Race and Ethnicity Commons^™

Neighborhood-Level Deprivation Mediates Racial And Ethnic Disparities In Hcc Diagnosis In Texas, Itunu O Sokale, Aaron P Thrift, Hashem B El-Serag, Abiodun O Oluyomi

Faculty, Staff and Students Publications

BACKGROUND: Texas has the highest HCC rates in the United States, and the greatest burden is among Hispanics. Racial and ethnic disparities in HCC incidence have multiple underpinning factors. We conducted a mediation analysis to examine the role of neighborhood disadvantage (Area Deprivation Index) as a potential mediator of the association between neighborhood race and ethnicity distribution and neighborhood HCC case counts in Texas.

METHODS: The primary outcome measure was counts of new HCC diagnoses per census tract based on Texas Department of State Health Services Texas Cancer Registry data. The primary exposure of interest was the race and ethnicity-based …

Providing End-Of-Life Counseling: A Narrative Inquiry, Carol Hecht, Sibyl West

Adultspan Journal

This qualitative study aimed to address the gap in the research related to end-of-life counseling by exploring the experiences of counselors working with clients at end of life. While counseling literature and education are lacking regarding end of life, many counselors will work alongside clients approaching death. The purpose of this study was twofold: (a) to better understand the nuanced experiences of counselors providing end-of-life counseling and (b) to explore the supports and preparations helpful for counselors to provide end-of-life counseling. A narrative approach, using the Listening Guide (Gilligan, 2015), was employed to analyze and present the stories of three …

Considerations Of Medicare Telehealth Services With Older Adults, Sonah Kho, Amanda Dediego

Adultspan Journal

The onset of the COVID-19 pandemic set in motion a rapid expansion of mental health services offered via telehealth. With this rapid expansion came the need to examine how policy and practice should be shaped in a future where telehealth is considered common in counseling practice. For counselors to understand how to support older adult clients in using telehealth services, they must understand telehealth policy. Following the eligibility of licensed counselors to participate in Medicare, counselors need to stay abreast of regulatory changes regarding restrictions and regulations on use of telehealth for mental and behavioral health services, including video and …

Skin Tone Discrimination And Birth Control Avoidance Among Women In Harris County, Texas: A Cross-Sectional Study, Kimberly Baker, Susan Tortolero Emery, Evelyn Spike, Jazmyne Sutton, Eran Ben-Porath

Faculty, Staff and Student Publications

INTRODUCTION: Structural racism plays a major role in reproductive health inequities. Colorism, discrimination based on skin color, may profoundly impact reproductive health access and service delivery. However, quantitative research in this area is limited.

METHODS: We administered an online survey of women (n = 1,299) aged 18-44 from Harris County, Texas to assess the relationship between skin color discrimination and reproductive health service avoidance. The survey included questions on demographics, self-reported skin tone, and dichotomous measures of previous discrimination experiences and avoidance of care because of perceived discrimination. Binary logistic regression was used to examine whether race/ethnicity, skin tone, and …

Admixture Mapping Of Cognitive Function In Diverse Hispanic And Latino Adults: Results From The Hispanic Community Health Study/Study Of Latinos, Rui Xia, Xueqiu Jian, Amanda L Rodrigue, Jan Bressler, Eric Boerwinkle, Biqi Cui, Martha L Daviglus, Charles Decarli, Linda C Gallo, David C Glahn, Emma E M Knowles, Jee-Young Moon, Thomas H Mosley, Claudia L Satizabal, Tamar Sofer, Wassim Tarraf, Fernando Testai, John Blangero, Sudha Seshadri, Hector M González, Myriam Fornage

Faculty, Staff and Student Publications

INTRODUCTION: We conducted admixture mapping and fine-mapping analyses to identify ancestry-of-origin loci influencing cognitive abilities.

METHODS: We estimated the association of local ancestry intervals across the genome with five neurocognitive measures in 7140 diverse Hispanic and Latino adults (mean age 55 years). We prioritized genetic variants in associated loci and tested them for replication in four independent cohorts.

RESULTS: We identified nine local ancestry-associated regions for the five neurocognitive measures. There was strong biological support for the observed associations to cognitive function at all loci and there was statistical evidence of independent replication at 4q12, 9p22.1, and 13q12.13.

