By Sally Crocker

Dr. Teresa Wagner, right

Dr. Teresa Wagner’s own experiences as a mother trying to help her daughters through two life-threatening health scares, misdiagnosis and providers’ failure to recognize critical symptoms ignited her passion to lead the charge for improved patient health literacy and better communication between physicians and patients across Texas.

In recognition of her efforts to bring about change in the ways people navigate and understand today’s complex healthcare environment, Dr. Wagner has been named as the 2018 Health Literacy Hero by the Health Literacy Collaborative, a network of healthcare professionals, educators, businesses and community members working for improvement and increased awareness of health literacy.

The award was presented at the partnership’s 14^th Annual Texas Health Literacy Conference in San Antonio.

Dr. Wagner is Assistant Professor of Health Behavior and Health Systems at the UNT Health Science Center School of Public Health and serves as Senior Fellow for Health Literacy at the UNTHSC Institute for Patient Safety.

She remembers the struggles her older daughter, then in college and living away from home, went through before it was finally discovered that she had appendicitis.

“The symptoms were getting worse; my daughter knew that what she was feeling wasn’t right, yet the physician continued to say it was something else, not that serious,” Dr. Wagner said. “Years later, at 27, she went through a similar situation with diverticulitis.”

Dr. Wagner’s younger daughter sought care for a different problem but ended up silently suffering in pain from an undiagnosed hormonal syndrome, after deciding not to go back to the physician who had told her the only thing wrong was that she needed to lose weight.

“When someone feels shamed, or that they are just not being listened to, they can end up living with symptoms that are often debilitating or even deadly,” Dr. Wagner said.

Age-related disparities can have a profound impact on health literacy, she said, with the most vulnerable populations being young people just learning to live on their own, roughly ages 18 to 23, and senior adults, who may be too frail or too ill to speak up for their own care.

Solutions point to a give-and-take relationship and clear, open, two-way communications between patients and their health providers, both in person and in the directions and medications provided.

“There are many facets to health literacy,” Dr. Wagner said. “Consider the pages and pages of discharge paperwork that patients receive when leaving the hospital. If patients have trouble understanding what they should do when they get home, the repercussions could be critical. Prescriptions, as well as recommendations sent home after a clinic or physician’s office visit, represent other good examples where instructions might be confusing. Revising these types of materials into plain language can make a real difference.”

As the result of a policy brief Dr. Wagner developed for the State Health Committee and her testimony during  the 2017 Texas legislative session, state leaders will be reviewing recommendations for improved health literacy actions in the 2019 legislative session.

“Five other states now have legislation, and others have centers dedicated to health literacy. The hope is that Texas will move forward in this direction as well,” she said.

Dr. Wagner’s current research interviewing administrators and leaders representing up to 80 different healthcare organizations across North Texas is giving her a unique opportunity to examine the health literacy challenges that exist in hospitals today, based on the National Academy of Medicine’s model for Attributes of a Health Literate Organization.

Through the study, each participating hospital will receive a report on the strengths and opportunities of their organization, as well as recommendations, training options and areas for collaborative health literacy efforts across healthcare systems.

Dr. Wagner is also involved in research related to the impact of health literacy on maternal health, birth outcomes and postnatal care.

“As a mom who has been there, my hope is that no patient has to go through what my daughters have endured. The push for greater awareness and improvements in health literacy has the power to change and save lives,” she said.

By Sally Crocker

Dr. Dana Litt

What happens in the first semester of college can profoundly impact students’ alcohol use and future drinking behaviors, especially during the first six weeks, says UNTHSC Associate Professor Dana M. Litt, PhD, who is leading a new study on ways to reach freshmen when they are most impressionable.

This three-year project is funded by a $600,000 grant from the National Institute on Alcohol Abuse and Alcoholism (NIAAA), one of 27 institutes and centers comprising the National Institutes of Health (NIH).

“An extensive amount of research to date has focused on problems and prevention related to heavy drinking in college, but significantly, we see that about 25% of students who were previously non-drinkers or light drinkers often begin drinking or progress to heavy alcohol use during their freshman year,” Dr. Litt said. “Timing interventions during the first six weeks of college, the critical ‘red zone’ period, could provide an opportunity to reach these freshmen during their highest time of vulnerability for either beginning or escalating drinking.”

