Poster Day 2024: Abstracts: Population Health

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. 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.

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This literature review was conducted by researching articles containing studies on pregnant women who transmit CS to their newborn. Databases searched included PubMed, the National Institute of Health, the Center for Disease Control, and the American Journal of Obstetrics and Gynecology. Studies conducted measured trends of CS with various factors including location, socioeconomic status, and access to prenatal care. The peer-reviewed studies chosen were published post-2000 and included a large sample size.

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Discussion:

Healthcare inequities and discrepancies in socioeconomic status, demographics, and residence all contribute to the rise of CS in America. Removing barriers to healthcare availability to make prenatal screening more accessible should be the main strategy to reduce the rates of CS. Sexual-health education is also paramount in reducing rates of primary and secondary syphilis, in turn reducing CS. Research on this topic may be expanded by examining which of these contributing factors is the most crucial.

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. 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.

The findings indicate that transportation barriers may play a more critical role than facility availability in determining healthcare access for individuals with ambulatory disabilities in rural areas. The use of secondary data limits the ability to account for individual-level factors, such as socioeconomic status or quality of healthcare facilities, that may confound the relationships investigated. Public health strategies should focus on improving transportation infrastructure and expanding accessible options to reduce health disparities and improve outcomes for rural populations with disabilities.

Type 2 diabetes was already a serious threat to public health when the COVID-19 pandemic hit. Concurrent cases of COVID-19 and diabetes cause a higher risk of complications and research was in an effort to highlight these risks and better quantify them. To accomplish this, PolicyMap was used to understand the amount of people who have been diagnosed with type 2 diabetes. Second, the current literature was reviewed to gain insight into how patients with type 2 diabetes as an underlying condition affects the complication profile of those infected with COVID-19. The primary findings indicated COVID-19 infection was consistently found to be more severe in patients with diabetes (Du et al., 2020). These severe symptom profiles included a higher likelihood of requiring hospitalization and ICU care (Cariou et al., 2020). Additionally, diabetic patients showed an increased risk of developing acute respiratory distress syndrome (ARDS) and multi-organ failure compared to non-diabetic patients (Cariou et al., 2020). The findings were limited by the newness and relative lack of information on COVID-19 in general. The research was also limited to the applicability of our researched populations to the local population. In the future, more research can be done to find the mechanisms behind these increased risks for complications as well as elucidate whether these risks are solely due to the biological states associated with diabetes or if socioeconomic status is also playing a role.

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Further studies on legal, political, and incentives that would effectively increase OBGYN access and physician retention are necessary to prevent the widening of the current health equity gap.

Members of the LGBTQ+ community face delayed diagnoses and higher recurrence rates of breast cancer compared to their heterosexual and cisgender peers. This disparity often stems from individuals not seeking care due to a dissonance between their body image and gender identity. As a result, delayed care frequently leads to worse prognoses. A literature review was conducted using databases like PubMed to identify relevant articles, primarily sourced from Cancer: An International Interdisciplinary Journal of the American Cancer Society and JAMA Oncology. These studies highlight healthcare disparities, particularly regarding delays in care, treatment, and outcomes for LGBTQ+ individuals with breast cancer compared to heterosexual, cisgender individuals. Additionally, visuals from PolicyMap and the journals mentioned were incorporated to demonstrate epidemiological evidence from prior research. With increased awareness, healthcare policies and practices can be adjusted to ensure that sexual orientation and gender identity are not barriers to quality care. 

Moving forward, research should focus on identifying sustainable methods for promoting early screening, especially for transgender individuals (Poteat et al., 2021). Poteat (2021) notes that healthcare providers often feel apprehensive about asking crucial social history questions, such as those regarding sexual orientation, leading to missed opportunities for timely care. Future studies should investigate the barriers preventing the collection of this vital information during patient interviews, with the goal of improving physician competence and sensitivity in navigating these social contexts. Research should also explore which healthcare approaches most effectively promote early screening among transgender individuals (Poteat et al., 2021).

