Introduction: The purpose of this study was to examine the impact of disability status and social determinants of health (SDOH) on adherence to breast and cervical cancer screening recommendations among women.

Methods: A secondary analysis of data from the 2020 Behavioral Risk Factor Surveillance System was conducted. Adherence to screenings was defined according to the United States Preventive Services Task Force guidelines for breast and cervical cancer screening. The analysis included respondents assigned female at birth, aged 50 to 74 years old (breast cancer screening) or aged 21 to 65 years (cervical cancer screening), resulting in a sample population of 11,023 respondents. Logistic regression models were used to evaluate variations breast and cervical cancer screenings, considering different disability statuses and SDOH (health insurance coverage, marital status, and urban residency).

Results: Adjusted analysis revealed associations between disability status and SDOH and being current with mammogram and Pap smear screenings. When adjusting for SDOH, respondents with a disability were less likely to be current with mammograms (aOR 0.71, 95% CI: 0.55-0.91) and Pap smear screenings (aOR 0.61, 95% CI: 0.48-0.77) compared to those without disabilities. Respondents living outside urban areas as well as respondents earning ≤$25,000 annually had lower odds of being up to date with both screenings.

Conclusion: The findings of this study highlight the intricate relationship between disability status and SDOH and their impact on breast and cervical cancer screening rates amid the COVID-19 pandemic. Public health strategies that acknowledge and address these disparities are crucial.

Introduction:

Among the many challenges of the COVID-19 pandemic was the rapid shift to telehealth. Although some studies have examined gender or other demographic disparities in telehealth utilization, most have relied on samples of patients belonging to one healthcare system and therefore are not generalizable to the larger U.S. population. Additionally, there has been little attention paid to how social statuses may interact to influence telehealth utilization.

Methods:

Using data from the U.S. Census Bureau’s nationally representative Household Pulse Survey, this study analyzes gender differences in rates of recent telehealth utilization and the likelihood of utilization by telehealth modality (audio-only, video-enabled, or utilization of both audio and video). Using an intersectional framework, this study also examines how gender and disability status interact to affect odds of telehealth utilization.

Results:

Results show that transgender adults had the highest rates of any telehealth utilization and the highest rates across each modality. Disability status moderated the effect of gender on telehealth utilization; specifically, reporting a hearing disability decreased the likelihood of telehealth utilization for transgender adults.

Discussion & Conclusion:

While at first glance results that show high rates of telehealth utilization among transgender adults may mean improved access to these services for historically marginalized populations, results from interaction analyses suggest that this improved access and subsequent utilization is not universal. Gender minority adults who have other structurally marginalized identities, such as being physically disabled, continue to face barriers to utilizing telehealth services despite expanded access during the pandemic.

Inadequate medication literacy among the Deaf population contributes to challenges

accessing and understanding health information. Of ongoing concern are language

and communication barriers to understanding prescription labels – a situation which

can contribute to unintentional medication misuse or non-use with potentially

adverse consequences for those who already experience sub-optimal health

outcomes. Within this context, the aim of this exploratory study was to gain an

understanding of medication literacy among Deaf adults as reected in medication

information-seeking behaviors, practices, and preferences. In 2022 a total of 101

Deaf ASL users, who picked up a prescription within the 12 months prior, completed

an online survey, which focused on identifying (1) sources of medication information

sought, accessed, used and (2) relative importance of different elements of

medication-related information - dosage, timing, purpose, directions for use, and side

effects. Responses from interviews conducted in 2020 informed these questions.

Survey ndings: 65.5% of participants reported searching online for new medication

information - most often on WebMD or Medscape, 24.5% sought details from a

physician, but only 18.7% relied on prescription label information. Participants also

cited dosage, purpose, and brand name recognition as most important medication

information. These insights will inform the development of a web-based assessment

tool, designed to measure levels of medication literacy relating to understanding and

using information provided on prescription labels. The more we understand about

medication literacy within this population, the better we are able to advance

interventions to support equitable access to understandable and actionable

medication information for improved outcomes.

Background:Parkinson’s Disease (PD) causes impaired walking and affects patients’ emotional well-being. Regular exercise and exposure to enriched environments are crucial to managing symptoms. This systematic review extracted evidence from studies regarding built environment impacts on reducing PD progression.

Methods:We used a combination of Creswell’s “literature map” and Maxwell’s “concept map” to identify terms related to effects of the built environment on PD. Keywords (e.g., biophilic design, enriched environments, environmental psychology, interior and landscape architecture, PD) were used in four databases (PubMed, Web of Science, UGA Library, and Google Scholar) from 2005 to 2022 to extract information regarding enriched/friendly-environments and the use of virtual reality in PD management, environmental psychology role and indoor/outdoor issues for PD management, and physical activity and walking effects on PD.

Results:116 articles were classified based on the five main categories above. 48 studies emphasized physiotherapy and training for physical enhancement. Some others highlighted advantages of non-slip flooring and accessible outdoor spaces. Only 13 articles considered emotional and environmental psychology impacts (e.g., stress indicators, landscape quality, visual art and aesthetics, walkability and safety index) of built environments, showing a considerable gap in research evaluating both psychological and physical perspectives of Parkinson’s-friendly environments.

Conclusion:This study identified wide-ranging criteria for designing environments that promote well-being. Exposure to enriched environments and nature demonstrated a positive effect on improvement of PD conditions. Biophilic design principles, universal design motifs, and environmental psychology theories were also found essential in this area. More research is needed to evaluate environmental design that decreases PD progression.

Background

To date, there is a dearth of literature investigating the potential utility of psychosocial approaches in stroke rehabilitation. This review explores theoretical foundations and influences of psychosocial resources on rehabilitation outcomes in stroke survivors with chronic communication disorders. The authors explored the existing literature to determine what factors characterize psychosocial resilience and interventions that indicate potential facilitation of psychosocial resilience among adult stroke survivors with communication disorders.

Methods

The inclusion criteria for the review were structured using population (stroke survivors with communication disorders in the U.S.), concept (psychosocial resilience), and context (life participation) framework. The research team devised a search strategy, querying CINAHL, Embase, PsycINFO, PubMed, Rehab Data, Scopus, and Web of Science databases. The final search was limited to articles published in English. Citations were exported to Covidence review management software. Title and abstracts will be screened by three independent reviewers for relevance. Full-text article screening will be conducted following the same process. A data extraction table will be generated using Covidence.

Results

Test search results yielded approximately 800 references for screening. The review is currently in the screening stage and the results will be presented thematically. It is expected that the results will encompass characteristics and predictors of psychosocial constructs relevant to disability and health-related conditions, as well as interventions that target these constructs.

Conclusions

This scoping review is expected to synthesize findings in the existing literature and to clarify concepts on psychosocial resilience as it relates to stroke outcomes for individuals with communication disorders.

Corporate wellness initiatives are pivotal for employee well-being and company productivity. Professionals' demands for improved work-life balance, enhanced health benefits, and a more laid-back organizational culture have increased. This study encompassed surveys and interviews with 45 Charlotte employees, aiming to discern preferences for wellness programs, evaluate existing company culture, and comprehend job-related stress. The survey, fashioned after the National Institute for Occupational Safety and Health’s Quality of Worklife Questionnaire and contemporary literature, facilitated data collection. A two-sample t-test scrutinized the correlation between wellness culture aspects and job stress. Respondents were categorized by reported wellness culture attributes, like high-pressure work beyond established hours versus low-pressure. Outcomes underscored key insights. Job stress varied dependent on work modality, gender, and age. Specifically, company cultural norms such as pressure to exceed regular work hours and work-life encroachment exhibited statistically significant contribution in job stress. In conclusion, this research underscores the importance of tailoring corporate wellness programs to accommodate specific demographics and unique company culture needs. By pinpointing the influences on job stress, organizations can formulate targeted strategies to amplify employee well-being and contentment, ultimately fostering a healthier and more productive work culture.

The objective of the present study is to propose an experimental technique to assess the effect of glove stretch on the barrier performance of a variety of intact medical glove materials. Methods: We improved a consensus method by incorporating domed shaped screens into the penetration cell, which enhances the detection of failures for glove integrity. Two screen types and three glove materials were selected to compare the barrier performance of unstretched and stretched glove specimens and the performance of various glove materials. Fluorometric analysis was used to detect fluid challenge with fluorescent dye in the recovery buffer to indicate barrier failure. Results: In the visual inspection method, 5 sample failures were found (5.68%; n=88) regardless of test condition. All three glove materials provided similar results and were not significantly different. The differences in failure rates between stretch and unstretched gloves were insignificant. By dividing the detected fluorescent concentrations into groups: above LOQ, between LOD and LOQ, the domed-shape screen provided greater sensitivity to assess glove barrier performance between the LOQ and LOD when glove was in a stretched state (18.18%) compared to the unstretched state (2.27%). The fluorometric method demonstrated a better detection sensitivity (AUC=0.848) compared to visual inspection method (AUC= 0.608). Conclusions: The present study confirms not only previous observations that nitrile examination gloves are a suitable alternative to the latex but also adds to the literature showing the use of a fluorescence agent and a fluorometric spectroscopy may provide an improved detection mechanism compared to visual penetration.

Background: Occupational injury remains a high cause of morbidity among non-English language preference (NELP) individuals in the United States (U.S). A retrospective review conducted at a hospital in the Southeast demonstrated that nearly all NELP patients hospitalized for an injury were Spanish-speaking. The purpose of this study was to explore occupational injuries for NELP individuals including access to workplace safety and knowledge of their federal labor rights under the Occupational Safety and Health Act (OSHA).

Methods: We conducted four semi-structured interviews with Spanish speaking patients admitted to an urban Level 1 hospital for occupational injuries. An interview guide was utilized and interviews were conducted in Spanish, recorded, transcribed, and translated into English. A codebook was developed iteratively and transcripts were double coded. Interviews will continue until thematic saturation is reached and data will be analyzed using a thematic analysis approach.

Results: Preliminary analysis reveals major themes related to the workplace environment and perceptions of safety. All participants reported working in hazardous environments that resulted in an injury yet were interested in returning to work quickly. Participants expressed a relative acceptance of hazardous work and minimized these hazards and the severity of the injury sustained. Participants were unfamiliar with OSHA requirements and their rights as workers.

Conclusions: We identified several themes related to occupational injury, many of which raise concerns about re-injury and long-term recovery. Future efforts should focus on developing hospital based resources to enhance workplace safety, knowledge of workers’ rights, and injury prevention strategies.

Issues: In the last 10 years alone, over 15 million liters of crude oil have been spilled into the environment in Nigeria’s Niger Delta region, comprising six states. This longstanding issue has led to monumental destruction of the environment, potential deterioration of the health of over 30 million citizens in the region, as well as destruction of aquatic life in the region.

Description: The study assesses the participation of the faith community and their role in health advocacy in a region that has been suffering from severe environmental health issues. In its theoretical framework, the study is anchored on the Functional Theories of Religion, an approach with postulations from notable scholars like Karl Marx and Sigmund Freud. The Niger Delta houses the largest concentration of Christians in Nigeria; hence this research employs a case study design in assessing the role played by the church, in actively advocating and fighting against long existing health issues caused by spillage in the region. It includes cancer, respiratory issues, liver damage, decreased immunity, etc.

Recommendations: The study recommends that faith communities should deploy its societal influence to initiate and deepen their advocacy for healthier communities. Also, it recommends that faith communities should pursue greater collaboration with relevant stakeholders like the media, traditional rulers, etc. to increase their impact.

Background: Nitrogen dioxide (NO₂) and particulate matter (PM) are known air pollutants that impact health outcomes especially for vulnerable populations with respiratory diseases such as asthma.

Objective: Identify factors influencing indoor NO₂ and PM in low-income housing of older adults with asthma.

Method: Participants were adults aged ≥55yrs, cook with gas stoves and live in low-income housing in Lowell, Massachusetts. Environmental sampling included measuring NO₂, PM, stove use, temperature, and humidity for 5 -7 days. Questionnaires were used for data collection on factors that influence indoor NO₂ and PM concentrations. Outdoor NO₂ and PM2.5 concentrations were obtained from the United States Environmental Protection Agency (EPA). Paired t-test was conducted between indoor and outdoor NO₂ and PM2.5, and linear regression was used to predict the factors influencing indoor NO₂ and PM 2. 5.

Results: Environmental sampling was conducted in 70 homes between December 2020–July 2022. The average indoor concentration for NO₂ and PM2.5 were 28.90ppb and 30.5µg/m³ respectively, they both exceeded EPA standards. Indoor NO₂ and PM2.5 exceeded outdoor concentration significantly. Factors that influence indoor concentrations of NO₂ were stove use and season, and for PM2.5 were season, air freshener use 6-7 days/week and gas station within 1/2mile.

Conclusion: Gas stoves contributed significantly to indoor NO₂ but not PM2.5. Winter had higher concentrations of indoor NO₂ and PM2.5 which may be due to reduced ventilation. With indoor concentration of NO₂ and PM2.5 exceeding outdoor levels and EPA standards, it is important to identify sustainable interventions to reduce indoor NO₂ and PM2.5.

Background: The food service industry has long-standing inequities, further exacerbated over the past years due to recent events like COVID-19. These inequities have led to disparities in health outcomes, financial insecurity, and resource deprivation, steadily increasing the precarious work conditions and environments that are permeated with worker disempowerment. The objectives of this study are to understand the experiences of worker disempowerment and the impact on the worker's health and well-being and overall job satisfaction.

Methods: In Minnesota, we conducted semi-structured interviews with 15 food service industry workers—who worked in front-of-house, back-of-house, and managerial positions. Interview questions examined work schedules, perceived discrimination and bias, voice in the workplace, and health and well-being. All interviews were recorded, transcribed, and analyzed using NVivo 14.

Results: We identified a parent theme of 'Worker Disempowerment', described as times when workers feel that their voice is not heard or decisions that will impact them are made without their consent. The following subthemes were identified under this parent theme: 'Discrimination and Bias', 'Harassment', 'Power Imbalance', 'Retaliation or Fear', 'Unfair Treatment', and 'Voice in the Workplace'. Participants reported that these experiences of disempowerment have adversely affected their 'Health and Well-Being', 'Job Satisfaction', and 'Job Retention'.

Conclusion: This pilot study highlights experiences of disempowerment and its perceived effects among marginalized food industry workers. These experiences can lead to a worker leaving their place of employment or the industry altogether. Findings will assist in developing strategies or policies to promote a healthy work environment.

Background: The association of cognitive decline and blood pressure (BP) categories has not been well studied after the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline came out. Sex difference in cognitive decline is unclear.

Objectives: This study aimed to examine the longitudinal associations and trajectories between cognitive decline and BP categories defined by the 2017 ACC/AHA guideline and to explore sex differences in cognitive decline trajectories in each BP category.

Methods: The Atherosclerosis Risk in Communities is a longitudinal cohort study (1987-2018). 10,456 of 15,792 participants (female 55.5%) were included in the analysis with a median follow-up time of 22.2 years. BP was measured at 6 of the study visits and was categorized as normal BP (n = 930), elevated BP (n = 853), hypertension stage 1 (n = 1,142), and hypertension stage 2 (n = 7,531). Linear mixed-effects models were used for cognitive scores over time. Baseline and most recent cognitive assessment were included in the analysis.

Results: Stage 2 hypertension participants showed the fastest decline per year in executive function (-0.401, 95% CI: -0.409, -0.392), language (-0.109, 95% CI: -0.120, -0.099), and global cognition (-0.335, 95%: -0.344, -0.326). Females across all BP categories experienced a significantly faster decline in executive function per year than males, with the greatest difference in elevated BP (-0.071, 95% CI: -0.071, -0.073).

Conclusions: Participants with stage 2 hypertension experience the fastest cognitive decline rate. Women have a faster decline rate in the executive function domain in all BP categories than men.

