Medicine and Health Sciences Commons^™

The Tensegrity Curriculum: A Comprehensive Curricular Structure Supporting Cultural Humility In Undergraduate Medical Education., Anne C Jones, Kristin N Bertsch, Deborah Williams, Millicent King Channell

Rowan-Virtua School of Osteopathic Medicine Faculty Scholarship

Due to growing health disparities in underserved communities, a comprehensive approach is needed to train physicians to work effectively with patients who have cultures and belief systems different from their own. To address these complex healthcare inequities, Rowan-Virtua SOM implemented a new curriculum, The Tensegrity Curriculum, designed to expand beyond just teaching skills of cultural competence to include trainees' exploration of cultural humility. The hypothesis is that this component of the curriculum will mitigate health inequity by training physicians to recognize and interrupt the bias within themselves and within systems. Early outcomes of this curricular renewal process reveal increased student …

A Brief Overview Of Food Insecurity In Southern New Jersey, Lisa Ting Huang, Krisha Darji, Jariatou Diallo, Amin Abdul Khan

Rowan-Virtua Research Day

Atlantic County, located off the Jersey Shore, faces the highest level of food insecurity in New Jersey, with a rate of 11.2% as of 2021, surpassing the state's overall rate of 8.8%. This situation contributes to health issues such as hypertension, diabetes, and heart disease.

The objective of this research is to understand and address the persistence of food insecurity in Atlantic County. Community stakeholders and local physicians were interviewed to identify barriers and disparities contributing to food insecurity.

Methods included a literature review using keywords like "food insecurity" and "southern New Jersey". Proposed interventions suggest collaboration with health centers …

Challenges In Capacity: A Case Report Exploring Social Determinants Of Health And Psychiatric Illness, Hunter Smith, Jacob Light, Jenys Allende

Research Day

I. Introduction

An assessment of capacity is a critical part of the surgical consent process in order to ensure that the patient understands the risks, benefits, and alternatives to treatment. When a patient refuses life-saving care, it is essential to evaluate them to determine their capacity for decision-making. While there are specific components to a capacity evaluation, the capacity assessment process can be clouded by other factors in the patient’s history. The purpose of this case study is to illuminate the myriad challenges faced by surgeons assessing capacity in patients with complex social and psychiatric backgrounds.

II. Case

A 53-year-old …

The Impact Of Household Income On The Development Of Long-Covid After Covid-19 Infection, Clayton Mowrer

Capstone Experience

Objective

Long-COVID can occur following coronavirus-19 infection and can have debilitating consequences. It is unclear how household income (a social determinant of health) might impact the development of long-COVID. This study aims to characterize and compare the prevalence of long-COVID in persons who have been diagnosed with COVID-19, according to household income.

Methods

Using data from the 2022 Behavioral Risk Factor Surveillance System Questionnaire, 124,313 respondents who reported a diagnosis of COVID-19 infection were analyzed for the development of long-COVID (outcome) and compared across annual household income (exposure). Other demographic and socioeconomic factors were similarly analyzed.

Results

The prevalence of …

Increasing Utilization Of Community Resources To Address Social Determinants Of Health Barriers In Patients With Diabetes Mellitus Type 2, Kimberly Williams

The Eleanor Mann School of Nursing Student Works

PURPOSE: To determine if identifying SDOH barriers to care in adults with DMT2 and providing information about community-based resources designed to decrease the impact of these barriers will improve adherence, decrease SDOH barriers, and reduce HbA1c levels.

DESIGN/METHODS: Quasi-experimental design. Participants completed PRAPARE screenings and received handouts detailing contact information for local resources. HbA1c levels were collected prior to or at the initial appointment. Contact was attempted at 4-6 weeks to ensure resources were utilized. 3-month follow up appointments were completed during which PRAPARE screenings were repeated, HbA1c levels were collected, and post-intervention surveys were completed.

CONClUSIONS: Participants who did …

Addressing Social Determinants Of Health In Medication-Assisted Treatment Programs, Audrey Hunter

The Eleanor Mann School of Nursing Student Works

ntroduction: Medication-assisted treatment (MAT) is considered the most effective treatment for patients with opioid use disorder (OUD); however, MAT program retention rates are consistently low across the United States. Addressing social determinants of health (SDOH) through text message could impact MAT retention; therefore, a pilot project at a federally qualified healthcare center (FQHC) was implemented.

