizations enjoy tax relief benefits. Does the charity care provided by nonprofit hospitals equal the value of the tax exemption? Few studies have identified specific nonprofit hospital characteristics or discussed how these variations in characteristics may impact policies regarding charity care. Charity care policies are established by each nonprofit hospital. This study was undertaken to provide specific information about the charity care eligibility policies of nonprofit hospitals. The study examines hospitals characteristics-by physical location, bed size, disproportionate share, etc and county demographics to determine the relationship to charity care eligibility polices.

Beyond Fee-For-Service-Building Primary Care Infrastructure Capacity in Texas, Mary Kathryn Martin, “Kate”

Target audience: Government Contractors and Nonprofit Organizations

How need for research or education project was established: One hundred and seventy-seven counties in Texas are federally designated as Medically Underserved Areas (MUA) indicating high poverty, infant mortality, inadequate provider to patient ratios, etc. MUA designation is a requirement for health care organizations to be designated as Federally Qualified Health Centers (FQHCs). FQHCs receive federal grants and enhanced reimbursement for Medicaid and Medicare patients. The FQHC Incubator Program supports the development of new and expansion of existing FQHCs addressing access to primary care in MUAs. FQHCs have increased from 32 to 59 in five years.

Objectives of education project: The FQHC Incubator Program is designed to support the efforts and collaborations of local public and private nonprofit entities to develop FQHCs. Funds and technical assistance are provided for clinic start-up, sustainability, federal guideline compliance, and submittal of federal applications. The FQHC Incubator Program is vendor contract with a set of “deliverables” that parallel the federal program requirements. Deliverables must be completed to the

satisfaction of the DSHS staff prior to approving reimbursement. However, developing, implementing, and measuring a “deliverables” contract program has not been without its difficulties. The poster will identify how these specific program requirements, problems/difficulties, etc have developed organizational infrastructure for the delivery of primary care in MUAs.

Use of Promotores to Improve Cardiovascular Health of Hispanics in Fort Worth, Texas, Erin K. Carlson, M.P.H. and Nuha A. Lackan, Ph.D. , University of North Texas Health Science Center, Fort Worth, TX

Target audience: Public health practitioners, providers and others interested in the use of lay health workers to improve health in underserved populations

Need for Research: Evidence suggests that effective prevention strategies engage the community. Such approaches are particularly utilized in Hispanic populations in response to Hispanics’ strong sense of community. Promotores de salud, Spanish for lay community health workers, offer health education to members of Hispanic communities and link those they serve with health services. Promotores have been effective at filling gaps in health services for medically underserved, socio-economically disadvantaged communities by providing culturally competent education to help individuals prevent the onset of or manage existing diseases. Several studies report the effectiveness of chronic disease interventions that employ promotores. Health outcomes that have been improved as a result of promotores interventions include self-reported health status, chronic disease management/prevention behaviors, and/or health knowledge from pre-test to post-test measures.

Research Objective: The purpose of this study was to conduct an educational intervention delivered by Promotores (lay Hispanic health workers) who would also serve as case managers to subjects in a Hispanic community. The intervention was aimed at improving cardiovascular health (CVH).

Methods: Individuals attending health fairs whose screening measurements indicated risk for developing cardiovascular disease were invited to enroll. Subjects were assigned to a Promotora for case management. Promotores attempted at least monthly contact with study subjects via phone, educational classes or home visits. Educational classes were conducted using the National Institutes of Health National Heart, Lung and Blood Institute curriculum for improving CVH. Subjects were invited to health fairs in January and March for interim and final measurements. Screening measures included: total cholesterol, LDL cholesterol, triglycerides, blood pressure and blood glucose.

Results: Seventy-seven subjects enrolled in the study. Only 16 (20.7%) subjects attended at least one class, and these subjects comprised the intervention group. The remaining 61 (79.2%)

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subjects comprised the control group, and were screened in both September and March. Over the study period, subjects in the intervention group realized reductions in fasting blood glucose levels, but did not have other substantive changes in cardiovascular health indicators.

