Medicine and Health Commons^™

Brave New Wombs: Hysterectomy, Gender, And Stratified Reproduction, Andréa Becker

Dissertations, Theses, and Capstone Projects

Hysterectomy is the most common gynecological surgery worldwide and approximately one third of people assigned female at birth in the U.S. will have their uterus removed by the age of 65. Despite the high prevalence, sociologists have neglected to examine this procedure amid broader systems of gender, health, and race inequality. Over 90% of hysterectomies are deemed “elective,” including for chronic reproductive illness or as gender affirming care for trans and nonbinary individuals. Given the various reasons for a hysterectomy, and the incidence of this procedure across gender identities, an analysis of hysterectomy experiences allows for a rich investigation into …

Interrogating Race And Place-Based Inequities In Hiv And Covid-19, Rohan Khazanchi

MD Honors Theses

Over the last four years, I have developed a research focus examining the intersections of race, place, and health. My M.D. Honors Thesis reflects a snapshot of these efforts. In this collection of brief research reports, I leverage area-based measures to investigate structural inequities in three contexts: the HIV epidemic in our hyperlocal community, the early stages of the COVID-19 pandemic, and clinical trials for novel COVID-19 therapeutics. I apply novel social epidemiologic tools to measure and explore disparate outcomes. And, in reflecting upon my findings, I discuss concrete implications for clinicians, researchers, and policymakers alike.

Chapter 1: Neighborhood-Level Deprivation …

Citizenship Matters: Non-Citizen Covid-19 Mortality Disparities In New York And Los Angeles, Jason A. Douglas, Georgiana Bostean, Angel Miles Nash, Emmanuel B. John, Lawrence M. Brown, Andrew M. Subica

Health Sciences and Kinesiology Faculty Articles

U.S. non-citizen residents are burdened by inequitable access to socioeconomic resources, potentially placing them at heightened risk of COVID-19-related disparities. However, COVID-19 impacts on non-citizens are not well understood. Accordingly, the current study investigated COVID-19 mortality disparities within New York (NYC) and Los Angeles (LAC) to test our hypothesis that areas with large proportions of non-citizens will have disproportionately high COVID-19 mortality rates. We examined ecological associations between March 2020–January 2021 COVID-19 mortality rates (per 100,000 residents) and percent non-citizens (using ZIP Code Tabulation Areas (ZCTA) for NYC and City/Community units of analysis for LAC) while controlling for sociodemographic factors. …

Demographic And Regional Trends Of Mortality In Patients With Aortic Dissection In The United States, 1999 To 2019, Salik Nazir, Robert W Ariss, Abdul Mannan Khan Minhas, Rochell Issa, Erin D Michos, Yochai Birnbaum, George V Moukarbel, P Kasi Ramanathan, Hani Jneid

Faculty, Staff and Students Publications

Background Aortic dissection (AoD) is associated with high morbidity and mortality. However, the burden of AoD mortality is not well characterized, and contemporary data and mortality trends in different demographic and geographic subgroups have not been described. Methods and Results Trends in AoD mortality were assessed using a cross-sectional analysis of the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database. Crude and age-adjusted mortality rates (AAMR) per 1 million people with associated annual percent changes were determined. Joinpoint regression was used to assess trends in the overall sample and different demographic (sex, race and ethnicity, …

Interrogating Race And Place-Based Inequities In Hiv And Covid-19, Rohan Khazanchi

EMET Projects

Over the last four years, I have developed a research focus examining the intersections of race, place, and health. My M.D. Honors Thesis reflects a snapshot of these efforts. In this collection of brief research reports, I leverage area-based measures to investigate structural inequities in three contexts: the HIV epidemic in our hyperlocal community, the early stages of the COVID-19 pandemic, and clinical trials for novel COVID-19 therapeutics. I apply novel social epidemiologic tools to measure and explore disparate outcomes. And, in reflecting upon my findings, I discuss concrete implications for clinicians, researchers, and policymakers alike.

