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Articles 1 - 30 of 244
Full-Text Articles in Social and Behavioral Sciences
Diet By Genomic Interactions In Determining Metabolic Traits And Profiles On Glucose Metabolism Among Mexican Americans In Starr County, Texas, Shinhye Chung
Dissertations & Theses (Open Access)
Worsening glycemia, prediabetes and diabetes, is one of the essential diseases in public health, considering their high prevalence, the enormous impact on multiple organs, and the economic burden on the community. Various factors can affect the pathogenesis of worsening glycemia, and this study focused on macronutrient intake, genes, and their interactions with metabolome data. 616 self-reported Mexican American participants in Starr County were recruited with informed consent. 308 identified and 2,471 unidentified metabolites were used for the analysis, and all the metabolites were inverse normalized with less than half of the missing rate. Each of the five glycemic and lipid …
Economic And Policy Determinants Of National Abortion Rates: A Cross-National Study, Olufunke Akiyode
Economic And Policy Determinants Of National Abortion Rates: A Cross-National Study, Olufunke Akiyode
Dissertations & Theses (Open Access)
Abortion is as old as humanity and exists in all cultures. The number and rate of abortions differ among countries and regions of the world. Some determinants of abortion may include economic indicators and policy restrictiveness. This study analyzes the economic and policy determinants of abortion by evaluating the association of income and policy on abortion rates. It uses a panel data regression to examine the association between income, Gini Coefficient and abortion rates. Gini Coefficient measures income inequality, and GNI represents a country’s income. Publicly available longitudinal data obtained from the World Bank, United Nations, United Nations Population Development …
Difference In Smoking Patterns And Quitting Status Between Premium And Non-Premium Cigar Users After Two Years Of Follow Up In Us Adults: Findings From The Population Assessment Of Tobacco And Health (Path) Study, 2016-2019, Sarah Valencia
Dissertations & Theses (Open Access)
Previous studies have described the demographics, purchasing behaviors, trends in frequencies of cigar use, and quitting status among cigar poly users, however, there has not been a study that evaluates differences in demographic characteristics and quitting status for premium and non-premium U.S. adult cigar users. This study used secondary data analyses of the Population Assessment of Tobacco and Health (PATH) Study public-use files dataset for adult traditional cigar users in wave 4 (2016-2018) and wave 5 (2018-2019). Traditional cigars were classified as premium or non-premium at wave 4 (2016-2018) using the brand and price per stick of cigar that was …
Pregnant Black/African Americans' Experiences In Prenatal Genetic Counseling, Latonya Alexander
Pregnant Black/African Americans' Experiences In Prenatal Genetic Counseling, Latonya Alexander
Dissertations & Theses (Open Access)
Pregnant Black/African American patients have faced systematic racism in the U.S. healthcare system embodied in the high maternal morbidity and mortality rates. Patients have the desire to feel heard and connected with their healthcare providers. Prenatal genetic counselors are not only trained to provide education to individuals, couples, and families who may be seeking genetic counseling, but also to use psychosocial skills with patients. Previous studies with majority of White participants have described how psychosocial skills build patient trust. Therefore, this study aimed to determine what factors made pregnant Black/African American patients feel heard and trustful with their prenatal genetic …
Viral Particle Detection In Wastewater, Katelyn Clark
Viral Particle Detection In Wastewater, Katelyn Clark
Dissertations & Theses (Open Access)
Wastewater is an underutilized resource for recognizing the epidemiology of pathogen transmission and infections within a community that has the potential to mitigate disease outbreaks. Pathogens of public health concern, such as adenovirus, norovirus, and SARS-CoV-2, occur in wastewater from excretion of infected individuals. Despite the potential for wastewater pathogen data to predict future outbreaks, the relationship between viral shedding patterns in wastewater and case counts of infectious disease remains unclear. An evaluation of the peer-reviewed literature was conducted to compile characteristics of adenovirus, norovirus, and SARS-CoV-2 in the wastewater environment. These characteristics were considered in prioritizing the key pathogens …
The Substance Use Disorder Peer Workforce In Texas And The United States: Assessing And Addressing The Workforce Development And Economic Evaluation Gaps, Sierra Castedo De Martell
