The value of community-integrated health information exchanges: three recent examples from El Paso, Texas.

The foundational role of health information exchanges (HIEs) is to facilitate communication between clinical partners in real time. Once this infrastructure for the secure and immediate flow of patient information is built, however, HIEs can benefit community public health and clinical care in myriad other ways that are in line with their mission, goals, patient privacy, and funding structures. We encourage the development of community-integrated HIEs and list specific steps that can be taken toward community integration. We give three examples of those steps in action from a community HIE in El Paso, TX. Each local partnership, in combination with technology innovation, resulted in the development of informatics tools to address community health needs and generated long-term benefits, especially for the most vulnerable patients. Two examples relate to different aspects of the COVID-19 pandemic and a third to the Afghan refugee evacuation.

Psychographic characteristics, tobacco, and alcohol use in a sample of young adults on the U.S./México border.

Few studies using psychographic segmentation have been conducted; even fewer in minority samples. Study aims were to identify psychographic clusters and their relation to tobacco and alcohol use within a predominantly Hispanic (87%) young adult (ages 18-25) sample. Participants (N=754; 72.5% female; Mage=20.7 [2.2]) completed the following measures online: sociodemographics, tobacco use history, the Daily Drinking Questionnaire (Collins, Parks, & Marlatt, 1985), a social activities scale, a psychographic survey, a music preference item, the Brief Sensation Seeking Scale (Hoyle, Stephenson, Palmgreen, Lorch, & Donohew, 2002), and the Mini-International Personality Item Pool (Donnellan, Oswald, Baird, & Lucas, 2006). Two step cluster analysis identified two groups. 'Popular Extroverts' (49.3% of sample) reported higher: extroversion scores F(1, 652)=40.03, sensation seeking scores F(1, 652)=20.38, alcohol use (greater number of drinks per week [F(1, 652)=9.69]; and past month binge drinking [χ² (1)=12.80]), and lifetime tobacco use (χ² [1]=10.61) (all ps≤0.002). 'Mainstream/Conventionals' (50.7% of sample) reported greater intentions to smoke in the next month F(1, 284)=11.81, p=0.001. 'Popular Extroverts' may benefit from prevention/cessation messaging promoting peer support and intensity-oriented activities. For 'Mainstream/Conventionals,' messaging communicating negative attitudes toward smoking and the tobacco industry may be effective. Future directions include testing targeted messages which may be incorporated into mass media tobacco and alcohol interventions for young adults on the U.S./México border.

A baseline assessment of attitudes toward tobacco free campus policies in a U.S./México border university.

In recent years there has been an increase in the number of smoke/tobacco free settings, including university campuses. Given the benefits associated with the implementation of smoke and tobacco free campus policies, it is important to study attitudes toward these due to their potential association with subsequent implementation issues. The present study assessed potential predictors of attitudes toward tobacco free campus (TFC) policies, tobacco use risk perception, and perceived problematic campus tobacco use at a university located on the U.S./México border. University faculty, staff, and students (N=3002; Mage=30.4; 60% female; 67.1% Hispanic) completed an online survey regarding tobacco use history, attitudes toward TFC policies, tobacco use risk perception, perception of problematic tobacco use on campus, and awareness of the current tobacco use campus policy. Male gender, non Hispanic white ethnicity, smoking behavior (history/current), and identifying the current tobacco use policy were associated with less positive attitudes toward TFC policies and lower tobacco use risk perception. Non Hispanic white ethnicity and current smoking were associated with a lower perception of problematic campus tobacco use. Attitudes toward TFC policies and perceptions were generally positive, yet educating about the risks associated with tobacco use and addressing misconceptions about the dangers of secondhand smoke to potentially promote TFC policies seem warranted.

Internal Structure Analysis of a Tobacco Control Network on the U.S.-México Border.

Tobacco control (TC) networks (in which multiple agencies collaborate) are essential components within comprehensive TC efforts. The aim of this study was to assess the internal coalition outcomes hierarchy model (via the Internal Coalition Effectiveness [ICE] scale) in the present sample. Participants (members of a TC Network on the U.S.-México border; independent Waves 1 [N = 30] and 2 [N = 33; at a 1-year subsequent assessment]) completed a background questionnaire and an adapted version of the ICE scale. Mean values for ICE subscales suggested a strong enthusiasm of Network members and recognition of the importance of a cohesive social vision, employment of efficient practices, a need for improved and maintained knowledge/training, and stable social relationships among members. However, no significant differences were observed between data waves in the ICE subscales, multivariate analysis of variance: λ = .97, F(4, 43) = 0.31, p > .86. Considering a multifaceted assessment may enhance the understanding of the dynamics and strengths of the Network. Finally, including an assessment of the leadership's perspective regarding internal coalition outcome hierarchy model constructs to compare them with members' perspective is warranted.