The scarcity of clean, accessible water available to global populations has led to an alarming rise in waterborne illnesses across communities and in turn negatively impacted the healthcare system. This project examines the impact of disease due to water scarcity across the United States, and highlights patient hospitalization and mortality counts, key pathogens involved, the financial impact on the healthcare sector, and potential solutions to mitigate these effects. Information from the Center for Disease Control and Prevention (CDC), PolicyMap, and data from earlier research was utilized. Findings indicated that most cases of waterborne illness originated from Illinois, Maryland, Florida, and Georgia, despite poor water quality being prominent more in the Western and Southern US (Kunz et al, 2024). Disease spread was more prominent in lower socioeconomic communities (Ross et al, 2019). Biofilm pathogens and the bacterium Legionella and Nontuberculous mycobacteria are the most common source of waterborne diseases (Kunz et al, 2024). Diseases have led to high hospitalization and mortality rates, causing a significant financial strain on the healthcare system, with billions being spent in disease management and control (CDC, 2024). Limited access to clean water has a significant impact on population health, specifically in low socioeconomic areas, and this in turn burdens healthcare resources and finances. For future research, continuous monitoring of reports, utilizing individual state data, and examining causes of water scarcity in detail would be beneficial. This can allow development of targeted solutions to prevent future outbreaks and limit effects on population health and the healthcare system.

Antiretroviral Therapy (ART) is an integral part of disease management in individuals living with Human Immunodeficiency Virus (HIV). While ART primarily benefits the individuals living with the disease, rates of ART adherence may lessen the public health burden. According to the U.S. Department of Health and Human Services, Southern and homeless populations experience higher public health burden when compared to the national average. Therefore, the current study focused on identifying if a relationship exists between homeless individuals and ART adherence in Alabama, specifically, and factors that could be addressed to improve ART adherence within the homeless population in the state. A literature review was conducted, and relevant peer-reviewed articles were selected. A key finding was that homelessness within the HIV community correlated with higher rates of low ART adherence (Kidder, 2007). The literature also showed that the Southern United States has the lowest rates of adherence to ART in the nation (McComsey, 2021). However, published data showed that Alabama has one of the lowest rates of homelessness whilst maintaining a relatively low ART adherence (U.S. Department of Housing and Urban Development, 2022). This suggests that homelessness may not be a primary factor influencing ART adherence in Alabama, which highlights the need to explore other factors contributing to low adherence in the state. These factors may include limited education on HIV risks and safe intercourse, poor healthcare access, and the stigma surrounding HIV. Further research into these areas could provide insights to address low ART adherence in Alabama more effectively.

A food desert refers to a geographic area with limited access to grocery stores and healthy food choices. Food deserts are especially present in low-income, rural communities. This is significant because Alabama is the 7th lowest-income state in the country. This project aims to determine the effects of food deserts on rates of obesity, cardiovascular health, and diabetes.   

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Overview:

Tobacco use among healthcare workers (HCWs) is a significant public health concern, affecting both individual health and patient care quality. Despite awareness of smoking's harms, many HCWs in high-stress roles continue to smoke. This study evaluates smoking prevalence among HCWs, identifies influencing factors, and examines the impact on patient counseling.

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Inadequate access to healthy food poses a burden to public health outcomes in rural communities. These rural populations are at a disproportionate risk of developing chronic illnesses. This study investigates the socioeconomic factors contributing to the food inequities in rural America. In addition, the correlation between limited access to healthy foods and prevalence of chronic diseases was explored. Various research databases such as PubMed were searched with key words to compile a list of relevant articles.  Factors such as grocery store access and quality of foods available in rural counties were analyzed against the prevalence of chronic diseases in these regions. A direct correlation was found between rurality and food insecurity due in part to surging prices of healthy food, increased distance to grocery stores, and decreased availability of public transportation. Furthermore, data indicated a correlation between inadequate access to healthy foods and the prevalence of chronic illnesses. Specifically, rural areas with fewer grocery stores, fewer fruits and vegetables available, and decreased affordability of healthy foods were linked to higher rates of obesity, heart disease, diabetes, and cancer. A proportional relationship was found between food insecurity and increasing rural status. Proposed solutions should concentrate on increasing the number of grocery stores and providing healthier alternatives to fast food to combat these preventable diseases. Additional research to further understand the complex nature of this issue should focus on expanding on previous studies, assessing the effects of food insecurity on children, and examining how specific food groups impact health outcomes.