Chapter 1: Neighborhood-Level Deprivation …

The Correlation Between Vaccine Hesitancy And Privilege: Exploring The Degree To Which Education And Income Foster Resistance To Vaccination Efforts, Sophie Goldenberg

Independent Study Project (ISP) Collection

Vaccine hesitancy is a public health issue of growing concern. Extensive pre-existing literature offers several explanations and conflicting viewpoints regarding reluctance toward vaccinations. However, minimal research has been done exploring the upstream social determinants driving vaccine hesitancy. Utilizing academic and gray literature and interviews with experts in the field, this study addresses this gap in knowledge with the research question: To what extent does privilege impact vaccine hesitancy and resistance? Vaccine hesitancy appears globally and is particularly concerning given the re-emergence of vaccine-preventable diseases (VPDs). Additionally, due to inconsistent causes, vaccine hesitancy is difficult to combat. In referencing the history …

Endocrine-Disrupting Chemicals And Breast Cancer: Disparities In Exposure And Importance Of Research Inclusivity, Ashlie Santaliz Casiano, Annah Lee, Dede Teteh, Zeynep Madak Erdogan, Lindsey Trevino

Health Sciences and Kinesiology Faculty Articles

Endocrine-disrupting chemicals (EDCs) are known contributors to breast cancer development. EDC exposures commonly occur through food packaging, cookware, fabrics, and personal care products as well as through the environment. Increasing evidence highlights disparities in EDC exposure across racial/ethnic groups, yet breast cancer research continues to lack the inclusion necessary to positively impact treatment response and overall survival in these socially disadvantaged populations. Additionally, the inequity in environmental exposures has yet to be remedied. Exposure to EDCs due to structural racism poses an unequivocal risk to marginalized communities. In this review, we summarize recent epidemiological and molecular studies on two lesser-studied …

Development Of A Men’S Health Course For First-Year Undergraduates Using Culturally Responsive Teaching Strategies, Ania A. Majewska, Johnasha D. Stuart, Kelsey M. Gray, Pearl V. Ryder, Ethell Vereen

Biology, Chemistry, and Environmental Sciences Faculty Articles and Research

Purpose

A novel first-year experience course was developed using culturally responsive teaching strategies at an undergraduate liberal arts college in the southeastern USA to promote health advocacy and to provide students with an overview of male health. The course focuses on the biological, sociocultural, economic and gender influences that shape men's health beliefs and practices. It also emphasizes health disparities in the USA among Black/African American men compared to other racial groups and intervention strategies to improve health outcomes.

Design/methodology/approach

The lecture and laboratory components of the course were designed as a blended learning environment with a modified flipped class …

Florida Fish And Wildlife Conservation Commission Comment Tool On Changes To Trapping Regulations, Jacquelyn Reiss, Amy Donley Phd, Brian Hall

Institute for Social and Behavioral Science (ISBS)

To collect public comments on the modernization of trapping rules and analyze the feedback provided, the Florida Fish and Wildlife Conservation Commission (FWC) and the FCRC Consensus Center contracted with the Institute for Social and Behavioral Sciences (ISBS). Together the FWC, FCRC Consensus Center, and ISBS constructed a comment tool that was comprised of 5 different sections.

Maternal Wellness: Self, Matrescence, Obstetric Violence, And Self-Care, Vanessa V. Vales-Lewis

Dissertations, Theses, and Capstone Projects

In this dissertation, I engage in a self-study through an examination of my experience of matrescence (i.e., the transition to motherhood). I discuss my praxis in the development of a self-study on maternal wellness as it applies to my well-being as both a researcher and the researched. In Chapter 1, I preface this study by highlighting critical scholars and the bricoleurs who have been foundational in my undertaking of this work on a narrative study on maternal wellness. Using bricolage as part of a research methodological framework that involved key scholarly methodologies of authentic inquiry, emergence and contingence, and narratology, …

Disability And Health In African Americans: Population Research And Implications For Occupational Therapy Community-Based Practice, Emily Schulz, Debarchana Ghosh, Eddie M. Clark, Beverly R. Williams, Randi Williams, Lijing Ma, Crystal L. Park, Cheryl L. Knott

The Open Journal of Occupational Therapy

Background: Population-based research and community-based interventions are integral to occupational therapy’s scope of practice, yet they are underdeveloped in actual implementation. Therefore, this paper focuses on some health challenges facing the African American population, guided by the Person-Environment-Occupation-Performance Model.

