Medicine and Health Commons^™

Social Vulnerability And The Prevalence Of Opioid Use Disorder Among Older Medicare Beneficiaries In U.S. Counties, Tse-Chuan Yang, Seulki Kim, Stephen A. Matthews, Carla Shoff

Department of Sociology: Faculty Publications

Objectives: Recent research has investigated the factors associated with the prevalence of opioid use disorder (OUD) among older adults (65+), which has rapidly increased in the past decade. However, little is known about the relationship between social vulnerability and the prevalence of OUD, and even less about whether the correlates of the prevalence of OUD vary across the social vulnerability spectrum. This study aims to fill these gaps. Methods: We assemble a county-level data set in the contiguous United States (U.S.) by merging 2021 Medicare claims with the CDC’s social vulnerability index and other covariates. Using the total number of …

Revisiting The Rainbow: Culturally Responsive Updates To A Standard Clinical Resource, Angela M. Dietsch, Richard Mocarski, Debra A. Hope, Nathan Woodruff, Miechelle Mckelvey

Department of Special Education and Communication Disorders: Faculty Publications

Purpose

Cultural responsivity is essential for efficacious and affirming clinical relationships. This may be especially important with historically marginalized clients, such as transgender and gender-diverse (TGD) people seeking behaviorally based affirming communication services. We recommend modifications to standard tools for diagnostics and training that otherwise might undermine our efforts to create an inclusive and affirming environment.

Method

Modifications to the Rainbow Passage, a standardized paragraph utilized for eliciting speech samples in clinical settings, focused on nongendered terminology and the elimination of content with religious connotations.

Results

The recommended edits to the Rainbow Passage maintain similar length, cadence, and phonetic balance …

Understanding The Implications Of Under-Reporting, Vaccine Efficiency And Social Behavior On The Post-Pandemic Spread Using Physics Informed Neural Networks: A Case Study Of China, Samiran Ghosh, Alonso Ogueda-Oliva, Aditi Ghosh, Malay Banerjee, Padmanabhan Seshaiyer

Faculty, Staff and Student Publications

In late 2019, the emergence of COVID-19 in Wuhan, China, led to the implementation of stringent measures forming the zero-COVID policy aimed at eliminating transmission. Zero-COVID policy basically aimed at completely eliminating the transmission of COVID-19. However, the relaxation of this policy in late 2022 reportedly resulted in a rapid surge of COVID-19 cases. The aim of this work is to investigate the factors contributing to this outbreak using a new SEIR-type epidemic model with time-dependent level of immunity. Our model incorporates a time-dependent level of immunity considering vaccine doses administered and time-post-vaccination dependent vaccine efficacy. We find that vaccine …

Age And Sex-Specific Stroke Epidemiology In Covid-19, Youngran Kim, Maria A Parekh, Xiaojin Li, Yan Huang, Guo-Qiang Zhang, Bharti Manwani

Faculty, Staff and Student Publications

BACKGROUND: COVID-19 has emerged as an independent risk factor for stroke. We aimed to determine age and sex-specific stroke incidence and risk factors with COVID-19 in the US using a large electronic health record (EHR) that included both inpatients and outpatients.

METHODS: A retrospective cohort study was conducted using individual-level data from Optum

RESULTS: Of 387,330 COVID-19 patients, 2,752 patients (0.71%, 95% CI 0.68-0.74) developed stroke during the 180-day follow-up, AIS in 0.65% (95% CI 0.62-0.67), and ICH in 0.11% (95% CI 0.10-0.12). Of strokes among COVID-19 patients, 57% occurred within 3 days. Advanced age was associated with a substantially …

Healthcare Access And Experiences Among Transgender University Students, Micah Reisner

Honors Undergraduate Theses

Background

As transgender identification rises in younger generations, it is imperative that colleges and universities account for the health and wellbeing of this growing subset of the student body. Previous research indicates that transgender populations experience unique barriers to accessing healthcare, including socioeconomic barriers and a lack of healthcare providers experienced in transgender medicine. These barriers contribute to low rates of healthcare utilization and significant health disparities in transgender populations.

