Poster Day 2022: Abstracts: Population Health

Alina F. Faunce, OMS-I, Taylor F. Faust, OMS-I, Johnny Dang, OMS-I, Samira Stutman, OMS-I, William Baker, OMS-I

Urban-Rural Disparities in Opioid Use Disorder Prevention and Response Activities: A Cross-Sectional Analysis study showed that nonmetropolitan areas, specifically non-core areas, faced more significant barriers to implementing opioid policy and program activities.

Literature searches using the keywords ‘COVID-19’, ‘rural’ ‘Alabama’, and ‘opioid treatment’ were conducted within PubMed, EMBASE, JAMA Network, and Cochrane Database of Systematic Reviews (2019-2022) for studies examining the scale of the opioid epidemic and the efficacy of OUD treatment before, during, and after the initial onset of COVID-19 in rural Alabama. Selection criteria included data on (1) overdose and mortality rates, (2) prescribing and dispensing of medication-assisted therapy (MAT), and (3) ease of access to diagnostic and follow-up visits, addiction counseling, and harm-reduction services. Relevant studies were reviewed for completeness and those meeting the above criteria were synthesized into the following review.

Very little data was elicited describing the effects of the COVID-19 pandemic on opioid use and treatment in rural Alabama specifically; however, significant correlations were observed across other rural U.S. populations. In Alabama specifically, the rate of Naloxone administration by EMS increased from 2019-2021, suggesting that overdoses also increased during this time.
Alternatively, positive outcomes were observed as a result of policy changes for prescribing medications for opioid use disorder (MOUD).  

This report offers more information about the opioid crisis and began to shed light on the gaps in knowledge that the pandemic facilitated. There needs to be more research done to see the extent the pandemic affected rural areas in Alabama.

Supreet Kaur Raina, Jamie Hsin, Brandon Phan, Veronica Nkie

Numerous communities struggle with access to quality medical care in both virtual and in-person capacities. To that effect, there has been an increasing push for remote patient healthcare access and services (RPM). In this paper, we explore and chronicle the factors that facilitate and hinder RPM implementation for use by patients and suggest recommendations for optimizing remote medical care to pave the way for sustainable, effective RPM processes. 

Extensive chart reviews were performed for the identification and follow-up of potential RPM enrollees. Graphs of patients’ RPM activity and use, and patient feedback regarding ease of use and RPM efficacy were obtained and analyzed.

Of the 202 patients enrolled, frequency of RPM use was as follows:
● 86 (42.6%): None 
● 74 (36.6%): very infrequently 
● 23 (11.4%): infrequently
● 19 (0.09%): frequently 

Most patients (79.2%) did not utilize the RPM as much as would prove beneficial for patient health. Several challenging factors contributed to these results, including limited staff for patient enrollment, difficulty of use of RPM Devices and access to high-speed internet. Recommendations on how to improve the usefulness and efficacy of RPM systems include training clinic staff to recognize patients eligible for RPM and providing patient support and incentives to promote patient adherence and compliance. If implemented, these could greatly improve the use of RPM systems and provide much relief to patients burdened by difficulties in availability and affordability of proper healthcare in their communities. 

Erin Park BS, MS, OMS-II, Mariana Arévalo PhD, MPH, Veronica Barrios-Monroy, BA, Melisa Ramos, Ana Guzzi PhD, Cyril Patra, MPH, Juliana Borrego MPH, MSW, Cathy D. Meade, PhD, RN, FAAN, Ada Sulbaran, Susan T. Vadaparampil PhD, MPH, Julio Jimenez, MD, Julian Sanchez, MD, Melissa Marzan-Rodriguez DrPH, MPH & Shannon M. Christy PhD  

Sexual minority men are at increased risk for human papillomavirus (HPV) infection and subsequent HPV-related cancers, yet vaccine uptake remains low among young adults, especially among Latino sexual minority men. Our team is developing a targeted HPV vaccination intervention for young adult Latino men who have sex with men (YLMSM). 

Recruited through emails, flyers, and personal referrals, participants (n=10) were staff members from healthcare and community organizations who serve YLMSM in Florida or Puerto Rico, aged 21 or older, could speak English or Spanish, and had access to a telephone or computer. Participants completed a brief sociodemographic questionnaire and an in-depth interview with a trained research coordinator. Participants’ views on three Consolidated Framework for Implementation (CFIR) domains: 1) outer setting (e.g., governmental policies), 2) inner setting (e.g., characteristics and culture of an organization), and 3) characteristics of individuals (e.g., beliefs about an intervention) were assessed, and feedback on draft educational materials was obtained. Interview transcripts were analyzed in NVivo.

Stakeholders most frequently indicated outer setting influences, followed by characteristics of individuals and inner setting influences. Barriers to HPV vaccination among YLMSM identified by stakeholders included: 1) financial costs, 2) administrative challenges, and 3) current health education efforts in sexual minority communities being mainly focused on HIV/AIDS rather than HPV. All stakeholders and facilitators mentioned that HPV vaccination education is crucial for YLMSM.