The Substance Use Disorder Peer Workforce In Texas And The United States: Assessing And Addressing The Workforce Development And Economic Evaluation Gaps, Sierra Castedo De Martell
Dissertations & Theses (Open Access)
The infrastructure for addressing problematic substance use and substance use disorder (SUD) across the US has shortages in many areas, and suffered additional challenges during the COVID-19 pandemic. One method to address shortages in SUD care infrastructure relatively quickly is to expand the peer workforce delivering peer recovery support services (PRSS). This workforce has expanded to cover most US states over the past two decades, but gaps in the evidence base for peer workforce development and economic evaluations of PRSS have persisted. To address these gaps, three studies were undertaken with the following aims: (1) Conducted a systematic review of …
The Need For Racial And Ethnic Health Disparity Curriculum In Genetic Counseling Programs, Yusra Aziz
The Need For Racial And Ethnic Health Disparity Curriculum In Genetic Counseling Programs, Yusra Aziz
Dissertations & Theses (Open Access)
Racial and ethnic health disparities (REHD) exist across all organized medicine, including the spectrum of genetic counseling, particularly in genomic testing and access to care. While cultural competency and health disparities have been included as a part of the Standards of Accreditation for Genetic Counseling, there have not been previous efforts to define what topics related to REHD are most important to include in graduate program curriculum. Therefore, this study aimed to determine what topics related to REHD should be taught in genetic counseling program curriculum by assessing what topics genetic counselors (GCs) learned about and in what settings, …
Good Faith: Surveillance And Evaluation Of 911 Good Samaritan Laws In The United States, Shane W. Reader
Good Faith: Surveillance And Evaluation Of 911 Good Samaritan Laws In The United States, Shane W. Reader
Dissertations & Theses (Open Access)
To fight soaring overdose mortality rates in the United States, lawmakers adopted a variety of harm reduction tools. Among these, 911 Good Samaritan Laws (GSLs) derive their name from the biblical parable of the Good Samaritan, a bystander who broke cultural convention to come to the aid of a man beset by thieves. These laws provide limited criminal immunity for bystanders in possession of controlled substances to encourage them to report drug overdoses. While previous studies associate GSLs with a modest reduction in opioid mortality, analyses often model them as equivocal or divide them coarsely across individual provisions. Evaluating these …
Investigating Fruit And Vegetable Variety In A National Food Co-Op: A Brighter Bites Evaluation, Katherine G. Hearne
Investigating Fruit And Vegetable Variety In A National Food Co-Op: A Brighter Bites Evaluation, Katherine G. Hearne
Dissertations & Theses (Open Access)
American children eat fewer fruits and vegetables (F&V) and less variety of F&V than recommended for health. Food cooperatives and other programs have become a popular way to increase F&V intake, but little is known about the variety of F&V distributed by these programs or its relationship with program attendance or child F&V intake. Brighter Bites is a national, school-based food co-op distributing rescued, donated, fresh F&V to families in low-income schools. We evaluated, for the first time, the variety of F&V Brighter Bites distributed to families in the 2018-2019 school year and the relationships between that variety and both …
Parental Stress In Tuberous Sclerosis Complex, Jenny Do
Parental Stress In Tuberous Sclerosis Complex, Jenny Do
Dissertations & Theses (Open Access)
Tuberous Sclerosis Complex (TSC) is a multi-systemic genetic disorder with great clinical variability. As the needs of one child with TSC may vastly differ from another, parenting demands may similarly differ. Characterizing parental stress, or emotional maladaptation arising from parenting duties, can enable healthcare providers to assist parents of children most efficiently with TSC-related symptoms and improve both parent and child health outcomes. This study surveyed 269 parents of children (aged 0-12 years) with TSC and received the following information: children’s TSC clinical features, parent demographics, and a Parent Stress Index (PSI) score. Parents reported higher stress levels for children …
Invisible Disabilities, Academic Capital And Competitiveness Of Genetic Counseling Applicants, Natalie E. Stoner, Meagan Choates, Carla Mcgruder, Debra Murray, Theresa Wittman, Sara Wofford, Claire N. Singletary
Invisible Disabilities, Academic Capital And Competitiveness Of Genetic Counseling Applicants, Natalie E. Stoner, Meagan Choates, Carla Mcgruder, Debra Murray, Theresa Wittman, Sara Wofford, Claire N. Singletary
