Violence is a pervasive public health issue that disproportionately affects certain populations, particularly young black males in urban settings. Though this population experiences higher rates of violent victimization and perpetration, race should not be analyzed as an isolated variable. The social disorganization theory posits that social, cultural, and structural environmental factors shape a person’s behavior; this theory would suggest that higher rates of violence in young black men can be attributed to environmental factors rather than intrinsic traits like race. Young black males in urban settings experience high rates of poverty and institutional oppression, which primes these communities for excessive psychological trauma. The lasting effects of trauma, through Adverse Childhood Experiences and post-traumatic stress disorder, increase a person’s risk of violent victimization and perpetration, creating a cycle of violence in the community. Likewise, the high rates of firearm ownership create more opportunity for violent confrontation, especially in impoverished areas where joining a gang is perceived as one of the only options for economic and social survival as per the “Code of the Street.” In order to alleviate the burden of violence on this population, the root causes of violence, such as socioeconomic inequity and under-resourcing of disadvantaged communities, must be addressed by providing appropriate social services to those whom are most affected. / Urban Bioethics

There are about 2 million adults incarcerated. Of those, approximately 62% of women and 51% of men have a child less than 18 years old—that is about 4% of the US population (Ghandnoosh, Trinka, and Barry 2024; Glaze and Maruschak 2010; Turney and Goodsell 2018). In fact, if parental incarceration was considered a chronic health condition, it would be the second most prevalent childhood chronic condition in the U.S. (Axelson and Boch 2019). These children often already live in impoverished areas and the parental incarceration worsens their financial, educational, physical, and mental situations, forcing them to grow up faster and work harder (Miller 2006). They are at increased risk of facing more ACEs in childhood and by extension, at increased risk of morbidity and mortality in childhood and adulthood. I did a literature review on the various physical and mental health inequalities these children face. Using that as the foundation, I highlight the social responsibility towards these children. The literature review showed that children are more likely than their peers without incarcerated parents to have higher rates of infant mortality, increased BMI, hypercholesterolemia, asthma, migraines, hypertension, high-sensitivity-c-reactive-protein, ADHD, ODD, conduct and substance use disorder, and lower life expectancy (Holaday et al. 2023; Austin, White, and Kim 2022; Roettger and Boardman 2012; Lee, Fang, and Luo 2013a; Tung et al. 2023; Sundaresh et al. 2021; Gifford et al. 2019). I believe there are many players responsible for the physical and mental well-being of these children: themselves, family, society, and government. They are responsible for seeking help, and family members should prioritize their individual well-being. Society should encourage destigmatization, and the government should decrease costs for communication, and increase access to healthcare for the children and caregivers. These various agents need to work together to ensure the best health for the children of our future. / Urban Bioethics

Moral distress in the healthcare field includes feelings of frustration, anger, guilt, anxiety, depression, despair, and powerlessness to carry out ethically appropriate actions to patients in line with personal values in the setting of external constraints. Psychiatry residents are particularly vulnerable to experiencing moral distress due to the coercive aspects of psychiatric treatment, constraints in the medical system, and the internal conflicts caused by a resident’s identity as a trainee physician and competing duties to an individual patient, healthcare organizations, health care professionals, and society. Psychiatrists make complex assessments that often cannot be made with absolute certainty, but regardless, they are tasked with the duty to identify and ultimately act on their risk assessments. These unrealistic societal expectations are especially difficult for psychiatry residents who have not yet had the experience to grow their knowledge and confidence in their decision-making skills yet still must make difficult decisions in their new role as physicians. Ethical decision-making can be used to alleviate moral distress, and a consistent utilization of an ethical decision-making framework can help guide decisions that are both objective and thoughtful. The ethical framework proposed includes considerations of the patient's capacity to consent or refuse medical treatment, the urgency of the medical condition, the feasibility of the actions needed to address the medical condition, and the countertransference of the treatment team. This framework helps guide clinicians by ensuring they understand and address the ethical considerations involved in treating patients and the moral distress that arises from these difficult choices. / Urban Bioethics

Interpreter services play an integral role in ensuring equity in healthcare for patients with limited English proficiency (LEP), whose language barrier places them at increased risk for healthcare disparities. Even with the growing number of non-English-speaking patients, a sizeable number being Spanish-speaking, and although such training leads to more culturally competent care with better patient outcomes, there is little curricular time during medical school devoted to effectively using interpreters. This study aimed to understand better how medical education prepares future physicians for their encounters with LEP patients and what experiences they would appreciate in their medical training. Temple LKSOM student from the class of 2024-2027 (M1-M4s), were recruited through flyers and educator announcements to participate in three virtual focus groups with a total of 26 participants. Qualitative data analysis resulted in five themes which were: students felt that interpreters were integral to culturally competent care, students who speak another language have the undue burden of interpreting even when not comfortable doing so, students felt that there was not enough training in medical school regarding various types of interpreters, how to reach them or how to use them properly, students are open to doctoring sessions or simulations with non-English speaking standardized patients and interpreters, and the final theme was that there mixed feelings amongst students regarding the desire to have OSCEs with non-English speaking standardized patients and interpreters. / Urban Bioethics

