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Poster Day 2023: Abstracts: Population Health

PH101: The Impact of Civil Commitment Laws for Substance Use Disorder on Opioid Overdose Deaths

Authors: Phillip Cochran, BS; Peter S. Chindavong, BS; Jurian Edelenbos, BS; Amy Chiou, JD; Haylee F. Trulson, MS; Robert W. Parker, PharmD

We analyzed the impact of civil commitment laws for substance use disorder (SUD) on opioid overdose death rates (OODR) from 2010-21. 


CDC Wide-ranging Online Data for Epidemiologic Research (WONDER) dataset was used to extract death rates from 2010-21 focusing on opioid deaths using ICD-10 codes. T-tests were conducted using Excel. A two-way ANOVA was performed using GraphPad Prism 10.0. 

Results: T-test indicates no significant difference in the annual mean of age-adjusted OODR from 2010-21 between states with and without CC SUD laws (p=0.35). Before the COVID era/fentanyl influx (2010-19), the presence or absence of CC SUD law had no difference in age-adjusted OODR (p=0.39). However, in 2020-21, there is a significant increase in states with a CC SUD law compared to states without the law (p=0.032). For the ten-year range (2012-21), although no statistical significance difference is observed between states without CC SUD laws and states with CC SUD laws, an increasing trend is seen (p=0.053).  
Conclusion: Reasons for higher age-adjusted OODR in states with a CC SUD law include states enacting these laws in response to the opioid crisis or physicians' opposition to or unawareness of the law’s existence leading to underutilization, suggesting a correlation of elevated age-adjusted OODR in these states. Recency of CC SUD law enactment or ineffectiveness at opioid overdose rate reduction, despite similar completion rates compared to voluntary treatment along with lack of relapse rate recording demonstrates the need for further investigations to uncover factors influencing the OODR.                                 

PH102: Nutrition Literacy: What Are Young Adults With Type-1 Diabetes Missing?

Authors: Cassandra Abrams, OMS-II

This study aimed to evaluate the nutrition literacy and perceived emotional burden of disease in young adult type-1 diabetics. All participants are members of the non-profit organization The Diabetes Link, a 501 c3 nonprofit organization working to connect and support young adult type-1 diabetics. Previously conducted research showed a significant uptick in HbA1c levels in type 1 diabetics between the ages of 18 and 24. Lack of nutritional knowledge is frequently highlighted as the cause.


Participants completed a 40-question survey via Google Forms containing questions about their treatment, dietary habits, confidence in healthcare professionals, and overall feelings towards their diagnosis. The survey also included 4 questions aimed at evaluating the participant’s carbohydrate counting knowledge. A binary logistic regression was performed using SPSS 27 to assess the influences of burden and carbohydrate counting knowledge on participants’ diabetes care and nutrition perception.


Data from this study shows that participants who scored high on the carbohydrate counting quiz were 2.389 times more likely to avoid eating because of an out-of-range blood sugar (P-value= 0.05), and participants who reported higher levels of burden were 9.325 times more likely to avoid a social gathering because of food (P-value= 0.002). 


Results from this study demonstrate that the emotional burden associated with eating contributes to HbA1c spikes, not necessarily nutritional literacy. Emotional aids should be an added component of care for this demographic to correct burnout. Future studies should be conducted to evaluate the type of support necessary to alleviate the reported symptoms.

PH103: Weight gain following cessation of GLP-1 agonists


Ryan Pearman, MS; Victoria Boyd, MS


The use of GLP-1 receptor agonists in the settings of obesity and type 2 diabetes mellitus has increased dramatically in recent years. Though this drug class has been shown to promote significant weight loss in patients, the high cost of these drugs and shifting insurance policies frequently forces patients to discontinue their medication. The purpose of this study is to assess the outcomes of patient weight following the discontinuation of GLP-1 agonists.


Data was retrieved from the Semaglutide Treatment Effect in People with Obesity (STEP) clinical trial program. We analyzed data following cessation of semaglutide therapy at 68 weeks and 120 weeks. Our outcome variable was percent increase in weight compared to the patient’s weight on the first day of semaglutide cessation.


We found that patients tend to experience rebound weight gain following cessation of GLP-1 agonists. At 68 weeks following medication cessation, patient weight increased by 6.9% on average. At 120 weeks, patient weight increased by 11.6% from baseline.


Though patients tend to lose clinically significant weight while using GLP-1 agonists, patients tend to gain weight following their cessation. We show that patients’ weight increased by an average of 6.9% at 68 weeks and 11.6% at 120 weeks, showing a steady rebound weight gain following GLP-1 discontinuation. Thus, continued weight loss interventions may be needed if a patient must discontinue their medication. Future research is needed to explore effective weight loss maintenance solutions in these patients.

PH104: Every Second Counts: The Effects of Rural/Urban Location on Trauma Course and Outcomes in Florida


Ashley James, OMS-III, Ryan Liengswangwong, OMS-III, Danielle Roehrs, OMS-III


In patients suffering traumatic injuries, every second between injury and initiation of care matters. In this study we investigate whether rural/urban classification reveals health disparities with respect to the course and outcome of trauma cases in Florida.

Design: To evaluate this, we utilized national databases and reviewed current literature to examine areas of rural/urban classification, locations of trauma centers, estimated time to physician care, and trauma outcomes based on rural/urban residence.