Conclusions: Using promotores to deliver an educational intervention and serve as case managers can be effective in reaching Hispanic communities, though subject recruitment and retention must be emphasized throughout the duration of the study. (Source of support: UNTHSC EXPORT grant)

Kids Growing Healthy Program, Keisha Leatherman, Yvette Jones, Doug Fabio, Dana Tarter

Target Audience: 5th Grade Students

Need Statement: The need for a nutrition/physical activity program was established by reviewing various forms of primary and secondary data and research. The broad based need indicated in the Healthy People 2010 Objectives, as it relates to nutrition and overweight, is “to reduce obesity in children to 5 percent.” It is evident that trends in U.S. children mirror a similar increase over the same approximate time period as adults. However, on a more local level, we utilized the Tarrant County Public Health initiative, Monitoring & Assessment Project (M.A.P.) report and the 2004 Behavioral Risk Factor Surveillance System survey report to identify both target populations and areas. Two specific factors that were considered were: overweight/obesity morbidity rates and socioeconomic income levels in Tarrant County. In addition, we also reviewed Speaker Bureau Request Forms submitted by external cliental, paying close attention to subject of presentation and audience. We also found that a large percentage of requests were nutrition and/or physical activity based and were aimed at elementary/middle school-aged children.

Program Objective: To launch program into four different ISDs and reach 400 5th grade students during the school year throughout Tarrant County.

Participant Objective: To increase by 30 percent the students’ consumption of fruits and vegetables and/or physical activity.

Importance of measuring performance to identify key factors impacting the target population’s access to health care and effective strategies to improve performance, Wanda I. De Mello, MBA and Princess D. Jackson, MS; Co-Author(s): Cynthia L. Garcia, BA, David S. de la Cruz, Ph.D., MPH, Kirk Barnes, MCRP, Llamara Padro-Milano, BS, Robert Sappington, DMD, MPH, Shirley Henley, EdD, ANP

Target Audience: Maternal and Child Health Program Administrators, Public Health Officers, Community Health Centers Administrators,

Continuous Quality Improvement (CQI) and Public Health Program Evaluators.

How need for research of project was established: Each year, Health Resources and Services Administration (HRSA) Office of Performance Review (OPR) conducts performance reviews to assure organizations receiving HRSA funds are successfully accomplishing their program goals. The purpose of OPR performance reviews is to improve the performance of HRSA supported programs by working collaboratively with grantees to select performance review measures, analyze factors that impacted performance in relation to the selected performance review measures, identify effective strategies to improve performance, and develop an action plan, which includes performance improvement actions to be completed by the grantee on each performance review measure selected. In 2007, the Dallas Regional Division (DRD) OPR conducted a performance review with Baptist Children’s Home Ministries - Healthy Start Laredo (HSL) Program to address the successes and challenges faced by the organization in increasing access to health services to women and their children living in the colonias of Webb County, Texas. Colonias are rural, mostly unincorporated communities located in California, Arizona, New Mexico, and Texas along the U.S.- Mexico border and are characterized by high poverty rates and substandard living conditions, such as lack of potable drinking water, water and wastewater systems, paved streets, and standard mortgage financing.

Objectives of Research: To increase knowledge of the importance of measuring public health programs performance, identify key factors impacting the target population’s access to health care, and describe strategies to improve performance.

Abstract: The Health Resources and Services Administration (HRSA) Office of Performance Review (OPR) conducted a performance review with Baptist Children’s Home Ministries - Healthy Start Laredo (HSL) Program to address the successes and challenges faced by the organization in increasing access to health services to women and their children living in the colonias of Webb County, Texas. The performance review measure selected was “The percentage of HSL women who stay in the program 24 months after delivery regardless of birth outcome.” Data analyzed indicated a progressive decline in the percent of women who stay in the program the complete time. The research revealed the reasons for the high attrition among HSL women were: status of parents, transiency of program participants, issues related to culture, and family priorities and commitments. In conclusion, to increase access to health services and retain women and their children living in colonias, public health programs should: bring access to the colonias (e.g., mobile units), build and maintain trust in the colonias, increase collaboration and partnerships with faith-based organizations, provide culturally and linguistically appropriate health education for the entire family, promote father involvement, and

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maintain a high level of promotion of health services available through outreach efforts.

Background: Each year, Health Resources and Services Administration (HRSA) Office of Performance Review (OPR) conducts performance reviews to assure that organizations receiving HRSA funds are successfully accomplishing their program purposes. The purpose of OPR performance reviews is to improve the performance of HRSA supported programs by working collaboratively with grantees to select performance review measures, analyze factors that impacted performance in relation to the selected performance review measures, identify effective strategies to improve performance, and develop an action plan, which includes performance improvement actions to be completed by the grantee on each performance review measure selected. In 2007, the Dallas Regional Division (DRD) OPR conducted a performance review with Baptist Children’s Home Ministries - Healthy Start Laredo (HSL) Program to address the successes and challenges faced by the organization in increasing access to health services to women and their children living in the colonias of Webb County, Texas.

