Texas Residents Research Articles

Characteristics Associated with Feeding Tube Placement: Retrospective Cohort Study of Texas Nursing Home Residents with Advanced Dementia

ObjectivesTo investigate resident-level, provider-type, nursing home (NH), and regional factors associated with feeding tube (FT) placement in advanced dementia. DesignRetrospective cohort study. Setting and ParticipantsNH residents in Texas with dementia diagnosis and severe cognitive impairment (N = 20,582). MethodsThis study used 2011-2016 Texas Medicare data to identify NH residents with a stay of at least 120 days who had a diagnosis of dementia on Long Term Care Minimum Data Set (MDS) evaluation and severe cognitive impairment on clinical score. Multivariable repeated measures analyses were conducted to identify associations between FT placement and resident-level, provider-type, NH, and regional factors. ResultsThe prevalence of FT placement in advanced dementia in Texas between 2011 and 2016 ranged from 12.5% to 16.1% with a nonlinear trend. At the resident level, the prevalence of FT decreased with age [age > 85 years, prevalence ratio (PR) 0.60, 95% confidence interval (CI) 0.52-0.69] and increased among residents who are black (2.74, 95% CI 2.48-3.03) or Hispanic (PR 1.91, 95% CI 1.71-2.13). Residents cared for by a nurse practitioner or physician assistant were less likely to have an FT (PR 0.90, 95% CI 0.85-0.96). No facility characteristics were associated with prevalence of FT placement in advanced dementia. There were regional differences in FT placement with the highest use areas on the Texas-Mexico border and in South and East Texas (Harlingen border area, PR 4.26, 95% CI 3.69-4.86; San Antonio border area, PR 3.93, 95% CI 3.04-4.93; Houston, PR 2.17, 95% CI 1.87-2.50), and in metro areas (PR 1.36, 95% CI 1.22-1.50). Conclusions and ImplicationsRegional, race, and ethnic variations in prevalence of FT use among NH residents suggest opportunities for clinicians and policy makers to improve the quality of end-of-life care by especially considering other palliative care measures for minorities living in border towns.

Population Based Analysis of Mantle Cell Lymphoma in Texas: Are Outcomes Any Different in Hispanics?

Introduction: Mantle cell lymphoma (MCL) is a rare type of incurable B-cell lymphoma with an incidence rate of ~0.8/100,000 in the United States (US) (Blood, PMID: 30154113; CA Cancer J Clin, PMID: 27618563). Recent advances in understanding of MCL biology, development of new therapeutic modalities such as Bruton tyrosine kinsase inhibitors (BTKi), and advancement of treatment strategy incorporating chemotherapy and non-chemotherapy treatment modalities have improved survival (Am J Hematol, PMID: 30963600; Blood, PMID: 26059948; Blood, PMID: 28899853). However, prognosis for MCL remains poor overall (Blood, PMID: 30154113). Although variations in incidence in MCL by race has been reported in the literature (CA Cancer J Clin, PMID: 27618563), there is currently limited data available on differences in demographics, treatment patterns, and outcomes in Hispanic (H) MCL patients. Methods: In this retrospective cohort study, de-identified data was obtained from the Texas Cancer Registry (TCR) database for those diagnosed with MCL between 2006-2016. Standard demographic variables collected include gender, race, ethnicity, birthplace, dates at diagnosis and death, primary payer at diagnosis, stage, type of treatment, poverty index, and vitality status among others. The significance of variation in the distribution of outcomes with ethnicity [H, non-Hispanic (NH)] was assessed with Fisher's Exact test, Pearson's Chi-square test, T-test, or Wilcoxon test as appropriate. Survival time was measured in years from date of primary diagnosis to date of death. Patients not coded as dead were considered censored on survival time at the date last seen. Survival distributions were described with Kaplan-Meier curves and significance of variation in median survival with ethnicity was assessed with log rank testing. All statistical testing was two-sided with a significance level of 0.05. Results: A total of 1852 (296 H, 1556 NH) patients were included in the final analysis. Median age at diagnosis were 65.5 (H) and 68.0 (NH). 72.6% of H and 72.7% of NH cohorts were male. Of the NH cohort, 92.5% were White, 5.3% Black, 1.5% Asian, 0.4% Native American and 0.1% with unknown race. There was a statistically significant difference between the cohorts in the poverty index. Most H (50.5%) were in the 20-100% bracket, while the majority of NH (36.2%) were in the 10-19.9%. The majority of the cohort were from metro areas (90.2% H and 82.6% NH) and non-border counties (72.6% H and 97.2% NH). There was a statistically significant difference in insurance status at diagnosis between the cohorts. Medicare was the most common type for both H (41.1%) and NH (50.2%), while 13.4% of H and 4.0% of NH were uninsured. The majority of H (66.2%) and NH (64.0%) were diagnosed with stages 3-4 MCL; for H, stage 1 10.5%, stage 2 6.1%, stages 3-4 66.2%; for NH, stage 1 10.4%, stage 2 6.6%, stages 3-4 64.0%. The most common treatment received was combination chemotherapy (43.2% H, 38.8% NH); for H, combination chemotherapy (CC) 43.2%, single agent chemotherapy (SAC) 7.4%, chemotherapy not otherwise specified (CNOS) 14.5%, died prior to recommended treatment (PRI) 1%, refused recommended treatment (REF) 0.7%, treatment recommended but not given (NG) 0.3%, treatment contraindicated (CI) 0.7%, no treatment (NT) 18.6% and unknown treatment status (UTS) 13.5%; for NH, CC 38.8%, SAC 10.5%, CNOS 14.5%, PRI 0.2%, REF 1.3%, NG 0.3%, CI 0.8%, NT 23.0% and UTS 10.4%. Regarding BMT/stem cell infusion, 3.1% H and 3.6 NH were confirmed to have received it; 2.5% H and 2.1% NH were confirmed to have received treatment involving radiation. Median survival was 3.7 years (y) and 3.8 y for H and NH respectively; the survival probability at 2 y was 0.65 (0.59-0.71) vs 0.65 (0.62-0.68), 5 y 0.40 (0.33-0.48) vs 0.41 (0.38-0.44) and 10 y 0.19 (0.12-0.30) vs 0.14 (0.09-0.21) for H and NH respectively. There was no statistically significant differences between the cohorts on stage of disease at diagnosis, types of treatment received or overall survival probability. Conclusions: In Texas residents diagnosed with mantle cell lymphoma between 2006-2016, there were statistically significant differences in the level of poverty and insurance coverage between H and NH cohorts but no differences in stage at diagnosis, type of treatment received, or survival. Disclosures Diaz Duque: ADCT Therapeutics: Research Funding; Molecular Templates: Research Funding; AstraZeneca: Research Funding; Hutchinson Pharmaceuticals: Research Funding; Seattle Genetics: Speakers Bureau; Verastem: Speakers Bureau; AbbVie: Speakers Bureau.