Background- Exclusion of patients with prior cancer from clinical trials is common but not evidence based, potentially affecting enrollment for rare cancers like male breast cancer (BC). Limited evidence exists on the impact of prior cancer on outcomes in male BC.

Objectives- To examine the effects of prior cancer on overall and BC-specific survival in men newly diagnosed with BC between 2011-2015 using population-based data from Surveillance, Epidemiology, and End Results Program.

Methods- We estimated prevalence of prior cancer of a different type amongst men with BC. We modeled sub-distribution hazard ratio using the Fine and Gray method to quantify the effects of prior cancer on overall and BC-specific specific survival. We accounted for competing risks of death due to other causes.

Results- Among 1932 men diagnosed with BC during 2011-2015, 226 had prior cancer of a different type. We observed 670 deaths from any cause, with 291 attributed to BC. Median survival time was 5.2 years. In the adjusted Cox models, men with prior cancer had worse overall survival (HR=1.5, 95% CI: 1.2, 1.9) compared to those without prior cancer. We did not observe statistically significant difference in BC-specific survival between the two groups.

Conclusions- These findings emphasize the need to consider prior cancer history when making clinical trial participation decisions. Further research is warranted to better understand the impact of prior cancer on outcomes in male BC, enabling informed decisions for both patients and investigators regarding trial enrollment, especially in the context of rare cancers.

Introduction:

Chronic Kidney Disease (CKD) is a degenerative condition that impacts an estimated 37 million people nationwide. Without treatment, CKD can progress to renal failure; however, this disease can be prevented through health promotional outreach and screenings. Although, most CKD studies utilize state-level analyses or cohort-based foci, smaller geographies such as census tracts may serve as functional units to study the relationship between socioeconomic status (SES) and CKD prevalence in Orange County, FL (OC). Smaller geographies can also better inform targeted intervention strategies.

Methods:

American Community Survey 2015-2019 data were compiled, and seven SES predictor variables were selected. These data were combined with the Behavioral Risk Factor Surveillance System PLACES 500 Cities Project 2017-2019 dataset to collect estimated CKD prevalence by census tract. Data were filtered to reflect only census tracts in OC. Multiple linear regression analysis using census tracts as units of measurement were conducted.

Results:

Out of the 1.3 million individuals among 206 census tracts, the mean CKD prevalence was 2.97%. Six out of the seven variables were of moderate to strong correlation, and all were statistically significant at F(7,198) = 80.124, p < 0.001, R² = 0.732.

Conclusion:

This findings from this study highlight the potential for socioeconomic variables to serve as sentinel indicators to identify census tracts of higher CKD within OC. These data may inform potential targets for disease prevention and health promotion such as screenings or nutritional outreach.

Background: Emerging research suggests links between gut microbiome (GM) disruptions and depressive disorders. Akkermansia muciniphila, GM bacteria, has been studied for its potential antidepressant effects. However, its role in mediating the association between metal exposures and depression in childhood is not known.

Objectives: This study aims to identify associations between prenatal metal exposure, A. muciniphila, and depression in children 9-11 years old.

Methods: Data come from the Programming Research in Obesity, Growth, Environment, and Social Stressors (PROGRESS) cohort. Maternal whole blood samples were drawn during the second and third trimesters of pregnancy to measure prenatal metal concentrations. Stool samples were collected at 9–11 years of age and underwent metagenomic sequencing to comprehensively assess the GM. Children’s Depression Inventory (CDI) was administered at 9-11 years. We used adjusted linear models, Weighted Quantile Sum (WQS) regression to estimate the individual and mixtures associations, and a nonparametric bootstrap approach to estimate proportion mediated.

Results: Of the 112 children, A. muciniphila was detected in 24%. Presence of A. muciniphila was associated with a significantly decreased log-transformed, t-score normalized CDI score (log-tCDI) (beta=-0.13, 95%CI=[-0.21, -0.04]). WQS analysis indicated that exposure to a mixture of metals in the second trimester was associated with significantly increased log-tCDI (beta=0.06, 95%CI=[0.01,0.10]). A quartile increase in this metal mixture was associated with decreased odds of A. muciniphila (OR=0.54, 95%CI=[0.23, 1.24]). The presence of A. muciniphila mediates this association between the metal mixture and log-tCDI by 25%.

Conclusion: A. muciniphila mediates the association between prenatal metal exposure and childhood depression.

Background: Polysubstance drug use is a driver of morbidity and mortality. We characterized present-day polysubstance behavioral patterns in the general adult population, beyond diagnosed substance use disorders (SUD).

Methods: From a 2022 nationally representative survey, we defined polysubstance use as last 12-month use of ≥2 drugs (n=15,863). Latent class analyses included medical (as indicated) and non-medical (not as directed) use of prescription opioids, stimulants, benzodiazepines, and antidepressants; recreational use of cannabis, psilocybin/mushrooms, other psychedelics, cocaine, methamphetamine, and illicit opioids; and concomitant (simultaneous) use with alcohol, cannabis, prescriptions, or recreational drugs.

Results: The national prevalence of polysubstance use was 20.96% (95%CI:20.57-21.36). The four observed profiles were:

• Medically Guided Use (prevalence: 11.52%): Medical use across multiple prescribed drugs, half used cannabis, but no concomitant use. 6% estimated to have a SUD.
• Principal Cannabis Use Variety (4.0%): Cannabis users with variety of other prescription and recreational drugs concomitantly used with alcohol as well. 32% were estimated to have a SUD; 8% received treatment.
• Self-Guided Use (3.34%): Non-medical use of prescriptions sourced from providers and elsewhere, and concomitant use with alcohol or other prescriptions. 14% were estimated to have a SUD.
• Indiscriminate Co-exposures (2.07%): All four types of concomitant drug use with indiscriminate drug preference. 60% were estimated to have a SUD; 23% received treatment.

Conclusions: In 2022, 1:5 adults used multiple drugs. The profiles show there are adults with untreated SUDs, and two previously unrecognized classes. Prevention/treatment strategies addressing polysubstance use should take a precision health perspective and tailor to individuals’ use profile.

Background: Knowledge of decedent characteristics associated with methadone involvement in unintentional drug overdose deaths can help to inform efforts to intervene these deaths. ML models with existing data, offer a cost-effective means to help create effective interventions. We aim to develop an optimized ML algorithm for predicting methadone involvement in unintentional drug overdose deaths using data from Illinois's State Unintentional Drug Overdose Reporting System (SUDORS).

Methods: We utilized IL SUDORS 2019-2021 data for training (n = 8391) with selected indicators To address the we applied the Synthetic Minority Oversampling Technique (SMOTE). Next, we assessed various machine learning models, including logistic regression, support vector machine, random forest, neural network, and ridge regression. Model performance was evaluated using metrics such as accuracy, precision, area under the precision-recall curve (AUPRC), .

Results: Utilizing separate training (n = 11,067), validation (n = 2,371), and test (n = 2,372) datasets, the Random Forest Model outperforms all other models with 95% accuracy, 96% precision, 92% recall, and a 0.98 AUPRC. Notably, these outcomes were achieved using primarily demographic indicators.

Conclusion: This study demonstrates the potential of machine learning models in predicting methadone involvement in unintentional drug overdose deaths and, by extension, contributing to the knowledge base needed for the prevention of these deaths. Leveraging SUDORS data, the Random Forest Model exhibited exceptional performance, highlighting its value for healthcare professionals, prevention and harm reduction specialists, and policymakers.

Background: Some people who inject drugs (PWID) have shifted from injecting to smoking fentanyl in the U.S., which requires further exploration. We studied trends in heroin, fentanyl, and methamphetamine injecting and smoking over a three-year period in San Diego, CA.

Methods: We analyzed longitudinal cohort data from semi-annual surveys conducted between 2020-2023. We examined whether participants smoked or injected each drug over five six-month periods and whether they used these drugs more frequently by smoking or injecting. We used multivariable Poisson regressions via generalized estimating equations with robust standard errors and time as the primary predictor.

Results: Among 362 participants, mean age was 42.5 years, and most identified as male (71.5%), non-Hispanic (55.1%), and were unhoused (67.1%). Heroin and methamphetamine use decreased overall from period 1-5. Relative to period 1, fentanyl injection was stable from period 2-4, then decreased in period 5 (adjusted relative risk [aRR]=0.43, 95% confidence interval [CI]: 0.25, 0.72). Fentanyl smoking increased significantly in period 3 (aRR=1.44, 95% CI: 1.06, 1.94), 4 (aRR=1.65, 95% CI: 1.24, 2.20) and 5 (aRR=1.90, 95% CI: 1.43, 2.53). Smoking heroin and methamphetamine more often than injecting increased across all periods, while smoking fentanyl more often than injecting only increased significantly in period five (aRR=1.80, 95% CI: 1.39, 2.33).

Conclusions: PWID in San Diego reduced heroin and methamphetamine use, particularly injection. Fentanyl injection also decreased, giving way to smoking. Increased access to safe smoking supplies is warranted, as are prospective studies to determine if these trends translate to reductions in overdose.

Background: The national prevalence of stroke among US adults is lower than that of Middle Tennessee, highlighting the need for outpatient stroke rehabilitation (OSR) in this region. Certification of OSR can contribute to greater reliance on evidence-based stroke treatments and improved patient outcomes. Accordingly, we sought to assess the availability of OSR in Middle Tennessee and determine if certification of facilities is associated with the offering of OSR.

Methods: We identified 73 facilities in this region by scraping Google Maps with the keywords “stroke,” “rehabilitation,” and “outpatient.” Facility information was derived via phone calls and website navigation. We calculated odds ratios to determine if there is an association between certification and OSR availability in Middle Tennessee.

Results: Around 32% of counties in Middle Tennessee have facilities offering OSR services, and 29% of counties have facilities that are certified. Furthermore, the odds ratio suggested that certified facilities in Middle Tennessee are 7.5 (95% CI: 2.1-26.7) times as likely to have OSR than facilities that are not certified. The most widely available OSR services in this region were physical, occupational, and speech therapy (respectively 29%, 27%, 24% of counties) and patient and family education (22% of counties).

Conclusions: Our results indicated that the overall availability and variety of OSR services are limited in this region with a clear association between facility certification and the offering of OSR. These findings suggest a greater focus towards expanding OSR availability across Middle Tennessee, while meeting evidence-based stroke care guidelines is warranted.

Background: Stroke occurs when blood flow to the brain is interrupted or reduced. Outpatient stroke rehabilitation (OSR)is integral to helping stroke survivors return to everyday life but may be unavailable in rural areas. The State of Tennessee has a high stroke prevalence among US States with 93% of the state being rural. This study sought to evaluate access to OSR availability in rural versus urban areas in East Tennessee.

Methods: OSR facilities were identified by scraping Google Maps using the words “stroke”, “rehabilitation”, and “outpatient”. These facilities were contacted over the phone or email to ensure that the business was a confirmed stroke rehabilitation facility and still open. Counties were labeled either rural or urban based on the Rural-Urban Commuting Area Codes. Odds ratios were calculated to assess the association between rural/urban county status and OSR availability in East Tennessee.

Results: There was a total of 58 facilities in East Tennessee. Results showed that 60% of rural counties offer OSR while 56% of urban counties offer OSR. Our odds ratio (1.20 (95% Cl: 0.29-4.82)) indicated there was no statistically significant difference between the availability of OSR between rural and urban counties.

Conclusions: While OSR availability did not differ between rural versus urban counties, additional efforts are needed to determine if the availability of specific OSR services differs between rural and urban counties in this region. Furthermore, further studies should examine availability under different criteria (i.e., affordability, accessibility to transportation).

Background: Evidence connecting temperature, air pollution, and dementia is limited and heterogeneous. People with dementia may be more vulnerable to these environmental factors due to their existing comorbidities and cognitive and mobility limitations.

Objectives: To quantify the short-term associations between temperature, NO2, O3, PM2.5, and SO2 and dementia-associated hospital admissions within Alberta, Canada.

Methods: Health data were from the Discharge Abstract Database and the Ambulatory Care Reporting System. Daily counts of dementia-related health events (Jan 1, 2009 to Dec 31, 2019), were linked to daily mean air pollutant concentration data (NO₂, O₃, PM_2.5, SO₂) from the National Air Pollution Surveillance program and daily mean temperature (֯C) and precipitation (mm) from Oak Ridge National Laboratory’s Daymet data. We employed time-series regression with zero-inflated negative binomial modeling to assess environmental exposure links to daily dementia-related health events. Analyses were stratified by health zones (Calgary, Central, Edmonton, North, and South), which represent five geographically-distinct administrative areas across Alberta.

Results: After adjusting for seasonality and seven-day lag effects, higher levels of NO₂ were associated with higher counts of dementia events in all health zones except the North zone (IRR_Calgary=1.041 95%CI=1.028,1.053; IRR_Central=1.056 95%CI=1.033,1.079; IRR_Edmonton=1.032 95%CI=1.013,1.048; IRR_South=1.038 95%CI=1.002,1.074; IRR_North=1.021 95%CI=0.986,1.057). Conversely, higher O₃ levels were associated with lower dementia counts in the Calgary zone (IRR_Calgary=0.992 95%CI=0.987, 0.998). Results for the temperature, PM_2.5 and SO₂ models were largely non-significant across health zones.

Conclusion: This study presents limited evidence linking air pollutants with dementia-related health events. Future research will involve stratifying exposures by ecological zones and wildfire season.

Background: Chronic Obstructive Pulmonary Disease (COPD) mortality rates in rural Appalachian counties are 55% higher than in urban counties within this region. While prior literature substantiates smoking cessation to be the most effective treatment for COPD patients, information on whether contemporary levels of smoking differ by rural/urban residence status among individuals with COPD in Appalachia is unavailable. Accordingly, our study compares smoking continuation patterns in rural vs urban Appalachian residents living with COPD.

Methods: Our study uses 2020 Behavioral Risk Factor Surveillance system data from adults in the Appalachian region (Alabama, Georgia, Kentucky, Maryland, Mississippi, New York, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Virginia, West Virginia) with COPD. We determined the prevalence of current smokers by rural/urban residence. Logistic regression was used to calculate an unadjusted odds ratio (OR) and an OR adjusted for potential confounders (age, race, sex, education level, health insurance status, and ability to afford healthcare).

Results: The study included 9,034 individuals (11.5% rural residents). Additionally, 40% of rural and 38% of urban residents reported being current smokers. Both the unadjusted OR (0.91, 95% CI: 0.75-1.10) and adjusted OR (0.98, 95% CI: 0.79-1.22) indicated no significant association between rural/urban residence status and smoking continuation patterns in Appalachians with COPD.

Discussion: While smoking continuation patterns in Appalachians with COPD appear to have no association with rural/urban residence status when adjusted for confounding variables, a large percentage of COPD patients in this region continue smoking after diagnosis, increasing their risk for COPD complications.

Objective. To assess information from non-adverse event complaints received by the United States Food and Drug Administration (FDA) regarding products labeled as containing cannabis.

Background. Unlike mandatory submission of serious adverse events required by law, complaints are voluntary and involve concerns unrelated to such health events. Complaints may identify alleged problems ranging from unsafe manufacturing practices (i.e., unsanitary conditions) to health claims (i.e., cures cancer). Consumer complaints help inform FDA recalls and warning letters; however, lack of consistent cannabis industry regulation leaves consumers vulnerable.

Methods. We analyzed data from complaints submitted to the FDA between 1/1/2018 and 5/4/2023 to characterize product concerns, forms of cannabis, and reporter demographics.

Results. The 109 complaints cited single or multiple concerns involving fraudulent health claims [n=33 (30%)], legality [n=33 (30%)], improper manufacturing [n=29 (27%)], and mislabeled content [n=20 (18%)]. The complaints indicated cannabidiol or hemp [n=85 (78%)], cannabis/tetrahydrocannabinol (THC) [n=16 (15%)], delta-8 THC [9, (8%)], and/or other minor cannabinoids [n=5 (5%)]. Of 86 complaints mentioning specific products, gummies/candies were most frequently noted ([n=30 (35%)]. Consumers [n=87 (80%)] and current/former company employee whistleblowers ([n=10 (9%)] submitted most complaints. Women submitted 22 of the 55 (40%) complaints that included gender information.