PH105: Analyzing Differences in Gunshot Wound Outcomes Between Alabama and the Rest of the US by Investigating the Potential Impact of Healthcare Disparities


Ashley James, OMS-III, Allison Lewis, OMS-III, Soumya Sidana, OMS-III, Johnny Dang, OMS-III


In 2021, Alabama had the 3rd highest homicide rate in the US and the 4th highest death rate from firearms according to data from the CDC. That same year, firearms passed motor vehicle traffic to become the leading cause of death of minors between 1 and 17 in Alabama. These statistics beg the question of what factors contribute to the high rates of death attributable to gun violence in Alabama.

Design: In this study, we examine national and state data as well as recent literature to investigate the potential relationship between healthcare disparities and GSW outcomes in Alabama.

PH106: Impact of Comorbidities on Medicare Expenditures for Inpatient Hospital Stays in Alabama


Justin Thorne, B.S.E., Patrick Ransbottom, M.S., Peyton McMahan M.S., Rahul Garg, Ph.D., MPharm


Chronic diseases are common among elderly individuals and a significant cost burden on the U.S. healthcare system. Additional multiple comorbidities add to this cost burden which varies by hospital type, region, and specific chronic condition, and are principally borne by Medicare. Alabama has among the highest incidence rates of multiple chronic conditions. It is imperative to investigate the burden of multiple comorbidities on the cost of care on Medicare in Alabama.


We analyzed Alabama 2021 Centers for Medicare and Medicaid Services (CMS) healthcare claims data for the most discharged Diagnosis Related Groups (DRGs). We compared cost burdens associated with DRG codes with Major Complication and Comorbidity (MCC) and without MCC by using t-tests. We excluded DRGs with non-major comorbidities and those reported by less than four hospitals, resulting in 6 top discharged DRGs.


We found that the top discharged health conditions with MCC cost an average of $4,703.98 more than those without MCC (p <.0001). Average additional costs due to MCC varied with specific conditions: Stroke ($7670.6), Sepsis ($5711.4), Myocardial infarction ($5420.6), Heart failure ($4389.6), Esophagitis ($3113.3), and Kidney infections ($1918.4). These substantial added expenses highlight inefficiencies in our medical payment system andcall for better prevention and treatment of comorbidities.


Utilization of Medicare and other insurance expenditures for preventive measures and improved management of chronic conditions may yield substantial long-term cost savings. Affordable generic drugs and routine screenings could prevent chronic conditions from worsening and lessen the burden on an already strained healthcare budget.

PH107: Lack of Access to Quality Food and Risk of Cardiovascular Disease in the Black Belt Region of Alabama


Alec Lippman, OMS-II, Cory Dixon, OMS-II, Francis Sto. Domingo, OMS-II, Sawyer Longley, OMS-II


Food deserts are characterized as an area of low-income and poor access to affordable healthy foods. Compared to their urban counterparts, food deserts are found in rural areas of the United States. Food deserts have been shown to have a higher prevalence of cardiovascular disease risk. This study focuses on food deserts and the prevalence of cardiovascular risk in the Black Belt region of Alabama. The Education Policy Center (EPC) of Alabama created the most comprehensive, current, and expansive definition, which defined it as totaling 24 counties.

Design: Using data from the Rural Data Explorer on the Rural Health Information Hub, access to quality food was compared to cardiovascular disease in the Black Belt region alongside the rest of Alabama.
Results: Findings from this study indicate that the Black Belt region of Alabama has a higher incidence of cardiovascular disease as well as lower access to quality food compared to the rest of Alabama.
Conclusion: Through this study, food deserts have been shown to increase correlation with the risk of cardiovascular disease in the Black Belt. Black Belt counties are classified as Health Professional Shortage Areas as designated by the Alabama Department of Public Health. The shortage of primary care physicians might be exacerbating patients' management of cardiovascular risk factors. This study identifies urgent trends that health professionals and policymakers can use to assess overall patient health in the Black Belt. Future studies could address specific factors contributing to the high incidence of cardiovascular disease, including the impact of healthcare infrastructure.

PH108: Social Vulnerability related to Mental Health During the 2020 COVID-19 Pandemic in Alabama, Georgia, and Florida

Authors: Alejandro Arroyo Rodriguez OMS-II,, Joy Taazieh OMS-II, Stephanie Gonzalez OMS-II, Cassie Odahowski MPH, PHD
Background: The fall of mental health during the 2020 COVID-19 pandemic has been a well-documented change. Our paper aims to understand the relationship between the socioeconomic and sociodemographic factors that were protective and harmful to mental health during this time.
Design: We examined socioeconomic and sociodemographic characteristics by means of the Social Vulnerability Index, self-rated mental health from the BRFSS, and urban vs rural classifications. We used a t-test for unequal variances to examine differences in mean self-rated mental health status in the tri-state area. ArcGIS visually displayed a bivariate (rural self-rated mental health) map and linear regression was used to examine county social vulnerability (SoVI) metrics and Medically Underserved Areas (MUA) related to self-rated mental health.
Results: Our statistical analyses showed that Alabama had the highest frequency of individuals reporting poor mental health, while Florida had the lowest frequency. The use of the Social Vulnerability Index highlighted protective and risk factors based off each state and urban vs rural counties. The exact factors per state and urban vs rural counties are being finalized and will be complete for the poster presentation*.
Conclusion: During the 2020 COVID-19 Pandemic there was a dip in mental health, and the effects of been long lasting. Our paper highlights the exact factors with our communities that must be capitalized on, and those which must be aided in order to better serve everyone post COVID-19. In this way we can be better prepared for any other event that may come about.

