Medicine and Health Commons^™

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 …

The Effect Of Covid-19 On Depression In Hispanic Vs. Non-Hispanic Populations In South Jersey, Rana Cheikhali, Daniel Casal

Rowan-Virtua Research Day

The COVID-19 pandemic has been challenging for Americans and the world as a whole. It has especially taken a toll on mental health. Studies show that the incidence of depression in the United States was three times greater during the pandemic compared to pre-pandemic times. One specific community in the United States that has been greatly affected by the pandemic is the Hispanic American community. Many Americans across the country have received federal surveys that aim to determine the social and economic impacts of COVID-19. Results revealed that the Hispanic population had the greatest rise in mental illness, with 40% …

Political, Racial, And Household Income Barriers For Access To Healthcare In Illinois Counties, Kennedy Bray '23

Student Publications & Research

Access to health care impacts many people throughout the United States, as it restricts their ability to solve their health concerns. People who have the highest risk of a lack of access include people who are uninsured, people a part of a specific social class, or people belonging to a specific political party. In a particular geographical region, these factors could lead to groups of people suffering because of circumstances that they cannot control in their region. In my project, I determine how better access to healthcare and the percentage of people insured are affected by a measurement of the …

Public Health Contagion Of White Supremacy: Examining The Pipeline Of Attitudes About Racism And Racial History Education Among High School Students., Trinidad Jackson

Electronic Theses and Dissertations

We are living in compounded states of upheaval. Violence and exemption from it across socioecological levels have shaped how humans survive, thrive, and die. While different violence typologies exist, the U.S., prioritizes interpersonal violence as its primary target of intervention, often through structural means that foster and reinforce interpersonal violence. The omission of structural and cultural agents and outcomes of violence allows perpetrators to infiltrate and reproduce savage, dehumanizing ideologies in perpetuity. Instead of sustaining societal pillars that oppress and destroy, we must fertilize public health research, practice, and sociopolitical activism with pillars that both inform and activate liberatory consciousness …

County Social Isolation And Opioid Use Disorder Among Older Adults: A Longitudinal Analysis Of Medicare Data, 2013–2018, Tse-Chuan Yang, Carla Shoff, Seulki Kim, Benjamin A. Shaw

Department of Sociology: Faculty Publications

This study aims to fill three knowledge gaps: (1) unclear role of ecological factors in shaping older adults’ risk of opioid use disorder (OUD), (2) a lack of longitudinal perspective in OUD research among older adults, and (3) underexplored racial/ethnic differences in the determinants of OUD in older populations. This study estimates the effects of county-level social isolation, concentrated disadvantage, and income inequality on older adults’ risk of OUD using longitudinal data analysis. We merged the 2013–2018 Medicare population (aged 65+) data to the American Community Survey 5-year county-level estimates to create a person-year dataset (N = 47,291,217 person-years) and …

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 …

Intergenerational Risk And Resilience Pathways From Discrimination And Acculturative Stress To Infant Mental Health, Sabrina R. Liu, Curt A. Sandman, Elyssia Poggi Davis, Laura M. Glynn

Psychology Faculty Articles and Research

Preconception and prenatal stress impact fetal and infant development, and women of color are disproportionately exposed to sociocultural stressors like discrimination and acculturative stress. However, few studies examine links between mothers’ exposure to these stressors and offspring mental health, or possible mitigating factors. Using linear regression, we tested associations between prenatally assessed maternal acculturative stress and discrimination on infant negative emotionality among 113 Latinx/Hispanic, Asian American, Black, and Multiethnic mothers and their children. Additionally, we tested interactions between stressors and potential pre- and postnatal resilience-promoting factors: community cohesion, social support, communalism, and parenting self-efficacy. Discrimination and acculturative stress were related …

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 …

A Technology-Based, Mixed Methods Approach To Examining The Psychosocial Determinants Of Maternal Health Disparities, Hannah M. Ming

Theses and Dissertations

Background: Exposure to racism and discrimination in the U.S. increases Black women’s risk for experiencing maternal health disparities. Additionally, racism and discrimination affect maternal psychosocial well-being, creating evidence for a biopsychosocial relationship between racism and maternal health outcomes. However, current research does not define the psychosocial Black maternal self well. Given the dynamic relationship between racism, psychosocial well-being, and Black maternal health outcomes, research must comprehensively examine the Black maternal self. The operationalization of a comprehensive construct for Black maternal psychosocial well-being can improve understanding of the relationship between racism, psychosocial well-being, and Black maternal health outcomes.