The increased risk of cardiovascular disease among South Asians living in the United States has been studied in relation to its contributing factors. While multiple causes for the higher incidence among this population have been examined, the role of diet has been the major variable discussed. A literature review was conducted to assess dietary risk factors that contribute to the prevalence of cardiovascular disease in the South Asian population within America. Data was collected through PubMed with the following keywords: "South Asian," "cardiovascular disease,” “diet,” and "living in the United States". Publications were filtered for primary research published within the last five years. Through thorough analysis, it was concluded that South Asian populations living within the United States have a higher incidence of cardiovascular disease when compared to other ethnic and immigrant populations of the United States. This contradicts the expected health outcomes of South Asian diets that include essential fatty acids and complex carbohydrates. Despite the healthier diets that South Asians are presumed to hold, there is a seemingly inverse relationship of worsening health outcomes when compared to other ethnicities. The current evidence indicates that this population’s health may involve a more complex cause, potentially including cultural influence creating a more Americanized diet. Genetic disposition may also play a role, but current research explores the dietary patterns of almost exclusively first-generation immigrants. Future studies could investigate how more Westernized diets are affecting the children of these immigrants, or if there are other variables involved with greater impact.

Background:

Socioeconomic status (SES) is a key determinant of health outcomes, including incidence of chronic conditions like type 2 diabetes mellitus (T2DM). SES can influence access to healthcare, diet, exercise, and lifestyle, which are significant factors in developing T2DM. This study aims to explore relationships between SES and incidence of diabetes in Alabama, analyzing how economic changes within the community correlate with diabetes prevalence.

Background:

Infant mortality remains a critical public health issue in the southeastern United States, characterized by significantly higher rates compared to the national average. Factors contributing to this disparity include socioeconomic status, healthcare access, maternal education, and more. This study will analyze the underlying causes of infant mortality in this region.

Rheumatoid arthritis (RA) hits rural and underserved communities particularly hard, where limited access to specialized care, economic struggles, and isolation make timely diagnosis and effective management difficult. These challenges often lead to higher rates of chronic pain, disability, and increased healthcare costs, placing an enormous burden on patients and the healthcare system.  A review of existing literature was conducted, exploring disparities in RA care, including access to rheumatologists, the impact of diagnosis delays, and how socioeconomic factors like income and education limit care. It also highlighted the increased risk of comorbidities, such as cardiovascular disease, in these populations. Possible solutions like telehealth services and patient navigation programs were evaluated.  The findings were clear: delays in diagnosing and treating RA in rural areas lead to faster disease progression, more joint damage, and higher rates of disability. A shortage of specialists and financial barriers only adds to the problem. These delays also increase the risk of cardiovascular disease, worsening the patient and economic burden.  Programs that help patients navigate the healthcare system and expand access to telehealth could make a real difference. However, more research is needed to determine how effective these strategies could be. Addressing the gaps in RA care could significantly improve patient outcomes while reducing the economic and societal burden associated with the disease.

The opioid epidemic has severely impacted both rural and urban communities in the U.S., but rural areas face unique challenges that intensify opioid misuse and overdose rates. Limited healthcare access, economic hardship, and social isolation increase the vulnerability of rural populations. This study explores disparities in opioid-related outcomes between rural and urban areas, focusing on socioeconomic and healthcare access factors that make rural communities more susceptible to opioid misuse. A systematic review was conducted using Google Scholar and PubMed to compare opioid misuse in rural and urban settings, and relevant studies were selected. Additionally, national surveys and CDC data were reviewed to assess opioid-related mortality and misuse trends. The findings show that rural areas face higher overdose rates and economic challenges, such as unemployment and poverty, along with limited healthcare resources. Rural populations also demonstrate lower levels of opioid-related knowledge, contributing to higher overdose risks. Rural adolescents are particularly vulnerable to prescription opioid misuse, further widening the gap in opioid use between rural and urban areas. In conclusion, rural communities are disproportionately affected by the opioid epidemic, with higher overdose rates and limited treatment access. While strategies like early education and improved healthcare access have been proposed, targeted public health interventions are needed to address the specific socioeconomic and healthcare challenges in rural areas. Future research should evaluate the effectiveness of these interventions in reducing opioid misuse and overdose rates in rural populations.                           

