Texas Department of State Health Services

HighlightsWhat are the main findings?•Watching TV and playing video/computer games has differential associations with sleep duration among adolescents, and these associations differ by grade, gender, and ethnicity.What are the implications of the main findings?•These contextual differences in screentime should be considered when exploring how media use influences other health behaviors and outcomes. Researchers and policymakers involved in creating screentime guidelines should take into account the differences between passive and interactive media use. In essence, not all screentime is created equally.Background: Although several studies have reported associations between screentime and shortened sleep duration among adolescents, contextual relationships between different forms of screentime are not well understood. The purpose of this study was to examine how television (TV) watching (passive media use) and video/computer gaming (interactive media use) are associated with short sleep duration among 8th and 11th grade adolescents. Methods: We used data from adolescents (8th and 11th grade students) who participated in the Texas School Physical Activity and Nutrition (Texas SPAN) survey in 2015–2016. Sleep duration was the outcome variable, which was dichotomized into short sleep duration (less than 8 h) and meeting sleep recommendations (more than 8 h). Independent variables included daily TV screentime and video/computer game screentime. We used weighted logistic regression models to understand associations between sleep duration and both TV screentime and video/computer game screentime. Results: Among both 8th grade boys and Hispanic 8th grade girls, spending more than 2 h/day playing video/computer games was associated with greater odds of shorter sleep duration. Among 11th graders, TV screentime was associated with lower odds of shorter sleep duration. Conclusions: Watching TV and playing video/computer games have differential associations with sleep duration among adolescents, and these associations differ by grade, gender, and ethnicity. Researchers and public health agencies interested in associations between meeting sleep recommendations and screentime in adolescents should consider these contextual differences when designing and conducting studies related to electronic media use and sleep.

People with HIV (PWH) have increased Kaposi sarcoma (KS) risk. Among 2,645 PWH with KS in the United States HIV/AIDS Cancer Match Study, subsequent cancer risk was elevated 2.8-fold (95% confidence interval [CI]: 2.4–3.3) compared to PWH without KS. Mortality after KS declined 2000–2002 and 2012–2015 (hazard ratio = 0.64; 95%CI: 0.55–0.74).Supplementary InformationThe online version contains supplementary material available at 10.1007/s10552-025-02105-0.

The rate of preterm birth among infants with trisomy 21 (22%) is around twice that among the general population (10%). We conducted a descriptive epidemiologic study to address the gap in knowledge on what maternal and infant factors are associated with preterm birth among infants with trisomy 21. Singleton infants with trisomy 21 born between 1999 and 2018 were identified from the Texas Birth Defects Registry. We used multivariable logistic regression to assess associations between preterm birth and 14 maternal and infant characteristics. Statistically significant associations were observed between preterm birth and maternal race/ethnicity, maternal age, maternal birthplace, prenatal care, smoking, infant sex, and infant delivery year. For instance, preterm birth was associated with maternal age (adjusted odds ratio [aOR] 1.44, 95% CI: 1.23-1.70 for ≥ 40 vs. 25-29 years) and prenatal care (aOR 1.59, 95% CI: 1.25-2.03 for no care versus any care). Our findings contribute toward a better understanding of the risk profile of preterm birth among infants with trisomy 21 and can guide further research on risk factors and potential interventions for reducing preterm birth rates in this population.

Down syndrome (DS) is a common chromosomal aneuploidy characterized by intellectual disability. Older maternal age is the strongest known risk factor for DS. The purpose of this study was to describe DS prevalence among major racial/ethnic groups stratified by maternal age, and to assess trends in prevalence over time in Texas. Cases with DS diagnoses delivered between 1999 and 2020 were identified from the Texas Birth Defects Registry (TBDR). Birth prevalence and crude prevalence ratios (PRs) by maternal race/ethnicity, maternal education, residence along the Texas-Mexico border, and Texas public health region (PHR) were calculated. Trends over time were assessed using Joinpoint. DS prevalence was significantly lower among mothers < 35 years compared to those 35+ years. Hispanic mothers, mothers with less than high school education, and mothers residing along the Texas-Mexico border had consistently higher PRs. Joinpoint analyses revealed significant increases in DS prevalence over time among non-Hispanic Black and Hispanic mothers. These findings identified significant increases in DS prevalence among non-Hispanic Black and Hispanic mothers compared to non-Hispanic White mothers, suggesting a potential widening of racial/ethnic differences in DS occurrence. Further research is needed to explore underlying drivers of these trends and to address differences in DS prevalence.

