Central Texas Community Research Articles

Objective and perceived barriers and facilitators of daily fruit and vegetable consumption among under-resourced communities in Central Texas

IntroductionFruit and vegetable consumption (FVC) continues to be low, particularly among people living in under-resourced communities. Identifying barriers and facilitators of FVC and whether those barriers and facilitators differ for racially and ethnically minoritized people is imperative for developing effective and equitable public health policies and interventions. MethodsA baseline cohort of 390 participants from Central Texas communities historically lacking healthy food retailers completed a survey including FVC, 7 psychosocial barriers and facilitators of FVC, distance to a grocery retailer, participation in government assistance programs, and race/ethnicity. ResultsNot having time to prepare fruits and vegetables was the only significant psychosocial barrier identified (B = -.11, t(390) = 2.04, P = .04), but was not significant after accounting for sociodemographic variables. Significant facilitators of daily FVC were liking F&V (B=.31, t(390) = 6.40, P<.001), participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (B=.14, t(390) = 2.81, P = .005), and Hispanic/Latino(a) ethnicity (B = -.21, t(390) = 4.30, P<.001). The final model accounted for 17% of the variance in daily FVC (R2=.17, F(4, 375) = 7.69, P < .001). Black, white and Other race participants were more likely to report having difficulty using F&V before spoiling than Hispanic/Latino(a) participants (P = .003). White and Other race participants were more likely to report that F&V were hard to prepare (P = .006) and that they didn't have time to prepare F&V (P = .005). DiscussionWhen designing public health policy and interventions to increase FVC, researchers could prioritize identifying ways to alleviate time constraints, increase F&V liking, and help eligible participants to enroll in WIC. Strategies that reduce the risk of F&V spoiling and make F&V easier to prepare may also benefit some groups.

Correlates of Transitions in Food Insecurity Status during the Early Stages of the COVID-19 Pandemic among Ethnically Diverse Households in Central Texas.

Food insecurity increased substantially in the USA during the early stages of the 2020 COVID-19 pandemic. The purpose of this study was to identify potential sociodemographic and food access-related factors that were associated with continuing or transitioning into food insecurity in a diverse population. An electronic survey was completed by 367 households living in low-income communities in Central Texas during June–July 2020. Multinomial logistic regression models were developed to examine the associations among food insecurity transitions during COVID-19 and various sociodemographic and food access-related factors, including race/ethnicity, children in the household, loss of employment/wages, language, and issues with food availability, accessibility, affordability, and stability during the pandemic. Sociodemographic and food access-related factors associated with staying or becoming newly food insecure were similar but not identical. Having children in the household, changes in employment/wages, changing shopping location due to food availability, accessibility and/or affordability issues, issues with food availability, and stability of food supply were associated with becoming newly food insecure and staying food insecure during the pandemic. Identifying as Latino and/or Black was associated with staying food insecure during COVID-19. These findings suggest that the COVID-19 pandemic did not create new food insecurity disparities. Rather, the pandemic exacerbated pre-existing disparities.

Prevalence of Intestinal Parasites in a Low-Income Texas Community.

Strongyloidiasis affects an estimated hundreds of millions of people worldwide, with infection possibly persisting for life without appropriate therapy because of the helminth's unique autoinfection cycle. Like other soil-transmitted helminths, because of the environmental conditions required for the life cycle of Strongyloides stercoralis, this parasite is endemic to tropical, subtropical, and temperate countries and areas with inadequate sanitation infrastructure. Given continued poverty and that nearly one in five American homes are lacking proper sanitation systems, many U.S. regions are at risk for intestinal parasites. A central Texas community was chosen as the study site, given previous reports of widespread sanitation failure, degree of poverty, and community willingness to participate. A total of 92 households were surveyed and residents tested for nine intestinal parasites using a multi-parallel quantitative real-time polymerase chain reaction and ELISA serology. From 43 stool samples, 27 (62.8%) tested positive for Blastocystis spp. and one (2.3%) for Giardia lamblia. From 97 serum samples, Strongyloides serology detected 16 (16.5%) positive individuals. These high rates of heterokont and helminthic laboratory findings in a peri-urban central Texas community suggest several key policy implications, including that strongyloidiasis should be added to the Texas notifiable conditions list, that clinical suspicion for this infection should be heightened in the region, and that residents without access to functioning and sustainable sanitation infrastructure should be provided that access as a basic human right and to promote public health.