O1 Out-of-state abortions increased for Texas residents after House Bill 2

Objectives: Examine changes in the number of out-of-state abortions for Texas residents following clinic closures and gestational age limits imposed by House Bill 2 (HB2), which passed in July 2013 and was implemented in November 2013.

Incidence of Primary Central Nervous System Tumors Among the Hispanic Population in Texas 1995-2013.

Introduction: Primary central nervous system (CNS) tumors constitute a group of rare and heterogeneous tumors. A rising incidence rate in the United States has been linked to modern changes in early diagnosis and reporting. This study aims to examine temporal incidence trends, geographic variation, and the average annual age-adjusted rates among Hispanic populations in Texas from 1995 to 2013.Methods: SEER*STAT (Surveillance Research Program, National Cancer Institute (seer.cancer.gov/seerstat) version 8.3.2) and Joinpoint Regression 4.4.0.0 (Statistical Methodology and Applications Branch, Surveillance Research Program, National Cancer Institute) software were used to analyze incidence of primary brain and CNS tumors among Texas residents. Data were obtained from the Texas Cancer Registry of the Texas Department of State Health Services.Results: From the 30,122 cases of primary CNS tumors diagnosed throughout the state of Texas from 2008 to 2012, the overall average annual age-adjusted incidence rate for Hispanics and non-Hispanics combined was 25.35 per 100,000 persons. Among Hispanics, West Texas had the highest incidence trends and the highest average age-adjusted incidence rate of 27.17, followed by North Texas at 26.01 and the Panhandle at 23.63. East Texas had the lowest incidence rate of 16.23. The incidence trend among Hispanics has decreased consistently at a rate of 0.83 % from 1995 to 2013.Conclusions: The incidence of tumors was more pronounced in the Hispanic population in northern Texas compared with southern Texas. The presence of oil and gas production industries with farming and construction could play a role in the observed incidence of disease. Further studies with a focus on occupational health among Hispanics in Texas will be needed to elucidate the cause of such distribution.

