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Background: While the Texas infant mortality rate (IMR) is below the Healthy People 2020 objective (5.7 per 1,000 live births), stark differences in IMR are seen across Texas communities. Health indicators for the state suggest important missed opportunities for improving maternal and infant outcomes. The Healthy Families initiative was a collaboration between a Texas state agency, community partners, and academic institutions to understand how evidence based interventions could be identified, adapted, and implemented to address community priorities and reduce disparities in pregnancy outcomes. Method: The Healthy Families initiative included two Texas counties, one with low utilization of prenatal care and one with persistent disparities in infant mortality. The model served to (1) identify community factors influencing IMR and maternal morbidity through stakeholder engagement and secondary data, (2) build community capacity to link pregnant women with existing and newly developed services, and (3) develop partnerships within the community and clinics to improve access to and sustainability of services. Results: A community-based participatory approach focused on stakeholder engagement was used to identify, design, and adapt strategies to address community-identified priorities. Conclusions: The Healthy Families initiative is a unique state-community-academic partnership aimed at improving pregnancy outcomes in vulnerable communities, with a focus on promotion of capacity building, maintenance, and sustainability of maternal and infant health programs

Objective To describe health burden and health service utilization from the prenatal period to 1 year postpartum among women with births covered by Texas Medicaid, focusing on the major contributors to maternal mortality after 60 days postpartum in Texas. Methods We analyzed diagnoses and health service utilization during the prenatal, early postpartum (5-60 days postpartum), and late postpartum (> 60 days to 1 year postpartum) periods, using administrative medical claims data for women ages 18-44 years with a Medicaid-paid delivery in 2017 residing in selected regions in Texas (n = 49,302). Results Overall, 12.6% and 17.5% of women had diagnoses of cardiovascular/coronary conditions and substance use disorder, respectively. Mental health conditions affected 30% of women, with anxiety (47.1%) and depression (34.3%) accounting for the greatest proportion of diagnosed mental health conditions. The prevalence of these conditions was higher during the late (19.4%) versus early (9.9%) postpartum period. About 47.8% of women had other chronic health conditions, including obesity, diabetes mellitus, and hypertension. Among women with the selected health conditions, utilization of any health services was higher during the prenatal period compared to early and late postpartum periods (e.g., any mental health service utilization: prenatal period (57.4%) versus early postpartum (26.9%) and late postpartum (25.5%) periods). However, among women with the selected health conditions, there was a high utilization of emergency room services during the late postpartum period [e.g., emergency room service utilization among those with mental health conditions: prenatal period (35.6%); postpartum period: early (5.5%) and late (30.1%)]. Conclusions for Practice Increasing access to the full range of recommended services during the prenatal period through 1 year postpartum has potential to help improve vulnerable women's birth outcomes., Author(s): Meliha Salahuddin [sup.1] [sup.2] [sup.3] , Krystin J. Matthews [sup.2] [sup.3] , Nagla Elerian [sup.2] , Patrick S. Ramsey [sup.4] , David L. Lakey [sup.1] [sup.2] , Divya A. [...]

Background: The effectiveness of pre-exposure prophylaxis (PrEP) and non-occupational post-exposure prophylaxis (nPEP) in preventing HIV is well-established, yet their use in clinical practice remains low. Healthcare providers, especially those in primary and emergency care settings, play a crucial role in adopting and implementing these prevention strategies. We conducted a statewide survey with 519 healthcare providers in Texas to assess their knowledge, practices, and barriers related to prescribing PrEP and nPEP. Methods: The survey collected data on demographics, clinical experience, practice type, awareness of recommended guidelines, knowledge of PrEP and nPEP, prescribing practices, and challenges encountered to prescribe these medications. We used multiple regression analysis to identify factors associated with PrEP and nPEP prescribing behavior. Results: While most providers were familiar with CDC and/or USPSTF-recommended PrEP guidelines, fewer had adequate knowledge of nPEP. Key challenges identified by providers included concerns about cost (48%), limited time (40% for PrEP and 51% for nPEP), and insufficient education or training (40% for PrEP and 35% for nPEP). Providers who were more familiar with the recommended guidelines and had greater experience in sexual health assessment were more likely to prescribe both PrEP and nPEP. Conclusions: This study highlights the need for enhanced education and training to boost providers' knowledge and confidence in prescribing PrEP and nPEP. It also underscores the importance of addressing cost-related barriers and simplifying care processes to better integrate these HIV prevention strategies into primary and emergency care settings. [ABSTRACT FROM AUTHOR]