Conclusions. Effective reporting of complaints is essential for the FDA’s surveillance efforts. The FDA monitors complaints and takes actions to safeguard public health as novel cannabinoids continue entering the market. Given a ~2% reporting rate in the FDA's passive surveillance system, future analyses should address underreporting for better public health protection.

Background: Reducing incidence rates of cardiovascular disease in children for communities at risk is a public health priority. Previous research has shown that cardiovascular disease correlates with obesity and elevated amounts of epicardial adipose tissue (EAT) in children. Investigating how EAT varies based on socioeconomic factors during childhood will provide insight into how culture shapes human biology.

Methods: EAT was collected for 289 pediatric decedents aged six months to 15 years who lived and died in New Mexico between 2011 and 2019 using 3D Slicer. EAT volume was z-standardized by sex and age (zEAT). Linear regression was done with zEAT as the dependent variable and the independent variables including race/ethnicity, sex, age, housing type (proxy for socioeconomic status), obesity, fatty liver disease (FLD), and whether a county is rural/urban, or food insecure.

Results: Results of linear regression show that EAT is significantly higher in those who lived in manufactured homes, as compared to brick-and-mortar or apartment style homes, and that EAT is lower in those with FLD.

Conclusion: Housing type was used as a proxy for socioeconomic status (SES) here. Manufactured housing has no equity, as the value depreciates over time, so they act as a proxy for lower SES. The relationship between higher amounts of epicardial adiposity in children that live in manufactured homes is a potential public health concern due to these individuals being at greater risk of cardiovascular disease. Additional research is needed to discover the potential effect of other socioeconomic effects on EAT.

Background:

Antenatal depression (AD) is one of the most common pregnancy complications. Recent studies indicated that immune responses during pregnancy may contribute to development of AD.

Objectives:

This study aimed to identify possible inflammatory biomarkers in early pregnancy to predict maternal depressive symptoms before delivery.

Methods:

This case-control study was conducted within the Maternal and Infant Health (MI-Health) birth cohort (Beijing, China) and depressive symptoms were assessed by Zung Self-rating Depression Scale (SDS) in both second and third trimesters. By using immune multi-factors kits, we tested 26 inflammatory factors in the serum of 38 cases with antenatal depression symptoms in both trimesters (SDS≥53) and 38 controls. Logistic regression was used to identify candidate biomarkers, and the predictive capabilities were evaluated by using Receiver Operator Characteristics (ROC) analysis.

Results:

The concentrations of ln(CCL24) (p=0.020), IL-7 (p=0.006) and IL-10 (p=0.014) were higher in early pregnancy among women with depressive symptoms comparing to healthy controls. The difference remained statistically significant after adjusting for maternal age, education level, gestational diabetes mellitus, pre-pregnancy BMI and gestational weeks of blood sampling (OR(ln(CCL24))=4.625, OR(IL-7)=1.414, OR(IL-7)=1.151). In ROC analysis, ln(CCL24), IL-7, and IL-10 achieved discrimination for depressive symptoms antepartum, with the values of AUC estimated at 0.75. Among 58 linked offspring, IL-7 is negatively associated with head circumference.

Conclusion:

Higher levels of CCL24, IL-7 and IL-10 may indicate a higher risk of antenatal depression and are potential biomarkers indicating the pathogenesis of antenatal depression and intergenerational effects.

BACKGROUND: Human anthrax infection is rare in the United States with <5 cases annually but can be deadly without treatment. Caribbean areas without widespread livestock vaccination have reported higher incidences of human anthrax infection. In December 2022, the United States Virgin Islands Department of Health (VIDOH) was notified of blood cultures with suspected B. anthracis growth that were obtained from a patient with neck cellulitis, who later died of disseminated intravascular coagulopathy. VIDOH launched an investigation to confirm the causative agent and coordinate response.

OBJECTIVES: Describe the investigation of a travel-associated cutaneous anthrax case in the United States Virgin Islands (USVI).

METHODS: VIDOH identified close contacts through case interviews and medical record reviews and provided evaluation for symptoms. Polymerase Chain Reaction (PCR) and Whole Genome Sequencing (WGS) were conducted for confirmation of causative agent and origin characterization.

RESULTS: VIDOH identified 19 hospital employees and 4 family members as close contacts and provided postexposure antibiotics. No additional community cases identified as of July 2023. PCR testing confirmed B. anthracis was the causative agent. WGS data revealed the isolate likely originated in Haiti.

CONCLUSIONS: We confirmed a travel-associated case of cutaneous anthrax in USVI. Rapid confirmation allowed prompt identification, treatment, and monitoring of close contacts. As a Caribbean island, this investigation highlights the need for maintaining public health partnerships and improving access to care for emerging infectious disease surveillance and response in the USVI. VIDOH used associations with local and mainland partners to respond to a public health threat quickly and successfully.

Background: The consumer food environment is filled with increased exposures to unhealthy foods and beverages, often disproportionately impacting low-income communities. Less is known about whether consumers in different social neighborhoods and stores have the same kind of information and opportunities when making beverage choices and how this might vary across product healthfulness. In this project, we examined differences in the presence of sales and point-of-sale price information for water and sugar-sweetened beverages across different neighborhood and store characteristics.

Methods: Data on point-of-sale price tags and sale presence for beverages were collected by observational store assessments from 150 randomly-sampled small food retailers (i.e., gas-marts, convenience stores, dollar stores, pharmacies) in Atlanta, GA during Spring 2022. Store characteristics included the store’s ownership model (independent v. corporate/franchise) and whether U.S. Supplemental Nutrition Assistance Program (SNAP) benefits were accepted. Neighborhood socioeconomic status of each store was mapped to census-tract income from U.S. Census Bureau’s American Community Survey.

Results: Compared to higher income neighborhoods, small food retailers located in the lowest median income neighborhoods were significantly less likely to display prices for water, soda, and energy drinks as well as had fewer sales for water and energy drinks (P≤0·05). In addition, compared with SNAP-retailers, non-SNAP retailers were less likely to display prices for water (P≤0·05). Similar results were found across store ownerships.

Discussion: Our findings suggest that consumers shopping in more advantaged communities and retailers are receiving more complete point-of-sale price information and favorable deals for healthy beverages than those shopping in more disadvantaged locations.

Background: Low-income African-American women are at highest risk for hypertension. Although the Dietary Approaches to Stop Hypertension (DASH) diet significantly reduces hypertension risk, dietary adherence is a major barrier. This study aims to evaluate how currently available DASH recipes perform in terms of cultural relevance and economic feasibility for this marginalization population in the U.S. South.

Methods: An integrative literature review to identify DASH recipes tailored for African Americans was conducted using various databases and government, academic, and professional websites. Recipes were evaluated based on a 2-point scale for three criteria, i.e., cultural relevance, economic feasibility, and DASH conformity.

Results. Several recipes, such as smothered greens, jumpin’ jambalaya, spicy okra, candied yams were culturally-appropriate and used soul food ingredients (e.g., okra, mustard greens). In terms of economic feasibility, several recipes cost greater than maximum benefit allotments suggested by the USDA Thrifty Food Plan for the Supplemental Nutrition Assistance Program (SNAP) benefits. To reduce recipes costs, example adjustments included registered dietitian-led investigations of and substitutions with accessible, low-cost, culturally appropriate substitutions for high-cost ingredients in existing DASH recipes.

Conclusions: There is a need for accessible resources that provide practical steps and tools in improving culturally relevance and reducing cost for better DASH diet adherence. Findings will be used to create an accessible, culturally-adapted, low-cost DASH diet resource with recipes for low-income African-American women, verified by a registered dietitian-led team. This project has a potential to improve current DASH diet literature and further reduce hypertension racial and economic disparities among target population.

Background: Despite the many benefits of school meals, not all students participate. A reason for non-participation may be that children instead purchase food from nearby outlets (e.g., fast-food restaurants, convenience stores). We examined whether school participation in the Community Eligibility Provision (CEP), which allows qualifying schools to serve free meals to all students, moderated associations between the community food environment around schools and student meal participation.

Methods: We employed a longitudinal repeated-measures design using data collected between 2014 and 2020 within four low-income school districts (n=126 schools). We obtained meal participation data from state records and created a measure characterizing the community food environment within 0.25-miles of schools (low-density environment/high-density environment) through latent class analysis. Regression models for panel data estimated associations between community food environments, CEP participation, and participation rates in school breakfast and school lunch, assessed in separate models.

Results: Among non-CEP schools, school breakfast participation was predicted to be 5% lower in high-density environments than in low-density environments (P-value=.03), while there was no difference in participation by the community food environment among CEP-participating schools. Differences in breakfast participation by the community food environment among non-CEP schools were mostly attributable to middle/high schools, with 13% lower predicted participation in high-density environments than in low-density environments (P-value<.001). No moderating effect by CEP participation was detected for school lunch participation.

Conclusions: Associations between community food environments and school breakfast participation differed by CEP participation, suggesting that policy actions to increase program reach may benefit students—particularly older children and adolescents.

Background:

College food insecurity (CFI) is a huge public health issue, with the prevalence of food insecurity on college campuses ranging from 10% to 75%. Majority of CFI research is quantitative which provides valuable statistics but does not capture the actual experience of CFI. This study utilized the narratives of food insecure college students to gain a deeper understanding of the phenomena of CFI.

Methods:

Semi-structured phenomenological interviews with 22 college students who self-identified as food insecure were conducted at a large Southern university, resulting in 371 pages of single-spaced transcription. A thematic analysis revealed three themes related to the experience of CFI.

Results:

Themes included (1) Mental Health Outcomes, (2) Physical Health Outcomes, and (3) Academic Performance Outcomes. Theme 1: Participants described how CFI causes “constant mental turmoil,” anxiety, and depression. Theme 2: Participants shared physical effects of CFI such as “getting sick all the time,” being “malnourished,” and “gain[ing] weight.” Theme 3: Participants detailed how CFI affects academic performance with statements such as “there’s no way you would study when you’re not eating well” and “I can’t really be present [in class] because I’m in pain.”

Conclusions:

Participants detailed the negative mental health, physical health, and academic performance outcomes related to CFI, unveiling the realities of CFI in a way that even comprehensive quantitative surveys cannot. This qualitative data can be used in conjunction with quantitative data to stress the severity of CFI and push for interventions that better address the needs of food insecure college students.

Background: Food insecurity, known as a lack of consistent access to adequate food to meet individual’s basic needs, has been associated with adverse health outcomes including obesity. But little is known about its effect on gestational weight gain (GWG). We aimed to determine the association of food insecurity with gaining weight more than guidelines during pregnancy.

Methods: Eligible participants were recruited if pregnant women were more than 34 weeks' gestation and attended Shahid Akbarabadi Hospital for prenatal care. Cases and controls were selected based on the rate of GWG. Short form of the Household Food Security Scale was assessed in 182 women with excessive (case) and 182 women with adequate GWG (control). Data on physical activity and food intake were also collected. Logistic regression analysis was performed to explore the odds of excessive GWG adjusted for age, overnight sleep, physical activity, energy and energy-adjusted macronutrients intakes.

Results: Based on univariable analysis, more than 1.5-fold increased risk of excessive GWG was associated with food insecurity without hunger (OR=1.71,95%CI:1.06-2.75). Multiple logistic regression showed that compared to food security, food insecurity with hunger in pregnant women was not significantly associated with excessive GWG (OR=1.32,95%CI:0.62-2.79). However, food-insecure pregnant women without hunger were significantly at higher risk for excessive GWG (OR=1.92,95%CI:1.13-3.27) compared to food-secure women.

Conclusions: Our findings suggest that food insecurity without hunger is associated with a greater likelihood of excessive GWG. Thus, those who are insecure without hunger are the target group to receive interventions to gain weight according to guidelines during pregnancy.

The University of South Alabama Student-Run Free Clinic (USA SRFC) is a multidisciplinary student-led initiative designed with the purpose of enhancing wellness amongst underserved populations in Mobile, Alabama. Being a student-run free clinic, services are entirely self-funded, which means donations are an integral part of the clinic’s operations to support all the programs continually offered, along with regular clinic maintenance. With an annual operating budget of $14,000, a method has been strategically designed to maximize fundraising targets.

The clinic operates largely on a three-tier system that focuses on different donor populations. The first-tier fundraisers focus on targeting the student population through restaurants and food-based fundraisers. Members aim for 2 of these fundraisers a semester, usually netting between $200-$400. Second-tier fundraisers are larger and require more coordination on the front end, usually in the form of expenses and personnel. Once a semester, the clinic alternates between an apparel-based fundraiser and annual 5K race. These events usually net between $1000-$3000. The third-tier fundraiser is the most high-impact fundraiser, focused on partnering with stakeholders and influential members of the medical and philanthropic community. This past year, this event netted $25,000.

With each fundraiser, the goal is to provide a clear message regarding the financial need and local impact that the clinic provides. In 2023 alone, over $30,000 was raised for the clinic, surpassing the yearly budget. The goal is to continue to build upon this foundation so that the clinic can continue to grow, update, and add additional services to this population.

Background

Recently, emergency departments have implemented patient voter registration, often using registration staff. While this results in increased civic engagement, there is little data exploring the impact of these programs on the staff implementing them.

Methods

An anonymous 9 question four-point Likert scale survey was created to address personnel opinions around whether patients’ health could be improved with increased voter registration access, whether voter registration was appropriate in healthcare, and if staff would find this task burdensome. A convenience sample was obtained during business hours. The data was analyzed as a whole.

Results

22 surveys were distributed. The majority agreed that the government plays a direct role in patients’ health, that patients’ health could be improved with better voting access, that registering patients to vote would be rewarding, that registering patients would have a positive impact, and that registering patients is appropriate in the hospital setting.

The majority disagreed on a role for hospital workers in helping patients register. Around half stated that patients would not accept being asked about voter registration and that registering patients would be burdensome.

Conclusion

The staff agreed on the positive impact of increasing registration access by helping patients register to vote, but felt the hospital should not play a role in it. This may be due educational deficits in this area and presents educational opportunities on public policy in healthcare.

The perceived increased burden may be due to understaffing in the ED. We suggest investigating staff-facing barriers that oppose helping patients register to vote.

Background: In an ever-evolving healthcare landscape, effective healthcare administration and management are essential for ensuring the delivery of high-quality care, optimizing resource utilization, and achieving improved patient outcomes. This research aims to explore the key strategies and ethical considerations in healthcare administration, particularly in the context of emerging challenges and opportunities.

Methods: This study employs a comprehensive approach to investigate healthcare administration and management strategies. We analyze existing literature, case studies, and interviews with healthcare leaders to identify trends, best practices, and ethical dilemmas. Participants include healthcare administrators, policymakers, and experts in the field. We employ qualitative content analysis to extract meaningful insights.

Results: Our research reveals critical insights into the current state of healthcare administration and management. We identify emerging trends in leadership, the impact of technology on healthcare delivery, and the ethical considerations surrounding resource allocation and patient care. Notable findings include the increasing importance of data-driven decision-making and the role of diversity and inclusivity in healthcare leadership.

Conclusions: The main outcome of this study is a comprehensive understanding of the strategies and ethical considerations essential for effective healthcare administration and management in the future. By addressing the identified trends and challenges, healthcare leaders can better prepare for the evolving healthcare landscape and navigate the complexities of healthcare delivery while upholding ethical standards. This research contributes to the ongoing conversation about the future of healthcare administration and its pivotal role in shaping the quality and accessibility of healthcare services.

Background: Sickle cell disease (SCD) is an inheritable non-communicable disease endemic in Sub-Saharan Africa (SSA) where 80 percent of people globally with the disease live. Access to hydroxyurea, an integral medication for managing SCD, remains a challenge but whether African media cover this medication is unknown. This study sought to assess media coverage of hydroxyurea in terms of themes, namely use for SCD, access, policy and side effects.

