United States

Background
Differing health outcomes in maternal and child health among communities are the result of a multitude of factors. Despite considerable advancements in women’s reproductive health, social disparities continue to affect the health and well-being of mothers and infants. These racial and socioeconomic disparities become evident especially in medically underserved regions where health providers and resources are few. This study investigated the relationship between race and maternal and infant health outcomes in San Bernardino County compared to Los Angeles and Riverside Counties.

Methods
Public datasets were retrieved from the California Health and Human Services and California Department of Public Health, containing data on the state’s birth and death records and infant health indicators for 2010 to 2021. Only data from San Bernardino (SB), Los Angeles (LA), and Riverside (RS) Counties were included. Within each county, maternal and infant deaths and infant health measures such as birthweight and gestational age were further examined and stratified by race. To compare maternal mortality, a rate of pregnancy-related deaths per 1000 live births was calculated. ANOVA was performed to analyze for differences in maternal and infant mortality and infant health measure rates relative to race among the three counties, with significance level set at 0.05.

Results
Average pregnancy-related deaths in SB, LA, and RS Counties were 124, 300, and 55 per year, respectively, with Hispanics accounting for approximately 50% of maternal deaths across each county. After analyzing pregnancy-related mortality rates, there were significant differences between SB and LA (4.3 vs 2.4, p=0.009) and SB and RS (4.3 vs 2.0, p=0.003) among Hispanics and between SB and LA (8.5 vs 5.1, p=0.04) only among Blacks. Also, SB County had a significantly greater pregnancy-related mortality rate than LA and RS Counties (both p&lt;0.001). Furthermore, SB had higher rates compared to RS for low birthweight (p=0.02), preterm status (p&lt;0.001), and infant mortality (p&lt;0.001). SB also had a higher infant mortality rate compared to LA (p&lt;0.001).

Conclusion
SB County experienced higher rates of pregnancy-related mortality compared with its neighboring counties, with infant mortality and birth complications following a similar trend. Our findings suggest that racial disparities can contribute to health inequity, as predominantly Hispanic and Black communities were adversely affected. Further research is needed to understand the potential social barriers confronting underserved communities in San Bernardino. Identifying the root causes for racial disparities in health outcomes can help guide community health programming and policy-making to address gaps in maternal and infant health.

AMA Research Challenge 2023

Examining Disparities in Maternal and Child Health: A Comparative Study of San Bernardino County and Its Neighbors

Background
Differing health outcomes in maternal and child health among communities are the result of a multitude of factors. Despite considerable advancements in women’s reproductive health, social disparities continue to affect the health and well-being of mothers and infants. These racial and socioeconomic disparities become evident especially in medically underserved regions where health providers and resources are few. This study investigated the relationship between race and maternal and infant health outcomes in San Bernardino County compared to Los Angeles and Riverside Counties.

Methods
Public datasets were retrieved from the California Health and Human Services and California Department of Public Health, containing data on the state’s birth and death records and infant health indicators for 2010 to 2021. Only data from San Bernardino (SB), Los Angeles (LA), and Riverside (RS) Counties were included. Within each county, maternal and infant deaths and infant health measures such as birthweight and gestational age were further examined and stratified by race. To compare maternal mortality, a rate of pregnancy-related deaths per 1000 live births was calculated. ANOVA was performed to analyze for differences in maternal and infant mortality and infant health measure rates relative to race among the three counties, with significance level set at 0.05.

Results
Average pregnancy-related deaths in SB, LA, and RS Counties were 124, 300, and 55 per year, respectively, with Hispanics accounting for approximately 50% of maternal deaths across each county. After analyzing pregnancy-related mortality rates, there were significant differences between SB and LA (4.3 vs 2.4, p=0.009) and SB and RS (4.3 vs 2.0, p=0.003) among Hispanics and between SB and LA (8.5 vs 5.1, p=0.04) only among Blacks. Also, SB County had a significantly greater pregnancy-related mortality rate than LA and RS Counties (both p<0.001). Furthermore, SB had higher rates compared to RS for low birthweight (p=0.02), preterm status (p<0.001), and infant mortality (p<0.001). SB also had a higher infant mortality rate compared to LA (p<0.001).

Conclusion
SB County experienced higher rates of pregnancy-related mortality compared with its neighboring counties, with infant mortality and birth complications following a similar trend. Our findings suggest that racial disparities can contribute to health inequity, as predominantly Hispanic and Black communities were adversely affected. Further research is needed to understand the potential social barriers confronting underserved communities in San Bernardino. Identifying the root causes for racial disparities in health outcomes can help guide community health programming and policy-making to address gaps in maternal and infant health.

