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Objectives. To propose a novel Bayesian spatial-temporal approach to identify and quantify severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing disparities for small area estimation. Methods. In step 1, we used a Bayesian inseparable space-time model framework to estimate the testing positivity rate (TPR) at geographically granular areas of the census block groups (CBGs). In step 2, we adopted a rank-based approach to compare the estimated TPR and the testing rate to identify areas with testing deficiency and quantify the number of needed tests. We used weekly SARS-CoV-2 infection and testing surveillance data from Cameron County, Texas, between March 2020 and February 2022 to demonstrate the usefulness of our proposed approach. Results. We identified the CBGs that had experienced substantial testing deficiency, quantified the number of tests that should have been conducted in these areas, and evaluated the short- and long-term testing disparities. Conclusions. Our proposed analytical framework offers policymakers and public health practitioners a tool for understanding SARS-CoV-2 testing disparities in geographically small communities. It could also aid COVID-19 response planning and inform intervention programs to improve goal setting and strategy implementation in SARS-CoV-2 testing uptake. ( Am J Public Health . 2023;113(1):40-48. https://doi.org/10.2105/AJPH.2022.307127).

We assessed sociodemographic disparities in basic service disruptions caused by Winter Storm Uri in Texas. We collected data through a bilingual telephone survey conducted in July 2021 (n  = 753). Being Black, having children, and renting one's residence were associated with longer power outage durations; being Black was also associated with longer water outages. Our findings highlight the need to plan for and ameliorate inequitable service outages and their attendant health risks in climate change-related extreme weather events such as Uri. ( Am J Public Health . 2023;113(1):30-34. https://doi.org/10.2105/AJPH.2022.307110).

This quasi-experimental study (a community-based, physician-led human papillomavirus [HPV] education campaign and school-based vaccination program) followed 6481 students at eight Pharr-San Juan-Alamo Independent School District (Rio Grande Valley, Texas) middle schools between August 2016 and March 2021. We describe the successes and challenges experienced during the COVID-19 pandemic. HPV vaccine initiation and completion rates increased 1.29-fold and 1.47-fold, respectively, between June 2019 and March 2021. Between March 2020 and March 2021, 268 HPV vaccine doses were provided through 24 school-based interventions. Our program continued successes seen in increasing HPV vaccination rates and reducing possible HPV-associated cancers. ( Am J Public Health . 2022;112(9):1269-1272. https://doi.org/10.2105/AJPH.2022.306970).

Texas discontinued state-sponsored business restrictions and mask mandates on March 10, 2021, and mandated that no government officials, including public school officials, may implement mask requirements even in areas where COVID-19 hospitalizations comprised more than 15% of hospitalizations. Nonetheless, some public school districts began the 2021-2022 school year with mask mandates in place. We used quasi-experimental methods to analyze the impact of school mask mandates, which appear to have resulted in approximately 40 fewer student cases per week in the first eight weeks of school. ( Am J Public Health . 2022;112(6):871-875. https://doi.org/10.2105/AJPH.2022.306769).

Objectives: To assess the environmental justice implications of flooding from Hurricane Harvey in Greater Houston, Texas, we analyzed whether the areal extent of flooding was distributed inequitably with respect to race, ethnicity, and socioeconomic status, after controlling for relevant explanatory factors., Methods: Our study integrated cartographic information from Harvey's Inundation Footprint, developed by the US Federal Emergency Management Agency, with sociodemographic data from the 2012-2016 American Community Survey. Statistical analyses were based on bivariate correlations and multivariate generalized estimating equations., Results: The areal extent of Harvey-induced flooding was significantly greater in neighborhoods with a higher proportion of non-Hispanic Black and socioeconomically deprived residents after we controlled for contextual factors and clustering., Conclusions: Results provide evidence of racial/ethnic and socioeconomic injustices in the distribution of flooding and represent an important starting point for more detailed investigation of disproportionate impacts associated with Hurricane Harvey. Public Health Implications. Our findings highlight the need to prepare for and address the unequal social consequences of climate change-related disasters, which are expected to increase in frequency and severity.

Objectives: To demonstrate the benefits-mapping software Environmental Benefits Mapping and Analysis Program-Community Edition (BenMAP-CE), which integrates local air quality data with previously published concentration-response and health-economic valuation functions to estimate the health effects of changes in air pollution levels and their economic consequences., Methods: We illustrate a local health impact assessment of ozone changes in the 10-county nonattainment area of the Dallas-Fort Worth region of Texas, estimating the short-term effects on mortality predicted by 2 scenarios for 3 years (2008, 2011, and 2013): an incremental rollback of the daily 8-hour maximum ozone levels of all area monitors by 10 parts per billion and a rollback-to-a-standard ambient level of 65 parts per billion at only monitors above that level., Results: Estimates of preventable premature deaths attributable to ozone air pollution obtained by the incremental rollback method varied little by year, whereas those obtained by the rollback-to-a-standard method varied by year and were sensitive to the choice of ordinality and the use of preloaded or imported data., Conclusions: BenMAP-CE allows local and regional public health analysts to generate timely, evidence-based estimates of the health impacts and economic consequences of potential policy options in their communities.