Methods: The Protocol for Responding to and Assessing Patients’ Assets, Risk, and Experiences (PRAPARE) SDOH screening tool was implemented for patients undergoing MAT for OUD. Community resource referrals were provided via text message based on the screening results. Retention in treatment was measured by prescriptions …

Drivers Of Being Unhoused And The Prevalence Of Health Conditions Among Unhoused Individuals In Asheville, Nc, Andrea K. Yontz, Amber Beane, Tessa Frank, Amy Upham, Dustin V. Patil, Dan Pizzo, Steve Buie, Jacqueline R. Halladay

HCA Healthcare Journal of Medicine

Background

During the COVID-19 pandemic, there was an increase in the number of unhoused individuals in Asheville, North Carolina resulting in more tent encampments.

Understanding the physical, mental, and socially determined health characteristics associated with being unhoused can help guide stakeholders with policy development, healthcare program planning, and funding decisions to support unhoused individuals.

Methods

In this study, we used an observational cross-section methodology. Using a convenience sample approach, we interviewed 101 participants who were receiving services from 2 emergency hotel shelters, a day center, and a resource center. Data were analyzed using descriptive statistics, and open-ended responses were collected …

Ensuring Equitable Application Of Interventions To Vulnerable Subpopulations In The Kentucky Consortium For Accountable Health Communities (Kc-Ahc), Jing Li, Jessica M. Clouser, Akosua Adu, Aiko Weverka, Nikita Vundi, Terry D. Stratton, Mark V. Williams

Journal of Appalachian Health

Introduction: The Centers for Medicare and Medicaid Services (CMS) has funded the Accountable Health Communities (AHC) model to test whether systematically identifying and addressing the health-related social needs (HRSNs) of individuals would impact healthcare utilization and total cost of care for Medicare and Medicaid beneficiaries. Toward this effort, AHCs implement screening, referral, and community navigation services in their local areas. There are 28 CMS-funded AHCs nationwide, including the Kentucky Consortium for Accountable Health Communities (KC-AHC).

Purpsoe: This study aims to assess the equity of KC-AHC model activities in three vulnerable sub-populations: dual enrollees, disabled individuals, and women.

Methods: Twenty-eight primary …

Healthcare Team Members’ Views On Social Determinants Of Health Screening And Referral Practices In A Pediatric Emergency Department, Jadelynn Nagy, Natalie J. Tedford, Sahlil Ahmed, Sofia Thoms, Akiko Kamimura, Maija Holsti

Patient Experience Journal

We aimed to explore the healthcare team members’ (HTMs) views on social determinants of health (SDH) screening and referral processes in a pediatric emergency department (PED). We conducted a cross-sectional, mixed-methods study to explore PED HTMs’ views on social care practices at a quaternary-level children’s hospital. The survey was created using a goal identification framework. The survey gathered quantitative and qualitative data by assessing SDH screening practices, comfort and personal habits in screening, prioritization of SDH domains, workflows to perform screening, and perceived barriers to screening. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using thematic analysis …

Statistical Genetic Approaches To Investigate Genotype-By-Environment Interaction: Review And Novel Extension Of Models, Vincent P. Diego, Eron G. Manusov, Marcio Almeida, Sandra Laston, David Ortiz, John Blangero, Sarah Williams-Blangero

School of Medicine Publications and Presentations

Statistical genetic models of genotype-by-environment (G×E) interaction can be divided into two general classes, one on G×E interaction in response to dichotomous environments (e.g., sex, disease-affection status, or presence/absence of an exposure) and the other in response to continuous environments (e.g., physical activity, nutritional measurements, or continuous socioeconomic measures). Here we develop a novel model to jointly account for dichotomous and continuous environments. We develop the model in terms of a joint genotype-by-sex (for the dichotomous environment) and genotype-by-social determinants of health (SDoH; for the continuous environment). Using this model, we show how a depression variable, as measured by the …

Assessing Social Vulnerabilities Of Salivary Gland Cancer Care, Prognosis, And Treatment In The United States, Govind S. Bindra, David J. Fei-Zhang, Atharva Desai, John Maddalozzo, Stephanie S. Smith, Urjeet A. Patel, Daniel C. Chelius, Jill N. D'Souza, Jeffrey C. Rastatter, M. Boyd Gillespie, Anthony M. Sheyn

School of Medicine Faculty Publications

Background: Salivary gland cancers (SGC)-social determinants of health (SDoH) investigations are limited by narrow scopes of SGC-types and SDoH. This Social Vulnerability Index (SVI)-study hypothesized that socioeconomic status (SES) most contributed to SDoH-associated SGC-disparities. Methods: Retrospective cohort of 24 775 SGCs assessed SES, minority-language status (ML), household composition (HH), housing-transportation (HT), and composite-SDoH measured by the SVI via regressions with surveillance and survival length, late-staging presentation, and treatment (surgery, radio-, chemotherapy) receipt. Results: Increasing social vulnerability showed decreases in surveillance/survival; increased odds of advanced-presenting-stage (OR: 1.12, 95% CI: 1.07, 1.17), chemotherapy receipt (OR: 1.13, 95% CI: 1.03, 1.23); decreased odds …