Objective: Despite declining cigarette smoking rates in the US, there is a continued need for tobacco prevention education campaigns to reach young adults. Recognizing the need for improved tobacco control messaging, the University of Texas (UT) System engaged The University of Texas at Austin Center for Health Communication to develop a brand and message that would strengthen tobacco control efforts at its 14 institutions. Methods: This article describes the iterative process involved in creating a brand for tobacco control, including an environmental scan, identifying potential message themes, and creating and refining logos. Results: This article highlights the process of developing a system-wide tobacco control brand. Specifically, the process included coordinating an interdisciplinary team with content and design experts, and presenting ideas to stakeholders for serial feedback and refinement, among others. Conclusions: Ultimately, this project offers a model for other systems of higher education interested in pursuing similar initiatives.

Introduction: Studies indicate that individuals with chronic conditions and specific baseline characteristics may not mount a robust humoral antibody response to SARS-CoV-2 vaccines. In this paper, we used data from the Texas Coronavirus Antibody REsponse Survey (Texas CARES), a longitudinal state-wide seroprevalence program that has enrolled more than 90,000 participants, to evaluate the role of chronic diseases as the potential risk factors of non-response to SARS-CoV-2 vaccines in a large epidemiologic cohort. Methods: A participant needed to complete an online survey and a blood draw to test for SARS-CoV-2 circulating plasma antibodies at four-time points spaced at least three months apart. Chronic disease predictors of vaccine non-response are evaluated using logistic regression with non-response as the outcome and each chronic disease + age as the predictors. Results: As of April 24, 2023, 18,240 participants met the inclusion criteria; 0.58% (N = 105) of these are non-responders. Adjusting for age, our results show that participants with self-reported immunocompromised status, kidney disease, cancer, and "other" non-specified comorbidity were 15.43, 5.11, 2.59, and 3.13 times more likely to fail to mount a complete response to a vaccine, respectively. Furthermore, having two or more chronic diseases doubled the prevalence of non-response. Conclusion: Consistent with smaller targeted studies, a large epidemiologic cohort bears the same conclusion and demonstrates immunocompromised, cancer, kidney disease, and the number of diseases are associated with vaccine non-response. This study suggests that those individuals, with chronic diseases with the potential to affect their immune system response, may need increased doses or repeated doses of COVID-19 vaccines to develop a protective antibody level. [ABSTRACT FROM AUTHOR]

Objectives Provision of long-acting reversible contraception (LARC) after delivery and prior to discharge is safe and advantageous, yet few Texas hospitals offer this service. Our study describes experiences of Texas hospitals that implemented immediate postpartum LARC (IPLARC) programs, in order to inform the development of other IPLARC programs and guide future research on system-level barriers to broader adoption. Methods Eight Texas hospitals that had implemented an IPLARC program were identified, and six agreed to participate in the study. Interviews with 19 key hospital staff covered (1) factors that led the development of an IPLARC program; (2) billing, pharmacy, and administrative operations related to implementation; (3) patient demand and readiness; (4) the consent process; (5) staff training; and (6) hospital plans for monitoring and evaluation of IPLARC services. Results Most hospitals in this study primarily served Medicaid and un- or under-insured populations. Participants from all six hospitals perceived high levels of patient demand for IPLARC and provider interest in providing this service. The major challenges were related to financing IPLARC programs. Participants from half of the hospitals reported that leadership had concerns about financial viability of providing IPLARC. The hospitals with the longest-running IPLARC programs were safety net hospitals with family planning training programs. Conclusions for Practice We found that hospitals with IPLARC programs all had strong support from both providers and hospital leadership and had funding sources to offset costs that were not reimbursed. Strategies to reduce the financial risks related to IPLARC provision could provide the impetus for new programs to launch and support their sustainability., Author(s): Ashley V. Hill [sup.1] [sup.2] , Eileen Nehme [sup.3] , Nagla Elerian [sup.3] , Ella D. Puga [sup.1] [sup.3] , Brandie D. Taylor [sup.2] [sup.4] , David Lakey [sup.3] [...]

