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Capstone Abstracts & Posters
Social Epidemiology - Loop Cohort 2023
Capstone abstracts are listed alphabetically from A-Z. Click on posters for enlarged viewing.
Impact of Equitable Transportation Access on Prenatal Stress
Practicum Site: Northwestern University
Megan Barrera-Lessinger
Introduction. Prenatal psychological distress can produce adverse health outcomes for birthing parents and infants. Transportation access, a social determinant of health, allows populations to reach essential services and inaccessibility may produce experiences of distress. This research explores the relationship between transportation access and prenatal distress among pregnant persons. Methods. This exploratory analysis uses data from the Stress, Pregnancy, and Health (SPAH) Study, a longitudinal cohort study. The explanatory variable of transportation access is defined as the average number of transit trips per hour within a census block. The outcome of interest was self-reported prenatal distress. Multiple linear regressions were performed to assess the relationship between the explanatory variable and outcome of interest, with controls of perceived neighborhood safety, income to poverty ratio (IPR), birthing parent age, birthing parent race/ethnicity, birthing parent education, and place of residence. Results. The relationship between transportation access and prenatal distress did not produce significant results (β = 0.02, p = .49). However, birthing parent age and perceived neighborhood safety were significantly associated with prenatal distress (β = -0.21, p = .01; β = -0.24, p = .003). Conclusion. Further research is needed to understand the influence of transportation access on prenatal experiences among a diverse population of birthing persons.
Differences in Postpartum Education Levels: Exploring Associations with Geographic Location, Race, and Insurance Status
Practicum Site: Illinois Perinatal Quality Collaborative
Grayson Combs
Introduction. In this research, we are looking at how different hospital characteristics like geographic location, race/ethnicity, and insurance status affect Illinois birthing hospitals’ ability to educate patients in postpartum care. Methods. The data for this analysis was provided by the Illinois Perinatal Quality Collaborative (ILPQC). Of the 122 birthing hospitals in Illinois, we were interested in the 56 hospitals that are actively participating in the birth equity (BE) initiative through ILPQC, with baselines starting in October, November, and December of 2020 and their most recent reported data from October, November, and December of 2022. Results. The overall results from the data we collected shows that between the baseline period (the last quarter of 2020) and the most recent data collected (the last quarter of 2022), there were major improvements and sustainability in patient education in every measure of data collected (the number of patients receiving education on urgent maternal warning signs, patients receiving education on where to call for immediate help with concerns, those receiving scheduled early postpartum follow-up.) Conclusion. Overall, we can conclude that the quality improvement efforts being executed by ILPQC have worked in the past two years and could be moved from planning to sustainably soon.
Racism in Medical Journals in the Era of COVID-19
Practicum Site: The American Medical Association
Ryan Cooper
Introduction. Medical gatekeepers’ racial biases influence racism in the United States healthcare system. While improving health equity is critical, it is necessary to examine how the leaders of medicine are acknowledging or addressing past harms that contribute to racial inequities, especially in the wake of COVID-19. Methods. An analysis was conducted to study the world’s leading public health and medical journals in who is talking about the topic of racism, in what frequency, and how the articles published in these journals are addressing it in 2021. Results. Structural racism was named the most across all publications (AJPH, JAMA, NEJM, BMJ, and The Lancet). Mention of “structural racism” (N = 431; χ2 = 14.98; p = 0.005) and “racism not specified” (N = 431; χ2 = 14.58; p = 0.006) was statistically significant. Five themes emerged from articles studied; historic injustices, direct causes of inequities, issues to be addressed, solutions provided, and other mentions of racism. Conclusions. There is a lack of published empirical studies that highlight the effects of systemic racism in these medical journals. These journals should take effort into promoting authors and researchers to empirically study the topic that has plagued the United States for far too long.