Dissertations & Theses (Open Access)
The field of genetic counseling has historically lacked diversity. Recent research has begun to explore how visible diversity may present barriers to a genetic counseling applicant becoming competitive, but has not yet characterized potential barriers with invisible diversities, such as being a first-generation college student, or a part of the LBGTQ+ community. Therefore, this study aimed to address this gap among those with invisible diversities, as well as explore their academic capital (AC), a theoretical framework used to identify factors that make students more likely to succeed in post-secondary work including supportive networks, trustworthy information, family uplift, college knowledge, overcoming …
Understanding Young Adult Tobacco And Marijuana Use, Shazia Rangwala
Understanding Young Adult Tobacco And Marijuana Use, Shazia Rangwala
Dissertations & Theses (Open Access)
In 2015, young adults in the United States (U.S.) reported co-use of tobacco and marijuana at a much higher rate than exclusive use of marijuana. While there is some qualitative research specific to using tobacco and marijuana separately, there is a lack of qualitative research studying poly/dual or co-use of these products and to understand the complex interactions between the varied modes of delivery for tobacco and marijuana. Qualitative research in this area is important especially due to the major developmental shifts that occur as youth transition into young adulthood. The proposed study is a descriptive analysis of qualitative data …
Genetic Testing In Pregnancies With Ultrasound Anomalies: Exploration Of Factors That Influence Uptake, Lukas D. Kruidenier
Genetic Testing In Pregnancies With Ultrasound Anomalies: Exploration Of Factors That Influence Uptake, Lukas D. Kruidenier
Dissertations & Theses (Open Access)
Prenatal genetic diagnostic and screening tests have been rapidly evolving over the past decade with the introduction and expansion of cell free DNA screening (cfDNA) and the use of chromosomal microarray (CMA) as a first-line test for evaluation of fetal anomalies. Understanding patient motivations for or against expanded genetic testing options is paramount, therefore this study aimed to ascertain the patient perspective. Ninety-nine patients with an ultrasound anomaly participated in an anonymous, cross-sectional, research survey assessing coping strategies, factors influencing the genetic testing decision, and demographic variables. After multivariable analysis, the desire for directive counseling regarding testing was correlated with …
Assessing Genetic Counselors' Clinical Approach And Practices Regarding Pathogenic/Likely Pathogenic Variant Downgrades, Grant Bonesteele
Assessing Genetic Counselors' Clinical Approach And Practices Regarding Pathogenic/Likely Pathogenic Variant Downgrades, Grant Bonesteele
Dissertations & Theses (Open Access)
Although rare, variant downgrades from a pathogenic/likely pathogenic (P/LP) variant to a variant of uncertain significance can have a significant impact on patients and their families in the clinical cancer setting. However, there is a lack of literature about how to approach these potentially challenging cases as a genetic counselor. Therefore, we aimed to characterize genetic counselors’ experiences, approach, and practices to variant downgrade cases using an online survey. The survey asked participants how they would approach variant downgrade scenarios involving the CDH1 or ATM genes with variable family histories. Genetic counselors appear to be united in whether they would …
Evaluating Insurance Approval Rates Of Exome Sequencing And Its Effect On Minority Patients' Access To Genetic Care, Katlyn Frane
Evaluating Insurance Approval Rates Of Exome Sequencing And Its Effect On Minority Patients' Access To Genetic Care, Katlyn Frane
Dissertations & Theses (Open Access)
Exome sequencing (ES) is often a standard step in the genetic testing process for patients with rare or complex disease. Despite clinical implementation of ES, insurance companies (payers) continue to deny this test. We investigated if the payer barrier is influenced by payer type, and if other demographic or clinical information correlated to ES approval and obtainment. To do this, a retrospective chart and clinical database review was completed on patients seen at a tertiary care center and community-based clinic. Patient demographics, clinical indications, and testing recommendations and outcomes were used to assess ES approval and obtainment. We found that …
Survival Analysis Of Colorectal Cancer Patients With Liver Metastasis, Brandon O’Grady
Survival Analysis Of Colorectal Cancer Patients With Liver Metastasis, Brandon O’Grady
Dissertations & Theses (Open Access)