Objectives: To investigate the association between acculturation and diabetes risk in the Mexican American Mano a Mano (hand to hand) Cohort., Methods: We recruited 15 975 men and women in the Houston, Texas, area from 2001 to 2014. We used language use, birth country, and duration of US residence (among Mexico-born) to assess acculturation. Participants self-reported a physician's diagnosis of diabetes during annual follow-up over an average of 5.4 (range = 1-13) years. Self-reported diabetes status was validated in medical records for a subset of 235 participants with 98% agreement., Results: Diabetes risk was higher among immigrants with 15 to 19, 20 to 24, and 25 or more years (relative risk = 1.47; 95% confidence interval = 1.07, 2.01) of US residence, relative to those with less than 5 years. Neither language acculturation nor birth country was significantly associated with diabetes risk., Conclusions: Among participants born in Mexico, diabetes risk increased with longer duration of US residence.

Objectives: We investigated whether Mexican immigration to the United States exerts transnational effects on substance use in Mexico and the United States., Methods: We performed a cross-sectional survey of 2336 Mexican Americans and 2460 Mexicans in 3 Texas border metropolitan areas and their sister cities in Mexico (the US-Mexico Study on Alcohol and Related Conditions, 2011-2013). We collected prevalence and risk factors for alcohol and drug use; Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, alcohol-use disorders; and 2 symptoms (hazardous use and quit or control) of drug use disorder across a continuum of migration experiences in the Mexican and Mexican American populations., Results: Compared with Mexicans with no migrant experience, the adjusted odds ratios for this continuum of migration experiences ranged from 1.10 to 8.85 for 12-month drug use, 1.09 to 5.07 for 12-month alcohol use disorder, and 1.13 to 9.95 for 12-month drug-use disorder. Odds ratios increased with longer exposure to US society. These findings are consistent with those of 3 previous studies., Conclusions: People of Mexican origin have increased prevalence of substance use and disorders with cumulative exposure to US society.

Objectives: We determined the association between maternal neighborhood socioeconomic position (SEP) and the risk of cleft lip with or without cleft palate (CL±P) or cleft palate alone (CP) in offspring., Methods: We obtained information on CL±P (n = 2555) and CP (n = 1112) cases and unaffected controls (n = 14 735) among infants delivered during 1999 to 2008 from the Texas Birth Defects Registry. Neighborhood SEP variables, drawn from the 2000 US Census, included census tract-level poverty, education, unemployment, occupation, housing, and crowding, from which we created a composite neighborhood deprivation index (NDI). We used mixed-effects logistic regression to evaluate neighborhood SEP and oral clefts., Results: Mothers with CL±P-affected offspring were more likely to live in high-NDI (adverse) areas than mothers with unaffected offspring (odds ratio [OR] = 1.20, 95% confidence interval [CI] = 1.05, 1.37). This association was strongest among Hispanic mothers (OR = 1.32, 95% CI = 1.07, 1.62). No associations were observed with CP., Conclusions: Using data from one of the world's largest active surveillance birth defects registries, we found that adverse neighborhood SEP is modestly associated with CL±P, especially among Hispanics. These findings may have important implications for health disparities prevention.

Objectives: We demonstrated the effectiveness of an accelerated hepatitis B vaccination schedule in drug users., Methods: We compared the long-term effectiveness of accelerated (0-1-2 months) and standard (0-1-6 months) hepatitis B vaccination schedules in preventing hepatitis B virus (HBV) infections and anti-hepatitis B (anti-HBs) antibody loss during 2-year follow-up in 707 drug users (HIV and HBV negative at enrollment and completed 3 vaccine doses) from February 2004 to October 2009., Results: Drug users in the accelerated schedule group had significantly lower HBV infection rates, but had a similar rate of anti-HBs antibody loss compared with the standard schedule group over 2 years of follow-up. No chronic HBV infections were observed. Hepatitis C positivity at enrollment and age younger than 40 years were independent risk factors for HBV infection and antibody loss, respectively., Conclusions: An accelerated vaccination schedule was more preferable than a standard vaccination schedule in preventing HBV infections in drug users. To overcome the disadvantages of a standard vaccination schedule, an accelerated vaccination schedule should be considered in drug users with low adherence. Our study should be repeated in different cohorts to validate our findings and establish the role of an accelerated schedule in hepatitis B vaccination guidelines for drug users.

Objectives: We examined whether It's Your Game . . . Keep It Real (IYG) reduced dating violence among ethnic-minority middle school youths, a population at high risk for dating violence., Methods: We analyzed data from 766 predominantly ethnic-minority students from 10 middle schools in southeast Texas in 2004 for a group randomized trial of IYG. We estimated logistic regression models, and the primary outcome was emotional and physical dating violence perpetration and victimization by ninth grade., Results: Control students had significantly higher odds of physical dating violence victimization (adjusted odds ratio [AOR] = 1.52; 95% confidence interval [CI] = 1.20, 1.92), emotional dating violence victimization (AOR = 1.74; 95% CI = 1.36, 2.24), and emotional dating violence perpetration (AOR = 1.58; 95% CI = 1.11, 2.26) than did intervention students. The odds of physical dating violence perpetration were not significantly different between the 2 groups. Program effects varied by gender and race/ethnicity., Conclusions: IYG significantly reduced 3 of 4 dating violence outcomes among ethnic-minority middle school youths. Although further study is warranted to determine if IYG should be widely disseminated to prevent dating violence, it is one of only a handful of school-based programs that are effective in reducing adolescent dating violence behavior.