Comparison of Medication for Opioid Use Disorder by Patient Centered Care
Practicum Site: Rush University Alzheimer's Disease Center
Richard DeMaria
Introduction. As we continue trying to understand and combat the opioid epidemic. Access to care is a major obstacle, for which we still lack some understanding. There are also differences by race/ethnicity, gender identity in the type of medication assisted treatment. Overdose deaths, for those 55 and older who are most at risk is still a growing concern. Methods. This analysis involved the All of Us dataset at Rush University, involving a total of 21,015 participants’ who received either methadone or buprenorphine for an opioid use disorder. The main relationship we looked at were whether patients who were asked their opinion about their medical care, was different depending on receiving methadone or buprenorphine. In analysis a X2 test of independence and a binary logistic regression was done. Results. Results show that when patient’s doctor asked their opinion about their care “Most the time”, to Hispanic, females whose insurance coverage stayed the same in the last year, had lower odds of receiving methadone opposed to buprenorphine. Conclusion. In summation there is a need for further research into understanding and reducing the racial disparities and improved access to MAT, also strategies to increase treatment uptake in diverse groups for opioid use disorders.
Evaluation of Helping Women Recover: A Trauma-Informed Mental Health Program
Practicum Site: Illinois Department of Public Health
Janelle Flores
Introduction. Substance use is a public health issue that can lead to mortality and decreased quality of life. To address this issue, the Illinois Department of Public Health implemented Helping Women Recover, a mental health program for incarcerated women. The purpose of this project is to evaluate the effectiveness of this program using a mixed methods approach. Methods. Univariate and bivariate analyses were performed on participants’ pre and post program surveys. Qualitative analysis was conducted on letters written by the participants who completed the program. Results. The t-test analysis showed that the program was effective in promoting attitudes and behaviors related to self-efficacy (M = 0.86, SD = 1.01), t(58) = 0.86, p = 0.00), self-identity (M = 0.80, SD = 1.04), t(59) = 5.97, and self-worth (M = 0.72, SD = 0.94), t(59) = 5.90, p = 0.00. The univariate analysis indicated that most participants felt they experienced positive change as a result of the program, especially when it came to understanding healthy relationships. The qualitative analysis indicated that intrapersonal factors, interpersonal factors, and facing trauma were important for change. Conclusion. Overall, the program was effective in positively changing participants’ attitudes and behaviors that are important for substance use recovery.
Posttraumatic Stress Disorder and Access to Mental Health Services in Women
Practicum Site: Rush Alzheimer's Disease Center
Allison Keller
Introduction. Research demonstrates that trauma and posttraumatic stress disorder (PTSD) are common in women. However, research regarding the rates at which women experiencing PTSD access mental health services is scarce. This capstone examined mental health service utilization in women with PTSD while factoring in race, ethnicity, age, insurance type, and income. Methods. A cross-sectional study on a cohort of women was designed using the NIH All of Us database. A binomial logistic regression model was developed to analyze the relationship between PTSD diagnosis, age, race, ethnicity, insurance type, income and having sought mental health services in the last 12 months. Results. Women with PTSD showed 2.46-times higher odds of seeing mental health providers than women without PTSD when adjusting for race, ethnicity, age, income, and insurance (AOR=2.46, 95% CI = 1.99-3.04). Individuals with non-White racial identities and who were Hispanic/Latino had lower odds of receiving mental health services. Those with income below $10,000 annually, Medicaid insurance, and in age groups below 65-years-old showed higher odds of receiving care. Conclusion. The association between PTSD and increased mental health services warrants future research dedicated to gender-specific mental health support. Disparities in healthcare utilization across demographic and socioeconomic factors merit further investigation.
Patient and Hospital-Level Factors Associated with Cesarean Sections: A Multilevel Logistic Regression Analysis
Practicum Site: Illinois Perinatal Quality Collaborative
Erin Elizabeth Power
Introduction. Nulliparous, Term, Singleton, Vertex (NTSV) C-section rates exist as a key reproductive health indicator. The Illinois Perinatal Quality Collaborative (ILPQC) established an aim of 70% of Illinois hospitals meeting the Healthy People 2030 NTSV C-section rate of 23.6% or below. This study sought to support the initiative by identifying the patient-level and hospital-level characteristics associated with NTSV C-sections. Methods. A cross-sectional study evaluating a secondary data set provided by ILPQC was conducted. The final data set of 25,076 observations across 86 hospitals was analyzed using univariate, bivariate, and multilevel binary logistic regression analyses. Results. Results showed that patients with private insurance are significantly more likely to have an NTSV C-section than those with Public/Medicaid insurance, even after controlling for race, BMI, maternal age, type of professional managing the delivery, and hospital’s percent Medicaid/public insurance (OR = 1.10, 95% CI = 1.01 – 1.20). All covariates significantly impacted the odds of a C-section. Certified Nurse Midwives (CNMs) as the professional managing the delivery significantly decreased the odds of C-section by half (OR = 0.53, 95% CI = 0.43 – 0.66). Conclusion. A multilevel, evidenced-based approach for reducing NTSV C-section rates remains imperative for addressing the worsening public health area of reproductive health.