SERUM 25-HYDROXYVITAMIN D LEVELS IMPACT RISK OF EXTENSIVE ASSISTANCE NEEDED BY OLDER ADULTS TO WALK

Study objective is to determine the association between deficient 25-hydroxyvitamin D [25(OH)D] serum levels and the amount of assistance needed to walk in a room by older adults living in long-term care (LTC) communities. Participants (age ≥ 65) from five LTC communities in Central Texas were recruited for a multi-site, cross-sectional study (n=169). Double-blinded data abstraction protocols were used to collect a one-year medical history. Laboratory blood draws measured serum 25(OH)D levels. Level of assistance was measured by the activities of daily living score for walking in room from section G of the Minimum Data Set (MDS). To determine the association between deficient 25(OH)D serum levels (≤20 ng/ml) and assistance with walking, adjusted logistic regression was used. Total vitamin D per day (supplementation and meals), therapy and/or restorative programs, body mass index, race, gender, age, and years living in the community were used as confounders. Of the 169 participants (mean age=83) 27.17% had deficient serum 25(OH)D and 9.25% required extensive assistance to walk in a room. The mean serum level and supplementation rate of participants was 32.61 ng/ml and 1,160.64 IU per/d, respectively. Participants with deficient 25(OH)D serum levels had significantly elevated odds (OR=8.73; CL: 1.28, 8.54; p=0.027) of requiring extensive assistance to walk in a room compared to those with adequate serum levels (>20 ng/ml). Deficient 25(OH)D serum levels are associated with increased assistance to walk in a room indicating that adequate serum levels in LTC residents could potentially decrease burden on staff.

HOPE AND RESILIENCE AMONG VULNERABLE, COMMUNITY-DWELLING OLDER PERSONS

Community-dwelling older adults in the U.S. are at risk for experiencing a number of physical, emotional, and social issues including poverty, social isolation, and deteriorating health and daily functioning. Despite such challenges, research indicates that many older adults remain resilient and that factors such as social support, spirituality, and self-esteem contribute to resilience and improved outcomes. One factor that has been found to be particularly important for resilience among older adults is a sense of hopefulness. However, research has not looked specifically at the effects of hope on older adults experiencing severe economic and psychosocial challenges. Utilizing survey data drawn from a unique sample (n = 64) randomly drawn from 224 clients of a Meals on Wheels program, we explore the relationship between hope and resilience among a group of at-risk, community-dwelling older adults in one central Texas community. We find that hope, after accounting for the effects of social support, spiritual experience, health (ADL), and ethnicity, is a strong and significant predictor of resilience among at-risk older adults and that hope tends to mediate the effect of spiritual experience on resilience. Drawing on these findings, we discuss potential implications for social workers and congregational leaders working with older adults and for future scholarship on hope and resilience.

Eternal vigilance: politics, race, and the struggle for educational equity in a Central Texas Community

This article documents the emergence of a Mexican-American political consciousness in a Central Texas Community and the efforts to dismantle decades of inequitable, exclusionary educational policies and practices. We take readers into a community on the verge of profound change by exploring primary historical data and situating the voices of community leaders in a historical context. We employ a theory of change framework (RASPPA) to chronicle a community’s response to macro-level societal changes. To understand the need for Mexican-American activism in Central Texas, we providing a survey of literature that chronicles Mexican-American experience in Texas. This is a story about a community realizing its political capacity and leveraging its own agency for change. We take a walk-through history and use place, race, identity and courage to inform a new vision for educational equity.

Duration of propagule pressure affects non-native plant species abundances.

Invasions by non-native species are known to be related to present propagule pressure (e.g., the number of non-native seeds arriving in a site each year). However, previous studies have mostly ignored the potential effects of the length of time that a site has experienced propagule pressure. This study is novel in studying past as well as present propagule pressure and in demonstrating the importance of past propagule pressure. We tested the importance of past and present propagule pressure in three plant communities in central Texas to quantify relationships between variables representing past and present propagule pressure, other environmental variables, and the abundance of non-native and native woody plant species. Duration of propagule pressure predicted non-native species richness. Sites had greater non-native species richness if they were nearer to development (houses, roads) and if nearby development was older. While mesic woodlands had the most native species, streamside woodlands had the most non-native species. First, future studies of non-native invasions would benefit from including past as well as present propagule pressure. If past propagule pressure is not considered, its effects may be wrongly ascribed to present propagule pressure. Second, the non-native species in this study are widely used in landscaping, and development age reflects the years that landscaping has been present nearby. As xeriscaping becomes more common, streamside woodlands may someday not have the highest non-native species richness: the new drought-tolerant landscaping plants may be better invaders of drier sites than their predecessors.