Background:

This review examines youth mental healthcare access in rural Alabama and aims to analyze access barriers and strategies to overcome them. Access varies based on location, socioeconomic status, education, and awareness. Inadequate mental healthcare leads to poor outcomes and increased comorbidities.

This systematic search identified relevant studies on youth access to mental healthcare. Databases searched included PubMed and Google Scholar, with keywords focusing on child/youth mental healthcare access and barriers. Studies published between 2000-2024 were selected using inclusion criteria from the Centre for Evidence-Based Medicine and University of Oxford's Critical Appraisal Worksheet. Data from PolicyMap, CDC, and HRSA identified geographic and demographic variables for analysis.

Many factors contribute to the deficit in adequate mental healthcare for rural Alabama youth. Proposed solutions for the issue include mental healthcare educational programs, community/school initiatives, telemedicine utilization, and improved access to transportation/technology services. Limitations to this review include sparse data on rural Alabama youth and effectiveness of proposed solutions. Future research should aim to uncover why available resources are underused and what programs provide a resolution.

Background:

There are an estimated 1.2-1.7 million people of Sudanese origin living outside of Sudan. Data of Sudanese migrants within the United States is scarce; however, there are an estimated 46,700 Sudanese Americans. It is well documented that significant healthcare disparities and barriers to care exist for African Americans as a homogenous population; however, the immigrant subculture of Sudanese Americans has not been explored to the same degree. Specifically, no studies to date have examined the systemic barriers to care faced by Sudanese Americans. This study aims to elucidate concerns regarding healthcare access by a population of Sudanese Americans.

Background:

The southeastern U.S. has the highest rates of new HIV infections, predominantly affecting African Americans, relating to an increased rate of morbidity and mortality. This disparity is driven by socioeconomic, geographical, and infrastructure challenges.

The study analyzed secondary data focused on access to HIV testing, treatment, stigma, public health infrastructure, PrEP availability, healthcare provider engagement, intravenous drug use (IVDU), and retention in HIV care.

In Alabama, a disproportionate number of new HIV diagnoses occur among African Americans. Cultural stigma around homosexuality and insufficient public health funding hinder care. Expanded HIV screening in Federally Qualified Health Centers could improve testing and care. Though the region has the highest new HIV diagnosis rate, fewer than 30% receive PrEP. Rural areas, lacking infrastructure, present another barrier, along with healthcare provider bias.

Addressing the disparities that have been demonstrated in these studies through targeted interventions could improve outcomes for HIV positive African Americans in the Southeast.

Background:

Emergency medicine is essential for supporting public health. However, reliance on Emergency Departments (ED) for everyday issues has limited resources for critical patients. This analysis will explore this public health issue and its contributing factors.

It is clear that several factors contribute to the use of Emergency Departments for Primary Care complaints based on literature review. These factors are mainly related to low socioeconomic status (SES) and barriers that affect access to care. Additionally, individuals with lower health literacy are more likely to use the Emergency Department for minor complaints. Furthermore, CMS beneficiaries are more inclined to visit the ED rather than a primary care provider.

The use of Emergency Departments for Primary Care is influenced by factors such as low SES, limited health literacy, and poor access to care as highlighted in studies by Rust et al. and Schumacher et al. While there is no correlation between ED use and connection to a Primary Care Physician, it can impact access to care. Medicare and Medicaid patients have higher ED admission rates, as shown by Purkurdpol et al. 2014, PolicyMap, CDC, and NIHS data. These trends are consistent across the continental United States, according to PolicyMap.