We compared characteristics of homeless smokers and economically disadvantaged domiciled smokers (Dallas, TX; August 2011-November 2012). Although findings indicated similar smoking characteristics across samples, homeless smokers (n = 57) were exposed to more smokers and reported lower motivation to quit, lower self-efficacy for quitting, more days with mental health problems, and greater exposure to numerous stressors than domiciled smokers (n = 110). The sample groups reported similar scores on measures of affect, perceived stress, and interpersonal resources. Results may inform novel cessation interventions for homeless smokers.

Objectives: We evaluated a strategy for preventing tuberculosis (TB) in communities most affected by it., Methods: In 1996, we mapped reported TB cases (1985-1995) and positive tuberculin skin test (TST) reactors (1993-1995) in Smith County, Texas. We delineated the 2 largest, densest clusters, identifying 2 highest-incidence neighborhoods (180 square blocks, 3153 residents). After extensive community preparation, trained health care workers went door-to-door offering TST to all residents unless contraindicated. TST-positive individuals were escorted to a mobile clinic for radiography, clinical evaluation, and isoniazid preventive treatment (IPT) as indicated. To assess long-term impact, we mapped all TB cases in Smith County during the equivalent time period after the project., Results: Of 2258 eligible individuals, 1291 (57.1%) were tested, 229 (17.7%) were TST positive, and 147 were treated. From 1996 to 2006, there were no TB cases in either project neighborhood, in contrast with the preintervention decade and the continued occurrence of TB in the rest of Smith County., Conclusions: Targeting high-incidence neighborhoods for active, community-based screening and IPT may hasten TB elimination in the United States.

Objectives: We examined the contribution of perceived racial/ethnic discrimination to disparities in problem behaviors among preadolescent Black, Latino, and White youths., Methods: We used cross-sectional data from Healthy Passages, a 3-community study of 5119 fifth graders and their parents from August 2004 through September 2006 in Birmingham, Alabama; Los Angeles County, California; and Houston, Texas. We used multivariate regressions to examine the relationships of perceived racial/ethnic discrimination and race/ethnicity to problem behaviors. We used values from these regressions to calculate the percentage of disparities in problem behaviors associated with the discrimination effect., Results: In multivariate models, perceived discrimination was associated with greater problem behaviors among Black and Latino youths. Compared with Whites, Blacks were significantly more likely to report problem behaviors, whereas Latinos were significantly less likely (a "reverse disparity"). When we set Blacks' and Latinos' discrimination experiences to zero, the adjusted disparity between Blacks and Whites was reduced by an estimated one third to two thirds; the reverse adjusted disparity favoring Latinos widened by about one fifth to one half., Conclusions: Eliminating discrimination could considerably reduce mental health issues, including problem behaviors, among Black and Latino youths.

Tuberculosis (TB) surveillance among the homeless is not supported by the political will necessary for TB elimination. We merged the first stakeholder-accepted enumeration of homeless persons with existing surveillance data to assess TB risk among the homeless in Houston, Texas. The average incidence per 100,000 was 411 among homeless and 9.5 among housed persons. The homeless were more likely than the housed to be US-born, clustered, and in a larger-sized cluster. Multivariate analysis revealed that TB rates among the homeless were driven not by comorbidities but by social determinants. Homeless patients were hospitalized more days than the housed and required more follow-up time. Reporting of TB rates for populations with known health disparities could help reframe TB prevention and better target limited funds.

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.

We conducted the first US study using graphic-output temperature data loggers in quantifying cold chain failure. Fifty-four vaccine refrigerators of a county outpatient health system were studied. Forty-eight percent maintained temperatures of 2°C to 8°C and 24% had protracted periods of temperatures less than 0°C. The correlation between the percentage of refrigerators with freezing temperatures and the pertussis rate for each health region was r = 0.76. The findings suggest that improper vaccine storage may have contributed to recent increases in pertussis rates.

After litigation against the tobacco industry ended in a settlement, the Texas legislature funded pilot projects to reduce tobacco use in selected areas of the state. Subsequent telephone surveys showed that well-funded activities were successful in reducing population rates of self-reported cigarette smoking. We present evidence that the reduction in smoking promptly led to lower rates of death from acute myocardial infarctions.

A widely publicized but unpublished study of the relationship between gun shows and gun violence is being cited in debates about the regulation of gun shows and gun commerce. We believe the study is fatally flawed. A working paper entitled "The Effect of Gun Shows on Gun-Related Deaths: Evidence from California and Texas" outlined this study, which found no association between gun shows and gun-related deaths. We believe the study reflects a limited understanding of gun shows and gun markets and is not statistically powered to detect even an implausibly large effect of gun shows on gun violence. In addition, the research contains serious ascertainment and classification errors, produces results that are sensitive to minor specification changes in key variables and in some cases have no face validity, and is contradicted by 1 of its own authors' prior research. The study should not be used as evidence in formulating gun policy.

