Health Disparities

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    Interactive Association of Chronic Illness and Food Insecurity with Emergency Room Visits among School-aged Children in the United States
    (2022) Ghani, Farheen; Manning, Sydney E.; Sambamoorthi, Usha
    Objective: This study examined the prevalence of food insecurity among children aged 6-17 years and the interactive association of chronic conditions and food insecurity with healthcare utilization, specifically ER visits. Methods: Data on children aged 6-17 (N = 5,518, representing 50,479,419 children) were obtained from the 2017 Medical Expenditure Panel Survey (MEPS). We measured food insecurity (Yes/No) using responses to a 10-item food security scale developed and validated by the USDA, adapted here for the MEPS 30-day window. Healthcare utilization consisted of cumulative ER visits in 12 months. Chi-square tests and adjusted Poisson regression were used to determine interactive associations of chronic conditions and food insecurity on ER visits. All analyses involved complex survey procedures. Results: 20% of school-aged children had food insecurity; 21% had a chronic condition. After adjusting for age, sex, race, insurance coverage, poverty status, physical and mental health status, obesity, and region, we observed that children with chronic conditions and food insecurity had a higher number of ER visits (Incident rate ratio = 2.79, 95% CI = 1.892, 4.120), compared to children without food insecurity and chronic conditions. Conclusions: 1 in 16 school-aged children had both a chronic condition and experienced food insecurity in the last 12 months. Food insecurity in children with chronic conditions was associated with more ER visits. Our findings suggest that policies and programs that provide linkages to community resources can help reduce food insecurity among children in the US and reduce healthcare utilization.
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    Perspectives on Sexual and Reproductive Health Screening Conversations Between Healthcare Providers and Women Experiencing Homelessness
    (2022) Diener, Anelise; Galvin, Annalynn; Griner, Stacey; Garg, Ashvita; Thompson, Erika
    Purpose: Women experiencing homelessness are at a heightened risk of sexually transmitted infections (STI) and unintended pregnancy. While the healthcare setting may be an ideal venue to assess the reproductive health needs of women experiencing homelessness, it is unknown how consistently this may be occurring for a population with competing health and social demands. This study aimed to assess healthcare providers' and women experiencing homelessness' perspectives of reproductive health discussions during healthcare visits. Methods: Semi-structured interviews were conducted with healthcare providers (n=6) and women experiencing homelessness (n=19) between December 2019 and November 2020 in Fort Worth, TX. Interviews were conducted as part of a larger systemwide study examining preferences for, facilitators of, and barriers to contraception for women experiencing homelessness. Participants were recruited through convenience and snowball sampling from local community and healthcare organizations serving the target population. Interviews assessed perceptions regarding need and implementation of women's health exams, birth control counseling, STI testing, and sexual health screening. Coding achieved consensus and thematic analysis was conducted. This study was reviewed and approved by the North Texas Regional Institutional Review Board. Results: Several themes emerged regarding the timing of healthcare appointments, sexual and reproductive health conversations, and perceptions of these conversations among women experiencing homelessness and healthcare providers. Only about half of the healthcare appointments occurred in the last year, within the recommended timeframe for annual health exams. In recalling STI and birth control conversations, women recounted inconsistency in the occurrence of these conversations and screenings. When these conversations occurred, women reflected on both positive (e.g., friendly, comfortable) and negative (e.g., awkward) experiences with their healthcare providers. Finally, healthcare providers described the importance of having sexual and reproductive health conversations. However, healthcare providers acknowledged a bias as they perceive a lack of initiation of these conversations by women experiencing homelessness as disinterest in contraception and sexual healthcare. When aiming to prioritize these conversations, healthcare providers note conflicting priorities, including finding stable shelter, access to food, substance abuse, and healthy relationships with partners among women experiencing homelessness, as additional barriers that hinder the initiation of the conversations. Conclusion: This study identified potential inconsistencies in the frequency and quality of reproductive and sexual health conversations, STI screening, and birth control discussions between healthcare providers and women experiencing homelessness. Assumptions by healthcare providers that interested women will initiate sexual and reproductive health conversations puts the onus on women experiencing homelessness to be knowledgeable about, self-screen for sexually risky behaviors, and advocate for their sexual health needs. These findings, coupled with potentially extended periods of time between healthcare appointments, may highlight an opportunity for enhanced reproductive healthcare for this population. Future interventions can focus on improved sexual and reproductive health screening tools, patient intake forms, and clinical practice guidelines for healthcare providers, which can help achieve sexual and reproductive health equity for vulnerable populations.