Background- Colorectal cancer is the third most common cancer in the world. I investigated the survival rates among colorectal cancer patients diagnosed with hepatic metastasis to see if any variables are associated colorectal risk and survival. Methods- Patients were diagnosed from 2000-2019 and collected through MD Anderson’s database. A descriptive analysis, univariate analysis, Kaplan-Meier with Mantel log-rank test, Cox proportion hazard regression and a Stratified Cox Model was performed to investigate death. A competing risk regression was implemented to investigate liver recurrence. Results- There was a clear difference in the survival outcome between liver surgery patients and non-liver surgery patients …
Breastfeeding Duration And Reasons Given For Early Cessation Of Breastfeeding Among Wic Mothers, Amy Willa
Breastfeeding Duration And Reasons Given For Early Cessation Of Breastfeeding Among Wic Mothers, Amy Willa
Dissertations & Theses (Open Access)
The Breastfeeding Duration and Reasons for Early Cessation of Breastfeeding Among WIC Mothers study was conducted to describe the duration of and factors associated with early breastfeeding cessation among the Women, Infants, and Children (WIC) population. We collected data from a random sample of WIC medical records, sampling medical records belonging to mothers who initiated breastfeeding an infant but did not breastfeed to 52 weeks. Data were analyzed to answer the questions: How long do WIC mothers breastfeed? What reasons are given during counseling sessions at WIC for early cessation of breastfeeding? Do socio-economic, demographic, or medical factors influence the …
The Comparative Effect Of Automated Reminders/Recalls Interventions On The Appointments Rate Of Adolescent Wellness Care Visit, Biai Dominique Elmir Digbeu
The Comparative Effect Of Automated Reminders/Recalls Interventions On The Appointments Rate Of Adolescent Wellness Care Visit, Biai Dominique Elmir Digbeu
Dissertations & Theses (Open Access)
An Adolescent Wellness Care (AWC) visit is an annual preventive doctor visit predestined to assess the overall health of adolescents aged between 12 and 21 years old. Compared to their younger counterparts, adolescents who are using public insurance are at risk of not completing AWC visits due to several factors related to age or providers disparities in their living environment. This research was a quasiexperimental study aiming to compare two methods of automated Reminders/Recalls (RR) interventions, ‘phone-only’ versus ‘phone-and-text’, in order to evaluate which method is more effective in helping parents/guardians or young adults to schedule an AWC visit. A …
Characterization Of Age-Associated Copd Progression In The Copd Gene Cohort, Lauryn A. Winter
Characterization Of Age-Associated Copd Progression In The Copd Gene Cohort, Lauryn A. Winter
Dissertations & Theses (Open Access)
Chronic obstructive pulmonary disease (COPD) is a progressive and debilitating lung disease affecting primarily older adults. Incidence, morbidity and mortality from COPD are increasing worldwide. The purpose of this study was to determine the associations between age at baseline and markers of disease progression in COPD patients using data generated by the Genetic Epidemiology of COPD (COPD Gene) study. Participants with COPD were stratified by age (younger: age <65 years, elderly: age ≥ 65 years) and disease characteristics (lung function, exercise tolerance, exacerbation history, and comorbidity burden) at baseline and five-year follow up were compared between groups. Associations between age group and changes in these measures were also assessed. Disease characteristics differed significantly between elderly and younger COPD patients at both study visits. Elderly COPD patients had worse lung function and more comorbidities than younger COPD patients, while younger COPD patients reported more dyspnea and more frequent and severe exacerbations than elderly COPD patients. Following covariate adjustment, elderly participants were less likely than younger participants to develop new frequent exacerbations over the study period (relative risk ratio (95% confidence interval): 0.42 (0.20, 0.87)). There were no other significant associations between age group and markers of disease progression. These results suggest that although elderly COPD patients exhibit evidence of more severe lung function impairment than younger COPD patients, the rate of disease progression is similar between elderly and younger patients. However, further exploration is needed to understand the possible contribution of survivorship bias to this finding. Nevertheless, this study supports the importance of early detection and early intervention to slow disease progression and maximize both life expectancy and quality of life for COPD patients.