PH109: The impacts of limited grocery store access on osteoarthritis prevalence in Alabama


Victoria Boyd MS OMS-III, Ryan Pearman MS OMS-III


Osteoarthritis is the most common arthritis worldwide, causing progressive loss of joint function and eventual joint failure. Several risk factors contribute to the disorder; however, a patient’s diet and BMI are the greatest modifiable risk factors. Lack of access to grocery stores may put patients at risk for a poor diet and obesity, and thus, increase their risk of osteoarthritis. The current study’s purpose is to determine a relationship between the prevalence of osteoarthritis and patient access to grocery stores.


A literature search was performed using Google Scholar, PubMed, and ClinicalKey using terms such as, “osteoarthritis and grocery access.” The literature search was not restricted by a time frame or geographic area. A similar search was performed on PolicyMap, using the most recent data available. Geographic data was unavailable for osteoarthritis specifically, and therefore arthritis, including OA and other arthritides, was substituted. The maps were used to analyze a geographic relationship between arthritis and grocery store locations in Alabama.


There were no articles that analyzed the relationship between osteoarthritis prevalence and patient access to grocery stores. A relationship was seen, however, when analyzing the data geographically. Areas of Alabama with a greater density of grocery store retail locations (Figure 1) show a decreased prevalence of patients diagnosed with arthritis (Figure 2).


Geographic population data illustrates that limited access to grocery stores may be a risk factor for arthritis in Alabama. Further research is needed to identify the scale of the impact that grocery store access has on joint health.

PH110: An Analysis of the Effects of Opioid Prescribing Rates in Rural vs. Urban Communities


Justin Moon, MEd, OMS-II, Swarna Sakshi, MS, OMS-II, Katherine Thornburgh, MPH, OMS-II

Background: The United States (US) opioid epidemic, spanning the past two decades, claimed nearly 280,000 lives from 1999 to 2021, with a daily average of 45 opioid-related deaths in 2021. In 2017, the US government declared a public health emergency due to this crisis. Opioid prescribing rates are notably elevated in rural areas, exacerbating health challenges in these communities.
Design: Literature search was conducted using key words “opioid related mortality”, “opioid related death”, “opioid-prescribing in rural areas”, “opioid prescribing rates to opioid misuse relationship”, and “opioid-mortality and effect on healthcare costs” within PubMed and Concensus. Results >10 years were excluded. Clinical studies, clinical trials, meta-analyses, randomized controlled trials, reviews, and systematic reviews were included. Search results focusing on the effects of specific opioids on health conditions or health outcomes were also excluded.
Results: This investigation indicates a complex, multifactorial link between opioid prescription rates and opioid-related mortalities, encompassing factors like prescription rates, sociocultural aspects, and accidental deaths. The literature lacks a definitive consensus on whether rural or urban populations are more affected. Data suggests that geographic regions exhibit varying trends with rural regions facing greater impact by prescription opioids and urban regions facing a greater impact by heroin in opioid-related deaths.
Conclusion: Discussions surrounding the opioid epidemic often overlook the geographic disparities in its impact. Rural communities face unique challenges in healthcare access, addiction treatment, and prevention. Addressing this crisis requires adaptable and comprehensive strategies.

PH111: Assessing the Impact of State Opioid Prescription Cap Laws on Adult Opioid Overdose Rates: A National Comparative Analysis


Mary Olivia Smith, OMS-II  Sarah Duffy, MMS, OMS-II Maya Kalaria, OMS-II  Caitlin Curran, OMS-II

Background: This project examines opioid overdose incidence before and after prescription capping laws were enacted. These laws began to appear in 2016 and 39 states had implemented them by 2019. They aimed to lower opioid abuse and encourage alternative methods for pain relief, however, there may have been unintended effects of decreasing access for chronic pain patients in need or leading patients to source street drugs.

This is a retrospective correlational study observing the impact of opioid prescription capping laws on opioid overdose mortality. Archival data was obtained via PolicyMap, Centers for Disease Control, Clinical Key, and Drug and Alcohol Dependence journal. The years 2014 and 2019 were examined in order to analyze outcomes before and after capping laws implementation.


Prescription opioid overdose deaths began declining in 2010 while other causes were rapidly increasing nationwide. The decline in prescription opioid overdoses was seen across the US in both states that did not have opioid capping laws and states that did have opioid prescription capping laws.

Conclusion: Based on the data, state opioid prescription capping laws have not made a significant difference in the rate of opioid overdoses. While these laws could have impacted the rates of opioid prescription deaths in the states they were implemented in, there was likely an overall decline due to the preference for heroin and synthetic opioids after an increase in opioid epidemic awareness and local, state, and federal efforts. Future endeavors should focus on controlling the amount of synthetic opioids and developing preventive measures.