Findings provide insights into stakeholders’ beliefs about intervention implementation. Future research will test the effectiveness of these educational materials in the YLMSM population.

Prit Dhagat, Elizabeth Ward

Maternal mortality is defined as the death of a female because of her pregnancy either during the gestational period or within six weeks of giving birth. There are many factors such as distance to healthcare providers, access to perinatal education, and socio-economic status, obtainable abortion care is also an element in maternal death. The United States has one of the highest maternal mortality rates compared to other high-income countries, as well as some of the most restrictive abortion policies.  

We compiled data from states with varying levels of restriction to abortion care. Oregon had most accessible resources for termination, while South Dakota was last. We compiled data from Illinois, Colorado, and Pennsylvania to diversify the patient outcomes as these states were average, slightly above average, and slightly below average with their laws. Texas and Alabama have recently enacted some of the most restrictive abortion laws, so we also wanted to include that in our analysis.

After analyzing the data reported by the Guttmacher Institute and the CDC, the percentage of women of reproductive age who live in counties with no abortion facilities is correlated to the number of maternal mortalities per 100,000 live births. Ultimately, the number of abortion-providing facilities in a state is directly proportional to the maternal mortality rate.

The less access women of reproductive age have to abortion care, the more likely they are to experience maternal mortality. Some variables influencing both maternal mortality and access to abortion care might be availability of sex education and birth control, access to health care facilities, and socio-economic status. This information could be expanded upon and used as a guide to inform future abortion policy and procedures to improve health outcomes across the country.

Mohkam Singh, Sarah Adkins-Jablonsky, Angela Rubino, Mindy Higley, Aaron Dramann, Lisa Ennis, Nicole Mitchell 

Adverse Childhood Experiences (ACEs), stressful or traumatic events, like physical abuse or sexual abuse, experienced before the age of 18. High ACE scores are correlated with poor preventable health outcomes. Considering rural populations make up 14% of the United States, understanding how ACEs uniquely impact rural health outcomes is imperative to population-specific interventions.  

Client data was obtained as a retrospective study using the 10-item ACE survey administered at the Exchange Center for Child Abuse Prevention. Participants received trauma-informed services through the Exchange Center from 2019 - 2021 (N=1643). Outcome measures were presenting victimization code as well as ACE scores correlated with county of origin. This study was approved by ACOM IRB# HS220919-EX.

We found an overall mean ACE score of 5.897 across 7 Wiregrass counties with no significant differences between ACE scores between counties (p > 0.05). Patients who came to the clinic with the in-patient code Adult Sexually Abused as Children had the highest ACE scores of all clients (6.74). Those reporting verbal, cyber, or physical bullying had the lowest ACE scores of all clients (3.57).

This is the first known research to demonstrate high ACE scores across Alabama Wiregrass counties, where no significant difference was found between scores of patients from urban vs rural counties. This work can benefit the region by quantifying the needs of Alabama clients, thus demonstrating the importance of trauma-informed care. Awareness of ACEs can help adults and children limit risk factors and stop the ACEs cycle between generations.

Rebecca Telese, Alyssa Zakala, M.S., Andrew D. Vogel, M.S., Mohammed T. Azam, Patrick G. Dickinson, Juanita T. Heersink, M.D.

Maternal mortality continues to rise in the United States (U.S.) and disproportionately affects women in Alabama. Studies have shown an association between health literacy and adult literacy.  Alabama is ranked 51st in the U.S. for education, and ranked 39th in adult literacy rate.  We hypothesized that reduced health literacy is a modifiable driver of poor maternal outcomes and that improving health literacy may improve maternal outcomes.  This article aims to quantify existing research investigating the effect of improving patient education on maternal mortality.  

Researchers searched Pubmed and Embase with key words and filters, including “maternal mortality” and “warning signs,” in order to compile 3139 articles.  We used Rayyan to exclude and include articles in a blinded review process. If a conflict regarding inclusion of a paper arose, a blinded third researcher decided. Inclusion criteria required an article be original research completed within the U.S. in the last 10 years.

We selected 24 articles for inclusion in our review- 14 articles from Embase and 10 articles from PubMed. None of the included studies were performed in Alabama. However, these articles contained compelling evidence that interventions improving patient education improve maternal mortality.

Our scoping review determined that more research is needed in Alabama to demonstrate the positive impact of patient education on maternal mortality. Existing research in the U.S. demonstrates that improving a women’s health literacy can drastically improve mortality. Applying similar research techniques within the state of Alabama may reduce local rates of maternal mortality.

Alejandro Arroyo Rodriguez, Cassie Lewis Odahowski MPH, PhD 

Rural and urban counties in Florida exhibit different socioeconomic characteristics and access to healthcare, potentially impacting rates of colorectal cancer (CRC). We examined rural and urban differences in county-level CRC incidence, CRC mortality, and characteristics related to rural disparity in CRC mortality in Florida.  