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Background:
Anemia remains a major public health concern, especially in developing countries, despite various public health policies targeted for correction. With this study, the authors aim to underline the need for region-specific policies contrasting the correlates of anemia in non-pregnant females of East and West Uttar Pradesh (UP), India.

Methods:
A detailed secondary data analysis was performed on NFHS-5 data covering the socio-demographic correlates of East and West UP non-pregnant females. Various explanatory variables were tested against the outcome variable of anemia using binary and ordinal logistic regression. For variables whose proportional odds assumptions were not satisfied, binary categorization of the ordinal variables were done.

Results:
The study found a significant difference in correlates of anemia among non-pregnant females of East and West UP on a detailed analysis. The odds of being anemic were higher in women living in rural settings, especially in West UP. Further, in West UP, the odds of being anemic were higher in women who were alcoholics (OR=1.153; p=0.000), having heart disease (OR=1.155; p=0.000), younger, economically weak, illiterate (OR=1.335; p=0.000), or underweight (OR=1.523; p=0.012). While, in East UP, the odds of having anemia were found to be higher among women who were illiterate (OR=1.095, p=0.010), had age of last child ≤48 months (OR=1.296; p=0.000), were currently breastfeeding (OR=1.067, p=0.000), were alcoholics (OR=1.155, p=0.000), were hypertensive (OR=1.502, p=0.000) or were underweight (OR=1.523; p=0.012).

Conclusion:
In line with the demographic differences between East and West UP, a stark difference exists in socio-epidemiological correlates of anemia between both regions, and a blanket public health policy is not enough. In the age of precision medicine, we must evolve to a “Precision Public Policy” tailored specifically towards the regions allowing better implementation and outcomes.

Epidemiological correlates of Anemia among non-pregnant females of East and West
Uttar Pradesh, India

Background: The impact of the COVID-19 pandemic on mental health has been substantial. Existing evidence indicates that religious coping behaviors could serve as a protective factor against the onset of mental illness. To delve deeper into this relationship, our study focused on exploring the religious coping behaviors and mental health status of the Muslim diaspora during the pandemic.

Methods: Two surveys were administered to a total of 1,723 Muslims residing in predominantly non-Muslim countries during the initial phases of the COVID-19 pandemic. The first stage of the survey centered on coping behaviors and anxiety levels, while the second stage emphasized coping behaviors in relation to depression. Regression analysis methods were employed to explore the variables associated with anxiety and depression.

Results: In Stage 1, both negative coping behaviors (B = 0.11, p < 0.001) and intolerance of uncertainty (B = 0.47, p < 0.001) showed a positive association with anxiety. In contrast, daily prayer (B = -0.09, p < 0.01) was negatively associated with anxiety. In Stage 2, intolerance of uncertainty (OR = 1.60, p < 0.01) and negative coping behaviors (OR = 1.69, p < 0.001) were linked with higher odds of reporting depression, while prayer and reading scripture did not exhibit a significant correlation with depression.

Conclusion: Our results indicate that during the early stages of the pandemic, Muslims predominantly relied on religious coping mechanisms like prayer and reading scripture, which were linked with lower levels of self-reported anxiety. However, these coping behaviors showed no correlation with depression.

Exploring the Intersection of Faith, Distress, and Resilience: An Investigation into the Experiences of Muslim Communities in Western Countries during COVID-19

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**Abstract:**



Grow502: a Pop-up Clinic to Tackle Health Disparities in the Houseless Population

Background
Over 100 bills have been introduced in the United States 2023 legislative session that restrict access to care for transgender and gender diverse (TGD) individuals. Passage of these bills by individual states may prompt medical students to seek residency training in other states, exacerbating the healthcare disparities and barriers to care that already exist for TGD individuals. This study assesses medical students’ perspectives on legislation prohibiting gender transition procedures (GTP) and how this affects where medical students apply to residency programs.

Methods
We analyzed responses from medical students at a Midwest institution. Data examined includes demographics, self-reported knowledge of GTP legislation, impact on residency applications and future practice, and agreement with proposed legislation. Respondents were asked to share factors influencing their feelings about applying for residency in states that restrict GTP, as well as considerations informing their position about regulations. Responses were coded for recurring themes and analyzed.

Results
80 medical students participated, and 39 responded to both free response questions. 36.8% report GTP legislation is important when considering where to apply for residency. 60.5% think this will impact how they practice medicine in the future, regardless of specialty. 57.3% are against restricting GTP for minors, and 82.7% for adults. Factors influencing residency applications fell into five themes: LGBTQ+ safety (38.5%), government interference (33.3%), education/training (33.3%), neutral (20.5%), and against GTP (15.4%). Four themes emerged regarding factors informing position on GTP: best medical practices (71.8%), minors’ capacity to consent (30.8%), government interference (30.8%), and a need for more data (7.7%).

