Medicine and Health Commons^™

Addressing Gaps In Clinical Trial Access For African Americans, Vanessa Veltre, Michael Acevedo, Alexandra Stone, Lydell Lettsome, Brian Stone

Rowan-Virtua Research Day

Background: Clinical trials are essential for generating evidence on the safety and efficacy of new treatments. However, Black Americans remain underrepresented in clinical research, particularly for conditions that disproportionately affect them. This underrepresentation compromises the generalizability of findings and perpetuates health disparities. This study aimed to identify barriers and facilitators to African American participation in clinical trials and to inform culturally sensitive strategies to improve enrollment of diverse populations.

Methods: We developed a 38-question web-based survey, divided into three domains: (1) cultural affinity, (2) trust, and (3) background information. The survey was administered using Jotform, a HIPAA-compliant platform. Participants—Black adults …

Relationship Between Maternal Mortality And Zip Code In New Jersey, Katarina Rusinak

Rowan-Virtua Research Day

Maternal mortality remains a pressing public health concern in the United States, with significant disparities influenced by geography and social determinants of health. This study investigates the relationship between zip code-level factors and maternal mortality rates (MMR) in New Jersey (NJ), a state with demographic and socioeconomic diversity. Using data from the NJ Department of Health, CDC, and recent literature, I identified patterns correlating higher MMR with areas experiencing poverty, limited access to healthcare, and predominantly minority populations. Counties such as Essex, Union, and Cumberland—classified as Health Professional Shortage Areas (HPSAs) and Medically Underserved Areas (MUAs)—exhibited particularly high vulnerability. These …

Heart To Heart: Exploring Why Cardiovascular Risk Is Higher In South Asians, Jasjeet Kaur Dhaliwal

Rowan-Virtua Research Day

Cardiovascular disease (CVD) is a leading global cause of mortality, but South Asians experience a disproportionately high burden of disease, often developing CVD at younger ages and with lower body mass indices compared to other populations. This project explores the underlying genetic and lifestyle factors contributing to elevated cardiovascular risk in South Asians, aiming to highlight the need for targeted prevention strategies and policy reforms.

A literature review was conducted using peer-reviewed studies, meta-analyses, and reviews published between 2007 and 2024. After screening 47 initial articles, 18 were selected for analysis based on their relevance to genetic and lifestyle risk …

Changes In The Perceptions Of The Neighborhood Environment And Physical Activity Patterns Among Mexican Americans On The Texas-Mexico Border, Natalia I Heredia, Soo Kyung Park, Minjae Lee, Lisa Mitchell-Bennett, Paul Yeh, Rose Gowen, Arturo Rodriguez, Miryoung Lee, Belinda M Reininger

Faculty, Staff and Student Publications

INTRODUCTION: Little research on the association of neighborhood environment with physical activity in resource-poor communities has been done. This study assessed changes in perceptions of the neighborhood environment and the association between those perceptions and physical activity in Mexican Americans on the Texas-Mexico border in an area where there would be community efforts to enhance pedestrian and cycling infrastructure and programming.

METHODS: We analyzed data from a population-based cohort of Mexican American individuals on the Texas-Mexico border. From 2008 to 2018, interviewer-administered questionnaires were used to collect perceptions of neighborhood environment and physical activity at baseline, 5- and 10-year follow-ups, …

Communities Disproportionately Affected By Carbon Monoxide Exposure After Winter Storm Uri, Elyse N Portillo, Casandra Quiñones, Zachary C Foughty, Ryan Ramphul, Asha T Morrow, Kathryn Fisher, Stephen A Harding, Elizabeth A Camp, Shubhada Hooli, Eric A Russell

Faculty, Staff and Students Publications

Extreme cold in February 2021 precipitated prolonged power failure in Texas. In Houston, many patients presented for carbon monoxide exposure from neighborhoods with lower per capita income, higher rates of limited English proficiency, and greater median Social Vulnerability Indices than Greater Houston. Weather-related disasters disproportionately affect socially vulnerable communities.

Leveraging The Science Of Early Life Predictability To Inform Policies Promoting Child Health, Laura M. Glynn, Sabrina R. Liu, Candice Taylor Lucas, Elysia Poggi Davis

Psychology Faculty Articles and Research

Addressing the tremendous burden of early-life adversity requires constructive dialogues between scientists and policy makers to improve population health. Whereas dialogues focused on several aspects of early-life adversity have been initiated, discussion of an underrecognized form of adversity that has been observed across multiple contexts and cultures is only now emerging. Here we provide evidence for “why unpredictability?”, including: 1. Evidence that exposures to unpredictability affect child neurodevelopment, with influences that persist into adulthood. 2. The existence of a translational non-human animal model of exposure to early life unpredictability that can be capitalized upon to causally probe neurobiological mechanisms. 3. …

Feasibility Of Fit24, A Digital Diabetes Prevention Program For Hispanic Adolescents: Qualitative Evaluation Study, Erica G Soltero, Salma M Musaad, Teresia M O'Connor, Debbe Thompson, Keith Norris, Bettina M Beech

Faculty, Staff and Students Publications

BACKGROUND: Digital health interventions are promising for reaching and engaging high-risk youth in disease prevention opportunities; however, few digital prevention interventions have been developed for Hispanic youth, limiting our knowledge of these strategies among this population.