PH112: The Effects of Peer-Led Health Education in Schools on the Improvement of Health Outcomes

Authors: Nikoleté Hurrinus M.S., OMS-II, Lauren Henehan M.S., OMS-II, Zainalabedeen Sabah OMS-II
Background: Education significantly influences social determinants of health, particularly in early childhood and adolescence. Disparities in education lead to avoidable long-term health outcomes. Peer-led interventions in schools improve health knowledge but require better evaluation for broader societal benefits.

PubMed database was primarily utilized with keywords "peer-based," "school education," and "health outcomes" to narrow 900+ articles. Filters included text availability, type, and publication date, selecting five articles focused on peer-based school education's impact on health outcomes. Additional information was obtained from the CDC. The study strategy incorporated a global perspective, ultimately examining six sources total.

Results: Preliminary research highlights the importance of early education and its impact on disadvantaged children. Factors like mother's education, welfare use, single-parent households, and language barriers influence both educational and long-term health outcomes. Peer-led interventions in schools, particularly in topics like sex education and healthy lifestyles, show positive effects. Analyzing data in Alabama reveals a link between educational attainment and physical health. Standardized health education programs are seen as crucial for improving long-term health outcomes and fostering risk awareness in students.
Conclusion: Peer-led interventions have effectively increased students' knowledge of health topics, enhancing their understanding of risks associated with unhealthy behaviors. Standardized peer-led health education programs could raise risk awareness, improve decision-making, and foster long-term health. However, while knowledge increases, behavioral lifestyle changes may not follow, suggesting a need for further investigation. Future research should explore the impact of standardized health education programs on both knowledge and behavior changes to ensure positive patient outcomes.

PH113: Kratom – The Gas Station Heroin

Authors: Zoya Hussain, OMS II Robert Wayne Parker, PharmD

Kratom, a psychoactive derivative of Mitragyna Speciosa, originally prevalent in Southeast Asia, is increasingly becoming a concern in the United States. This herbal substance targets opioid receptors in the brain, akin to the potent opioid, fentanyl. In Southeast Asia, kratom is commonly consumed as a tea, serving as a cost-effective alternative for opioid addiction treatment, withdrawal management, and fatigue reduction. Conversely, in the United States, a significant portion of the population turns to kratom primarily to address chronic pain and alleviate opioid withdrawal symptoms.

As accessibility to kratom widens, it emerges in various forms, including powders, capsules, and extracts, often sold in gas stations, smoke shops, and lounges advertising euphoria and relaxation. Kratom has been referred to as “gas station heroin” due to its ease of access. Despite escalating apprehensions about its abuse potential, the Drug Enforcement Administration (DEA) lists kratom as a "drug of concern," remaining legal in most states except for a few. The lack of stringent regulation leads to concerns regarding the authenticity, potency, and quality of this substance, raising contamination-related issues.

While the long-term effects of kratom remain poorly studied, there is a growing body of evidence indicating kratom-related toxicities and numerous associated fatalities. This discussion underscores the clinically significant aspects of kratom use and abuse, emphasizing the need for further research, regulation, and public awareness regarding this evolving issue.

PH114: Accessibility of Naloxone and its Impact on Opioid Overdoses

Authors: Bri Amos, OMS-II, R. Wayne Parker, PharnD
Background: In recent years, the opioid endemic has proven to be more pronounced than ever. The crisis began in the 1990s, but the COVID pandemic has shown an increase in overdose deaths. Evidence shows prescription opioids contribute, but heroin and synthetic opioids are the main source of overdose deaths. Many synthetic opioids are illegally produced to be more potent than drugs such as morphine and thus have higher potential for overdose. To combat the opioid endemic, community organizations have proposed distribution of naloxone to those using opioids. Prevention programs have been designed to distribute naloxone to decrease opioid overdose deaths.
Design: A case study was designed to evaluate the accessibility of naloxone and its impact on opioid overdoses. It also aimed to identify the efficacy of naloxone against fentanyl and fentanyl analogs. To do this, literature searches were conducted through PubMed online databases using the search query.
Results: Naloxone is the most used reversal agent for opioid overdose, and studies have proven it to be safe and efficacious in doing so. Community-based programs have worked to assist in naloxone delivery to individuals using opioids. The study found that areas with higher program enrollment had lower rates of opioid-related overdose death. Additionally, new evidence suggests naloxone is effective against fentanyl and its analogs, if administration is performed within a reasonable amount of time.
Conclusions: The rate of opioid overdoses has decreased amid readily available naloxone. No studies have proven naloxone to be ineffective against opioids mixed with fentanyl. 

PH115: HIV Testing Accessibility in Rural Communities in the Southeastern United States

Authors: Susana Giraldo, M.S., OMS-II, Mary Fabbrini, OMS-II, Rebecca Suk, M.S., OMS-II
Background: Advances in HIV prevention have contributed to a decrease in national HIV cases. However, HIV remains a significant threat in the Southern United States. Gaps in healthcare accessibility, physician knowledge on preventive measures, and proper education regarding HIV prevention and management have led to greater disparities within rural communities.
 Design: A literature search was conducted using PubMed, CDC, and IDSA databases, focusing on HIV testing accessibility in rural communities in the Southeastern U.S. The search included articles from the last decade addressing HIV/AIDS prevalence, healthcare barriers, testing access, prevention efforts, financial burdens, and physician knowledge.
Results: The Southeastern U.S. has among the highest prevalence of HIV positive individuals. Within rural communities, multiple socioeconomic factors, sexual and gender discrimination, and lack of experienced clinicians prevented access to HIV care. Furthermore, high-risk individuals in the South show low pre-exposure prophylaxis (PREP) use, due to cost and stigma.
Conclusions: Despite high HIV rates in the country, rural communities in the Southern U.S. struggle to provide community members with resources to prevent and treat HIV. Lack of access to care, limited awareness and education, and financial disadvantages manifests in lower use of preventative measures such as HIV testing and pre-exposure prophylaxis. Furthermore, cultural and religious stigmas create unsupportive environments for high-risk patients like members of the LGBTQIA+ community. To address these challenges, healthcare authorities should prioritize financial assistance for testing, free distribution of prophylaxis, and provide sensitivity training to healthcare professionals for more comprehensive care.