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    COVID-19 Vaccination Disparities and Hesitancy in the United States
    (2022) Xavier, Christy; Lindley, Bryn; Rasu, Rafia
    Background: Currently, 62.8% of Americans are fully vaccinated against COVID-19, which is lower than most first-world countries. Despite the ongoing COVID-19 pandemic and complications, many Americans are still hesitant to vaccinate. Objectives: The purpose of this study is to identify vaccine rates and trends by biological and socioeconomic demographics and determine reasons for vaccine hesitancy in the U.S. Methods: This is a repeated cross-sectional analysis with data on American adults without missing data on vaccine status and vaccine intent (N = 59,989) from the U.S. Census Bureau's Household Pulse Survey (Phases 3.2-3.3, July 21, 2021-February 7, 2022). The Household Pulse Survey is an online randomized survey to get information on how COVID-19 affects American households. The survey is collected every two weeks in phases. Vaccine hesitancy was divided into two groups: 1) probably, not sure, probably not, and definitely not receiving the vaccine, and 2) received the vaccine and definitely will get the vaccine. Chi-square tests and logistic regressions were conducted using replicate weights with SAS. Logistic regressions adjusted for sex, age, race and ethnicity, income, education, Covid-19 infection, health insurance, food insecurity, children under 17 years in the household, remote work, health worker status, functional status, and mental health. Results: During the December 1-13, 2021 survey period, 78.9% had received at least two doses of the COVID-19 vaccine. A majority of the vaccinated (51.6%) received the Pfizer vaccine. Those that were highly educated with a college degree (68.1%) and had a salary of $100,000+ (38.5%) were more likely to be vaccinated. Of those not vaccinated (Wt N = 33,340,678), 87.7% reported that they are unsure, probably, or definitely not (51.5%) get the vaccine. In adjusted analyses, older adults (AOR = 0.85, 95% CI=0.77 - 0.94 for 5-year increments) and health workers (AOR = 0.24, 95% CI = 0.08-0.69) were less likely to be vaccine-hesitant. Those with high school education were more likely to be vaccine-hesitant (AOR = 2.37, 95% CI = 1.44-3.90) compared to college-educated adults. Adults with COVID-19 infection were more likely to be vaccine-hesitant (AOR = 2.24, 95% CI = 1.41-3.57). Mistrust of the vaccine or government (52.1%), side-effects (50.2%), vaccine not needed (32.1%), and the vaccine will not protect me (23.6%) were cited as the top four reasons for vaccine hesitancy. Blacks and Hispanics reported similar reasons. Individuals in the South were more likely to cite distrust in COVID-19 vaccines than any other region. Conclusions: Among unvaccinated, over 50% of adults reported that they are "definitely not getting the vaccine". Vaccine hesitant adults were more likely to distrust the vaccine or the government; they were also concerned about the side effects. Targeted interventions by clinicians, public health officials, and policy makers to educate the public about side effects of the vaccine and increase trust in the health care system may help improve vaccination rates and achieve herd immunity in the US.
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    Hypothetical Mechanisms for Increased Risk of Sudden Cardiac Death During Sleep in URM Populations
    (2022) Rai, Shefali; Smith, Michael
    Purpose: Sudden cardiac death (SCD) is one of the leading causes of death. It is an unanticipated natural death from a cardiac pathology that occurs within an hour of onset of symptoms and no prior fatal condition. The majority of SCD are due to fatal arrhythmias. Prolongation of ventricular depolarization and repolarization, represented by the QT interval, affects impulse conduction and therefore increases the risk of these fatal arrhythmias. Additionally, SCD is presumed to be the primary cause of death during sleep including in underrepresented minority (URM) populations. Factors such as BMI and home environment can negatively impact sleep quality and potentially lead to increased susceptibility to sleep apnea and SCD within URM populations. Preliminary findings from our lab using a simulated obstructive sleep apnea (OSA) model demonstrates increased QT interval duration during sleep apnea and a follow-up study in patients with OSA as summarized below. This poster summarizes these prior findings and describes proposed studies to test the hypothesis that QT interval prolongation during sleep apneic events will be more pronounced in URM populations. Methods: We reviewed lab studies demonstrating the mean change in QT intervals throughout the night in individuals with sleep apnea. Preliminary Results: Individuals with OSA demonstrate prolonged mean QT intervals (> 400 ms). The mean QT interval duration during sleep apnea measured late in the night (433 ms) was longer than the interval measured early in the night (423 ms). The QT interval duration was longer in African American individuals (450 ms) when compared to Caucasian individuals (432 ms). Conclusion: Sleep apnea is associated with cardiovascular disease and can therefore potentially lead to increased risk of SCD in sleep. The OSA model lab studies show that sleep apnea can lead to prolonged QT intervals and a potential for URM to be at a greater risk of arrhythmia and SCD during sleep apneic events. This poster will focus on developing a new study for a series of physiologic studies to address the hypothesis that URM subjects with OSA are at increased risk of SCD during sleep. Student doctor Rai was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number (R25HL125447). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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    Barriers to Diabetes Management in the Homeless Population