Understanding Vaccine Hesitancy: An Analysis Of Caregiver Influences On Pediatric Covid-19 Vaccination Decisions, Neiki Rokni, Shu Zhao Md, Matthew Nguyen, David Liu, Harrison Jordan Do, Jory Parson, Sidharth Sahni Do, Tanner Walsh Md, Ashley Henderson Md, Jennifer Higgins Md

Tower Health Research Day

No abstract provided.

Readmission Rates Of Mothers Experiencing Preeclampsia Or Complications After Delivery In Underserved Populations, Sadia Robinson

MUSC Theses and Dissertations

Hospital readmissions during pregnancy nationwide impacts maternal health outcomes elevating the risk of maternal deaths after discharge. The accessibility and affordability of necessary prenatal care is integral to the field of health across the lifespan. Socioeconomic barriers within rural locations place expecting mothers at an adverse risk of developing conditions including preeclampsia and other complications that may result in hospital readmission. Economic barriers including hospital closures, shortages of specialty healthcare providers, unstable internet access and, ease of care access on further contribute to this disparity among rural women.

A retrospective analysis was conducted using data from Health Care Cost and …

Establishing The First Student-Run Clinic To Provide Free Health Care To A South Texas Colonia, John Nicholas Cauba, Andrew B. Callan, Beatriz Tapia

Research Symposium

Purpose: The purpose of the University of Texas Rio Grande Valley School of Medicine Student Run Clinic is to bridge the healthcare gap in the local colonias by providing excellent, compassionate primary care to all who enter our doors, free of charge. We also work to connect our patients to low-cost, high-quality services in the area like women’s health visits, appointments with social workers, and dental services. Additionally, we offer medical students’ opportunities from their first year to serve an underserved population and get hands-on experience with patients.

Many patients in colonias face challenges like limited transportation options and a …

Impact Of Social Determinants Of Health On Healthcare Disparities In Florida, Kayla L. Haydon, Catarina Jim, Joel J. Mantilla, Noel C. Barengo

American Journal of Non-Communicable Diseases

Objective

Healthcare disparities disproportionately affect underserved and marginalized communities due to social determinants of health (SDoH), contributing to significant differences in health outcomes and life expectancy within different communities in Florida. This observational study aimed to understand the impact of SDoH, such as race/ethnicity, income level, and education attainment on healthcare access in Florida.

Methods

Self-reported data from the 2020 Behavioral Risk Factor Surveillance System were pooled to evaluate disparities in healthcare access by race/ethnicity, income, and education level in Florida.

Results

Health status and healthcare access vary based on characteristics related to SDoH, including race/ethnicity, income level, and educational …

Vulnerable Neighborhoods Had Smaller Gains In Health Insurance Coverage During Early Covid-19, Ismail Mustafa Aijazuddin, Ammar Sukari

Medical Student Research Symposium

Background:

The Covid-19 pandemic has illuminated the inequities that jeopardize health, prompting rapid interventions to promote care access. However, such efforts have had mixed success in eradicating disparities. One focus is the equity of improvements in insured rates.

Methods:

Self-reported health insurance coverage rates among adults aged 18-64 were obtained from the CDC’s PLACES datasets for collection years 2018 and 2021, at the Census Tract level. These data were merged with the CDC’s 2018 Social Vulnerability Index (SVI), which ranks Tracts on 15 measures of social determinants of health. Across Tracts nationally and by state, univariate correlations between Overall SVI …

Natural Spaces, A Social Determinant Of Health, And Self-Rated Health Among Medical Students, Josiah P. Stryd, Anil N. F. Aranha

Medical Student Research Symposium

Background and Purpose: Natural spaces are areas which have a majority of natural ground cover such as vegetation or water. These spaces have positive effects on both physical and mental health. The purpose of this study was to investigate whether medical students who have greater accessibility and use of natural spaces have better self-rated health.