Dr. Litt and UNTHSC Professor Melissa A. Lewis, PhD, Co-Investigator on the study, will conduct focus groups of incoming North Texas-area college freshmen who are either non-drinkers or light drinkers to learn about their opinions and personal experiences with alcohol, and to measure the importance of friend/peer influences, personal goals and alcohol-free events and activities on campus.

Focus groups will also be asked to evaluate proposed content and delivery methods for text messaging interventions, which will then be tested with different follow-up groups of new freshmen the next year, from their first day on campus throughout the entire first two semesters.

Significantly, students themselves will be helping to create the ways to reach future freshmen down the road.

“In phase one, we want to learn what type of information these target freshmen would like to receive via text, how often, which days of the week and which times of day,” Dr. Litt said. “During phase two, as we actually follow the next groups of students from their first day forward, the value of the messaging will be assessed after the first six weeks of college, then at three, six and nine months afterward, to evaluate if they have been influenced to drink less or not to start drinking at all.”

Typically, non-drinking or light-drinking college students are considered as relatively low risk in research studies, but negative consequences measure higher among these groups if they begin or escalate alcohol use during their freshman year.

“Most freshmen are entering into a new social environment with much less parental oversight. You want to meet people and go to parties, have fun and be a part of it all, but for kids without experience, drinking can be especially risky,” Dr. Litt said. “Our goal is to support their decisions to not drink or to drink lightly, in part by correcting the belief that everyone is doing it, by reinforcing goals that don’t involve alcohol, and by encouraging these students to find non-drinking activities they enjoy where they can meet like-minded friends.”

By Sally Crocker

Dr. Scott Walters

When the U.S. Surgeon General published a recent health advisory – the first such alert in the last decade – asking for the public’s assistance in tackling the nation’s growing opioid epidemic, Dr. Scott Walters from the UNTHSC School of Public Health made plans to do his part.

“Be prepared. Get naloxone. Save a Life,” the Surgeon General said. “For patients currently taking high doses of opioids as prescribed for pain, individuals misusing prescription opioids and individuals using illicit opioids such as heroin or fentanyl, health care practitioners, family and friends of people who have an opioid use disorder, and community members who come into contact with people at risk for opioid overdose, knowing how to use naloxone and keeping it within reach can save a life.”

As a behavioral health professor and researcher at the UNTHSC School of Public Health, Dr. Walters has worked with people who are homeless, on probation and at risk of interpersonal violence. His research takes him to community shelters, institutional settings and out to the streets.

“Being able to react quickly when an overdose is suspected could mean the difference between life and death,” Dr. Walters said. “If there is a chance I could help someone in an emergency, I want to be ready. Not many people, though, know where or how to get naloxone, or realize that it’s available through their insurance without questions or a prescription.”

Naloxone, sometimes referred to by the brand name Narcan, is a safe antidote for overdose that has been used in hospitals and among emergency medical personnel for years, Dr. Walters said. It is available in injection form or as a nasal spray.

“There are no side effects,” he said. “The only result is to reverse the deadly threat of an overdose.”

Over the last 15 years, individuals, families and communities across the U.S. have been tragically affected by the opioid crisis, with the number of deaths from prescription and illicit opioids doubling from 21,089 in 2010 to 42,249 in 2016.

“The problem is real, and unfortunately, it is still growing,” Dr. Walters said. “We can all help by understanding the signs of opioid abuse and knowing what to do in an emergency.”

Obtaining naloxone was initially challenging for Dr. Walters.

The first pharmacy he tried was hesitant and not familiar with the new guidelines. To bill his insurance, they suggested he needed a doctor’s prescription.

A call to his doctor didn’t help either, as the physician wasn’t comfortable with moving away from typical protocol for prescribing a medication. Because it would be used for someone else, the doctor didn’t feel able to assist.

As Dr. Walters pursued it further with the Texas Pharmacy Association, he discovered that a standing naloxone prescription order exists for all Texas citizens and is now applicable in most other states.

A visit to a second pharmacy with this new information yielded a better outcome. The medication was provided without a personal prescription, at a cost of his usual insurance copay.