Methods

A community health assessment of transgender and gender-nonconforming (TGNC) students at the University of Central Florida was conducted in order to assess: (1) students' access to and experiences with …

Uncovering The Connection Between Mental Health Service Availability And Violent Crime: A Test Of Macrolevel Theory, Tatianna R. Pugmire

Graduate Student Theses, Dissertations, & Professional Papers

Since the decline of mental health service funding and availability, the relationship between untreated (or improperly treated) serious mental illness and violent crime is increasingly critical to examine. Rooted in a social support and institutional anomie theory (IAT) perspective, the purpose of this quantitative study is to analyze the relationship between mental health service availability and violent crime rates across the United States for the year 2016. It was hypothesized that findings would suggest an inverse relationship between mental health service availability and rates of violent crime. Results revealed the opposite, however, indicating that the more psychiatric hospitals in an …

Deadly Divisions: Class And Stigma As Fundamental Social Causes Of Spatial Health Inequalities, Misty Lee Harris

Graduate Theses, Dissertations, and Problem Reports (ETD)

The objective of this dissertation is to investigate how class and stigma influence spatial inequalities in health across the US, from the structural to the individual level. Class, stigma, and subsequent access to capital resources are not equally distributed across the US. Women, poor, and minority populations continue to have unequal access to capital resources across the country, though this is spatially determined. Similarly, while there are health inequalities along the same social cleavages at the national level, they differ significantly across localities. Research has not paid enough attention to the fundamental social causes of inequities, resulting in the inability …

Sheprep: Examining The Influence Of The Messaging And The Messenger Associated With Prep Uptake Among African American Women, Christian C. Spears

College of Graduate Studies: Theses & Dissertations

African American Women (AAW) make up less than 15% of the female population in the United States but account for over 50% of new HIV diagnoses among females. This largely preventable health disparity can be mitigated by advocating and prescribing Pre-exposure Prophylaxis (PrEP), a preventive HIV medication, to persons at risk. Despite advances in medication options, there are less than 13% of Black people who could benefit from having been prescribed PrEP, and limited research and promotion on the effectiveness of PrEP for AAW. The “ShePrEP Study” aimed to assess awareness, perceptions, and receptivity toward PrEP among AAW. This study …

Ethnic And Racial Differences In Self-Reported Symptoms, Health Status, Activity Level, And Missed Work At 3 And 6 Months Following Sars-Cov-2 Infection, Kelli N O'Laughlin, Robin E Klabbers, Imtiaz Ebna Mannan, Nicole L Gentile, Rachel E Geyer, Zihan Zheng, Huihui Yu, Shu-Xia Li, Kwun C G Chan, Erica S Spatz, Ralph C Wang, Michelle L'Hommedieu, Robert A Weinstein, Ian D Plumb, Michael Gottlieb, Ryan M Huebinger, Melissa Hagen, Joann G Elmore, Mandy J Hill, Morgan Kelly, Samuel Mcdonald, Kristin L Rising, Robert M Rodriguez, Arjun Venkatesh, Ahamed H Idris, Michelle Santangelo, Katherine Koo, Sharon Saydah, Graham Nichol, Kari A Stephens

Faculty, Staff and Student Publications

INTRODUCTION: Data on ethnic and racial differences in symptoms and health-related impacts following SARS-CoV-2 infection are limited. We aimed to estimate the ethnic and racial differences in symptoms and health-related impacts 3 and 6 months after the first SARS-CoV-2 infection.

METHODS: Participants included adults with SARS-CoV-2 infection enrolled in a prospective multicenter US study between 12/11/2020 and 7/4/2022 as the primary cohort of interest, as well as a SARS-CoV-2-negative cohort to account for non-SARS-CoV-2-infection impacts, who completed enrollment and 3-month surveys (

RESULTS: Following SARS-CoV-2 infection, the majority of symptoms were similar over time between ethnic and racial groups. At …

Development Of Competency-Based Online Genomic Medicine Training (Cogent), Susanne B Haga, Wendy K Chung, Luis A Cubano, Timothy B Curry, Philip E Empey, Geoffrey S Ginsburg, Kara Mangold, Christina Y Miyake, Siddharth K Prakash, Laura B Ramsey, Robb Rowley, Carolyn R Rohrer Vitek, Todd C Skaar, Julia Wynn, Teri A Manolio

Faculty, Staff and Student Publications

The fields of genetics and genomics have greatly expanded across medicine through the development of new technologies that have revealed genetic contributions to a wide array of traits and diseases. Thus, the development of widely available educational resources for all healthcare providers is essential to ensure the timely and appropriate utilization of genetics and genomics patient care. In 2020, the National Human Genome Research Institute released a call for new proposals to develop accessible, sustainable online education for health providers. This paper describes the efforts of the six teams awarded to reach the goal of providing genetic and genomic training …