Methodology: The OPR review team (public health analysts and maternal and child health consultant) and Maternal and Child Health Bureau (MCHB) Project Officer collaborated with the grantee for a period of twelve weeks to discuss the performance review process and select performance measures for the onsite performance visit and analysis of factors impacting performance. The performance measure “The percentage of HSL women who stay in the program 24 months after delivery regardless of birth outcome” was selected in collaboration with the HSL, OPR review team and Healthy Start program MCHB project officer. This performance measure was chosen because it reflects the MCHB Healthy Start programs goal of linking mothers and infants to a medical home and following them, at a minimum, from entry into prenatal care through two years after delivery (interconceptional care). HSL data of 117 interconceptional women who reported program start and end dates during the period 2005-2007 were used for the trend analysis. The OPR team visited the grantee for two days and met with all program staff to discuss performance trend, analyze the factors impacting performance, and identify strategies to improve performance.

Results: Of the 117 women, only 6% stayed in the program for 24 months after delivery. Data indicated a progressive decline in the percent of women who stay in the program as time progresses; from 55% retention (0-5 months) to 23% (6-11 months), 16% (12-17 months, and 6% (18-24 months). Some participant’s factors associated with the short stay in the Healthy Start program described by the HSL staff and client survey were: status of parents (program participants without legal residency constantly fear deportation and family separation), transiency of program participants (migration to different locations to be closer to family members, obtain basic needs and get away from border towns with high police activity, or to return to Mexico), issues related to

culture such as husbands do not allow outsiders to contact their wife nor permit the wife to discuss personal or health issues, and family priorities and commitments (e.g. school, household duties, medical and non-medical appointments).

Conclusion: To increase access to health services and retain women and their children living in the colonias, public health programs should: bring access to the colonias (e.g., mobile units), build and maintain trust in the colonias, increase collaboration and partnerships with faith-based organizations providing support and assistance to the Hispanic population in the colonias, provide culturally and linguistically appropriate health education for the entire family, promote father involvement, and maintain a high level of promotion of health services available through outreach efforts.

Implications: Healthy Start programs and other public health programs working with women and children living in colonias should evaluate health education curriculum and services provided to ensure that a great amount of information is presented and needed services are prioritized and provided appropriately to the target population shortly after labor and delivery and before the women and children are lost to follow-up care.

Risk and Outcomes of Serious Postoperative Infections among Cancer Patients with Solid Tumors, Elenir B. C. Avritscher, Catherine D. Cooksley, Linda S. Elting

Target Audience: Public health community, infections control professionals, oncology researchers and clinicians.

How need for research was established: Cancer patients are at increased risk of infections because of treatment- and/or disease-related changes in their immune system. Infections during periods of chemotherapy-induced neutropenia have being extensively researched, due to its significant morbidity and mortality. However, postoperative infections among non-neutropenic cancer patients remain largely undescribed. Owing to the frequent surgical treatment of common solid tumors, there is a large population of solid tumor patients at risk for postoperative infections.

Objectives of research: To estimate the risk of serious infections and associated in-hospital mortality among patients with common intra-thoracic and intra-abdominal solid tumors undergoing surgery at the primary site of their cancers.

ABSTRACT: Background: Postoperative infections among solid tumor patients remain largely undescribed. We conducted a population-based study of morbidity and mortality of serious postoperative infections among patients with common intra-thoracic and intra-abdominal solid tumors.

Methods: All Texas residents with cancer of the lung, colon, rectum, bladder, pancreas, esophagus, or

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stomach who underwent surgeries at the primary site of their cancers in Texas between 1/1/1991 and 12/31/2001 were identified from the Texas Hospital Discharge Database. Patients who underwent emergency procedures were excluded. The billing records of the eligible pts were examined for ICD-9 codes indicating bacteremia or septicemia, pneumonia, wound abscess/infection.