OBJECTIVE: This study qualitatively assessed the feasibility and acceptability of Fit24, a 12-week goal-setting intervention that uses a Fitbit watch (Fitbit Inc) and theoretically grounded SMS text messages to promote physical activity and sleep among Hispanic adolescents (aged between 14 and 16 years) with obesity.

METHODS: After completing the intervention, a subsample of youth (N=15) participated in an in-depth interview. We categorized the themes …

Unveiling The Impact: Structural Racism And Childhood Lead Exposure's Health Consequences In Philadelphia, Mahhum Naqvi, Mahrukh Naqvi, Justin Stout, Colton Spencer

Rowan-Virtua Research Day

Childhood lead exposure poses a significant risk to health and well-being, adversely affecting brain function, nervous system development, and behavioral patterns. This study examines the health disparities and inequities associated with childhood lead exposure in Philadelphia, focusing on structural racism and residential segregation as crucial lenses for analysis. By delving into the sociocultural context of lead exposure, this study underscores the imperative of collaborative efforts among stakeholders to safeguard Philadelphia's most vulnerable populations. Healthcare professionals and policymakers play pivotal roles in enhancing funding and prevention strategies. Addressing this issue through the prism of structural racism allows for the identification and …

Impact Of Socioeconomic Inequalities On Racial/Ethnic Disparities In Adrd Incidence Rate In South Carolina, Noor Nishan

All Theses

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Inter-Institutional Analysis Of Skin Of Color Representation In Dermatological Lecture Content At Md And Do Medical Schools, Oluwafunke Oluwatosin Ogunremi, Blake Fredericksen, John Komas, Sana Ismail, Siri Knutsen-Larson Md, Valeriy Kozmenko Md, Afia Albin Do

Aesculapius Journal (Health Sciences & Medicine)

The purpose of this study was to analyze the lecture materials provided in medical schools through a diversity lens. Skin pathologies manifest distinctively on various shades of skin and physicians must be equipped with the proper knowledge to identify and diagnose these conditions accurately and promptly. For most medical students, images in prominent textbooks and lecture slides are their first encounter with disease presentations. Therefore, it is important to analyze the diversity of skin tones in the content that is being delivered. Specifically, the use of images featuring darker skin tones compared to those depicting lighter skin tones. This study …

Facilitators To Cervical Cancer Screening In A Minority, Urban, Underserved Population, Noel Higgason, Linh Nguyen, Yen-Chi Le, Ogochukwu Juliet Ezeigwe, Tong Han Chung, Natalia Williams, Xochitl K Olguin, Abigail S Zamorano

Faculty, Staff and Student Publications

OBJECTIVES: Cervical cancer has markedly declined due to widespread use of screening, but Hispanic women continue to bear a disproportionate amount of the cervical cancer burden due to under-screening. Previous studies have explored barriers to screening but have failed to identify targetable facilitators in this group. We aimed to assess facilitators to cervical cancer screening among a predominantly urban, Hispanic population who presented to a no-cost, community-based clinic.

METHODS: Patients completed demographic and health information, a validated social determinants of health (SDOH) screen, and a self-reported facilitators survey on factors which enabled them to present to clinic. Descriptive statistics were …

Perceived Neighborhood Disorder And Type 2 Diabetes Disparities In Hispanic, Black, And White Americans, Min Ying Yu, Alfredo J. Velasquez, Belinda Campos, Jennifer W. Robinette

Psychology Faculty Articles and Research

Introduction: Approximately 32 million Americans have type 2 diabetes, and that number continues to grow. Higher prevalence rates are observed among certain subgroups, including members of marginalized racial/ethnic groups as well as residents of disordered neighborhoods (i.e., those with more trash and vandalism). Institutionalized discriminatory practices have resulted in disproportionate representation of marginalized racial/ethnic groups in disordered neighborhoods compared to non-Hispanic Whites. These neighborhood disparities may partially contribute to health disparities, given that signs of neighborhood disorder often relate to a general withdrawal from the neighborhood, minimizing opportunities for both physical and social engagement. Yet, research suggests variability across …

Examination Of Disparities In Prehospital Encounters For Pediatric Asthma Exacerbations, Lauren Riney, Sam Palmer, Erik Finlay, Andrew Bertrand, Shannon Burcham, Phyllis Hendry, Manish Shah, Kathryn Kothari, David W Ashby, Daniel Ostermayer, Olga Semenova, Benjamin N Abo, Benjamin Abes, Nichole Shimko, Emily Myers, Marshall Frank, Tim Turner, Mac Kemp, Kim Landry, Greg Roland, Jennifer N Fishe

Faculty, Staff and Student Publications

INTRODUCTION: There are disparities in multiple aspects of pediatric asthma care; however, prehospital care disparities are largely undescribed. This study's objective was to examine racial and geographic disparities in emergency medical services (EMS) medication administration to pediatric patients with asthma.

