Community Health and Preventive Medicine Commons^™

Health Practices And Use Of Traditional Medicine Among Asian Indian Immigrants In The United States: A Pilot Study, Parita Patel, Anil N.F. Aranha

Medical Student Research Symposium

Title: Health Practices and Use of Traditional Medicine Among Asian Indian Immigrants in the United States: A Pilot Study

Authors

Parita Patel, MPH¹; Anil N.F. Aranha, PhD^1,2

Medical Education¹, Internal Medicine², Wayne State University School of Medicine, Detroit, Michigan

Abstract

Background and Purpose: Traditional and alternative medicine (TAM), including Ayurveda, Homeopathy, Naturopathy, and home remedies, remains widely used among Asian Indian (AI) immigrants in the United States alongside Western medicine. Cultural familiarity, family influence, and perceived safety shape these practices. This pilot study examined TAM prevalence, patterns, and perceptions among AI immigrants and …

Leveling The Playing Field: Ensuring Hydration Equity For Detroit’S Student-Athletes, David Abdelnour, Noah Kos, Alqasim Elnaggar, Jack Mao, Rumyah Rafique, Julian D Johnson, Marley Sternberg, Audrey Millar, Faith Scott, Susan Lagrand, Ammar Chaudhri, Magd Boutany, Rahul Vaidya

Medical Student Research Symposium

Background:

The Detroit Public Schools Health Corps (DPSHC) provides free sideline medical coverage to Detroit Public Schools Community District (DPSCD) athletic events to address healthcare disparities in underserved communities. During 408 hours of coverage across 214 games, DPSHC volunteers observed frequent shortages of water and electrolyte drinks among teams. Given the importance of hydration in preventing heat-related illness and optimizing athletic performance, a systematic needs assessment was conducted.

Methods:

A survey was distributed to athletic coaches and administrators across DPSCD schools. Survey questions evaluated the availability of hydration resources, frequency of shortages, responsible providers, and priority needs for additional funding …

Guidelines For Community Engaged Health Research, Carrie Leach, Hayley Thompson, Alex Sass, Patricia Wren, Rodlescia Sneed, Rhonda Dailey, Elizabeth Towner, Maha Albdour, Carla Caringi, Alyssa W. Beavers, Theresa A. Hastert, Vanessa Rorai, Peter A. Lichtenberg, Angulique Outlaw, Ijeoma Nnodim Opara

Institute of Gerontology

Executive Summary:

Wayne State University’s Guidelines for Community Engaged Health Research provide a practical framework for designing, conducting, and evaluating ethical, equitable, and impactful health research that engages community experts in projects that advance health equity in Detroit.

Purpose 

Developed for WSU faculty, staff, and research teams, the guidelines support the meaningful involvement of community experts across all phases of research. They respond to common challenges in community-engaged work, including limited experience with engagement approaches, the need for reflexive and equitable practices, and the time and coordination required for authentic collaboration.

The document defines Community-Engaged Research (CEnR) as collaborative work …

Understanding Vaccine Hesitancy And Barriers To Access In Hispanic Individuals Of Metro Detroit​, Rafael Ramos, John Gallegher, Nevil Khurana, Ingrid Rocha, Rene Andino-Galva, Izabel Thomas, Deni Peterson, Alexander Eskandarian, Eliezer Arody Gomez, Md

Medical Student Research Symposium

Background:

Detroit’s Hispanic community is still disproportionally uninsured at about 2x the rate of non-Hispanic white and 3x the rate of non-Hispanic Black residents. In the post-COVID era, vaccine hesitancy and barriers to access have been well-documented. Studies suggest that minority populations, including the Hispanic population, may experience unique social determinants of health which affect their vaccination rates and outcomes. Additionally, research shows that knowledge of vaccines may correlate with levels of trust.

Methods:

We sought to describe the knowledge, barriers to access, and levels of trust regarding the influenza (flu) vaccine in Hispanic individuals of Metro Detroit. We used …

Differences In Self-Reported Cancer Measures Persist Despite Covid-Era Improved Insurance Access, Ismail Mustafa Aijazuddin, Ammar M. Sukari

Medical Student Research Symposium

Background:

The Covid-19 pandemic has challenged healthcare access, jeopardizing cancer-related health measures. However, pandemic-era health policies led to increased health insurance coverage across most counties in the United States. This study aims to explore relationships between uninsured rates and cancer prevalence and screening behaviors.

