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

The U.S. has a complex history with immigration, marked by shifting policies. Despite the polarized climate, undocumented immigrants remain vital to American society contributing to the United States demographics, economy, and culture. This paper explores the ethical frameworks and clinical approaches relevant to providing ethical psychiatric care for undocumented individuals and their families. This exploration includes examining the application of core principles of bioethics—autonomy, beneficence, non-maleficence, and justice—in the context of undocumented immigration status. Finally, this thesis provides practical methods by which psychiatrists and other physicians can provide ethical care to undocumented immigrants in the clinical setting. / Urban Bioethics

BACKGROUND/RATIONALE: Persons with intellectual and developmental disabilities (pIDD) face barriers to quality health care, including psychiatric care, that result in worse health outcomes. While the mental healthcare community is increasing attention towards the psychiatric needs of pIDD, there continues to be a deficit of knowledge regarding psychiatric conditions, including suicidality. Engaging in community-based participatory research (PAR) with pIDD is the ethical way to address these deficits. An academic researcher (AR) must first educate herself on lessons from disability rights activism and disability bioethics. OBJECTIVE: Apply the intertwining history and principles of disability rights movements and disability bioethics to lessons learned from previous PAR with pIDD in order to propose a PAR project that aims to alleviate knowledge deficits regarding suicidality in pIDD. METHODS/APPROACH: Historical research will focus on landmark texts in disability rights movements and disability bioethics. Lessons learned from previous PAR is mostly obtained from reflexive accounts on behalf of the AR and outside of psychiatry. Analyzing these sources will result in a proposal of six principles that can guide the AR when ethically engaging in PAR with pIDD. RESULTS: The AR must understand the history of society valuing non-disabled lives over disabled lives, inclusive of pIDD, and the social model of disability as it relates to the human variation model. When engaging with pIDD, the AR can question the traditional definition of vulnerable populations, challenge the group to progress beyond informed consent, continually support a capacity-building approach to research and power-sharing skills, and embrace empowerment to enact political change. DISCUSSION: ARs, pIDD, and pIDD advocates must not accept the dearth of knowledge regarding psychiatric conditions, including life-threatening suicidality, in pIDD. The medical community should prioritize PAR with persons with pIDD to elucidate psychiatric conditions in pIDD that result in more efficacious and compassionate treatment. This proposal outlines major principles through which the AR can move forward ethically by engaging in PAR with pIDD. / Urban Bioethics

Physicians encounter significant difficulty when faced with decisions related to withdrawal of life-sustaining therapy (WLST) in patients with devastating brain injury (DBI). The complexity of this decision-making process is multifactorial, including practitioner- and patient-specific variables, as well as surrogate decision-maker bias, inaccuracies in scoring systems, and inconsistencies in guidelines endorsed by professional societies; these issues all contribute to the significant uncertainty of these situations and variability in treatment paradigm. Solutions are complex; however, analyzing WLST with an urban bioethical lens — which emphasizes the principles of solidarity, agency, and social justice — can enhance physicians’ ability to navigate this uncertainty and ensure that potential solutions are patient-centered. / Urban Bioethics

The COVID-19 pandemic highlighted the well documented health disparities affecting racial and ethnic minorities, particularly those living in underserved urban settings. Due to historic and contemporary structural racism, these areas are often food deserts, lack adequate access to primary care services, and have higher rates of maternal and infant mortality. The lack of public health infrastructure to respond to emergencies, such as pandemics, can be rapidly met with collective action from communities to take care of their most vulnerable. After providing a basic overview of how structural racism has created the present-day disparities seen in communities such as North Philadelphia, this thesis investigates and makes the case for the capacity of these resilient communities to take care of themselves. To this end, I describe the work of North10 Philadelphia, Fabric Masks for North Philly, and the Maternal Wellness Village—community-based organizations that rapidly pivoted their work to fill the unmet needs of people in North Philadelphia related to food insecurity, personal protective equipment, and childbirth preparation and social support, respectively. I describe the utilization of the services provided by these groups and evaluate the evolution of their work from the onset of the pandemic through present day. Following each case study, I share the stories of the leaders behind each project to give voice to the people fighting for the health and wellbeing of their community. Lastly, I reflect on my positionality as a Black woman and medical student at a large academic institution partnering with these groups and assert the need to maintain partnerships with these and similar organizations to ensure the sustainability of their programming in the long term. / Urban Bioethics