    (2022) Scherer, Nathalie; Smith, Glen; Teigen, Kari
    There are few studies assessing outcomes for homeless patients with diagnosed diabetes, despite evidence that homeless patients suffer from diabetes at about the same rate as the general public, which as of 2018 is approximately 10.5% of the U.S. population. Diabetes is a chronic disease that usually does not present with acute symptoms until late into the course of disease progression. Due to social vulnerability, homeless patients often present a particular set of challenges that require different approaches from healthcare providers. These challenges include unstable housing, limited food choices, behavioral health problems, lack of access to stable care and transportation, and chronic stress. These challenges build barriers that prevent homeless patients from managing their chronic diseases effectively. There are very few studies looking at which particular barriers are the most challenging for patients, so we believe a survey quantifying the barriers will be useful for the field of diabetes management and for chronic disease management in the homeless population as a whole. We expect that by identifying specific barriers we could impact both better patient outcomes and lower healthcare costs for unhoused patients by targeting the specific issues that they struggle with. In our study, we will be operating out of the True Worth Clinic, which is a JPS clinic that primarily serves homeless patients. There is a robust diabetes education team that works to provide care to homeless patients with diabetes mellitus. Our aim is to work with the diabetes education team to create and implement a survey that will be administered to patients coming into the clinic over the next 6 months. The survey will focus on barriers to care that are unique for homeless patients managing chronic conditions, such as diabetes. Having data on patient's barriers to care will allow the True Worth Clinic to more effectively address the unique barriers that their patients face.
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    Information, Motivation, and Behavioral Skills for Contraception Use among Women Experiencing Homelessness
    (2022) Garg, Ashvita; Galvin, Annalynn; Diener, Anelise; Griner, Stacey; Akpan, Idara N.; Thompson, Erika
    Purpose: Women experiencing homelessness have been reported to have higher rates of sexually transmitted infections, lower rates of contraceptive use, and higher rates of unintended pregnancies than stably housed women. Higher unintended pregnancy and lower contraceptive use in women experiencing homelessness warrant more research on behavioral cognitions for contraception access and utilization in this population. Assessing cognitions that affect contraception behaviors can be guided by utilizing a health behavior theory, such as the Information-Motivation-Behavioral (IMB) Skills model. Therefore, this study explored the IMB characteristics that play an important role in an individual's health behavior and could affect the contraception preferences among women experiencing homelessness. Methods: Semi-structured interviews (n=19) were conducted among women 18-45 years of age, not sterilized, English-speaking, and were currently experiencing homelessness. Women were recruited between December 2019 to March 2020 by convenience sampling through partnerships with local community organizations in Tarrant County. In-person or telephone interviews were conducted. Interviews were audio-recorded, transcribed, coded, and thematically analyzed based on the IMB framework. This study was approved by the North Texas Regional Institutional Review Board. Results: The mean age of women in the study sample was 33.4 years (SD = 7.6) and living situations included emergency shelters (37%), unsheltered locations (32%), transitional housing (26%), and rapid re-housing (5%). In the information construct, most women were aware of different contraceptive methods including intrauterine devices, implants, Depo shots, birth control pills, and condoms; however, many desired to learn more about the side effects of various methods. Additionally, some women had misconceptions regarding the possible side effects of different contraceptive methods. For motivation, most women (n=16) had negative attitudes regarding becoming pregnant at that time. Various reasons for not desiring to become pregnant included age, new responsibilities, presence of other children, finances, health concerns, negative beliefs about abortion, or risks involved with having a baby while being homeless. Additionally, most women had a positive attitude towards their current method of contraception, but their motivation to use a type of contraceptive method depended on side effects and comfort with the method. When examining behavioral skills, benefits and barriers to accessing contraception were inquired. Several women mentioned the better health insurance coverage for birth control would benefit them. Lack of adequate insurance coverage and transportation were the major barriers. Other barriers included financial constraints, not enough knowledge regarding how to use birth control, and not enough information knowing how to get an appointment or start the process of getting birth control. Conclusions: Findings highlight the information, motivation, and behavioral skills for contraception use among women experiencing homelessness. Improving knowledge about side effects of various contraceptive methods, addressing any misconceptions, and increasing accessibility to contraceptive methods by providing transportation and financial assistance while maintaining reproductive autonomy might be effective strategies to improve contraception uptake and reduce unintended pregnancies among women experiencing homelessness.
