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UVB Protection Causing Deficiency Introduction Sunscreen is used to prevent burning of the skin caused by the sun

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as it absorbs or reflects some of the rays in the UVB part of the light spectrum. There are many forms of sunscreen but they all serve the same purpose of protecting our skin. This product is regulated by the U.S. Food and Drug Administration and it has been recommended to prevent skin cancer and other diseases associated with UVA radiation. According to the American Cancer Society, “Some of the chemicals in sunscreens that help protect against UVA rays include avobenzone (Parsol 1789), ecamsule, zinc oxide, and titanium dioxide. Only broad spectrum sunscreen products with an SPF of 15 or higher can state that they help protect against skin cancer and early skin aging if used as directed with other sun protection measures.” Many will continue using sunscreen for protective measures although some can be skeptical of the ingredients and health related issues that it may cause in the future. Does the use of sunscreen cause deficiency in the intake of Vitamin D levels of an individual? Research Questions Vitamin D is necessary to regulate calcium to maintain healthy bones, regulate insulin, support lung function and cardiovascular system, regulate cell growth which is overall beneficial to the prevention of cancer. The lack of Vitamin D can result in obesity, hypertension, depression, osteoporosis, fibromyalgia, neurodegerative diseases, and more. If we are encouraged to use this protection, are we potentially risking the possibility of having a deficiency? The use of sunscreen is has many benefits and potential risks as well so we will consider the following research questions. 1. Does sunscreen cause a deficiency in Vitamin D? 2. Is the use of sunscreen more beneficial than it is harmful? 3. Why does the protection cause deficiencies in a vitamin that impacts our health significantly? 4. Do we need to be concerned about the chemicals and ingredients in sunscreen? Background and Significance The use of sunscreen prevents the possibility of enduring a sunburn for a duration of time after sun exposure through the lack of absorption of ultraviolet rays. The product will be applied to the skin The Food and Drug Administration proposes to regulate sunscreen to ensure high quality, safety, and effectiveness of the product in 1978. During this time, the “How Do I Protect Myself from UV Rays?” American Cancer Society, www.cancer.org/cancer/skin-cancer/prevention-and-early-detection/uv-protection.html. THE IMPACT OF HEALTH CARE SAFETY NET POLICIES ON HEALTH CARE DECISION MAKING: A KATRINA EVACUEE CASE STUDY (Proposal) Introduction On August 29, 2006 Hurricane Katrina hit New Orleans and the storm and flooding forced the evacuation of over 1 million people. Houston became a shelter of last resort for thousands of desperate evacuees. Eighteen months since Hurricane Katrina hit New Orleans and adjacent Gulf Coast areas, thousands of Katrina evacuees remain in the Houston area and are enrolled in the Harris County Hospital District (HCHD) clinics, calling Houston their home today. While retrospective reviews of administrative and clinical records of patients, initially served by special medical clinics established to provide emergent care or and now served by regular hospital district clinics to provide regular care 18 months out have been undertaken elsewhere, it is unclear as to what factors serve to facilitate or hinder health care seeking and use. The goal of this study is to examine the health care utilization decisionsmaking of the current HCHD patients that were formerly classified as Katrina evacuees. Their health care decisionmaking will be compared with a non-Katrina patient group of Houstonians with similar characteristics. The comparisons are intended to highlight the impact of Katrina-related policies and programs on health care decision making and realated use. As public insurance and safety net policies for the former Katrina group were specially designed to mediate health service gaps, we hypothesize that the Katrina group’s health care seeking decision processes and related care utilization are not likely to differ from non-Katrina groups in HCHD. Given that the strength or presence of medical conditions drives use of health services, we predict that greater perceived and evaluated Katrina Research Proposal:3/21/07 Page 1 of 12 Sondip Mathur (TSU COPHS) need (for chronic and other conditions) would be the primary decision variable associated with use/access to treatment. Our prediction provides support for the hypothesis that Katrina-related policies and programs resulted in the equitable distribution of health care utilization. Inequity will be indicated if we find that access factors such as insurance coverage and availability of safety net services and other factors such as housing stability and transportation, determine decisions to seek care. The study will identify predisposing, enabling, and need factors associated with health service seeking among the two HCHD patient groups using a behavioral model of health care. Research Objectives 1. Survey a convenience sample of former Katrina evacuees who are presently HCHD patients and a matched sample of current HCHD non-Katrina patients to document information on their respective health care decision making behaviors. 