Silesians in Texas and Upper Silesia: anthropometric, functional and physical activity characteristics

Anthropometric, functional and physical activity characteristics of contemporary adult descendants of Upper Silesian immigrants to Texas in the mid-19th century and current residents in Upper Silesia were compared. The sample included 45 residents in Central Texas, 25 women and 20 men, and 36 residents in rural Upper Silesia, 24 women and 12 men, 54-76 years of age. Variables included selected demographic characteristics, anthropometry, estimated body composition, several physiological indicators, strength and functional fitness, and physical activity. Sex-specific MANCOVA and Chi square were used for comparisons. Descendants of Silesian immigrants to Texas were taller, on average, while differences in other anthropometric variables were variable. All residents in Silesia and the majority of descendants of Silesian migrants to Texas were overweight or obese. Differences in hemodynamic and respiratory functions and responses to a 6-minute walk were inconsistent, while none of the fitness variables differed significantly between the samples. Although residents in Upper Silesia were significantly more physically active descendants of Silesians in Texas, >80% of the men and women in both samples scored below the criterion-reference standard for the maintenance of physical independence in the 6-minute walk.

A Geographic Population-level Analysis of Access to Total Shoulder Arthroplasty in the State of Texas.

Managing costs and improving access to care are two important goals of healthcare policy. The purposes of this study were to (1) evaluate the changes in distribution of total shoulder arthroplasty (TSA) cases in the state of Texas from 2010 to 2015 and (2) to evaluate patient access to TSA surgery centers as measured by driving miles. Inpatient (IP) and outpatient (OP) records were obtained from 2010 to 2015 from the Texas Department of State Health Services. All primary elective anatomic or reverse TSAs for patients with Texas-based home residence zip codes were included. Driving miles between patient zip codes and their chosen TSA surgery centers were estimated, and the results were compared between IP (high-volume [HV-IP] or low-volume [LV-IP]) and OP centers. Paired student t-tests, multivariate regressions, and mixed-model analysis of variance (ANOVA) were performed for volume comparisons, interactions between TSA centers types, and yearly trend data, respectively. Between 2010 and 2015, a total of 21,092 TSA procedures were performed across 321 surgery centers in the state of Texas (19,629 IP [93.1%] and 1,463 OP [6.9%]). During this time, the cumulative volume of IP TSA per 100,000 Texas residents increased by 109.1%, whereas the cumulative volume of OP TSA increased by 143.7%. Approximately 85.5% of included patients resided within 50 miles of any TSA surgery center; however, only 47.0% of the total Texas population resided within 50 miles of any TSA surgery center. This relationship remained true at every time point irrespective of their volume designations (OP, IP, HV-IP, and LV-IP). Despite the overall increase in TSA volume over time, the majority all TSA utilization in the state of Texas occurred in patients who resided within 50 miles of a TSA center. Increasing volume seems to reflect concentration of care into HV-IP and OP centers. Strategies to improve access to TSA care for underserved areas should be considered. Level II.

County-Level Poverty and Barriers to Breast and Cervical Cancer Screening in a Health Education and Patient Navigation Program for Rural and Border Texas Residents.

The study examined the impact of (1) county-level poverty rates and (2) patient navigation on breast and cervical cancer screening outcomes for women in rural and border counties in Texas reporting barriers to screening.Univariate analyses described the distribution and screening prevalence rates in the sample, while a series of random intercept logistic regression models analyzed mammogram (N = 2326 women aged 40+) and Papanicolaou (Pap; N = 2959 women aged 21-64) screening separately.Mammogram and Pap screening prevalence rates were highest among women who were aged 40-64, Spanish-speaking Latinas, lower educated, attending cancer education events because of the cost of the screenings, patient navigation recipients, living in the south region of Texas, and in counties with high poverty. Although models indicated significant variability in screening rates by county, county-level poverty was only significantly associated with odds of getting Pap screening in adjusted models. Not receiving patient navigation vs. receiving it was associated with lower odds for both mammogram (OR: 0.51, CI: 0.38-0.70) and Pap (OR: 0.69, CI: 0.50-0.94) screenings.County-level variation in screening rates exists for both mammogram and Pap tests and should be considered in the development and implementation of screening interventions in rural and border areas. However, other factors beyond poverty levels may explain the variation.