Results: From 1999 to 2001, 17,085 procedures were conducted. Colorectal (52%), and lung (34%) cancers predominated. Postoperative infections occurred following 1,183 procedures (7%). The risk of postoperative infections varied significantly by primary cancer site; from 5% in the colon/rectum to 26% in the esophagus. Pneumonia alone accounted for over half of the infections. Inpatient mortality was significantly more common among patients with postoperative infections than those without (19% vs. 2%, p <0.001).

Conclusions: Postoperative infections result in significant morbidity and mortality among patients with common solid tumor undergoing surgery to treat their primary cancers. Further study of preventive strategies is warranted.

Proyecto Bienestar Laredo: A translation study of the Bienestar School-based, diabetes Prevention Health Program, Design and Challenges, RM. Echon. A Bizzari, J. Treviño, V. Castillo, N. Martinez, and R. Treviño, The Social & Health Research Center and City of Laredo Department of Health

Background: The Bienestar Health Program is a bilingual, school-based, diabetes prevention program that aims to reduce the biological risks for diabetes in high-risk Mexican-American children. Proyecto Bienestar Laredo (PBL) is a translation study designed to test the effectiveness of the Bienestar program as implemented by local school districts in Laredo, Texas. The primary aim of the intervention is to test the study’s hypothesis that children participating in PBL will have significantly lower fasting capillary glucose (FCG) and percent body fat (PBF) than children in schools receiving another state-approved health curriculum.

Design and Methods: PBL is an NIH funded, three-year randomized controlled intervention that targets 3rd-5th grade Mexican-American students in Laredo, Texas, with 19 intervention and 19 control schools. Total number of 3rd grade students recruited for the study was 2,376; of which 1,121are males and 1,198 are females. School staffs in the intervention schools were trained to administer the Bienestar’s components and were instructed to log their administration reports in a specific evaluation database. Baseline data were collected on sociodemographics, anthropometrics, behavioral, and cognitive variables. A follow-up data collection was instituted at the end of school years for each of the three years. The Bienestar Program comprises 5 components: Health Curriculum, Physical Education Curriculum, Family/Community

component, Food Service component, and an After-School Health Club. Results: Biological measures collected at the beginning and end of third grade were body mass index (BMI), PBF and FCG. BMI and PBF are indicators of obesity and FCG is an indicator of diabetes. At the beginning of third grade, 33% of the students were found to be overweight and 4% were found to have high blood sugar levels. This is a concern because nationally only 12% of children in this age group are overweight. Follow-up data on FCG showed no change between students in intervention and control schools after 7 months of intervention. However, to understand the effect of the Bienestar program implementation level on blood sugars, intervention schools were divided between schools that implemented the programs properly (for 14 weeks) and schools with questionable implementation (less than 14 weeks). The program was designed to be implemented over 20 weeks but not all schools reached that level. Students from schools that implemented the program for ≥ 14 weeks showed a decrease in blood sugars (84.54 ± 1.55 mg/dl) and students from schools that implemented the program for < 14 weeks showed increased in blood sugars (86.55.188 mg/dl). This was a statistically significant finding (p < .001).

Challenges: The Bienestar Health Program’s efficacy trial had shown significant results in reducing FCG, PBF and BMI when implemented with fidelity. However, translating the program in a different setting, where school staff is in charge of administering the program, created a new challenge, which is the level of organization within the school system, as well as the willingness and competence of the individuals accountable for its administration.

Discussion: School-based health programs can face a number of challenge and obstacles. The current observations and findings highlight the significance of the organizational climate in schools implementing an innovative program.

Hurricane Katrina evacuees in Texas: a comprehensive needs assessment, Judy Temple, MSSW, Jimmy Blanton, MPAff, David Lynch, MA, and Gary Rutenberg, PhD.Target audience: Public health administrators, related professionals Purpose: In May 2006, the State of Texas partnered with the Gallup Organization to survey Katrina evacuees in Texas. As one of the largest needs assessments ever conducted on a group of displaced U.S. citizens, the survey collected valuable data to assist in the planning of health and human services over upcoming years.

Methods: Gallup completed telephone interviews with a random sample of 6,415 evacuee households selected from FEMA’s emergency relief database. The survey collected data on housing, employment, health, insurance, and social service needs.

Results: Eight months after the hurricane, an estimated 251,000 evacuees remained in Texas.

