Texas Health and Human Services Commission

IntroductionThis study examines how an early-life small-quantity lipid-based nutrient supplement (LNS) interacts with the home environment to influence Ghanaian children's social-emotional functioning at preschool age.MethodIn a randomized controlled trial, 1,320 Ghanaian women received either daily LNS, multiple micronutrients (MMN) or iron and folic acid (IFA) during pregnancy through 6 months postpartum. Infants in the LNS group received the daily supplement from 6 to 18 months. The IFA and MMN groups were combined to be the control group. At 4–6 years (n = 966), we assessed children's home environments (caregiver responsivity, negative behavior acceptance, physical environment, learning materials, academic stimulation) and their social-emotional strengths and difficulties.ResultsBoth LNS and higher quality home environments—particularly caregiver responsivity and negative behavior acceptance—predicted children having fewer social-emotional difficulties. LNS supplementation moderated relations between the home environment and children's hyperactivity/inattention and total difficulties. Living in a safer physical environment was related to fewer hyperactivity/inattention problems and total difficulties only for children who received LNS. Less academic stimulation was related to more hyperactivity/inattention only for children in the control group.ConclusionEarly-life LNS supplementation and supportive home environments reduce social-emotional difficulties in Ghanaian children. Nutritional interventions are most effective in the context of safe, stimulating households, demonstrating that integrated interventions support children's wellbeing in low- and middle-income countries.Clinical trial registrationclinicaltrials.gov; identifier: NCT00970866.

The objectives of the study were to describe an integrated screening, brief intervention, treatment and referral (SBIRT) prenatal care program for opioid use disorder (OUD), factors influencing program engagement, and the characteristics of pregnant and postpartum people with OUD. This was a retrospective cohort study of 245 pregnant and postpartum people with OUD who had access to a 30-day SBIRT program at a safety-net hospital between March 15, 2021, and March 15, 2024. Multivariable logistic regression models assessed predictors of program completion, defined as engaging in 4 weekly outpatient visits. Forty-two percent of participants completed the program, and 86% received medication for opioid use disorder (MOUD). Factors that increased the likelihood of program completion included entry through referral versus the emergency department (OR: 3.05, 95% CI: 1.58-6.04), family history of SUD (OR: 2.28, 95% CI: 1.31-4.01), and comorbid psychiatric diagnosis (OR: 1.87, 95% CI: 1.04-3.39). The use of multiple substances (OR: 0.43, 95% CI: 0.19-0.92) and positive fentanyl screens (OR: 0.26, 95% CI: 0.12-0.55) decreased the likelihood of program completion. Neither trimester of pregnancy nor severity of OUD influenced program completion. Social determinants of health were common. An SBIRT program offering 24-hour coverage with skilled providers offering trauma-informed care and social supports integrated with prenatal care results in high engagement and acceptance of MOUD. Policy implications support improved access to naloxone, fentanyl testing strips, and maternity housing. Results suggest further research into the specific nature of how family history of SUD improves engagement in treatment programs.

Texas Medicaid improved infant well-child visit rates by participating in a national learning collaborative. The two-year program encouraged creativity and innovation in care for Medicaid recipients through partnerships with managed care organizations (MCOs). The MCO projects discovered valuable practices in member outreach and were disseminated in shared learning experiences. At the completion of the learning collaborative, Texas Medicaid surveyed the MCO participants to assess the impact of their projects on Medicaid beneficiaries in Texas as well as the quality improvement project format. Collectively, the MCOs raised the infant well-child visit rate year-over-year. All of the partner MCOs stated they plan to continue focused work on improving infant well-child visit rates after the learning collaborative.