We examined CRC data from National Cancer Institute (NCI) State Cancer Profiles and United States Census Bureau definition for rurality. We used a t-test for unequal variances to examine differences in mean CRC incidence and mortality for rural vs. urban counties. ArcGIS visually displayed a bivariate (rural mortality) map and linear regression used to examine county social vulnerability (SoVI) metrics and Medically Underserved Areas (MUA) related to CRC mortality.

Incidence of CRC was not significantly different for rural (40.93 per 100,000) and urban counties (36.82 per 100,000, p=0.16). The rural mortality per 100,000 for CRC was significantly higher than urban mortality per 100,000 (18.22 vs 13.12, p=<0.01). Mapping displayed clustering of high rural CRC mortality in north-central Florida. Regression results showed four SoVI variables significantly related to the observed rural disparity in CRC mortality: percent in nursing facilities, percent Native American, per capita income, and households earning >$200,000.

Rural CRC risk was not significantly higher than urban risk. However, the rural CRC death rate was significantly higher in rural than urban counties. These results identify and add to the understanding rural disparities in CRC mortality. Further work is needed to address strategies for eliminating rural disparities in CRC mortality in Florida.

Bailee Farmer, Erin McPherson, Sarah Taylor, Ekaterina Karelova 

Maternal mortality is defined as the death of a woman while being pregnant, or during the postpartum period, which refers to the period of returning to the unpregnant physiological state. Rural communities struggle the most with keeping the mortality low, and the state of Alabama has one of the third highest mortality rates in the country. More than 70% of all maternal deaths are due to hemorrhage, infection, unsafe abortion, hypertensive disorders of pregnancy, and obstructed labor. The underlying causes for these deaths are poverty, inadequate, inaccessible, or unaffordable health care, unequal access to resources, low economic status of women, and illiteracy. The consequences of these high maternal mortality rates that Alabama has leads to further increased costs for families, increased costs for the state due to orphaned children, and further economic divisions.  

The CDC Database as well as the Alabama Department of Public Health Maternal Mortality Review was used to provide population rates and access to women’s healthcare throughout the state of Alabama.

During the years of 2019 and 2020, among deaths that occurred associated with pregnancy, 8 out of 10 deaths occurred 6 weeks after delivery. This was mainly due to cardiovascular-related events; substance use and infections. Most of the deaths had multiple contributing factors such as delay in access to care, substance use disorder, and limited knowledge or understanding related to the significance of health events or needed treatment/follow-up. Additionally, there were system-level factors that include a lack of access to financial resources, poor communication, limited continuity of care, lack of standardized policies/procedures, and limited resources related to substance use disorders.

This data can be important in facilitating further state policies in furthering access to healthcare for women. This can bring awareness to the need for more community-based organizations and public health agencies that can help women and families in support of their maternal healthcare needs.

Makena Lewis, Austin Wynn, Garet Beyer, Rachel Shultz 

The purpose of this review is to assess whether there is a correlation between cesarean births and the development of asthma in children. There was evidence to show that preterm births and maternal asthma status did affect rates of asthma in different sexes of the child. Additionally, there is evidence of increased odds of adulthood asthma following cesarean delivery and more cost associated that requires further investigation to conclude.  

The search for a correlation regarding cesarean sections and asthma was through PubMed, national reports from the CDC, North Carolina Rural Health Research, and Policy Analysis Center.

Cesarean sections were performed more often in medically underserved areas, such as rural communities. One review found that children delivered by cesarean delivery had increased risk of asthma up to the age of 12 years (OR 1.21, 1.11 to 1.32; n = 887,960; 13 studies). Boys were more likely to be delivered by cesarean than girls (33% versus 30%). The strongest predictors of childhood asthma were male sex, maternal asthma, and preterm birth.

There was a higher prevalence of primary and repeat Cesarean deliveries in locations deemed rural by their respective state. The increase in Cesareans in rural populations could be due to a lack of resources that ensure the safety of a mother during vaginal delivery complications. These studies help show that asthma does have a correlation to Cesarean sections and there is an increase in Cesarean sections in rural locations.

Lauren Crowley, OMS-II and Robert W. Parker lll, PharmD 

As COVID-19 spread across the United States, hospitals began experiencing a large influx of patients, with some hospitals reaching over 90% capacity.  Hospital resources became limited, primary care visits declined as well as medication refills and mental health appointments. With reduced hospital staff and resources, it is thought that patients with opioid use disorders may have been at an increased risk for overdose due to social isolation, decreased access to healthcare appointments, and economic stressors.  The goal of this study was to identify populations that have shown an increased rate of opioid overdoses in the community after the COVID-19 pandemic.  

A retrospective study was conducted using patient electronic records from the years 2011-2021, identifying patients that had received Naloxone in the ED and were diagnosed with having an opioid overdose. These charts were further investigated to collect data on patient demographics, medical history, and social history.