Purpose: …

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 …

Cesarean Skin-To-Skin Contact: Who Gets The Experience In The Operating Room?, Jessica S. Junk-Wilson

Graduate Theses/Dissertations

For the past decade, skin-to-skin contact immediately after birth has been the general recommendation for all births, as there is evidence that it provides many benefits for mothers and infants. Yet, research has shown that immediate skin-to-skin contact is not the standard practice after most Cesarean births. This study assessed access, incidence, and circumstances surrounding Cesarean skin-to-skin contact (CSSC) in the operating room and examined influencing maternal characteristics of age, education, race, and number of births via a survey of 2327 people. Women who experienced a Cesarean section birth in the past 10 years were recruited through Facebook groups for …

The Neighborhood Environment And Hispanic/Latino Health, Natalia I Heredia, Tianlin Xu, Minjae Lee, Lorna H Mcneill, Belinda M Reininger

Faculty, Staff and Student Publications

PURPOSE: Hispanic/Latino adults on the Texas-Mexico border have high rates of chronic disease. Neighborhoods can influence health, though there is a limited research on neighborhood environment and health in Hispanics/Latinos. The purpose of this study was to assess the relation of neighborhood environment with health variables in Hispanic/Latino adults, including physical activity [PA], depression, anxiety, and lab-assessed conditions (type 2 diabetes, metabolic syndrome, and chronic inflammation).

METHODS: Participants were randomly-selected from a Hispanic/Latino cohort on the Texas-Mexico border. Neighborhood environment, self-reported PA, anxiety, and depression were assessed through questionnaires. Laboratory values determined Type 2 diabetes, metabolic syndrome, and C-reactive protein …

The Role Of Ethnicity And Nativity In The Correspondence Between Subjective And Objective Measures Of In-Home Smoking, Vincent Berardi, Georgiana Bostean, Lydia Q. Ong, Britney S. Wong, Bradley N. Collins, Melbourne F. Hovell

Psychology Faculty Articles and Research

Studies are needed to understand the association between self-reported home smoking bans and objective measures of in-home smoking according to smokers’ ethnicity/nativity. Data came from a trial that used air particle monitors to reduce children’s secondhand smoke exposure in smokers’ households (N = 251). Linear regressions modeled (a) full home smoking bans by ethnicity/nativity, and (b) objectively measured in-home smoking events, predicted by main and interaction effects of self-reported home smoking bans and ethnicity/nativity. Among smokers reporting < a full ban, US-born and Foreign-born Latinos had fewer in-home smoking events than US-born Whites (p < 0.001). Participants who reported a full smoking ban had a similar frequency of smoking events regardless of ethnicity/nativity. Results indicate that self-reported home smoking bans can be used as a proxy for in-home smoking. Establishing smoking bans in the households of US-born White smokers has the largest impact on potential exposure compared to other ethnicity/nativity groups.

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 …

Obesity, Age, And African American Males: The Impact Of Food Security On Cardiovascular Health Outcomes, Tangela G. Towns, Richard G. Moye, Antonius D. Skipper, Daniel J. Rose

Journal of Health Disparities Research and Practice

Although prevalence of food insecurity has declined over the last 5 years, food insecurity for African Americans and single individuals is increasing. The purpose of this paper is to examine the male-specific associations between food insecurity and cardiovascular-related health outcomes. We examine the relationship between single, African American male adults and food security, kidney disease risk, diabetes, and related comorbidities using the NHANES dataset (2013-2014). We build multivariate logistic regression models to estimate the association between gender, race, and food insecurity using stratified data from the 2013-2014 National Health and Nutrition Examination Survey.

Ethnic Disparities In Mental Health Among Asian Americans: Evidence From A National Sample, Fang Gong, Jun Xu

Journal of Health Disparities Research and Practice

Asian Americans have become the fastest-growing racial group in the United States, yet their health profiles are still under-explored. In particular, the existing research on Asian American mental health has not devoted adequate attention to the enormous ethnic heterogeneity of the group. Grounded upon theoretical frameworks of the tri-racial system and a contextual approach, we examined ethnic disparities in Asian American mental health using data from the National Latino and Asian American Study (NLAAS). We focused on ethnic membership, immigration-related factors, socioeconomic status, and social support as the main correlates of multiple outcomes, including self-rated mental health, psychological distress, and …

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).