PH116: Outcomes of curative colorectal cancer surgery stratified by race and socioeconomic status

Authors: Jenson Rawlings, OMSII; Gina Bae, OMSII; John Cho, OMSII; Brock Shipp, OMSII.
Background: This study aimed to identify disparities in surgical outcomes for colorectal cancer patients in the USA. Blacks, Hispanics, and Asian populations, as well as socioeconomically disadvantaged individuals consistently showed poorer postoperative outcomes than White patients.
Design: A retrospective study design was carried out. The retrospective design allowed treating physicians' discretion during treatment and management. Not all data provided contained details on case complexity, disease stage, and information on exposures or behaviors such as diet and exercise. These factors influence patients' trajectories, irrespective of race, ethnicity, or socioeconomic status.
Results: Our findings underscore the ongoing disparities when it comes to race and socioeconomic status. Black and Hispanic patients, along with those in lower socioeconomic brackets, consistently exhibited poorer postoperative outcomes, including prolonged hospital stays, increased complications, and higher mortality rates compared to White patients and those with private insurance.
Conclusion: Colorectal cancer's global prevalence necessitates attention. Access to care emerges as a critical determinant, with financial constraints and lack of medical coverage shaping recovery experiences. Disparities persist despite surgical treatment and reported adherence to standard of care. The methodology, utilizing a diverse cohort of colorectal cancer surgery (CRCS) patients in the United States, facilitated a comprehensive analysis. Despite limitations results underscore the importance of addressing disparities through tailored public health initiatives. This study calls for intensified efforts to reduce colorectal cancer recovery disparities, recognizing the influence of race and socioeconomic status and advocating for equitable access to successful recovery and improved quality of life for all patients.

PH117: Through the Lens of Equity: Addressing Visual Impairment's Influence on Academic Achievement in Public Health

Authors: Lauren Farrell, OMS-II; William White, OMS-II; Daylon Wingate, OMS-II; Carl Gammon, OMS-II
Background: Visual impairment encompasses various conditions affecting an individual’s ability to process visual information. In the U.S., approximately 6.8% of children live with diagnosed visual impairments, with disparities in prevalence based on race and socioeconomic status (SES). Lower SES often correlates with reduced access to healthcare and early interventions for visual impairment, leading to academic challenges.
Design: A systematic literature review was conducted using databases such as PubMed, Google Scholar, AMED, and JAMA Evidence. Keywords and MeSH terms related to visual impairment and academic performance were used. Inclusion criteria encompassed studies focused on the impact of visual impairment on academic performance, qualitative data, peer-reviewed articles, and studies conducted in educational settings from 2000 to 2021. Full-text articles were evaluated, and data were synthesized narratively.
Results: The literature review revealed the complex relationship between visual impairment and academic performance. Students with visual impairment face academic challenges, including difficulties in reading, writing, and information access, resulting in lower test scores and academic achievements. Educational interventions, such as corrective eyewear and assistive technologies, significantly improved academic outcomes. Lower SES was linked to delayed diagnosis and limited access to resources, exacerbating academic struggles. Inclusive educational environments and accessible materials positively influenced academic outcomes
Conclusion: This review highlights the impact of socioeconomic disparities on individuals with visual impairment, emphasizing the need for accessible resources and support systems. More rigorous research is needed to inform interventions and policies that can better support students with visual impairment, especially those facing socioeconomic challenges, in achieving academic success.

PH118: Perioperative Complications Relating to Food Insecurity: A Literature Review

Authors: Christa Haran, OMS-II, M.S., Nathan Jacobsen, OMS-II, Rosalinda Cruz, OMS-II, M.S., Tristan Sypula, OMS-II

Food insecurity (FI) is a growing public health concern within the U.S.; Alabama falls within the top ten FI states. FI is associated with poorer health outcomes, but little is known about the impact of FI and surgical outcomes. This study seeks to identify a correlation between FI and surgical outcomes in Alabama and how FI interventions can affect these outcomes.


A literature search was conducted across PubMed, Policy Maps, Center for Medicare and Medicaid Services, American Hospital Association, U.S. Department of Agriculture, Center on Budget and Policy Priorities focusing on FI and surgical outcomes in the southern U.S. with emphasis on Alabama. Articles and data from the last decade addressing FI prevalence, perioperative complications and mortality, food assistance programs (FAP) benefits and limitations, and healthcare preventative efforts were included. A search of FI interventions within healthcare was completed focusing on the U.S.