Texas Society of Addiction Medicine President Dr. Carlos F. Tirado, who signed the state’s standing order more than one year ago, said, “This medication has been available to the public for quite a while. We still have a lot of work to do in educating and informing pharmacists, physicians and citizens on how to obtain naloxone and the power we all have to save someone’s life. Anyone who has a concern about someone they know, or someone close to them, can get this medication at any pharmacy.”

People who keep opiates or painkillers at home or who have curious teenagers might be wise to have this antidote on hand, Dr. Walters recommends.

“Many colleges, in fact, keep naloxone available in case of emergency,” Dr. Walters said. “People who work in healthcare, public health or other fields where they encounter vulnerable populations, or anyone who suspects they might be around someone who could be abusing drugs, may also benefit.”

By Sally Crocker

Dr. Melissa Lewis

Two UNT Health Science Center public health researchers plan to get inside the minds of teens and young adults to learn what influences them to drink, and when they are most apt to use alcohol, through a new $2.6 million, five-year study funded by the National Institute on Alcohol Abuse and Alcoholism through the National Institutes of Health (NIH).

Dr. Melissa A. Lewis, UNTHSC Professor of Health Behavior and Health Systems, is leading the study, along with Dr. Dana M. Litt, UNTHSC Associate Professor, Health Behavior and Health Systems, and colleagues from the University of Washington.

The researchers will connect with volunteer participants ages 15-25 through smartphone technology to study situations, influences and state of mind that may lead to drinking.

“Some theories suggest drinking is intentional, while others believe it may not be so planned,” Dr. Lewis said. “We want to know more about that, by looking at how young people think and engage with others throughout the day, and how influences, situations and timing may affect their urge to drink. We also want to learn what may be different for a high school student, someone of college age, and a person who is slightly older, to see how factors and motivations may change over time or according to different stages of maturity.”

This NIH-funded project will examine decision-making multiple times throughout a day related to high-risk alcohol use among the 15- to 25-year age group, and is both significant and innovative in the way it will study drinking behaviors at both the daily level and developmentally over time, according to age and experience.

Volunteers enrolled in the study will receive random text surveys in quarterly “burst” segments over a one-year period. During each cycle, participants will be texted twice a day, three days a week, for three weeks. The aim is to collect data across three weekdays and three weekends per quarter.

Dr. Dana Litt

Rolling recruitment will continue to enroll new participants on an ongoing basis, using social media, peer referrals, ads and other methods of promotion. The goal is to gather data from more than 1,000 teens and young adults over five years in order to develop alcohol interventions tailored specifically to this demographic.

“Through this research, we plan to assess the best timing for alcohol interventions, by understanding what matters to teens and young adults and how their day-to-day thinking fluctuates depending on the time, influences and what is happening throughout their day,” Dr. Lewis said. “If you wake up not thinking about drinking or planning to, what changes that or triggers a willingness later on?”

The surveys delivered by smartphone technology will gather information on how individuals feel and what they are thinking to start their day, whether they drank or used substances the day before, how much they drank, whether they had planned to drink, where they drank and whether it was alone or with others.

Questions will gauge how friends and social environments may have impacted drinking decisions and determine how drinking made respondents feel physically and emotionally (got sick or hurt, felt bad, couldn’t remember things); whether drinking ended up getting them in trouble (skipped school or homework, got in fights or arguments); or if it made them regret something, or feel embarrassed or guilty.

“Alcohol use continues to be a growing problem among young adults and is a leading risk factor for disease, premature death and behaviors that lead to other serious consequences,” Dr. Litt said. “Through this study, we hope to better understand the motivators and influences to develop prevention and intervention recommendations for reaching young adults when they are most apt to make risky drinking decisions.”

By Sally Crocker

Dr. Scott Walters

For nearly 20 years, Dr. Scott Walters has served others in extraordinary ways through research, teaching, scholarship, community service and contributions to the public good.

In recognition of his work and its impact, the UNT System Board of Regents has awarded Dr. Walters with a rare academic distinction as Regents Professor.

Dr. Walters, who joined UNTHSC in 2011, serves as Professor and Chair for the Department of Health Behavior and Health Systems in the School of Public Health.