Background Breakthrough infections of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are well documented. The current study estimates breakthrough incidence across pandemic waves, and evaluates predictors of breakthrough and severe breakthrough infections (defined as those requiring hospitalization). Methods In total, 89 762 participants underwent longitudinal antibody surveillance. Incidence rates were calculated using total person-days contributed. Bias-corrected and age-adjusted logistic regression determined multivariable predictors of breakthrough and severe breakthrough infection, respectively. Results The incidence was 0.45 (95% confidence interval [CI],.38–.50) during pre-Delta, 2.80 (95% CI, 2.25–3.14) during Delta, and 11.2 (95% CI, 8.80–12.95) during Omicron, per 10 000 person-days. Factors associated with elevated odds of breakthrough included Hispanic ethnicity (vs non-Hispanic white, OR = 1.243; 95% CI, 1.073–1.441), larger household size (OR = 1.251 [95% CI, 1.048–1.494] for 3–5 vs 1 and OR = 1.726 [95% CI, 1.317–2.262] for more than 5 vs 1 person), rural versus urban living (OR = 1.383; 95% CI, 1.122–1.704), receiving Pfizer or Johnson & Johnson versus Moderna, and multiple comorbidities. Of the 1700 breakthrough infections, 1665 reported on severity; 112 (6.73%) were severe. Higher body mass index, Hispanic ethnicity, vaccine type, asthma, and hypertension predicted severe breakthroughs. Conclusions Breakthrough infection was 4–25 times more common during the Omicron-dominant wave versus earlier waves. Higher burden of severe breakthrough infections was identified in subgroups. [ABSTRACT FROM AUTHOR]

Objective: To describe COVID-19 illness characteristics, risk factors, and SARS-CoV-2 serostatus by variant time period in a large community-based pediatric sample. Design: Data were collected prospectively over four timepoints between October 2020 and November 2022 from a population-based cohort ages 5 to 19 years old. Setting: State of Texas, USA. Participants: Participants ages 5 to 19 years were recruited from large pediatric healthcare systems, Federally Qualified Healthcare Centers, urban and rural clinical practices, health insurance providers, and a social media campaign. Exposure: SARS-CoV-2 infection. Main Outcome(s) and Measure(s): SARS-CoV-2 antibody status was assessed by the Roche Elecsys® Anti-SARS-CoV-2 Immunoassay for detection of antibodies to the SARS-CoV-2 nucleocapsid protein (Roche N-test). Self-reported antigen or PCR COVID-19 test results and symptom status were also collected. Results: Over half (57.2%) of the sample (N = 3911) was antibody positive. Symptomatic infection increased over time from 47.09% during the pre-Delta variant time period, to 76.95% during Delta, to 84.73% during Omicron, and to 94.79% during the Omicron BA.2. Those who were not vaccinated were more likely (OR 1.71, 95% CI 1.47, 2.00) to be infected versus those fully vaccinated. Conclusions: Results show an increase in symptomatic COVID-19 infection among non-hospitalized children with each progressive variant over the past two years. Findings here support the public health guidance that eligible children should remain up to date with COVID-19 vaccinations. [ABSTRACT FROM AUTHOR]

Accurate estimates of natural and/or vaccine-induced antibodies to SARS-CoV-2 are difficult to obtain. Although model-based estimates of seroprevalence have been proposed, they require inputting unknown parameters including viral reproduction number, longevity of immune response, and other dynamic factors. In contrast to a model-based approach, the current study presents a data-driven detailed statistical procedure for estimating total seroprevalence (defined as antibodies from natural infection or from full vaccination) in a region using prospectively collected serological data and state-level vaccination data. Specifically, we conducted a longitudinal statewide serological survey with 88,605 participants 5 years or older with 3 prospective blood draws beginning September 30, 2020. Along with state vaccination data, as of October 31, 2021, the estimated percentage of those 5 years or older with naturally occurring antibodies to SARS-CoV-2 in Texas is 35.0% (95% CI = (33.1%, 36.9%)). This is 3× higher than, state-confirmed COVID-19 cases (11.83%) for all ages. The percentage with naturally occurring or vaccine-induced antibodies (total seroprevalence) is 77.42%. This methodology is integral to pandemic preparedness as accurate estimates of seroprevalence can inform policy-making decisions relevant to SARS-CoV-2. [ABSTRACT FROM AUTHOR]

