Dimension reduction of 911 Good Samaritan Laws: Drawing inferences from policy surveillance.

Background: 911 Good Samaritan Laws (GSLs) extend legal protection to people reporting drug overdoses who may otherwise be in violation of controlled substance laws. Mixed evidence suggests GSLs decrease overdose mortality, but these studies overlook substantial heterogeneity across states. The GSL Inventory exhaustively catalogs features of these laws into four categories: breadth, burden, strength, and exemption.

Review and inventory of 911 Good Samaritan Law Provisions in the United States.

Background: 911 Good Samaritan Laws (GSLs) confer limited legal immunity to bystanders in possession of controlled substances who report emergency overdoses. While these laws may decrease opioid overdose mortality, current literature reduces GSLs to a small number of variables, overlooking substantial differences in implementation and statutory context which dramatically alter their applicability.

Methods: We identified all state GSLs and their legislative history, characterizing features into four categories using a novel framework: breadth of protected activities, burden placed on Good Samaritans, strength of protection, and exemption in coverage.

Case growth analysis to inform local response to COVID-19 epidemic in a diverse U.S community.

Early detection of new outbreak waves is critical for effective and sustained response to the COVID-19 pandemic. We conducted a growth rate analysis using local community and inpatient records from seven hospital systems to characterize distinct phases in SARS-CoV-2 outbreak waves in the Greater Houston area. We determined the transition times from rapid spread of infection in the community to surge in the number of inpatients in local hospitals.

Trends and Correlates of Breakthrough Infections With SARS-CoV-2.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) delta variant has been hypothesized to decrease the efficacy of COVID-19 vaccines. Factors associated with infections with SARS-CoV-2 after vaccination are unknown. In this observational cohort study, we examined two groups in Harris County, Texas: (1) individuals with positive Nucleic Acid Amplification test between 12/14/2020 and 9/30/2021 and (2) the subset of individuals fully vaccinated in the same time period.

Wellness project implementation within Houston's Faith and Diabetes initiative: a mixed methods study.

Background: Faith-based health promotion has shown promise for supporting healthy lifestyles, but has limited evidence of reaching scale or sustainability. In one recent such effort, volunteers from a diverse range of faith organizations were trained as peer educators to implement diabetes self-management education (DSME) classes within their communities. The purpose of this study was to identify factors associated with provision of these classes within six months of peer-educator training.

The utility of a system dynamics approach for understanding cumulative health risk from exposure to environmental hazards.

The potential of system dynamics modeling to advance our understanding of cumulative risk in the service of optimal health is discussed. The focus is on exploring system dynamics modeling as a systems science methodology that can provide a framework for examining the complexity of real-world social and environmental exposures among populations-particularly those exposed to multiple disparate sources of risk. The discussion also examines how system dynamics modeling can engage a diverse body of key stakeholders throughout the modeling process, promoting the collective assessment of assumptions and systematic gathering of critical data.

Reducing the Cost of Medicaid: A Multistate Simulation.

According to some estimates, the United States wastes as much as 30% of health care dollars. Some of that waste can be mitigated by reducing certain costs associated with Medicaid. We chose 5 areas of savings applicable to Medicaid: (1) modification of physician payment models to reduce unnecessary care, (2) development of a medication adherence program for patients dually eligible for Medicaid and Medicare support ("dual eligibles"), (3) improvement in unnecessary admissions and readmissions for dual eligibles, (4) reduction in emergency department visits among children in Medicaid and dual-eligible beneficiaries, and (5) improvement in adoption of end-of-life advance directives.

The combined effect of ambient ozone exposure and toxic air releases on hospitalization for asthma among children in Harris County, Texas.

This study represents an analysis of the effect of exposure to ambient ozone and toxic air releases on hospitalization for asthma among children in Harris County, Texas. Our study identified temporal and spatial variations in asthma hospitalization across the study region and explored the combined effect of exposure to ambient ozone and air toxics on asthma hospitalization. Asthma hospitalization hot spots and clusters were mostly not located on zip codes with reported high quantities of total air releases of chemical pollutants.

Participants' perceptions of interactions with community health workers who promote behavior change: a qualitative characterization from participants with normal, depressive and anxious mood states.