The purpose of the current study was to examine the validity of an FFQ utilised in the Food Retail: Evaluating Strategies for a Healthy Austin (FRESH Austin) study, designed to evaluate changes in the consumption of fruits and vegetables (FV) in diverse low-income communities in Austin, TX. The FRESH Austin FFQ was validated against three 24-h dietary recalls (24hDR). All dietary assessments were administered (in-person or by telephone) by trained investigators. Recruitment was conducted at sites within the geographic areas targeted in the FRESH Austin recruitment. People at a community health clinic, a local health centre and a YMCA within the intervention area were approached by trained and certified data collectors, and invited to participate. Among fifty-six participants, 83 % were female, 46 % were non-White, 24 % had income < $25 K/year and 30 % spoke only/mostly Spanish at home. The FFQ and average of three 24hDR produce similar estimates of average total servings/d across FV (6·68 and 6·40 servings/d, respectively). Correlations produced measures from 0·01 for 'Potatoes' and 0·59 for 'Other Vegetables'. Mean absolute percentage errors values were small for all FV, suggesting the variance of the error estimates was also small. Bland-Altman plots indicate acceptable levels of agreement between the two methods. These outcomes indicate that the FRESH FFQ is a valid instrument for assessing FV consumption. The validation of the FRESH Austin FFQ provides important insights for evaluating community-based efforts to increase FV consumption in diverse populations.

Abstract LiDAR (light detection and ranging) allows for the quantification of three‐dimensional seascape structure, which is an important driver of coral reef communities. We hypothesized that three‐dimensional LiDAR‐derived covariables support more robust models of coral reef fish assemblages, compared to models using 2D environmental co variables. Predictive models of coral reef fish density, diversity, and biomass were developed using linear mixed effect models. We found that models containing combined 2D and 3D covariables outperformed models with only 3D covariables, followed by models containing only 2D covariables. Areas with greater three‐dimensional structure provide fish more refuge from predation and are crucial to identifying priority management locations that can potentially enhance reef resilience and recovery. Two‐dimensional seascape metrics alone do not adequately capture the elements of the seascape that drive reef fish assemblage characteristics, and the application of LiDAR data in this work serves to advance seascape ecology theory and practice in the third dimension.

Self-directed care allows individuals with disabilities and elderly persons to control public funds to purchase goods and services that help them remain outside institutional settings. This study examined effects on outcomes, service costs, and user satisfaction among adults with serious mental illness. Public mental health system clients were randomly assigned to self-directed care (N=114) versus services as usual (N=102) and assessed at baseline and 12 and 24 months. The primary outcome was self-perceived recovery. Secondary outcomes included psychosocial status, psychiatric symptom severity, and behavioral rehabilitation indicators. Mixed-effects random-regression analysis tested for longitudinal changes in outcomes between the two conditions. Differences in service costs were analyzed with negative binomial and zero-inflated negative binomial regression models. Compared with the control group, self-directed care participants had significantly greater improvement over time in recovery, self-esteem, coping mastery, autonomy support, somatic symptoms, employment, and education. No between-group differences were found in total per-person service costs in years 1 and 2 or both years combined. However, self-directed care participants were more likely than control group participants to have zero costs for six of 12 individual services and to have lower costs for four. The most frequent nontraditional purchases were for transportation (21%), communication (17%), medical care (15%), residential (14%), and health and wellness needs (11%). Client satisfaction with mental health services was significantly higher among intervention participants, compared with control participants, at both follow-ups. The budget-neutral self-directed care model achieved superior client outcomes and greater satisfaction with mental health care, compared with services as usual.

This research examines the historical role news elites have played in shaping public perceptions of immigrants as a distinct social group. To that end, we identify the discursive strategies used by The New York Times to construct the ‘American immigrant’ during the Ellis Island years (1892–1924), a pivotal period when some of the nation’s earliest immigration restriction laws were established. Data were collected from front page newspaper articles and analysis was developed using the techniques of critical discourse analysis. Drawing on Foucault’s (1977) theoretical understanding of the enmeshment of power relations in discourse as well as Blumer’s (1958) group position model, we develop and test five hypotheses about the role of news elites in constructing this social group. Finding support for all hypotheses, we show how the article’s discursive choices dehumanized immigrants, trivialized their experiences, silenced their voices and helped legitimate an unequal social hierarchy that positions immigrants beneath non-immigrants.