Investigating the impact of high-speed rail equipment visualization on mode choice models: Case study in central Texas

High-speed passenger rail (HSR) is seen as an ideal solution for fast, safe, and resource-efficient mobility for intercity travel. For proposed HSR service, stated preference (SP) surveys are necessary to obtain the data needed for ridership forecasting. In SP surveys, it may be helpful to include images of the options being examined to support respondent decision-making. However, it is unclear from the current literature how images of a passenger train included in an SP survey affect mode choice models developed from the resulting survey data. This paper presents a case study examining the impacts of including images of proposed high-speed passenger trains in SP surveys for HSR service planning activities based on a survey of residents in two communities in Central Texas. Three groups were examined − a control group with a “text-only” description of proposed rail service, an image of an average-quality train, and an image of a premium-quality train. Analysis of the survey responses found that the value of time (VOT) for respondents viewing the premium image was nearly twice the VOT for the text-only condition. However, the premium-quality train image had a lower error variance, resulting in a data set that was less “noisy” than the other image or the base condition. This analysis provides a starting point for a broader discussion on how HSR is portrayed in surveys and the potential for eliciting bias based on the images displayed.

Scientific Community Outreach in Central Texas

The Texas State ASBMB student chapter includes both undergraduate and graduate students. We collaborate with several other student organizations to develop and carry out a wide variety of science outreach events for elementary and junior high students in Central Texas. One of our primary goals for our outreach events is to engage both students and their families in fun, hands‐ on STEM experiences. Our events are substantially interdisciplinary, and include a variety of STEM topics in addition to the biological sciences. For example, we incorporate concepts like density and mass to draw connections between mathematics and physics and their practical applications. These accessible experiments help the community at large engage and develop critical thinking and reasoning skills. Texas State students derive significant benefit from these events, too, as these opportunities enable our student chapter members to utilize their science education as an instrument to connect with their community while encouraging young minds to engage in learning outside of the classroom environment. As a Hispanic‐serving institution, our student demographic parallels that of the Central Texas community. Youth participants interact with a diverse array of college students, who serve as role models to support an inclusive STEM learning environment. Finally, we have found increased student participation and stronger impact in our community when we collaborate and coordinate with other student scientific organizations, including the Texas State student chapter of the American Chemical Society.

Species composition but not diversity explains recovery from the 2011 drought in Texas grasslands

AbstractExtreme droughts can have profound direct consequences for grassland ecosystems, but it is poorly known how ecosystems recover from drought and what ecological factors are associated with recovery. Recovery occurs when ecosystem functioning returns to values observed prior to a perturbation. Here, we tested for ecosystem recovery after an extreme drought in 2011 in previously established native and exotic experimental communities in Central Texas. Planted mixtures of all native and all exotic species were crossed with a summer irrigation treatment, with eight community compositions (random draws) per treatment. Prior to the drought, native plots had higher diversity than exotic plots, which sets up the prediction that the high‐diversity native plots will recover more quickly than exotics. The extreme drought decreased rain‐use efficiency ([RUE], annual biomass production per unit of rainfall) by 82%. Rain‐use efficiency remained well below pre‐drought levels during the growing season after the drought. However, on average, RUE recovered to pre‐drought levels by the second growing season following drought. Exotic communities showed higher RUE than native communities, and irrigation significantly reduced RUE in both exotic and native communities across years. Interestingly, not all of the mixtures recovered from the drought, and recovery was associated with species composition, but not diversity. Rain‐use efficiency recovery from drought was greatest in native communities in which the proportion of C3 forb biomass increased during and following drought and in exotic communities with a low proportion of short grass biomass. Extreme droughts can exert differential impacts on plant functional groups, leading to a drought legacy effect that reduces recovery with possible long‐term repercussions.

Memory training plus yoga for older adults.