Background: Interventions that promote healthier lifestyles among Latinos often involve community health workers (CHWs). CHWs can effectively advocate for healthier lifestyles and may be pivotal in addressing such mental health conditions as depression and anxiety. The goal of this study was to characterize the relationship dynamics between Latino participants and CHWs, from the participant's perspective.

Innovating patient care delivery: DSRIP's interrupted time series analysis paradigm.

Introduction: Adoption of Medicaid Section 1115 waiver is one of the many ways of innovating healthcare delivery system. The Delivery System Reform Incentive Payment (DSRIP) pool, one of the two funding pools of the waiver has four categories viz. infrastructure development, program innovation and redesign, quality improvement reporting and lastly, bringing about population health improvement.

Area-level Socioeconomic Inequalities in the Use of Mammography Screening: A Multilevel Analysis of the Health of Houston Survey.

Background: An emerging literature reports that women who reside in socioeconomically deprived communities are less likely to adhere to mammography screening. This study explored associations between area-level socioeconomic measures and mammography screening among a racially and ethnically diverse sample of women in Texas.

Methods: We conducted a cross-sectional, multilevel study linking individual-level data from the 2010 Health of Houston Survey and contextual data from the U.

Associations between contextual factors and colorectal cancer screening in a racially and ethnically diverse population in Texas.

Background: Colorectal cancer is the third most commonly diagnosed cancer and the third leading cause of cancer death in the United States. Increased attention has been given to understanding the role of local contexts on cancer screening behaviors. We examined the associations between multiple tract-level socioeconomic measures and adherence to colorectal cancer screening (CRCS) in Harris County and the City of Houston, Texas.

Houston's Novel Strategy to Control Hazardous Air Pollutants: A Case Study in Policy Innovation and Political Stalemate.

Although ambient concentrations have declined steadily over the past 30 years, Houston has recorded some of the highest levels of hazardous air pollutants in the United States. Nevertheless, federal and state regulatory efforts historically have emphasized compliance with the National Ambient Air Quality Standard for ozone, treating "air toxics" in Houston as a residual problem to be solved through application of technology-based standards. Between 2004 and 2009, Mayor Bill White and his administration challenged the well-established hierarchy of air quality management spelled out in the Clean Air Act, whereby federal and state authorities are assigned primacy over local municipalities for the purpose of designing and implementing air pollution control strategies.

Predictors of Serious Psychological Distress in an Urban Population.

While there are state and national estimates of serious psychological distress (SPD), these are not useful for targeting local mental health interventions or for addressing the needs of sub-populations at increased risk for SPD. This cross-sectional study uses data from the population-based 2010 Health of Houston Survey (n = 5,116) to examine (1) the prevalence of SPD and its determinants in Houston area and (2) predictors of the utilization of mental health services among people with SPD. The prevalence of SPD among the Houston area adult population was 7 %, more than twice the national average.

Social Determinants of Health in Environmental Justice Communities: Examining Cumulative Risk in Terms of Environmental Exposures and Social Determinants of Health.

Residents of environmental justice (EJ) communities may bear a disproportionate burden of environmental health risk, and often face additional burdens from social determinants of health. Accounting for cumulative risk should include measures of risk from both environmental sources and social determinants. This study sought to better understand cumulative health risk from both social and environmental sources in a disadvantaged community in Texas.

Integrated assessment of risk and sustainability in the context of regulatory decision making.

Risk assessment is a decision-making tool used by the U.S. Environmental Protection Agency and other governmental organizations to organize and analyze scientific information so as to examine, characterize, and possibly quantify threats to human health and/or ecologic resources.

Evaluating the effects of maternal exposure to benzene, toluene, ethyl benzene, and xylene on oral clefts among offspring in Texas: 1999-2008.

Background: There is evidence from previous studies that maternal occupational exposure to hazardous air pollutants (HAPs) is positively associated with oral clefts; however, studies evaluating the association between residential exposure to these toxicants and oral clefts are lacking. Therefore, our goal was to conduct a case-control study examining the association between estimated maternal residential exposure to benzene, toluene, ethyl benzene, and xylene (BTEX) and the risk of oral clefts among offspring.

Methods: Data on 6045 nonsyndromic isolated oral cleft cases (3915 cleft lip with or without cleft palate [CL ± P] and 2130 nonsyndromic isolated cleft palate [CP] cases) delivered between 1999 and 2008 were obtained from the Texas Birth Defects Registry.

Case study of municipal air pollution policies: Houston's Air Toxic Control Strategy under the White Administration, 2004-2009.