The review highlights that FI elevates perioperative risks, readmission rates, and mortality. FI linked complications worsen outcomes in arthroplasty procedures. In Alabama, 8 hospitals with higher surgical complications than the national average are in counties with 11.82% FI (2019-2021). FI initiatives at health centers have shown a decrease in readmission rates. While FAP helps combat FI, Supplemental Nutrition Assistance Plan participants exhibit poorer Healthy Eating Index which could heighten perioperative risks.


This review emphasized the evidence linking FI and perioperative complications is limited. Additional research is needed to establish this connection and explore the advantages of implementing FI support interventions for surgical patients.

PH119: Access to Birth Control in the Women's Homeless Population in the United States

Authors: Kate Gargiula OMS - II, Ashley George OMS - II, Hannah Harris OMS - II, Erin Reid OMS - II, Ryan Sewell OMS – II
Background: In the United States, homeless women face many unique barriers in accessing most forms of contraception. This systematic review focuses on the many barriers that homeless women encounter when seeking birth control.
Design: Several databases were used to gain access to a variety of study types, and were screened for relevance towards the homeless population, study design, and possibility of bias. Review of resources was frequently precluded by lack of information and broad scope of studies.
Results: The most used form of contraceptives amongst the homeless population were condoms despite a majority of studies reporting the desire for long acting contraceptives. The desire for further information and improved access to all types of birth control amongst homeless women was apparent across the reviewed studies. Lack of patient-physician relationship and education are major factors that contribute to the lack of access to reproductive care. Consequences include higher rates of STIs/STDs and perpetuation of familial homelessness. The scope of research for general access to birth control is wide but there is an apparent lack of research specific to homeless women.
Conclusion: The research that is available shows the alarming need for more access to all types of contraceptives, specifically long acting prophylaxis. Potential solutions to resolving this disparity include allocating more funding towards free clinics, widespread distribution of condoms throughout public spaces, and providing educational pamphlets about different types of birth control.

PH120: Nutrition, Socioeconomic Factors, and Chronic Diseases: A Comprehensive Analysis in the Southeastern United States

Authors: Ryan Muchard, OMS - II Jack Shelton, OMS - II John Michael McAllister, OMS – II
Background: It has been well-documented that chronic diseases such as obesity, diabetes mellitus, and cardiovascular diseases are a growing problem in the United States, placing an undue financial and functional burden on the healthcare system. While these diseases are largely preventable with a healthy diet and regular exercise, rates still seem to increase in certain areas. This study aims to identify a specific correlation between nutritional status and chronic disease by analyzing factors such as dietary patterns, geographical area, and SES.
Design: A comprehensive analysis was conducted, focusing on the Southeastern United States, where the rates of chronic health conditions significantly exceed national averages. Data were sourced from reputable databases, including MDPI, NIH, PubMed, and the CDC, to understand possible correlations between SES, geographical area, dietary patterns, and the prevalence of chronic diseases.

The study revealed a significant association between dietary factors and chronic diseases. Reduced fruit consumption emerged as a leading contributor to these diseases, resulting in nearly 4.9 million attributable deaths annually. High sodium intake and reduced consumption of nuts, seeds, vegetables, and whole grains were also identified as significant risk factors. SES impacted dietary habits, particularly in low-income populations, increasing vulnerability to chronic diseases.

A notable finding was the inverse relationship between areas of high obesity and areas of high income in the Southeastern US. Traditional dietary practices deeply rooted in Southern culture, characterized by calorie-dense and processed foods, were identified as potential contributors to the elevated prevalence of chronic diseases in the region. The increased proportion of fast-food restaurants in certain areas was correlated with lower SES and adverse health trends.

Conclusions: This research underscores the urgency of targeted public health interventions in the Southeastern United States to address the root causes of poor dietary habits and improve access to healthier foods. Implementing strategies to promote nutritional awareness, education, and supportive environments for healthy eating is vital. Such initiatives can potentially reduce the incidence of chronic diseases, alleviate the burden on healthcare systems, and enhance the overall well-being of the population. Tackling these health challenges requires a multifaceted approach recognizing the intersection of nutrition, socioeconomic factors, and chronic diseases.

PH121: Mental Health Disparities in Immigrant Children and Adolescents

Authors: Kayla Rojics, OMS-II, Rhea Nichani, OMS-II, Meaghan Barros, OMS – II
Background: The causes of mental health discrepancies have been investigated to determine if immigrant children are more at risk of a mental health crisis than U.S.-born children. Interestingly, previous studies have shown an “immigrant paradox” where immigrant children fare better than those born in the U.S. These protective forces are thought to be partially a result of strong community ties. However, first-generation immigrants are more likely to experience discrimination and language barriers which can result in decreased psychosocial health.
Design: We utilized data base searches to find topics related to our literary review discussing aspects of mental health in immigrants both positive and negative aspects.
Results: While becoming a U.S. citizen affords its benefits, such as more access to financial and public resources, this push to assimilate may also influence the mental health of immigrant children. Immigrants were more likely to have lower socioeconomic statuses but significantly better mental health when compared to U.S. born citizens. The mental health protective factor was found to decrease the longer the immigrants remained in the U.S and they are less likely to use mental health services even when there is a greater need for these services.
Conclusions: With over 200,000 immigrants arriving to the US as of August 2023, it is important to find ways to increase and maintain the mental health of these immigrants. Through advocacy amongst pediatricians and politicians, including decreasing barriers and discrimination, as well as increasing access to financial and educational institutions, these immigrants can continue to thrive.