Objectives: We sought to identify cross-sectional hepatitis B virus (HBV) and HCV prevalence among Asian Americans at a community health fair and to assess referral rates., Methods: We determined HBV prevalence with hepatitis B surface antigen (HBsAg), antibodies to hepatitis B core antigen (anti-HBc), and antibodies to hepatitis B surface antigen (anti-HBs). We determined HCV prevalence with hepatitis C antibodies. Successful referral occurred when participants with HBV or HCV were contacted, medically evaluated, and given contact information of liver specialists for care., Results: Of 202 people screened, 118 were Asian Americans (65 Chinese and 39 Vietnamese). Twelve had chronic HBV with positive HBsAg. However, chronic HBV prevalence increased from 10.2% to 13.6% by concomitant HBsAg, anti-HBc, and anti-HBs testing. Prevalence of HCV was 6% overall but 15.4% among Vietnamese. Overall, 83% of patients with chronic HBV and 100% of patients with occult HBV or HCV were successfully referred., Conclusions: Concomitant HBsAg, anti-HBc, and anti-HBs testing permits diagnosis of chronic, occult HBV infections missed by testing with HBsAg alone. Persons identified with HBV or HCV at community health fairs can be successfully referred.

Objectives: We sought to modify an instrument and to use it to collect information on smoking knowledge, attitudes, beliefs, and behaviors among Hispanics/Latinos, and to adapt survey methods to obtain high participation levels. Methods. Promotoras (outreach workers) conducted face-to-face interviews with 1485 Hispanic adults (July 2007-April 2008). The project team used GeoFrame field enumeration methods to develop a sampling frame from households in randomly selected colonias (residential areas along the Texas-Mexico border that may lack some basic necessities (e.g. portable water), in El Paso, Texas., Results: The revised questionnaire included 36 unchanged items from the State Adult Tobacco Survey, 7 modified items, and 17 new items focusing on possible culturally specific quitting methods, secondhand smoke issues, and attitudes and knowledge about tobacco use that might be unique for Hispanic/Latino groups. The eligibility rate was 90.2%, and the conservative combined completed screener and interview response rate was 80.0%., Conclusions: Strategic, targeted, carefully designed methods and surveys can achieve high reach and response rates in hard-to-reach populations. Similar procedures could be used to obtain cooperation of groups who may not be accessible with traditional methods.

In data from the Texas Educational Agency and the Health Resources and Services Administration, we found fewer autism diagnoses in school districts with higher percentages of Hispanic children. Our results are consistent with previous reports of autism rates 2 to 3 times as high among non-Hispanic Whites as among Hispanics. Socioeconomic factors failed to explain lower autism prevalence among Hispanic schoolchildren in Texas. These findings raise questions: Is autism underdiagnosed among Hispanics? Are there protective factors associated with Hispanic ethnicity?

Objectives: We examined the long-term health consequences of relationship violence in adulthood., Methods: Using data from the Welfare, Children, and Families project (1999 and 2001), a probability sample of 2402 low-income women with children living in disadvantaged neighborhoods in Boston, Massachusetts; Chicago, Illinois; and San Antonio, Texas, we predicted changes in the frequency of intoxication, psychological distress, and self-rated health over 2 years with baseline measures of relationship violence and a host of relevant background variables., Results: Our analyses showed that psychological aggression predicted increases in psychological distress, whereas minor physical assault and sexual coercion predicted increases in the frequency of intoxication. There was no evidence to suggest that relationship violence in adulthood predicted changes in self-rated health., Conclusions: Experiences with relationship violence beyond the formative and developmental years of childhood and adolescence can have far-reaching effects on the health status of disadvantaged urban women.

Objectives: We assessed the statewide impact of the 2004 Texas Public School Nutrition Policy on foods and beverages served or sold in schools., Methods: We collected lunch food production records from 47 schools in 11 Texas school districts for the school years before (2003-2004) and after (2004-2005) policy implementation. Cafeteria servings of fruit, vegetables (regular and fried), and milk served each day were calculated. Twenty-three schools from 5 districts provided records of à la carte sales of candy, chips, desserts, drinks, ice cream, and water. We examined aggregated school-level differences in total items served or sold per day per student between study years., Results: School demographics were similar to state data. Regardless of district and school size, cafeterias served significantly fewer high-fat vegetable items per student postpolicy (P < .001). Postpolicy snack bar sales of large bags of chips were significantly reduced (P = .006), and baked chips sales significantly increased (P = .048)., Conclusions: School food policy changes have improved foods served or sold to students. It is not known whether improved lunch choices influence consumption for the whole day.

Objectives: We examined the relationship between fast-food restaurants near schools and obesity among middle and high school students in California., Methods: We used geocoded data (obtained from the 2002-2005 California Healthy Kids Survey) on over 500,000 youths and multivariate regression models to estimate associations between adolescent obesity and proximity of fast-food restaurants to schools., Results: We found that students with fast-food restaurants near (within one half mile of) their schools (1) consumed fewer servings of fruits and vegetables, (2) consumed more servings of soda, and (3) were more likely to be overweight (odds ratio [OR] = 1.06; 95% confidence interval [CI] = 1.02, 1.10) or obese (OR = 1.07; 95% CI = 1.02, 1.12) than were youths whose schools were not near fast-food restaurants, after we controlled for student- and school-level characteristics. The result was unique to eating at fast-food restaurants (compared with other nearby establishments) and was not observed for another risky behavior (smoking)., Conclusions: Exposure to poor-quality food environments has important effects on adolescent eating patterns and overweight. Policy interventions limiting the proximity of fast-food restaurants to schools could help reduce adolescent obesity.