Local government has traditionally played only a minor role in regulating airborne toxic pollutants. However, from 2004 to 2009, the City of Houston implemented a novel, municipality-based air toxics reduction strategy to address what it considered unacceptable health risks and an insufficient regulatory response from state and federal agencies. The city's effort to exert local control over stationary sources of air toxics represents a unique opportunity to study the selection and performance of policy tools and to consider their ramifications for the design of future air pollution control strategies.

Conceptual models for cumulative risk assessment.

In the absence of scientific consensus on an appropriate theoretical framework, cumulative risk assessment and related research have relied on speculative conceptual models. We argue for the importance of theoretical backing for such models and discuss 3 relevant theoretical frameworks, each supporting a distinctive "family" of models. Social determinant models postulate that unequal health outcomes are caused by structural inequalities; health disparity models envision social and contextual factors acting through individual behaviors and biological mechanisms; and multiple stressor models incorporate environmental agents, emphasizing the intermediary role of these and other stressors.

Cumulative risk assessment for combined health effects from chemical and nonchemical stressors.

Cumulative risk assessment is a science policy tool for organizing and analyzing information to examine, characterize, and possibly quantify combined threats from multiple environmental stressors. We briefly survey the state of the art regarding cumulative risk assessment, emphasizing challenges and complexities of moving beyond the current focus on chemical mixtures to incorporate nonchemical stressors, such as poverty and discrimination, into the assessment paradigm. Theoretical frameworks for integrating nonchemical stressors into cumulative risk assessments are discussed, the impact of geospatial issues on interpreting results of statistical analyses is described, and four assessment methods are used to illustrate the diversity of current approaches.

The role of cumulative risk assessment in decisions about environmental justice.

There is strong presumptive evidence that people living in poverty and certain racial and ethnic groups bear a disproportionate burden of environmental health risk. Many have argued that conducting formal assessments of the health risk experienced by affected communities is both unnecessary and counterproductive-that instead of analyzing the situation our efforts should be devoted to fixing obvious problems and rectifying observable wrongs. We contend that formal assessment of cumulative health risks from combined effects of chemical and nonchemical stressors is a valuable tool to aid decision makers in choosing risk management options that are effective, efficient, and equitable.

Cumulative cancer risk from air pollution in Houston: disparities in risk burden and social disadvantage.

Air toxics are of particular concern in Greater Houston, home to one of the world's largest petrochemical complexes and a quarter ofthe nation's refining capacity. Much of this complex lies along a navigable ship channel that flows 50 miles from east of the central business district through Galveston Bay and into the Gulf of Mexico. Numerous communities, including both poor and affluent neighborhoods, are located in close proximity to the 200 facilities along this channel.

Comparative assessment of air pollution-related health risks in Houston.

Background: Airborne emissions from numerous point, area, and mobile sources, along with stagnant meteorologic conditions, contribute to frequent episodes of elevated air pollution in Houston, Texas. To address this problem, decision makers must set priorities among thousands of individual air pollutants as they formulate effective and efficient mitigation strategies.

Objectives: Our aim was to compare and rank relative health risks of 179 air pollutants in Houston using an evidence-based approach supplemented by the expert judgment of a panel of academic scientists.

Assessing alternative medicine: methodological and research policy concerns.

Objectives: Setting funding priorities among research projects for complementary and alternative therapies is especially vulnerable to arbitrary, partisan criteria and opportunistic readings of controversial evidence. This study develops a procedural approach to characterizing, in a transparent and even-handed way, the available evidence on these treatments and demonstrates a simple analytical scheme for prioritizing competing, but typically incommensurable, research projects for public support.

Methods: A simple five-step scheme for categorizing therapies is developed and justified, based on a taxonomy of the study designs used to generate research evidence.

A comparison of the performance of for-profit and nonprofit U.S. psychiatric inpatient care providers since 1980.

Objective: The authors synthesized evidence from a systematic review of the literature reporting substantiated performance differences between private for-profit and private nonprofit psychiatric inpatient care providers in the United States since 1980. They also compared reported differences in performance between nonprofit and for-profit inpatient psychiatric care providers with reported differences between nonprofit and for-profit providers of other types of health care.

Methods: Studies were located by means of computerized bibliographic searches and follow-up searches of studies cited in the articles located in the computerized search.