A Smoke-Free Paso del Norte: impact over 10 years on smoking prevalence using the Behavioral Risk Factor Surveillance System.

OBJECTIVES: We assessed the impact of a tobacco control initiative over 10 years on cessation and prevention. METHODS: We examined 2000-2009 Behavioral Risk Factor Surveillance System cases of a metropolitan statistical area (MSA) with systematic tobacco control efforts throughout the decade (El Paso, TX) and 2 comparison MSAs similar in size and population with less coordinated tobacco control efforts (Austin-Round Rock, TX and San Antonio, TX). RESULTS: Yearly, El Paso exhibited a 6% increase in the prevalence of former smokers, a 6% decrease in prevalence of daily smokers, and a 7% decrease in the prevalence of established smoking (≥ 100 cigarettes per lifetime and currently smoking); we did not observe similar trends in the comparison MSAs. There was no change in the prevalence of nondaily smokers in any of the MSAs. CONCLUSIONS: The coordinated tobacco control activities in El Paso are related to cessation among daily smokers and prevention of established smoking at the population level but have not stimulated cessation among nondaily smokers. Comprehensive tobacco control should focus more on not only daily smokers but also nondaily smokers.

Proximal and distal determinants of access to health care among Hispanics in El Paso County, Texas.

In the United States, having health insurance is an important determinant of health care access and individual health outcomes. Nationwide, a significant proportion of the population does not have health insurance. Hispanics, in particular, are less likely than non-Hispanics to have insurance. A framework was established to examine the relationships between the determinants of insurance coverage and health care affordability in El Paso County, Texas. Data from the 2005 Behavioral Risk Factor Surveillance System were used to examine the relationships described by this framework. The sample included 653 adults, of those 477 self-identified as Hispanic or Latino. In El Paso County, almost half of adult Hispanics lack any type of health insurance coverage, three times the rate of non-Hispanics. Among Hispanics, the lack of health insurance was strongly associated with reduced affordability of health care. Employment status, income, and age were found to have significant associations with insurance coverage and health care affordability. Sex and education level were relevant, yet distal determinants of these outcomes. Ongoing conversations about health care reform should take into account the patterns of coverage within the Hispanic population. Knowing how economic and social factors affect coverage is necessary to inform policy that can effectively alleviate disparities experienced by Hispanics.

Cross-border utilization of health care services by United States residents living near the Mexican border.

OBJECTIVES: To determine what proportion of El Paso (Texas, United States of America) residents access health care services in Mexico, which services they use, and why they cross for care. METHODS: A cross-sectional, telephone survey of El Paso County residents was conducted from October-November 2007 to determine use of health care services in Mexico. At total of 2 560 telephone interviews were completed. Descriptive statistics and Chi-square analysis were used to determine the proportion crossing the US-Mexico border for care and identify correlates of crossing. RESULTS: The proportion of El Paso residents that had crossed into Mexico for some type of health care service during the two years prior to the survey interview was 32.5%. Of border crossers, 27.1% used health services; 63.2%, dental services; 82.0%, pharmacy; and 9.8%, traditional healers. Reasons given were cost, lack of health insurance, language barriers, and convenience. Hispanic ethnicity, having lived in Ciudad Juárez, being uninsured, and younger age were associated with crossing. The majority were satisfied with the health services received. CONCLUSIONS: Crossing the border to access health care services in Mexico is not uncommon for US residents living in El Paso County, Texas. Given the high rate of uninsured in the United States and the increasingly stringent security requirements, health policies may be needed that allow for cross-border care, making use of this alternative health care system easier and safer.

Cross-border utilization of health care services by United States residents living near the Mexican border / Utilización transfronteriza de los servicios de salud por residentes en los Estados Unidos que viven cerca de la frontera con México

OBJECTIVES: To determine what proportion of El Paso (Texas, United States of America) residents access health care services in Mexico, which services they use, and why they cross for care. METHODS: A cross-sectional, telephone survey of El Paso County residents was conducted from October-November 2007 to determine use of health care services in Mexico. At total of 2560 telephone interviews were completed. Descriptive statistics and Chi-square analysis were used to determine the proportion crossing the US-Mexico border for care and identify correlates of crossing. RESULTS: The proportion of El Paso residents that had crossed into Mexico for some type of health care service during the two years prior to the survey interview was 32.5 percent. Of border crossers, 27.1 percent used health services; 63.2 percent, dental services; 82.0 percent, pharmacy; and 9.8 percent, traditional healers. Reasons given were cost, lack of health insurance, language barriers, and convenience. Hispanic ethnicity, having lived in Ciudad Juárez, being uninsured, and younger age were associated with crossing. The majority were satisfied with the health services received. CONCLUSIONS: Crossing the border to access health care services in Mexico is not uncommon for US residents living in El Paso County, Texas. Given the high rate of uninsured in the United States and the increasingly stringent security requirements, health policies may be needed that allow for cross-border care, making use of this alternative health care system easier and safer.