A cross-sectional investigation of perceived neighborhood safety and healthcare utilization among cardiovascular disease patients
Practicum Site: Rush University Medical Center
Carmela Verderame
Introduction. Cardiovascular Disease (CVD) continues to be the leading cause of death across genders and most races/ethnicity groups in the U.S (CDC, 2022b). Using a socioecological approach to health behavior, this study aims research the relationship between the social determinants of health (SDOH), perceived neighborhood safety, and healthcare utilization of seeing a specialized medical doctor in the past year among CVD patients. Methods. Using data from the All of Us Research Program, a cross-sectional analysis was conducted on a cohort of 5,147 participants aged 18-80, assigned a sex of male or female, and a diagnosis of CVD. Results. Results did not show a significant relationship between perceived neighborhood safety and CVD patients seeing a specialized medical doctor in the past year. Secondary analyses revealed individuals aged 30-39 were twice as likely to have not seen a specialized medical doctor, as to those aged 70-80 (OR=2.079, 95% CI = 1.423 – 3.002). Non-Hispanic Blacks and Asians were twice as likely as Non-Hispanic Whites to have avoided interaction with a specialized doctor in the past year (OR=2.029, 95% CI = 1.535 – 2.665, OR=2.310, 95% CI = 1.195 – 4.294). Conclusion. Intrapersonal factors show the greatest association in healthcare utilization among CVD patients, and these findings are noteworthy for program design and implementation.
Racial Health Disparities in Infant Mortality: A Perinatal Periods of Risk Analysis
Practicum Site: Illinois Department of Public Health
Jillian Ward
Introduction. Fetal-infant mortality is a routinely analyzed marker of population health. Perinatal Periods of Risk (PPOR) analyses provide an in-depth look at differences in fetal-infant mortality between populations with better outcomes and populations with worse outcomes. This capstone employed a PPOR analysis with updated methods to determine racial health disparities in Illinois, searching for periods of greatest excess deaths for programming targets. Methods. A PPOR analysis was used to compare fetal-infant mortality between Non-Hispanic Black mothers and Non-Hispanic White mothers. This included a Kitagawa analysis in the Maternal Health/Prematurity Period, and a breakdown of SUID deaths vs other deaths in the Infant Health Period. Results. Maternal Health/Prematurity (50.0% of excess deaths) and Infant Health (25.8% of excess deaths) were the greatest contributors to excess deaths among NH-Black mothers. In the Maternal Health/Prematurity Period, birthweight distribution is a greater contributor to excess deaths. In the Infant Health Period, SUID contributes to most excess deaths. Conclusion. Increased investment in strategies to prevent deaths occurring in the Infant Health and Maternal Health/Prematurity Periods is needed. This includes improving safe sleep adherence and addressing social determinants of health to reduce racial health disparities in fetal-infant mortality.
A Cross-Sectional Analysis of the Racial and Gender Variations in the Treatment of Glaucoma
Practicum Site: Rush Alzheimer's Disease Center
Colton Wyatt
Introduction. Research examining the racial and gender variations in the treatment experiences of glaucoma patients is rare. Therefore, this capstone was conceived to explore the associations between race, gender, and glaucoma treatment and the implications it has for healthcare equity. Methods. A cross-sectional dataset of 6,354 glaucoma patients, age 18 years or older, living in the United States was obtained from the All of Us Registered Tier Dataset v6. Data were aggregated into two race groups: White and patient of color (POC). Chi-square analysis and multinomial logistic regression modelling was performed to analyze the relationships between race, gender, and treatment experiences of participants. Results. Results indicated that compared to White patients, patients of color had a 63% lower odds of reporting feelings of respect among providers (OR = 0.37, 95% CI = -2.03 – 0.048). Additionally, female patients were approximately 129% more likely to report feeling respect “None of the time” versus their male counterparts (OR = 1.29, 95% CI = -0.63 – 0.10). Conclusion. Female POC were less likely to report feelings of respect from their glaucoma care provider compared to White male patients.