PH122: Correlation between nutrition-scarce areas and negative healthcare outcomes

Authors: Sai Vemula OMS-II Rohit Reddy OMS-II Vikranth Doppalapudi OMS-II Mirza Baig OMS-II

Access to nutrition is a critical social determinant of health in the United States. Many Americans live in food deserts or food swamps, which are areas with limited access to nutritious food. Obesity is closely associated with elevated risks of various cancers, amplified in regions with food deserts or swamps, which often coincide with low-income and underserved populations.


This paper explores the correlations between nutritious food availability and healthcare outcomes of communities that are affected by nutritious food insecurity. Current research suggests a potential correlation between food deserts and swamps, and increased obesity-related cancer mortality, even after adjusting for demographics. Variations exist in how different racial and ethnic groups perceive their environment, which may affect dietary habits.


A correlation between food insecurity and negative healthcare outcomes in regions labeled as food deserts and swamps exists. It is essential to mitigate obesity-related health disparities to improve healthcare outcomes in these vulnerable communities. However, addressing this complex issue requires a multifaceted approach encompassing access to nutritious foods and broader social determinants of health.


There is an overall correlation between the proliferation of fast-food and convenience markets and the exacerbation of obesity-related disease in regions where other nutritious food options are extremely limited. Further healthcare policy and efforts are needed to assist these communities which are in need of proper nutrition. The goal to ensure equitable access to nutritious foods and opportunities for physical activity, regardless of geographic location or socioeconomic status is possible with societal change.

PH123: Ensuring Price Transparency Compliance in Institutions that Serve Minorities

Authors: Allan Gutierrez, Tahnin Bluangtook, Victoria Gutierrez, Anna Ward
Background: In 2019, the Centers for Medicare and Medicaid Services (CMS) effectuated a law to increase price transparency in healthcare. Institutions must provide a comprehensible machine-readable file with items and services displaying at least 300 shoppable services to patients on their website. Our study aims to determine compliance and barriers presented to the top 50 hospitals serving minorities in the United States.
Design: The websites of the top 50 institutions ranked by the Lown Institute Index were searched to find publicly available data for the price of procedures and barriers to access. Data searched included the presence or absence of files, the number of clicks, time to find, barriers to accessing the files, compliance of 300 lines, and access to additional price calculators.
Results: 88% of the top institutions serving minorities in the United States had publicly available files containing pricing for medical procedures. 64% of the institutions provided additional tools, pricing calculators, to estimate the prices of procedures. 52% of institutions had barriers to accessing the charge files (e.g., requiring personal information, files too large to download, file formats not compatible).
Conclusion: Of the top 50 institutions serving minorities, compliant institutions provided data that, even if accessible, was difficult to interpret and required additional expertise to understand. Furthermore, over half of the institutions presented additional barriers to accessing the files, which increases the chances of stopping the search for pricing, increasing the disparity in healthcare when serving minority populations.

PH124: Uncovering Disparities: Social Determinants of Health Impacting Immigrant Populations in the United States

Authors: Katherine Lance, OMS-II Sonia Patel, OMS-II
Background: Profound health disparities exist between immigrants and native-born citizens in the United States. This has a prevalent impact on population health since noncitizen immigrants account for 14% of the total US population.
Design: We conducted a meta-analysis regarding barriers in immigrant healthcare in order to explore the various social determinants of health contributing to this gap.
Results: From our analysis, we propose healthcare coverage, English proficiency, and occupation hazards are the most significant contributing factors in immigrant health disparities. Private coverage options are limited for foreign-born populations as they tend to work in job sectors that are less likely to provide health benefits and face strict eligibility recruitments for public coverage. Despite obtaining coverage, English proficiency results in significant communication barriers affecting compliance and quality of care. Furthermore, immigrants are more at risk for occupational hazards due their high prevalence in sectors such as Construction, Agriculture, and Forestry.
Conclusion: It is essential to recognize these factors as major contributors to health inequities in foreign born populations in order to increase implementation of targeted strategies to mitigate them and initiate advocacy on both a community and government level. These strategies, such as patient care navigators, can positively impact communication between providers and patients, increase motivation to seek healthcare, and ultimately improve health outcomes for these vulnerable populations. Moreover, disparities in health lead to increased expenses for individuals and healthcare systems. Allowing these health inequalities to persist within the expanding foreign-born population will, in turn, have adverse consequences for the nation's economy and healthcare system.

PH125: Association Between Low Socioeconomic Status and Anxiety Disorders in U.S Adults

Authors: Paranjaya Pokharel, OMS-II, Sanjana Rasamsetti, OMS-II, Aesha Shah, OMS-II, Anjali Thomas, OMS-II
Background: The 2021 criteria from the U.S.D.A defined impoverished populations as those with an individual household income below $12,880. Generally, individuals with low socioeconomic status (SES) have lower autonomy to work, feel more pressure to survive, and cannot afford a comfortable standard of life. Although biomedical factors are linked to anxiety disorders, environmental factors must not be ignored. The purpose of this study was to determine how variables contributing to low SES impact how one experiences anxiety.