Introduction: Clinical settings are being encouraged to identify and address patients' social needs within the clinic or through partner organizations. The purpose of this qualitative study was to describe the current practice of social needs-targeted care in 3 Texas safety net clinics, and facilitators and barriers to adopting new social needs-targeted care tools and practices. Methods: Interviews were conducted with staff at 3 safety net clinics serving small and mid-sized communities. Analysis focused on perspectives and decisions around adopting new tools or practices related to social needs-targeted care, including standardized screening tools and community resource referral platforms. Results: Nine staff across 3 organizations were interviewed. Two organizations were currently using a standard social needs screening tool in their routine practice, and a third was considering doing so. One organization had adopted a community resource referral platform in partnership with a large community collaboration. Three case studies illustrate a range of facilitators, barriers, perceived benefits, and drawbacks influencing social needs-targeted practices. Benefits of systematic data collection on social needs included the generation of data for community action. Drawbacks include concerns about data privacy. Community resource referral platforms were seen as valuable for creating accountability, but required an influential community partner and adequate community resources. Concerns about disempowering clients and blurring roles were voiced, and potential to increase provider job satisfaction was identified. Conclusions: Benefits and drawbacks of adopting new tools and practices related to social needs-targeted care are strongly influenced by the community context. For the adoption of community resource referral platforms, the outer setting is particularly relevant; adoption readiness is best assessed at the community or regional level rather than the clinic system level. While screening tools are much easier than referral platforms for clinics to adopt, the ability to address identified needs remains heavily based on the outer setting. [ABSTRACT FROM AUTHOR]

Background: Severe maternal morbidity (SMM) prevalence was 194.0 per 10 000 deliveries in Texas in 2015. Chronic, behavioral, and pregnancy‐induced conditions, as captured by a maternal comorbidity index, increase the risk for delivery‐related morbidity and mortality. The objective of the study was to examine the association between maternal comorbidity index and SMM among delivery hospitalizations in Texas. Methods: Delivery‐related hospitalizations among Texan women aged 15‐49 years were identified using the 2011‐2014 Texas all‐payer inpatient hospitalization public use data files (n = 1 434 441). The primary outcome of interest was SMM, based on the Alliance for Innovation on Maternal Health's coding scheme. The exposure of interest was a maternal comorbidity index. Multivariable logistic regression model was used to examine the association between maternal comorbidity index and SMM. Results: SMM prevalence remained consistent between 2011 and 2014 (196.0‐197.0 per 10 000 deliveries, P >.05; n = 1 434 441). Nearly 40% of delivery‐related hospitalizations had a maternal comorbidity index of at least 1, and the proportion of deliveries in the highest risk category of comorbidity index (≥5) increased by 12.0% from 2011 to 2014. SMM prevalence was highest among the youngest and oldest age groups. With each unit increase in maternal comorbidity index, the odds of SMM increase was 1.43 (95% CI 1.42‐1.43). Conclusions: Maternal comorbidity index is associated with SMM; however, the low predictive power of the model suggests that other, unmeasured factors may influence SMM in Texas. These findings highlight a need to understand broader contextual factors (practitioner, facility, systems of care, and community) that may be associated with SMM to reduce maternal morbidity and mortality in Texas. [ABSTRACT FROM AUTHOR]

Background: Cesarean delivery accounts for over one‐third of the ~400 000 annual births in Texas, with first‐time cesarean accounting for 20% of the overall cesareans. We examined associations of maternal medical comorbidities with cesarean delivery among nulliparous, term, singleton, vertex (NTSV) deliveries in Texas. Methods: Nulliparous, term, singleton, vertex deliveries to women aged 15‐49 years were identified using the 2015 Texas birth file (Center for Health Statistics, Texas Department of State Health Services). A risk factor index was constructed (score range 0‐4), including preexisting/gestational diabetes mellitus, preexisting/gestational hypertension/eclampsia, infertility treatment, smoking during pregnancy, and prepregnancy overweight/obesity, and categorized as 0, 1, 2, and 3+ based on the number of risk factors present. Multivariable logistic regression analyses were conducted to examine associations between the categorized risk factor index and cesarean delivery, overall and by maternal race and ethnicity. Results: Among the 114 535 NTSV deliveries in Texas in 2015, 27.2% were by cesarean. The most prevalent maternal risk among all deliveries was prepregnancy overweight/obesity (42.4%). The odds of cesarean delivery increased significantly with increasing number of risk factors [one risk factor: 1.72 (95% CI 1.67‐1.78); two risk factors: 2.58 (95% CI 2.46‐2.71); and three or more risk factors: 3.91 (95% CI 3.45‐4.44)]. Discussion: In Texas in 2015, nearly half of NTSV deliveries had at least one maternal risk factor and the odds of cesarean delivery were significantly elevated for women with a higher risk index score. The findings from this study highlight the need for intervening during the preconception and interconception period as intrapartum care practices have an important influence on birth outcomes. [ABSTRACT FROM AUTHOR]