Method: Articles published in English up to February 28, 2023, in SSA were searched from LexisNexis and NewsBank databases. Search terms included (hydroxyurea) and (sickle cell disease). Out of 309 articles screened, 143 were eligible. Two coders analyzed the contents independently with inter-rater reliability kappa values ranging from 0.7 to 1. Descriptive statistics and chi-square tests were used to analyze frequencies and associations, respectively using SPSS version 27.

Results: The year 2019 had the highest number of articles (31), followed by 2020 (30) with 57 articles based on events. Also, Ghana had the highest number of articles (n=42). There were significant associations between country of newspaper and mentioning policy (p= 0.042) or side effects (p= 0.002) but not use (p=0.704) and access (p=0.065). Also, there were significant associations between event-based articles and mentioning access (p=0.003), or policy (P<0.001) but not side effects (p= 0.08) and use (p= 0.172).

Conclusion: There is a need to improve media coverage of hydroxyurea in SSA. This could empower patients and caregivers to make informed decisions on SCD and advocate for interventions to improve access to hydroxyurea.

Background

Tuberculosis (TB) is a significant health concern in low-resource countries like Haiti. Machine learning (ML) can aid in its early detection. However, most algorithms trained on data from lower TB-burden countries may underperform due to domain shifts. We aimed to describe a sample of individuals treated for TB in Haiti to inform ML algorithm optimizations.

Methods

We conducted a cross-sectional study between January 2021 and June 2022. Categorical variables were summarized using counts and percentages, and quantitative variables using the median, first and third quartiles, and standard deviation. Student t-test was used to compare patients' mean age and weight based on their diagnostic test results in both the entire sample and an adult subgroup. Fisher's Exact test was employed to explore the relationship between gender and test results.

Results

A total of 458 individuals were treated for TB, with 60% being males and 40% females. The median age and weight were 32 ± 15 years and 51 ± 16 kg, respectively. Most patients had GeneXpert-detected Mycobacterium tuberculosis (97.65%), while 76.92% culture-detected. Additionally, 3% showed Rifampin resistance. In the adult subgroup, a statistically significant difference in mean weight was observed between patients with and those without Rifampin resistance (t value = 2.04, p = 0.04).

Conclusion

Reporting demographic data in public datasets can address sex and racial disparities and avoid inconsistent performance. Therefore, ML algorithms training in Haiti should consider disease presentation in a younger population, circulating multidrug-resistant TB (MDR-TB), and the association of low weight with MDR-TB.

Background:

The incidence of elder abuse among women in India has significantly increased over the past 15 years, raising concerns about their physical and emotional wellbeing. This study provides a concise, integrated review of elder abuse and neglect in India, combining qualitative and quantitative studies on the relationship between elder abuse and various risk factors and/or consequences. It examines the significance of social acceptance and gender norms in shaping older women's experiences of violence, as well as the health impact of physical and mental exposure to violence. Additionally, it explores gender disparities, particularly among elderly women, aiming to inform enhanced protection and well-being strategies for older individuals in India.

Methods:

We systematically searched PubMed, SCOPUS, and Web of Science, and screened 131 articles, and ultimately included 39 articles. Themes include aging and abuse intersection, abuse experiences, and the impact of social acceptance and gender norms on violence.Searches of the indexed, published literature with no date limitation were conducted in the PubMed/MEDLINE, SCOPUS, and Web of Science online databases.

Findings:

Prevalence of violence against those who were single/widowed and older Indian women was high, impacting physical and mental well-being. Higher socioeconomic status was associated with less abuse. Chronic co-morbidities increased the odds of abuse. The need for further high-quality studies is evident to fully characterize factors associated with abuse, highlighting the urgency of targeted policy reforms and comprehensive research to effectively address elder abuse in India.

Background: The global burden of mental illness has been historically understudied. Due to a wide gap in existing literature, more qualitative research on the general social media impacts on health is needed to describe culturally-specific social media interactions in the context of American Samoa.

Objective: This study aims to understand the meaning of social media engagement among Samoan adolescents and its current role in their mental health behaviors.

Methods: This secondary qualitative analysis applied an interpretivist approach and alignment with the Fa’afaletui Pacific framework. Phenomenology methods were used to “bracket” researcher biases. A 21st-century flexible coding approach proposed by Deterding et al. 2021 was applied to the dataset. Transcript excerpts were re-sorted by the index code: social media/technology as a predictor of mental illness. An abductive thematic analysis was used to analyze the codebook and construct themes.

Results: The final indexed sample consisted of 18 key informants (>18 years) and 20 adolescents (13-18 years). Among the 20 adolescents, 11 were female (55%) and 9 were male (45%). Thematic analysis synthesized three themes: (1) messages communicated on social media, (2) influences of Americanization and Fa’asamoa, and (3) social media fostering connectedness.

Conclusion: Both KIs and Samoan adolescents described social media as a “double-edged sword” that could cause both positive and negative effects on adolescent mental health. Regulation and cultural sensitivity can potentially leverage social media as a tool in future health delivery. Findings from this study may be disseminated to inform school-based mental health policies.

Significance: The global tobacco crisis is evolving across countries, with continued health consequences. In 2010, the tobacco industry introduced cigarettes with flavor capsules in the filter to the Mexican market, with increasing market share annually. In this context, we aim to estimate the prevalence of flavored capsule and unflavored cigarette use at the intersection of four social identities.

Methods: We used the 2018-19 Mexican National Health and Nutrition Survey to estimate the prevalence and proportion of flavored capsule and unflavored cigarette use at the intersection of age (15-19, 20-34, 35-54, 55+), sex (male, female), wealth (low, medium, and high), and geographic region (south, center, north). All estimates were displayed using a visualization tool.

Results: The highest smoking prevalence was among male, low-wealth-adults aged 20-34 living in the north at 42.1%, and about a half of their use was of flavored capsule cigarettes (FCC). The second highest prevalence was among male, low-wealth-adults aged 20-34 living on the center (40.0%), and about a third of their use was FCC. While the prevalence of smoking was lower among female adults, the proportion of FCC use was higher. For example, the prevalence of smoking among female high-wealth adults aged 20-34 living in the north of Mexico was 18.6%, and about three quarters used FCC.

Conclusions: Our study reveals the groups of the population that are disproportionately affected by the use of flavored capsule cigarettes in Mexico. This information can be useful for policymakers to implement tobacco control policies to reduce smoking in these groups.

Menstrual health and hygiene (MHH) research has mainly focused on women and girls, with limited evidence on how transgender and non-binary (TNB) individuals manage their menstruation. This study aims to document the lived experiences of MHH among TNB people in urban India.

Using a qualitative approach, we conducted 13 semi-structured telephonic interviews with TNB adults aged 19-40 years in three major Indian metropolitan cities. Eleven participants identified as transmale, one as non-binary, and one as male/intersex. The interviews covered various aspects of life, such as home, school, workplace, and other public spaces. The researchers recorded, transcribed, and de-identified the interviews before conducting thematic analysis.

We identified three major themes: gendering of menstruation, navigating physical aspects of menstruation, and challenges beyond bleeding. The gendering of menstruation shaped the overall experiences of MHH among participants. Many participants reported having no knowledge about menstruation before menarche, which left them in a state of confusion, shame, and dysphoria. Managing dysphoria was a significant challenge of managing periods. Navigating physical aspects of menstruation was less challenging in familiar, private surroundings. However, accessing public spaces remained a major challenge and stressor. Despite participants undergoing hormonal replacement therapy (HRT) to suppress menstruation, they continued to experience menstrual symptoms, which continued dysphoria. Participants reported facing challenges beyond bleeding, including the burden of multiple diseases, accessing gendered healthcare services, and lack of social support.

Documenting the lived experiences of MHH among TNB people is a crucial step towards "de-gendering" menstruation and enhance their overall well-being.

Background: A sincere effort called the "Hope and Medicine Project" seeks to solve urgent public health problems in rural Ghana. It strongly aligns with the conference theme, which underscores the importance of surmounting social and ethical challenges in our pursuit of a healthier nation.

Methods: We worked closely with the neighborhood communities to provide comprehensive health education, health screenings, and critical medical services. We had the honor of connecting with two isolated communities and having a significant impact on 447 people's lives. We carefully examined the data gathered to determine the project's efficacy, placing a focus on the communities' increased empowerment and better health.

Results: This extensive public health project had outstanding results. Participants' understanding of healthcare was greatly increased, which helped with early disease diagnosis and better health outcomes. In addition to these accomplishments, our study also looked into more general public health issues, such as handling workforce changes during pandemics, improving access to healthcare, and addressing social determinants of health.

Conclusions: "Bringing Hope and Healthcare to Rural Ghana: The Hope and Medicine Project" is proof of the effectiveness of neighborhood-based public health programs. Because of its successes, it is now more important than ever to address global health inequities, fight for the underserved, and strengthen the public health workforce. We hope to spark meaningful debates about solving social and ethical challenges in our common journey toward a healthy country by sharing the knowledge and understanding obtained via this program.

Background

Climate change is one of several drivers of recurrent outbreaks and geographical range expansion of infectious diseases in Europe and beyond.

Methods

We identified references for this Health Policy paper by searching the PubMed database to identify peer-reviewed articles, published between January 2012 and December 2022.

Results

We propose a framework for the co-production of policy-relevant indicators and decision-support tools that track past, present, and future climate-induced disease risks across hazard, exposure, and vulnerability domains at the animal, human, and environmental interface. This entails the co-development of early warning and response systems and tools to assess the costs and benefits of climate change adaptation and mitigation measures across sectors, to increase health system resilience at regional and local levels and reveal novel policy entry points and opportunities. Our approach involves multi-level engagement, innovative methodologies, and novel data streams. We take advantage of intelligence generated locally and empirically to quantify effects in areas experiencing rapid urban transformation and heterogeneous climate-induced disease threats.

Conclusions

Our goal is to reduce the knowledge-to-action gap by developing an integrated One Health—Climate Risk framework.

Introduction. Engaging in physical activity (PA) such as walking can reduce morbidity and mortality in U.S. Veterans. Yet walking behaviors may depend on where Veterans live. This study assessed the influence of objective neighborhood walkability (ONW), as well as other individual and neighborhood level factors, on walking among New York City Veterans with overweight or obesity.

Methods. Home addresses were geocoded for a sample of 248 Veterans 18-70 years-old with a BMI ≥25kg/m² with a comorbidity or ≥30kg/m² without enrolled in the Goals for Eating and Moving study (2017-2022). Individual level variables (socio-demographics, PA self-efficacy) and neighborhood level variables (ONW, area deprivation) were aggregated by census tract. Logistic regression models estimated associations between these predictors and meeting national PA recommendations from walking. We also probed interactions between ONW and significant predictors.

Results. Neither ONW nor individual level socio-demographic predictors were associated with meeting PA recommendations from walking. The odds of meeting recommendations increased 4% (95% CI [1.02, 1.07]) as PA self-efficacy increased, but decreased 16% (95% CI [0.71, 0.99]) as area deprivation increased. An interaction was observed such that high PA self-efficacy offset negative effects of living in a below average walkable neighborhood (95% CI [1.01, 1.38]).

Conclusion. Whereas ONW alone did not influence Veteran walking behaviors, exploratory analyses found that individual level PA self-efficacy and neighborhood level area deprivation did. Furthermore, the interaction between ONW and PA self-efficacy suggests that Veterans with low PA self-efficacy living in neighborhoods with low ONW may benefit from additional clinical support.

Issues

Queer communities in the Middle East and North Africa (MENA) lack the terminology to describe issues pertaining to the community. This leads to stigmatization and the usage of hurtful language to describe the community, which leads to discriminatory policies.

Description

This project creates the first comprehensive Arabic dictionary containing LGBTQ+ terminology, notable Arab figures, and important events in the Arab LGBTQ+ community. Putting words to these processes and identities is an essential part of the process of LGBTQ+ liberation in the MENA region and is a way to promote social progress towards meaningful policy changes and the repealing of discriminatory laws.

Lessons Learned

It was found that the usage of language as a social change conduit is an unexplored field with much potential. The project has also led to many lessons in terms of international cooperation between researchers from stigmatized communities and living in exile and/or asylum in countries other than their home countries.

Recommendations

The dictionary is in the process of being uploaded online by different international Queer Arab organizations in order to increase access to Queer people in the MENA region. Activists living in the MENA region and facing discrimination are reviewing the dictionary and discussing important implementation techniques. It is difficult to push for social change in countries with negative connotations and stigmatization against minorities, and the usage of the dictionary showcases a novel way of moving towards social change in issues related to sexual minority health, maternal health and racial and ethnic health.

Background: During summer 2020, several stressors including police violence against people of color, anti-immigrant policies, and the COVID-19 pandemic heightened social and perinatal health disparities affecting Latinx-identified birthing people (LBP).

Objective: To describe the perspectives of LBP related to discrimination, anti-immigrant policies, and community violence affecting their perinatal experience.

Methods: We used thematic analysis to examine transcribed data from a subgroup of 26 semi-structured interviews of English- or Spanish-speaking, Medicaid-eligible LBP residing in Fresno County, California, and receiving prenatal care during the COVID-19 pandemic. Guided by theoretical frameworks of public health critical race praxis, intersectionality, and the political economy of health, we analyzed responses to questions about personal discrimination, the Black Lives Matter movement, and restrictive immigration policies.

Results: Three major themes were identified: sociopolitical (civic) disengagement due to fear for safety, passive support and empathy without active civic participation, and normalization/internalization of racism. Additional subthemes included the role of media and legal status in shaping perceptions and consequences of illicit behavior. Perceptions appeared heavily influenced by fear for safety, significance of law abiding, and expectations around unequal treatment.

Conclusions: The pervasiveness of fear and socioeconomic inequity associated with discrimination, anti-immigrant policies, and community violence can cause harm and influence access to healthcare for LBP; in the perinatal period the impact may be intergenerational. These findings contribute to our understanding of pathways between socioeconomic adversity and health outcomes. Importantly, they inform future research and interventions related to structural influences on perinatal health in the Latinx community.

Modifiable health behaviors play an important role on healthy ageing, especially for the prevention of chronic diseases. Due to household roles, individuals might have different experiences and outcomes depending on cohabitation status. The Dona Francisca Health Study was a 12-month randomized controlled trial conducted in southern Brazil that examined the feasibility of implementing a behavioral change program for older adults. Eight Community Health Workers (CHWs) were trained on program components (e.g., physical activity (PA), nutrition, and emotional wellbeing) and delivered the program for two years. We analyzed data on 649 participants (Mage= 62, 51.5% female, 70% married) on PA (International Physical Activity Questionnaire), eating habits (food frequency questionnaire), and body composition. Semi-structured interviews were conducted with participants (n=37) pre- and post-intervention. In a deductive analysis, cohabitant couples perceived more difficulties in dietary habit change due to their partner’s resistance to change certain items. PA was perceived more often as an individual choice, influenced by individual challenges. These results are confirmed by the quantitative findings. Multiple linear regressions were adjusted for age, sex, race and education. Results show that cohabitant couples are still more likely to eat items such as steak (p<0.001), fried chicken (p=0.015), condensed milk (p<0.001), desserts (p<0.01), and drink soda (p<0.01) after the intervention than their single counterparts. No linear associations were found for PA due to the intervention or cohabitation. Findings shed light on the importance of culturally tailored health promotion, providing solutions for both household and individual challenges for healthy diet and physical activity adherence.

Background: Depression is associated with cigarette use, but little is known about their daily relationship and whether disparities by sex and race/ethnicity exist. This study aimed to 1) estimate the association between daily depression and daily cigarette use, and 2) examine effect modification by the intersection of sex and race/ethnicity.