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Poor families headed by African-American women comprised a disproportionate share of the population. Respondents reported high unemployment and uninsured rates and declines in physical and mental health. Despite significant needs, the evacuees’ utilization of some state benefits was surprisingly low. Initially, evacuees appear to have prioritized necessities, such as shelter. While this strategy stabilized their living conditions, the survey results will help target the evacuees’ longer-term economic and healthcare needs.

Examining conventional assumptions of emergency department utilization: Texas and nationwide, Jimmy Blanton, MPAff, David Lynch, MA, Judy Temple, MSSW, Gary Rutenberg, PhD.

Target audience: Public health administrators, related professionals

Purpose: Emergency Departments (ED) have entered a crisis period characterized by overcrowding, patient boarding, and ambulance diversion raising concerns about patient safety and rising healthcare costs. This paper distinguishes supportable facts from six widely held assumptions about ED utilization.

Methods: We analyzed national survey and Texas Medicaid claims data to investigate ED utilization patterns.

Results: An increase in per capita ED utilization and a decrease in number of hospitals have contributed to the crisis. Medicaid/SCHIP clients’ ED utilization for non-urgent conditions explains part of this trend. However, they utilize ED services regardless of urgency at a higher rate than other patients. In Texas, a decline in the ratio of Medicaid Primary Care Physicians to enrollees may contribute to ED utilization. No consensus details the cost differential between treating non-urgent conditions in the ED versus doctor’s office. HMOs have not restrained ED utilization.

Conclusion: Shifting non-urgent ED utilization to another setting is unlikely to produce substantial cost savings but could improve quality of care and reduce burden on EDs.

Increase in Congenital Syphilis—Dallas County, 2007, Wendy Chung, MD MSPH1, Jonikquea Houston, MSPH1, Marisa Gonzales1, Jeanne Sheffield, MD2, George Wendel, MD2, Pablo J. Sanchez, MD2, John Carlo, MD MSE1(1Dallas County Department of Health and Human Services, 2University of Texas Southwestern Medical Center)

Target Audience: Public Health and Medical Professionals

Background/Need for Project: Congenital syphilis (CS) is a consequence of inadequately treated maternal syphilis during pregnancy. Rates of

congenital syphilis closely follow the incidence of early syphilis in women of reproductive age. Following the greater numbers of women reported with early syphilis in 2006, Dallas County has experienced an increase in CS cases in 2007.

Objectives: To investigate the epidemiology of CS cases in Dallas County in order to identify opportunities for prevention.

Methods: Infants meeting CDC case definition for CS were identified through Dallas County Department of Health and Human Services surveillance records from 2005 through October 2007. Medical records of these infants born in 2007 and their mothers were reviewed.

Results: Cases of early syphilis among women in Dallas County increased from 44 in 2005 to 78 in 2006. From January through October 2007, 19 cases of CS have been reported, compared to10 total cases in 2006. Of the 19 mothers, the mean age was 25 years; 17 (90%) were black; one had HIV infection, and 2 had cocaine-use during pregnancy. Eight mothers had previously non-reactive RPR tests within one year prior to delivery. In 8 cases (42%), the mother received no prenatal care or initiated care late in the third trimester. Of the 11 mothers who entered care by 28 weeks gestation, syphilis screening at 28 weeks gestation may have prevented 5 cases.

Conclusions: Timely antenatal screening and treatment of mothers is essential in the control of congenital syphilis. Lack of prenatal care and failure to screen pregnant women in the third trimester were factors in 68% of current CS cases in Dallas and remain important contributors to congenital syphilis. Using seasonal average temperatures to characterize warming winter trends: nine selected sites in Texas, 1970 to 2000, Roslyn M. Dupré, Keith Burau, and Irina Cech

TARGET AUDIENCE: Environmental Health andInfectious Disease Epidemiology professionals and students.

BACKGROUND: In 2003, the World Health Organization called for researchers to establish baseline relationships between weather and health in response to reported global warming temperature trends [1]. As a project for UTSPH course Medical Geography (Instructors: Drs. Irina Cech, Keith Burau and Michael Smolensky), National Climatic Data Center (NCDC) records for 9 cities in Texas approximately along latitude 30° N and between longitudes 95.35° and 100.91° W .

OBJECTIVE: To improve the characterization of changes in temperature in central Texas from 1970 to 2000 by NCDC average monthly temperature data.