Background: Induction of labor (IOL) is increasingly common in the United States, yet characteristics associated with IOL among primiparous women delivering at term are not well understood. Materials and Methods: Data from the Listening to Mothers III study, a survey of women aged 18–45 with singleton deliveries in U.S. hospitals in 2011–2012, were utilized. Weighted logistic regression models examined predictors of IOL among 924 primiparous women with term deliveries. Associations of maternal characteristics with delivery route (cesarean and vaginal delivery) were examined among primiparous women induced at term. Results: Four hundred twenty-three (45.8%) primiparous women with term deliveries underwent IOL; subjective reasons were reported by 53% of induced women. Women who were married (odds ratios [OR] = 1.8, 95% confidence intervals [CI] 1.2–2.9), felt pressure from a provider for IOL (OR = 3.5, 95% CI 2.0–6.2), and whose provider was concerned about the size of the baby (OR = 1.9, 95% CI 1.2–2.9) were significantly more likely to undergo IOL. Nearly 30% of primiparous women who underwent IOL at term had a cesarean delivery (CD). Among the induced women, those who were overweight/obese (OR = 4.9, 95% CI 2.5–10.0), felt pressure from a provider for CD (OR = 8.6, 95% CI 3.5–21.2), and whose provider suspected the baby might be getting large near end of pregnancy (OR = 2.7, 95% CI 1.1–7.0) were significantly more likely to have CD. Conclusions: In this study, nearly half of the primiparous women with term deliveries underwent IOL, with a sizeable proportion reporting subjective reasons for induction. A better understanding of the characteristics associated with IOL at term may help reduce unnecessary interventions and, ultimately, primary CD. [ABSTRACT FROM AUTHOR]

Health care personnel (HCP) caring for patients with Ebola virus disease (EVD) are at increased risk for infection with the virus. In 2014, a Texas hospital became the first U.S. community hospital to care for a patient with EVD; 2 nurses were infected while providing care. This article describes infection control measures developed to strengthen the hospital's capacity to safely diagnose and treat patients with EVD. After admission of the first patient with EVD, a multidisciplinary team from the Centers for Disease Control and Prevention (CDC) joined the hospital's infection preventionists to implement a system of occupational safety and health controls for direct patient care, handling of clinical specimens, and managing regulated medical waste. Existing engineering and administrative controls were strengthened. The personal protective equipment (PPE) ensemble was standardized, HCP were trained on donning and doffing PPE, and a system of trained observers supervising PPE donning and doffing was implemented. Caring for patients with EVD placed substantial demands on a community hospital. The experiences of the authors and others informed national policies for the care of patients with EVD and protection of HCP, including new guidance for PPE, a rapid system for deploying CDC staff to assist hospitals ("Ebola Response Team"), and a framework for a tiered approach to hospital preparedness. The designation of regional Ebola treatment centers and the establishment of the National Ebola Training and Education Center address the need for HCP to be prepared to safely care for patients with EVD and other high-consequence emerging infectious diseases. [ABSTRACT FROM AUTHOR]

The mobile insertion sequence, IS 6110, is an important marker in tracking of Mycobacterium tuberculosis strains. Here, we demonstrate that IS 6110 can upregulate downstream genes through an outward-directed promoter in its 3′ end, thus adding to the significance of this element. Promoter activity was orientation dependent and was localized within a 110 bp fragment adjacent to the right terminal inverted repeat. Transcripts from this promoter, named OP6110, begin ≈ 85 bp upstream of the 3′ end of IS 6110. Use of green fluorescent protein (GFP) expression constructs showed that OP6110 was upregulated in M. tuberculosis during growth in human monocytes and in late growth phases in broth. Analysis of natural insertion sites in M. tuberculosis showed that IS 6110 upregulated expression of several downstream genes during growth in human monocytes, including Rv2280 in H37Rv and the PE-PGRS gene, Rv1468c, in the clinical strain 210, which is a member of the Beijing family. Transcription between IS 6110 and downstream genes was confirmed by reverse transcription polymerase chain reaction. The ability to activate genes during infection suggests that IS 6110 has the potential to influence growth characteristics of different strains, and indicates another mechanism by which IS 6110 can impact M. tuberculosis evolution. [ABSTRACT FROM AUTHOR]