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    Analysis of the Impact of an Insulin Savings Model Among Medicare Part D Beneficiaries and Plan Sponsors
    (2022) King, Alyza; Voloudakis, Michael; Guhad, Ahmed; Stahlnecker, Alvah; Tabor, Pamela; Xavier, Christy; Rasu, Rafia
    Background: An estimated one in every three Medicare beneficiaries have diabetes, and over 3.3 million Medicare beneficiaries currently use at least one form of insulin. On average, insulin retail prices can range anywhere between $90 to $1300 per package. Additionally, Medicare beneficiaries may enter various coverage phases throughout a plan year, resulting in variable prices and in some cases, significantly higher copays on insulin from one month to the next. A higher patient copay during the coverage gap phase has been associated with reduced adherence, which can lead to disease progression and worse outcomes. In 2021, the Part D Senior Savings Model was introduced to offer a benefit design that includes predictable member copays during all the coverage phases. Methods: This study was designed as a retrospective analysis comparing post-implementation prescription claims from 2021 to pre-implementation claims from 2020. Inclusion criteria consisted of members enrolled in a Medicare Advantage Plan with a Senior Savings Model benefit design during 2021 and a pharmacy benefit manager aligned model insulin list. Exclusions consisted of members enrolled in a Medicare Prescription Drug Plan (PDP), a plan with a customized insulin drug list, and/or a member receiving Low Income Subsidy. The primary objective was to analyze changes in the number of model insulin utilizers among Medicare Part D beneficiaries and plan sponsors enrolled in the Senior Savings Model during the 2021 plan year. Secondary objectives were to evaluate other changes in model insulin utilization, including days supply and adherence. A financial analysis was also performed looking at changes among model insulins in member copay, total net cost, and total gross cost. Descriptive statistics were used for all study variables. Categorical data, including changes in the number of model insulin utilizers, was analyzed using a chi-square test to identify a P-value with a significance threshold set at 0.05. Quantitative data was evaluated through an unequal variances t-test. Results: The Senior Savings Model was found to significantly reduce member copay amounts, but did not result in adverse utilization of model insulins. The number of members who were optimally adherent did not change, but there was a slight reduction seen in overall adherence. Conclusion: Our findings would suggest that the SSM can improve member experience by reducing member copays but may not significantly impact adherence metrics.
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    Contraception use, perceived susceptibility to pregnancy, and pregnancy desire among women experiencing homelessness.
    (2022) Galvin, Annalynn M.; Garg, Ashvita; Griner, Stacey; Diener, Anelise; Akpan, Idara N.; Thompson, Erika
    Purpose: Women experiencing homelessness are at higher risk of unintended pregnancy. While contraception may reduce unintended pregnancy rates, women experiencing homelessness have low rates of effective contraception use. In addition to access and affordability, how women perceive their susceptibility to pregnancy on contraception may also explain disparate rates of contraception use. This qualitative study aimed to explore how women experiencing homelessness perceive their susceptibility to pregnancy with and without contraception. Methods: From December 2019 - March 2020, semi-structured interviews (n=19) were conducted among pregnancy-capable (i.e., not sterilized), English-speaking women experiencing homelessness in Fort Worth, TX, 18-45 years of age, as part of a larger system-wide study investigating contraception preferences for women experiencing homelessness. Participants were recruited through flyers at local shelters, active recruitment through case managers, community partnerships, and snowball sampling. Interview questions included hypothetical perceived susceptibility to pregnancy while on and off contraception, pregnancy attitudes, and actual contraception use. Interviews were audio-recorded, transcribed, and analyzed using a seven-step framework method for coding and theme identification. This study was approved by the North Texas Regional Institutional Review Board. Results: Women had a mean age of 33.4 years (SD=7.6 years), with reported race almost evenly split between Black (47%) and White (53%). Primary nighttime residence included emergency shelter (n=7), unsheltered locations (n=6), transitional housing (n=5), and rapid-rehousing (n=1). All but two women reported inconsistent or no contraception use. Most women were confident in general contraceptive efficacy and perceived low pregnancy susceptibility when using hypothetical contraception. Some women found their risk of pregnancy was equal with and without contraception based on perceptions of specific contraception efficacy (e.g., condoms versus pills); fertility and fecundity concerns; and high abstinence self-efficacy. When asked whether they would like to get pregnant in the next year, 47% said no (n=9), 21% said yes (n=4), and 32% said they did not know (n=6). All four participants who wanted to become pregnant in the next year did not report current contraception use at the time of the study. Most women who were unsure or not wanting pregnancy in the next year were also not using consistent contraception. Women who desired pregnancy in the next year or were uncertain of whether they wanted to get pregnant in the next year reported similar perceived susceptibility to pregnancy regardless of contraception use, compared to women not desiring pregnancy in the next year who had a higher perceived susceptibility to pregnancy without contraception and lower perceived susceptibility with contraception. Conclusions: Findings elucidate why some women experiencing homelessness may perceive similar pregnancy susceptibility with both contraception use and non-use. Given the need to have higher susceptibility to pregnancy without contraception use for consistent contraception uptake, findings may better explain lack of actual contraception use, preferences for contraception, and pregnancy desire. Understanding the interplay between perceived susceptibility to pregnancy, housing status, and pregnancy perceptions such as timing-based pregnancy intention can better promote contraception and pregnancy prevention for women experiencing homelessness who do not desire pregnancy.