Conclusion
The majority of medical students were against restriction of GTP, and over one-third felt it was an important consideration when applying to residency programs, suggesting that legislation prohibiting GTP may drive training physicians to other states. Responses also highlighted misconceptions and knowledge gaps about GTP, including rates and reasons for detransitioning, minors’ capacity to consent, and long-term risks and benefits of gender affirming care, which may improve with additional training during undergraduate medical education.

Medical students’ perspectives on transgender care legislation and its impact on medical residency applications.

Background
Despite the availability of effective preventative measures, women in rural communities of Louisiana face health disparities, specifically regarding human papillomavirus (HPV) infections. Along with suboptimal vaccination rates and cervical cancer screening, these disparities are further exacerbated by a lack of awareness and access to healthcare services. To effectively promote equity for women in rural Louisiana about HPV, understanding their needs is essential for developing appropriate strategies to eliminate the stigma surrounding reproductive health and decrease these health disparities. Therefore, this study aims to identify the risk factors contributing to health disparities related to HPV among women residing in rural areas of Louisiana.
Methods
This cross-sectional study is conducted in a Mobile Unit (MU) that travels to remote North Louisiana areas. Two hundred total participants are estimated for this study, with 123 responses providing preliminary results. The inclusion criteria are English-speaking women aged 25 – 64 without a total hysterectomy and cervical cancer history. With written informed consent and HIPAA authorization, participants responded to a questionnaire. HPV screening was offered and collected by the MU Nurse (NP).
Results
Based on preliminary results, the average age of participants was 54.31 years old. Most participants were African Americans (55.1%). Fifty-two percent had completed high school, 32.8% were married, 37.1% worked full-time, and 80.8% had low income. Regarding cancer history, 64.8% had a family history of cancer. Among them, 52% had a parent with cancer, while 35.8% had a grandparent with cancer. Eight percent had cancer, and 11% had been diagnosed with HPV. Regarding knowledge about HPV, 30% had never heard of it before our study. 46% did not know that HPV is sexually transmitted, 68.8% were unaware HPV causes genital warts, 33.6% did not know HPV can cause cervical cancer, and 47.6% were unaware that an HPV vaccine is available. Additionally, almost 91% of participants believed they were not at risk of HPV infection.
Conclusion
To achieve health equity for women in rural areas of Louisiana about HPV, we must focus on targeted interventions that address the specific challenges they encounter. With preliminary results showing most participants not knowing about HPV or its risk factors, further efforts should be prioritized to improve access to healthcare services, improve education and awareness, and foster community engagement. Understanding these disparities will allow us to create a future where women have equal access to healthcare regardless of where they live.

Bridging the Gap: Health Equity and HPV Among Women in Rural Areas of Louisiana

Analysis of Trauma Protocols & Bias in Toxicology Screening of Patients in Motor Vehicle Accidents

Background
Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) individuals face higher levels of stress than the general population in the form of minority stress, defined as discriminatory, stigmatizing, and victimizing experiences. Minority stress has been posited as a cause for LGBTQ individuals to smoke as a coping mechanism, leading to higher than average rates of smoking in this population. The Deep South states of Louisiana, Mississippi, Alabama, Georgia, and South Carolina represent an area with both high levels of minority stress and smoking. Therefore, the objective of this study was to elucidate how minority stress influences smoking among LGBTQ smokers in the Deep South, using a mixed methods approach.

Methods
A one-time, cross-sectional online survey was administered to 1,296 LGBTQ smokers in the Deep South. Survey measurements included previously validated measures of minority stress (prejudice events, perceived stigma, and internalized queerphobia), mental health, social support, smoking, quitting, LGBTQ and non-LGBTQ norms, self-efficacy, and smoking outcome variables (stage of change and nicotine dependence level). Multiple linear regression was used to assess the relationship between minority stress variables and smoking outcome variables. To expound on how minority stress affects mental health and subsequent stage of change, 15 individual, semi-structured online interviews were conducted with LGBTQ smokers in the Deep South. Interview topics spanned across 5 domains: LGBTQ identity, smoking/quitting, minority stress, mental health, and social support.

Results
Survey findings showed that after adjusting for covariates, increased levels of internalized queerphobia were significantly associated with increased nicotine dependence level, and decreased levels of perceived stigma were associated with further stage of change. Six themes emerged across interviews: struggles with LGBTQ identity, coping with minority stress, reasons for smoking, desire to quit smoking, and barriers to quitting smoking.