Methods: M2-M4 students from Wayne State University School of Medicine received an email link to the Qualtrics-based study. Variables evaluated included: sociodemographics, residence zip code, natural spaces access frequency, distance, and transportation method. Self-rated physical and mental health was measured using the Healthy Days measure …

Cultural Context Index: A Geospatial Measure Of Social Determinants Of Health In The United States, Alaina M Beauchamp, Gordon C Shen, Syed H Hussain, Atif Adam, Linda Highfield, Kai Zhang

Journal Articles

Minority populations will continue to grow in the United States. Such pluralism necessitates iterative, geospatial measurements of cultural contexts. Our objective in this study was to create a measure of social determinants of health in geographic areas with varying ethnic, linguistic, and religious diversity in the United States. We extracted geographic information systems data based on community characteristics that have known associations with population health disparities from 2015 to 2019. We used principal component analysis to construct a Cultural Context Index (CCI). We created the CCI for 73,682 census tracts across 50 states and five inhabited territories. We identified hot …

Sociodemographic Determinants Of Potentially Avoidable Hospitalizations Due To Ambulatory Care Sensitive Conditions Among Hospitalized Patients In The United States, Munira Kashem

Electronic Thesis and Dissertation Repository

Social determinants of health play a crucial role in explaining the variation of potentially avoidable hospitalizations (PAH) due to Ambulatory Care Sensitive Conditions (ACSCs). Utilizing data from the National Inpatient Sample from 2018 to 2020 in the United States, this study conducted retrospective cohort analyses to explore the relationships between sociodemographic factors, specifically income, race, geography, age, and sex and PAH. Our approach used multilevel logistic regression models to adjust for potential confounders and account for clustering of admissions within hospitals. Of the 17,629,891 hospital admissions examined in this study, 1,868,609 (10.6%) were attributable to ACSCs. Our results indicate that …

Creating An Interactive Guide To Support Health Disparities Competency, Lauren E. Robinson, Stephanie Henderson, Cayla M. Robinson, Rebecca J. Morgan, Beth Reeder

2024 R&I Day

Authors share their educational resource developed for the health sciences, that guides users in awareness of health disparities, vulnerable populations, and social determinants of health, directing them to specific guidance and resources available through the library.

Most Deprived Louisiana Census Tracts Have Higher Hepatocellular Carcinoma Incidence And Worse Survival, Kendra L. Ratnapradipa, Tingting Li, Mei Chin Hsieh, Laura Tenner, Edward S. Peters

School of Public Health Faculty Publications

Background: Liver cancer incidence increased in the US from 1975 through 2015 with heterogeneous rates across subpopulations. Upstream or distal area-level factors impact liver cancer risks. Objective: The aim of this study was to examine the association between area-level deprivation and hepatocellular carcinoma (HCC) incidence and survival. We also explored the association between area deprivation and treatment modalities. Methods: Louisiana Tumor Registry identified 4,151 adult patients diagnosed with malignant HCC from 2011 to 2020 and linked residential address to census tract (CT)-level Area Deprivation Index (ADI) categorized into quartiles (Q1 = least deprived). ANOVA examined the association between ADI quartile …

Association Between Community Social Vulnerability And Preventable Hospitalizations, Rachel Hogg-Graham, Joseph A. Benitez, Mary E. Lacy, Joshua Bush, Juan Lang, Haritomane Nikolaou, Emily R. Clear, J. M. Mccullough, Teresa M. Waters

Public Health and Population Science Faculty Publications and Presentations

Preventable hospitalizations are common and costly events that burden patients and our health care system. While research suggests that these events are strongly linked to ambulatory care access, emerging evidence suggests they may also be sensitive to a patient’s social, environmental, and economic conditions. This study examines the association between variations in social vulnerability and preventable hospitalization rates. We conducted a cross-sectional analysis of county-level preventable hospitalization rates for 33 states linked with data from the 2020 Social Vulnerability Index (SVI). Preventable hospitalizations were 40% higher in the most vulnerable counties compared with the least vulnerable. Adjusted regression results confirm …

Hidradenitis Suppurativa Disease Severity And Outcomes Among Black Patients From Low-Income Neighborhoods At A Tertiary Care Hospital: A Retrospective Review, Anna M. Catinis, Olivia A. Gioe, Caroline Savoie, Erika Rosen, Deborah Hilton

School of Medicine Faculty Publications

Hidradenitis suppurativa (HS) is a debilitating, inflammatory condition of apocrine sweat glands. Black patients are disproportionately affected, a finding largely attributed to lower socioeconomic status (SES) in the literature; yet, most HS studies include majority White cohorts. We present, to our knowledge, the first retrospective review of an entirely Black patient population living in low-income neighborhoods diagnosed with hidradenitis suppurativa (HS) to identify potentially modifiable factors related to disease severity and outcomes. We reviewed charts of Black patients with an encounter for HS from 2010-2020 in the New Orleans University Medical Center database. Hurley stage III (HSt III) disease was …

County-Level Trends And Potential Disparities In The Suicide Rates In Virginia, 2020 – 2022, Sharon A. Olowoyo, Oluwatosin M. Oduneye, Glodi B. Bokanya, Ayooluwa G. Olowoyo, Coralie E. Mugenga, Yuhan Yan, Robyn L. Anderson

Montview Journal of Research & Scholarship

Abstract

Objectives

This study aims to investigate the influence of social determinants of health (SDH) on suicide patterns in the state of Virginia.