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    Longitudinal Survey Examining Impact of COVID19 on AA with HIV
    (2022) Patel, Yesha; Oranu, Chukwuezugo; Cooper, Jennifer; Borgmann, Kathleen; Afrasiabian, Soma; Fleming, Marc; Lee, Deidra
    The impact of COVID-19 has been devastating. It increases the risk for individuals with chronic health conditions type 2 diabetes, obesity, and HIV. In addition, research has shown among individuals with comorbidities, African Americans have a higher prevalence and poorer prognosis of COVID-19. Non-medical factors (e.g., social determinants of health) are key drivers of health outcomes and inequities. Patient-reported health outcomes expounded by social determinants of health depict how vulnerable populations are faring over a year into the pandemic. Therefore, our goal was to assess the impact of the pandemic on African Americans living with HIV as it relates to social determinants of health. A longitudinal survey employing face-to-face interview questions was used to address the study objective at three-time points. Participants were part of an ongoing study to examine the impact of medication therapy management visits on patients' health. The inclusion criteria for the study were adults ≥18 years, the presence of hypertension or diabetes, and a positive HIV diagnosis being managed by anti-retroviral therapy. Participants selected for the presented study met the original inclusion criteria and had study visits within the time points defined as pre-COVID, during COVID, and post-COVID. Participants were excluded if they didn't have study visits within three-time points or inclusion criteria. Ten questions that examined social determinants of health and overall well-being were extracted from the survey used at each study visit. Participants met with pharmacists approximately every three months per the study protocol. Descriptive statistics and inferential statistics were used to analyze survey responses. A proportional odds mixed-effects logistic regression model assessed differences between time points. The last six questions were dichotomized due to data skewness. This study was approved by the University of North Texas Health Science Center's Institutional Review Board (IRB). A total of 27 participants were included. The average age of participants was 53. Participants' responses to the survey questions were fairly consistent across all three time points. The mean response to the questions increased (more favorable) from time point 1 to time point 2. The means were higher between time point 2 and time point 3. There was a significant difference between time point 3 and time 1 (odds ratio [OR] = 16.39, 95% CI [1.08-37.73], p= 0.04), regarding the statement "In the last month, I felt like my safety was threatened because of the place I sleep or live." A greater proportion of participants reported a score of 5 on this question, indicating they strongly disagreed with the statement. The results showed a statistically significant difference in participants feeling safer where they resided or slept post-COVID than pre-COVID. This perhaps can be explained by the rent and mortgage moratoriums, and housing protections provided by the Coronavirus Aid, Relief, and Economic Security (CARES) Act. Future research priorities should include the benefits of pharmacist-driven MTM in evaluating social determinants of health, and medication needs to inform public health goals and policy implementation better.
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    Multimorbidity and Whole Health among Adults in the United States: Evidence from the NHIS and BRFSS
    (2022) Warner, Mayela; Neba, Rolake A.; Manning, Sydney E.; Wiener, Constance; Sambamoorthi, Usha
    PUPROSE Whole health is a patient-centered approach that promotes self-management of what matters to the patient. Whole health focuses on mind-body, recharge(sleep), healthy diet, emotional health, and movement, all of which are critical for those with multimorbidity. We examined the association of multimorbidity with good whole health among adults in the United States. METHODS We conducted a cross-sectional design. As no one dataset provided information on all components of whole health, we analyzed mind-body therapies, recharge, emotional health, and movement from the 2017 National Health Interview Survey (NHIS), and healthy diet from the 2017 Behavioral Risk Factor Surveillance System (BRFSS). Multimorbidity was defined as the co-occurrence of two or more chronic conditions. Recharge was measured by adequate duration of sleep and the Kessler Psychological Distress Scale (K6) was used to measure emotional health. All unadjusted and adjusted analyses were conducted using the SAS survey procedures. The samples from NHIS (N=25,134) and BRFSS (N=347,029) represented 213 million and 183 million adults, respectively. RESULTS Prevalence of the whole health components varied from 24.4% (mind-body therapies use), 55.7% (healthy-diet), 57.1% (movement), 63.9% (adequate sleep), and good emotional health (78.4%). Based on NHIS, only 3.4% reported good health in all four components. A lower percentage of adults with multimorbidity used mind-body therapies (22.9% vs 25.2%), had adequate sleep (58.2% vs 67.1%), good emotional health (71.8% vs 82.1%), adequate movement (16.2% vs 28.2%), and healthy diet (54.5% vs 56.5%) compared to those without multimorbidity (p < .001). Adjusted analyses revealed that those with multimorbidity were less likely to engage in whole health practices compared to those without multimorbidity. CONCLUSIONS Seven in 10 adults had poor health in two or more components of whole health. Adults with multimorbidity were found to have poorer health in all components of whole health. Nationally representative data surveys should strive to collect information on all components of whole health with standardized measures.