Influence Of Genetic Counselor Personal Or Family Medical History On Genetic Counseling Specialization And Practice, Kaitlyn K. Amos Ms
Influence Of Genetic Counselor Personal Or Family Medical History On Genetic Counseling Specialization And Practice, Kaitlyn K. Amos Ms
Dissertations & Theses (Open Access)
A personal or family medical history inherently becomes part of a genetic counselor’s life story. Yet the degree to which a counselor’s experience influences his or her specialty choice and their psychosocial practice is unexplored. A medical diagnosis may foster a counselor’s capacity for greater empathy, understanding and rapport-building self-disclosure. Conversely, it could lead to interruptive countertransference, compassion fatigue, and eventually burnout. However, research has not specifically investigated this intersection. Therefore, the aim of this study was to explore the impact of a genetic counselor’s personal or family medical history on his or her choice of practice area, as well …
Asthma-Copd Overlap Syndrome And Disease Progression In The Copdgene Cohort Study, Caitlyn Winter
Asthma-Copd Overlap Syndrome And Disease Progression In The Copdgene Cohort Study, Caitlyn Winter
Dissertations & Theses (Open Access)
Chronic Obstructive Pulmonary Disease (COPD) is a debilitating and degenerative lung disease characterized by progressive airway obstruction and alveolar destruction. When asthma and COPD co-occur and interact, with asthma having been diagnosed first, the resulting respiratory disease is called Asthma-COPD Overlap Syndrome (ACOS). Current research suggests that persons with ACOS may have more severe respiratory disease and lifestyle limitations than those with either disease alone. The purpose of the current study was to determine if and how disease progression differs in patients with ACOS versus COPD only, using data collected during the COPDGene cohort study. Demographic characteristics and disease outcome …
Applications Of Statistical Methods Studying The Impact Of Mobilization Regimes On The Total Collection Yield Of Hematologic Stem Cell, Mengchen Ding
Applications Of Statistical Methods Studying The Impact Of Mobilization Regimes On The Total Collection Yield Of Hematologic Stem Cell, Mengchen Ding
Dissertations & Theses (Open Access)
Hematologic malignancies are cancers that develop in the blood, bone marrow, and lymph nodes. Hematopoietic stem cell transplantation (HSCT) is a critical therapeutic approach that contributes to offer a potential cure for hematologic cancers and other hematologic disorders by replacing abnormal bone marrow with healthy bone marrow components to help bone marrow function recovery. Peripheral blood is the primary resource for collecting hematopoietic stem cells (HSCs). The collection yield of HSCs is critical for successful transplantation. Few articles have discussed this topic that the collection of stem cells not only from healthy donors but also from donors with a hematologic …
Costs Of Coronary Artery Bypass Grafting And Percutaneous Coronary Intervention In Texas, Saleh Hamed Alsarhan
Costs Of Coronary Artery Bypass Grafting And Percutaneous Coronary Intervention In Texas, Saleh Hamed Alsarhan
Dissertations & Theses (Open Access)
Background: Coronary artery bypass grafting (CABG) surgery and percutaneous coronary intervention (PCI) procedures have been associated with substantial financial costs in Texas. The annual hospital charges in 2016 for CABG surgeries and PCI procedures in Texas were $3.6 billion and $4.1 billion, respectively. Recently, these two procedures have become a target for bundled payment initiatives. Due to the lack of information about the demographics and variations associated with CABG and PCI episode payments for commercially insured patients, more research needs to be conducted to understand the magnitude of payments and the drivers of variation in payments in Texas. Objective: This …
Epidemiology Of No -Syndromic, Orofacial Clefts In A RegistryBased, Birth-Cohort In Texas: Differences By Cleft Type And Presence Of Additional Defects, Maria Luisa Navarro Sanchez
Epidemiology Of No -Syndromic, Orofacial Clefts In A RegistryBased, Birth-Cohort In Texas: Differences By Cleft Type And Presence Of Additional Defects, Maria Luisa Navarro Sanchez
Dissertations & Theses (Open Access)
Although orofacial clefts, which include cleft palate alone (CP) and cleft lip with or without cleft palate (CL±P), are among the most common birth defects, their etiology is complex and is generally not well understood. While some clefts are caused by rare syndromes, the majority occur in the absence of a syndrome, either in association with co-occurring defects or as isolated defects. Among these non-syndromic cases, epidemiologic studies have identified demographic variables that are associated with CP and/or CL±P, such as geographic location and infant sex, as well as several maternal characteristics, though some of these associations have been weak …
Heat Stress Related Symptoms And Pulmonary Function In Oil Spill Response And Cleanup Workers Following The Deepwater Horizon Disaster, Yiyao Li
Dissertations & Theses (Open Access)