In recent years, an array of political, environmental, and health activists have brought to light the previously overlooked structural inequalities that plague many urban cities and their underserved populations. With a growing population and an increased dichotomy between social classes in the United States, urbanization may be inevitable. However, how urban planners and public agencies choose to build and design these areas is malleable. Provision of safe and equitable living conditions by these individuals is an obligation of utmost importance, and as such, this thesis aims to both provide insight as to how the built environment, development patterns, and land use play a significant role in in morbidity and mortality in urban communities across the nation and world, as well as assist in bridging the divide between disciplines of urban health and urban planning as we look towards creating healthier, greener, more equitable cities. The built environment and health can and should be discussed in the same breath during urban planning and development, and thus, the preservation, presence, and development of urban green space should be prioritized during processes of urbanization, with active engagement and empowerment from the communities in which we seek to build. The existing inverse association between increased urbanization and community health necessitates an induction of change and a call for action from urban planners, city and state officials, health scientists, environmental conservationists, and communities as a whole. / Urban Bioethics

Meeting the healthcare needs of the homeless continues to be a significant challenge in the United States. Homeless individuals suffer a disproportionately high burden of both communicable and non-communicable diseases and are at increased risk of dying prematurely. Additionally, this population faces barriers to receiving healthcare that are less prevalent for non-homeless persons. These include difficulties physically accessing care, underinsurance, and highly comorbid mental health and substance use disorders, all of which contribute to nonadherence and loss to follow-up. As such, homeless individuals report unmet needs across multiple types of healthcare services. Homeless people’s perceptions and attitudes towards healthcare also affect their propensity to utilize services. As with all patients, homeless individuals articulate a desire for compassionate, person-centered care involving meaningful engagement and trust. Yet, this is often not the case. Stigma and perceived discrimination from healthcare providers on the basis of poverty, race, mental illness or substance use have made the homeless feel unwelcome in many healthcare settings. Homeless people often describe being treated less compassionately by providers, feeling invisible, dehumanized, or reduced to objects. Perceived prejudice may contribute to poorer adherence and more frequent utilization of acute care or emergency services compared to routine ambulatory care. In this thesis, I explore homeless individuals’ attitudes of trust or mistrust towards the healthcare system using qualitative methods. I interviewed participants who identified as homeless at Philadelphia FIGHT and Broad Street Ministry, two healthcare and social service organizations that serve the homeless community in Philadelphia. I conducted interviews using a semi-structured interview guide. Below, I discuss my rationale for doing this study, my study methods, and results through five participant narratives elucidating key themes that arose during interviews. In the last chapter, I discuss why these results matter and how they can be used to inform future practice and policy aimed at reducing healthcare disparities for the homeless. / Urban Bioethics

Modifications, alterations, and enhancements to the body have been a practice forvarious ethnic, religious, and cultural groups across the globe for centuries. Over recent years, augmentations to the buttocks have become increasingly popular amongst women in Black and Brown communities. It is necessary to examine the health concerns, medical neglect, and societal influences that have contributed to the alarming increase of health complications and fatalities within these communities as a result of the procedures. Specifically, the administration of illegal injectable substances to the buttocks and the “Brazilian Butt Lift” procedure are in need of serious ethical focus and concern. In addition to the harmful health effects that result from these procedures, it is also important to recognize relevant societal and structural factors that intersect this rising issue. To fully comprehend the magnitude of the ongoing concerns, the history of buttock augmenting will be thoroughly discussed, other serious contributing factors, accessibility to adequate healthcare, and health knowledge. Cosmetic enhancements should come from a place of both empowerment and wellbeing, however the current conditions in the industry as it pertains to marginalized communities reflect otherwise. There are several contextual aspects as to why the ramifications of these procedures are so detrimental and it is my intention to highlight these issues, discuss the ethical implications, implore further research efforts, and then provide possible solutions to help address this growing issue. / Urban Bioethics