DISCUSSION: Our …

Reclaiming Healing Spaces: A Phenomenological Study On The Transformative Power Of Outdoor Therapy From The Lived Experiences Of Black Clinicians Working With Black Clients, Lynn Murphy

Dissertations

This phenomenological study involved assessing the experiences of Black therapists who engaged Black clients in outdoor therapeutic contexts. The study was founded on the existing literature that shows the quality of the therapeutic relationship is pivotal for client retention and the Western standards that have historically favored treatment within indoor environments. To contextualize this research, a comprehensive literature review was commenced, covering topics such as the decolonization of therapy, the historical and present-day relationship between Blacks and the outdoors in the United States, sedentary lifestyles, the psychological benefits of time spent in nature, various types of outdoor therapy, and the …

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, …

A Systematic Review Of Racial Disparities In Emergency Department Pain Evaluation And Treatment In The United States, Cyrus Wolff

Theses and Graduate Projects

Background: Providers working in emergency departments (ED) must balance the need to relieve patients’ pain with the dangers of overprescribing opioids. Lack of standardization of pain evaluation and treatment may contribute to inequities in the management of pain in emergency departments. Evaluating differences in how different populations receive care in emergency departments can help to identify problems and areas where improvements need to occur.

Purpose: The purpose of this literature review is to evaluate what current research states about the prevalence and causes of racial disparities in pain evaluation and treatment in United States emergency departments and determine what gaps …

How Has Telehealth Impacted Access To Mental Health Services In The Hispanic Population In Minnesota?, Jesse Ochoa

Theses and Graduate Projects

Background: The Hispanic population in the US continues to grow and mental health services still have barriers lowering access to care.

Purpose: The purpose of this literature review is to look at the stressors and perceptions of mental health in Hispanics and analyze how telehealth has impacted access to care despite the barriers present.

Methods: A comprehensive literature review was conducted using google scholar using the search terms With this search criteria, 600 articles were available. Inclusion criteria were studies that provided a comprehensive view about specific topics like telehealth with the hispanic population, mental health specific to Hispanic needs, …

Maternal Mortality In American Indian And Alaska Native Women: It Is Time To Prevent The Preventable, Brynn Cusack

Theses and Graduate Projects

Background: A concerning disparity exists between maternal mortality rates of American Indian and Alaska Native (AIAN) women and White women. Contributing factors include historical trauma, systemic inequities, inadequate funding, and deprioritization of the health of AIAN people.

Purpose: This literature review aims to address the research question: “Why were American Indian and Alaska Native women two times more likely to die of pregnancy-related causes than White women in the US during the period of 2017 through 2019?” The review explores historical context, current evidence, potential causes and interventions that can address AIAN maternal mortality.

Methods: A comprehensive literature review was …

The Bench To Community Initiative: Community-Based Participatory Research Model For Translating Research Discoveries Into Community Solutions, Jazma L. Tapia, Abigail Lopez, D. Bing Turner, Tonya Fairley, Tiah Tomlin-Harris, Maggie Hawkins, Pastor Rhonda Holbert, Lindsey S. Treviño, Dede K. Teteh-Brooks

Health Sciences and Kinesiology Faculty Articles

Methods: Community-based participatory research (CBPR) is an effective methodology for translating research findings from academia to community interventions. The Bench to Community Initiative (BCI), a CBPR program, builds on prior research to engage stakeholders across multiple disciplines with the goal of disseminating interventions to reduce breast cancer disparities and improve quality of life of Black communities.

The BCI program was established to understand sociocultural determinants of personal care product use, evaluate the biological impact of endocrine disrupting chemicals, and develop community interventions. The three pillars of the program include research, outreach and engagement as well as advocacy activities. The research …

Neighborhood Socioeconomic Context Predicts Pediatric Asthma Exacerbation, Ashley W. Kranjac, Zeev N. Kain, Louis Ehwerhemuepha, Michael Weiss, Brooke N. Jenkins

Sociology Faculty Articles and Research

Causes of asthma exacerbation in children have been studied extensively at the individual level, but contributions of neighborhood-level factors are less explored. We test which distinctive residential characteristics produce variation in uncontrolled asthma among pediatric patients. We extracted electronic medical record data from pediatric patients living in Southern California and used multilevel modeling techniques to isolate which neighborhood characteristics drive inequitable asthma control. Above and beyond the individual-level factors known to predict inadequate disease control, neighborhoods with greater concentration of non-Hispanic black residents (odds ratios [OR] = 1.02; 95% confidence interval [CI]: 0.99-1.03; P < .05), higher proportions of female-headed households (OR = 1.01; 95% CI: 0.99-1.01; P < .05), and higher levels of ambient air pollution (OR = 1.05; 95% CI: 1.01-1.10; P < .001) associate with greater odds of asthma exacerbation. The interplay between community characteristics and asthma management during childhood is complex, and place-based initiatives are needed to narrow the gap in asthma exacerbation.