He is the only SPH professor to receive this honor in the school’s nearly 20-year history.

As a behavioral health researcher seeking solutions to critical public health issues, Dr. Walters focuses on developing better ways to talk with people about making positive changes.

His research has developed new ways of using smartphones and computers to understand people’s motivation for substance use and other risky behaviors, in order to personalize ways to help them with recovery and other goals.

He and a colleague were recently awarded a major, $650,000 grant from the National Institutes of Health (NIH) to develop and test a unique smartphone-based alcohol treatment for homeless adults, using geolocation and self-reporting in real time to better identify factors that lead people to drink.

Dr. Walters has also created online solutions to help court-ordered probationers meet their substance abuse recovery goals through a unique program called MAPIT. The responsive, self-guided software program addresses a critical need in the criminal justice system, where more than half of the country’s 3.5 million probationers struggle with completing required treatment.

His work has also developed ways to address heavy drinking in hospital settings, vocational success for veterans with a criminal history, alcohol interventions for young adults, community-based health navigation and health advocacy for people at risk of interpersonal violence. In total, he has secured more than $10 million in research funding.

In addition to publishing more than 100 articles and book chapters and five books, Dr. Walters has been recognized for his teaching at UNTHSC and other universities.

“Dr. Walters is a highly sought teacher as well as an internationally renowned researcher and scholar,” said Dr. Mary Marden Velasquez, Director, Health Behavior Research and Training Institute and Centennial Professor in Leadership for Community, Professional and Corporate Excellence at The University of Texas at Austin, in a recommendation letter offered to the UNT System Board of Regents. “In my many years in higher education, I have not encountered a more outstanding teacher and mentor to students, faculty and colleagues.”

As a nationally recognized expert in Motivational Interviewing, a behavior change strategy that has been applied in a wide range of settings, Dr. Walters is frequently consulted by news media and invited to conduct trainings for criminal justice workers, counselors and healthcare professionals. In the last 15 years, he has conducted more than 200 trainings across the country.

By Sally Crocker

Dr. Katherine Fogelberg

Dr. Katherine Fogelberg and friends are building a school in Kenya.

Their mission is to empower girls, to show them that big dreams are achievable and anything is possible through education and support.

The UNT Health Science Center public health professor deeply understands what it means when someone is there to lend a helping hand.

As a South Korean orphan adopted by an American family, her personal experiences and the opportunities she found growing up in her new country forever shaped her life, career and desire to give back to others.

Over the years, Dr. Fogelberg studied animal science and became a doctor of veterinary medicine. She completed a master’s degree in educational leadership. She took that forward to gain a PhD in science education, and has worked in public health for the last eight years.

Along the way, she’s also traveled the world, serving in the U.S. Army and caring for wildlife in remote places like South Africa and Uganda.

Now she wants to help other women dream big and go for their personal best.

“Msomi means scholar in Swahili, the most commonly understood language in Kenya,” Dr. Fogelberg said, explaining why the non-profit she has founded is called Msomi Academy for Girls.

The small team spearheading this project has a long road ahead to secure funding, develop and pilot curriculum, and become known and accepted among parents and future students. They know it won’t be easy, but they are ready for the challenge.

“We want to do something good in the world. My colleagues and I are passionate about education. We want to help empower girls,” Dr. Fogelberg said.

The startup team includes teachers, marketing and creative counsel, those with experience in preparatory school management, and UNTHSC public health students and alumni.

Several team members visited Kenya in June to look for land, meet with families, learn more about the region’s different cultures, deliver mosquito netting and teach prevention of infectious diseases like malaria, typhoid and cholera.

“We talked with girls who want to someday become pilots, lawyers and physicians,” Dr. Fogelberg said. “Many believe, for the first time in their ethnic cultural history, that this is possible, in large part because of a local role model who’s become the area’s first female to graduate from medical school. They are starting to see possibilities that might exist for them too.”

As a primary school initially targeting grades 1 through 8, Msomi will focus on liberal arts and applied science, to give girls practical tools for improving quality of life in their home communities and beyond.