Methods:

Data were collected from the CDC’s PLACES datasets for the 2021 (collected 2018-2019) and 2024 (collected 2022) release years and merged at the county level. For both 2021 and 2024 releases, Pearson’s correlation and student’s t-test were performed between uninsured rates and the age-standardized rates of the following at the county level: cancer prevalence, colorectal …

Indeterminate Benefit Of Long-Term Beta-Blocker Use After Acute Myocardial Infarction For Some Patients, Logan S. Thayer, Khush Hussain, Nicholas Apostolakis, Gretchen Swift, Arifbillah Sarowar, Mohammad Al-Hadidi, Scott Yaekle

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using:

Yndigegn T, Lindahl B, Mars K, et. al., Beta-blockers after myocardial infarction and preserved ejection fraction. N Engl J Med. April 7 2024;390:1372-1381. https://doi.org/10.1056/NEJMoa2401479

for a patient showing 55% left ventricular ejection fraction after myocardial infarction.

Assessing Eye Care Needs And Service Accessibility In A Student-Run Free Clinic In An Underserved Urban Population, Hamza Khan, Arifbillah Sarowar, Olivia Jeakle, Sophia Griemert, Olivia Decker, Demetrius Moncrease, Timothy Page, Dominic Sacca, Anju Goyal

Medical Student Research Symposium

Introduction: Student-run free clinics offer valuable firsthand experience in providing care to uninsured and underserved communities. As efforts to enhance eye care expand over time, it is crucial to evaluate the accessibility and effectiveness of these services within the community. This study examines the demographics and needs of patients seeking eye care, as well as the availability of initial screenings at our clinic.

Methods: A retrospective review of patient charts was conducted for individuals who attended the Sight Saver’s free healthcare clinic to receive an eye exam. Data collected includes patient demographics, comorbidities, family history of eye-related diseases, visual acuity …

Evaluating Engagement In Health Care And Substance Use Disorder Services Among People Who Use Drugs, Tiffany Mckenney, Kevin Cobty, Divya Boorle, Julie Gleason-Comstock

Medical Student Research Symposium

An urban community-based organization conducted a study to examine demographics of individuals who use drugs and their approaches to risk reduction. A substantial proportion reported encountering significant barriers to accessing substance use disorder (SUD) services.

In collaboration with a state survey, the community organization recruited a convenience sample of individuals who actively used drugs, examining substance use patterns, healthcare access, and barriers to SUD services. Community health workers facilitated outreach efforts, focusing on harm reduction engagement, and healthcare access.

Data were collected from 55 individuals. 51% identified as male, 48% as female, and 2% as LGBTQIA+. 67% identified as White/Caucasian, …

Socioeconomic And Demographic Factors In Genetic Testing Utilization Among Advanced Prostate Cancer Patients: A Retrospective Single-Institution Study, Alexandra T. Skowron Ms, Karen Childers, Courtney M. Rose Ms, Kyle C. Mcelyea Md, Avery K. Supernois Bs, Yousuf Hussain, Mohammed Baseer Ms, Sunita Ghosh Phd, Clara Hwang Md

Medical Student Research Symposium

Introduction

Germline genetic testing in patients with advanced prostate cancer (PCa) is underutilized. Socioeconomic and demographic factors are hypothesized to affect low rates of testing, but causality has not been established. This single institution, retrospective study aimed to understand what barriers may affect germline genetic testing for PCa patients.

Methods

The Henry Ford Health (HFH) tumor registry was queried for new diagnoses of stage 3, 4A and 4B PCa from 2017-2022. Census tract levels were assigned using patient addresses and neighborhood-based geocoding was completed for Median household income (gMHI) and Social vulnerability index (SVI). gMHI and SVI were divided into …

Variation In Treatment Recommendations For Low-Risk Prostate Cancer: A Focus On Active Surveillance Across Physician Specialties, Sinyu Yang B.S., Tiffany Chu B.S., Cathryn Bock Ph.D, Jinping Xu M.D.