Evidence-Based Prostate Cancer Screening Interventions For Black Men: A Systematic Review, Abigail Lopez, Jared T. Bailey, Dorothy Galloway, Leanne Woods-Burnham, Susanne B. Montgomery, Rick Kittles, Dede K. Teteh-Brooks

Health Sciences and Kinesiology Faculty Articles

Abstract

Prostate cancer is the second leading cause of death for men in the U.S. and Black men are twice as likely to die from the disease. However, prostate cancer, if diagnosed at an earlier stage, is curable. The purpose of this review is to identify prostate cancer screening clinical trials that evaluate screening decision-making processes of Black men.

Methods

The databases PubMed, Ovid MEDLINE, CINAHL Plus, and PsychInfo were utilized to examine peer-reviewed publications between 2017 and 2023. Data extracted included implementation plans, outcome measures, intervention details, and results of the study. The Critical Appraisal Skills Programme was used …

Anal Human Papillomavirus (Hpv) Disagreement By Linear Array Compared To Spf10 Pcr-Deia-Lipa25 System In Young Sexual Minority Men, Trisha L Amboree, Jacky Kuo, Bradley A Sirak, John A Schneider, Alan G Nyitray, Lu-Yu Hwang, Elizabeth Y Chiao, Anna R Giuliano, Kayo Fujimoto

Faculty, Staff and Student Publications

Introduction: Young sexual minority men (SMM) bear the greatest burden of anal human papillomavirus (HPV) infections. We assessed anal HPV genotype discordance between the Linear Array (LA) and SPF10 PCR-DEIA-LiPA25 (LiPA25).

Methods: Discordance was assessed between LA and LiPA25 using self-collected anal swabs from 120 SMM aged 18-29 who were recruited in 2014-2016. Multiple-type infection was explored as a potential confounder of testing agreement, along with clinical and behavioral factors such as HIV status, syphilis status, incarceration history, health insurance coverage, having 3 or more sex partners in the past 6 months, and co-infection with HPV-16.

Results: Significant discordance was …

Two Cases Of Pigmented Basal Cell Carcinoma In African American Patients, Angelique Ruml, Joan K Fernandez, Ibeth Caceres, Nisha Ramani, Ida Orengo, Theodore Rosen

Faculty, Staff and Students Publications

Basal cell carcinoma (BCC) is the most common cutaneous malignancy, comprising approximately 80% of non-melanoma skin cancers. There are numerous subtypes, including pigmented basal cell carcinoma (pBCC), a rare clinical and histological variant. Skin cancers in African American patients, although rare, still do occur. BCC is an uncommon neoplasm in this population, but when it does occur, pigmentation is present in more than 50% of tumors compared with only 5% to 6% of BCCs in Caucasians. This report presents two cases of histologically verified pBCC in African American patients from dermatology clinics at the Veterans Affairs Hospital located in the …

Mobility Repertoires: How Chinese Overseas Students Overcame Pandemic-Induced Immobility, Jiaqi M. Liu, Rui Jie Peng

Research Collection School of Social Sciences

The burgeoning field of immobility studies focuses on how migratory aspirations and capabilities shape a given (im)mobility status but devotes scant attention to how people traverse different (im)mobility categories. Through a case study of Chinese students in the United States during the COVID-19 pandemic, this article develops two arguments to shed light on migrants’ experiences and strategies in mobility transitions. First, during the pandemic, while China's restrictive travel policies and unfavorable public discourses made return migration extremely difficult, Chinese overseas students also felt unwelcome in the United States, due to visa restrictions and Sinophobic violence. This dilemma of being unable …

Determining Factors For Improved Uptake Of Harm Reduction Services In The United States: A Study Of Inclusive, Culturally Sensitive Messaging, Lauretta Ekanem Omale

Dissertations

Harm reduction refers to public health policies and programs aimed at decreasing the adverse consequences associated with drug use. While harm reduction services (e.g., syringe exchange programs) can mitigate health risks, marginalized groups face barriers to service access and utilization, partially due to ineffective messaging approaches that fail to align with cultural values and experiences. A one-size-fits-all approach to messaging can negatively impact service utilization, health outcomes, and health disparities. Ineffective communication can lead to poor adherence to treatment, poorer health outcomes, and increased adverse events.