While Dr. Fogelberg’s ultimate goal is to “get just one girl ready for a university education,” the team understands that there are other needs and many ways that Kenyan girls can grow and contribute right where they live.

“The curriculum will relate to ways they can be successful in an agricultural society, so they can take on bigger roles typically reserved for men in their communities,” said UNTHSC MPH student Sarah Matthes, who is interning with Msomi and recently traveled with the team to Kenya. “Math and science classes through agriculture, using gardening and farming as teaching tools, will cover topics like planning and productivity of crops, composting techniques, when and how to plant, watering and other aspects related to the needs of their daily lives.”

Basics like reading, writing, culturally-relevant reproductive health and sex education will also be offered.

“The intent is to provide a comprehensive education, making it as useful as possible for their everyday lives,” Matthes said.

“As we are connecting with families and support organizations in the region, we are asking what people see as their biggest challenges, to learn more about how we can help,” Matthes said. “A big problem among women in Kenya is not knowing what their options are or thinking they might not be capable of going after what they want. We hope to change that.”

Msomi is currently in the process of acquiring 501(c)(3) status and fundraising to purchase land, construct the buildings and hire teachers, medical support and other needed staff.

Dr. Fogelberg’s plan is to use Kenyan resources, both human and material, to ensure the program is locally sustainable.

Along the way, the team continues to focus on their even bigger goal.

“It’s important to teach Kenyan girls how they can contribute successfully to society, but to do this, we have to get them to believe in themselves first,” Dr. Fogelberg said.

“Personally,” Matthes said, “I hope to see these girls find the way to pursue whatever is their best life and to have the resources to go for their dreams.”

Photos courtesy of Msomi Academy for Girls

Twitter: @MSoMI_Academy

Instagram: @msomiacademy

LinkedIn: https://www.linkedin.com/company/msomiacademy/

Dr. Austin Meyer

By Sally Crocker

Dr. Austin G. Meyer was already working on both a PhD in Biochemistry and a medical degree at other Texas universities when he decided to enroll in UNT Health Science Center’s Master of Public Health online program.

Why?

“I had thought about it for a long time,” he said. “Medical school focuses primarily on anatomy and physiology, and treatments based on pathophysiology of disease, but taking it a step further – to consider population health, the social determinants of health, health policy, or to organize, collect and analyze data for clinical trials and community health studies – all of that calls for a public health perspective.”

Dr. Meyer became interested in public health during his first year of medical school, when he took on a leadership team role with a free clinic managed by Texas Tech University in the Lubbock area.

“There were many areas of public health that I wanted to learn more about, such as how to interact with public health departments to set up vaccination days, how to navigate the policy landscape for a public health grant, how to develop funding for a public clinic and more,” he said. “The work I was beginning to do as a student leader in that role challenged me to look deeper into public health and how it impacts the practice of medicine.”

After his second year of medical school, he took a year off to finish his PhD.

At about that same time, the 2014 West African Ebola outbreak hit the news and quickly reached global concern levels.

With Dr. Meyer’s research on viral evolution already underway, he and a colleague were able to compare Ebola’s evolution at that point to earlier outbreaks, and to study it in contrast to other emergent viruses, like the 2009 pandemic H1N1 influenza virus, to understand whether Ebola was evolving more rapidly in 2014 than it had in the past.

As a result, they were invited to present their findings at the Ebola Modeling Workshop in Atlanta that was co-sponsored by Georgia Institute of Technology and the CDC.

“There were so many aspects of the Ebola outbreak that caught my attention as both a biochemistry researcher and a physician in training,” he said, “such as knowing how to treat the patient, how to interact with the public on a larger scale, how to contain the disease, the challenges and limitations of HAZMAT gear for emergency/medical personnel, and how to collect, organize and analyze data when situations are happening so rapidly and in numerous places.”

Doctors today, he said, are finding themselves in many different roles that call for public health knowledge and experience.

“Physicians touch on public health at almost every level. In addition to working with and sometimes for public health departments, doctors providing international aid can take on the role of community health worker, and through medical societies and advocacy efforts, physicians can impact policy,” Dr. Meyer said. “Public health is also important in reaching challenging populations to motivate better lifestyle choices related to diet, smoking, alcohol/substance use, exercise, blood pressure and cholesterol control, stress management and other conditions.”