Medical Student Research Symposium

Prostate cancer (PC) is the second leading cause of cancer-related death in men globally, with 1 in 8 men in the US diagnosed during their lifetime. For Low-Risk Prostate Cancer (LRPC), management options include Watchful Waiting (WW), Active Surveillance (AS), or curative treatments such as prostatectomy or radiation. While curative treatments can have significant long-term side effects like urinary incontinence and sexual dysfunction, AS is less invasive and preferred due to fewer adverse effects. However, variations in physician training may lead to differing recommendations, potentially causing confusion or frustration for patients consulting multiple specialists. This study investigates whether treatment recommendations—AS, …

Understanding Barriers To Fresh Produce Consumption In Detroit, Riley Ann Macdonald, Kalyyanee Ganesh Nanaaware, Jeff Lu, Derek Zahnleuter, Heather Sun, Sara Naessig, Aminah Bharadia, Eric A. Mcgrath

Medical Student Research Symposium

Title: Understanding Barriers to Fresh Produce Consumption in Detroit

Abstract:

Background Information:

Detroit has barriers to fresh produce consumption and poor health outcomes related to diet, which necessitate further study. We aim to investigate these barriers by understanding current consumption practices of fresh produce, and provide evidence for future solutions to combat these barriers.

Methods:

Surveys were distributed at two urban garden locations (Wayne State University School of Medicine Medical Student Garden and Wayne Pediatrics Garden) in Midtown, Detroit, to patrons (n=34) receiving fresh produce between March-October 2024. Surveys screened for demographics, transportation, what produce patrons took, if they …

Stopping The Cirrhosis: An International Review Of Hep C Screening In Prisons And Jails From 2004-2023, Anastasia Sahu Bs, Jack Spurlock Ba, Mhs, Eliza Beal Md

Medical Student Research Symposium

Background: As of 2023, HCV prevalence in state prisons in the United States was 9 times higher than the general population¹. Without treatment, 20% of people with HCV will develop cirrhosis, and some estimate that 70% of hepatocellular carcinoma (HCC) cases arise from cirrhosis or advanced fibrosis². Despite the high prevalence in prisons, the US does not have nationally standardized Hep C screening in correctional facilities. The goal of this study is to investigate different models of existing programs in prisons internationally. Understanding these models will inform Hep C screening in US prisons on a state …

Low, Current, And Persistent Poverty Area Residence And Social Risks Among Black Cancer Survivors, Leane S. Kuo, Theresa A. Hastert

Medical Student Research Symposium

Background: Persistent area-level poverty may contribute to long-term social and economic disinvestment and fewer health promoting resources even compared with current area-level poverty. This may contribute to unmet social needs, which are associated with adverse health outcomes. This study examines associations between living in persistent (vs. current and low) poverty areas and prevalence of social needs among African American cancer survivors.

Methods: We utilized data from 3,650 participants in the Detroit Research on Cancer Survivors (ROCS) cohort. African American adults were invited to participate if they were ages 20-79 at diagnosis with breast, colorectal, lung, prostate, or endometrial cancer (ages …

Sexual And Reproductive Healthcare Perceptions Among Arab-American Women: Implications For Gynecological Health Outcomes, Munna Hazime, Kaitlyn Zablock, Whitney Bowyer, Natalie Ahmad Mateju, Andrew Markowitz

Medical Student Research Symposium

This literature review analyzes the sexual and reproductive healthcare perceptions of Arab-American (AA) women living in the United States and how this impacts the prevalence of gynecological diseases. Sexual health is viewed promiscuously within the AA population and is generally reduced to the physical act of intercourse. It is considered either an agent of sexual desire or a means to reproduce. This dichotomy overlooks aspects of gynecological health within a broader framework. This attitude is evident in the minimal utilization of preventative screenings and increased rates of sexually transmitted infections (STIs) and gynecological cancers. Consequently, this narrow view of sexual …

The Role Of Churches In Enhancing Cancer Screening Adherence: A Focus On Faith-Based Health Literacy Among African American Women, Miranda I. Goodson, Genevieve Murray

Medical Student Research Symposium

Background: It is estimated that cancer is the second leading cause of death for African American women in the United States. One study revealed that Black women have a 1 in 3 chance of developing cancer with a 1 in 6 chance of mortality. Research has shown a lower breast cancer screening adherence among women in cultural minorities and faith-based communities. The importance of spirituality and religion as an influential factor on Black community members’ beliefs about health and medicine must be considered as churches are pillars of social support within Black American communities.

