A Model of Culex quinquefasciatus Abundance Constructed Using Routine Surveillance and Treatment Data in Tarrant County, Texas.

Mosquito surveillance and pesticide treatment data can be combined in statistical models to provide insight into drivers of mosquito population dynamics. In cooperation with the county-based public health authority, multiple municipalities in Tarrant County, Texas, supplied surveillance and pesticide treatment data available from the 2014 mosquito season for analysis. With these data, general linear mixed modeling was used to model population dynamics of Culex quinquefasciatus, the primary vector for West Nile virus. Temporally lagged pesticide treatment information, weather data, and habitat variables were used as predictors of log + 1 transformed mosquito count data, and Akaike information criteria corrected for small sample sizes (AICc)-based model selection and multimodel averaging was used to produce a final model of mosquito abundance. The model revealed that mosquito counts were driven mainly by seasonally fluctuating temperature, precipitation, human population density, and treatment. In particular, interactions between temperature and treatment, and precipitation and human population density significantly contributed to the interpretation of the effects of the nonweather variables.

Challenges with hepatitis B vaccination of high risk adults - A pilot program.

BACKGROUND: Acute hepatitis B virus (HBV) infections in the United States occur predominantly among persons aged 30-59 years. The Centers for Disease Control and Prevention (CDC) recommends vaccination of adults at increased risk for HBV infection. Completing the hepatitis B (HepB) vaccine dose-series is critical for optimal immune response. OBJECTIVES: CDC funded 14 health departments (awardees) from 2012 to 2015 to implement a pilot HepB vaccination program for high-risk adults. We evaluated the pilot program to assess vaccine utilization; vaccine dose-series completion, including by vaccination location type; and implementation challenges. METHODS: Awardees collaborated with sites providing health care to persons at increased risk for HBV infection. Awardees collected information on doses administered, vaccine dose-series completion, and challenges completing and tracking vaccinations, including use of immunization information systems (IIS). Data were reported by each awardee in aggregate to CDC. RESULTS: Six of 14 awardees administered 47,911 doses and were able to report patient-level dose-series completion. Among persons who received dose 1, 40.4% received dose 2, and 22.3% received dose 3. Local health department clinics had the highest 3-dose-series completion, 60.6% (531/876), followed by federally qualified health centers at 38.0% (923/2432). While sexually transmitted diseases (STD) clinics administered the most doses in total (17,173 [35.8% of 47,911 doses]), 3-dose-series completion was low (17.1%). The 14 awardees reported challenges regarding completing and tracking dose-series, including reaching high-risk adults for follow-up and inconsistencies in use of IIS or other tracking systems across sites. CONCLUSIONS: Dose-series completion was low in all settings, but lowest where patients may be less likely to return for follow-up (e.g., STD clinics). Routinely assessing HepB vaccination needs of high-risk adults, including through use of IIS where available, may facilitate HepB vaccine dose-series completion.

Paternal race/ethnicity and very low birth weight.

BACKGROUND: The purpose was to examine the association between paternal race/ethnicity and very low birth weight stratified by maternal race/ethnicity. METHODS: Birth data for Tarrant County, Texas 2006-2010 were analyzed. Very low birth weight was dichotomized as yes (<1,500 g) and no (≥1,500 g). Paternal race/ethnicity was categorized as Caucasian, African American, Hispanic, other, and missing. Missing observations (14.7%) were included and served as a proxy for fathers absent during pregnancy. Potential confounders included maternal age, education, and marital status, plurality, previous preterm birth, sexually transmitted disease during pregnancy, smoking during pregnancy, and Kotelchuck Index of prenatal care. Logistic regressions were stratified by maternal race/ethnicity. Odds ratios and 95% confidence intervals were calculated. RESULTS: Of 145,054 births, 60,156 (41.5%) were Caucasian, 22,306 (15.4%) African American, 54,553 (37.6%) Hispanic, and 8,039 (5.5%) other mothers. There were 2,154 (1.5%) very low birth weights total, with 3.1% for African American mothers and 1.2% for all other race/ethnicities. Among Caucasian mothers, African American paternal race was associated with increased odds of very low birth weight (OR = 1.52; 95% CI:1.08-2.14). Among Hispanic mothers, African American paternal race (OR = 1.66; 95% CI:1.01-2.74) and missing paternal race/ethnicity (OR = 1.65; 95% CI:1.15-2.36) were associated with increased odds of very low birth weight. CONCLUSIONS: Paternal race/ethnicity is an important predictor of very low birth weight among Caucasian and Hispanic mothers. Future research should consider paternal race/ethnicity and further explore the association between paternal characteristics and very low birth weight.

Outbreak of cryptosporidiosis associated with a man-made chlorinated lake--Tarrant County, Texas, 2008.