Culturally insensitive communication contributes to stigma, mistrust, and lack of perceived relevance, discouraging service …

Us Filipino Adults Have Elevated Prevalence Of Hypertension Across The Adult Lifespan: Findings From A Cross-Sectional Electronic Health Record Study, Nancy P Gordon, Irvin C Lien, Jamal S Rana, Joan C Lo

Faculty, Staff and Student Publications

INTRODUCTION: The prevalence of hypertension increases with age and differs by race and ethnicity. Among U.S. Asian adults, prevalence is higher for Filipino adults than for other major Asian subgroups, but whether this disparity exists across the adult lifespan is unknown. This study examined hypertension prevalence by age decade, comparing Filipino adults with South Asian, Chinese, Black, Hispanic, and White adults.

METHODS: This cross-sectional study used 2015-2016 electronic health record data from a Northern California integrated healthcare delivery system for 1,839,603 adults aged 30-79 years, including 128,124 Filipino adults. Hypertension was defined by diagnosis codes. Sex-specific prevalence was calculated by …

Trends In Fatal Opioid-Related Overdose In American Indian And Alaska Native Communities, 1999-2021, Cici Bauer, Ghada H Hassan, Ric Bayly, Jack Cordes, Dana Bernson, Cedric Woods, Xiaona Li, Wenjun Li, Leland K Ackerson, Marc R Larochelle, Thomas J Stopka

Faculty, Staff and Student Publications

INTRODUCTION: Opioid-related overdose mortality rates have increased sharply in the U.S. over the past two decades, and inequities across racial and ethnic groups have been documented. Opioid-related overdose trends among American Indian and Alaska Natives require further quantification and assessment.

METHODS: Observational, U.S. population-based registry data on opioid-related overdose mortality between 1999 and 2021 were extracted in 2023 using ICD-10 codes from the U.S. Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research multiple cause of death file by race, Hispanic ethnicity, sex, and age. Segmented time series analyses were conducted to estimate opioid-related overdose mortality growth …

A Quantitative Study Examining The Mental Health Needs Of African American Students Compared To Their Counterparts In Higher Education, Luxury Bryant

College of Education Theses and Dissertations

African American students are entering into higher education institutions at higher rates. This population has specific needs and faces various challenges entering college at predominantly white institutions compared to their counterparts of different races. While college is already a stressful time with academic pressures as well as navigating a new setting, African American students also face unique experiences that can impact their mental health. It has been found that African American students are less likely to seek out mental health services especially those that are attending predominantly White institutions (Anderson, 2018). This study will highlight African American undergraduate students' perceptions …

A Trauma-Informed Socially Just Approach To Working With Juvenile Justice-Involved Youth Utilizing Expressive Arts Therapy, Ciara Carr

Expressive Therapies Capstone Theses

Youth involved with the juvenile justice system often have a history of trauma and oppression resulting from their positionality and circumstances. Most juvenile justice-involved youth are boys, youth of color, low-income, LGBTQIA2S+, disabled, and traumatized. This literature review explores the history of the juvenile justice system, issues with the present-day model, and trauma-informed and transformative justice approaches to practice. The implementation of socially just, trauma-informed expressive arts therapy programs is proposed as a more equitable practice to replace commonly used punitive practices across the United States. More research is needed to understand the impact of such programs on this population …

Playing With International Students From Asia: An Exploration Of Cultural Commonalities And Differences In Developmental Transformations (Dvt), Hazuki Okamoto

Expressive Therapies Capstone Theses

Asian international students in the United States face a multitude of challenges such as language barriers, differences in cultural norms and behaviors, and identity confusion while navigating a foreign landscape. Developmental Transformations (DvT), a form of drama therapy, may apply to these challenges by enabling participants to explore different identities and express themselves creatively beyond the language barrier. This community engagement project was designed for Asian international students to be seen and heard by utilizing DvT. Within an in-person workshop, five participants played with their shared stories, and explored international and cultural roles in group DvT. Key takeaways from the …

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 …

Pediatric Caregiver Perspectives On Immigration Status In The Healthcare Setting, Anik Patel, Kimberly Randell, Jennifer Watts, John Cowden, Frances Turcotte Benedict, Juan Farias Torres, Ana Contreras, Ali Fowler, Estefania Bazan, Claudia Zepeda

Research Days

A qualitative study to explore pediatric parent/caregiver knowledge, attitudes, and beliefs regarding impacts of immigrant status on healthcare and describe health and social needs of families for whom one or more caregivers has undocumented immigration status as well as preferred methods for resource connections among undocumented caregivers.