Abstract B127: Hispanic-White residential segregation and stage at diagnosis among female residents of Texas

Abstract Background: Breast cancer is the second leading cause of cancer-related deaths among females in the United States. Individual and neighborhood-level characteristics have been associated with breast cancer-related disparities. There is a paucity of literature about Hispanic-White residential segregation and stage at diagnosis of breast cancer, and whether residential segregation explains or moderates disparities in stage at diagnosis among Hispanics. Objectives: To explore whether Hispanic-White residential segregation is associated with late-stage breast cancer, and how it explains or moderates disparities in stage at diagnosis of breast cancer associated with Hispanic ethnicity. To explore whether health insurance coverage and census tract (CT) poverty level explains or moderates disparities associated with residential segregation. Methods: This is a retrospective data analysis using the Texas Cancer Registry. The analyses were restricted to non-Hispanic White and Hispanic females ages 18 and older diagnosed with breast cancer from 2007-2014, and who had only one primary tumor. The dependent variable was stage at diagnosis (early, late). The independent variables of interest were Hispanic-White residential segregation, race/ethnicity, type of insurance coverage and CT poverty level. Multilevel logistic regression models with individuals nested within CT were used for analyses. The final sample size was 80,149 individuals nested within 5,023 CT. Results: Hispanics were more likely to be diagnosed with late-stage breast cancer (OR=1.14; 95% CI=1.10-1.19). Increasing Hispanic-White residential segregation was associated with increased likelihood of late-stage diagnosis (OR=1.46; 95% CI=1.04-2.05). Type of health insurance explained some of the association between residential segregation and late-stage diagnosis. Residential segregation did not explain or moderate the association between Hispanic ethnicity and breast cancer stage at diagnosis. Predicted probability estimates showed that individuals who were uninsured or insured through Medicaid had similar probabilities of late-stage diagnosis. These disparities were worse for uninsured or Medicaid-insured Hispanic residents of highly segregated CTs. Conclusion: Hispanic-White residential segregation was associated with increased likelihood of late-stage breast cancer diagnosis. Interventions to increase early-stage breast cancer diagnosis are needed among residents of CTs with high residential segregation, especially among Medicaid insured and uninsured women. Interventions aimed at raising awareness of the association between Hispanic residential segregation and breast cancer stage at diagnosis among healthcare providers should be explored. Citation Format: Chinedum Ojinnaka. Hispanic-White residential segregation and stage at diagnosis among female residents of Texas [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B127.

Reasons for not receiving the HPV vaccine among eligible adults: Lack of knowledge and of provider recommendations contribute more than safety and insurance concerns.

BackgroundThe upward trends of vaccine exemptions in Texas are alarming. While HPV vaccine rates in this State are among the lowest nationwide, factors that contribute to the low HPV vaccination uptake among adults remain unknown. In this study, we examined the main reasons for not receiving HPV vaccination among age‐eligible adults.MethodsThe Texas health screening survey (2018), a multistage area probability design‐based survey of a representative sample of Texas residents, was used to identify 907 eligible adults (age ≥ 18 years) respondents, including 724 women aged ≤ 26 years in 2007 (≤38 years in 2018), and 183 men aged ≤ 21 years in 2011 (≤28 years in 2018). Participants who reported having never received an HPV shot, where asked the main reason for not receiving the vaccine.ResultsOverall, 58.5% (95%CI: 55.1‐62.0) of vaccine eligible adults reported having never received the HPV vaccine. The most commonly reported reasons for not receiving it were: did not know about the vaccine (18.5% (14.9‐22.1)), and provider did not recommend (14.1% (10.9‐17.4)). In contrast, commonly perceived reasons such as: safety concerns (7.2% (4.8‐9.5)), lack of insurance (3.4% (1.7‐5.1), and concerns about increasing sexual activity if vaccinated (0.2% (0.0‐0.5)), were less frequently reported.ConclusionAmong vaccine‐eligible adults, safety and sexuality concerns do not appear to be the prime factors underlying low HPV vaccination rates. Rather than emphasizing them, educational interventions should aim at improving vaccine's knowledge, and enhancing provider recommendations on the necessity of HPV vaccination.

Psychosocial Factors Are Associated with Electronic Portal Registration.