Objectives: We evaluated the presence of misclassification bias in the estimated effect of parental involvement laws on minors' reproductive outcomes when subjection to such laws was measured by age at the time of pregnancy resolution., Methods: Using data from abortion and birth certificates, we evaluated the effect of Texas's parental notification law on the abortion, birth, and pregnancy rates of adolescents aged 17 years compared with those aged 18 years on the basis of age at the time of pregnancy resolution and age at conception., Results: On the basis of age at the time of the abortion or birth, the law was associated with a fall of 26%, 7%, and 11% in the abortion, birth, and pregnancy rates, respectively, of 17- relative to 18-year-olds. Based on age at the time of conception, the abortion rate fell 15%, the birth rate rose 2%, and the pregnancy rate remained unchanged., Conclusions: Previous studies of parental involvement laws should be interpreted with caution because their methodological limitations have resulted in an overestimation of the fall in abortions and underestimation of the rise in births, possibly leading to the erroneous conclusion that pregnancies decline in response to such laws.

Objectives: We sought to identify the functional, cognitive, and social factors associated with self-neglect among the elderly to aid the development of etiologic models to guide future research., Methods: A cross-sectional chart review was conducted at Baylor College of Medicine Geriatrics Clinic in Houston, Tex. Patients were assessed using standardized comprehensive geriatric assessment tools., Results: Data analysis was performed using the charts of 538 patients; the average patient age was 75.6 years, and 70% were women. Further analysis in 460 persons aged 65 years and older showed that 50% had abnormal Mini Mental State Examination scores, 15% had abnormal Geriatric Depression Scale scores, 76.3% had abnormal physical performance test scores, and 95% had moderate-to-poor social support per the Duke Social Support Index. Patients had a range of illnesses; 46.4% were taking no medications., Conclusions: A model of self-neglect was developed wherein executive dyscontrol leads to functional impairment in the setting of inadequate medical and social support. Future studies should aim to provide empirical evidence that validates this model as a framework for self-neglect. If validated, this model will impart a better understanding of the pathways to self-neglect and provide clinicians and public service workers with more effective prevention and intervention strategies.

Objectives: Associations between subjective social status, a subjective measure of socioeconomic status, and predictors of risk for postpartum smoking were examined among 123 pregnant women (aged 18-24 years) who stopped smoking because of pregnancy. The goal was to identify how subjective social status might influence the risk for postpartum smoking and to elucidate targets for intervention., Methods: We used multiple regression equations to examine the predictive relations between subjective social status and tobacco dependence, self-rated likelihood of postpartum smoking, confidence, temptations, positive and negative affect, depression, stress, and social support. Adjusted analyses were also conducted with control for race/ethnicity, education, income, and whether participant had a partner or not (partner status)., Results: In unadjusted and adjusted analyses, subjective social status predicted tobacco dependence, likelihood of postpartum smoking, confidence, temptations, positive affect, negative affect, and social support. Adjusted analyses predicting depression and stress approached significance., Conclusions: Among young pregnant women who quit smoking because of pregnancy, low subjective social status was associated with a constellation of characteristics indicative of increased vulnerability to postpartum smoking. Subjective social status provided unique information on risk for postpartum smoking over and above the effects of race/ethnicity, objective socioeconomic status, and partner status.

Objectives: We sought to determine whether mortality rates among immigrant and US-born Hispanic young adults were higher or lower compared with non-Hispanic Whites. We also sought to identify which causes of death accounted for the differences in mortality rates between groups. Measures. We used Texas and California vital registration data from 1999 to 2001 linked to 2000 census denominators. We calculated cause-specific, indirectly standardized rates and ratios and determined excess/deficit calculations comparing mortality rates among US- and foreign-born Hispanic men and women with rates among non-Hispanic White men and women., Results: Mortality rates were substantially lower among Hispanic immigrant men (standardized mortality ratio [SMR]=0.79) and women (SMR=0.59) than among non-Hispanic White men and women. Most social and behavioral and chronic disease causes in Texas and California other than homicide were noteworthy contributors to this pattern. Mortality rates among US-born Hispanics were similar to or exceeded those among non-Hispanic Whites (male SMR=1.17, female SMR=0.91)., Conclusions: Mortality rates among younger Hispanic immigrants in Texas and California were lower than rates among non-Hispanic Whites. This pattern was not observed among US-born Hispanics, however.