Health Disparities In Slipped Capital Femoral Epiphysis (Scfe) Presentation, Rithika Ginjupalli, George Thomas, Rohit Siddabattula, Richard M. Schwend, Caleb Grote

Research Days

This study identifies various health disparities in SCFE presentations using neighborhood-level determinants COI and ICE in addition to sociodemographic determinants such as race and gender.

Gut Microbiota, Blood Metabolites, And Left Ventricular Diastolic Dysfunction In Us Hispanics/Latinos, Kai Luo, Alkis Taryn, Eun-Hye Moon, Brandilyn A Peters, Scott D Solomon, Martha L Daviglus, Mayank M Kansal, Bharat Thyagarajan, Marc D Gellman, Jianwen Cai, Robert D Burk, Rob Knight, Robert C Kaplan, Susan Cheng, Carlos J Rodriguez, Qibin Qi, Bing Yu

Faculty, Staff and Student Publications

BACKGROUND: Left ventricular diastolic dysfunction (LVDD) is an important precursor of heart failure (HF), but little is known about its relationship with gut dysbiosis and microbial-related metabolites. By leveraging the multi-omics data from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a study with population at high burden of LVDD, we aimed to characterize gut microbiota associated with LVDD and identify metabolite signatures of gut dysbiosis and incident LVDD.

RESULTS: We included up to 1996 Hispanic/Latino adults (mean age: 59.4 years; 67.1% female) with comprehensive echocardiography assessments, gut microbiome, and blood metabolome data. LVDD was defined through a composite criterion …

Emotion Regulation Strategies And Perceived Emotional Intelligence: The Effect Of Age., Iwanna Sepiadou

Adultspan Journal

The aim of this study was to investigate the relationship between perceived emotional intelligence and the reported use of cognitive reappraisal and expressive suppression. We also investigated the possible effects of age on the aforementioned variables. The total sample consisted of 379 people (158 men, 220 women, 1 unreported). Across participants, 273 were young (20-39 years old) and 106 were middle-aged (40-65 years old). We found statistically significant positive correlations between the dimensions of perceived emotional intelligence and the reported use of cognitive reappraisal and negative primarily correlations between the dimensions of perceived emotional intelligence and the reported use of …

Timely Ambulatory Follow Up After Emergency Department Discharge, Kevin Endersby, Jackson Weber, Marisyl De La Cruz

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement:

Patients over the age of 65 lack timely ambulatory follow up after discharge from the ED, leading to increased return to the ED, resource utilization, and mortality.

Project AIM:

Within 6 months of intervention, 70% of patients over the age of 65 who were recently discharged from the ED will follow up with their PCP within 7 days of the timeline recommended by the ED provider.

Developing A Taskforce To Improve Digital Health Equity, Samuel Wilson, Natalia Queenan, Julianna Lenoir, Alexzandra Gentsch, Jay Trivedi, Rohith Tudi, Nikita Nair, Akshay Krishnan, Andrew Vanichkachorn,, Tien Vu, Alexandra Cohen, Eleanor Jenkins, Marissa Witmer, David Rigas, Jeffrey Ndubisi, Isabella Muti, Kristin Rising, Md

Health Equity and Quality Improvement (HEQI) Summit

Our Population

• Thomas Jefferson University Hospital (TJUH) is a tertiary care center and L1 trauma center, and we serve patients from all areas in Philadelphia for acute health crises
• In Philadelphia, major disparities exist regarding health factors and health outcomes
• When stratifying by neighborhood or zip code, these disparities become even more apparent
• Several studies have also shown that these geographic demarcations coincide with racial disparities for access to health resources, like primary care physicians, COVID-19 vaccinations, and public health interventions
• Accessibility of health resources for our inpatients is thus highly variable.

Identifying Inappropriate Dual Anti-Platelet Therapy (Dapt) Utilization In The Outpatient Setting, Youssef Elfatatry, Julia Palecki, Nevin Varghese, Amry Majeed, Alexis Wickersham

Health Equity and Quality Improvement (HEQI) Summit

Background

Problem Statement:

• Dual anti-platelet therapy (DAPT) is a cornerstone in management of many cardiovascular and cerebrovascular conditions; however, inappropriate and prolonged use can lead to increased bleeding risk. Despite guidelines on optimal DAPT duration for various clinical scenarios, a proportion of patients receive inappropriately extended courses of therapy, exposing them to unnecessary risk.

Project AIM:

• We aim to (1) identify inappropriate DAPT use using established clinical guidelines at two academic primary care clinics and (2) develop and implement a targeted best practice advisory (BPA) in EPIC to address gaps in adherence to DAPT guidelines to enhance patient safety and …