Post COVID-19 data showed that African Americans, females, and those within the age ranges of 28-37, 48-57, 58-67 and 68-77 all had increased incidence of opioid overdoses in the emergency department in the post COVID-19 years. The data also discovered that opioid overdoses in individuals with a previous history of mental health, substance abuse and chronic pain has decreased post COVID-19.

This research has given us an insight into which populations within the community are showing an increase in opioid overdoses since the pandemic began, and how to best address the concerns of those individuals with an increased risk of opioid misuse.

Gabriela Galan, Ivana Gutman, Megan Richards, Michelle Sindoni  

Despite the prevalence of substance abuse across the nation, treatment facilities are largely inaccessible due to various factors including socioeconomic status and site geographic distribution. The prevalence of substance abuse in Alabama is reflected by its status as the state with the highest opioid prescription per capita and is ranked as the 19th worst state for availability of drug abuse treatment facilities.  

We used the Policy Map to identify the locations of substance use disorder (SUD) treatment facilities and income per capita of the counties in Alabama.  We then found the ratio of the number of facilities to counties in each income bracket.

There was a proportional relationship between the number of facilities and income. The counties in the higher income brackets had more facilities compared to those in the lower income bracket.

This study identified that there is a discrepancy between socioeconomic status compared to geographic distribution of treatment facilities. Additional research is still necessary to integrate the multiple variables that contribute to this multifaceted issue. Further studies can now focus on looking at what interventions would be most effective in eradicating the issue.

Colton Boney, Erin Park, Mariana Arévalo, PhD, Wayne Parker, PharmD 

The South is the epicenter for the United States’ Human Immunodeficiency Virus (HIV) epidemic with disproportional effect on men who have sex with men (MSM), people of color (POC), uninsured, and those in poverty. Despite highly effective prevention methods, many barriers make Pre-Exposure Prophylaxis (PrEP) unobtainable for some patients at high-risk of HIV acquisition. In 2020, Okaloosa AIDS Support & Informational Services (OASIS) Florida funded a free PrEP program for uninsured persons living in Escambia County, FL.  

This study uses enrollment data from the program to analyze relationships between HIV testing history, risk factors, Race/Ethnicity, prior PrEP use, etc. We looked for correlations between these factors and compared the program’s demographics to the county’s census data to see if no-cost PrEP increased enrollment of POC. With approval from the Florida Department of Health, OASIS provided a limited data set containing HIPAA compliant information from enrollment and HIV test forms. Statistical analysis was done on Stata v16 through chi-square tests.

The program’s profile contains 5% more POC as compared to Escambia County’s demographics. The data showed that patients with more risk factors were more likely to have been tested for HIV within the timeline of CDC recommendations. 76% of patients had never been on PrEP or lost to care despite being high-risk for acquisition. White patients were more likely to have never had an HIV test as compared to Black participants.

Our findings suggest that uninsured patients understand their risk for HIV, get tested within CDC guidelines, but weren’t accessing PrEP care previously.

Faust, Taylor MS; Donnelly, Megan; Castaneda, Pablo MD; Cooper, Joie MS 

We investigated the trend in upper extremity (UE) neuropathies at a single large, urban tertiary care facility in the U.S. from 2018-2022. We hypothesized there would be an increased incidence, as the COVID-19 pandemic reshaped society and increased risk factors for UE neuropathies.
Method: A retrospective review of the electronic medical record was performed. Data was collected from patient records identified using ICD-10 codes over the last 5 years.  

We identified 109 newly diagnosed pediatric and 9,532 adult patients. Most diagnosed with UE neuropathies were 55+ years (47.2%), followed by those 45-54 (19.1%) and those 35-44 (15.1%). Approximately 1% of all patients diagnosed were children. There was an overall increase in diagnoses of UE neuropathies across all ages, with the most noticeable increases from 2018 to 2019 (+1,230 diagnosed individuals or +130%) and from 2020 to 2021 (+673 diagnosed individuals or +33.3%). Despite few pediatric patients, this trend was similar, with an increase of +125% diagnoses from 2018 to 2019 and +88.9% diagnoses from 2020 to 2021.

Over the past five years, there has been an increase in UE neuropathy diagnoses at our facility, and a significantly increased rate from 2020-2021, coinciding with the COVID-19 pandemic. Working from home likely increased the use of repetitive hand movements on computers, rates of obesity and diabetes, and delayed care causing critical illness, which have all been implicated as risk factors for UE neuropathies. We identified a need for early intervention, education, and prevention techniques to avoid neuropathies.

Alex Betit, Alex Orta, Guo Qian, Kavya Penmethsa, Kaylan Burgess

Lawfully enforced abstinence-only sexual education is a topic of controversy within the United States. In Alabama, students are not formally introduced to any form of sexual education until ages 13 or 14. This project explores the potential pitfalls of sexual education by how they have contributed to teen pregnancy rates in Alabama.   