Objectives: Hurricane Katrina's impact on public health has been significant and multifaceted, with trauma-related psychological sequelae likely to result in a sizable burden of disease. Data were collected that assessed acute stress disorder (ASD) prevalence and factors related to ASD symptomatology among sheltered evacuees., Methods: On days 12 to 19 after Katrina, evacuees at a major emergency shelter completed surveys that assessed demographics, Katrina-specific experiences, and ASD symptomatology., Results: Sixty-two percent of the sample met ASD threshold criterion. Projections based on the predictive power of ASD to posttraumatic stress disorder (PTSD) suggest that 38% to 49% of the sample will meet PTSD criteria 2 years post-disaster. Female gender (odds ratio [OR] = 4.08), positive psychiatric history (OR=5.84), injury (OR=2.75), increased life-threat perception (OR=1.37), and decreased sense of personal control (OR=1.56) were significantly related to ASD. Black race was associated with greater symptom severity (B=7.85, SE[B]=3.50)., Conclusions: Katrina-related trauma and its psychological sequelae will remain a significant public health issue for years to come. The identification of several vulnerability factors related to ASD and PTSD provides a brief sketch of those at greatest risk.

Objectives: We examined the "Hispanic paradox," whereby persons of Hispanic origin seemed to experience lower mortality than the non-Hispanic White population. This paradox coincided with a change from the classification of deaths and population by Spanish surname to the use of Hispanic-origin questions in the census and vital statistics., Methods: To estimate US Hispanic and non-Hispanic White mortality, we applied a familiar relation between death rates for population subgroups to Hispanic and non-Hispanic White population death rates. We calculated age-specific death rates for the Hispanic population and the non-Hispanic White population and computed life tables for each. Result. For Texas between 1980 (surname) and 1990 (origin), the change in Hispanic deaths in persons aged 65 years or older was only half as great as the change in population size, implying a relative omission of 15% to 20% of deaths. By a different approach, the life tables for the US Hispanic and non-Hispanic White populations pointed to a similar omission., Conclusions: There is no "Hispanic paradox." The Hispanic paradox described in past research derives from inconsistencies in counts of Hispanic-origin deaths and populations.

Objectives: We examined the major causes of and risk factors for death among migrants who died while making unauthorized border crossings into the United States from Mexico., Methods: Decedents were included in the study if (1) their remains were found between January 1, 2002, and December 31, 2003, in any US county along the 650-mi (1040-km) section of the US-Mexican border from Yuma, Ariz, to El Paso, Tex; (2) their immigration status was unauthorized; and (3) they were believed to have died during transit from Mexico to the United States. Characteristics of the decedents and causes of and risk factors for their deaths were examined., Results: Among the 409 decedents meeting our inclusion criteria, environmental heat exposure (n=250; 61.1%) was the leading cause of death, followed by vehicle crashes (n=33; 8.1%) and drownings (n=24; 5.9%). Male decedents (n= 298; 72.8%) outnumbered female decedents (n = 105; 25.6%) nearly 3 to 1. More than half of the decedents were known to be Mexican nationals (n=235; 57.5%) and were aged 20 to 39 years (n=213; 52.0%); the nationality of 148 (36.2%) decedents was undetermined., Conclusions: Deaths among migrants making unauthorized crossings of the US-Mexican border are due to causes that are largely preventable. Prevention strategies should target young Mexican men, and focus on preventing them from conceiving plans to cross the border, discouraging them from using dangerous routes as crossing points, and providing search-and-rescue teams to locate lost or injured migrant crossers.

Partnerships were established with the University of Arizona's Healthcare Partnership to train promotores--Spanish-speaking community health workers--as tobacco cessation counselors. Tobacco Free El Paso certified promotores to help identify tobacco users and offer tobacco cessation counseling services. The project certified 89 participants, of whom 95% were promotores; 88% were Hispanic/Latino, 67% were females, and 62% indicated Spanish as their primary language. Participants who completed Técnicas Básicas, Treatment Specialist, and Déjate de ese Vicio certifications significantly increased self-confidence levels to deliver brief smoking cessation interventions (P < .05). Satisfaction scores (scale = 1-5) were also relatively high for each certification (Técnicas Básicas, mean = 4.8; Treatment Specialist, mean = 4.7; Déjate de ese Vicio, mean = 4.6). The results suggest that promotores understood the concepts and methodologies presented.

Objectives: We investigated differences in smoking behaviors between US-and Mexican-born ever smokers and examined the influence of US culture on smoking initiation., Methods: Participants were 5030 adults of Mexican descent enrolled in an ongoing population-based cohort in Houston, Tex., Results: More men than women reported current smoking; rates among US-born women were higher than those among Mexican-born women. Smoking rates among US-born men were higher than earlier published rates among Hispanics and non-Hispanic Whites but similar to rates among African Americans. Current smoking rates among Mexican-born women were lower than published rates for Hispanics, non-Hispanic Whites, and African Americans. Older age, male gender, a higher level of acculturation, more than a high school education, and residing in a census tract with a higher median age predicted history of smoking among US-born participants. Among Mexican-born participants, older age, male gender, a higher level of acculturation, and younger age at migration predicted history of smoking., Conclusions: Smoking interventions for people of Mexican descent should be tailored according to gender, nativity, and acculturation level and should target all ages, not just young people.