In July 2008, clusters of laboratory-confirmed cryptosporidiosis cases and reports of gastrointestinal illness in persons who visited a lake were reported to Tarrant County Public Health. In response, epidemiologic, laboratory, and environmental health investigations were initiated. A matched case-control study determined that swallowing the lake water was associated with illness (adjusted odds ratio = 16.3; 95% confidence interval: 2.5-infinity). The environmental health investigation narrowed down the potential sources of contamination. Laboratory testing detected Cryptosporidium hominis in case-patient stool specimens and Cryptosporidium species in lake water. It was only through the joint effort that epidemiologic, laboratory, and environmental health investigators could determine that >1 human diarrheal fecal incidents in the lake likely led to contamination of the water. This same collaborative effort will be needed to develop and maintain an effective national Model Aquatic Health Code.

Having a personal healthcare provider and receipt of adequate cervical and breast cancer screening.

INTRODUCTION: The purpose of this study was to assess the relationship between having a personal health care provider and adequate cervical and breast cancer screening behavior. METHODS: Cross-sectional data were obtained from the 2004 Behavior Risk Factor Surveillance System. For cervical cancer, female respondents 18 years of age and older who did not have hysterectomy were included (n = 130,359); for breast cancer, female respondents 40 years of age or older were included (n = 129,929). Multiple logistic regression analyses were performed to determine the association between having a personal health care provider, specific demographics, and health insurance status with adequate cervical and breast cancer screening behavior. RESULTS: Approximately 9% and 14% of the study population for the breast cancer and cervical cancer analyses, respectively, did not have a personal health care provider. Having at least one personal health care provider was significantly associated with adequate cervical cancer screening behavior (odds ratio, 2.37; 95% CI, 2.08-2.70) and breast cancer screening behavior (odds ratio, 2.86; 95% CI, 2.54-3.24) in multivariate analyses. Both multivariate analyses were adjusted for age, race/ethnicity, education, income, and health insurance. CONCLUSION: Having at least one personal health care provider was associated with adequate cervical and breast cancer screening behavior. Efforts to increase primary care access are a necessary part of the plan to increase preventive health services utilization.

Racial and ethnic differences in cardiovascular disease risk factors: a systematic review.

OBJECTIVE: This systematic review was undertaken to expand our understanding of the factors associated with racial/ethnic disparities in cardiovascular disease (CVD) risk factors (hypertension, diabetes, obesity, hypercholesterolemia, no leisure-time physical activity, and smoking), to assess the potential differences in the CVD risk factors by race/ethnicity, and to update and expand on existing reviews. METHODS: English-language, population-based CVD studies published between 1995 to present, which included one or more ethnic comparison in an adult population were reviewed. RESULTS: Sixteen studies were included in this review. Most of the studies found hypertension to be significantly higher in Blacks than Whites. Minority status was also significantly associated with diabetes. No one racial/ethnic minority population was consistently found to have a higher or lower prevalence of obesity or hypercholesterolemia. Mexican Americans had a significantly lower prevalence of smoking than Whites and Blacks; American Indian/Alaskan Natives (AIANs) had significantly higher prevalence of smoking compared to Whites. Mexican Americans had the highest prevalence of no leisure-time physical activity, followed by AIANs and Blacks. CONCLUSION: Cardiovascular diseases are the leading cause of death in the United States, and disproportionate rates are seen in racial and ethnic minority populations. Systematically assessing and quantifying modifiable CVD risk factors is therefore crucial in these populations. Better understanding and awareness of the disparities of CVD risk factors by race and ethnicity may help clinicians and public health professionals develop culturally sensitive interventions, prevention programs, and services specifically targeted toward risk burdens in each of these populations.

Racial and ethnic differences in the effects of regular providers and self-management education on diabetes preventive care.

OBJECTIVE: To examine the effects of having regular healthcare providers and diabetes self-management education (DSME) on the receipt of diabetes preventive care among all groups and by race/ethnicity. DATA SOURCE: The 2004 Behavioral Risk Factor Surveillance Survey. METHODS: Logistic regression analyses were performed for the full sample and separately for Blacks, Hispanics, and Whites. RESULTS: Among all persons, having at least one regular provider and DSME were significantly associated with higher odds of receipt of a glycosylated hemoglobin (HbA1C) test, foot exam, and dilated eye exam in the past year. Results from analyses stratified by race/ethnicity reveal differential effects of having a regular provider and DSME. Among Whites, having at least one regular provider helps assure that diabetes patients receive each of the three recommended preventive services. Among Blacks, having at least one regular provider was significantly associated with receipt of an HbA1C but not other preventive services. Among Hispanics, having a regular provider was significantly associated with receipt of an HbA1C test and dilated eye exam, but not a foot exam. Independent of having a regular provider, DSME appears to be beneficial for Whites and Blacks but not Hispanics. For Whites, DSME was significantly associated with all three types of diabetes preventive care. For Blacks, DSME was significantly associated with the receipt of a foot exam but not an HbA1C test and a dilated eye exam. However, among Hispanics, DSME was not significantly associated with any of the three preventive services. CONCLUSION: Access to personal healthcare providers should be promoted among Whites, Blacks, and Hispanics to assure patients with diabetes receive recommended secondary preventive services. Diabetes self-management programs should also be expanded among Whites and Blacks but may need to be modified to benefit Hispanics.