Objective: The objective of this study was to estimate the relationship between heat stress and pulmonary function among OSRC workers following the Deepwater Horizon (DWH) disaster. Methods: Pulmonary function test results were analyzed from a cohort of oil spill response and cleanup workers 1-3 years following the DWH disaster (N=5,131). Proxies for heat stress was employed by using information on heat stress-related symptoms as well as a questionnaire on stopping work due to heat reported during a structured telephone enrollment questionnaire. Associations between heat stress proxies and lung function were estimated using multivariable linear models and binomial logistic regression models …
Area-Level Landfill Density And Asthma Prevalence In Urban Texas Areas, Jessica Meighan Herrin
Area-Level Landfill Density And Asthma Prevalence In Urban Texas Areas, Jessica Meighan Herrin
Dissertations & Theses (Open Access)
Environmental exposures, especially air pollutants, pose a threat for an increase in asthma prevalence. In particular, hydrogen sulfide (H2S) gas can cause severe health effects closely resembling asthmatic symptoms. Ambient concentrations of H2S gas correlates with the amount of solid waste found in landfills. The potential for adverse health risks associated with H2S emitted from landfills is of concern for those populations living in close proximity to landfills. Asthma is one of the adverse health effects that can occur due to H2S exposure. However, there is a lack of detailed studies characterizing possible associations between the density of landfills and …
Cross-Sectional Analysis Of The Relationship Between Violent Crime And Mental Health Disorders In A Sample Of Homeless Adults Recently Released From Jail, Addison Ransom
Dissertations & Theses (Open Access)
Adverse mental health conditions among incarcerated populations are high, and treatment for these conditions is particularly low. Additionally, there is a culture of stigma in the United States towards those with mental health conditions and violent criminal history, contributing to mass incarceration. The present cross-sectional study sought to assess the association between violent criminal history and mental health symptoms among recently incarcerated homeless adults in Dallas, Texas. This study included 230 participants, taking place at The Bridge Homeless Recovery Center, evaluating non-violent versus violent criminal history. Outcome measures of positive screens for post-traumatic stress disorder, generalized anxiety disorder, and depression …
Effect Of The Expanded Prospective Payment System On Dialysis Initiation, The Usage Of Erythropoiesis-Stimulating Agents, And Medicare Expenditures, Lu Zhang
Dissertations & Theses (Open Access)
In January 2011, the U.S. Centers for Medicare & Medicaid Services (CMS) implemented the expanded prospective payment system (PPS) for financing the management of end-stage renal disease (ESRD). Expanded PPS may not only change healthcare providers’ decisions about patient care by removing the financial incentives associated with the previous composite rate payment methodology, but also change the Medicare expenditures associated with various treatment patterns by using a constant base rate for all dialysis modalities. This study aimed to examine the effect of the expanded PPS on providers’ decisions on timing of dialysis initiation and ESA utilizations in ESRD patients as …
Hospital Market Analysis Using A Cohort Of Privately Insured Patients With Total Hip And Knee Replacement Procedures, Elifnur Yay Donderici
Hospital Market Analysis Using A Cohort Of Privately Insured Patients With Total Hip And Knee Replacement Procedures, Elifnur Yay Donderici
Dissertations & Theses (Open Access)
Background: Several recent studies have analyzed the contribution of hospital inpatient prices and utilization to variation in medical spending. However, it is still unknown how the drivers of spending for specific procedures differ within privately insured patients. Next, the market concentration of hospitals has been a matter of concern for several decades. However, researchers usually calculate Herfindahl-Hirschman index (HHI) as a measure of market concentration or power, but there is a drawback of using this measure. Hospitals sell differentiated products, and the HHI measure does not take this differentiation into account in its formulation (Gaynor and Town, 2011). Objective: First …
Health Disparities Across Funcitonal Disability Groups, Katherine Sanches
Health Disparities Across Funcitonal Disability Groups, Katherine Sanches
Dissertations & Theses (Open Access)
Background: People with disabilities experience higher rates of chronic disease and poor health status compared to those without disability. People with disabilities do not participate in community health programs to the same degree as those without disability due to social, programmatic, and environmental barriers. The Community Health Inclusion Index (CHII) is a community health assessment tool which evaluates the degree to which community-level health promoting opportunities to promote nutrition and physical activity are inclusive and accessible to people with disabilities. The CHII assess barriers to inclusion across five domains: build environment, equipment, program/services, staff, and policies. Objective: The purpose of …