Holly E. Jacobson

Evaluating the disparity of female breast cancer mortality among racial groups - a spatiotemporal analysis

BackgroundThe literature suggests that the distribution of female breast cancer mortality demonstrates spatial concentration. There remains a lack of studies on how the mortality burden may impact racial groups across space and over time. The present study evaluated the geographic variations in breast cancer mortality in Texas females according to three predominant racial groups (non-Hispanic White, Black, and Hispanic females) over a twelve-year period. It sought to clarify whether the spatiotemporal trend might place an uneven burden on particular racial groups, and whether the excess trend has persisted into the current decade.MethodsThe Spatial Scan Statistic was employed to examine the geographic excess of breast cancer mortality by race in Texas counties between 1990 and 2001. The statistic was conducted with a scan window of a maximum of 90% of the study period and a spatial cluster size of 50% of the population at risk. The next scan was conducted with a purely spatial option to verify whether the excess mortality persisted further. Spatial queries were performed to locate the regions of excess mortality affecting multiple racial groups.ResultsThe first scan identified 4 regions with breast cancer mortality excess in both non-Hispanic White and Hispanic female populations. The most likely excess mortality with a relative risk of 1.12 (p = 0.001) occurred between 1990 and 1996 for non-Hispanic Whites, including 42 Texas counties along Gulf Coast and Central Texas. For Hispanics, West Texas with a relative risk of 1.18 was the most probable region of excess mortality (p = 0.001). Results of the second scan were identical to the first. This suggested that the excess mortality might not persist to the present decade. Spatial queries found that 3 counties in Southeast and 9 counties in Central Texas had excess mortality involving multiple racial groups.ConclusionSpatiotemporal variations in breast cancer mortality affected racial groups at varying levels. There was neither evidence of hot-spot clusters nor persistent spatiotemporal trends of excess mortality into the present decade. Non-Hispanic Whites in the Gulf Coast and Hispanics in West Texas carried the highest burden of mortality, as evidenced by spatial concentration and temporal persistence.

Self-Assessed Emergency Readiness and Training Needs of Nurses in Rural Texas

OBJECTIVE Nurses, particularly public health nurses, play a key role in emergency preparedness and response in rural areas. To prepare rural jurisdictions for unforeseen disastrous events it is imperative to assess the public health emergency readiness and training needs of nurses. The objective of this study was to assess the self-reported terrorism preparedness and training needs of a nurse workforce. DESIGN AND SAMPLE Cross-sectional prevalence of practicing nurses in regions of North Texas. 3,508 rural nurses practicing in North Texas participated in the study. MEASUREMENTS Data were collected through a mailed survey; analyses included multinominal logistic regression and descriptive statistics. RESULTS A total of 941 (27%) nurses completed the survey. The majority of respondents reported limited bioterrorism-related training. Fewer than 10% were confident in their ability to diagnose or treat bioterrorism-related conditions. Although only 30% expressed a willingness to collaborate with state and local authorities during a bioterrorism event, more than 69% indicated interest in future training opportunities. Preferred training modalities included small group workshops with instructor-led training, and Internet-based training. CONCLUSIONS Licensing agencies, professional organizations, and community constituencies may need to play a stronger role in improving the bioterrorism-related emergency preparedness of rural nurses.

Predictors of English Health Literacy among U.S. Hispanic Immigrants: The importance of language, bilingualism and sociolinguistic environment

In the United States, data confirm that Spanish-speaking immigrants are particularly affected by the negative health outcomes associated with low health literacy. Although the literature points to variables such as age, educational background and language, only a few studies have investigated the factors that may influence health literacy in this group. Similarly, the role that bilingualism and/or multilingualism play in health literacy assessment continues to be an issue in need of further research. The purpose of this study was to examine the predictors of English health literacy among adult Hispanic immigrants whose self-reported primary language is Spanish, but who live and function in a bilingual community. It also explored issues related to the language of the instrument. An analysis of data collected through a randomized controlled study was conducted. Results identified English proficiency as the strongest predictor of health literacy (p < 0.001). The results further point to the importance of primary and secondary language in the assessment of heath literacy level. This study raises many questions in need of further investigation to clarify how language proficiency and sociolinguistic environment affect health literacy in language minority adults; proposes language approaches that may be more appropriate for measuring health literacy in these populations; and recommends further place-based research to determine whether the connection between language proficiency and health is generalizable to border communities.