Method: Using data from an observational cross-sectional nationwide telephone survey of African American adults, we examined differences between African Americans who are receiving disability payments (RDP) and those who are employed full time (FTE) on several physical health behaviors and psychosocial health indicators. We further compared the differences between African Americans RDP versus those FTE on those physical health …

Healing Racial Injustice With Mindfulness Research, Training, & Practice, Danielle "Danae" Laura

Mindfulness Studies Theses

This thesis offers a collection of authors and studies in support of improved research, training, and practice connecting mindfulness with racial justice through intergroup applications. The paper identifies barriers at work (e.g., colorblindness, spiritual bypass, white fragility, and implicit bias) in contemplative science, Western Buddhist communities, and secular mindfulness centers, which block the sizeable contributions possible in studying the intergroup application of mindfulness practice—specifically Lovingkindness Meditation, among others—when used as an intervention with anti-racist aims. Through secondary qualitative research, I reviewed six key works from Black authors on mindfulness and race, as well as six sample studies on the prosocial …

The Program To Reduce Implicit Bias In Carroll Hospital Center Using The Implicit Association Test, Katherine E. Traynor

Capstone Showcase

Natural brain processes make all individuals susceptible to unconscious bias; however, stressful, fearful, or anger-evoking situations as well as the negative influence of media and social surroundings increase the risk of holding obstructive bias, and there is a greater risk of being negatively impacted by this phenomenon when belonging to a minority population (Rose & Flores, 2020). As a result, high rates of infant mortality (10.2 deaths per 1,000 live births for the Non-Hispanic Black population compared to 4.1 in the White population) and cardiovascular related diseases (190.0 cases per 1,000 in the Non-Hispanic Black population compared to 161.3 in …

Disparities In Accessing Sexual And Reproductive Health Services And Rights Among Adolescents And Young People During Covid-19 Pandemic: Culture, Economic, And Gender Perspectives, Rogers N Ssebunya, Mafusi Boopa, Diane Nguyen, Lee Ligon

Faculty, Staff and Students Publications

PURPOSE OF REVIEW: As the world grapples with the health systems' challenges during the COVID-19 pandemic, addressing the needs of the already vulnerable adolescents and young people is vital. This narrative synthesis is aimed to highlight the current gender, cultural, and socioeconomic dynamics fueling inequalities to accessing sexual, reproductive health and rights (SRHR) services among adolescents and young people in low- and middle-income countries (LMIC).

RECENT FINDINGS: The COVID-19 pandemic has in most countries exacerbated already existing inequalities due to economic, gender, cultural, and legal aspects. Strategies implemented by most governments to mitigate the spread of the virus have also …

Unpacking The Influence Of Islamic Religious Culture And Individual Religious Affiliation On Testing Hiv-Positive, Brittany Hayes, Amy Adamczyk

Publications and Research

The distribution of HIV cases varies cross-nationally. We separate the influences of Islam at the macro-and micro-levels to understand the role of religion in shaping the spread of HIV. Drawing on biomarker data from the Demographic and Health Surveys, we construct a multilevel database (Individual N= 568,476; Country N= 30). We examine a series of national-and individual-level predictors that may mediate the relationship between Islam and testing HIV-positive. Individual religious affiliation and proportion Muslim retained their risk-reducing effects even when accounting for a range of mediators and suppressors. Islam has a sui generis effect on testing HIV-positive.

The Contribution Of Racism-Related Stress And Adversity To Disparities In Birth Outcomes: Evidence And Research Recommendations, Sabrina R. Liu, Laura M. Glynn

Psychology Faculty Articles and Research

Currently, racial and ethnic differences in adverse birth outcomes and infant mortality are some of the largest and most persistent health disparities in the United States. This narrative review article synthesizes existing literature to present a conceptual model of how racism-related stress and adversity are critical determinants of such disparities. We describe how historical and ongoing racism has created conditions wherein women of color are disproportionately exposed to chronic, multilayered stress and adversity and how the biological consequences of exposure to these stressors confers risk for adverse birth outcomes. Next, we identify important priorities and considerations for future research, including …

Health Inequality Analysis In Europe: Exploring The Potential Of The Eq-5d As Outcome, Inge Spronk, Juanita A. Haagsma, Erica I. Lubetkin, Suzanne Polinder, M F. Janssen, G J. Bonsel

Publications and Research

Objective: This study explored the additive value of the multi-item EuroQol 5-Dimension 5-Level (EQ-5D-5L) as an outcome measure in health inequality analyses, relative to the single-item EuroQol visual analog scale (EQ VAS).

Methods: A sample comprising the general population from Italy, the Netherlands, and United Kingdom (UK) completed the EQ-5D-5L and the EQ VAS. The level of education was selected as a proxy for socio-economic status (SES). EQ-5D-5L level sum scores (LSS) were compared against EQ VAS scores. Stratified and multivariable analyses were used to study the associations between SES and the LSS/EQ VAS relative to the presence of chronic …

Survey Measures On Substance Use Amongst College Students, Jacquelyn Reiss, Amy Donley

Institute for Social and Behavioral Science (ISBS)

The Institute for Social and Behavioral Science (ISBS) reviewed measures utilized in 3 major surveys administered within middle schools, high schools, and colleges state-wide and nationally to compile a list of tested survey measures on youth substance use. The 3 surveys that were assessed are the Florida Youth Substance Abuse Survey (FYSAS), the American College Health Association National Collegiate Health Assessment (ACHA-NCHA), and the Monitoring the Future Survey (MFS).