Methods: A search for studies about …

Addressing Barriers To Black Americans Participation In Clinical Trials: A Faith-Based Community Survey, Alexandra Stone, Lydell Lettsome Md, Brian A. Stone Md, Clinical Diversity Solutions

Medical Student Research Symposium

Background: The underrepresentation of high-risk minority groups in clinical trials remains a crisis in American healthcare. Despite pressures from the NIH to increase Black-American participation in trials, recruitment and retention in this group rarely match population demographics. Our company launched an opinion survey polling 260 Blacks regarding their thoughts and awareness about clinical trial participation.

Methods: We created a web-based survey consisting of 38 items and subdivided it into three main sections: (1) cultural affinity, (2) trust, and (3) background information. The survey was conducted using Jotform, a HIPAAcompliant web-based application. Our target population was Black Americans in central Alabama. …

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 …

M-Chat Implementation Strategies To Improve Autism Screening Rates In Pediatric Clinics In Metro Detroit, Karamoja Monchamp

Medical Student Research Symposium

The Modified Checklist for Autism in Toddlers (M-CHAT) is the most widely used autism screening tool. However, current practices for M-CHAT roll-outs and follow-ups are not wide-reaching, culturally sensitive, or consistent. This study aims to address the existing barriers to universal autism screenings and design a sustainable implementation strategy for a successful M-CHAT roll-out. We implemented strategies in five Henry Ford Health pediatric clinics, incorporating iPad-administered M-CHAT in waiting rooms, multilingual options, task shifting for referrals, forced choice mechanisms, and audit-and-feedback support. A Clinical Screening Dashboard tracked real-time M-CHAT data, including demographic information, collected from EPIC. Our goal is to …

Medications For Opioid Use Disorder & Implications For Mobile Methadone Units, Sarah Boeke, Samantha Singer, Stella Resko

Substance Use Research Team

Research has shown the urgent need for updates to guidelines regulating opioid treatment programs (OTPs), especially as the COVID-19 pandemic exacerbated overdose rates and the drug supply became increasingly contaminated with fentanyl, synthetic opioids, and xylazine (Moghtaderi et al., 2023)(DEA, 2022). Part 8 of Title 42 of the Code of Federal Regulations (CFR), originally enacted in 2001, includes regulations that guide OTPs. The 42 CFR Part 8 final rule, issued by SAMHSA, updates these federal regulations. It is the first major revision since 2001, aimed at expanding access to care, improving patient outcomes, and integrating lessons learned from the COVID-19 …

Retrospective Assessment Of A Collaborative Digital Asthma Program For Medicaid-Enrolled Children In Southwest Detroit: Reductions In Short-Acting Beta-Agonist (Saba) Medication Use, Meredith Barrett, Rahul Gondalia, Vy Vuong, Leanne Kaye, Alex B. Hill, Elliot Attisha, Teresa Holtrop

Urban Studies and Planning Faculty Research Publications

Background
Real-world evidence for digitally-supported asthma programs among Medicaid-enrolled children remains limited. Using data from a collaborative quality improvement program, we evaluated the impact of a digital intervention on asthma inhaler use among children in southwest Detroit.

Methods
Children (6–13 years) enrolled with Kids Health Connection (KHC), a program involving home visits with an asthma educator, were invited to participate in a digital self-management asthma program (Propeller Health). Patients were provided with a sensor to capture short-acting beta-agonist (SABA) medication use, and given access to a paired mobile app to track usage. Patients’ healthcare providers and caregivers (“followers”) were invited …

Worse Postoperative Outcomes And Higher Reoperation In Smokers Compared To Nonsmokers For Arthroscopic Rotator Cuff Repair, Susan G. Wager, Spencer Brown, Michael Gaudiani, Joshua P. Castle, Eric Jiang, Vasilios Moutzouros, Eric Makhni, Stephanie J. Muh

Medical Student Research Symposium

Introduction: Smoking impairs healing potential and is a significant risk factor for complications following orthopaedic surgeries. The purpose of this study was to determine if a cohort of former or current smokers at time of surgery met the minimally clinical important difference (MCID) for Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS-UE), Depression (PROMIS-D), and Pain Interference (PROMIS-PI) scores in comparison to nonsmokers.