Being able to complete the MPH online through the UNTHSC School of Public Health was a real benefit, Dr. Meyer said, to “add the context and background to complete the picture” that has now taken him to the next level, as an Internal Medicine and Pediatrics resident physician at the Ohio State University College of Medicine.

By Sally Crocker

Dr. Liam O’Neill

Private hospital rooms may save lives by reducing the risk of a dangerous type of hospital-acquired infection, according to UNT Health Science Center researchers in a new study published in PLOS ONE.

Liam O’Neill, PhD, Associate Professor of Health Behavior and Health Systems at the UNTHSC School of Public Health, who led the study with Frank Rosinia, MD, UNTHSC Professor and Executive Vice President for Strategy and Performance, and doctoral student Sae-Hwan Park, sought to understand the impact of private rooms on patient safety events and preventable complications, such as central line infections.

Examining discharge records for more than one million inpatients across 335 Texas hospitals, the research team found that patients who stayed in bay (double occupancy) rooms had 64% more central line infections than patients who stayed in private rooms. After adjusting for patient characteristics and risk factors, such as race, ethnicity, age, sex and comorbidities, the study’s authors found that patients who stayed in bay rooms had a 21% increase in the relative risk of a central line infection compared to patients assigned to private rooms.

Central line-associated bloodstream infections are those acquired through central venous catheters. Due to the central line’s proximity to the heart, such infections are both costly and extremely dangerous.

The mortality rate for patients with central line infections is 12-25 percent, accounting for about 5,000-10,000 preventable deaths each year.

“At the hospital level, taking overall facility design into account, a 10% increase in private rooms was associated with an 8.6% decrease in central line infections, regardless of individual room assignments. This suggests that there may be some positive externalities at work that benefit all patients, not just those assigned to private rooms.”

The study also found significant racial and ethnic differences in the likelihood of being assigned to a private room. Compared with non-Hispanic whites, African-Americans were 1.63 times more likely, and Hispanics were 1.44 times more likely, to stay in a bay room. Most of these differences appear to be driven by a hospital’s geographic location.

South and west of San Antonio, bay rooms are still predominant.

By contrast, the “Texas Triangle” – defined nationally as one of the country’s mega regions, bordered by the four main cities of Houston, Dallas-Fort Worth, San Antonio and Austin – has seen significant population growth and new hospital construction over the past decade, with the majority of hospital rooms in the region now private.

The researchers noted that hospitals with mostly private rooms also employed more nurses and had shorter lengths of stay with fewer in-hospital transfers. Each of these factors is also associated with fewer hospital-acquired infections.

“Private hospital rooms have numerous other benefits that are harder to quantify,” Dr. O’Neill said, “such as more privacy, reduced noise, fewer dietary and medication mix-ups, and reduced stress.”

While this study focused on only one aspect of private rooms, the research team plans to study other aspects in the future, he said.

“We hope that our findings will start to change the conversation in hospital board rooms from how much will private rooms cost to how many lives will they save,” Dr. O’Neill said.

By Sally Crocker

A new study led by a UNT Health Science Center researcher suggests that requiring HPV vaccinations for school enrollment may be an effective way for states to improve vaccine rates and meet CDC guidance for health protection among boys and girls beginning around seventh grade, as well as boost compliance rates specifically among boys.

The report, published in the American Journal of Public Health (AJPH) by Erika L. Thompson, PhD, MPH, and colleagues, found a rise in starting the series of HPV vaccination among adolescent boys in Rhode Island after the enactment of a new 2015 state policy.

“Few states have enacted policies for HPV vaccine as a school-entry requirement,” said Dr. Thompson, Assistant Professor of Health Behavior and Health Systems at the UNTHSC School of Public Health. “Though Virginia and the District of Columbia were early adopters of this plan in 2008 and 2009, respectively, school prerequisites focused only on girls and were broadly defined, resulting in easily obtained objections to starting the vaccine series.”

HPV vaccination is recommended by the CDC for both males and females. It is routinely given at 11 or 12 years of age, but can be given beginning at age 9 through age 26. Depending on the age when a person receives the first dose, the vaccine may be administered as either a two- or three-dose series.