Methods: We used data from the 2020-2022 National Interview Health Survey on adults 18 years or older (n=83,472). To estimate the association between daily depression and daily cigarette use, we conducted logistic regression, adjusted for sociodemographic, health insurance, antidepressant use, and other tobacco use characteristics. We tested statistical interactions between depression, sex, and race/ethnicity and assessed effect modification by stratifying models by sex and race/ethnicity.

Results: Among the sample, 3.9% experienced daily depression and 9.0% smoked cigarettes daily. Adults with daily depression had higher odds of daily cigarette use in the adjusted model. Single stratified models showed that depression was associated with higher odds of cigarette use for Hispanic, non-Hispanic (NH) Black, and NH White adults, but not NH Asian adults and adults who identified as another race/ethnicity and both females and males. In fully stratified models, NH Black male (OR: 2.03, 95% CI: 1.19-3.47), NH White male (OR: 1.79, 95% CI: 1.44-2.21), and NH White female (OR: 1.74, 95% CI: 1.45-2.08) adults with daily depression had higher odds of daily cigarette use.

Conclusions: Daily depression is linked to daily cigarette use in the US adult population and among certain sex and racial/ethnic groups, including NH Black men.

Women of color had the highest rates of unmet mental healthcare needs during COVID-19. This qualitative study address how this period impacted their access and utilization of services. These first-person narratives provide much needed context for policy makers and researchers when designing programs aimed at addressing social determinants of health and the mental health needs of vulnerable and racially diverse communities.

Non-probability purposive sampling was used to recruit a homogenous sample of Black, Asian, Latina, Southeast Asian, Middle Eastern, and multi-racial women who sought mental health care during COVID-19. Eight women were interviewed using a semi-structured interview tool and analyzed using Narrative Analysis. This methodology centers the voices of racially diverse women who are systematically silenced in the U.S.

Participants discussed how COVID and racism created both a need and opportunity to engage in therapy. The physical distance from predominantly White institutions, provided protection from having to engage with White colleagues who forced conversations on race and racism. These microaggressions caused more racial harm, which prompted looking for therapy. Participants were intentional in finding therapists of color, despite longer wait-times, because of racism from previous White therapists. Participants also enjoyed the flexibility of telehealth which reduced barriers to accessing services.

The complexity of interpersonal and structural racism experienced by these participants can inform policy and challenge existing assumptions about community needs. How mental health care providers address racism and their own implicit biases must be a priority area of change because the ongoing traumatization of communities of color is unethical.

Background:

In the United States, elevated levels of anxiety and depression post-COVID-19 are a critical concern due to their impact on illness, job loss, and financial instability.

Objective:

This study analyzed the association between social determinants of health and the severity of depression/anxiety.

Methodology:

This study used data from the 6^th waive of Health Information National Trends Survey (HINTS) (N=5,122), conducted from March 7 to November 8, 2022. The dependent variable was the depression and anxiety scale score (survey variable PHQ4) score, recoded as none, mild, moderate to severe. The independent variables are race, gender, age, living in an urban area, lack of transportation access, and household income. Multinomial regression analysis was conducted.

Results:

Approximately 37% of the respondents had mild, moderate, or severe anxiety/depression. Females (RRR=1.39, CI; 1.10-1.75) had a higher risk of mild anxiety/depression (vs. males). Non-Hispanic Blacks (RRR= 0.66, CI;0.45-0.97) had a lower risk of mild anxiety/depression compared to Whites. Adults 18 years and older were less likely to have anxiety/depression.

Respondents with transportation difficulty had a higher risk of mild (RRR=2.40, CI;1.65-3.48) and moderate to severe anxiety/depression (RRR=3.99; CI=2.87-5.53). However, urban residents (RRR=0.62, CI; 0.43-0.89) and having a household income of $20,000-<$35,000 (RRR= 0.53, CI; 0.28-0.99), $50,000- <$75,000 (RRR=0.55, CI; 0.31-0.98) and >$75,000 and above (RRR= 0.39, CI; 0.22-0.71) were less likely to have moderate to severe anxiety/depression (p<.05).

Conclusion:

Public health intervention targeted at social determinants of behavioral health may reduce the severity of anxiety and depression and improve health outcomes.

Background:

In 2019, studies show that older adult were more likely to be hospitalized due to the coronavirus disease (COVID-19) and were prioritized to be vaccinated when vaccines became available. However, vaccine hesitancy has long been a public health challenge. It is imperative to explore the association between religiosity and COVID-19 vaccine hesitancy among older American adults.

Method:

Data were taken from the Health and Retirement Study (HRS), a national representative of Americans aged 50 or over, and the HRS participants selected were N=4432. Vaccine hesitancy was measured by the single item, “How likely are you to take the coronavirus vaccine when it becomes available to you? Responses were recoded to “very likely,” and “not likely.” Religiosity was measured by the frequency of attending religious services and a count of self-report chronic diseases was summed up to measure comorbidity.

Results:

Results from Logistic regression showed that HRS participants who attended religious service more than once a week expressed a higher hesitancy (OR=2.02 p<.05) in taking a COVID-19 vaccine if available. Compared to other races, the black participants had higher vaccine hesitancy (OR=2.49; p<.05) and lower odds of taking the COVID-19 vaccine if available. However, there was no association between the number of comorbidities and COVID-19 vaccine hesitancy.

Conclusion:

Our findings show that HRS participants who attended religious services more often had higher vaccine hesitancy towards COVID-19 vaccines. More studies are needed to disentangle the mechanisms linking religiosity and vaccine hesitancy among older adults.

Background

Mobile health (mHealth) interventions have shown promise in reducing sexual health disparities that disproportionately affect young Black women. To maximize the mHealth intervention format among this key population, it is imperative to elicit feedback during intervention development.

Methods

This study modified an evidence-based mHealth behavioral HIV risk-reduction intervention to include content about pre-exposure prophylaxis (PrEP) and a virtual peer support component. Three focus group discussions were held with Black women (ages 18-30) in North Carolina (n = 15). Analysts reviewed notes and transcripts for themes related to intervention content and format.

Results

The primary themes for intervention adaptation were tailoring, privacy, and gamification. Across group discussions, PrEP awareness was low. Participants emphasized centering young Black women when introducing PrEP by including population-specific statistics and peers sharing personal PrEP experiences. Discussions highlighted privacy as a strength of the virtual format, especially given stigma surrounding topics related to HIV. Participants described circumstances where it would be challenging for young women to use the mHealth application, which underscored the importance of offering tools to preserve privacy, such as chat features. There was strong agreement that augmenting game-like elements would encourage interest and engagement in the virtual peer support component.

Conclusions

Several key areas were identified that need to be prioritized for the mHealth intervention to better resonate with young Black women. Improving mHealth interventions by incorporating the voices of young Black women has the potential to leverage the intervention format more fully and ultimately contribute to ending the HIV epidemic.

Issue/Background: Inequalities in health and healthcare exist worldwide. The health of any individual is strongly affected by social factors at personal, family, community, and national levels. Smoking has been identified as the single biggest cause of inequality in morbidity and mortality between rich and poor people in many countries. This study is a descriptive assessment of the influence of socio-cultural factors on smoking during pregnancy, and its resultant health effects.

Description: Descriptive literature review is based on empirical original papers derived from samples of pregnant women with smoking habits and or histories.

Lesson Learned: There is overall consistency in literature about cigarette smoking as it follows a social class gradient in the USA and most developed countries. Beginning in youth, smoking initiation is positively correlated with being from a low-income household and performing poorly in school. While maternal smoking during pregnancy plays a major role on adverse postnatal outcomes, it may also culminate negatively with exposure to socio-cultural factors.

Recommendation: This study is an ongoing broad debate about the growing health concerns of socioeconomic inequality and its impact on health, more so, the addictive nature of cigarette smoking. This review strengthens the need to plan population health policies aimed at implementing educational programs to hopefully minimize this public health concern. Recommendations should be made to affected communities to avoid sources and enablers of smoking while pregnant.

Background: Black and Latine Americans experience the highest burden of HIV across U.S. racial and ethnic populations. Experiences of intersectional stigma and medical mistrust are key contributors to HIV-related disparities. Methods: We conducted 21 semi-structured interviews with Black and Latine HIV care consumers from November to December 2021 to explore perceptions of health care provider behaviors that increase or decrease HIV care consumers’ trust and mistrust, experiences of stigma, and behaviors and responses when experiencing medical mistrust. Conventional content analysis was conducted to derive meaning from the narratives shared by participants. Results: Participants expressed that provider behaviors that increase HIV care consumers’ mistrust (e.g., beliefs that healthcare providers and institutions do not genuinely care for patients’ interests, are not honest or have the competence to produce the best achievable results) include lack of person-centered care, lack of partnership in health decision making, perceived provider incompetence, lack of adequate follow-up to care, and . Perceived experiences of intersectional stigma and discrimination in healthcare included feeling judged and discriminated against by healthcare providers regarding HIV status and observing differential care outcomes and delayed care delivery by race and ethnicity. When they experienced medical mistrust, participants changed providers or engaged in self-advocacy. Conclusion: Findings can inform the development of provider-level interventions to address medical mistrust.

Keywords: intersectional stigma, discrimination, medical mistrust, HIV, Black/African American, Latine

Background: As Latina/o/x comprise a significant and rapidly growing population in the U.S., their access to and participation in healthcare are critical public health concerns. This study analyzes the prevalence in care utilization, preferred versus experienced levels of involvement in decisions, and potential obstacles across racial groups to reveal where disparities may exist.

Methods: An online survey assessed 760 adults’ (28.6% Latina/o/x, 71.4% Whites) respective frequencies and behavior in interacting with healthcare providers.

Results: Latina/o/x and Whites expressed similar desire to have a say in choosing their healthcare providers and making treatment decisions. However, Whites reported having a significantly easier experience than Latina/o/x in finding a provider, having a choice in selecting one, and participating in shared decision-making. Latina/o/x were significantly less likely to regularly see a primary care provider (65.6% Latinx, 78.7% Whites), dentist (37.6% vs. 69.5%), or optometrist (33.0% vs. 51.7%); the proportion of female participants who had visited a gynecologist indicated no racial difference (66.0% and 65.3%). Some of these differences were partially due to self-reported health literacy and English proficiency. Whites were more likely to have public insurance. While a higher ratio of Latina/o/x lived in urban area and Whites in suburban, they traveled on average about the same distance to see a doctor.

Conclusion: Latina/o/x’s cultural identities, custom, and language challenges could impact their healthcare choices and experiences. Our findings signaled larger systematic inequalities beyond structural differences. Future research could explore mediators contributing to variations in care-seeking behavior and disparities in healthcare participation or outcomes.

Background: This study investigated the variations in outcomes of MISSION, a multicomponent intervention for homeless individuals with Co-occurring mental health and substance use disorders (CODs) by baseline sociodemographic characteristics.

Methods: This analysis utilized data from a MISSION study involving 147 individuals who are homeless with CODs. Using multiple linear regression models, the study examined variations in pre-post changes in BASIS-32 scores at six months by selecting sociodemographic characteristics. BASIS-32 assessed the patient’s medical and psychiatric symptoms on six subscales (i.e., relation to self/others, depression/anxiety, daily living/role functioning, impulsive/addictive behaviors, psychosis, and total score) at baseline and 6-month post treatment.

Results: The participants included 74% men, 52% of age >=50y, 52% White, 22.5% Blacks and 21.1% Hispanics, 74% with high school education or less, and 7.5% experienced childhood homelessness. Pre-Post changes in BASIS-32 overall and sub-scales at 6 months differed significantly by childhood homelessness in addition to race, and marital status (not shown). After adjusting for sex, age, race and marital status as appropriate, persons experienced childhood homeless had less pre-post changes in relation subscale (-0.34 (95% CI: -0.39, -0.30), p<0.001), greater in depression/anxiety subscale (0.33 (0.28, 0.38), p<0.001), greater in daily living subscale (0.10 (0.05, 0.15), p<0.001), more in psychosis (0.20 (0.17, 0.23), p<0.001), and greater in total score (0.04 (0.001, 0.07), p=0.043). The scores did not differ by sex and age group.

Conclusion: The 6-month post treatment outcomes of MISSION varied significantly by patient childhood homelessness, race and marital status. Such variations should be further investigated.

Background: Internalized homophobia (IH) occurs when an LGB person adopts society's antigay sentiment and directs it toward themselves. Negative associations between IH and mental/physical health are well-established, as are mediators of these associations. However, the emergent psychosocial construct, LGBT community connectedness, has not been tested as a mediator of IH-health relations, despite theory and empirical work suggesting a potential mediation.

Methods: We used baseline, cross-sectional data (N=1,345) obtained online from the Generations data set, a multiwave project exploring health across generations of LGB individuals. IH was measured using a revised IH scale, community connectedness was measured using an internally-created scale, and the dependent variables were mental health (Kessler-6 score), physical health (number of health conditions), and healthcare integration (feelings surrounding healthcare utilization). Hayes' Process Macro was used to test a mediation model for each dependent variable.

Results: Results indicated a significant mediation of the IH-healthcare integration association by community connectedness. There also was a direct effect between IH and mental health, but no mediation by community connectedness. No direct or indirect effect of the IH-physical health relation was found.

Discussion: Community connectedness may explain the IH-healthcare integration. More IH may relate to less community connectedness, which may relate to less healthcare integration. Community connectedness may be a useful target for future public health interventions and public policy. Community health programs could aim to recruit and connect LGB individuals, while local/state/federal level policy should actively protect LGB individuals - which itself could promote community connectedness, increased healthcare integration, and ultimately improved health.

Mental health disparities continue to exist and at its core, disenfranchises marginalized populations. With the impact of COVID-19 and the increased discussions for the need for improved mental health services and care, as well as the urgent need for healthcare policies that cater to underserved populations, this study explored mental health seeking behaviors in 2021 from a nationally representative sample of Americans (n=19,555). Using the Andersen’s Healthcare utilization framework, we examined the associations between predisposing, Enabling and Need factors on mental health care utilization among a diverse population of US adults. This study also sought to identify some of the barriers to mental health use during the COVID-19 pandemic. Our research questions particularly addressed the associations between predisposing, enabling and need factors and mental health service use. Data used for analyses was derived from the 2021 adult sample of the National Health Interview Survey (NHIS). We estimated multivariate logistic regression models using SAS, accounting for complex design and multiple imputation procedures. Results indicated significant lower odds of using mental health services among older persons OR 0.94 [CI 0.91-0.98], being Black, non-Hispanic, Hispanic, or Asian, non-Hispanic OR 0.59 [CI 0.49-0.71], OR 0.44 [CI 0.37-0.50], and OR 0.36 [CI 0.28-0.46]) as compared being to non-Hispanic White, the uninsured OR 0.60 [CI 0.48-0.76] and have lower than a collegiate formal level education (OR 0.39 [CI 0.31-0.51]. Our findings suggest a need for improved policies and culturally relevant evidence-based interventions in improving mental health seeking attitudes and overall care specifically for underserved populations.

Background: The U.S. Surgeon General’s Advisory (2021) urges timely research and action to address the adolescent mental health crisis. Youth Participatory Action Research (YPAR) is a transformative approach that leverages youth expertise to spur positive social change.

Methods: The current study is an ongoing YPAR project led by a youth council (YC) in the central coast of CA, and supported by university allies. The YC identified youth mental health as their initiative, beginning in 2019. The YC used an anonymous online survey including a validated screener, scaled questions, and open-ended questions to gather data on peer mental health in Spring 2020 (n = 176) and 2022 (n = 243). Undergraduate researchers facilitated research design and data analysis workshops for the YC (e.g., coding qualitative data).

Results: Despite a statistically significant decrease in mental health risk between 2020 to 2022, 36% of high schoolers were still at risk for anxiety and/or depression in 2022. The research team identified a gap in participant’s awareness of mental health resources and likelihood to utilize resources. YC researchers successfully advocated for an additional school social worker and are continuing to use this data to inform activism within the local community.