Previous tests of the SeniorWISE intervention with community-residing older adults that were designed to improve affect and cognitive performance were successful and positively affected these outcomes. In this study, we tested whether adding yoga to the intervention would affect the outcomes. Using a quasiexperimental pre-post design, we delivered 12 hours of SeniorWISE memory training that included a 30-minute yoga component before each training session. The intervention was based on the four components of self-efficacy theory: enactive mastery experience, vicarious experience, verbal persuasion, and physiologic arousal. We recruited 133 older adults between the ages of 53 and 96 years from four retirement communities in Central Texas. Individuals were screened and tested and then attended training sessions two times a week over 4 weeks. A septuagenarian licensed psychologist taught the memory training, and a certified yoga instructor taught yoga. Eighty-three participants completed at least 9 hours (75%) of the training and completed the posttest. Those individuals who completed made significant gains in memory performance, instrumental activities of daily living, and memory self-efficacy and had fewer depressive symptoms. Thirteen individuals advanced from poor to normal memory performance, and seven improved from impaired to poor memory performance; thus, 20 individuals improved enough to advance to a higher functioning memory group. The findings from this study of a memory training intervention plus yoga training show that the benefits of multifactorial interventions had additive benefits. The combined treatments offer a unique model for brain health programs and the promotion of nonpharmacological treatment with the goals of maintaining healthy brain function and boosting brain plasticity.

IYCr2014: "Crystals and Crystallography" at "Explore UT"

IYCr2014 is a unique opportunity for increasing the public awareness about the importance of crystallography, and promoting educational awareness of crystallography. Explore UT is a campus-wide open house of the University of Texas at Austin campus for the central Texas community that attracts thousands of visitors to campus each spring, including many busloads of school children and their teachers. We describe our experience at a booth for this event of presenting a variety of educational and learning tools to illustrate the benefits to society of 100 years of crystallography and the significance of IYCr2014. The exhibit featured posters, computer stations with web links and software, experiments and movies on crystal growth, lessons on symmetry, optical transform demonstrations, graphics software, as well as a variety of molecular models including 3D printed molecular models. Teaching structure/function concepts in chemistry, biochemistry, molecular biology, pharmacy, biomedical engineering, etc. has always been a challenge due to the inherent importance of understanding the role of 3D structure in order to understand function. Most students find it easier to understand the concepts when they have access to molecular models. For protein molecules, the sheer size and number of atoms involved make assembling molecular models from atomic parts impractical. Advances in computers and availability of high quality computer graphics software for the display of molecular models has helped, but does not replace the benefit of being able to hold and examine a physical model. We describe our experience using 3D printing technology to generate molecular models for use in the classroom and research laboratories to improve learning of structural concepts. See the IYCr2014 website for more information – http://www.iycr2014.org

Short-Term Effects of Repeated Wildfires in Oak-Juniper Woodlands

AbstractFire can shape both the structure and composition of vegetation communities, especially those dominated by species with different regeneration strategies. The dominant species of oak-juniper communities in central Texas include resprouters (oaks [Quercus spp.]) and a reseeder (Ashe juniper [Juniperus ashei Buchholz]). We studied the effects of two overlapping wildfires (1996 and 2009) on oak-juniper woodlands on Fort Hood Military Reservation, Texas, USA. We estimated burn severity and measured vegetation regeneration along permanent transects in once-burned, twice-burned, and nonburned areas. Burn severity was highly variable, but was higher in 1996 than in 2009. In the first growing season after the second fire (2009), understory stem density was 3 to 4 times higher than in 1996, but that difference had disappeared by the third growing season. Overstory density did not differ after the two fires, but density on slopes was 3 to 10 times higher than on mesas. Overall species composition was similar after the two fires, but differed from nonburned areas due to the absence of Ashe juniper. Ashe juniper was still absent from twice-burned areas in 2011, whereas small numbers of junipers (21 ± 34 stems ha−1) had colonized the once-burned areas within three years. Our data suggest that wildfires controlled the historical distribution of Ashe juniper, but not of resprouting species, in the Edwards Plateau, and that long intervals between wildfires are required for Ashe juniper to become a canopy dominant in these woodlands.