Electronic health records often include a portal for secure patient-clinician communication. There is evidence that use of electronic portals increases satisfaction, treatment adherence, safety, and clinical outcomes. We want everyone to enjoy these benefits and we noticed low and uneven portal use. We studied factors that we can address to improve portal use. After controlling for differences in patient characteristics, what psychological and demographic factors are associated with an increased likelihood of registering for an electronic health record portal among people seeking musculoskeletal specialty care? We reviewed data on 5672 adult English or Spanish-speaking patients seen in a musculoskeletal specialty office between October 2017 and December 2019. Eighteen percent (996 patients) had missing measures of symptoms of depression and anxiety due to intermittent problems with survey technology, leaving 4676 for analysis, 42% (1970 of 4676) men and 58% (2706 of 4676) women with a mean age of 51±15, 76% (3569 of 4676) of patients were English speaking, 22% (1015 of 4676) were Spanish speaking, and 2% (92 of 4676) spoke another language. Seventy-seven percent (3620 of 4676) of patients were residents of Austin, Texas, USA, 4% (159) were from Pflugerville, Texas, USA, 3% (143) were from Del Valle, Texas, USA, and 16% (754 of 4676) were from other areas of Texas. Ninety nine percent of patients were residents of Texas (4645 of 4676). Twenty-three percent of patients visited the upper extremity team (1077 of 4676), 37% the lower extremity team (1721 of 4676), 21% the back and neck team (1002 of 4676), and 19% the sport medicine team (876 of 4676). Seventy eight percent of patients (3654 of 4676) registered in portal and 22% (1022 of 4676) did not. The omitted population were not different from our study population in terms of age, gender, language, residence, and region of symptoms. We used a two-question measure of symptoms of depression (Patient Health Quality-2 [PHQ-2]) and a two-question measure of symptoms of anxiety (General Anxiety Disorder-2 [GAD-2]). The primary outcome was portal registration. To account for potential confounding, a multivariable logistic regressions model was used to determine the influence of age, spoken language, city and state of residence, care team, number of completed visits and GAD and PHQ scores on portal registration. After controlling for potentially confounding variables such as state of residence, we found younger age (odds ratio 0.98 [95% CI 0.97 to 0.99]; p < 0.01), speaking English (OR 1.85 [95% CI 1.14 to 3.02]; p = 0.01) rather than Spanish (OR 0.27 [95% CI 0.17 to 0.45]; p < 0.01), seeking care for back or neck symptoms, (OR 3.84 [95% CI 2.60 to 5.66]; p < 0.01) and higher number of completed visits (OR 1.03 [95% CI 1.01 to 1.05]; p < 0.01) were associated with an increased likelihood of portal registration while living in Austin, Texas, USA (OR 0.68 [95% CI 0.53 to 0.87]; p < 0.01) and Del Valle, Texas, USA (OR 0.47 [95% CI 0.30 to 0.74]; p < 0.01) compared with Pflugerville, Texas, USA, or other cities, seeking care for upper extremity (OR 0.74 [95% CI 0.58 to 0.94]; p = 0.01) or lower extremity symptoms (OR 0.68 [95% CI 0.53 to 0.86]; p < 0.01), and greater symptoms of anxiety (GAD score) (OR 0.97 [95% CI 0.95 to 0.99]; p < 0.01) or depression (PHQ score) (OR 0.97 [95% CI 0.95 to 0.98]; p < 0.01) were associated with lower likelihood of registering for the portal. English language, city of residence, and seeking care for back or neck symptoms (due to insurance contracts) were all associated with higher socioeconomic status in our setting. The association of better mental and social health (financial, employment, housing and food security; connectedness) with registration in a communication portal directs us to be more intentional about efforts to specifically welcome disadvantaged people to participate in the portal and to study the impact and effectiveness of such efforts. Level III, therapeutic study.

Influence of Community and Culture in the Ethical Allocation of Scarce Medical Resources in a Pandemic Situation: Deliberative Democracy Study.

BackgroundStark gaps exist between projected health needs in a pandemic situation and the current capacity of health care and medical countermeasure systems. Existing pandemic ethics discussions have advocated to engage the public in scarcity dilemmas and attend the local contexts and cultural perspectives that shape responses to a global health threat. This public engagement study thus considers the role of community and culture in the ethical apportionment of scarce health resources, specifically ventilators, during an influenza pandemic. It builds upon a previous exploration of the values and preferences of Maryland residents regarding how a finite supply of mechanical ventilators ought to be allocated during a severe global outbreak of influenza. An important finding of this earlier research was that local history and place within the state engendered different ways of thinking about scarcity.ObjectiveGiven the intrastate variation in the themes expressed by Maryland participants, the project team sought to examine interstate differences by implementing the same protocol elsewhere to answer the following questions. Does variation in ethical frames of reference exist within different regions of the United States? What practical implications does evidence of sameness and difference possess for pandemic planners and policymakers at local and national levels?MethodsResearch using the same deliberative democracy process from the Maryland study was conducted in Central Texas in March 2018 among 30 diverse participants, half of whom identified as Hispanic or Latino. Deliberative democracy provides a moderated process through which community members can learn facts about a public policy matter from experts and explore their own and others’ views.ResultsParticipants proposed that by evenly distributing supplies of ventilators and applying clear eligibility criteria consistently, health authorities could enable fair allocation of scarce lifesaving equipment. The strong identification, attachment, and obligation of persons toward their nuclear and extended families emerged as a distinctive regional and ethnic core value that has practical implications for the substance, administration, and communication of allocation frameworks.ConclusionsMaryland and Central Texas residents expressed a common, overriding concern about the fairness of allocation decisions. Central Texas deliberants, however, more readily expounded upon family as a central consideration. In Central Texas, family is a principal, culturally inflected lens through which life and death matters are often viewed. Conveners of other pandemic-related public engagement exercises in the United States have advocated the benefits of transparency and inclusivity in developing an ethical allocation framework; this study demonstrates cultural competence as a further advantage.