What Predicts How Safe People Feel In Their Neighborhoods And Does It Depend On Functional Status?, Alfredo J. Velasquez, Jason A. Douglas, Fangqi Guo, Jennifer W. Robinette

Health Sciences and Kinesiology Faculty Articles

Feeling unsafe in one's neighborhood is related to poor health. Features of the neighborhood environment have been suggested to inform perceptions of neighborhood safety. Yet, the relative contribution of these features (e.g., uneven sidewalks, crime, perceived neighborhood physical disorder) on perceived neighborhood safety, particularly among people with disabilities who may view themselves as more vulnerable, is not well understood. We examined whether sidewalk quality assessed by third party raters, county-level crime rates, and perceived neighborhood disorder would relate to neighborhood safety concerns, and whether functional limitations would exacerbate these links. Using data from the 2012/2014 waves of the Health and …

Should I Stay Or Should I Go? Mexican Return Migration Across The Life Course, Mara G. Sheftel

Dissertations, Theses, and Capstone Projects

Foreign-born individuals make up a growing share of older adults in the US. Older immigrants offer an important vantage point from which to investigate integration because outcomes at older ages can be considered “final” measures providing empirical evidence for theoretical understandings of the forces impacting immigrant trajectories. However, considering the non-negligible portion of immigrants that ultimately return to their country of origin it is impossible to get the full range of immigrant outcomes without considering returnees. Further, patterns of return may differ across the life course with distinct economic, social, and health considerations at older ages. However, the impact of …

Can I Buy My Health? A Genetically Informed Study Of Socioeconomic Status And Health, Jennifer W. Robinette, Christopher R. Beam, Tara L. Gruenewald

Psychology Faculty Articles and Research

Background

A large literature demonstrates associations between socioeconomic status (SES) and health, including physiological health and well-being. Moreover, gender differences are often observed among measures of both SES and health. However, relationships between SES and health are sometimes questioned given the lack of true experiments, and the potential biological and SES mechanisms explaining gender differences in health are rarely examined simultaneously.

Purpose

To use a national sample of twins to investigate lifetime socioeconomic adversity and a measure of physiological dysregulation separately by sex.

Methods

Using the twin sample in the second wave of the Midlife in the United States survey …

Self-Reported Health Among Sexual Minorities In The United States, Christopher Burton

Electronic Theses and Dissertations

Previous literature on LGBTQ+ people (lesbian, gay, bisexual, transgender, queer/questioning, and other sexual minorities) reports that this community experiences greater health problems than heterosexuals. LGBTQ+ people experience higher rates of chronic conditions, STIs, addiction, poor mental health, and cancer, which highlights the importance of capturing data regarding health. A growing concern is that social surveys fail to find meaningful ways to gather gender and sexuality data to understand possible health disparities for LGBTQ+ people. This study uses data from the General Social Survey to examine the physical and mental health outcomes of LGB people compared to straight people in a …

Addressing Diabetes Distress In Self-Management Programs: Results Of A Randomized Feasibility Study, Ranjita Misra, Samantha Shawley-Brzoska, Raihan Khan, Brenna O. Kirk, Sijin Wen, Usha Sambamoorthi

Journal of Appalachian Health

Background: West Virginia ranks 1st nationally in the prevalence of hypertension (HTN; 43.8%) and diabetes (16.2%). Patients with type 2 diabetes mellitus (T2DM) are distressed over physical and psychological burden of disease self-management.

Methods: This study investigated the effectiveness of an intervention to reduce diabetes distress and outcomes [glycemic control, blood pressure (BP)] among T2DM adults with comorbid HTN. Participants were randomized to a 12-week diabetes and hypertension self-management program versus a 3-month wait-listed control group. Trained health coaches and experts implemented the lifestyle program in a faith-based setting using an adapted evidence-based curriculum. Twenty adults with T2DM and HTN …

Neighborhood Safety Concerns And Daily Well-Being: A National Diary Study, Jennifer W. Robinette, Jennifer R. Piazza, Robert S. Stawski