Objectives: We estimated the effect of community and school district resources on the identification of children with autistic disorder., Methods: Latent growth curve regression models were applied to school district-level data from one large state., Results: The rate of identification of autistic disorder increased on average by 1.0 child per 10000 per year (P<.001), with statistically significant district variation. After adjustment for district and community characteristics, each increase in decile of school revenue was associated with an increase of 0.16 per 10000 children identified with autistic disorder. The proportion of economically disadvantaged children per district was inversely associated with autistic disorder cases., Conclusions: District revenue was associated with higher proportions of children identified with autistic disorder at baseline and increasing rates of identification when measured longitudinally. Economically disadvantaged communities may need assistance to identify children with autistic spectrum disorders and other developmental delays that require attention.

Objectives: We compared reports of deaths in which tobacco use was a contributing factor ("tobacco-associated deaths") before and after the addition to death certificates in Texas of a check-box question asking whether tobacco use contributed to an individual's death., Methods: We examined Texas vital statistics files from 1987 to 1998. We calculated differences in percentages of reported tobacco-associated deaths (and 95% confidence intervals [CIs]) for the periods 1987 to 1992, before the addition of the check-box question, and 1993 to 1998, after the addition of the check-box., Results: Reports of tobacco-associated deaths were significantly less frequent before addition of the check-box question (0.7%; 95% CI = 0.4%, 1.0%) than after addition of the question (13.9%; 95% CI = 13.0%, 14.7%). From 1993 to 1998, percentages of tobacco-associated deaths reported on the check-box question increased steadily., Conclusions: The addition of a tobacco-associated-death check box on Texas death certificates significantly increased reporting of tobacco use contributions to mortality.

Objectives: We describe results from year 1 of a surveillance system to monitor body mass index in children at the state level., Methods: A sample of 6630 children attending Texas public schools, weighted to represent 4th, 8th, and 11th grades within race/ethnic subpopulations, was assessed. Body mass index was calculated from measured height and weight; demographic information was obtained from a questionnaire., Results: Prevalence of overweight was 22.4%, 19.2%, and 15.5% for 4th-, 8th-, and 11th-grade students, respectively. Overweight prevalence was highest among Hispanic boys (29.5%-32.6%), fourth-grade Hispanic girls (26.7%), and fourth- and eighth-grade African American girls (30.8% and 23.1%, respectively). Eleventh-grade White/other girls had the lowest prevalence of overweight (5.5%)., Conclusions: These data confirm the increasing prevalence of overweight among US children, especially among Hispanic and African American students compared to White/other students and fourth-grade students relative to 8th- and 11th-grade students.

Objectives: We compared types and frequencies of intimate partner violence experienced by women before and after receipt of a 2-year protection order., Methods: Participants were 150 urban English- and Spanish-speaking Black, Hispanic, and White women who qualified for a 2-year protection order against an intimate partner., Results: One woman committed suicide 6 weeks into the study. The remaining 149 women completed all interviews. Results showed significant reductions in threats of assault, physical assault, stalking, and worksite harassment over time among all women, regardless of receipt or nonreceipt of a protection order., Conclusions: Abused women who apply and qualify for a 2-year protection order, irrespective of whether or not they are granted the order, report significantly lower levels of violence during the subsequent 18 months.

Objectives: We examined the association between exposure to violence and asthma among urban children., Methods: We obtained reports from caretakers (n = 851) of violence, negative life events, unwanted memories (rumination), caretaker-perceived stress, and caretaker behaviors (keeping children indoors, smoking, and medication adherence). Outcomes included caretaker-reported wheezing, sleep disruption, interference with play because of asthma, and effects on the caretaker (nights caretaker lost sleep because of child's asthma)., Results: Increased exposure to violence predicted higher number of symptom days (P =.0008) and more nights that caretakers lost sleep (P =.02) in a graded fashion after control for socioeconomic status, housing deterioration, and negative life events. Control for stress and behaviors partially attenuated this gradient, although these variables had little effect on the association between the highest level of exposure to morbidity, which suggests there are other mechanisms., Conclusions: Mechanisms linking violence and asthma morbidity need to be further explored.

Objectives: We studied the impact of globalization on the making of health policy. Globalization is understood as economic interdependence among nations. The North American Free Trade Agreement is used as a marker to assess the effects of economic interdependence on binational health cooperation along the United States-Mexico border., Methods: We observed participants and conducted in-depth interviews with policymakers, public health specialists, representatives of professional organizations, and unions., Results: Globalization has not promoted binational health policy cooperation. Barriers that keep US and Mexican policymakers apart prevail while health problems that do not recognize international borders go unresolved., Conclusions: If international health problems are to be solved, political, cultural, and social interdependence need to be built with the same impetus by which policymakers promote international trade.

Objectives: The purpose of this study was to describe differences in childhood pesticide exposures between counties on the Texas-Mexico border and nonborder counties., Method: The authors reviewed all pesticide exposures among children younger than 6 years reported to the South Texas Poison Center during 1997 through 2000., Results: Nonborder counties had twice the reported exposure rate of border counties. Parents of border children were significantly less likely to contact the poison center after an exposure and more likely to have their children evaluated in a health care facility., Conclusions: Increasing residents' awareness of the poison center and identifying potential barriers to its use among residents of Texas-Mexico border communities may prevent unnecessary visits to health care facilities.