HPV vaccine is important in protecting against cancers and other diseases caused by human papillomavirus (HPV) infection.

Nearly 80 million people—about one in four, according to the CDC —are currently infected in the United States.  About 14 million people, including teens, become infected each year.

“Rhode Island’s recent school-entry requirements specify the first dose of the vaccine for both girls and boys before entering the seventh grade and completion of the series before entering ninth grade, using a narrow definition of exemption, making it more difficult to opt out,” Dr. Thompson said.

The researchers used National Immunization Survey-Teen (NIS-Teen) parental reporting data from 2010 through 2016 in their analysis, comparing changes in vaccination rates before and after Rhode Island’s new policy. A control group of all other states’ data before and after Rhode Island’s change was used as a means for comparison within the study model. HPV vaccination rates were modeled separately for boys and girls, since typically boys have lower utilization of this vaccine.

Significantly, their findings showed an 11% increase in the vaccination initiation rate for boys after the requirements were established, while rates among girls remained high and steadily consistent, suggesting that by mandating the vaccine for school, state-level public policy may be able to close the gap between boys and girls while boosting vaccine rates among adolescents overall.

“Rates of HPV vaccination across the U.S. have been less than optimal to this point, and with the federal government’s Healthy People 2020 goal of achieving 80% compliance over the next two years, continued research into Rhode Island’s results may be helpful in informing state-level public policy for school requirements with more narrow opt-out guidelines in the future,” Dr. Thompson said.

By Sally Crocker

Jessica Allen and Yolanda Ortiz, NTACHC, with Armando Moreno at the CDC, Atlanta

When public health and private healthcare work together, more can be accomplished in preventing tuberculosis (TB), says recent UNT Health Science Center graduate Armando Moreno, MPH ’18, Health Management and Policy.

Moreno had an opportunity to collaborate over the last year with another graduate of the UNTHSC School of Public Health while completing an internship at the North Texas Area Community Health Centers (NTACHC) patient care clinic in North Fort Worth.

The nonprofit NTACHC network operates three clinics in Fort Worth and Arlington, serving a primarily uninsured and underinsured population.

Northside Community Health Center, where Moreno worked, is located in the center of 13 federally designated, medically underserved census tracts in Tarrant County where a shortage of health professionals and services exists.

Partnering with UNTHSC alum Jessica Allen, MHA, who serves as Northside’s Manager of External Affairs, Moreno’s work represents a national CDC initiative to reduce TB risk and infection.

Since 2001, UNTHSC has served as one of 10 sites around the country focused on this effort through the CDC’s Tuberculosis Epidemiologic Studies Consortium (TBESC), led by Thad Miller, DrPH, MPH, Associate Professor, Health Behavior and Health Systems.

Moreno’s goal was to build a connection between TBESC and NTACHC’s ongoing work serving Fort Worth’s underserved population.

“One of the biggest risks for TB infection in the U.S. comes from other countries where TB rates are especially prevalent. By working through clinics like Northside, which serves a high foreign-born population, it may be possible to identify risk factors early on, so that individuals with latent TB infection could receive treatment,” Moreno said. “Latent TB can remain hidden, or dormant, with no symptoms for years but can still present a potential risk to others.”

A model was created for administrative and clinical protocol on how to screen and manage care for patients showing latent TB indicators, and Moreno recently traveled to the CDC’s Atlanta headquarters with NTACHC representatives to present the results of this new program.

“We were able to show what can happen when private healthcare joins in collaboration on a public health goal,” Moreno said. “While a public health goal may be deemed as ‘the right thing to do,’ putting it into practice in the private sector, administratively and clinically, has aspects that may require additional costs, changes in coding and billing practices and more, presenting some challenges. So the discussion hinges on how to make it work.”

In sharing their presentation, “A view from the other side: A community provider’s perception of proactive TB prevention,” Moreno, Allen and Northside’s assistant director of nursing emphasized that an important early step in working together is for public health to understand the perspectives and incentives of providers and their agencies in order to partner more effectively.

Another UNTHSC public health student will be transitioning into Moreno’s role with the program this fall as he moves to San Antonio for medical school.