The ability of Mycobacterium tuberculosis to grow in macrophages is central to its pathogenicity. We found previously that the widespread 210 strain of M. tuberculosis grew more rapidly than other strains in human macrophages. Because principal sigma factors influence virulence in some bacteria, we analysed mRNA expression of the principal sigma factor, sigA, in M. tuberculosis isolates during growth in human macrophages. Isolates of the 210 strain had higher sigA mRNA levels and higher intracellular growth rates, compared with other clinical strains and the laboratory strain H37Rv. SigA was also upregulated in the 210 isolate TB294 during growth in macrophages, compared with growth in broth. In contrast, H37Rv sigA mRNA levels did not change under these conditions. Overexpression of sigA enhanced growth of recombinant M. tuberculosis in macrophages and in lungs of mice after aerosol infection, whereas recombinant strains expressing antisense transcripts to sigA showed decreased growth in both models. In the presence of superoxide, sense sigA transformants showed greater resistance than vector controls, and the antisense sigA transformant did not grow. We conclude that M. tuberculosis sigA modulates the expression of genes that contribute to virulence, enhancing growth in human macrophages and during the early phases of pulmonary infection in vivo. This effect may be mediated in part by increased resistance to reactive oxygen intermediates. [ABSTRACT FROM AUTHOR]

Evaluates the mRNA expression of multiple mycobacterial genes. Competitive reverse-transcriptase polymerase chain reaction; Hybridization of mycobacterial cDNA to Mycobacterium tuberculosis microarray; Primers used for amplification of mycobacterial genes.

Background. Histochemical staining of bone marrow biopsy samples for microorganisms may provide a presumptive diagnosis weeks before culture. Methods. To identify predictors of histochemical positivity, we reviewed 161 bone marrow biopsies from febrile patients with human immunodeficiency virus (HIV) infection. Results. By multivariate analysis, both hematocrit value <30% and white blood cell count <4,000/mm[sup 3] predicted biopsy positivity by culture or staining, but only anemia predicted histochemical stain positivity. Of cases with serum lactate dehydrogenase (LDH) levels >600 U/L, histoplasmosis was diagnosed in 31.6% versus 7.8% with lower LDH levels. Among histoplasmosis cases, staining showed fungi in all, with LDH levels >600 U/L versus 44.4% with lower levels. Conclusions. Bone marrow biopsy will most likely provide a rapid diagnosis in patients with anemia. Markedly elevated LDH levels suggest stain positivity for Histoplasma capsulatum . Histopathologic patterns may also guide empiric therapy. [ABSTRACT FROM AUTHOR]

Research Objective: The purpose of this qualitative study was to describe the current practice of social needs‐targeted care in three Texas safety net clinics, and facilitators and barriers to adopting new social needs‐targeted care tools and practices. Study Design: This qualitative, case‐comparison study used data from with staff at three safety net clinics serving small and mid‐sized communities. Analysis focused on perspectives and decisions around adopting new tools or practices related to social needs‐targeted care, including standardized screening tools and community resource referral platforms. Population Studied: Nine staff across three organizations were interviewed. Organization A is a five‐clinic FQHC serving two rural communities. Organization B is an independent pediatric clinic that provides medical and dental care from birth to age 21, in a mid‐sized community. Organization C is an FQHC with 12 sites serving small and mid‐sized communities. All three served patients regardless of their ability to pay. Principal Findings: Organizations B and C were currently using a standard social needs screening tool in their routine practice, and organization A was considering doing so. Organization C had adopted a community resource referral platform in partnership with a large community collaboration. The three case studies illustrate a range of facilitators, barriers, perceived benefits, and drawbacks influencing social needs‐targeted practices. Beyond the potential usefulness of social needs screening tools to help facilitate social needs‐targeted care, interviewees from all three organizations mentioned their potential value to create aggregated social needs data to understand community problems. Drawbacks include concerns about data privacy. Community resource referral platforms were seen as valuable for creating accountability, but required an influential community partner and adequate community resources. The most salient theme related to referral platform adoption was the importance of the community context, or outer setting. Clinics can play a leadership role, but cannot establish a referral platform without a larger community coalition or organizing force and well‐resourced community partners. The CEO from Organization A did not think their community social service organizations had the technological or staffing capacity to participate in a referral platform. The pediatrician interviewed from Organization B felt her clinic wasn't influential enough to get the needed buy‐in from all the community partners. Concerns about disempowering clients and blurring roles by providing social needs‐targeted care and unintentionally disempowering clients were also voiced, and the potential beneficial impact on provider job satisfaction with an effective system for social needs‐targeted care provision in place was identified. Conclusions: Benefits and drawbacks of adopting new tools and practices related to social needs‐targeted care are strongly influenced by the community context. For the adoption of community resource referral platforms, the outer setting is particularly relevant. While screening tools are much easier than referral platforms to adopt, the ability of a clinic to address identified needs remains heavily based on the outer setting. Implications for Policy or Practice: Adoption readiness related to social needs‐targeted care interventions should be assessed at the community or regional level in addition to the clinic system level, and implementation may be most effective at a community or regional level. Primary Funding Source: Episcopal Health Foundation. [ABSTRACT FROM AUTHOR]