METHODS: This is a substudy of the Early Administration of Steroids in the Ambulance Setting: An Observational Design Trial, which includes data from pediatric asthma patients ages 2-18 years. We examined rates of EMS administration of systemic corticosteroids and inhaled bronchodilators by patient race. We geocoded EMS scene addresses, characterized the locations' neighborhood-based conditions and resources relevant to children using …

Parabens Promote Protumorigenic Effects In Luminal Breast Cancer Cell Lines With Diverse Genetic Ancestry, Jazma L. Tapia, Jillian C. Mcdonough, Emily L. Cauble, Cesar G. Gonzalez, Dede K. Teteh, Lindsey S. Treviño

Health Sciences and Kinesiology Faculty Articles

Context

One in 8 women will develop breast cancer in their lifetime. Yet, the burden of disease is greater in Black women. Black women have a 40% higher mortality rate than White women, and a higher incidence of breast cancer at age 40 and younger. While the underlying cause of this disparity is multifactorial, exposure to endocrine disrupting chemicals (EDCs) in hair and other personal care products has been associated with an increased risk of breast cancer. Parabens are known EDCs that are commonly used as preservatives in hair and other personal care products, and Black women are disproportionately exposed …

Addressing Medical Mistrust Within The Black Community To Improve Their Health Ourcomes, Jillian Weathington

Honors Undergraduate Theses

Mistrust of the healthcare system is increased among the Black population compared to other race/ethnicity groups. Medical mistrust can lead to intensified health inequities and negative health outcomes among this population. Currently, there is limited research that explores ways to address medical mistrust, especially among the Black population. This study investigated medical mistrust to find ways to improve the quality of life amongst the Black population. Twenty-one participants in this study completed a Group Based Medical Mistrust Survey and five of those participants participated in a semi-structured interview. Descriptive and correlation analyses were conducted. The GBMMS was separated into three …

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. …

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: …

Social And Biological Determinants Of Pregnancy-Related Mortality And Morbidity In A Rural, Underserved Population, Anna Hansen

Theses and Dissertations--Sociology

Cases of severe maternal morbidity (SMM) and pregnancy-related mortality (PRM) are increasing in the US. Research concerning SMM and PRM has neglected women in Central Appalachia; a largely rural, health-disparate population. The aims of this study are two-fold: (1) Examine patient-level and place-based predictors of SMM/PRM via hierarchical logistic regression modeling, and (2) Elucidate Appalachian healthcare patients’ and providers’ experiences with SMM/PRM, perceptions of contributing factors, and insights on points of intervention.

This study uses a mixed methods approach guided by the WHO’s conceptual framework for action on social determinants of health to identify determinants of SMM and PRM among …

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 …

Associations Between Physical Activity And Alcohol Consumption In Rural Cancer Survivors, Scherezade K Mama, Natalia I Heredia, Hannah Johnston, David E Conroy

Faculty, Staff and Student Publications

PURPOSE: Rural adults and cancer survivors are more likely to be physically inactive and exceed recommendations for alcohol use. Physical activity and alcohol use are positively associated in adults and cancer survivors but associations between physical activity and alcohol use in rural cancer survivors is unknown. This cross-sectional study explored associations between physical activity, sitting time, and alcohol use in rural cancer survivors.

METHODS: Cancer survivors residing in central Pennsylvania were recruited to the Partnering to Prevent and Control Cancer (PPCC) study and completed mailed questionnaires assessing physical activity (low, moderate, high), sitting time (≥6 hours/day), and alcohol use (0 …

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.