ABSTRACT: To characterize temperature changes in Texas during the past three decades, NCDC records of average monthly temperatures were analyzed with a STATA logistic regression. Nine sites were used for the time series analysis: Houston

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IAH, Angleton, Conroe, Brenham, San Marcos, San Antonio, Austin, Fredericksburg, and Del Rio. Warming over the past three decades was observed for most sites, but was not statistically significant, nor was it of similar magnitude or direction when full years were compared. Data were also analyzed by coldest month, warmest month, three coldest months, three warmest months and season. Seasonal analysis produced strong characterizations of changing temperature and indicated increasing temperatures for all nine sites. Winter month temperatures (January, February, and March) for all sites except Del Rio followed an ascending wedge distribution and increased 0.13 to 0.18 °F per year for the six easternmost sites (p < 0.05). Summer month temperatures were also increasingly warmer and better characterized when analyzed by summer season months (July, August and September). The changes ranged from 0.07 to 0.09 °F increased temperature per year for eight sites with a maximum change of 0.15 °F in Del Rio.

“Cheese” Drug (Heroin) Related Deaths in Students—Dallas County 2004-2007, Calvin White, MPH, Melicia R. Brown, MPH, John Carlo, MD, MSE, Dallas County Health and Human Services, Jeffrey Barnard, MD, Dallas County Medical Examiner’s Office

BACKGROUND: Heroin is the least used illegal substance by students, but remains one of the most common drugs causing overdose and death in children under the age of 18 in Dallas County. A drug with a new name “cheese” has been reportedly used by school-age children since 2005. “Cheese” or “starter heroin” is a combination of heroin and crushed cold medicine (Tylenol PM) containing acetaminophen and diphenhydramine.

METHODS: A retrospective review of the County Medical Examiners’ Database for Dallas County residents under the age of 18 with toxic effects of heroin listed as cause of death was conducted for the period of January 2004- April 2007.

RESULTS: There were a total of 23 deaths during this time period. Cases were disproportionately higher in males (80%) than females (20%). Toxicology testing demonstrated a high percentage of cases with poly substance abuse.

CONCLUSIONS: Compared to prior years Dallas County has experienced an increase in deaths due to targeted efforts to increase heroin use among school-age children.

Educational Materials

Innovations in Public Health Practice in a Tuberculosis (TB) Control and Prevention Program, John Nava, MD, Cara Hausler, BS, Edwardo Dominguez, San Antonio Metropolitan Health District, TB Control & Prevention Program

Target Audience: Public health practitioners, physicians, patients and the public

Objective: To improve three areas of public health practice within a TB program at a local health department: 1) to improve efficiencies in clinician evaluation of TB contacts and high-risk populations, 2) to improve identification of the sources of TB exposure in newly diagnosed pediatric TB cases or suspects and 3) to improve understanding of the difference between latent TB infection and active TB disease by TB patients and the public.

Innovative materials were developed to improve the practice of public health in three areas. First, a high volume of persons with exposure to active TB and populations with elevated risk factors need evaluation. Clinician time is limited; priority must be placed on TB suspects and cases. Clinical templates were developed to improve efficiencies in evaluation of TB contacts and high-risk populations.

Second, pediatric TB cases (<12 years of age) are usually not contagious and the TB investigation focuses on finding the source case that transmitted TB to the child. The DSHS tool for TB investigations does not easily apply to this situation. A new interview worksheet was developed to more specifically focus on the child’s home, school and play environments, improving source case identification.Third, TB patients, contacts and members of the community have difficulty understanding the differences between latent TB infection and active TB disease. An English and Spanish educational tool was developed to clarify these differences.

The presentation will highlight these innovations. Staff will be available to discuss them and provide resources for use by others. In a recent DSHS review, the reviewers were impressed with the clinical templates and suggested they be shared throughout the state.

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Admissions Information Applicant must hold a minimum of a bachelor’s

degree Completion of the non-degree application No GRE or GPA requirement as a non-degree

student $25 application fee is WAIVED

Be a part of the Inaugural2008 Summer Institute ● June 9 – 27

Courses Offered: Biostatistics Epidemiology Environmental Health Health Management Health Policy Social & Behavioral Sciences

Classes offered from 8:30-11:30 and12:30-3:30, Monday – Friday

To speak to an admissions representative, contact the Office of Student & Academic Services

Phone: 817.735.2401Toll-free: 877.868.7741Email: sph@hsc.unt.edu

www.hsc.unt.edu/education/sph

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