PubMed and the National Center for Health Statistics (NCHS) were utilized for appropriate figures from the Center for Disease Control and Prevention (CDC), and Guttmacher Institute. Keywords were entered into databases and further modified to find relevant parameters.

We found a positive correlation between the high rate of teen pregnancy, 23.54 to 27.9, and Alabama’s sparse sex education curriculum. Alabama has one of highest teen birth rates in the country, between 23.54 and 27.9 teen births per 1,000 females aged fifteen to nineteen. Conversely, Northeastern states such as New York, have teen birth rates as little as 6.1 to 10.46.
Sexual education in Alabama is not mandated by the state and if available, must stress abstinence. Compared to New Jersey, where sex education is mandated and more inclusive, the rates of teen pregnancy were significantly lower, around 6.1 to less than 10.46.

Programs in Alabama omit critical information and stigmatize sexuality. The inconsistency of Alabama’s sexual education policies and practices contribute to the above national average teen pregnancy rates. Modeling sexual health education on policies in the Northeast by mandating education, supporting contraceptives, and providing medically accurate information would likely decrease these rates.

Rebecca Donham

Identification cards (IDs) are essential for an individual’s ability to access medical care, accept a job, enroll children in school, sign a lease, find refuge at a shelter, open a bank account, vote, and enroll in most rehabilitation programs. Without ID, individuals are ineligible for these life-essentials. To obtain a new ID, one must show at least two forms of personal documentation-- such as a birth certificate, social security card, medical insurance card, or a valid School ID with photo. To obtain any of these required personal documentations, an individual must show their Identification Card or at least one current official document with the individual’s name and address, such as a utility bill, credit card statement, lease agreement or mortgage statement.   

Herein lies a vicious cycle: Without ID, one cannot sign a lease, buy property, or enroll in shelter—and without this proof of permeant address, they are ineligible obtain an ID. 

Municipal IDs may prove to be an effective, cost-saving, and immediately-implementable solution to bridging those without identification to obtaining official identification cards through the appropriate channels. Individuals will be able to accept job positions, enroll their children in school, access medical care, and enroll in shelter and support programs.

Addressing these policy gaps may help alleviate chronic homelessness and connect individuals experiencing homelessness to existing resources. 

Bella Fernandez, Scott Kohlhepp, Sarina Kothari, Daniel Mazzorana

Due to the exponential rise of coronary heart disease (CAD) in the United States of America, it is crucial to assess the correlation between healthcare determinants and incidence. The project aims to compare the top five cities in Alabama based on population. Each city's respective CAD rate and income per capita were investigated.   

The project took a multifaceted approach to determine risk factors that could lead to coronary heart disease in Alabama. After searching various databases, PolicyMap was used to overlay income per capita, the healthcare determinant, and incidence of CAD.

The results and statistical analysis showed that Montogmery, Birmingham, and Mobile are areas with lower income per capita and a higher prevalence of CAD. However, both Huntsville and Tuscaloosa remain outliers and don’t fit with the previous relationship. These results could be attributed to factors including varying prevalence of available healthy food options or disparities in public health education efforts. 

Ultimately, we can not confidently claim that low income alone is a significant enough measure of the risk of coronary heart disease. However, it is likely that income does have a role in the equation and the results do help suggest that the risk of CAD is a multifactorial issue. By being aware of the various interrelated risk factors contributing to morbidity and the prevalence of heart disease, healthcare providers will gain perspective on the struggles certain communities face in combating health co-morbidities and will be able to provide better care to their patients.

Sreeja Choppara, Tashi Heran, Maria Locklar, Bilal Saedeldine, Yassmin Shaltout

This experiment aimed to link two major problems surrounding much of the population, socioeconomic status and access to mental health care, which were found to be positively correlated with each other. Poverty and resource disparities aid greater incidences of mental ailments, along with decreased rates of sought treatment. The Southeast United States was sampled for this experiment due to their low ranking amongst states with incidences of mental health and least access to proper care.   

Data was culminated from PubMed, Mental Health America, and United States Census Bureau to create standardized definitions of mental health, poverty, and care resources for these events. The PubMed site was filtered using the MESH-add on to find the most up to date information, while Mental Health America provided multiple years of mental health surveys with rankings for states in America. 

It was determined that there was a strong correlation between higher prevalence of mental health illness to the lower rates of access of the Southeastern United States to proper care and their lower socioeconomic income. Many of those afflicted fall into the “poverty” category. Stressors, specifically those associated with destitute economic stress, lack of available care, and inability to afford what is available may be passed onto the next generation as well. 

Overall, this article discusses the intricately related nature of poverty and proper access to mental care these individuals require.

Whitney Vaughan, Angalina Quinones, Milan Lanier, Markia Pettway, Leticia Perez

The COVID-19 pandemic has disproportionately affected racial and ethnic minority groups. Non-hispanic white persons have exhibited lower infection rates and death rates and better health outcomes compared to their racial and ethnic minority counterparts. The cause of these disparities is multifactorial, but may be due in part to the historically decreased access to the social determinants of health in minority communities.  

