Reports

State Rankings of Health

The report America’s Health Rankings 2008 is now available from the United Health Foundation.  It reports that Texas is now ranked 46th in the nation – dropping from 37 in 2007.  Only Tennessee, South Carolina, Mississippi, and Louisiana ranked lower than Texas.  According to the report, Texas faces challenges due to limited access to primary care, a high rate of uninsured population, a high percentage of children in poverty, and a high incidence of infectious disease.

The complete national report or state-by-state reports can be downloaded from http://www.americashealthrankings.org/2008/index.html.

Study of Border Moms Reveals Similarities and Differences

The results of a study conducted in 2005 of almost 1,000 new mothers on both sides of the border by the Brownsville-Matamoros Sister City Project for Women’s Health has revealed both similarities and differences in pregnancy and health practices. 

The basis for conducting the study was to see if the data they collected would accurately represent what was happening along the border.  Sister cities were chosen in hopes that similar studies might be conducted in other sister cities along the border.

Among the similarities was the fact that nearly half of the pregnancies on both sides of the border were unplanned.  According to Dr. Brian Castrucci with the Texas Department of State Health Services, this should cause concern.  “Almost every piece of reproductive health is based on planned pregnancies.  Take folic acid, get prenatal care, be healthy before you get pregnant – all based on a planned model.”  The large number of unplanned pregnancies presents an opportunity for both nations to collaborate on addressing this problem.  Other similarities included the age upon having sex for the first time and the percentage of women under the age of 20 giving birth.

Differences between the two sides included figures that showed Brownsville women were more likely to see a doctor in their first trimester, but Matamoros women were more likely to receive counseling about postpartum contraception during prenatal care.  Matmoros women were almost four times more likely to begin breastfeeding before leaving the hospital and less than half as likely to drink alcohol.  According to Dr. Carstrucci, the reasons behind some of the differences may fall more under the category of government policy than cultural differences. 

Results of the study have been published online in English and Spanish in multiple papers in the October 2008 issue of Preventing Chronic Disease.

Study on sex tourism along the border, and its consequences

A recent study by researchers at the University of California San Diego, in cooperation with partners on both sides of the border, reveals some of the serious health consequences of sex tourism in Mexican border cities, and urges binational prevention efforts — focused on both the sex workers and their customers — in an effort to prevent the very real possibility of a generalized HIV/STI epidemic.

The paper, “Characteristics of Female Sex Workers With US Clients in Two Mexico-US Border Cities,” currently appears online and will appear in a forthcoming issue of the journal Sexually Transmitted Diseases. The paper reports on the initial stage of a behavioral-intervention study to promote safer sex, involving 474 female sex workers (FSW) in Tijuana, BC (across the border from San Diego CA) and 450 in Ciudad Juárez, Chih (across from El Paso TX), who had reported unprotected sex encounters in the previous 2 months and who had not previously tested positive for HIV. The subjects were interviewed on working and social conditions, financial need, risk behaviors, sociodemographic characteristics, and physical & psychiatric health, and they provided samples for HIV and STI testing.

The paper found that in comparison to the overall group of sex workers studied in Tijuana and Cd. Juárez, the subset who said they had US clients were younger on average than the group as a whole, and more likely to:

  • speak English,
  • engage in unprotected sex,
  • report risky behavior involving injecting drugs,
  • have syphilis titers (16% vs. 10% overall),
  • have gonorrhea (8% vs. 2%), and
  • test positive for HIV (30% vs. 20%).

In addition, the paper indicates that “FSWs reporting US clients also had greater numbers of male clients and were more likely to report earning more money for having sex without a condom… The practice of offering more money for unprotected sex is not unique to our settings, as it has been reported elsewhere. Since FSWs in Mexico are primarily engaged in sex work due to economic need, this practice threatens to undermine HIV and STI prevention efforts and should be actively discouraged.”