Data came from peer-reviewed sources published on PubMed using “AND/OR” functions, as follows:


((((anxiety[Title]) OR (anxiety disorder [Title])) AND (low socioeconomic status [Title] OR (poverty[Title]))


We excluded articles that didn’t mention a relationship between the variables, and those whose primary studies were outside the United States.

Results: Preliminary data shows that individuals and families in the United States with low SES often have a higher incidence of mental health symptoms, including psychiatric hospitalization and mental disabilities. Data also suggests a reciprocal relationship between low SES and mental illness. For example, those living with mental illness may, as a result of their disability, have lower employment rates or those living with low SES can also subsequently experience greater anxiety due to their means of living.
Conclusion: Implementing policy changes or community outreach initiatives to improve SES can potentially reduce anxiety, allowing for more tailored treatments and preventative measures. A larger sample size and separation of external variables like gender, race, education level, and medical conditions would further strengthen the results.

PH126: Analyzing Correlations to Poor Mental Health and Outcomes in Children and Adolescents in the United States


Authors:   Abeer Fatima, OMS-II; Sireen Hilo, OMS-II; Zainab Imami, OMS-II, Zalak Navadia, OMS-II
Background: Adverse Childhood Experiences (ACE’s) are early life events that cause significant stress, such as child abuse or household dysfunction (Kerker, et. al). The frequency of ACE’s are increased in children with low socioeconomic status (SES) and may contribute to poor childhood mental health and poor mental health outcomes in later life.  This review explores the prevalence of poor mental health in children and adolescents and discusses possible contributing factors and long-term effects.  
Design: PubMed was primarily used to search for relevant literature. PolicyMap was utilized to find data that supported the claim of low SES leading to higher rates of children with mental health issues. Cohort studies, literature reviews, and studies that investigated the relationship between variables relating mental health to children were included. 
Results: There is a correlation between children who suffer from mental health issues and the socioeconomic status of their families. Children coming from lower SES households face more stressful life situations and worse mental health outcomes. This is primarily due to the lack of resources available for children, parental education, and the overall outlook on mental health in lower SES areas. 
Conclusion: Children from low SES households and those raised in poverty had a high prevalence of developing mental health issues due to facing more stressors compared to their counterparts of normal/high SES. Taking proactive measures early to protect children from experiencing mental health conditions in their childhood is vital to ensuring a healthy adulthood and preventing many hurdles and challenges in adult life.

PH127: Navigating Breast Cancer Disparities in Hispanic and Immigrant Communities: Challenges and Solutions.

Authors: Shane Mohsin, OMS-II. Claudia Romero, OMS-II. Samiha Sayed, OMS-II.
Background: Extensive breast cancer research suggests despite Latina women having lower rates of breast cancer than non-Hispanics, Latinas still had worse treatment outcomes. Our goal is to examine the intersectional factors that cause this disparity and discuss their pervasive consequences in the hope of prompting further research into rectifying this imbalance, particularly in rural communities. 
Design: This study primarily analyzed peer-reviewed research published under the National Center for Biotechnology Information and PubMed. These databases were chosen due to their comprehensive filtration systems that selected resources that were recent, relevant, and specific to the correct region and population subset.
Results: Results suggest Latinas are more likely to possess a protective ESR1 gene variant and fewer BRCA1/BRCA2 mutations compared to non-Hispanic women yet still have worse treatment outcomes. For rural Latinas, the main obstacles to treatment included: lack of language proficiency or knowledge of treatment, lack of proactive health behavior, lack of care coordination, emotional distress, and difficulty understanding or retaining health information. 
Conclusions: Breast cancer incidence rates are lower amongst Latina women than other ethnic groups, yet breast cancer is a leading cause of cancer-related deaths in this subpopulation. This discrepancy is rooted in factors such as immigration status, language proficiency, limited access to healthcare resources, cultural attitudes, and low socioeconomic status. With this research, we now understand the needs of Latina women in the context of breast cancer, so as to incite further investigations on the matter, setting the stage for better future targeted interventions and improved outcomes.

PH128: Monitoring skin cancer occurrences, risk factors, and behaviors among rural farmers.

Authors: Sheridan Padgett OMS-II, Margaret Deyton OMS-II, Camille Chancellor OMS-II, Alison Shames OMS-II
Background: Farmers are exposed to environmental conditions, such as sun exposure, that have negative effects on their health. Farmers rarely include protective measures into their routine to combat exposure to the elements. Rural areas often lack access to specialists such as dermatologists. Therefore, skin cancer is often detected later at more progressive stages in rural populations.
Design: We performed a scoping review investigating the risk factors and behaviors among rural farmers that contribute to increased rates of skin cancer. We conducted a database search. The parameters for rural were set as a city or town of less than 10,000 people. Farmers were defined as anyone participating in agricultural work. We did not exclude any study type.
Results: A study conducted during the 2011 Wisconsin Farm Technology Days found that most farmers could identify sun protection methods but did not use them. Carley et al. (2015) Due to lack of protective measures, skin cancer rates among rural farmers are higher compared to urban populations. Zahnd et al. (2010) found that rural populations were 33% less likely to wear sunscreen to protect themselves from UV radiation. The lack of preventative measures can correlate to increased incidence of skin cancer among rural farmers.
Conclusions: Per our review, farmers are at an increased risk of developing skin cancer. This increased risk is correlated with environmental exposures such as UV radiation, rural health gaps, and lack of education, and awareness.

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