2. Compare the health care use decision making (behavioral) patterns of the above two HCHD patients groups. Research Questions The primary research questions related to health care decision making relate to determining which factors influence the decision to seek, delay, not seek health care will be investigated, using the Aday/Anderson behavioral model as a guide. The Behavioral model has three categories of predictor variables—predisposing, enabling, and need variables. We will consider the following research questions. Katrina Research Proposal:3/21/07 Page 2 of 12 Sondip Mathur (TSU COPHS) a. What are the differences between individuals in the formerly Katrina patient group and the comparable general/non-Katrina patient group with respect to predisposing factors? b. What are the differences between individuals in the (formerly) Katrina group) and the general non-katrina group with respect to enabling characteristics? c. What are the differences between individuals (in the Katrina group) and (the non-Katrina group) with respect to need factors? d. What are the factors that influence the decision to seek, not seek, or delay in the Katrina Group versus the non-Katrina Group Background and Significance During the initial fortnight following Hurricane Katrina thousands of evacuees sought shelter at the Astrodome/Reliant Center and the George R. Brown Convention Center in Houston. Comprehensive health clinics were set up at both sites to provide basis diagnostic, treatment, and referral services to people staying at the shelters and in other locations throughout the area (Gavagan et al. 2006). At the shelter and subsequently many of the evacuees were introduced to the health care resources operated by the HCHD in the Houston area. Those who have stayed in Houston and have sought care within the HCHD system can be followed through the unique medical record number that they received when treated at the shelter. Consequently, we have an opportunity to review health care decisions making processes of former Katrina evacuees to investigate whether the safety net policies and programs for evacuees have been effective in meeting their needs. Katrina Research Proposal:3/21/07 Page 3 of 12 Sondip Mathur (TSU COPHS) Study results will provide evidence of continuity of care as understood from the patient/evacuee’s point of view and the role of public and private insurance coverage, safety net policies and programs in access to care. For example, steps to help Hurricane victims with Federal, state and local benefits, included expeditious enrollment of evacuees in Medicaid, FEMA financial and housing supports and HCHD Gold Card coverage. The validity of the null hypothesis would suggest that public insurance and related policies, by mediating potential health practice gaps, contribute to the effectiveness of protective actions. Study results may encourage states and communities to revisit their Medicaid coverage and local safety net resources in disaster prone or otherwise vulnerable areas. Theoretical Framework The Behavioral Health Model will be used to identify predisposing, enabling, and need factors associated with health decision making for among Katrina and non-Katrina patient groups (Figure 1). The Behavioral model has three categories of predictor variables—predisposing, enabling, and need variables. Predisposing characteristics include demographic characteristics such as age, gender, race, marital status, and education. Predisposing factors predict the propensity of an individual to use health care. They include demographic and social structural factors such as age, gender, race, and ethnicity, level of education, marital status, family composition, and health beliefs. Enabling factors facilitate or impede use of healthcare services, including individual characteristics, such as income and health insurance coverage, as well as structural factors, such as availability of healthcare services in their geographic area. Enabling factors, which are thought to Katrina Research Proposal:3/21/07 Page 4 of 12 Sondip Mathur (TSU COPHS) play a role in access to care, include social factors such as income level, social support and availability of care. Need characteristics include objective and subjective assessment of health status. Perceived need, or illness level, is the judged severity of illness on the part of the patient. Theoretically, we expect that each of the components of predisposing, enabling, and need factors would make an independent contribution to explaining health care seeking. Figure 1. Behavioral Health Care Model (Andersen, 1995, Aday 2001)] COMMUNITY CHARACTERISTICS INDIVIDUAL HEALTH BEHAVIOR OUTCOMES CHARACTIERISTICS Predisposing Predisposing Enabling Need Personal Health Practices Enabling Use and Quality of Health Services Need Perceived Health Status Evaluated Health Status Consumer Satisfaction Methods Design. A matched comparison study design will be used to determine the impact of Katrina and Katrina-related policies and programs on health decision making. Data will be obtained for the former Katrina evacuees presently enrolled in the HCHD and a similar group of HCHD enrollees matched by age, gender, and type of medical problems. A member of the research team will work with the HCHD IT department to abstract the medical records related to former Katrina and non-Katrina patient. Katrina Research Proposal:3/21/07 Page 5 of 12 Sondip Mathur (TSU COPHS) Patient groups. Given the exploratory nature of the research, we are interested in getting an inexpensive approximation of reality. The abstraction of a Katrina group from the participating HCHD clinics will provide a convenient sample to study to get a gross estimate of the results without incurring the cost or time required to select a random sample. A unique medical record number (MRN) was assigned to former Katrina evacuees. The MRN will be the basis to identify the former Katrina evacuees as current users of the HCHD services. Likewise, a matched non-Katrina group will be identified but without the former Katrina classification. The sample size is estimated to be 733 evacuees from the original 13, 132 who were seen at the Katrina Clinic. An equivalent sample size for the non-Katrina patient group will be surveyed. Survey instrument. The survey questionnaire is designed to capture patient demographic information, social and economic characteristics, health status, health care use and related decision making. A draft of the