Methods: A retrospective review of patients who underwent rotator cuff repair was performed. Patients who completed preoperative and 6-month postoperative PROMIS scores were included. The MCID was calculated using a distribution technique with a threshold of 0.5 …

The Top 50 Most Cited Articles On The Medial Patellofemoral Ligament (Mpfl): A Bibliometric Analysis, Varag Abed, Alex Duvall, Jonathan D. Rexroth, Alyssa Goodwin, Joseph Liu, Austin Stone

Medical Student Research Symposium

Objectives: To determine which original articles on the topic of the medial patellofemoral ligament (MPFL) have been cited the most in the literature utilizing a bibliometric approach. Secondarily, to determine temporal trends between article types.

Methods: Articles on the topic of the MPFL were identified by utilizing the Web of Science Database. The search yielded 1,596 results and the top 50 cited original articles were collected for further analysis. The following information was gathered for all included articles: title, first author's name, journal name, year of publication, impact factor of the journal in 2021, total number of citations of the …

Impact Of A Health Fair On Student Organizations Providing Care To The Detroit Hispanic/Latinx Community And Barriers Affecting Patients Of A Student-Run Clinic Primarily Serving This Population, Amanda Rodriguez Bs, Lucas Edgren Bs, Sanjana Rao Bsph, Diane L. Levine Md, Jennifer Mendez Phd, Joel Appel Do

Medical Student Research Symposium

Current literature shows Hispanic/Latinx populations in the U.S. face health inequities. Amigos Medicos (AM) Clinic, located in Southwest Detroit, is a student-run free clinic that addresses these issues through preventive health screenings. We hosted a health fair in 2022 and invited other student organizations in efforts to connect the community to resources. Our aim is to identify specific barriers faced by our population in receiving health care and to identify the impact of participation in the fair on those organizations. One survey was administered to patients attending clinic that identified health barriers they face. The other survey was administered to …

“Community Members Have More Impact On Their Neighbors Than Celebrities”: Leveraging Community Partnerships To Build Covid-19 Vaccine Confidence, Maria Tjilos Mph, Autumn L. Tamlyn, Elizabeth J. Ragan Mph, Sabrina A. Assoumou Md, Mph, Katherine Gergen Barnett Md, Petrina Martin Mba, Rebecca Perkins Md, Msc, Benjamin P. Linas Md, Mph, Mari-Lynn Drainoni Phd, Med

Medical Student Research Symposium

Vaccines are a strong public health tool to protect against severe disease, hospitalization, and death from COVID-19. Still, inequities in COVID-19 vaccination rates and health outcomes continue to exist among Black and Latino populations. Boston Medical Center (BMC) has played a significant role in vaccinating medically underserved populations, and organized a series of community-engaged conversations to better understand community concerns regarding the COVID-19 vaccine. We accessed and analyzed nine publicly available recordings of the community-engaged conversations which were held between Mar 2021-Sep 2021 (n=8-122 attendees). We employed a Consolidated Framework for Implementation Research-driven codebook to code our data and utilized …

The Role Of Vigorous And High Intensity Interval Training Physical Activity Counseling In Prenatal Care, Emily Lau, Brendan T. Lynch, Sonia Hassan

Medical Student Research Symposium

Background: Physical activity is becoming a more common component of preventative medicine and patient counseling; however, the prevalence of physical activity counseling and specific social determinants of health have prevented women, namely prenatal patients, from receiving this counseling from their providers¹. Physical activity, including high intensity interval training (HIIT), has been shown to be feasible for implementation in patient counseling³ and shown to be safe for pregnant women, even into the third trimester². We hypothesize that the current percentage of patients, including prenatal patients, being counseled on physical activity is lacking. In addition, we hypothesize …