Conclusion
This study elucidates how increased levels of minority stress are associated with poorer smoking outcomes among LGBTQ individuals in the Deep South. Findings will help guide future smoking prevention and cessation programs for LGBTQ smokers. Addressing minority stress in future targeted smoking interventions has the potential to reducing smoking disparities in LGBTQ populations.

Minority Stress among LGBTQ Smokers in the Deep South: A Mixed Methods Study

Background:
Historical redlining, a discriminatory practice that denied mortgage loans to people of color based on perceived risk, has had lasting effects on communities. These redlined areas, marked as high-risk on maps, continue to face health disparities. This study investigates the relationship between redlining and all-cause mortality rates in Austin, Texas.


90 Years Later: How Historical Redlining Predicts All-Cause Mortality in Austin, Texas

Background
Louisiana's Hispanic/Latinx population is a diverse community that has experienced significant growth in recent years. Unfortunately, COVID-19 has disproportionately impacted racial and ethnic minority groups, including Hispanics/Latinx, who often face disparities in healthcare access and outcomes. This study aims to investigate the impact and potential disparities of COVID-19 infection among the Hispanic/Latinx community in Northwest Louisiana.

Methods
A cross-sectional survey was conducted between June 2022 and March 2023. A total of 242 participants were recruited and asked to complete a structured questionnaire. Eligible participants included individuals above 18 years old who identified as Hispanic or Latinx and resided in Northwest Louisiana. Data analysis was conducted using SPSS Version 28 with a statistical significance level set at p < 0.05. Descriptive statistics were utilized to summarize and compare the characteristics of the overall sample, while Pearson’s Chi-squared tests were used to identify risk factors.

Results
The average age of the participants was 42.2 years, 64.7% were female, 56.6% were born in Mexico, 37.7% had attained high school education, 54.1% did not speak English, 61.3% were married, and 51.1% were below the poverty level. Approximately 80% of the study participants had access to COVID-19 testing, with 44.3% receiving testing in a clinical or hospital setting. Among the study participants, 53.6% had been infected with COVID-19. Of those infected, more than half (50.4%) did not receive medical care from a clinic or hospital. Additionally, 63.9% personally knew someone who had suffered severe illness due to COVID-19, and 68% expressed concern about contracting the virus. Factors associated with increased risk of COVID-19 infection included being female, having limited English proficiency, living with 3 or more people, obesity, and asthma.

Conclusion
This cross-sectional survey offers insights into the impact and disparities experienced by the Hispanic/Latinx population in Northwest Louisiana during the COVID-19 pandemic. These findings can aid in implementing prevention measures, resource allocation, and targeted interventions to reduce the risk of COVID-19 and other infectious diseases among minority communities, particularly Hispanics/Latinx.

Disparities and risk factors of COVID-19 infection among Hispanic/Latinx in northwest Louisiana: A Cross-Sectional Study

Background:
Firearm violence is increasingly prevalent in the United States. As such, the number of people living with retained bullet fragments (RBFs) is rising. Lead toxicity is a rare, but known complication of living with an RBF. Lead is a teratogen and fetal exposure to lead has been linked to a variety of congenital abnormalities and cognitive development impairment. Little is known about the risk of maternal-fetal lead toxicity from RBFs. The purpose of this dual systematic review is to investigate the impact that RBFs may have on pregnant patients and their fetuses.
Methods:
Two systematic reviews were conducted, adhering to PRISMA guidelines, using
PubMed/MEDLINE and Embase: one explored the relationship between lead poisoning and retained bullet fragments/foreign bodies, and the second examined the relationship between prenatal lead exposure and fetal/child development. The quality of each included study was assessed on a scale of 0 to 5.
Results:
Of the 494 search results of the first review, only 5 (average quality: 4.2) explored the relationship between retained bullet fragments and blood lead levels, all of which demonstrated a strong association. Of the 753 search results of the second review, 11 (average quality of 3.91) examined the relationship between elevated maternal BLL and fetal development, and all highlighted that elevated maternal BLL is associated with neurobehavioral, cognitive, and cardiovascular fetal development.
Conclusions:
Retained bullet fragments may be a risk factor for lead toxicity in pregnant people with the potential for detrimental effects on the pregnancy and fetus. These patients should be educated about the risk and screened for lead levels during pregnancy. To further improve the health outcomes of this subpopulation and to determine the most appropriate treatment options, more research is needed.

Next from AMA Research Challenge 2023

Epidemiological correlates of Anemia among non-pregnant females of East and West Uttar Pradesh, India