A Paleozoological Perspective on White-Tailed Deer (Odocoileus virginianus texana) Population Density and Body Size in Central Texas

Archaeological and paleontological datasets are used in conservation to add time-depth to ecology. In central Texas, several top carnivores including prehistoric Native American hunters have been extirpated or have had their historic ranges restricted, which has resulted in pest-level white-tailed deer (Odocoileus virginianus texana) populations in some areas. Differences in body size of deer between prehistory and modernity are expected, given that a lack of predation likely has increased intraspecific competition for forage among deer, resulting in smaller body size today. In fact, modern deer from settings without harvest pressure are significantly smaller than those from harvested areas and from prehistoric deer. From a natural history perspective, this research highlights potential evolutionary causes and effects of top-predator removal on deer populations and related components of biological communities in central Texas.

Overweight and perceived health in Mexican American children: a pilot study in a central Texas community.

This study assessed actual and perceived health status of overweight Mexican American clients at a central Texas school-based health center in a predominantly Hispanic school district. It also explored the participants' interest in making lifestyle changes to promote a healthy weight. A medical records review indicated that of the Hispanic children between the ages of 7 and 12 years, 38% had a weight status at or above the 85th percentile. Assessments were conducted in a sample of these overweight Mexican American children to learn about their medical history, eating and activity patterns, perceived health and body size, and general health-risk status. Weight-related conditions, such as elevated blood pressure and cholesterol levels, were found in more than half the sample. Few consumed fruits and vegetables, and many engaged in only sedentary activities. The majority perceived themselves as "big," wanted to make changes in their body size, and wanted family members to participate in making changes with them. Although most of the sample were in the 97th body mass index percentile, many perceived themselves to be as healthy as or healthier than others. These findings substantiate the need to design and implement a culturally appropriate weight management and obesity prevention program in this community. However, the perception of being healthy in the presence of multiple indicators of poor health may pose challenges to successful intervention.

The Utility of fFN for the Prediction of Preterm Birth in Twin Gestations

To determine the sensitivity, specificity, and positive predictive value (PPV) of fetal fibronectin (fFN) and to determine its usefulness, in conjunction with selected other clinical assessment measures, in the prediction of preterm birth for women with twin gestations. A prospective, descriptive, longitudinal design. An obstetrical high-risk clinic that received patient referrals from several surrounding communities in central Texas. Forty-eight women identified with twin gestations prior to the 22nd week of pregnancy; primarily of Hispanic ethnicity. A substantial number of outcome variables were assessed in this study. In the present report, data derived from weekly assessments for the identification of the presence of fFN, the diagnosis of bacterial vaginosis, and the measurement of cervical length were reviewed for their relationship to prematurity, birth weight, birth weight discordancy and placental chorionicity. The relative risk of birth prior to 35 weeks gestation, fetal death, or discordance of twin birth weights of greater than 20% was 2.22 (CI: 1.09, 4.55, P < 0.015) when fFN was found to be positive at any weekly testing after 22 to 24 weeks gestation (sensitivity 76.82%, specificity 58.33%, PPV 66.7%). The presence of fFN was most highly predictive of preterm birth when performed during the 24th to 28th gestational week. Shorter cervical lengths were highly correlated with preterm birth (r = -0.6). An association between bacterial vaginosis and preterm birth was not demonstrated in this sample. Sampling for the presence of fetal fibronectin can be easily accomplished by RNs in labor triage units and by advanced practice nurses in outpatient settings. The identification of fFN, particularly during the 24 to 28 weeks gestational time frame, is highly predictive of preterm birth, and particularly so for women with twin gestations.

Structural framework of the Edwards Aquifer recharge zone in south-central Texas

The Edwards Aquifer, the major source of water for many communities in central Texas, is threatened by population growth and development over its recharge zone. The location of the recharge and confined zones and the flow paths of the aquifer are controlled by the structure of and deformation processes within the Balcones fault system, a major system of predominantly down-to-the-southeast normal faults. We investigate the geologic structure of the Edwards Aquifer to assess the large-scale aquifer architecture, analyze fault offset and stratigraphic juxtaposition relationships, evaluate fault-zone deformation and dissolution and fault-system architecture, and investigate fault-block deformation and scaling of small-scale (intrablock) normal faults. Characterization of fault displacement shows a pattern of aquifer thinning that is likely to influence fault-block communication and flow paths. Flow-path constriction may be exacerbated by increased fault-segment connectivity associated with large fault displacements. Also, increased fault-zone deformation associated with larger-displacement faults is likely to further influence hydrologic properties. Overall, faulting is expected to produce strong permeability anisotropy such that maximum permeability is subhorizontal and parallel to fault-bedding intersections. At all scales, aquifer permeability is either unchanged or enhanced parallel to faults and in many cases decreased perpendicular to faults.