Assessing The Contribution Of Different Causes Of Death To Life Expectancy Disparities In The United States, Max Tyler Roberts

All Graduate Theses and Dissertations, Spring 1920 to Summer 2023

Life expectancy is not the same for all people in the United States. While some enjoy life expectancies of more than 80 years, others are at risk of dying much sooner. The following studies investigate how different causes of death such as homicide, diabetes, heart disease, and drug poisoning contribute across the life span to: 1) life expectancy gaps across different sex, racial, ethnic, and education groups, and 2) life expectancy change over time for different sex, racial, ethnic, and education groups. Each study focuses on a different area of the U.S., with Chapter 2 focusing on the national-level, Chapter …

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 …

Moving Past The Binary: Transgender And Gender Non-Conforming Students’ Experiences Of And Perspectives On College Campus Fitness Centers, Rachel E. Petterson

Honors Projects

Transgender and gender non-conforming (TGNC) people face various mental and physical health disparities. Despite this, spaces related to health and wellness are not always inclusive. Similarly, college campuses are often not as inclusive or accommodating as they should be. This study looks at the experiences of TGNC students at campus fitness centers. Through both quantitative and qualitative data gathered through an online survey, it aims to better understand the following: the presence of inclusive facilities; the perceived importance of facility variables; use of campus fitness facilities by TGNC students; what improvements they would like to see; and how any of …

Health Disparities By Sexual Orientation Components In The United States, Julia Kay Wolf

Graduate Theses, Dissertations, and Problem Reports (ETD)

Fundamental cause theory encourages researchers to consider broad social conditions that put people at risk of individual-level health-related risks that can lead to health disparities between social groups. Stigma has recently been proposed as a fundamental cause of health disparities as it influences multiple disease outcomes, affects access to resources, and is consistently related to health inequities across historical and geographical contexts. Minority stress theory describes how sexual minorities endure excess stressors in the form of prejudice and discrimination due to their stigmatized status. Considering both frameworks, I explore how stigmatized sexual orientation minority respondents compare to their sexual majority …

Discordance In Perceptions Of Barriers To Breast Cancer Treatment Between Hispanic Women And Their Providers, Swapna Reddy, Mary Saxon, Nina Patel, Matthew Speer, Tiffany Ziegler, Nirali Patel, Madison Ziegler, Stephany Esquivel, Andrea Daniella Mata, Asha Devineni, Pooja Paode, Nitika Thawani, Subhakar Mutyala

Journal of Patient-Centered Research and Reviews

Despite comparable screening and incidence rates that are 26% below that of non-Hispanic Whites, Hispanic women present with breast cancer at more advanced stages of disease, representing a continuing and troubling health disparity for this population. Reducing these disparities warrant more innovative research approaches to better understand perspectives of Hispanic patients regarding barriers to treatment and how these perspectives compare to those of their providers. A pilot qualitative study was conducted at a major urban cancer center in Arizona that measured both patient and provider perspectives regarding barriers to treatment. Through a multimethod qualitative analysis, researchers surveyed patients and providers …

Covid-19 Treatment Resource Disparities And Social Disadvantage In New York City, Jason A. Douglas, Andrew M. Subica

Health Sciences and Kinesiology Faculty Articles

Black and Hispanic communities in the U.S. have endured a disproportionate burden of COVID-19-related morbidity and mortality. Racial and ethnic health disparities such as these are frequently aggravated by inequitable access to healthcare resources in disadvantaged communities. Yet, no known studies have investigated disadvantaged communities' access to COVID-19-related healthcare resources. The current study accordingly examined racial and ethnic differences in (1) April 2020 COVID-19 total and positive viral test rates across 177 New York City (NYC) ZIP Code Tabulation Areas (ZCTA); and (2) November 2019–April 2020 licensed and intensive care unit (ICU) hospital bed access across 194 NYC ZCTAs. Pairwise …

The Intergenerational Transmission Of Discrimination: Children’S Experiences Of Unfair Treatment And Their Mothers’ Health At Midlife, Cynthia G. Colen, Qi Li, Corinne Reczek, David R. Williams

Department of Sociology: Faculty Publications

A growing body of research suggests that maternal exposure to discrimination helps to explain racial disparities in children’s health. However, no study has considered if the intergenerational health effects of unfair treatment operate in the opposite direction—from child to mother. To this end, we use data from mother-child pairs in the National Longitudinal Survey of Youth 1979 to determine whether adolescent and young adult children’s experiences of discrimination influence their mother’s health across midlife. We find that children who report more frequent instances of discrimination have mothers whose self-rated health declines more rapidly between ages 40 and 50 years. Furthermore, …

How Professional Physical Therapist Education Programs Develop Cultural Competence Within Their Students: An Exploratory Concurrent Mixed Methods Study, Dustin E. Domingo

Dissertations

Purpose: The purpose of this exploratory concurrent mixed methods study was to describe experiences that shape the factors of cultural intelligence (CQ) as perceived by students of professional physical therapist education programs. In addition, it was the purpose of this study to determine whether any particular factor of cultural intelligence influenced one’s overall cultural competence according to the cultural competence continuum by Cross et al. (1989).

Methodology: Students in a professional physical therapist education program completed a questionnaire, which included Likert scale questions, open ended questions, and a 37-item self-assessment based on the expanded cultural intelligence scale by Van Dyne …