Low SES, barriers to healthcare, and Medicaid and uninsured beneficiaries contribute to increased use of emergency services for minor complaints. Further examination on how ER admission rates vary between states with and without expanded Medicare coverage may show a correlation.

Background:

Type 2 diabetes mellitus is a chronic condition that disproportionately affects patients of lower socioeconomic status. When left untreated, it can result in severe health risks and even death. Diabetes has a significant impact on society with 11.6% of the US population being diagnosed in 2021. Medication adherence is a crucial factor in the successful management of type 2 diabetes and the reduction of adverse events. Studies have shown that lower socioeconomic status is associated with poorer glycemic control, including higher HbA1c levels.

This research reinforces the need for healthcare providers to consider food insecurity as a barrier to medication adherence among diabetic patients of low socioeconomic status. Future research should

investigate interventions that can alleviate food insecurity and negative impacts on medication adherence in this population.

Background:

This study investigates the influence of access to insurance on the prevalence of HIV in Alabama, Georgia, and Florida. These states have a higher incidence of HIV compared to national averages. The study focuses on populations with HIV including individuals insured, uninsured, and those eligible for Medicaid but remaining uninsured.

Maternal mortality is a worldwide public health concern that is rooted in racial and socioeconomic factors and is defined by deaths related to pregnancy and childbirth. Research analysis demonstrated that maternal mortality rates (MMR) disproportionately affect black individuals. This can partially be explained by state-mandated Medicaid statutes that limit healthcare coverage to 60 days postpartum. Alabama recently expanded its Medicaid coverage to 12 months post-delivery and consequently, data to determine the effects of this change is minimal. This literature review analyzes the impacts of expanded Medicaid programs on MMR by utilizing the following criteria on PubMed: “Maternal Mortality,” “Medicaid,” and “United States.” Peer-reviewed articles published in the past 5 years (2019-2024) were screened and it was determined that the generalized expansion of postpartum pregnancy insurance coverage had more positive outcomes across the United States regarding MMR and follow-up care. While expanding Medicaid is a step in the right direction, many variables need to be addressed to reduce MMR to insignificant values. Due to the relatively recent changes in Medicaid expansion, the research was limited to individual statewide policy changes. The impacts of Medicaid expansion in the United States on improvements in pregnancy-related outcomes should be continuously pursued to gather more significant data for the analysis of maternal mortality rates.

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Data was collected from the Alabama Department of Public Health, Google Scholar, PubMed, and PolicyMap utilizing key words, “rural,” and “transportation and healthcare outcomes.” Various data sets were chosen to provide insight into demographics, perceived barriers to healthcare access, and relationships between lack of access and poor health outcomes.

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Discussion:

Literature review findings suggest a relationship between transportation options, healthcare access, and potential health consequences in rural communities. Travel distance, cost, and lack of infrastructure were key barriers identified (Del Rio et al., 2017; Henning-Smith et al., 2017; Wolfe et al., 2020). These barriers contributed to rural residents’ delay of care (Wolfe et al., 2020; Collin et al., 2007) and forced patients to miss work when traveling for appointments (Maganty et al., 2023). Studies show providers in rural areas are aware of how these barriers impact patient care (Buzza et al., 2011; Maganty et al., 2023).

This project demonstrates connections between rural transportation services, access to healthcare services, and their impact on health outcomes. Although there is evidence suggesting that a lack of transportation leads to poorer healthcare outcomes, viable solutions and discussions targeting these barriers are insufficient. Further research should be aimed at curative initiatives for this health disparity and assessing their effectiveness.

As the opioid epidemic continues to effect individuals, it is clear that pregnant individuals are not spared. There are detrimental developmental and neurocognitive effects to the fetus. Patient education on opioid risk is necessary to help individuals understand the risk to the fetus. Additionally, underlying OUD treatment options should be discussed. Future research could include OUD treatment programs and their effect on NAS, or the correlation with NAS and the later development of substance use disorder.