Political Hippies and Hip Politicos: Counterculture Alliance and Cultural Radicalism in 1960s Austin, Texas

Political Hippies and Hip Politicos:Counterculture Alliance and Cultural Radicalism in 1960s Austin, Texas John A. Moretta* Click for larger view View full resolution University of Texas students affiliated with the Students for a Democratic Society (SDS) protest the Vietnam War at the Texas State Capitol. Mariann Wizard Papers, di_06907, The Dolph Briscoe Center for American History, The University of Texas at Austin. [End Page 266] In recent decades, residents of Texas's capital city have been enjoined to "Keep Austin Weird." Although this slogan evades precise definition, it does capture something important about the city's collective identity.1 It has long been a haven for the offbeat, and its progressive politics often put it at odds with much of the rest of Texas. While several recent books have challenged the idea that Austin has lived up to its progressive self-image, especially in terms of racial equality, urban development, and conservation, there is at least some truth that Austin is defined by its "weirdness," even as the city's tech-oriented economy booms and its population swells.2 It is the city Willie Nelson and others put firmly on the [End Page 267] nation's cultural map with the "outlaw country" music scene of the 1970s. However, that scene did not come out of nowhere; it was built on a foundation largely established in the 1960s.3 It was during that decade that the blend of progressive politics and cultural experimentation that still makes Austin "weird" was defined on the campus of the University of Texas (UT), the result of the unlikely alliance of hippies and New Left politicos. UT's hip/radical coalition transcended the antagonisms between these two groups evident in countercultural centers such as the San Francisco Bay Area and New York City and forged an enduring identity for Texas's capital city. To be sure, Austin was not the only college town in 1960s America defined by the blending of radical politics and cultural libertinism. From Madison, Wisconsin, to Norman, Oklahoma, and many other places in the American Midwest and on the Southern Plains, the "prairie power" student movement within the New Left proved to be a more open, less uptight, spontaneous, and more action-oriented alternative to the more doctrinaire New Left traditionalism of the Atlantic and Pacific Coasts—indeed, it also helped to give some of these "heartland" places a progressive identity that still endures.4 But as Austin has grown to be a much larger city than these other centers of "prairie power," it might be argued that its national—perhaps even international—influence and reputation is that much greater. With apologies to Portland, Oregon, among other places, Austin is the "weird city," par excellence. Austinites have fully embraced both their dissident past and current political and cultural singularity, often viewing their city as "a progressive island in a sea of intolerance" and a "liberal Mecca in a desert of conservatism." The roots of the city's eccentricities were planted in the late 1960s when a rebellious and contentious spirit emerged from the radical fusion of the University of Texas's Students for a Democratic Society (SDS) and their community's hip counterparts. Together they transformed Austin from a "sleepy, beautiful little town" to a city "vilified by the rest of Texas as the long-haired, hippie, pot-smoking, hell-raising Gomorrah of the Western [End Page 268] world."5 Indeed, for many Austin natives, the sixties and early seventies was the city's Golden Age, a time "Old hippies … blather endlessly about while picking dope seeds out of their dentures. … It was a good time to be in Austin … [when] it was cooler to be a hippie than be in a frat. It was really like what you read about. And it allowed for more weird things to happen … and that gave you time to do something weird."6 The alliance of UT student radicals and Austin's hip community challenges most standard interpretations of the era that contend that SDS affiliates, such as the one at UT, who welcomed the hippies as fellow rebels, contributed to both the New Left's and SDS's eventual demise by...

Impacts of Hurricane Harvey on drinking water quality in two Texas cities

Hurricane Harvey devastated large parts of the US Gulf Coast in 2017, and its floodwaters posed a number of threats to the environment and human health. In particular, an estimated 375 000 Texas residents experienced issues related to the provision of safe drinking water at the peak of the hurricane. In this study, physical, chemical, and biological water quality was monitored in two drinking water systems in Texas following Hurricane Harvey to understand the relationship between water quality parameters and changes in the drinking water microbiota. Results show initial surges in total organic carbon, trihalomethanes, and bacterial concentrations in finished water immediately following Hurricane Harvey. Microbial community analyses highlight the dependence of the distribution system microbiota on distribution system characteristics (i.e. water age), raw water quality, and disinfectant residual, among other factors. While both systems had problems maintaining disinfectant residual in the weeks following the hurricane, stabilization of water quality occurred over time. Overall, this study provides an understanding of the challenges associated with maintaining drinking water quality in the wake of a natural disaster and can be used to better prepare drinking water managers and engineers to combat changing weather patterns in the future.