One example of how COVID-19 disproportionately impacted various racial and ethnic communities is seen in the increased percentage of low birth weights in minority communities nationwide. Birthweight was measured as a prevalence of births under 2,500 grams.

When comparing national percentages of low birth rates from 2018-2021, the Native American community had the largest change with a 1.4% increase, followed by the Black community who exhibited an increase of 1.2% from 2018 vs 2021.
When assessing the COVID-19 vaccination trends among different racial and minority groups in 2021, the Black community had the lowest vaccination rate among all groups studied. There was not a specific data set for vaccination status in the Native American population, and this is a point that warrants further study.

Consequences of increased incidence of low birth weight include failure to thrive, potential neurological disorders, immunocompromised states all of which will lead to increased cost of healthcare for the affected family. Additionally, we could expect higher costs for health insurance overall due to increased demand for government healthcare assistance. This will lead to increased adverse socio-economic and health outcomes in an already overburdened minority communities. 

Asad Ali, Jeewan Ambat, Prahaseetha Gundampalli, Jason Mathew, Jacob Sinopoli 

In 2022, the WHO declared a global monkeypox outbreak with over 25,000 lab-reported cases worldwide. Infected individuals most notably have a rash located on or near the genitals or anus, which can also present on the hands, feet, chest, face or mouth. The purpose of this study is to examine the increase in monkeypox caseload in urban communities in the US, with emphasis on New York City and San Francisco City.  

For the 30-day case count forecasts, we obtained our from the CDC, NYC Department of Health and Mental Hygiene, and the San Francisco Department of Public Health. We calculated the cumulative case count using daily new case data, and imported these data into R to be converted into a time series to map the rise of cases. We then made an Auto-Regressive Integrated Moving Average (ARIMA) model to simulate monkeypox total case trends in each of these three regions.

A logistic growth curve is seen in Monkeypox transmission in San Francisco, New York City, and the United States. The US caseload increased dramatically, while the San Francisco and New York City growth curves leveled off. Within New York City, Manhattan had the highest case burden.

A potential mechanism of our ARIMA model findings of this may be an increased monkeypox awareness in these two cities with effective public health communication. Additionally, raising awareness and educating vulnerable communities about measures to reduce exposure may improve outcomes in controlling and eradicating Monkeypox and establishing health equity in the current outbreak.

Matt Crisler, Samantha Loew, Ryyan Kassoo, Sarah Sass, Sarah Seghrouchni

The presence of Individuals with intellectual disabilities (ID) in the United States has steadily increased each year. This unique population faces numerous health disparities and adversities ranging from lack of access to quality health care as well as a lack of education and knowledge on healthy lifestyles. Health outcomes for individuals with ID include a substantially higher risk of obesity as well as other chronic conditions compared to individuals without. This review discusses the correlations present between obesity and individuals with ID in the United States among adults. With the rising correlation between ID and obesity in the United States, the benefits of education and behavior modification can be astronomical to this populations health.  

Sameeksha Malhotra, Regen Morgan, Sedona Robrahn, Camila Vega 

Education has been shown to be one of the strongest predictors of health, and increased schooling has been linked to improved health outcomes. On average, public education spending per pupil in the United States is $13,187; however, this number falls short in Alabama to only $10,100. We hope to understand if educational level extends to the attainment of prenatal care and associated maternal and fetal health outcomes.  

Information was collected from the following databases: Alabama Vital Statistics 2018, Policy Map for educational data, and the Census website. We found the percent of the county populations that had some high school or less, a high school diploma, or a bachelor’s degree or more. This was correlated to the percent of the county populations that had adequate plus, adequate, intermediate, or inadequate prenatal care.

Our data shows a correlation between the education levels in rural counties in Alabama and the quality of prenatal care. For instance, Greene County shows the highest incidence of inadequate prenatal care received (30.7%), while also having the lowest incidence of people with a bachelor’s degree (5.76%). The urban counties did not follow this trend, as Montgomery County shows the highest incidence of inadequate prenatal care (25.2%), but it did not also show the lowest incidence of people with a bachelor’s degree.

Our data demonstrates a correlation between education status and prenatal care in rural counties in Alabama only. This data could be used to support the implementation of programs improving educational attainment in rural counties, as well as educational seminars focusing on prenatal care.

Naziyya Haque, Ryan Liengswangwong, Ashley James, Sarah Clark 

Bipolar Disorder (BPD) is less represented in epidemiological studies relative to other mental health conditions. Current literature focuses on treatment rather than provider and socioeconomic (SES) factors that could affect BPD prevalence. We sought to compare Alabama’s rate of BPD to the US national rate, and how provider density and overall household income may affect it.  

We conducted a literature review assessing the prevalence and incidence of BPD and possible interaction with provider accessibility and SES status at the state and national levels.