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    Pilot Testing a Web-Based Mobile App Designed to Increase Communication and Care Coordination Among Patients, Physicians and Pharmacists
    (2022) Clark, Rachel; White, Annesha; Liu, Jin; Vo, Tram
    OBJECTIVES- The fragmented healthcare system in the United States results in failures of care coordination estimated to cost the healthcare system between $27.2 billion to $78.2 billion. Improving communication between providers, pharmacists, and patients is an area with potential to reduce medication errors. Current fax and phone-based communication between pharmacists and physicians is insufficient to address patient concerns. The objective of this pilot project was to test the feasibility and categorize the desired features of a mHealth web-based platform. METHODS- Market research was conducted to identify the available mobile applications focused on patient engagement with physicians and pharmacists. Once the functional web-based application was developed, feasibility and desirability was tested by the assessment of feedback received from early users (patients, physicians and pharmacists). After contact was established and eligibility confirmed, participants were interviewed to collect baseline information about facilitators and barriers in their process of communication. Once the interviews were complete, responses were content analyzed. RESULTS- A total of 10 patients, 9 pharmacists, and 12 physicians (N=31) provided positive feedback on the feasibility and desirable features of the app as evidenced by high rates of interest (all respondents shared that they would use the app if available) and low participant burden. Feedback on desirability was categorized as features that include: (1) Telemedicine/communication, (2) E-prescriptions, (3) Prescription discounts, and (4) Patient EHR portals. Based on the stakeholder interviews, there was interest in integrating a platform spanning across health systems to promote more efficient communication and reduce the barriers to patient-initiated collaboration between physicians and pharmacists. CONCLUSION- There is a need to consolidate health information to improve healthcare outcomes. A web-based communication platform would serve to reduce medical errors caused by a lack of care coordination between physicians, pharmacists, and patients. The application will empower patients and include pharmacists in digital collaboration for patient care.
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    Health Advocates Addressing Vaccine Hesitancy in Minority Communities: A Program of the Texas Community Engagement Alliance (CEAL) of Fort Worth, Texas
    (2022) Nguyen, Helen; Scott, Gabrielle; Davis-Lydia, Elizabeth; Nava, Marcela; Bunnell, Bruce; Jones, Harlan
    Racial and ethnic minority groups have experienced worse health outcomes related to the COVID-19 pandemic, including higher rates of infection, hospitalization and death when compared to White people. Community health outreach offers a tailored approach to delivering health information, taking into account the cultural differences among ethnic minority groups. While health profession schools often incorporate cultural competency training in the curriculum there is often little time for students to work with the community in a partnership. Through support provided by the Texas Community Engagement Alliance (CEAL) Against COVID-19 Disparities program, we recruited health profession students from the UNTHSC campus as community health advocates to provide a service learning experience. Students were provided a structured course providing contextual information on health disparities and participated in building a community project to increase COVID-19 vaccine uptake. Pending IRB approval, we will evaluate student's cultural competency and efficacy in participating as student health advocates. This research was, in part, funded by the National Institutes of Health (NIH) Agreement 1OT2HL156812-01 as part of the NIH Community Engagement Alliance (CEAL)
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    Application of Geographic Information Systems to support Collaboration in Rural Osteopathic Medical Education and Community Health Initiatives
    (2022) Tadesse, Meron; Allsopp, Leslie C.; Smith, Annette; Bratton, Bobbie; Wagner, Teresa
    Purpose: Geographic Information Systems (GIS) support collaboration in public health program planning, implementation, and evaluation, but there is an absence of models for the application of GIS to enhance collaboration between rural health and medical education initiatives. Rural communities experience entrenched health disparities as a result of poor access to healthcare and other barriers inherent to remote circumstances. Although varying across rural populations, urgent issues include shortages and poor retention in the primary care workforce; lack of resources for population-specific needs; and threats to financial sustainability for rural practices. Challenges are posed by the need to span diverse geographic regions, administrative systems, and professional backgrounds. Collaboration between medical education and community health initiatives offers an opportunity to maximize the impacts of scarce rural health resources. The Texas College of Osteopathic