OBJETIVOS: Determinar la proporción de habitantes de El Paso (Texas, Estados Unidos de América) que acceden a los servicios de salud de México, los servicios utilizados y las razones para buscar atención del otro lado de la frontera. MÉTODOS: Se realizó un estudio transversal mediante encuesta telefónica a personas residentes en el condado de El Paso. La encuesta se aplicó a 2560 personas entre octubre y noviembre de 2007 para determinar el uso de servicios de salud en México. Se utilizaron métodos de estadística descriptiva y la prueba de la c² para determinar la proporción de personas que cruza la frontera de los Estados Unidos hacia México en busca de atención sanitaria e identificar los factores relacionados con ello. RESULTADOS: La proporción de habitantes de El Paso que han cruzado a México en busca de algún tipo de atención sanitaria en los 2 años previos al estudio fue de 32,5 por ciento. De los que cruzaron la frontera, 27,1 por ciento utilizaron servicios médicos; 63,2 por ciento servicios estomatológicos; 82,0 por ciento farmacéuticos y 9,8 por ciento curanderos. Las razones ofrecidas fueron: el costo, no tener seguro de salud, las barreras idiomáticas y la conveniencia. Los factores asociados con el cruce de la frontera fueron ser hispano, haber vivido en Ciudad Juárez, no tener seguro y una menor edad. La mayoría se manifestó satisfecha con los servicios de salud recibidos. CONCLUSIONES: Entre los residentes del condado de El Paso, Texas, es frecuente el cruce de la frontera para acceder a los servicios de salud de México. Dada la elevada proporción de personas sin seguro médico en los Estados Unidos y los requisitos cada vez más rigurosos para obtener un seguro, se necesitarían políticas de salud que permitan la atención sanitaria transfronteriza, con el uso de un sistema alternativo de salud más fácil y seguro.

CBPR as community health intervention: institutionalizing CBPR within community based organizations.

BACKGROUND: A community-academy partnership was created with a commitment to developing a program for institutionalizing community-based participatory research (CBPR) capacity within community-based organizations (CBOs), with the intention to enhance CBOs' existing capabilities to understand and improve community health. OBJECTIVES: This article presents the design and conceptual foundations for a year-long CBPR education and training program in which CBO teams learn research design, discuss the principles of CBPR, design and implement a community health-related research project tailored to their program and community, conduct analyses, and initiate integration of the results into the organization and community. One objective is to integrate a commitment to and the practice of CBPR within CBOs' program and policies. METHODS: An initial partnership was created between the Center for Border Health, El Paso, and Texas A&M University School of Rural Public Health, College Station. Three additional CBOs then joined the partnership and participated in the CBPR education and training program consisting of four stages: (1)3 intensive months devoted to learning about and creating a research design; (2) 6 months for implementation of the design; (3) 2 months for analyses, interpretation, and consolidation of results into one or more final products; and (4) 1 month for development of protocols for integrating research results into community health development. RESULTS: In the first iteration, an interactive process evaluation was conducted during each program stage, plus a final year-end exit interview with each participating CBO. Evaluation demonstrated strong positive results and specific lessons learned. A proposal incorporating the lessons learned was presented to the funding source. A second iteration has been funded, with monies included to develop a formal outcome evaluation.

Functional magnetic resonance imaging activity during the gradual acquisition and expression of paired-associate memory.

Recent neurophysiological findings from the monkey hippocampus showed dramatic changes in the firing rate of individual hippocampal cells as a function of learning new associations. To extend these findings to humans, we used blood oxygenation level-dependent (BOLD) functional magnetic resonance imaging (fMRI) to examine the patterns of brain activity during learning of an analogous associative task. We observed bilateral, monotonic increases in activity during learning not only in the hippocampus but also in the parahippocampal and right perirhinal cortices. In addition, activity related to simple novelty signals was observed throughout the medial temporal lobe (MTL) memory system and in several frontal regions. A contrasting pattern was observed in a frontoparietal network in which a high level of activity was sustained until the association was well learned, at which point the activity decreased to baseline. Thus, we found that associative learning in humans is accompanied by striking increases in BOLD fMRI activity throughout the MTL as well as in the cingulate cortex and frontal lobe, consistent with neurophysiological findings in the monkey hippocampus. The finding that both the hippocampus and surrounding MTL cortex exhibited similar associative learning and novelty signals argues strongly against the view that there is a clear division of labor in the MTL in which the hippocampus is essential for forming associations and the cortex is involved in novelty detection. A second experiment addressed a striking aspect of the data from the first experiment by demonstrating a substantial effect of baseline task difficulty on MTL activity capable of rendering mnemonic activity as either "positive" or "negative."