Health literacy level of Hispanic college students.

Objectives The purpose of this study was to assess the health literacy levels of Hispanic college students. Methods Participants were students at a major Hispanic-serving university in the southwestern United States. The design was cross-sectional, and data were collected using the Newest Vital Sign in English. Analyses included frequencies and descriptive statistics, simple and multiple logistic regression, and &khgr;2/Fisher exact tests. Results A total of 331 students participated. The overall Newest Vital Sign mean score was 5.1 (standard deviation 1.18); more than 90% (n = 299) obtained a score equivalent to an “always adequate literacy.” A lower percentage than that found by a national survey scored at the “below adequate literacy” level. Language spoken at home was the only covariate that significantly affected test scores (P = 0.01). Conclusions The overall health literacy level of the participants was higher than the general Hispanic adult population. Investing in the education of Hispanics may help to address disparities in health literacy.

Assessing Bioterrorism Preparedness and Response of Rural Veterinarians: Experiences and Training Needs

Veterinarians play a unique role in emergency preparedness and response, and federal agencies and academic institutions therefore allocate considerable resources to provide training to enhance their readiness. However, the level of preparedness of veterinarians in many rural regions is yet to be improved. This article reports an assessment of the bioterrorism preparedness, specifically the experience and training needs, of rural veterinarians in North Texas. The study employed a cross-sectional design with a study population that included all veterinarians (N = 352) in the 37 counties within Texas Department of State Health Services Regions 2 and 3. Data on veterinarians practicing or residing in the target region were obtained from the Texas State Board of Veterinary Medical Examiners. The response rate was 35% (n = 121). Results indicate that chemical exposure was the condition most frequently seen and treated, followed by botulism and anthrax. The majority (80%) of respondents indicated that they had not previously participated in training related to bioterrorism preparedness, and many (41%) also indicated a willingness to participate in a state health department-initiated bioterrorism response plan. However, only 18% were confident in their ability to diagnose and treat bioterrorism cases. These results suggest that many North Texas veterinarians practicing in rural regions could benefit from additional training in bioterrorism preparedness and response. An area in particular need of further training is the diagnosis and treatment of Category A agents. Federal, state, and local health agencies are urged to increase training opportunities and to make additional efforts to involve veterinarians in bioterrorism preparedness and response.

Adult Education and the Health Literacy of Hispanic Immigrants in the United States

ABSTRACT Discussion on the advantages of integrating health literacy into adult education has primarily been theoretical and conceptual. There is a need for studies that assess the impact of adult education on health literacy. This study implemented a quasi-experimental design to explore whether basic adult instruction may constitute a venue for improving health literacy among Spanish-speaking immigrants. Participants included adults in a High School Equivalency program in a US-Mexico border community who received either a standard GED curriculum or a GED curriculum enhanced with health literacy content. The Short Spanish TOFHLA was used to measure health literacy. While S-TOFHLA scores and health literacy levels improved in all participants, no statistically significant differences were observed across groups. Results are consistent with recommendations supporting adult education as a strategy for improving health literacy.