Medicine, (TCOM) Department of Family Medicine began implementing an articulated Rural Family Medicine Track program in 1996. This community-based curriculum prepares students for life and practice in rural and underserved communities; it includes real-world experience of living and working in rural Texas with faculty from all specialties, and providing free, mobile clinic services. SaferCare Texas is a department at the University of North Texas Health Science Center whose mission is to eliminate preventable harm through innovation. SaferCare Texas' community health initiatives including health literacy programs and community health worker (CHW) training to expand the rural workforce, improve access to preventative care services, engage citizens in care decisions, and promote healthy living; these, in turn, may lead to the reduction of chronic illnesses, improved management and control of chronic conditions, and the early detection of treatable diseases. The purpose of this study is to explore the potential of Geographic Information Systems to enhance collaboration between existing Rural Family Medicine initiatives and the development and implementation of programs to increase CHW capacity in the Big Bend region of Texas, with a long-term goal of innovation and research to address rural health disparities. Methods: An interdisciplinary team has identified public datasets to advance collaboration. ESRI ArcGIS software is used as a mapping platform. Initial datasets include 1) Texas county boundaries obtained from Texas Department of Transportation (TxDOT) with the designation of hospital districts; 2) Texas census tract Social Vulnerability Index (SVI) which is comprised of 15 Social Determinants of Health and is developed by the Centers for Disease Control 3) location of Critical Access Hospitals and other clinical services, 4) Rural Family Practice preceptor and mobile, free clinic sites. Results: A preliminary map has been developed for use by project team members. Potential CHW sites and synergies to address unmet community health needs are being investigated. Identification of additional spatial data to support service coordination and collaboration is ongoing. Conclusions: Preliminary results indicate that data integration and visualization through GIS, may allow Rural Scholars and SaferCare Texas to more effectively engage rural health partners, develop a shared understanding of rural health issues, identify synergies to maximize the benefit of available resources, and provide a foundation for evaluation and research.
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    Examining Disparities in the Use of Electronic Vapor Products (EVPs) among the US Youths
    (2022) Dhakal, Smriti; Thompson, Erika
    Background: Electronic vapor products (EVPs) use is more common than cigarette smoking among US youths. EVPs may contain nicotine which is highly addictive, and the aerosol generated has carcinogens and toxic chemicals. Although public health efforts to reduce EVP use are in place, some demographic groups continue to experience a higher burden. In particular, sexual minorities are exposed to targeted marketing strategies and normative influence in social networks which puts them at increased risk. However, little is known about the prevalence of EVPs among sexual minority youths living in the US. This study aims to (1) identify sociodemographic characteristics associated with the use of EVP among US youths and (2) determine if EVP use disparities exist among sexual minorities. Methods: The 2019 Youth Risk Behavior Surveillance (YRBS) data for the entire US were used to assess demographic correlates of EVP use among high school students. The study sample was a nationally representative sample of students in grades 9-12 (n=13677). The CDC's YRBS data portal was used for analysis. T-test was used to identify statistical significance among variables and the level of significance was p< .05. Results: About 50.1% of US youths reported ever using EVPs. Non-Hispanic Black (p-value < .001), Hispanic/Latino (p-value < .001), and Asians (p-value < .001) were significantly less likely to ever use EVPs as compared to Non-Hispanic White students. More than half (56.0%) of students who identified as sexual minorities (gay/lesbian/bisexual students) reported ever using EVPs and sexual minorities were significantly more likely to have ever used EVPs as compared to heterosexual individuals (p-value < .001). Further, 71.4% of the students whose sexual contacts were same-sex only or both sexes reported ever using EVPs. Conclusion: The use of electronic vapor products is significantly high among Non-Hispanic White students and sexual minorities. This finding highlights the existence of disparities in EVP use and warrants the need for developing evidence-based strategies focusing on high-risk groups. Tailored efforts that can reach sexual minorities, combined with regulatory efforts from FDA, should be launched to reduce EVP use. Future research should focus on the factors influencing EVP use among sexual minorities such that specific areas could be targeted.
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    Association between sociodemographic and knowledge, attitude, and behavioral factors and Pap test; Health Information National Trends Survey 2020.