Food-As-Medicine: An Everyday Strategy Of Health, Rachel Rebecca Bogan

Dissertations, Theses, and Capstone Projects

Using food-as-medicine, a valuable strategy of health, as its focus, this dissertation examines why and how New Yorkers use food to negotiate their health. I argue that while using food medicinally is a common health practice, food-as-medicine operates unequally among different groups of New Yorkers. I attribute this inequity, in part, to how those in power, including public health experts, biomedical doctors, and the food industry, operationalize food-as-medicine as a health remedy and to a neoliberal, healthist context that ties people’s morally “correct” uses of food-as-medicine to their abilities to access “good” citizenship and optimal health.

I chose to write …

Make Your Wishes Known: Understanding The Challenges And Barriers For Providing Effective Ethics Consults To Low-Income African American Men, Ruth Nwefo

Symposium of Student Scholars

The distrust of the U.S. health care system is prevalent, especially within the African American (AA) community. This distrust is largely based on infamous cases such as the Tuskegee Syphilis Experiment and experiments conducted by James Marion Sims on slave women without anesthesia. While these experiments along with many others further advanced medicine, they severed trust between health care institutions and the African American community, bringing upon repercussions still felt today. Although many steps have been taken to rebuild trust in the health care system by establishing effective ethical guidelines, more needs to be done in terms of rebuilding the …

Associations Of Hair Dye And Relaxer Use With Breast Tumor Clinicopathologic Features: Findings From The Women’S Circle Of Health Study, Rohan Rao, Jasmine A. Mcdonald, Emily Barrett, Patricia Greenberg, Dede K. Teteh, Susanne B. Montgomery, Bo Qin, Yong Lin, Chi-Chen Hong, Christine B. Ambrosone, Kitaw Demissie, Elisa V. Bandera, Adana A.M. Llanos

Health Sciences and Kinesiology Faculty Articles

Background

Building upon our earlier findings of significant associations between hair dye and relaxer use with increased breast cancer risk, we evaluated associations of select characteristics of use with breast tumor clinicopathology.

Methods

Using multivariable-adjusted models we examined the associations of interest in a case-only study of 2998 women with breast cancer, overall and stratified by race and estrogen receptor (ER) status, addressing multiple comparisons using Bonferroni correction.

Results

Compared to salon application of permanent hair dye, home kit and combination application (both salon and home kit application) were associated with increased odds of poorly differentiated tumors in the overall …

"Divide, Divert, & Conquer” Deconstructing The Presidential Framing Of White Supremacy In The Covid-19 Era, Vivian Louie, Anahi Viladrich

Publications and Research

Based on the analysis of President Donald J. Trump’s social media, along with excerpts from his speeches and press releases, this study sheds light on the framing of white supremacy during the first months of the COVID-19 pandemic in the United States. Our findings reveal that the triad of divide, divert, and conquer was crucial to Trump’s communications strategy. We argue that racist nativism—or racialized national threats to American security—is key to comprehending the external divisiveness in this strategy. When Trump bitterly cast China as the cause of America’s pandemic fallout and Mexico as the source of other key American …

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 …

Ethnic Differences In Maternal Cytokines And Adipokines And Their Association With Spontaneous Preterm Delivery, Yelizavet D. Lomakova, Xinhua Chen

Rowan-Virtua Research Day

Spontaneous preterm delivery (SPTD, birth at <37 weeks’ gestation) is a leading cause of infant mortality in the United States [1]. Infants born prematurely are more likely to suffer from both short and long-term complications including neurodevelopmental delay, visual and hearing impairment, and chronic diseases such as heart disease, hypertension and diabetes in later life [2-4]. African American women have a 2-fold increased risk of preterm delivery compared to Caucasian women [5].The reasons for this disparity are poorly understood. This limits the ability to predict and prevent preterm delivery in the most high-risk populations.

Eastern European Orthodox Christian Immigrant Women: A Pilot Study And Needs Assessment, Kimberly A. Babich-Speck

Doctor of Nursing Practice Scholarly Projects

The healthcare perceptions of the Eastern European Orthodox Christian immigrant women (EEOCIW) to the United States (U.S.) are under-represented in the literature. Although they appear similar to Americans, their cultural and religious traditions are outside the mainstream American culture. This pilot study and health needs assessment examines the women’s healthcare perceptions of 14 EEOCIW and identifies similarities and differences with 25 U.S. born Orthodox Christian women (USOCW). Between September and November 2020, interviews were conducted with Orthodox Christian immigrant women from Eastern Europe and Orthodox Christian women born in the U.S. Questions covered the perceptions of women’s healthcare, factors influencing …