The objective of this study was to determine characteristics associated with potentially preventable pediatric admissions as defined by the Agency for Healthcare Research and Quality. The Texas Inpatient Public Use Data File, an administrative database of hospital admissions, identified 747 040 pediatric admissions ages 0 to 17 years to acute care facilities between 2005 and 2008. Potentially preventable admissions included 5 diagnoses: asthma, perforated appendicitis, diabetes, gastroenteritis, and urinary tract infection. A hierarchical multivariable logistic regression model clustered by admitting hospital and adjusted for admission date estimated the patient and hospital factors associated with potentially preventable admission. An average of 71 444 hospital days per year and 14.1% (N = 105 055) of all admissions were potentially preventable, generating $304 million in hospital charges per year in 1 state. Younger age (odds ratio [OR]: 2.88 [95% confidence interval (CI): 2.80-2.96]), black race (OR: 1.48 [95% CI: 1.45-1.52]) or Hispanic ethnicity (OR: 1.06 [95% CI: 1.04-1.08]), lower income (OR: 1.11 [95% CI: 1.02-1.20]), comorbid substance abuse disorder (OR: 2.03 [95% CI: 1.75-2.34]), and admission on a weekend (OR: 1.05 [95% CI: 1.03-1.06]) or to a critical access hospital (OR: 1.61 [95% CI: 1.20-2.14]) were high-risk factors for potentially preventable admission, whereas Native American race (OR: 0.91 [95% CI: 0.85-0.98]), government insurance (OR: 0.83 [95% CI: 0.89-0.96]) or no insurance (OR: 0.93 [95% CI: 0.89-0.96]), and living in a rural county (OR: 0.70 [95% CI: 0.68-0.73]) were associated factors. However, most factors varied from high to low odds depending on which of the 5 potentially preventable diagnoses was examined. Potentially preventable admissions represent a high burden of time and costs for the pediatric population, but strategies to reduce them should be tailored to each diagnosis because the associated factors are not uniform across all potentially preventable admissions.

Six million US children are uninsured, despite two-thirds being eligible for Medicaid/Children's Health Insurance Program (CHIP), and minority children are at especially high risk. The most effective way to insure uninsured children, however, is unclear. We conducted a randomized trial of the effects of parent mentors (PMs) on insuring uninsured minority children. PMs were experienced parents with ≥1 Medicaid/CHIP-covered child who received 2 days of training, then assisted families for 1 year with insurance applications, retaining coverage, medical homes, and social needs; controls received traditional Medicaid/CHIP outreach. The primary outcome was obtaining insurance 1 year post-enrollment. We enrolled 237 participants (114 controls; 123 in PM group). PMs were more effective (P< .05 for all comparisons) than traditional methods in insuring children (95% vs 68%), and achieving faster coverage (median = 62 vs 140 days), high parental satisfaction (84% vs 62%), and coverage renewal (85% vs 60%). PM children were less likely to have no primary care provider (15% vs 39%), problems getting specialty care (11% vs 46%), unmet preventive (4% vs 22%) or dental (18% vs 31%) care needs, dissatisfaction with doctors (6% vs 16%), and needed additional income for medical expenses (6% vs 13%). Two years post-PM cessation, more PM children were insured (100% vs 76%). PMs cost $53.05 per child per month, but saved $6045.22 per child insured per year. PMs are more effective than traditional Medicaid/CHIP methods in insuring uninsured minority children, improving health care access, and achieving parental satisfaction, but are inexpensive and highly cost-effective.

This study examines breast cancer knowledge, attitudes and screening behaviors of Hispanic women living in the South Texas colonias of Maverick and Val Verde Counties. We used the Health Belief Model to analyze the effects of HBM constructs on clinical breast exam (CBE) and mammogram screening. Using a multistage systematic sampling approach we interviewed women living within these colonias. Logistic regression analysis was used to predict CBE and mammography screening behaviors. The results indicate that knowledge, susceptibility, barriers and source of health information were statistically significant in predicting CBE among these women. In addition, background variables such as marital status and health insurance were also significant in predicting CBE. Findings further indicate that source of health information, barriers, and health insurance significantly predicts mammography screening behaviors. Results suggest that for women living in colonias along the South Texas Border socio-demographic variables play a significant role in CBE and mammography utilization.