    (2022) Basu, Priyanka; Griner, Stacey
    Purpose In the past two decades, cervical cancer cases have decreased in the U.S., largely attributed to the secondary prevention by Papanicolaou (Pap) test to detect alterations in cervical cytology. However, racial and ethnic minority women are underscreened and report higher incidence and mortality from cervical cancer. Updated (2018) screening guidelines recommended Pap testing every 3 years for women ages 21-29 years and Pap testing every 3 years, or co-testing with HPV every 5 years, or HPV testing every 5 years for 30-65 years age group. Lack of knowledge regarding risk factors and negative attitudes towards cancer-preventive behaviors may affect adherence to screening recommendations, but research is limited. This study examines the association of sociodemographic and knowledge, attitude, and behavioral factors with adherence to Pap testing among a nationally representative sample of U.S. women. Methods The cross-sectional study was conducted using the 2020 Health Information National Trends Survey (HINTS 5, Cycle 4; n=1,089 women of screening age, 21-65 years). The outcome variable, adherence to cervical cancer screening recommendations were dichotomized into Pap testing within the last 3 years (adherent) or Pap test beyond 3 years/no Pap testing (non-adherent). Questions representing sociodemographic features and knowledge, attitudes, and behavioral measures were selected. Survey-weighted adjusted multivariable logistic regression models were used to assess the association of the sociodemographic and knowledge, attitude, and behavioral factors with Pap testing. Variables associated with Pap test adherence in the regression models were stratified into racial/ethnic groups. Results Approximately 79.3% of women reported being guideline adherent. Most of the sample were Non-Hispanic White women (63.1%), with 61.7% reporting Pap testing guideline adherence. 15.09% of Hispanic women and 14.1% of African American women reported Pap tests within the last 3 years. Compared to women up to high school education, college graduate/post-graduate women (aOR=1.95, 95%CI 1.01-3.79) had higher odds of being guideline adherent. Women with health insurance had higher odds of guideline adherence (aOR=3.60, 95%CI 1.49-8.73), compared to those uninsured. Compared to those with lower knowledge, those with higher knowledge of HPV (aOR=2.41, 95%CI 1.31-4.43) showed higher odds of guideline adherent Pap testing. Non-Hispanic White women with college/post-graduate degree (aOR=3.06, 95%CI 1.27-7.38) and health insurance (aOR=5.26, 95%CI 1.43-19.30) were more likely to be guideline adherent than those with up to high school education and no insurance. The odds of receiving guideline adherent Pap testing are higher for those non-Hispanic White women with knowledge of HPV (aOR=2.98, 95%CI 1.59-5.57) as compared to those who are unaware of it. Conclusion With changes in recommendation guidelines, lack of higher education, lack of health insurance, and lower HPV knowledge may be factors associated with the underscreening of racial and ethnic minority women. Future studies focusing on the HPV and Pap testing knowledge, attitudes, and behaviors of women by race and ethnicity will help to identify and address culture-specific barriers related to Pap testing and ultimately reduce racial disparities in cervical cancer incidence and deaths.
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    Outcomes from Team-based Comprehensive Assessment in a Geriatric Clinic
    (2022) Morkos, Johny
    Purpose: Comprehensive geriatric assessment (CGA) is a pivotal evaluation in an ambulatory setting because it can allow physicians to identify early issues that can alter a patient's quality of life. Nonetheless, CGA evaluations can be inconsistent due to the workflow in a primary care setting, especially where the majority of patients have a language barrier. The aim of this project was to examine the outcomes of a collaborative geriatric assessment intervention implemented at the HSC Health Center for Older Adults geriatric clinic from January 2021 to May 2021, particularly for the Spanish-speaking population. Methods: A geriatric primary care clinic collaborated with an Area Agency on Aging (AAA), a governmental organization that coordinates community services, to provide an intervention for Spanish-speaking older adult patients visiting the clinic either as a new patient or for their Annual Wellness Visit (AWVs). Patients are seen by a Spanish-fluent AAA social service coordinator who administered the comprehensive geriatric assessment in the patients' first language. The comprehensive assessment included an evaluation of the patient cognitive function using the Montreal Cognitive Assessment (MoCA), a geriatric depression scale (GDS), and discussion and review of advanced care planning documents. Additionally, the social service coordinator assessed their activities of daily living (ADLs) as well as instrumental activities of daily living (IADLs). Using a retrospective chart review of the electronic medical record (EMR), we examined patient demographics, clinical characteristics, community-based service referrals, and screenings completed over a six-month period during which the intervention was implemented. Results: Most of the participants (n=41) were Hispanic females between the ages of 70 to 79. Thirty percent (30%) reported elementary school level or no formal education, but 53% did not report their educational attainment. A majority (70%) of the patients lived with family such as a spouse or child, and 43% were married. Additionally, 83% of patients had a geriatric depression screening score in the normal range. Almost half of the participants received a MoCA score of less than 19, which indicates moderate cognitive impairment. Lastly, 70% of the patients reported that they have not completed their advanced care planning. About 10% of the patients were able to enroll with the Area Agency on Aging and received services based on their needs, including but not limited to personal assistance, respite care, and durable medical equipment (DME) services. The remainder of the patients were either ineligible or did not follow up with the referral information provided at the clinic visit. Conclusion: Although only a few patients were able to benefit from enrollment with AAA, the partnership was instrumental in improving the utilization of screenings to help primary care providers identify the needs of older adult patients, especially in the Spanish-speaking population, as this was one of the challenges that healthcare providers faced. These results show that primary care and community partnerships have the potential to enhance geriatric assessments and improve education and awareness of resources for patients from underserved populations.