Conclusions: YPAR can be an impactful tool for improving youth health. We include reflections on navigating the interdisciplinary team process, challenges and joys of community partnerships, and overcoming ethical challenges (e.g., IRB, power dynamics). Youth should be valued as leaders in creating a healthy nation via data-driven action for positive social change.

Background: Despite their increased risk of contracting, being hospitalized, and dying as a result of COVID-19, in December of 2020 35% of Black Americans surveyed stated they would “definitely/probably NOT” get vaccinated. By understanding where exactly this mistrust stems from, we may begin to rebuild trust in the COVID-19 vaccine and the medical system as a whole.

Methods: A sample of Black/African American residents of Georgia, 18 years or older, were recruited from February 2021 through October 2021. Each participant (n = 15) completed a survey and interview which measured attitudes toward the vaccine and the U.S. healthcare system. Data was coded to reflect larger themes of trust, mistrust, and ways to rebuild trust.

Results: History and racism in medicine—that persists systemically and interpersonally—were amongst the most cited mistrust codes. In terms of sources of trust, participants called upon Black physicians and seeing positive vaccine outcomes within their own circles. To rebuild trust, participants recommended community-based efforts to build connections with Black neighborhoods and networks to provide tailored, culturally specific education on the vaccine.

Conclusions: History and racism in the medical field today work synergistically to develop high levels of mistrust. Based on experiences of racism in medicine in combination with America’s sordid history, participants have not been given a reason to believe the medical industry works in their favor. Rebuilding trust will take time and systemic change rooted in accountability and acknowledgment of harm that has occurred both in the past and in today’s medical field.

Background:

Prior research has found that smoking cessation is associated with improved mental health outcomes, including reductions in depression, anxiety, and psychological.

Objective:

We hypothesized that not good mental health days is a contemporaneous factor associated with current and former smoking after adjustment for history of depression, access to medical care, and demographics.

Methodology:

Data from the 2020 Behavioral Risk Factor Surveillance System Survey were analyzed. Chi Square tests evaluated independence and univariate and multiple logistic regression quantified relative-risk ratios (RRRs).

Results:

Relative to those who never smoke, those who currently [RRR=1.99 (95% CI:1.69-2.35)] and formerly smoke [1.46 (1.28-1.66)] reported more history of depression and relative to zero not good mental health days, those reporting 1-14 days [1.24 (1.06-1.45)] or more than 14 days [1.63 (1.35-1.97)] have significantly elevated RRRs.

Marital status of widowed/separated/divorced; employment status of out of work/unable to work; educational level (high school); and no physical exam in >5 years contributed to having a current/former smoking status while student, female, black, or Hispanic individuals showed lowered RRRs for currently/formerly smoking.

Conclusion:

We have identified three contemporary population subsets that are at risk for smoking: those reporting depression and/or not good mental health days, those lacking social connectedness through employment, intimate relationships, or physician checkup, and those under age 35 who are more prone to mental health issues and are developing adult health habits. These findings during COVID isolation may prod public health efforts to design new or rejuvenate existing interventions to target and reach these at-risk groups.

Background:

The prevalence of childhood obesity and mental health challenges in the US has been steadily increasing over the past 15 years. There are multiple social and ethical challenges associated with addressing the need for effective, accessible interventions to treat childhood obesity and mental health, especially for low-income and communities of color, which are particularly affected by both of these public health crises.

Methods:

In preliminary work at an urban safety net hospital, surveys indicated that many primary care (PC) providers seek more behavioral health support in co-managing pediatric obesity. We ran an intensive, community-based pilot program led by a multidisciplinary team (PC, nutrition, behavioral health) which promoted whole body health, by integrating culturally focused nutrition guidance and behavioral health interventions. We implemented the program in one clinic with minority-identifying 9-13 year-olds. Evaluation included pre-post measures to assess parental stress, child wellbeing, and nutritional behavior, as well as qualitative interviews with families and providers.

Results:

Families who completed the group reported fewer familial stressors. Qualitative interviews with providers illustrated interest in continuing to partner across disciplines to improve access. Interviews with parents indicated that children shared knowledge gained, while children described positive engagement. However, the attrition rate was higher than expected.

Conclusions:

Successful implementation of pediatric obesity programs for children in under-resourced settings requires increased coordination with parents and pediatricians. Future directions include using feedback from participants to inform future implementations, engaging providers and participants to discuss social and ethical considerations, program expansion to other clinics, and examining long-term impact.

Background: Substance misuse continues to be a national public health crisis that strains families and communities. Community anti-drug coalitions are a useful approach to implement prevention efforts at the local level. Coalitions rely on members from diverse community sectors to share information coalitions need to address community issues and remain sustainable. The objective of this study was to assess whether the density (i.e., number) of multisectoral connections to share information at time 1 would be associated with higher member perceptions of coalition sustainability at time 2.

Methods: Using an observational design, surveys at two timepoints separated by 12 months collected data from 63 coalitions in Pennsylvania and Missouri on members’ cross-sectoral connections to share information on coalition-related issues. Network analysis and multiple linear regression examined the effects density of information sharing connections has on perceived coalition sustainability, controlling for poverty level in coalition’s service region.

Results: Findings supported our hypothesis that the density of information sharing connections (B=0.75, β=0.3, p<.05) was positively associated with members’ perceptions of coalition sustainability. Poverty level was negatively associated (B=-1.44, β=-0.23, p<.05) with perceived coalition sustainability.

Conclusions: This study suggests that dense connections among members from diverse community sectors may help coalitions acquire essential information, e.g. funding opportunities, increasing their capacity to implement prevention and remain sustainable over time. Ideally, coalitions should ensure their membership is sufficiently diversified and create activities that enable members to develop and strengthen their connections. Higher poverty levels may create a more challenging context for coalition sustainability, requiring additional planning.

Background: Alcohol’s effects on late-life cognition/cognitive decline are complex and understudied in older racially/ethnically diverse populations.

Methods: In a cohort with approximately equal proportions of Asian, Black, Latino and White participants, participants self-reported drinking frequency and volume (coded as abstainer (never drink), light drinkers (1-7 drinks/week) or moderate-heavy drinkers (>7 drinks/week)). Longitudinal mixed effects models examined associations of drinking with executive function (EF) and verbal episodic memory (VM) adjusted for baseline age, race/ethnicity, gender, education (years), baseline income, loneliness, and depression. Models corrected for practice effects in repeated cognitive assessment.

Results: Compared to light drinkers, abstainers were older (mean 76.3; SD=6.8), and more likely to be women (68%), Black (34%) and Asian (30%); moderate-heavy drinkers were less likely to be women (42%) and more likely to be White (42%). In fully adjusted models, abstainers had lower baseline EF (-0.23, CI: -0.32, -0.14) and VM (-0.18, CI: -0.28, -0.90) when compared to light drinkers (ref.), with no significant difference in EF or VM change over time. There was no difference in baseline or longitudinal change in EF or VM between moderate/heavy drinkers and light drinkers. We observed race/ethnic differences in the association of drinking level and executive function change (interaction p-value=0.003), but not in baseline EF or baseline/longitudinal VM.

Conclusions: Abstainers had lower baseline cognition, but cognition did not change significantly over time. Future work will further explore racial/ethnic differences in the effect of drinking on late life cognitive change.

Filipinos Americans are disproportionately affected by higher obesity rates compared to other Asian American groups (Bates et al., 2008; Maxwell et al., 2012). Filipinos also have a higher central adiposity (higher waist circumferences) and increased fat intake compared to other racial/ethnic groups (Vargas & Jurado, 2015). The purpose of this poster is to describe the design and development of an ongoing pilot study examining how cultural variables (e.g., acculturation, acculturative stress, ethnic identity, and cultural values) contribute to the understanding of disparities in modifiable risk factors (e.g., diet, physical activity body image) associated with overweight or obesity among Filipino adults. The study aims to: 1) develop culturally appropriate materials and measures to successfully assess diet, physical activity and body image, 2) examine the feasibility and acceptability of selected questionnaires administered during planned interviews, and 3) obtain pilot data that can be used to guide a future larger study with Filipinos. In partnership with the Filipino Young Leaders Program (FYLPRO) and Filipino Health Community Advisory Board members, this study will enroll 25 Filipino Americans and immigrants, ages 18-65, with body mass index ≥ 18.5 kg/m2. Participants will complete an interview focused on health, culture, diet, physical activity and body image. Additionally, objective measures (e.g., weight, height, body fat) will be collected. This research study is a work in progress. The poster describes the development of a study that will inform future community-based, culturally tailored cancer risk reduction interventions focused on overweight and obesity among Filipino adults.

Physicians with rural backgrounds and Family Medicine (FM) specialties are more likely to practice in rural areas (AAFP, 2019). Shortages of clinicians in rural areas relate to negative health outcomes and health inequalities. Because retaining providers leads to healthier lives in rural areas, understanding these concepts is critically important. This study explored the association between physician background (rural n=25, non-rural n=71) and location of FM residency programs (Asheville n=69, Hendersonville n=27, N=96) with provider retention in rural areas. Data originated from MAHEC’s Graduate Medical Education department, Library department, and data self-reported to HRSA from 2014-2019. Initial and current employment rurality were determined by RUCA scores and HRSA designation. Hendersonville’s FM residency program is more targeted to rural medicine. A Chi-Squared test for independence revealed a significant association between physician’s residency program and initial rural employment location post-residency (χ2=11.78, df=2, p=.003), as well as current rural employment location (χ2=9.45, df=2, p=.009). A greater proportion of residents from the Hendersonville FM residency program practiced in a rural area immediately following graduation (63%) and currently (37%) compared with Asheville FM program residents (38% and 26%, respectively). The association between rural background and rural current placement trended toward significance (χ2=5.61, df=2, p=.061). A greater sample size may yield a statistically significant difference. There is no correlation between physician background and initial employment location post-residency (χ2=1.52, df=2, p=.468). These findings are consistent with literature and important in helping MAHEC leadership understand which residents will likely improve health access for rural patients.

*Citations included on poster*

Background: Public Health Fellowships have become more common today. The decision to apply and accept a fellowship as a student should be considered with care. For one fellow the experience was summarized into three categories; personal development, professional development and the cultural and societal influences that frame the accomplishments and ongoing work.

Methods: From June 2022 to May 2023 a remote fellowship inclusive of an internship with a community-based organization (CBO) was accomplished while simultaneously pursuing a DrPH degree part time and working full time. Pros and cons were considered with mentors and a previous fellow of the program. The socioecological rainbow model from Dahlgren and Whitehead framed the fellow’s journey naturally in hindsight. Identification and development of a work plan with a CBO aligned with the student’s interest in environmental justice, particularly within the food system.

Results: The fellowship provided a platform and legitimacy for the fellow to engage in activities outside of school and work. The monthly meetings and trainings, CBO work, presentations and networking added to their coursework. Connecting with stakeholders and organizations permitted them to cross into the broader cultural and societal influences of the food system.

Conclusion: The fellow's experience embodied personal and professional development (abstract preparation, IRB submission, leadership) and the cultural and societal influences for them to pursue their passion. The value the fellow added to the CBO’s ongoing work was recognized. New DrPH dissertation research questions arose, including professional credentialing, and career opportunities in agriculture, emergency preparedness, and population-based research.

Background: The “double pandemic” of COVID-19 and systemic racism saw an increase in calls to dismantle racism across major public health and healthcare entities, including within academic health institutions. A scoping review was conducted to identify if and how declarations against racism have translated into antiracism action within academic health settings since 2020. Methods: PRISMA guidelines were used to identify, screen, and include records on antiracism in academic health settings for scoping review synthesis. Five health and education databases were searched to identify records, of which 1048 initial records were found. A total of 190 articles met the final inclusion criteria and were assessed in the scoping review synthesis. Results: The synthesis process involved the full-text review of records and categorization into four major themes: format of publication; purpose of publication; type of academic health setting; and antiracism focus area. A majority of records were in commentary format (56.5%) with the intended purpose of presenting antiracism recommendations relevant to academic health contexts (51.3%). Academic medical settings, such as schools of medicine and residency training programs, appeared the most in the scoping review (53.7%). The two antiracism focus areas that appeared most in the scoping review were multi-pronged approaches (42.1%) and pedagogical approaches (32.1%). Conclusion: Authors conclude with five recommendations for academic health institutions to consider for advancing antiracism action: moving beyond statements; increasing attention to antiracism actions at non-medical academic health institutions; implementing multi-level antiracism interventions; clearly distinguishing antiracism from diversity, equity, and inclusion efforts; and empowering student activists.

Background: To achieve equitable health for rural communities, it is crucial to adopt policies and education through the policymakers, public health professionals and universities that rural residents rely on for their well-being. An effective strategy to bridge this gap involves providing specialized education and training for public health professionals.

Methods: This study identified and investigated the inclusion of degrees, certificates, concentrations, or courses specifically addressing rural health issues in graduate public health programs. An environmental scan of 218 CEPH-accredited graduate MPH programs was conducted, systematically examining publicly available program details, as mandated by CEPH accreditation standards, from February to June 2023.

Results: Analysis revealed that among these 218 programs, 10 institutions and 15 programs explicitly incorporate rural health considerations across 39 courses. Among the 25-degree programs offering such content, two were located in rural counties, while the remaining 23 were located in urban areas.

Conclusions: Less than 12% of all CEPH-accredited graduate public health degree programs offer any content related to rural health. These findings underscore a deficiency in providing essential public health education to address the needs of underserved rural populations. Findings invite subsequent research to explore institutional perspectives and attitudes concerning the absence of rural health content within graduate MPH programs and institutions.

Background: Long COVID, persistent symptoms after COVID-19 infection, affects 20% of US adults. This study explores factors linked to long COVID in the US, highlighting the scarcity of research on this topic and its consequences for physical and mental health.

Methods: The 2022 Behavioral Risk Factor Surveillance System (BRFSS) was utilized to investigate long COVID in US adults aged 18 or older. Long COVID was identified based on self-reports of symptoms lasting over 3 months post-COVID-19 infection. Predictors were selected from scientific literature and clinical expertise. Statistical analyses, including chi-square and multivariable logistic regression with odds ratios (OR) and 95% confidence intervals (CI), were employed to evaluate the connection between long COVID and various independent variables.

Results: Among adults diagnosed with COVID-19, the majority (76.6%, 38,544) had been vaccinated, and 26,783 (21.8%) had long COVID. At adjusted analysis, those who, are females (AOR 1.65, 95%CI 1.49-1.82), had no COVID vaccination (AOR = 1.18, 95%CI = 1.05 – 1.33), had attended college (AOR 1.16, 95%CI 1.03-1.31), were self-employed, had no insurance, had obesity (AOR 1.36, 95%CI 1.21-1.52), asthma (AOR 1.34, 95%CI 1.19-1.51), COPD, diabetes, and depression had a higher odds of reporting long COVID symptoms. Participants 65 years or older (AOR = 0.76, 95%CI = 0.62 – 0.92) were less likely to report long COVID symptoms.

Conclusion: COVID-19 vaccination preventives, while comorbidities like obesity, lung diseases, diabetes, and depression increase the risk of long COVID.

When a community is struck by a disaster, the needs of vulnerable populations are often unknown and underserved, leading to gaps in the quality and effectiveness of emergency response efforts. A “whole community” approach is recommended to address the social, communication, and systematic challenges that impact a community’s ability to prepare, respond, and recover from a disaster.

Community Health Workers (CHWs) are trusted members of the community who can identify immediate social and health needs of vulnerable communities that may otherwise go unaddressed. However, despite the skills and community connections of CHWs, they are often absent from emergency planning sessions, and emergency managers and responders do not regularly include CHWs during disaster response or recovery efforts.

This presentation discusses steps currently being taken in Texas to integrate CHWs across the state into emergency preparedness planning, response, and recovery efforts through the CHW Emergency Preparedness and Response Initiative. This state-wide initiative promotes basic emergency response training for CHWs and leverages inter-organizational collaborations across the state to ensure efficient utilization of resources.