Psychology Faculty Articles and Research

People living in unsafe neighborhoods often report poor health. The reasons for this are multi-faceted, but one possibility is that unsafe neighborhoods create a situation of chronic stress, which may deplete people's resources to cope with the daily stressors of life. How people respond to daily stressors (e.g., with increased self-reported negative affect and physical symptoms) is positively associated with health problems and may thus be one pathway linking perceptions of neighborhood safety to poor health. The current study investigated the relationship between neighborhood safety concerns, daily stressors, affective well-being, and physical health symptoms in a national sample of adults …

Black And White Health Disparities: Racial Bias In American Healthcare, Yasmeen Almomani

Bridges: An Undergraduate Journal of Contemporary Connections

This paper explores the historical implications of race in American society that have led to implicit racism in the healthcare system. Racial bias in healthcare against Black people is a factor in the health disparities between Black and white people in America, such as the gap in life expectancy, infant death, and maternal mortality. Black people are more likely to report racial discrimination from healthcare providers, which is a reason for the decreased quality of care received. The past justifications of slavery, the Tuskegee syphilis study, and the medical experimentations on Black women are horrifying but were considered acceptable in …

Science In Service Of Man: Towards An Understanding Of Medicine As An Institution Of Control, Amanda M. Strother

University Honors Theses

This paper applies the theoretical work of Frantz Fanon to discuss healthcare as an institution that upholds the will of the dominant authority in the contemporary United States. The use of Fanon's work outside of its original context is justified by applying the internal colonialism theory. Correctional healthcare is discussed as an area of overtly controlling and dehumanizing medical care, highlighting caregiver loyalty to correctional authority and reciprocal distrust between prison physicians and patients. This inquiry proposes that clinical healthcare displays the same power relationships through loyalty to the business of healthcare and the reciprocal distrust between physicians and patients …

The Medical Treatment Of Obesity: On The Page & In The Office, Shayla J. Staley

LSU New Orleans Theses and Dissertations

This paper sought out the causes of weight discrimination in healthcare. Through content analysis of medical journals, the study illuminated several causes. These causes were used to create a concept matrix surrounding the medicalization of fatness that illustrated how these concepts are defined relationally, as well as how they combine to form the medical conception of the “obesity epidemic”. The concept matrix carries an indirect influence upon weight stigma that can lead to weight discrimination when fat folks seek out healthcare.

Racial And Ethnic Disparities In Opioid Use For Adolescents At Us Emergency Departments, Michael T. Phan, Daniel M. Tomaszewski, Cody Arbuckle, Sun Yang, Candice D. Donaldson, Michelle A. Fortier, Brooke Jenkins, Erik Linstead, Zeev N. Kain

Pharmacy Faculty Articles and Research

Background

Racial/ethnic disparities in the use of opioids to treat pain disorders have been previously reported in the emergency department (ED). Further research is needed to better evaluate the impact race/ethnicity may have on the use of opioids in adolescents for the management of pain disorders in the ED.

Methods

This was a cross-sectional study using data from the National Hospital Ambulatory Medical Care Survey from 2006 to 2016. Multivariate models were used to evaluate the role of race/ethnicity in the receipt of opioid agonists while in the ED. All ED visits with patients aged 11–21 years old were analyzed. …

Reporting Of Eating Disorder Deaths, Katherine Mobley, Amy Hord

Symposium of Student Scholars

Those affected by eating disorders experience disturbances in eating behaviors which are often related to underlying psychiatric disorders such as anxiety, depression, or obsessive-compulsive disorder (Parekh, 2017, Drieberg et al., 1998 p.53). The duplicitous nature of the disorder makes it difficult to diagnose, and the tole it takes on an individual’s physical health makes its mortality rate the second highest among psychiatric disorders (Guinhut et al., 2021 p.130). Even if the correct education and resources are accessible to certain individuals, negative stigmatization about the disorder can make sufferers unlikely to seek help (Becker et al., 2010). Findings from analysis of …

County-Level Factors That Influenced The Trajectory Of Covid-19 Incidence In The New York City Area, Ashley Wendell Kranjac, Dinko Kranjac

Sociology Faculty Articles and Research

More than a century of research has shown that sociodemographic conditions affect infectious disease transmission. In the late spring and early summer of 2020, reports of the effects of sociodemographic variables on the spread of COVID- 19 were used in the media with minimal scientific proof attached. With new cases of COVID-19 surging in the United States at that time, it became essential to better understand how the spread of COVID-19 was varying across all segments of the population. We used hierarchical exponential growth curve modeling techniques to examine whether community socioeconomic characteristics uniquely influence the incidence of reported COVID-19 …