Quality Care Is Equitable Care: A Call To Action To Link Quality To Achieving Health Equity Within Acute Care Surgery, Lisa M Knowlton, Tanya Zakrison, Lillian S Kao, Marta L Mccrum, Suresh Agarwal, Brandon Bruns, Kathie-Ann Joseph, Cherisse Berry

Faculty, Staff and Student Publications

Health equity is defined as the sixth domain of healthcare quality. Understanding health disparities in acute care surgery (defined as trauma surgery, emergency general surgery and surgical critical care) is key to identifying targets that will improve outcomes and ensure delivery of high-quality care within healthcare organizations. Implementing a health equity framework within institutions such that local acute care surgeons can ensure equity is a component of quality is imperative. Recognizing this need, the AAST (American Association for the Surgery of Trauma) Diversity, Equity and Inclusion Committee convened an expert panel entitled 'Quality Care is Equitable Care' at the 81st …

Assessing The Relationships Between Direct And Vicarious Exposure To Healthcare Discrimination And Erasure, Mistrust In Healthcare, And The Healthcare Utilization Behaviors Among Transgender And Gender Independent Individuals, Kyle L. Mason

Theses and Dissertations

Healthcare inaccessibility through direct exposure (i.e., personal) to myriad forms of gender identity-related discrimination and erasure among the Transgender and Gender Independent (TGI) population has been documented by prior studies. The myriad barriers that individuals who embody TGI identities encounter to accessing healthcare are associated with the underutilization of healthcare, which may further exacerbate the health disparities that exist between this population and cisgender individuals in the United States (U.S.). Although the impacts of the harm that direct exposure to healthcare discrimination and erasure may have on TGI individuals are known, their exposure to such harm vicariously (i.e., through observation …

Climate Change As A Social Determinant Of Health: An Interactive Case-Based Learning Activity, Arindam Sarkar, Nital P Appelbaum, Rathi Asaithambi, Connie Tran, Doris Lin, Anjali Aggarwal, Stephanie Nguyen

Faculty, Staff and Students Publications

INTRODUCTION: Despite consensus on climate change's impact on humans, medical schools have not widely adopted inclusion of environmental topics into their mandatory curriculum. This educational activity explicitly addresses climate change as one of the environmental determinants of health (EDH).

METHODS: We developed a required, 1-hour module for all first-year medical students. This interactive, case-based, small-group activity was incorporated into a curriculum within an advising program but could be run independently. Before and after the session, participants completed evaluations assessing knowledge gains and attitude shifts.

RESULTS: Of 183 first-year students, 155 completed both pre- and postmodule surveys. Participants' rating increased on …

The Maternal And Infant Environmental Health Riskscape Study Of Perinatal Disparities In Greater Houston: Rationale, Study Design And Participant Profiles, R Jeanne Ruiz, Kristyn Grimes, Elizabeth Spurlock, Angela Stotts, Thomas F Northrup, Yolanda Villarreal, Robert Suchting, Melissa Cernuch, Liza Rivera, Raymond P Stowe, Rita H Pickler

Faculty, Staff and Student Publications

BACKGROUND: Pregnant Mexican Americans (hereafter called Latinas) and Black/African American women are at increased risk for psychological distress, contributing to preterm birth and low birthweight; acculturative stress combined with perceived stress elevates depressive symptoms in Latinas. Based on our prior research using a psychoneuroimmunology framework, we identified psychological and neuroendocrine risk factors as predictors of preterm birth in Latina women that are also identified as risk factors for Black/African American women.

METHODS/DESIGN: In this prospective, randomized controlled trial with parallel group design we will explore psychosocial, neuroendocrine, and birth outcome effects of the Mastery Lifestyle Intervention (MLI). The MLI is …

Exome Array Analysis Of 9721 Ischemic Stroke Cases From The Sign Consortium, Huichun Xu, Kevin Nguyen, Brady J Gaynor, Hua Ling, Wei Zhao, Patrick F Mcardle, Timothy D O'Connor, O Colin Stine, Kathleen A Ryan, Megan Lynch, Jennifer A Smith, Jessica D Faul, Yao Hu, Jeffrey W Haessler, Myriam Fornage, Charles Kooperberg, On Behalf Of The Trans-Omics For Precision Medicine Topmed Stroke Working Group, James A Perry, Charles C Hong, John W Cole, Elizabeth Pugh, Kimberly Doheny, Sharon L R Kardia, David R Weir, Steven J Kittner, Braxton D Mitchell, Sign Consortium