In 2020, the national incidence of BPD is 5 per 100,000 people, while the national prevalence of BPD is 2.8%. The national Population per Provider Ratio (PPR) for primary care providers is 1,428.6; Alabama’s PPR is 1,706.4. The national PPR for psychiatrists is 8,057.9; Alabama’s PPR is 8,628. The national median household income is $67,521 compared to $54,393 in Alabama. The annual collective economic burden of BPD is $219 billion and $67,521 per person. The mean payroll in Alabama in 2020 was $54,393.

Our findings indicate a significant shortage of providers and lower household income in Alabama compared to the rest of the nation. Little data exists on the prevalence of BPD on state or national levels. Acknowledging the lack of epidemiological data, understanding how physician shortages for mental health treatment and potential SES interaction may influence BPD incidence may provide the necessary impetus to increase advocacy efforts and focus epidemiological reporting for BPD.

Catie Duchette, Rebecca Donham, Ami Wang 

Previous research has investigated the relationship of insurance coverage as predictor of healthcare-seeking behaviors, but little has demonstrated the relationship between health insurance and pathways of healthcare accessed, level of health, and associative state healthcare costs.​ This project explores the correlation between health insurance subtypes (e.g. employer-provided, federal-funded, bronze through platinum plans) and ​pathways of healthcare accessed (e.g. emergency, primary care, subspecialty care), level of health (e.g. comorbidities, DALYs, life expectancy), and associative state healthcare costs (e.g. cost of defaulted payments annually, percentage of state budget spent on healthcare and public health initiatives).  

Databases searched included Center for Disease Control, Centers for Medicare & Medicaid Services, Kaiser Family Foundation, and Policy Map. ​Data captured identifies state trends from 2011 to 2021 in insurance coverage, types of coverage, level of coverage, and cost of plans/deductibles and compares these factors with patient comorbidities, life expectancy, DALYs, and overall state costs associated with healthcare. ​

Database searches yielded national-level data depicting insurance expenditures by state, insurance coverage by county, and life expectancy by state​. Gray literature review further elucidated secondary factors, overlapping demographic trends, and budget spent on public health initiatives.​ Positive predictors of healthcare costs, level of health, and pathways of healthcare access were associated with healthcare insurance subtype.​

The results exhibit the many social determinants that influence a patient’s ability to obtain not just health insurance but a high tier of health insurance that correlate with ameliorated health outcomes.

Garet Dunivin, Mark Katz, Brennan Lasher

Environmental health disparities exist throughout the United States commonly in the form of social inequity where impoverished communities are subject to inferior living conditions than their wealthier counterparts. These disparities make disadvantaged groups more susceptible to illness and disease. In this study, we looked at thermal inequities throughout Birmingham, Alabama.  

Our methodology consisted of analyzing the correlation between urban heat maps and health disparities within Birmingham, Alabama. Initially, we identified variations in temperatures and socioeconomic status using multiple resources throughout the city. Using this as a baseline we made a broader search to better identify other factors affecting these populations including local industries and pollution emitters.

Utilizing heat maps of Birmingham, we were able to see that the spheres of increased temperature were in the north and south of the city with a division across the middle. Correlating to a per capita income map, the individuals in these same areas also had below average income levels overall. Finally, these same areas in the north and south of the city also showed increased distributions of mills and factories as compared to the rest of the city.

Utilizing these methods and figures, we were able to conclude that the extreme heating conditions within Birmingham, Alabama correlate to those populations experiencing worse health care outcomes. Further studies involving this topic could be applied to more cities across Alabama and the United States to identify more factors contributing to thermal inequity and health inequalities.

Nathan Zhang, Zach Dumont, Paul Vu, Esteban Ramos 

Using poverty as a measure of Socioeconomic Status (SES), we looked at surgical and consequential inpatient death rates within Alabama counties. ​51 counties in Alabama have 15.39% or more households living below the poverty threshold. We hypothesized counties with higher poverty tend to have higher incidence of surgical and inpatient mortality.  

Using Policymap.com's qualification for poverty, healthrankings.org, and the Alabama department of public health,  surgical and inpatient mortality for the years of 2019-2020 were separated into 5 categories of household poverty.
These counties were separated into categories by the proportion of households in poverty according to Policymap's qualification for poverty. For each category, the surgical and inpatient death rates were averaged to determine a distribution.​

For the counties of Alabama, we classified poverty into 5 categories based on proportion of households living in poverty: very low (<9.59%), low (9.60% – 12.40%), moderate (12.41% – 15.38%), high (15.39% – 19.65%), very high (>19.66%). 2 counties qualified for very low poverty (average death rate of 1.55), 3 counties qualified for low poverty (average death rate of 1.13). 11 qualified for moderate poverty (average death rate of 3.55). 30 counties qualified for high poverty (average death rate of 1.82), and 21 counties qualified for very high poverty (average death rate of 1.84).