Overweight and Perceived Health in Mexican American Children: A Pilot Study in a Central Texas Community

This study assessed actual and perceived health status of overweight Mexican American clients at a central Texas school-based health center in a predominately Hispanic school district. It also explored the participants’ interest in making lifestyle changes to promote a healthy weight. A medical records review indicated that of the Hispanic children between the ages of 7 and 12 years, 38% had a weight status at or above the 85th percentile. Assessments were conducted in a sample of these overweight Mexican American children to learn about their medical history, eating and activity patterns, perceived health and body size, and general health-risk status. Weight-related conditions, such as elevated blood pressure and cholesterol levels, were found in more than half the sample. Few consumed fruits and vegetables, and many engaged in only sedentary activities. The majority perceived themselves as “big,” wanted to make changes in their body size, and wanted family members to participate in making changes with them. Although most of the sample were in the 97th body mass index percentile, many perceived themselves to be as healthy as or healthier than others. These findings substantiate the need to design and implement a culturally appropriate weight management and obesity prevention program in this community. However, the perception of being healthy in the presence of multiple indicators of poor health may pose challenges to successful intervention.

A Hospital-Based Case-Control Study of Stillbirths and Environmental Exposure to Arsenic Using an Atmospheric Dispersion Model Linked to a Geographical Information System

Although adverse reproductive outcomes have been associated with arsenic exposure, the extent and severity of the effects of chronic inhalation of low levels of arsenic on reproduction are not known. We conducted a hospital-based case-control study of stillbirths in a central Texas community that included a facility with more than a 60-year history of producing primarily arsenic-based agricultural products. We collected data on 119 cases and 267 controls randomly selected from healthy live-births at the same hospital and matched for year of birth. We abstracted medical and demographic data for the period January 1, 1983, to December 31, 1993, from hospital records and estimated socioeconomic status by median income from the 1990 Population and Housing Census data. We estimated arsenic exposure levels from airborne emission estimates and an atmospheric dispersion model and linked the results to a geographical information system (GIS) database. Exposure was linked by GIS to residential address at time of delivery. A conditional logistic regression model was fitted including maternal age, race/ethnicity, parity, income group, exposure as a categorical variable, and exposure-race/ethnicity interaction. The prevalence odds ratio observed for Hispanics in the high-exposure group (>100 ng per m3 arsenic) was 8.4, with a 95% confidence interval of 1.4-50.1.

A comparison of classroom and distance learning techniques for rural emt-i instruction

Objectives. To determine whether two different distance learning techniques are as effective as classroom teaching for training rural-based emergency medical technician-intermediate (EMT-I) students. Methods. A prospective, nonrandomized comparison of three different instructional methods, with the outcome measurements being mean test scores and attrition rates, was devised. Fifty-seven EMT-I students from rural communities in central Texas were assigned to one of three groups. Each group received 50 hours of didactic instruction based on the U.S. Department of Transportation EMT-I curriculum. The same instructor taught all classes, and all groups used the same workbooks, syllabi, and computer-based tutorials. Group 1 (n = 25) received traditional classroom instruction. Group 2 (n = 18) received instruction using a two-way audio/graphic computer network. Group 3 (n = 14) received instruction using a satellite-based audio/video network. All students then took a standardized multiple-choice examination. Attrition rates were based on the number of those who qualified for EMT-I certification. Results. Mean test results for each group were as follows: group 1, 93 (95% CI = 91-95); group 2,94 (95% CI = 93-96); group 3, 94 (95% CI = 92-96). No significant difference was noted in mean test scores between groups (p = 0.21). Attrition rates were as follows: group 1, 88% (95% CI = 69-97%); group 2,100% (95% CI = 81-100%); group 3, 86% (95% CI = 57-98%). No significant difference was seen in attrition rates between groups (p = 0.24). Conclusions. No difference was found in mean test scores or attrition rates between traditional classroom and two distance learning methods for rural-based EMT-I students. Distance learning techniques may offer an effective alternative for providing educational opportunities to rural EMS providers.