Faculty, Staff and Student Publications

Recent genome wide association studies have identified 89 common genetic variants robustly associated with ischemic stroke and primarily located in non-coding regions. To evaluate the contribution of coding variants, which are mostly rare, we performed an exome array analysis on 106,101 SNPs for 9721 ischemic stroke cases from the SiGN Consortium, and 12,345 subjects with no history of stroke from the Health Retirement Study and SiGN consortium. We identified 15 coding variants significantly associated with all ischemic stroke at array-wide threshold (i.e., p < 4.7 × 10-7), including two common SNPs in ABO that have previously been associated with stroke. Twelve of the remaining 13 variants were extremely rare …

Racial Disparities In Physician And Non-Physician Health Professionals: Investigating Barriers For Pre-Professional Students, Emily Remer

Honors Projects

“Diversity” is a buzzword across today’s educational, professional, and office settings. With so many looking to “diversify” their fields, it is important to note the endless ways in which people are diverse. From culture to religion to age to gender to race, and the intersectionality of them all, there has been a push to increase diversity as a means to better serve individuals in minority groups. While all forms of diversity are important, as is their intersectionality, the purpose of this project is to focus on racial disparities. There is no question that racial disparities exist across many roles we …

Acid Attacks: An Overview Of Legal Measures And Motivation Trends In India, Pakistan, Bangladesh, Colombia, And Cambodia, Gaia Calcini

Dignity: A Journal of Analysis of Exploitation and Violence

Vitriolage is a form of widespread violence around the world. This research analyzed legislative measures against the practice adopted by India, Bangladesh, Pakistan, Colombia, and Cambodia. The strengths and weaknesses of the different legal systems were examined. Motivational trends on why the violence was committed were reviewed in the literature in these countries. It was found that acid attacks are a form of gender-based violence. Countries where the measures were adopted to prevent attacks but failed to achieve the goal did not consider the attacks as a part of a broader problem. The only country that seems to have achieved …

Assessing Treatment Access, Medication Use, Caregiver Strain And Emergency Service Use In Families Of Youth With Autism, Emmaline Thorpe

Psychological Science Undergraduate Honors Theses

Background: Families with autistic youth utilize emergency services (e.g., police, emergency department) at greater rates than neurotypical peers. While research has recently explored this phenomenon, unknowns remain in how pharmaceutical, therapeutic, family (e.g., caregiver strain), and child factors (concurrent challenging behaviors) may influence the likelihood of this population resorting to emergency care. Method: The current study recruited caregivers (N = 55) of youth with autism and co-occurring challenging behaviors (ages 2 – 22) to complete an online survey regarding their use of emergency services, child medication and therapy, and caregiver strain. Caregivers were compensated for their time. Results: Outcomes revealed …

The Impact Of Having Foreign Domestic Workers On Informal Caregivers Of Persons With Dementia: Findings From A Multi-Method Research In Singapore, Qi Yuan, Yunjue Zhang, Ellaisha Samari, Anitha Jeyagurunathan, Tee Hng Tan, Fiona Devi, Peizhi Wang, Harish Magadi, Richard Goveas, Li Ling Ng, Mythily Subramaniam

Research Collection School of Social Sciences

Background: Informal caregivers of persons with dementia (PWDs) sometimes engage foreign domestic workers (FDWs) to support their caregiving journey. However, there has not been much research to establish if this is really beneficial. The current study aims to investigate whether engaging FDWs specifically for caregiving of PWDs truly moderates caregiver stress and to explore caregivers’ experiences of engaging FDWs. Methods: A multi-method study design with a quantitative and qualitative sub-study was adopted. For the quantitative sub-study, 282 informal caregivers of PWDs were recruited. Propensity score matching analysis was used. For the qualitative sub-study, 15 informal caregivers with FDWs were interviewed. …

Examining Effective And Realized Healthcare Access In The West South Central Division., Katherine Cameron

Electronic Theses and Dissertations

This study explores realized and effective access domains outlined by Andersen’s Behavioral Model of Health Services Use. Exploring other domains of access is critical to understanding how the healthcare system functions (Kirby & Yabroff, 2020). This study evaluates rural-urban and racial/ethnic differences in access to care using two underresearched domains of healthcare access. It also allows for exploring access disparities within rural communities amongst minority populations. This dissertation is divided into five chapters. Chapter One provides an overview of health disparities and inequities and a brief overview of the study. Chapter Two details a high-level history of racism and its …