A variety of elements, such as architecture, written material, usability, credibility, and accessibility, are evaluated when determining the quality of a website. Layout, aesthetics, and navigation are design components that influence user engagement and experience. The material on high-quality websites is useful, timely, and well-organized. Usability emphasizes on the user interface's simplicity, search capabilities, and ease of navigating. Websites should enable user interactions and offer a smooth surfing experience. Analyzing the authority, knowledge, and correctness of the information supplied entails determining the sources' reputation and dependability. Customer retention has emerged as a crucial element for long-term performance and profitability in the fiercely competitive telecoms sector. In order to keep their current client base, telecom businesses must put in place successful strategies since customers have more alternatives and mobility when selecting service providers. This introduction gives an overall summary of customer retention methods used in the telecommunications industry, emphasizing their importance in preserving long-term client relationships and enhancing operational efficiency. Client retention strategies are a collection of actions and programmers designed to lower churn, develop loyalty, and raise client lifetime value. Telecom firms may reduce the expenses of obtaining new customers and gain from the income produced by devoted, long-term consumers by concentrating on customer retention. Providing outstanding customer service is a key tactic in client retention It is crucial to comprehend and put into practice efficient client retention tactics in the telecoms sector. For telecom firms, it provides numerous significant advantages: Increased Profitability: client retention techniques assist in reducing client turnover, which may be expensive in terms of revenue loss and acquisition costs. Retaining current customers allows telecom firms to increase customer lifetime value, which boosts profitability. Effective client retention tactics provide businesses a competitive edge in the fiercely contested telecoms sector. Telecom operators can set themselves apart from their rivals, draw in repeat business, and keep their current clientele by offering excellent customer experiences and individualized services. In the telecommunications sector, the methodology for researching client retention tactics often combines both qualitative and quantitative methods of research. Here is a summary of the popular methodologies: Data collection: Information on client retention, such as rate of churn, customer satisfaction ratings, and engagement indicators, is obtained from telecom firms. This information offers a starting point for assessing the efficacy of various client retention methods. Surveys and survey responses: Surveys are carried out to obtain input from customers on their satisfaction, loyalty, and opinions of various retention techniques. Online platforms, emails, and phone interviews are all options for distributing questionnaires. Trust, Reliability, Security, Accuracy and Awareness Security clearly outweighs other considerations like reliability, accuracy, knowledge, and trust. This shows that customers give top attention to a secure online environment that protects their personal data. The emphasis on reliability demonstrates that users expect trustworthy, reliable service from websites. Additionally underlined is accuracy, underscoring how crucial it is to deliver reliable information. The significance of awareness argues that customers like websites that make their objectives and service offerings apparent.

Traditional strategies for grouping congenital heart defects (CHDs) using birth defect registry data do not adequately address differences in expected clinical consequences between different combinations of CHDs. We report a lesion-specific classification system for birth defect registry-based outcome studies. For Core Cardiac Lesion Outcome Classifications (C-CLOC) groups, common CHDs expected to have reasonable clinical homogeneity were defined. Criteria based on combinations of Centers for Disease and Control-modified British Pediatric Association (BPA) codes were defined for each C-CLOC group. To demonstrate proof of concept and retention of reasonable case counts within C-CLOC groups, Texas Birth Defect Registry data (1999-2017 deliveries) were used to compare case counts and neonatal mortality between traditional vs. C-CLOC classification approaches. C-CLOC defined 59 CHD groups among 62,262 infants with CHDs. Classifying cases into the single, mutually exclusive C-CLOC group reflecting the highest complexity CHD present reduced case counts among lower complexity lesions (e.g., 86.5% of cases with a common atrium BPA code were reclassified to a higher complexity group for a co-occurring CHD). As expected, C-CLOC groups had retained larger sample sizes (i.e., representing presumably better-powered analytic groups) compared to cases with only one CHD code and no occurring CHDs. This new CHD classification system for investigators using birth defect registry data, C-CLOC, is expected to balance clinical outcome homogeneity in analytic groups while maintaining sufficiently large case counts within categories, thus improving power for CHD-specific outcome association comparisons. Future outcome studies utilizing C-CLOC-based classifications are planned.

Emerging evidence suggests newborn screening analytes may yield insights into the etiologies of birth defects, yet no effort has evaluated associations between a range of newborn screening analytes and birth defects. This population-based study pooled statewide data on birth defects, birth certificates, and newborn screening analytes from Texas occurring between January 1, 2007 and December 31, 2009. Associations between a panel of thirty-six newborn screening analytes, collected by the statewide Texas Newborn Screening Program, and the presence of a birth defect, defined as at least one of 39 birth defects diagnoses recorded by the Texas Birth Defects Registry, were assessed using regression analysis. Of the 27,643 births identified, 20,205 had at least one of the 39 birth defects of interest (cases) as identified by the Texas Birth Defects Registry, while 7,438 did not have a birth defect (controls). Among 1,404 analyte-birth defect associations evaluated, 377 were significant in replication analysis. Analytes most consistently associated with birth defects included the phenylalanine/tyrosine ratio (N = 29 birth defects), tyrosine (N = 28 birth defects), and thyroxine (N = 25 birth defects). Birth defects most frequently associated with a range of analytes included gastroschisis (N = 29 analytes), several cardiovascular defects (N = 26 analytes), and spina bifida (N = 23 analytes). Several significant and novel associations were observed between newborn screening analytes and birth defects. While some findings could be consequences of the defects themselves or to the care provided to infants with these defects, these findings could help to elucidate mechanisms underlying the etiology of some birth defects.