Methods

A secondary statistical analysis was conducted using publicly accessible data from the County Health Rankings & Roadmaps database for Virginia. Data from 2020 to 2022 were analyzed, focusing on age-adjusted suicide rates and SDH factors, including % rural, mental health provider rate, median household income, high school completion, and unemployment rates. Multiple regression analysis and visualizations were employed for data interpretation.

Results

The analysis revealed that SDH factors significantly predicted suicide rates across the study period. …

Development And Implementation Of Occupational Therapy Group Protocols For Individuals In Recovery For Substance Use Disorder: Considering Social Determinants Of Health And Occupational Areas Of Need, Samantha Jane Windisch

Graduate Theses, Dissertations, and Problem Reports

Substance use disorders (SUDs) are becoming a more widespread issue globally. According to the National Survey on Drug Use and Health, 19.7 million adults in the U.S. suffered from an SUD in 2017. (SAMSHA, 2018). Recurrent alcohol and/or drug use that results in significant disability, including health issues, and/or a failure to prioritize obligations like employment, school, or family life are characteristics of SUD (SAMHSA, 2022). Research suggests that healthcare providers must integrate cutting-edge and successful treatments for this population to lower the risk of overdose and relapse rates, given the swift global spread of addictive disorders. In the past, …

Cost Of Eating Well, Jake Ermolovich

Larner College of Medicine Fourth Year Advanced Integration Teaching/Scholarly Projects

No abstract provided.

Weight Health In The Modern Lens: Investigating The Intersectionality Of Obesity, William Bohne, Anthony Onochie

Scholarship in Medicine - All Papers

Purpose The purpose of this study is to investigate the relationship between these social determinants of health and obesity to provide a better understanding of geographical differences in obesity rates. Methods All data was collected using countyhealthrankings.org. The variables that were studied included access to exercise, food insecurity, and life expectancy due to previous literature demonstrating probable association between these variables and the prevalence of obesity. Results Statistically significant increase in number of adults with obesity from 2016 to 2022 (32% to 37%). Statistically significant weak, negative correlation between access to exercise and obesity (r=-.306). Statistically significant weak, negative correlation …

Discussing Systemic Racism And Racial Privilege At A Large, Academic Health Center Using A Modified Privilege Walk, Elizabeth A. Brown, Rosemarie Jones

Community & Environmental Health Faculty Publications

Background: There is a motivation for organizations to understand race and racism from the perspective of minoritized individuals. Academic health centers (AHC) are ideal organizations to have these conversations as they educate healthcare providers, support research in health disparities, and care for diverse patients.

Methods: We piloted and evaluated a virtual Modified Privilege Walk (MPW) with faculty, staff, and students at an AHC in July 2020 to promote difficult conversations about race/racism, social class, and privilege. Each MPW session was voluntary, held virtually over Zoom, and lasted one hour and thirty minutes. Before attending, participants answered questions based on their …

Exploring Cultural Humility Prevalence And Barriers In Masters Of Science In Athletic Training Education Programs, Nathalie Towchik

Antioch University Dissertations & Theses

The purpose of this study is to understand the prevalence of faculty members’ abilities to incorporate cultural humility into their Masters of Science in Athletic Training (MSAT) program curriculum and barriers they feel they face in implementing this into regular practice. There is a severe lack of focus on issues pertaining to social justice within the athletic training profession, and implementation of cultural humility skills into MSAT programs can help address the systemic injustices within athletic training healthcare delivery. While there has been a focus on cultural competency in athletic training education, there is little to no current research on …

Assessing And Addressing The Determinants Of Appalachian Population Health: A Scoping Review, David L. Driscoll, Hannah O'Donnell, Maitri Patel, David C. Cattell-Gordon

Journal of Appalachian Health

Introduction: Residents of Appalachia experience elevated rates of morbidity and mortality compared to national averages, and these disparities are associated with inequitable exposures to various determinants of population health. Social and environmental determinants of health are a useful lens through which to develop and evaluate programs to mitigate regional health disparities.

Methods: This 2023 scoping review was conducted of studies linking determinants of Appalachian health with leading causes of regional mortality and morbidity. The search strategy employed a keyword search that included geographic terms for the Appalachian Region and the primary adverse health outcomes in that region. Studies meeting the …