questionnaire is appended to the proposal. The survey questions will be clearly connected to the research objectives. While the survey design is expected to identify various predisposing and health care need variables the impact the service utilization decisions, it will identify enabling factors related public policy. Survey reliability and validity will be ensured as the study will adapt a survey instrument that another related study had prepared and used to survey a Harris County residents. Toward this end, the study team will obtain related feedback from the other study team surveying the Houstonians. Katrina Research Proposal:3/21/07 Page 6 of 12 Sondip Mathur (TSU COPHS) Respondent privacy. Adequate privacy arrangements will be made at the interviewer’s work station. Interviews will be conducted with voluntary subjects and will last about 30 minutes. At the outset, the interviewer will initiate the consent process. As the participant will be adults (18 years or older) the consent will be requested verbally.. The subjects will informed about their rights as a research subject. They will be informed that they may choose not to answer any question that is asked, and all the information that they provide will be kept confidential; that is, their identity or anyone in their household’s will not be revealed to anyone. The subjects will be informed that their refusal to participate does not involve any penalty or loss of benefits to which the subject is otherwise entitled. Likewise, they will be informed that they may discontinue participation at any time without penalty or loss of benefits to which the subject is otherwise entitled. When the subject’s first language is not English, translators or a bilinugal interviewer will process the consent. Informed consent request will be presented in a language that the subject can understand. Also, two names and related phone numbers will be provided to the subjects if they wished to contact someone with questions or concerns about this study. Participants will remain anonymous and their identities will be protected throughout the study. The data to be used for this study will be collected from human subjects using survey instruments. No invasive measures will be used to generate data. Data will consist of responses to questions on factors that impact individual or household health care use decisions. Related draft surnvey instrument/informed consent request is attached. Katrina Research Proposal:3/21/07 Page 7 of 12 Sondip Mathur (TSU COPHS) Survey administration. Interviews will be conducted by graduate and/or undergraduate students in the College of Pharmacy and Health Sciences (COPHS) at TSU. The questionnaire will be administered by a trained interviewer by telephone, following enrollment of patients in the study. The interviewer will either be bilingual or will be accompanied by a translator. Phone interviews will be conducted from computer labs located in the COPHS at TSU. A web-based survey tool, called SurveyMonkey.com, will be used to create the survey. The software has options that allow answers to questions and control the flow with custom skip logic. While the tool has real-time analytical tools, it allow raw data to be downloaded into Excel or SPSS. A professional subscription is $19.90 per month and includes up to 1000 responses per month. The web-based survey tool has been used for another on-going study which is surveying Harris County residents, and may also provide baseline comparison data as well as it provides the survey questionnaire draft for the proposed study. Data and analysis. A codebook will used to translate survey responses for computerized data analysis. The code book contains the survey instrument; variable names, labels, and values or codes. A sample excerpt of the code book is attached. Information obtained from the surveys of both the Katrina and matched comparison group, will be categorized as predisposing, enabling, and need variables. For example, predisposing variables will include the following: Race, age, gender, marital status, ethnicity, education, family size, birth country, mobility. Enabling factors will include regular care source, insurance, income, public benefits, transportation, and other community resources. Need factors would include perceived health and evaluated health. Katrina Research Proposal:3/21/07 Page 8 of 12 Sondip Mathur (TSU COPHS) The evaluated health need with be available from the HCHD medical record data as well. The outcomes of interest are primarily related to health care decision making (e.g., decision to avoid, delay or seek health care services). Additional outcomes measures may include perceived health status as well as satisfaction with care indicators. In addition to these traditional behavioral model domains, particularly in reference to the former Katrina group, besides health coverage, enabling factors of interest include presence or absence of Medicaid eligibility, HCHD Gold Card eligibility, FEMA and other public or private insurance coverage, and other state and local coverage such as the Health Care Safety Net (i.e., shelter clinics, referral services, HCHD clinics). Likewise, we will consider health-seeking behavior prior to the Hurricane event and homelessness as predisposing characteristics. In support of the research questions, the data will be analyzed to determine if decision making to use different for the two groups. To examine health care decision making, the frequencies of decision to seek care, delay care, or avoid use will be derived for each individual in each group over the study period. The relative/average frequency to delay, avoid, and seek use will be compared between the two groups. In order to test the hypothesis that decision making (across the three decisions) is different, we will compare the decision making of the former Katrina group with the non-Katrina group using a paired t-test (p
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