Although this paper specifically studied Tijuana and Cd. Juárez, the conditions and regulations surrounding the sex trade in those cities have been described as similar to those present in the “Zonas Rojas” or “Boystowns” in Matamoros, Reynosa, and Nuevo Laredo — so the study’s findings deserve attention in the South Texas health community as well. The paper is summarized in this article from the San Diego Union-Tribune, which also includes this link to the full text of the paper; it was also recently covered in this segment from PRI’s “The World”. Here’s the full citation:

Strathdee SA, Lozada R, Semple SJ, Orozovich P, Pu M, Staines-Orozco H, Fraga-Vallejo M, Amaro H, Delatorre A, Magis-Rodríguez C, Patterson TL. Characteristics of Female Sex Workers With US Clients in Two Mexico-US Border Cities. Sex Transm Dis [forthcoming]. doi:10.1097/OLQ.0b013e31815b0 OVID JumpStart link

Surgeon General’s Workshop on Improving Health Literacy

Proceedings from the Surgeon General’s Workshop on Improving Health Literacy, held on September 7, 2006, were recently made available on the DHHS Web site. A separate panel focused on the needs of special populations, with findings and recommendations especially relevant to health literacy initiatives in South Texas and along the US-Mexico border.

Texas-Mexican Border Study finds pesticides a BIG problem.

HARLINGEN,TX— Air samples from homes of Hispanic mothers-to-be along the Texas-Mexico border contained multiple pesticides in a majority of the houses, according to a study conducted by the School of Medicine at The University of Texas Health Science Center San Antonio.
Several studies have reported that pesticide exposure may adversely affect mental and motor development of the infants during infancy and childhood. The new report is in the summer issue of the Texas Public Health Journal .

Click Here to read the entire story as it appears in the HSC News Publication, and what suggestions are being made to remedy the situation.  Story by Will Sansom and Sheila Hotchkin.

Text Messaging as a Supplement to Traditional Disease Surveillance

The August issue of Emerging Infectious Diseases includes a report about how Mexico’s Ministry of Health relied on a text message-based survey to supplement traditional surveillance methods during the H1N1 outbreak in 2009. The speed of responses to the survey is highlighted, as are the limitations of the data collected: “Our study was limited by potential selection bias, recall bias, and inclusion of mostly young persons from urban areas.”

Undocumented Hispanics Less Likely to Use US Health Care Services

This brief article from HealthDay (via MedlinePlus Health News) summarizes the findings of a recent study that analyzed four specific subsets of data from the 2003 California Health Interview Survey to identify patterns in the healthcare choices and experiences of California Hispanics — patterns which are very much worth our attention here in South Texas.

The study, entitled “Health Care Access, Use of Services, and Experiences Among Undocumented Mexicans and Other Latinos,” analyzed responses from four specific subsets of the 42,000+ respondents to the 2003 CHIS: 1,317 undocumented Mexicans, 2,851 US-born Mexicans, 271 undocumented Hispanics from countries other than Mexico, and 852 US-born Hispanics from non-Mexican heritage. Results found that…

undocumented Mexicans had 1.6 fewer physician visits compared with US-born Mexicans; other undocumented Latinos had 2.1 fewer visits compared with their US-born counterparts. Both undocumented groups were less likely to report difficulty obtaining necessary health care than US-born Mexicans and other US-born Latinos. Undocumented Mexicans were less likely to have a usual source of care and were more likely to report negative experiences than US-born Mexicans. Findings were similar for other undocumented Latinos, with the exception of having a usual source of care. Patterns of access to and use of health care services tended to improve with changing legal status.

Here’s the citation for the complete study:

Ortega AN, Fang H, Perez VH, Rizzo JA, Carter-Pokras O, Wallace SP, Gelberg, L. Health Care Access, Use of Services, and Experiences Among Undocumented Mexicans and Other Latinos. Arch Intern Med 2007;167(21):2354-2360. http://archinte.ama-assn.org/cgi/content/abstract/167/21/2354

Veterans’ health care in South Texas: one goal, different paths

In recent weeks, there’s been considerable controversy over the VA’s ideas for expansion in South Texas. Here’s a sampling of some of the differing views that have been expressed in the papers: a September 11 article from the Rio Grande Guardian, one from September 21 in The Monitor, and one from August 21 in the San Antonio Express-News.

If you’re interested in the background, here’s the full text of the report they’re all citing: VA Health Care Study for Inpatient and Specialty Outpatient Services in the South Texas Valley-Coastal Bend Market.

The one thing everyone agrees on is that a 10-hour round-trip drive for care is much too far!