BACKGROUND: For years, the trauma of acute inpatient psychiatric treatment has been studied. Trauma-informed models have been created to reduce the trauma of receiving care. These models primarily focus on patient-provider relationships and not the interpersonal dynamics between patients on acute psychiatric units. METHODS: A literature review via Temple University Library and Google Scholar databases as well as interviews with mental health professionals were conducted on the current trauma prevention initiatives in mental healthcare and on strategies to strengthen interpersonal relationships between patients in acute psych units and to quell patients’ perceived risk of harm from one another. RESULTS: A set of five principles is proposed for fostering community and safety in acute adult inpatient psychiatric units as it pertains to the interpersonal relationships between patients. These principles include: 1) Fostering a sense of community within the patient population 2) Rethinking the physical space to reduce patient stress and therefore reduce patient aggression 3) Providing a mentorship program led by peer mentors from the community 4) Providing better mental health education and awareness within society 5) Bridging the gap between the community and inpatient psychiatry. CONCLUSION: The five principles of this thesis can aid in positively transforming patients’ experiences in acute psychiatric units. This transformation requires a significant amount of activism and collaboration in order to stop repeating the cycles of trauma seen within the psychiatric field. / Urban Bioethics

To address today’s most pressing adolescent and young adult (AYA) health issues, researchers are increasingly using digital technologies to facilitate interventions. Studies conducted using digital crowdsourcing, mobile health (mHealth) applications, and wearables such as smartwatches may offer unique benefits, including more widespread access to tailored intervention content. However, there is a great deal of variation in the extent to which AYA themselves have a voice in this research, which affects not only a study’s ethical integrity, but also potentially its outcomes. This three-paper dissertation presents a spectrum of approaches to AYA engagement in digital health research, examining the implications of each approach. Collectively, these papers suggest that the genuine and meaningful engagement of AYA in digital health research is a health promotion strategy that may boost the likelihood of intervention relevance, acceptability, and impact for this population.

Mobile apps are the primary means by which consumers access digital health and wellness software, with delivery dominated by the ‘Apple App Store’ and the ‘Google Play Store’. Through these virtual storefronts Apple and Google act as the distributor (and sometimes, importer) of many thousands of health and wellness apps into the EU, some of which have a medical purpose. As a result of changes to EU law which came into effect in May 2021, they must now ensure that apps are compliant with medical devices regulation and to inform authorities of serious incidents arising from their use. The extent to which these new rules are being complied with in practice is uneven, and in some areas unclear. In light of EU legislation related to competition, which came into effect in November 2022, it is also unclear how conflicts of interest can be managed between Apple and Google’s roles as gateway duopoly importers and distributors whilst also developers of their own competitive health products. Finally, with the proposed European health data space regulation, wellness apps will be voluntarily registered and labelled in a fashion more like medical devices than consumer software. We explore the implications of these new regulations and propose future models that could resolve the apparent conflicts. All stakeholders would benefit from improved app store models to sustainably evolve safer, better, and fairer provision of digital health applications in the EU. As EU legislation comes into force it could serve as a template for other regions globally.

Disparities in breastfeeding are increasing for Black women in the United States despite initiatives aimed at improving breastfeeding outcomes. As a result, Black communities are not being protected, which is reflected in the disproportionate rates of mortality and morbidity for the Black dyad. Much of the qualitative studies in the literature have focused on the patient experience through focus groups or interviews. However, this information typically is not communicated to the same physicians providing the care in a study. This study aims to change that by obtaining the breastfeeding experiences and perspectives of patients and medical providers in a low-risk prenatal clinic in urban North Philadelphia. The secondary aim is to disseminate patient feedback to providers to develop a realistic call to action specific to that community. Work obligations and perceived necessary lifestyle changes were the patients' most significant barriers to breastfeeding. Patients desire more education from the medical community, but at the same time, providers lack the knowledge, comfort, and time to counsel. What is clear is that the medical system contributes to these poor outcomes; institutionalized barriers add to existing disparities and ultimately worsen the crisis for everyone, with long-term effects on the economy and productivity of the surrounding community and the population. Providers cannot create change by themselves, as breastfeeding disparities have roots in much larger policies and systems, but providers must examine what is in their scope of influence. Future research is needed to explore the effects of empowering Black communities with education regarding workplace laws and addressing myths that reinforce breastfeeding barriers. Medical education must incorporate breastfeeding into its curriculum as the consequences are dire and intersect with many areas of medicine. This research offers hope for change and has led to providers developing proposals for timely and realistic interventions based on community feedback and narratives. / Urban Bioethics

In the midst of the youth mental health crisis in the United States, Latinx adolescent females are at particular risk of having a mood disorder while being simultaneously disproportionately less likely to access mental health care due to a multitude of structural barriers. Nature-based social prescribing, increasingly popular in primary care settings, refers to recommending participation in community programs to provide a multitude of beneficial effects, including improved mental health. Gardening is an example of one of these programs that has been well studied in adults with evidence of positive impacts on mental health. However, it is unclear whether gardening has similar positive impacts on high-risk groups such as adolescent Latinx females with mood disorders. Using mixed-methods, this pilot study explored the experiences of adolescent Latinx females with mood disorders as they participated in an 8-week-long gardening club intervention. Quantitative findings demonstrated statistically significant reductions in participant Strengths and Difficulties Questionnaire (SDQ) impact scores and conduct scores after participation in the intervention. Qualitative feedback from participants supported these results and identified additional positive impacts of participation including relational connection, knowledge acquisition, and appreciation of having a safe space to engage with others. / Urban Bioethics

Artificial Intelligence (AI) has the capability to revolutionize modern life. From humble beginnings of simple machines to current day programs capable of winning “Jeopardy!” and passing medical board exams, the applications of this maturing technology are incredibly diverse. Healthcare in particular contains many inefficiencies and opportunities for improvement for which AI programs have shown encouraging results. However, the ramifications of extensive implementation are unclear. In order to cultivate innovative technology safely, the core ethical principles of beneficence, non-maleficence, autonomy and justice must be prioritized. / Urban Bioethics