Over 100 CHWs have participated in the initial training where 93% expressed an interest in engaging with local response agencies through the initiative. While participants shared enthusiasm for helping their communities, engaging youth was also suggested.

By establishing and maintaining a collaborative relationship with CHWs, the local emergency response community can scale up and access additional vulnerable neighborhoods. CHWs can play a crucial role in closing gaps that emerge during a crisis between vulnerable individuals, healthcare personnel and emergency responders.

Background: In the ongoing COVID-19 pandemic, public health schools hold the dual responsibility of training the next generation of public health professionals and keeping their campus communities safe. The United States has experienced multiple nationwide COVID-19 surges in the past year, and collective disease prevention strategies remain necessary. Our research examines how well public health schools have implemented mitigation practices.

Methods: We conducted a longitudinal policy surveillance study tracking campus COVID-19 mitigation policies of the 2022 US News Top 25 Public Health Schools. Between August 2022 and August 2023, we captured data systematically each month, documenting the mask, test, and vaccine policies listed on each institution’s website. We also monitored the status of public-facing COVID-19 campus dashboards and read formal communications about campus policy changes. This work allowed us to track changes across institutions and observe national policy trends.

Results: Preliminary results from our yearlong analysis reveal a broad removal of policies in all metrics: masks, tests, and vaccines. Many institutions also stopped updating their COVID-19 data dashboards or removed them from public view. Notably, institutions largely did not re-implement previous policies to respond to new COVID-19 surges.

Conclusion: Our data reveals a shift away from collective prevention of a highly transmissible infectious disease towards an individualistic approach. This is antithetical to public health and exacerbates health inequities. Further, the widespread removal of campus COVID-19 data abdicates responsibility and prevents informed decision-making. Public health institutions should lead by example to protect both the community and the future of our field.

Background: The influx of the COVID-19 patients overwhelmed both rural and urban US hospitals posing a threat to their financial health. The objective of this study was, therefore, to assess the impact of COVID-19 related emergency relief funding provided by the federal authorities on the total and operating margins of US hospitals with a special focus on differences between rural and urban settings.

Methods: The study adopted a quantile regression analysis based on hospital total and operating margins data (2018 to 2022) from the Center for Healthcare Quality and Payment Reform (CHQPR). The study examined 4417 hospitals’ (both rural and urban) from 2018 to 2022, before and after the hospitals started receiving COVID-19 related financial aid.

Results: Rural hospitals showed a stronger positive impact on total margins whereas, urban hospitals showed a better response to funding on their operating margins (an increasing scale of 0.031 p-value<0.05). Results further revealed that the COVID-19 related relief funding has positively impacted rural hospitals total margins across all pay methods such that, the impact is larger in terms of magnitude for CAH and RRC (0.180, p-value < 0.01 and 0.210, p-value<0.05 respectively).

Conclusion: Having no impact on the rural hospital’s operating margins of the relief funding suggests that the relief funding was not helpful in resolving financial distress the rural hospitals have been facing. This puts the rural hospitals at a higher risk of closure in comparison to urban hospitals after the public health emergency ends.

The tobacco industry’s marketing strategies have been constantly evolving. Previously, in-store coupons and direct mail coupons lead the promotions sent out by the industry. Now, with so much of our world being online, the tobacco industry has shifted to this space as well. Instead of those direct mail coupons, the industry has shifted to email subscriptions and online sales. Along with the shift in coupons, so much of the marketing and promotions are happening online. Social media marketing of commercial tobacco products have exploded in recent years due to platforms like TikTok, Instagram, and Twitter. On Tik Tok alone, the hashtag “vape”, has over 1 billion views. Influencer and celebrity depictions with products influences youth and young adults.

In this session, we will be providing an overview of the latest marketing and promotional trends- social media influencers and marketing. We will also be sharing current marketing trends of the tobacco industry such as rebranding initiatives, tobacco industry’s grassroots advocacy on Federal and statewide tobacco prevention laws, latest products and their outreach strategies. The findings from this project have been used to educate local decision makers on passing a price discounting ordinance in the city of Saint Paul, MN and include language in the statewide flavors bill to eliminate the online sale of flavored tobacco products.

Our organization is working towards reducing barriers in using public health data for decision making under our data democratization initiative. As part of these efforts, we have collaborated with our local heath partners to build data visualizations and dashboards that are designed to serve their critical data needs.

We hope to discuss our recent experience with building a drug overdose dashboard for local health partners. The dashboard provides fatal and non-fatal overdose prevention metrics from multiple surveillance data sources and presents these metrics by geography, time trends and demographics. Our primary objective of this project was to provide our local health partners with actionable data insights to respond to the drug overdose epidemic. We solicited direct feedback from local health jurisdictions and Tribes about the selection of specific measures, the display on the dashboard, and the types of demographic and geographic drilldowns through several listening sessions and targeted outreach via email.

Thanks to this co-design approach, we have achieved a high level of satisfaction with the end product. Close to 90 percent of our partners find the dashboard useful and informative, and they have expressed interest in using it to inform their local decision making. Based on our experience, we recommend replicating a similar approach when building data products and dashboards. While the co-design process takes longer to implement, the results are worth it.

Background/Significance: Native Hawaiians and Pacific Islanders (NHPI) in the United States (U.S.) are known to experience profound, persistent disparities across indicators of socioeconomic status and health when compared to the majority population. Similarly, the Indigenous Māori and Pacific peoples in Aotearoa New Zealand, parallel the same experiences. Improving health equity among racial/ethnic minority populations has been a national priority in both the U.S. and New Zealand.

Objectives: The study examined the extent to which structural racism is a fundamental cause of health inequities among Pacific Island peoples in the U.S. and New Zealand.

Methods: Semi-structured interviews were conducted with 27 (n=27) with community leaders and practitioners from the U.S. and New Zealand to explore the fundamental causes of these inequities. An interview guide was used to facilitate in depth discussions focused on Pacific Islander health, structural racism, and health equity. Thematic analysis was applied to identify key themes, patterns, and relationships.

Results: Participants described how structural racism operated across multiple domains to impact Pacific Islander health outcomes. To address these inequities, participants suggested applying decolonizing methodologies to dismantle structural racism.

Discussion/Conclusion: The continued racialization of Pacific Island identities has contributed significantly to their negative health status historically. The manifestations of racism and how they are operationalized create an interplay of cumulative disadvantages passed through multiple generations and across the social determinants of health. An applied critical approach examined the experiences of Pacific Islanders in the U.S. and New Zealand regarding perceived colonialism as an aspect of structural racism.

Background: Speeding is a dangerous driving behavior that is associated with an increased risk of serious injury/ fatalities and has become increasingly prevalent in the United States (U.S.). In 2019, approximately 9,500 deaths were associated with speeding in the US. During the 2020 COVID-19 lockdowns, per traffic safety data by the National Highway Traffic Safety Administration (NHTSA), prevalence of speeding behavior had significantly increased with a subsequent increase in fatal speed related crashes among male younger drivers in particular.

Methods: A non-adjudicated citations database was queried for all speed-related violations in the state of Nevada (2018-2020). Univariate and Bivariate statistical tests were conducted to analyze the data.

Results: During 2018-2020, 1,107,774 traffic citations were issued by law enforcement in Nevada, of which, 576,407 (52%) were speed related. The maximum speed limit in Nevada is 80 MPH, but nearly 34% of speed violations exceed this figure as measured by law enforcement for actual speed traveled (N=198,931). Half of all speeding violations were issued to drivers aged 35 years and under. Men were more frequently cited than women (63.2% vs 36.8%). The race of speeding drivers were White (69.9%), Black (12.9%), Hispanic (11.2%), Asian (5.2%), and Native American (0.7%). The number of citations for speeding 41 MPH or more over the posted speed limit nearly doubled between 2018-2020 (261 vs. 556).

Conclusions: Speeding in Nevada is a major traffic concern with serious consequences including injury/ death and requires policy action and advocacy.

Objectives: The purpose of this study is to evaluate type 2 diabetes health outcomes, including microvascular and macrovascular complications, in Spanish-speaking patients compared to English-speaking patients.

Background: Diabetes is a common chronic disease state, affecting 11.3% of the population in the United States. Within the US, type 2 diabetes is becoming more prevalent in the Hispanic population. Spanish speaking patients are less likely to have access to healthcare and utilize preventative services. Social determinants of health including decreased access to healthcare and lower income are factors that lead to an increase in chronic illnesses.

Methods: This was a retrospective, cohort study using the electronic health records of a charitable clinic located in Winchester, Virginia. The primary health outcome measured was incidence of hemoglobin A1c ≤7%. Secondary outcomes included number of oral and injectable diabetes medications. Data collected included demographics, insurance status, primary language(s), and comprehensive metabolic panel.

Results: A total of 255 patient charts were analyzed. The number of patients with A1c ≤7% was similar across Spanish-speaking and English-speaking groups (48.9% vs 47.5%, p = 0.818). English-speaking patients, on average, had more prescribed oral (1.36 vs 1.13 medications, p < 0.05) and injectable (0.69 vs 0.39 medications, p < 0.05) diabetes medications than Spanish-speaking patients.

Conclusion: There were no significant differences in hemoglobin A1c levels ≤7% between English- and Spanish-speaking patients. This was an unexpected outcome given that English-speaking patients were prescribed more diabetes medications than Spanish-speaking patients and medication labels and health information regarding disease states are in English.

Background: Prenatal depression and anxiety have been found to be associated with adverse birth outcomes. Increasing evidence highlights the importance and severity of prenatal depression and anxiety in the Chinese context. The COVID-19 pandemic is likely to further exacerbate prenatal mental health problems and increase the risk of adverse birth outcomes. This research aimed to assess and compare the impacts of prenatal mental health issues on birth outcomes before and during the COVID-19 pandemic in Ma’anshan, Anhui, China.

Method: Participants were women who visited local maternity and child healthcare hospitals in Ma’anshan. Pre-pandemic (May to September 2019) and pandemic (April to August 2020) maternal data were collected. Prenatal depression and anxiety were measured using Edinburgh Postnatal Depression Scale (EPDS) and General Anxiety Disorder-7 (GAD-7) via online questionnaires. Adverse birth outcomes were determined using hospital-recorded infants’ birth weight and gestational age at delivery.

Result: The prevalence of prenatal depression and prenatal anxiety among the pandemic cohort (14.5% and 26.7%, respectively) were both lower than the pre-pandemic cohort (18.6% and 36.3%, respectively). Prenatal depression was significantly associated with small for gestational age (OR=1.1, 95% CI 1.0 – 1.2, p=0.042) in the pandemic cohort.

Conclusion: The prevalence of prenatal depression, anxiety and adverse birth outcomes decreased after the onset of the COVID-19 pandemic. Small for gestational age was found associated with prenatal depression. Addressing prenatal depression can help reduce adverse birth outcomes during public health emergencies by establishing national plans and health priorities.

Background: In 2021, 47% of people living with HIV (PWH) in the U.S. were not consistently engaged in medical care. Regular HIV care engagement is critical for the long-term health outcomes of PWH. Historically, retention in HIV care has been measured through various metrics including viral testing, appointment adherence, gaps in care, and patient requests for anti-retroviral therapy (ART) refills. These criteria all rely on some form of in-person encounter. The COVID-19 pandemic prompted significant changes in healthcare delivery, with expanded telehealth services that continue today.

Methods: A review of 434 electronic health records of PWH not seen in-person for 6+ months was conducted as part of a pilot study for an acceptance-based behavioral therapy intervention aiming to re-engage out-of-care PWH and co-occurring substance use disorders.

Results: The review revealed 59 individuals regularly receiving ART refills and connecting, although sporadically, with clinic providers and/or staff remotely, despite being categorized as out-of-care. Thus, some PWH demonstrated signs of HIV care engagement, yet these indices would not be captured in traditional definitions of retention. Anecdotal evidence from clinic providers supports these findings. Additionally, 40 individuals attended at least 1 non-HIV-related health appointment during their out-of-care period.

Conclusion: The lasting impact of telehealth and evolving landscape of remote HIV care prompt reconsidering established definitions of retention in care. Further, these insights support on-going efforts to leverage encounters with “status-neutral” healthcare environments as opportunities to re-engage PWH in HIV care.

Background:

Although social cohesion is known to be strongly associated with healthier populations, various elements and dimensions make it difficult to operationalize for population-level studies. Volunteerism is a great way to measure social cohesion as it reflects the altruistic nature contributing to solidarity, reciprocates benefits of volunteering, and creates social capital. However, volunteerism and health outcomes are often studied at the individual level through surveys and there has been little work demonstrating the associations at the population level.

Methods:

This study uses United States state-level data from multiple sources, including the U.S. Census, CMS, CDC, and Feeding America. The association between social capital (volunteerism of adults ages 65 and older) and mortality (early deaths per 100,000 adults ages 65-74) was tested utilizing a linear regression analysis, controlling for individual and system level covariates. The regression includes individual determinants (mental distress, living alone, disability) and social determinants (poverty, access to geriatricians, housing problems, food insecurity).

Results:

This study finds that social capital is negatively associated with early death (p=0.04) in the 65-74 age group at the state level. Mental distress (p=0.01), disability (p<0.01), and food insecurity (p=0.02) are positively associated with early death, while having severe housing problems (p=<.01) is negatively associated with early death.

Conclusion:

Social cohesion at the population level shows a statistically significant, negative association with early death in the 65-74 age group. The wicked problem of an aging population requires including these individual and social determinants to improve health outcomes in an aging society.

Background: The COVID-19 pandemic has exacerbated language barriers, limiting healthcare access, especially for those with Limited English proficiency (LEP). Technologies to reduce such barriers are increasingly being adopted in vulnerable communities. The aim of the integrative review is to explore how technology can improve healthcare accessibility for individuals who have LEP. The review compiles data on feasible methods for using tech-based interpretation services to overcome language barriers.

Methods: Examine the structure, which includes detailing the participants involved. The framework employed was the Johns Hopkins Nursing Evidence-Based Practice Model. To cover pertinent articles, the PRISMA Flow Chart was applied. A total of ten articles, ranging from the years 2014 to 2022, were selected and incorporated into the final analysis.

Results: All studies received a 'B' rating, signifying good quality, as assessed by the appropriate evaluation metric, the Johns Hopkins Evidence-Based Practice Model. The types of technologies used for interpretation included telephones, video conferencing, and mobile applications. The result identified the following major themes: 1) technology serves as a practical and timely access resource; 2) technology enhances interactions between healthcare providers and patients who have LEP; and 3) technology boosts patient contentment.

Conclusions: The results of the integrative review indicate that interpretation technologies are both practical and readily accessible, and they hold significant potential for improving communication between healthcare providers and patients who have LEP.

Background: Southeast Asian refugee communities are underserved by social and medical systems, resulting in profound health and healthcare inequities. This study detailed the health needs, priorities, healthcare utilization, and social determinants of health of the Karenni, a Southeast Asian refugee community, in Forsyth County, NC, USA.

Methods: A mixed-mode survey (online and in-person) was distributed in Kayah, Burmese, and English to Karenni adults in Forsyth County. Of the 101 participants, 52% reported less than a high school education, 46% reported living in the USA for under 10 years, and only 9% reported being extremely or very comfortable with English. Quantitative and qualitative questions focused on community health needs, health and public health service utilization, and social determinants of health.

Results: 101 Karenni adults completed the survey. Utilization of healthcare and public health services were low and impacted by individual and contextual-level barriers, such as limited English proficiency, and lower levels of education and employment compared to state and national averages. Mental health, chronic pain, and healthcare access were highlighted as prominent community concerns while theh plaw theh jie (togetherness), and community organizations were described as community strengths.