The Right to Light: Visibility and Government in the Rio Grande Valley Colonias

Examining the Right to Light campaign carried out by colonia residents in south Texas, this article analyzes the relationship among three axes: the effects of the Valley’s urban geography on the grassroots struggle of marginalized citizens to install streetlights to attain material illumination and security; the ensuing visibility of these citizens to governing apparatus and their increased susceptibility to mechanisms of management and control; and, finally, the production of political visibility in the public sphere through collective action. I show how struggles over distribution of regional and national resources, social recognition, and political participation not only give shape to concrete spaces but also shape how colonia residents understand their own subjectivities as a concerned public. Considering the relationship between materiality, visibility, and power, I argue that the problem of darkness is deeply connected to racialized distinctions between citizens and immigrants, between legality and illegality, and between those who deserve to be part of the urban community and those who are obliged to stay outside its boundaries. Key Words: concerned publics, political visibility, streetlight infrastructure, Texas colonias, U.S.–Mexico border.

ABUSE, NEGLECT, AND EXPLOITATION IN ASSISTED LIVING: AN EXAMINATION OF LONG-TERM CARE OMBUDSMAN COMPLAINT DATA

Adult Protective Services (APS) has seen cases of elder abuse increase recently and older adults living in long-term care facilities are subject to abuse, neglect and exploitation (ANE) at higher rates than community-dwelling seniors. However, there is scant empirical literature about ANE in assisted living (AL) settings and skilled nursing facilities (SNFs). The purpose of this study is to examine ANE complaints in AL and SNFs as recorded by Long-term Care Ombudsman Programs (LTCOPs) utilizing secondary data from a statewide database as well as an agency database used by staff ombudsmen who work in a large Metropolitan city in Texas. The sample included 140,497 complaints made at 1,940 licensed ALs with approximately 45,107 residents and 1,231 SNFs with 93,932 residents in Texas from 2010-2017. The percent of total complaints coded as ANE was higher in AL (2.01%) than in SNFs (1.46%) (p < .001). However, after controlling for number of residents, the rate of total ANE complaints per resident was higher (0.019) in SNF compared to AL (0.007) (z = -17.221, p <. 001). The incidence of financial exploitation was significantly higher in AL (23.46%) than in SNF (11.90%) (z = 5.582, p < .001). The percentage of verbal/psychological abuse in SNF (34.78%) was significantly higher than that in AL (23.4%) (z = -2.238, p < .05). Study findings contribute to the knowledge about the prevalence and nature of ANE in long-term care communities and bolster support for increased AL ombudsman presence, staff training, resident-centered care models, and AL oversight.

RETRACTED: The Impact of the Castle Doctrine on Crime Rates in Texas: Policy Recommendations and Public Health Implications.

An amendment to the Castle Doctrine was implemented in Texas in 2007. The amendment allows the residents of Texas no obligation to retreat prior to using a weapon for protecting oneself, one's belongings, and/or one's property. The objective of the study is to examine whether the Castle Doctrine had an impact on individual crime rates, consolidated violent and consolidated property crime rates, and the overall combined crime rate as the dependent variables. The econometric method of analysis employed in this study is an interrupted time series regression with the line of interruption separating pre-/postimplementation periods marked in the year 2007 for time frames 1998-2006 (preimplementation years) and 2007-2016 (postimplementation years). The independent variables were time, the implementation of the Castle Doctrine-the intervention, and time after the intervention-the postimplementation intervention. Findings of the study indicated an increase in the individual crime rates of murders and rapes and a simultaneous decrease in individual rates of property crimes. Moreover, the analysis detected a decrease in the consolidated violent crime rate of 0.03% (95% confidence interval [CI: -0.012, 0.010]; p = .285) and a decrease in the consolidated property crime rate of 1.81% (95% CI [-0.104, 0.118]; p = .391). Conclusively, a decrease in the overall combined crime rate of 2.31% (95% CI [-0.116, 0.207]; p = .362) was detected over the analyzed time frame. The findings of the study denoted a decrease in the property crime rate that prospectively connects to the likelihood of the deterrence effect, which may imply that perpetrators may have been discouraged to invade properties due to notion of encountering armed homeowners.