An Interdisciplinary Theory-Based ESL Curriculum to Teach English as a Second Language

Among Hispanic immigrants in the United States (US), learning English is considered necessary for economic and social achievement. Asa consequence, there is a high demand for English as a Second Language (ESL) classes. Despite the recognized benefits of ESL programs,both at the individual and social levels, more research is needed to identify education strategies that effectively promote all aspects of learningEnglish as a second language. This article describes an ESL curriculum that incorporates a theory-based pedagogical approach specificallydesigned for immigrant Hispanic adults on the US-Mexico border region. The article also describes the implementation of the curriculum aswell as the results of the evaluation, which was conducted using both quantitative and qualitative methods. Quantitative results indicate thatthe participants significantly improved their English proficiency (L2). Qualitative results suggest that participants were positively impactedby both the content and pedagogical approaches used by the curriculum. Their experience with the ESL class was positive in general. It canbe concluded that the curriculum achieved its objective. This approach could serve as a model for second language teaching for adults

A Cardiovascular Health Intervention for Spanish Speakers: The Health Literacy and ESL Curriculum

Spanish speakers in the United States are in need of effective interventions that address both cardiovascular disease (CVD) and health literacy. However, the literature lacks interventions that have used and evaluated a strategies that focus on both, particularly at the community level. The aim of this study was to explore the effect of a health literacy curriculum on cardiovascular health behavior among Spanish speaking adults. It used a randomized controlled pre-posttest design. Participants included Hispanic adults with a low-to-intermediate level of English proficiency. The intervention group received the health literacy and English as a second language (ESL) Curriculum with CVD specific content, while the control group received a conventional ESL curriculum. Tools included the Spanish Cardiovascular Health Questionnaire (CSC), the test of functional health literacy in adults (TOFHLA), and the Combined English Language Skills Assessment. Analysis of change scores included independent sample t test and multiple linear regression. A total of 155 participants completed the study. There was a significant greater improvement for the intervention group in change of CSC score from pretest to posttest (P = 0.049) compared to controls. The study also found significantly improved TOFHLA (P = 0.011), however it did not find a relationship between changes in CVD behavior and health literacy or English proficiency. The Health Literacy and ESL Curriculum constitutes a valuable resource for addressing the cardiovascular health, literacy, and language needs of Spanish-speaking adults. Interventions that take a multilevel education and health approach may be more effective in addressing the needs of immigrants. Research should further explore the interactions between CVD behavior, health literacy, and English proficiency.

Advancing Health Literacy Among Hispanic Immigrants: The Intersection Between Education and Health:

Health literacy is a priority issue in both medicine and public health, as it refers to the capacity to obtain and understand basic health information and services and to make appropriate health decisions. Health literacy has been associated with a variety of health care and health outcomes such as hospital admissions, use of preventive services, management of chronic conditions, and mortality. There is also evidence of the connection between low health literacy and health disparities. Despite federal and private efforts, improving health literacy has proven to be an enormous challenge. The negative health consequences of low health literacy are being experienced by most minority groups; however, health literacy is particularly relevant to Spanish speakers. Although disparities in health literacy among language minorities have been sufficiently identified and reported, there continue to exist fundamental research gaps. This article discusses health literacy research and practice gaps affecting Spanish speakers and recommends educational opportunities as an effective strategy for improving the health literacy level of Hispanic immigrants.

Communicating H1N1 Risk to College Students: A Regional Cross-Sectional Survey Study

Abstract The purpose of this study was to assess university students’ self-reported knowledge, behavior, and behavioral intention regarding H1N1 influenza. Participants included students at a major university in the southwestern US. Data were collected in early spring 2010 through a 24-item self-administered survey. Outcome variables included knowledge, behavior and intention. A total of 483 students participated. Most reported trying to prevent H1N1 influenza though specific behaviors. Many lacked knowledge about symptoms and treatment; a few (10%) had been vaccinated; and half had no intention of getting vaccinated or practicing self-isolation. Gender and age were significantly associated with the three outcome variables. Intention was the most significant contributor to behavior [t (1) = 3.34, p<.001]. H1N1 influenza campaigns directed toward university students in the US should focus on undergraduate, male students, and revise their strategies regarding vaccination and self-isolation.