Conclusion: This assessment highlights the need to increase engagement with and lower barriers to health care for the Karenni in Forsyth County. To produce culturally congruent, acceptable care that mitigates health and healthcare inequities, community strengths like togetherness should be harnessed (e.g., through health navigator or social support interventions) and partnerships between healthcare and the Karenni community should be promoted, nurtured, and supported.

Background: Several studies have been done on the impact of wellness coaching and lifestyle conditions among adults. However, few of them have been done on accessibility of wellness coaching, among the senior population and even fewer included adults who are specifically residing in the senior living facilities. The results from these studies are mixed with no clear direction/conclusion. There is a lack of ‘action plan’ to improve health status of senior adults. Public health strategies and action plan can be developed to make wellness coaching accessible among them.

Methods: Systematic review was conducted with inclusion criterion. Peer reviewed journals in scientific databases such as PUBMED, CINAHL, EBSCO, with key words "Health and Wellness Coaching; Senior living”,” quality of life”, “senior/elderly living facilities”, were utilized. Studies included were in English, conducted among senior adults (age range of >65 years) residing at a senior living facility. Timeline was from 2013-2023.

Results: Initial research indicated 42 articles. Duplicates were removed. Abstracts were reviewed to narrow down the number of eligible studies to 35. Full text examination with data synthesis resulted in 9 articles. Examination indicated that there is a potential lack of access to wellness coaching among senior adults.

Conclusion: There is a lack of access to wellness coaching resources for senior adults. Investigation needs to be explored to determine if wellness coaching would be an advantageous modality for this population. Further strategic planning must be done to improve the quality of life among older adults.

Background: Workplace wellness programs can help employees by supporting healthy lifestyle
changes. WellFlorida Council conducted a community health needs assessment for Alachua
County, Florida, which found that physical inactivity, poor mental health, and lack of access to
nutritious foods and poor diet are some of the greatest health challenges facing community
residents. Since University of Florida (UF) employees make up 54% of Alachua County’s
workforce, we developed and implemented a workplace wellness program with a focus on
dimensions of wellness to address these issues. The purpose of the workplace wellness
program was to increase knowledge, improve attitudes, increase self-efficacy, and create
intentions regarding physical, nutritional, and mental health.

Methods: The program lasted eight-weeks with four, one-hour lunch-and-learn sessions
presented biweekly via Zoom. Each session featured UF faculty specializing on the week’s
topic, including home gardening, physical activity, nutrition, and mental health. A post-program
event was hosted at the local Farmers Market which included a group fitness class and
connected participants to local food resources.

Results: The program had 197 registered participants. Participants were sent a post-program
evaluation, which showed that participants improved attitudes, beliefs, self-efficacy, and
intentions regarding physical, nutritional, and mental health. Participants intended to home
garden, practice mindfulness, increase physical activity, and create healthy meals using
seasonal produce.

Conclusion: The program highlights the advantages of working with an interdisciplinary team to
implement workplace wellness programs that address community health needs. Comprehensive
programs addressing multiple dimensions of wellness have the potential to benefit community
health outcomes.

Race and the socioeconomic context of maternal neighborhood are important predictors of adverse maternal and infant health outcomes. Neighborhood Deprivation Index (NDI) is a validated measure of neighborhood socioeconomic conditions and was calculated using data from the 2010 Census and American Community Survey. A retrospective observational cohort study was conducted on live-born infants in Georgia from 2009 to 2019. Infant Mortality Rates (IMR) were calculated per 1,000 live births. Logistic regression models, adjusted for maternal factors, were used to analyze the association between NDI, race, and odds of mortality, categorized by cause.

Among 1,349,288 live births and 8,927 infant deaths, NDI ranged from -2.05 to 4.71, and overall IMR stood at 6.62. The highest NDI quintile had 2.05 times higher odds of infant mortality compared to the lowest (95% CI 1.89, 2.22), with a consistent increase across quintiles. Irrespective of NDI quintile, Black infants faced elevated mortality odds. Adjusted odds for post-neonatal mortality were 2.23 (95% CI 1.94, 2.56), and for neonatal mortality, they were 1.97 (95% CI 1.78, 2.18) in the highest NDI quintile compared to the lowest. Cause-specific mortality odds ranged from 1.52 (95% CI 1.26, 1.84) for congenital anomalies to 3.42 (95% CI 1.82, 6.44) for birth asphyxia in the highest NDI quintile versus lowest.

NDI was associated with significantly increased odds of infant mortality in both the neonatal and post-neonatal periods and with cause-specific mortality. This research may guide targeted interventions and resource allocation to mitigate infant mortality risk.

More research is needed to understand why rates of pediatric COVID-19 vaccination remain low in the U.S. Guided by Andersen’s behavioral model of health service utilization; this study evaluated factors associated with COVID-19 vaccination status in children by surveying 257 adults with children.

The survey included demographic, parental vaccination status, and health beliefs towards vaccination questions. Logistic regression modeling was used to estimate crude and adjusted odds ratio (aOR) with the corresponding 95% confidence interval (95% CI).

Pediatric COVID-19 vaccination rates were 35.5%, 42.0% and 53.4% for children under 5, 6-11 and 12-17 years, respectively. Findings from the multivarialble analysis indicated that parent’s sex, COVID-19 vaccine status, and political affiliation were significantly associated with pediatric COVID-19 vaccination status until further adjustment for enable, disabling, and need factors. The final adjusted model showed COVID-19 vaccine recommendation from healthcare providers was strongly associated with increased odds of vaccination in children compared to those who did not receive recommendation (aOR: 8.04, 95% CI: 3.70, 17.48), while higher parental hesitancy in COVID-19 vaccine in children was associated with reduced odds of vaccination compared to those with lower hesitancy (aOR: 0.87, 95% CI: 0.81, 0.93).

Our study findings indicated that effects of predisposing factors may be mediated by physician recommendation and beliefs about vaccination. These results highlight the importance of recommendation from health care providers and alleviation of parents’ hesitancy in vaccinating their children. Intervention strategies should address vaccination barriers and target vaccine hesitant parents through health care provider education to decrease COVID-19 vaccine disparities.

INTRODUCTION: Incarcerated women have higher rates of STIs, unintended pregnancies, and cervical cancer compared to the general population. University of Miami medical students partnered with an education program at a South Florida prison to develop a sexual health curriculum. The presentation includes anatomy, sexual and reproductive health and was designed with a dynamic structure to accommodate feedback into the workshop to cover topics of interest identified by participants.

METHODS: We hosted 5 sexual health workshops between 2020-2023. 72 incarcerated women participated in the workshops. Participants received optional surveys to complete after the workshops. 60 participants returned the survey. Upon completion of the first 30 surveys, a Likert scale was added to the subsequent 30 surveys on certain questions.

RESULTS: In response to the statement “the presentation met my needs,” on a scale from 1-5 with 1 being “strongly disagree” and 5 being “strongly agree,” participants' average response was 4.2 (N=30). In response to the statement, “I acquired new skills or knowledge about the topic discussed,” participants' average response was 4.9 (N=30). When asked for other comments, 7 women identified the influence of drugs and alcohol on fertility and pregnancy as a topic of interest.

DISCUSSION: The curriculum is a well-received modality for sexual health education in a prison setting. The observed participant interest in substance use and pregnancy will guide future directions of the program to include education on substance use in pregnancy and will guide future research into misconceptions regarding substance use and pregnancy within the incarcerated population.

Background: Motor vehicle crashes remain a leading cause of unintentional morbidity and mortality among children in the US. Although child safety seats are highly effective and widely used by American families to prevent deaths and injuries, they are often difficult to use and commonly misused.

Objective: To evaluate an innovative child safety seat user engagement system comprised of a smartphone app and a network of sensors to actively educate, instruct, and alarm participants of safety seat misuses and errors.

Methods: 92 eligible adults completed three common safety seat scenarios during one in-person study visit. Participants were randomized to the control or intervention group. The intervention group was given a smartphone and asked to use the Cellular Car Seat (CCS) app during the scenarios, while the control group was given only the paper safety seat manual. Scenarios included: A) full convertible safety seat installation, B) recognize and correct loose harness straps, and C) recognize and correct loose attachment to the vehicle seat at the base.

Result: At the end of scenarios A, B, and C, participants using the CCS app had significantly fewer errors present, significantly higher average harness tensions, and a significantly greater portion had achieved a categorically safe harness tension of 4 newtons compared to the control group.

Conclusion: The innovative CCS system was highly effective at reducing errors in child safety seat use and has the potential to reduce child passenger deaths and injuries, especially among at-risk groups who are often overrepresented in car seat injuries and fatalities.

Background: The average deaf/hard-of-hearing (DHH) individual receives inadequate reproductive health education and services. Evidence suggests, however, that the Deaf community often feels comfortable and open with discussions of topics traditionally stigmatized, such as sexuality and sexual health. The limited research on this topic focuses on contraception and sexually transmitted diseases, and much of the existing research samples individuals with many different disabilities, resulting in the inability to make conclusions about menstruation and the DHH community specifically.

Methods: The current study analyzes and compares DHH and hearing menstruators’ opinions and feelings on menstruation as well as choices of menstrual products. A survey, distributed primarily via social media and printed flyers, could be completed via a secure online platform or an interview conducted in American Sign Language.

Results: 35 hearing and 44 DHH participants completed the survey which found that DHH people have fewer conversations about their menstrual experiences. However, DHH individuals reported that conversations they do have about menstruation are generally positive or neutral. DHH participants reported that they have generally positive views on menstruation whereas hearing people reported they have generally negative, mixed, or neutral views.

Conclusions: These results, along with existing literature regarding Deaf culture’s views on discussing personal information, have driven a new hypothesis that there is a cultural component to DHH individuals’ menstrual views. More research is needed to confirm this hypothesis and to provide more insight into the current state of menstrual health education and barriers to product access for DHH individuals.

Background

Promoting healthy behaviors is essential to prevent chronic health conditions, and college is a strategic setting to engage youths in healthy behaviors as they transition to adulthood. Although colleges often have wellness programs for interested students, what is not known is how mHealth messaging as a cue to action can promote students' wellness.

Objective

The objective of this study was to determine if biweekly health promotion messages led to improvements in recipients' knowledge about health promotion, health status, and academic satisfaction.

Methods

Using a randomized control trial, primary data for this study were collected from students at a University in Georgia. The total sample size was 28 with equal randomization to both the treatment and control groups. Descriptive analysis and Wilcoxon signed-rank test were performed.

Results

The results showed that there was a 34% and 68% percent increase in the knowledge of recommended fruits & vegetables and sleep hours respectively. There was a statistically significant difference (at p≤0.05) in academic satisfaction ratings and self-reported fruit & vegetable servings before and after the intervention among the treatment group. More than 90% of the participants found the messages useful and 75% reported that the messages improved their knowledge about the school wellness resources.

Conclusion

mHealth messages have the potential to promote healthy behaviors and improve academic satisfaction among students. More studies are needed comprising larger samples, to support evidence-based public health promotion practice and policy, and tease out health disparities in trust in health promotion messages.

Introduction/Purpose: Averting one opioid use disorder, especially in youth, is estimated to save $390,000 to the healthcare sector, $525,000 to the taxpayer, and $3.5M to society. Concurrently, the rising opioid misuse and mental health epidemics threaten to increase this cost. Enhanced education on these issues can reduce long term costs through preventative impact. Examining the anticipated expenses and outcomes of innovative teaching tools through economic evaluations enables accurate comparisons to traditional interventions which are typically costly due to training, labor and time. Serious videogames can serve as low-cost, engaging alternatives that are effective while teaching vital knowledge and health behavior skills. Through the National Institute on Drug Abuse (NIDA)’s Helping to End Addiction Long-Term (HEAL) Initiative, we are conducting a randomized controlled trial of the serious videogame PlaySmart in school-based health settings and evaluating its real-life implementation costs.

Methods: We will examine the startup and intervention delivery costs per individual, including the implementer’s salary, procedural preparation and execution, intervention duration, and the game’s effectiveness. Target outcomes include perception of risk of harm, attitudes, knowledge, and beliefs about opioid misuse and mental health.

Results: With current projections, the total intervention delivery cost ranges from $16.94 to $151.76 per individual; this cost encompasses maximum intervention exposure. We will complete collection of efficacy data in late 2024.

Conclusions/General Impact: PlaySmart is an evidence-based digital health intervention with an expected 15% decrease in the risk of initiating opioid misuse. This analysis will contribute critical information regarding its implementation feasibility and cost in educational spaces.

Background:

Childhood obesity is a critical public health challenge globally. Despite a World Health Organization report in 2016 calling for increased interventions to end it, childhood obesity is now reaching alarming proportions globally. With West Virginia having one of the highest childhood obesity rates in the United States, we aimed to explore how West Virginia-based newspapers have been framing childhood obesity from 2016 to 2022.

Methods:

Newspaper articles published in English from January 1, 2016 to December 31, 2022 in West Virginia were systematically searched from LexisNexis database using keywords including Child, fat, obese, and obesity. Two coders independently analyzed the content of these articles, and met to resolve outcomes that differed. Descriptive statistics and chi-square tests were conducted to describe key themes and potential associations between some variables.

Results:

Of 261 available articles, 95 met the inclusion criteria, with 32 (33.7%), 12 (12.6%), and 8 (3.2%) citing dietary, physical inactivity and economic factors respectively as potential causes of childhood obesity. Also, 34 (35.8%) mentioned general solutions while 15 (15.8%) mentioned resources for parents to use. There was a significant association between articles citing reports and citing health experts (p<.001) and mentioning resources for parents and kids to use (p=.005).

Discussion and Conclusion:

These results show that local newspapers could serve as a channel for public health practitioners to increase advocacy on childhood obesity, and fight the epidemic. Also, more public health scholars should increase efforts to engage with local newspapers to help fight childhood obesity in West Virginia.

Background: Roughly 21% of adolescent students have experienced bullying victimization in the U.S. Research is scarceregarding school bullying victimization in minority adolescents. Gender has an impact on school bullying victimization. For Black adolescents, hypermasculinity and specific sociocultural factors appear to impact the way boys and girls experience bullying victimization. Prior evidence has indicated that Black adolescents are primarily identified as bullying perpetrators even though school bullying victimization occurs frequently within the population. The purpose of this study was to examine gendered differences in the school bullying victimization experience for Black U.S. adolescents.

Methods: The 2017 version of the School Crime Supplement to the National Crime and Victimization Survey was utilized to examine gender differences. Variables from the dataset were analyzed via Chi-square analysis and binary logistic regression.

Results: Results from the study showed that gender was associated with the type of bullying victimization experienced, reasons for bullying victimization, and bullying perpetrator characteristics. Gender also impacted the quality of peer relationships for Black adolescents.

Conclusion: Examining factors that contribute to school bullying victimization in Black adolescents provides information to address these problems, develop programs, and guide future research. Black adolescent males and females have unique cultural experiences that influence their interactions with others which in turn impacts their experience with school bullying. Future work includes utilizing focus groups and critical textual analysis methods to gain more insight on bullying from the perspective of the target population. Results did not indicate how sexual identity may influence bullying victimization experience.

In recent years, after several requests from Asian and Pacific Islander-led organizations on how to support survivors who work to end the Gender-Based Sexual Violence field, a Wellness Guide was created with Asian and Pacific Islander practices that can help individuals and communities maintain/ balance their vitality. Individual wellness is a crucial part of building collective wellness. Eight practitioners and cultural and art workers shared their skills, practices, and wisdom for months through online meetings, and in August 2021 the team met in person to test various practices to ensure the practices would work well in supporting survivors needing to find balance.

The Wellness Guide includes a simplified version of the Five Elements from Traditional Chinese Medicine and divides the practices according to Earth, Water, Fire, Metal, and Wood elements. In addition, various practices for returning to our bodies such as qi gong, acupressure, and freestyle labyrinth, we also recognized the importance of returning to and infusing our culture through food, altars to honor ancestors, fostering pride in wearing traditional clothing, and make time for rest, play, and being in nature.