Counties with moderate poverty had a higher incidence of surgical and inpatient death compared to other levels of poverty. Future work will include linear regressions and multivariate models with adjustments for education, geographic distance, and health insurance.

Abdul R. Harris, Abdul Karim Taufique, Daniyaal Kamran  

The current goal of our research review is to investigate healthcare outcomes related to transportation accessibility (i.e. public transport via trams, bussing, biking, etc.) and its possible link to socioeconomic status (SES) within the Boston area. Access to healthcare and its relation to healthcare outcomes has been a widely discussed topic and has been linked to poorer health outcomes through missed preventative care, delayed interventions, and lack of timely diagnosis for those struggling to gain access to transportation. Additionally, while not specific to transportation solely, the economic burden of health inequalities has resulted in trillions of dollars in debt/losses to hospital and healthcare providers across the United States. By analyzing how policies specifically impacting lower income areas – within the Boston area – have affected many populations’ access to hospitals/healthcare facilities, this research can, and should, be further expanded to other cities across the nation that are implementing tighter restrictions on transportation access. The hope of this research is to shed light on the ramifications of a lack of reliable public transportation on the healthcare field, the economy of the city/area being studied, as well as healthcare outcomes of patients seeking medical assistance.  

Jonathan B. Wilson, Michael A. Johnson, Cory B. Pisarra 

Teens have markedly increased social media use, about half report their use as near-constant. Captivating content can elicit jealousy, depression, anxiety, and fear of exclusion. Skyrocketing teen depression, suicide, and anxiety have prompted investigation. Scholars have drawn a link between social media use, rising psychological fragility, and depression. Because depression is a highly recurrent disorder, the deleterious consequences may last well into adulthood.  

An advanced PubMed search was run combining adolescent, anxiety, depression, and social media terms using the ‘&’ operator between each; results yielded 45 articles. Sorting by articles offering free full text and associated data, then excluding irrelevant articles left one article (Charmaraman, 2021). A Pew Research data visualization of teens self-reported views on the overall effect social media use has upon them was included as an edifying contrast.

The data indicated following celebrities on social media significantly correlated with depression, online social anxiety, and greater frequency of checking social media. Difficulty making friends and social isolation were higher for those following celebrities but the difference between teens following celebrities and those not doing so was not significant. Frequent social media use was strongly correlated with dissatisfaction with body image.

Teen self-reported attitudes vary widely about the effect of social media on them. Because of the strong correlation between frequent social media use and decreased socio-mental health the authors conclude boundaries for intentional social media use should be considered. It is possible teens endorsing negative mental health outcomes increase social media use.

Silva N, Miller A, Kapur M, Mihalcea A

Hypertension in Alabama was reported in 2017 to have a prevalence of 41%. Hypertension can result in heart disease and stroke, leading to poor patient outcomes and increased healthcare costs. According to the USDA, food deserts are defined as having more than 33% of the population or more than 500 individuals reside further from a supermarket or large grocery store (>1 mile in urban areas, >10 miles in rural areas). Larger distances to grocery stores have been shown to predict lower dietary variety and utilizing restaurants and fast-food establishments as alternative sources of food. Restaurants, particularly fast food establishments, often offer significantly processed food with high salt and fat content that could increase the risk of hypertension in its frequent consumers.  

PolicyMap was used to count the number of grocery stores and the percentage of hypertension for each county in Alabama. These variables were plotted to determine correlation.

The results portray a negative correlation for the number of grocery stores and the prevalence of hypertension.

It is important to identify factors that could contribute to a populations risk stratification for hypertension. The negative correlation for the number of grocery stores and prevalence of hypertension in Alabama may serve as a novel indicator to identify populations most at risk for chronic disease and improve resource allocation.

Victoria Boyd, John-Paul Fattorusso, Lauren Mere, Ryan Pearman

Melanoma represents a significant healthcare burden to the underserved and healthcare system at large. Previous literature suggests that access to specialty care may play a key role in preventing and treating general disease progression. The purpose of this study was to elucidate the link between various social determinants of health and the prognosis and outcome of melanoma in the United States.

A literature search was performed on Google Scholar, PubMed, Clinical Key and PolicyMap using terms such as “melanoma and healthcare disparities.” Articles published prior to 2012 and articles focusing on locations outside the United States were removed from our search pool. Using the pre-existing literature, we analyzed the relationship between the incidence and treatment of melanoma, and social determinants of health.

We found that the population density of specialists in a given area directly correlates with the timely diagnosis and treatment of certain pathological diseases. In rural areas, the average time before diagnosis is greater than in urban communities with increased dermatologic access. For example, the average staging of melanoma at the time of diagnosis for patients in an urban setting was much lower than the average staging for rural patients.

It was discovered that an individual's outcomes can be based on socioeconomic status, lack of health insurance, and identifying as racial/ethnic minority. Rural areas in particular are vulnerable due to decreased access to melanoma screening and specialists. Further research on TeleMedicine may reveal its effect on increasing access to care.