The article discusses aspects of disaster management in Texas. The topics discussed include importance of being prepared for emergencies, Texas Department of State Health Services preparedness for dealing with emergencies, public health surveillance and investigations in Texas. Also discussed is the role of State Medical Operations Center (SMOC) in deployment of medical resources.

In this article the author comments on the impact of disasters in Texas. The author mentions that Texas has experienced more disasters than other states in the country, affecting thousands of individuals. Moreover, he suggests that preparations and change in behavior are needed in minimizing the impact of disaster on the state.

The author discusses the aim of the Department of State Health Services (DSHS) to improve public health in Texas as he attended the Texas Legislature gathering on January 13, 2009. He reveals that he tackles the DSHS appropriations request during the hearing. The inclusion of state hospital services, family planning reimbursement, and department operational costs to maintain operational capacity of DSHS are also examined.

The article discusses the concept of the campaign called "Ready or Not? HAVE A PLAN. It features radio, television, newspaper and outdoor advertising, community outreach events and an interactive Website to encourage people in Texas to create an emergency plan. This has been funded by the Centers for Disease Control and Prevention for public health preparedness.

The article discusses the author's experience of participating in the 80th Texas Legislature session held in 2007. He was able to observe how policy and budgets are made through the legislative process. As commissioner of the Texas Department of State Health Services (DSHS), he was mostly involved in the budgetary process. The author realized the importance of support in the community during the process.

The article focuses on issues related to public health in Texas. The author mentions that his interest in public health has been drawn by his realization that the root causes of diseases can be avoided through prevention instead of a medical approach. He states that the Texas Department of State Health Services must use an extensive approach to the physical and behavioral health challenges being faced by the state.

The article focuses on the healthcare services provided by the Baptist Child and Family Services (BCFS) and the U.S. Office of Refugee Resettlement (ORR) on children refugees in Texas Hill Country in Texas. It mentions that the medical services provided by the BCFS through its bilingual nurses and on-site pediatricians is thorough and excellent. It discusses the other services provided for to the said children.

The author reflects on the opportunities for the improvement of public health in Texas in 2013.

The article comments on prevention of chronic diseases in Texas. It has been informed that Texas has a higher prevalence of most chronic diseases with heart disease and stroke are the first and fourth leading causes of death in Texas. It has been informed that by addressing risk factors like inadequate physical activity, tobacco use, poor nutrition and substance abuse, chronic diseases could be mitigated.

The article presents the author's views regarding diagnosis and treatment of acquired immunodeficiency syndrome (AIDS). He discusses the role of local health departments in assessing risk, evaluation, epidemiologic assessment, research, planning and medical care for AIDS. He further reports that Texas has support from state legislature for raising awareness and providing medication for AIDS.

The article focuses on the recommendation of the Center of Dieses Control and Prevention about the screening for human immunodeficiency virus (HIV) in Texas. The medical center advocates that all citizens between 13-64 years old will be screened for HIV as part of medical practice. On the other hand, it mentions that one among the three people was diagnosed with AIDS within a year of getting their first diagnosis of HIV infection in previous five years.

The article discusses the implications the active hurricane season in 2008 in Texas. According to the author, this season has called into play all the planning and response resources that the state can muster. The article also discusses topics on public health preparedness and response including emergency management, disaster coordination, and community volunteers.