Effects Of Michigan Opioid Laws On Prescriber Practices In The Emergency Department, Lydia Ross, Gary Kanner, Claire Pearson

Medical Student Research Symposium

Introduction: Opiate analgesics (OA) are responsible for more overdose deaths than any other medication class. Michigan is among the states most greatly affected by the opioid epidemic, and in late 2017, the Michigan Opioid Laws were passed in efforts to decrease opioid associated addiction and overdose deaths. This set of laws provides regulation of OA prescriptions and to increase patient awareness of the associated risks of opioid use. These laws collectively require a physician to educate the patient on harms of opiates, provide substance abuse disorder services in the setting of an overdose, establish a relationship with the patient, obtain …

Influenza Vaccination Coverage Among An Urban Pediatric Asthma Population: Implications For Population Health, Sarah J. Parker, Amy M. Delaroche, Alex B. Hill, Rajan Arora, Julie Gleason-Comstock

Urban Studies and Planning Faculty Research Publications

Introduction
Asthma is the most common chronic disease in children. Children with asthma are at high risk for complications from influenza; however annual influenza vaccination rates for this population are suboptimal. The overall aim of this study was to describe the characteristics of a high-risk population of children with asthma presenting to an urban pediatric emergency department according to influenza vaccination status.

Methods
The study was a retrospective chart review of 4355 patients aged 2 to 18 years evaluated in a Michigan pediatric emergency department (PED) between November 1, 2017 and April 30, 2018 with an ICD-10-CM code for asthma …

Refining The Nutrition Environment Measures Survey (Nems) For Healthy Community Stores: Adaptations To Capture Alternative Food Retailers And Align With Dietary Guidelines, Alex B. Hill, Ravneet Kuar, Samantha M. Sundermeir, Christina Kasprzak, Megan Winkler, Sara John, Rachael D. Dombrowski, Bree Bode, Joel Gittelsohn

Urban Studies and Planning Faculty Research Publications

Inadequate consumption of healthy food is an ongoing public health issue in the United States. Food availability measures of supply versus consumption of healthy foods are disconnected in many studies. There is a need for an objective assessment of the food environment in order to assess how the food supply aligns with the Healthy Eating Index (HEI). Data were collected as part of the Healthy Community Stores Case Study Project, including a refined Nutrition Environment Measures Survey for Healthy Community Stores (NEMS-HCS) and an updated Healthy Food Availability Index that aligns with the Healthy Eating Index (HFAHEI). This paper will …

A Commentary On The Healthy Community Stores Case Study Project: Implications For Retailers, Policy, And Future Research, Samantha M. Sundermeir, Megan R. Winkler, Sara John, Uriyoán Colón-Ramos, Ravneet Kuar, Ashley Hickson, Rachael D. Dombrowski, Alex B. Hill, Bree Bode, Julia Deangelo, Joel Gittelsohn

Urban Studies and Planning Faculty Research Publications

In the United States, low-income, underserved rural and urban settings experience poor access to healthy, affordable food. Introducing new food outlets in these locations has shown mixed results for improving healthy food consumption. The Healthy Community Stores Case Study Project (HCSCSP) explored an alternative strategy: supporting mission-driven, locally owned, healthy community food stores to improve healthy food access. The HCSCSP used a multiple case study approach, and conducted a cross-case analysis of seven urban healthy food stores across the United States. The main purpose of this commentary paper is to summarize the main practice strategies for stores as well as …

Attitudes And Barriers Toward Covid-19 Vaccination Among People Experiencing Homelessness In Detroit, Mi, Sanjna Ghanshani, Sophie Wittenberg, Richard Bryce

Medical Student Research Symposium

Introduction: People experiencing homelessness (PEH) have a high risk of exposure to communicable diseases and limited access to health care services and treatment in their communities. Despite the availability of highly effective vaccines against COVID-19, the infection prevention practices and level of COVID-19 vaccine hesitancy among PEH in Detroit have not been well studied.

Methods: Medical students administered an electronic Qualtrics survey to consented participants during outreach visits to local homeless shelters and encampments organized by Street Medicine Detroit. The questionnaire comprised six topics, including hygiene and masking practices, experience with COVID-19 testing and vaccination, and attitudes toward …