Renewable energy's vanishing premium in Texas's retail electricity pricing plans

Traditionally, there has been a premium in green pricing plans for electricity supply with high renewable energy content. Using a sample of 710 plans offered in December 2018 by Texas's competitive retailers to residents in Dallas, Houston, Corpus Christi and Abilene, we document that there is no longer a statistically significant renewable energy premium in Texas's retail electricity pricing. Attributable to the declining cost of renewable energy, this finding's policy implication is that continuing development of renewable energy is unlikely to adversely impact Texas's residents.

Prevalence and determinants of cervical cancer screening with a combination of cytology and human papillomavirus testing

PurposeIn the United States, recommended options for cervical cancer screening in women aged 30 years or older include cytology alone or a combination of cytology and human papillomavirus (HPV) testing (co-testing). Although there is a body of evidence suggesting that co-testing may be the preferred screening option in this group of women, little is known about the characteristics of women who screen for cervical cancer with co-testing. MethodsA multistage area probability design-based survey was administered to a representative sample of Texas residents. Of the 1348 female respondents, 572 women aged 30 years or older were included in this analysis. Population-weighted survey logistic regression was used to identify determinants of cervical screening with co-testing versus screening with cytology alone. ResultsWomen vaccinated against HPV (aOR: 4.48, 95% CI: 1.25–15.97) or hepatitis B virus [aOR: 2.48 (1.52–4.02)], those with a personal cancer history [aOR: 2.96 (1.29–6.77)], and hormonal contraception users [aOR: 2.03 (1.03–3.97)] were more likely to be screened with co-testing than with cytology alone. Moreover, the likelihood of being screened with co-testing decreased with increasing age and decreasing annual household income. ConclusionsBenefits and indications of co-testing should be better explained to women and health care providers.

Factors associated with self-reported mental health of residents exposed to Hurricane Harvey

BackgroundElevated rates of mental morbidity have been reported among residents of areas exposed to hurricanes. This study aims to assess the self-rated mental health of Texas residents exposed to Hurricane Harvey and identify factors associated with variations in self-rated mental health. MethodsThe 12-item Short Form Health Survey (SF-12) was administered to 1086 residents of the Texas Gulf Coast exposed to Hurricane Harvey. Responses were scored using the algorithm recommended by Quality Metric. A multiple linear regression model was fitted to identify the factors that predicted the respondents' mental component summary scores (MCS). ResultsTexas Gulf Coast residents exposed to Harvey exhibited poorer self-rated mental health than the U.S national population (Mean MCS = 34.58 (SD = 8.89)). Respondents with graduate or professional degrees, older adults, and those with higher perception of surge risk had better reported mental health after Hurricane Harvey, while females and mobile home residents had poorer reported mental health. ConclusionResidents of areas exposed to Hurricane Harvey reported poorer self-rated mental health compared to national standards. These findings support the enhanced provision of mental health services after a disaster, and suggest that they may be most effective when integrated with economic and educational programs and directed towards populations that are younger and less-educated in addition to women with children as well as those who live in mobile homes.

Towards sustainable water management: Preferences and willingness to pay for smart landscape irrigation technologies

Urbanization trends, leading to growing irrigated residential landscapes continue to escalate concerns on surface, ground, and drinking water quantity and quality among environmental groups and regulatory agencies. While automated lawn irrigation systems established in urban areas are critical factors affecting water quantity and quality, homeowners’ water use may vary with their preferences for lawn irrigation systems. The choice of an irrigation system is not determined only by local restrictions or policies but also by homeowners’ preferences. Further, individuals’ preferences can be influenced by the availability of product-specific attributes such as evapotranspiration or soil-moisture based controllers (known as smart irrigation controllers). With a focus on single-family home residents in California, Florida, and Texas, the present study uses the discrete choice analysis framework to link smart irrigation attributes (e.g., sensor types, wireless operation, remote control, alert notification) and monetary incentives (e.g., annual water bill savings, rebates) to preferences and willingness-to-pay. Results indicate that homeowners prefer smart irrigation controllers to conventional automated systems, and that savings on annual water bills could be one of the most important features determining adoption of smart irrigation controllers. Controller features such as the type of operation (i.e., wireless/on-site weather station) and system malfunction alert/notification also impacted homeowners’ preferences. The findings provide practical insights into the promotion of smart irrigation controllers that can be integrated with educational campaigns, or advertisements highlighting benefits of smart irrigation technologies. Clearer understanding about homeowners’ preferences could serve as a feedback loop for policy makers and improve water policies at state and local levels.