Objectives: This study examined knowledge about prostate-specific antigen (PSA) screening among African Americans and Whites. Because PSA screening for prostate cancer is controversial, professional organizations recommend informed consent for screening., Methods: Men (n = 304) attending outpatient clinics were surveyed for their knowledge about and experience with screening., Results: Most men did not know the key facts about screening with PSA. African Americans appeared less knowledgeable than Whites, but these differences were mediated by differences in educational level and experience with prostate cancer screening., Conclusions: Public health efforts to improve informed consent for prostate cancer screening should focus on highlighting the key facts and developing different approaches for men at different levels of formal education and prior experience with screening.

Objectives: This study investigated whether health problems among poor mothers of chronically ill children affect their ability to obtain and maintain employment., Methods: Mothers of children with chronic illnesses were surveyed at clinical and welfare agency sites in San Antonio, Tex., Results: There were distinct health differences according to mothers' TANF and employment status. Mothers without TANF experience reported better physical and mental health and less domestic violence and substance use than did those who had TANF experience. Those not currently working had higher rates of physical and mental health problems., Conclusions: Poor maternal health is associated with need for cash assistance and health insurance. Policymakers must recognize that social policies promoting employment will fail if they do not address the health needs of poor women and children.

Objectives: This study analyzed changes in the financing of prenatal care and delivery, the use of prenatal care, and birth outcomes among foreign-born vs US-born Latino women following enactment of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) in August 1996., Methods: We used a pre-post design with a comparison group. The sample consisted of resident Latinas in California, New York City, and Texas who delivered a live infant in 1995 or 1998., Results: The proportion of births to Latinas that initiated prenatal care in the first 4 months of pregnancy increased for all foreign-born Latinas in California, New York City, and Texas between 1995 and 1998 (P <.05). Except for non-Dominicans in New York City, there was no increase in the proportion of low- or very-low-birthweight births among foreign-born vs US-born Latinas in the 3 localities between 1995 and 1996., Conclusions: There is little evidence from vital statistics in California, New York City, and Texas that PRWORA had any substantive impact on the perinatal health and health care utilization of foreign-born relative to US-born Latinas.

Objectives: This study investigated the association between depression and substance use in a sample of middle-school students., Methods: The 5721 students (59%-63% Hispanic) completed self-report items on depressive symptoms, recent smoking and binge drinking, and lifetime use of marijuana, cocaine, and inhalants., Results: Symptoms of depression were strongly and positively related to substance use. For every type of use, a stepwise increase was seen between the percentage of students with low symptom frequency and the percentage of students with more symptoms. A sizable number of users reported symptoms indicating major depression. Depression scores showed few clinically meaningful differences among demographic subgroups. Substance use scores, in contrast, showed meaningful intergroup differences for racial/ethnic group and other demographic variables., Conclusions: Depressive symptoms and substance use were associated in a sample of middle-school students who were largely non-White and predominantly Hispanic. Greater understanding of the nature of this association is needed; this understanding should be used to design prevention programs, and prevention programs should be introduced at least in the middle-school years.

Objectives: This study determined the prevalence of food insecurity and hunger in low-income legal immigrants., Methods: We conducted a cross-sectional survey of Latino and Asian legal immigrants attending urban clinics and community centers in California, Texas, and Illinois with a food security questionnaire., Results: Among 630 respondents, 40% of the households were food insecure without hunger and 41% were food insecure with hunger. Independent predictors of hunger were income below federal poverty level (odds ratio [OR] = 2.72, 95% confidence interval [CI] = 1.72, 4.30), receipt of food stamps (OR = 2.53, 95% CI = 1.57, 4.09), Latino ethnicity (OR = 2.39, 95% CI = 1.49, 3.82), and poor English (OR = 1.76, 95% CI = 1.10, 2.82)., Conclusions: The prevalence of hunger among low-income legal immigrants is unacceptably high. Access to food assistance programs is important for the health and well-being of this population.

Objectives: This study determined factors associated with drug resistance among 3496 patients with tuberculosis who resided in Texas counties along the Mexican border., Methods: Univariate and logistic regression analyses were performed to identify risk factors associated with drug resistance., Results: Among patients with a history of previous tuberculosis, being 19 years or younger was the only factor associated with multiple drug resistance. Female sex, being 20 to 39 years of age, and foreign birth were risk factors for resistance among patients with no history of previous tuberculosis., Conclusions: Factors contributing to drug resistance among Hispanic tuberculosis patients along the Texas-Mexico border may differ from those among other populations in the United States.

Objectives: After a syphilis epidemic in Jefferson County, Texas, in 1993 and 1994, congenital syphilis prevalence and risk factors were determined and local prenatal syphilis screening practices were assessed., Methods: Medical records were reviewed, pregnant women with syphilis were interviewed, and prenatal care providers were surveyed., Results: Of 91 women, 59 (65%) had infants with congenital syphilis. Among African Americans, the prevalence per 1000 live births was 24.1 in 1994 and 17.9 in 1995. Of the 50 women with at least 2 prenatal care visits who had infants with congenital syphilis, 15 (30%) had received inadequate testing. Only 16% of 31 providers obtained an early third-trimester syphilis test on all patients., Conclusions: Inadequate prenatal testing contributed to this outbreak of congenital syphilis.