Immigrants and refugees in the U.S. tend to face many significant difficulties in obtaining good health care. In this analysis, I review what is known and unique about the health of Middle Eastern immigrants/refugees in the U.S., with a particular focus on Iraqis, and identify the barriers to healthcare that they commonly face. The most significant obstacles noted include cultural and religious differences, poverty, discrimination and distrust, and language barriers. In the process of discussing these factors, I reveal how this population understands health in the context of their religion and of their migration status. I also extrapolate how the barriers they face are likely to be exacerbated due to the COVID-19 pandemic and postulate solutions to these issues. / Urban Bioethics

Amyotrophic Lateral Sclerosis is a neurodegenerative disease affecting adults with disease onset averaging between 50-60 years of age. As neurons die, patients experience rapid physical and cognitive decline with death typically following 3-5 years after diagnosis. As there is currently no cure for disease and no treatment to prolong life expectancy, medical management is focused on quality of life. In addition to traditional medical treatments, medical professionals must also consider maximizing autonomy as a way to increase quality of life with a focus on relational and psychological factors. For patients in low-income urban neighborhoods, inequalities affecting agency should be evaluated as part of medical care to increase both autonomy and overall quality of life. / Urban Bioethics

This body of work aspires to explore the avenues by which medical professionals can leverage adolescents' current and historic high social media usage to increase their health literacy. In order to accomplish this, several types of health literacy and the ethical implications of inadequate health literacy are discussed, specifically with adolescents in mind. Next, trends in media and social media usage by adolescents and its effects on this population are determined, and examples of interventions using these means in the literature are analyzed. Finally, the work discusses my personal experience using social media to disseminate health information, challenges our collaborative faces, and future directions for our project. / Urban Bioethics

As the opioid epidemic continues in Philadelphia, buprenorphine clinics are becoming a necessary mainstay in treatment of these patients. HIV and HCV rates are rising throughout the city due to injection drug use, and buprenorphine clinics could be a bridge to therapy for these conditions as well. This thesis explores the current data about HIV and HCV rates, their connection to injection drug use, and how these overlapping epidemics might be addressed in a comprehensive manner. Historical data, current trends, and first person reflections from clinicians in the TRUST buprenorphine clinic are used to inform our understanding of barriers to integrated screening and treatment. The thesis concludes with a discussion of a better integrated model of care.

Hepatitis C virus (HCV) is a major public health concern with significant morbidity and mortality. New HCV infection is primarily associated with intravenous drug use. With the ongoing opioid crisis, the incidence of injection drug use and new HCV infection has risen. From 2010 to 2019, the number of estimated infections increased by 387% which is largely attributed to the opioid epidemic and injection drug use (CDC Viral Hepatitis 2019). In 2011 the treatment of HCV was revolutionized with the introduction of direct acting agents which revolutionized the treatment of HCV. Despite guidelines recommending treatment for PWID infected with chronic HCV there are a number of reasons this population is not commonly offered treatment. A growing body of literature has shown that PWID can be successfully treated and attain SVR even in the presence of ongoing drug use. This thesis was prepared by search of pertinent literature to analysis and arguments and evidence for and against the treatment of HCV in those with active injection drug use. / Urban Bioethics

Stigma in the healthcare system is widely documented. A significant medium through which stigmatizing thoughts, opinions, and attitudes are propagated is language. Stigmatizing language can create barriers to care, while inclusive non-stigmatizing language has the ability to highlight a patient’s strengths, humanity, and potential for recovery. While several institutions have implemented campaigns and interventions aimed at reducing stigma in healthcare, research examining the impact of these interventions is limited. Specifically, no studies have examined the effects of language-focused campaigns on patient outcomes. This paper reviews the current literature on stigma and stigmatizing language in healthcare and proposes a hypothetical study designed to assess the effects of a clinician-facing training that emphasizes the use of non-stigmatizing language on opioid abstinence in patients newly diagnosed with opioid use disorder. Potential limitations in study design and data analysis, along with possible implications of study results, are discussed. / Urban Bioethics

Jeremy Bentham’s panopticon is a theoretical prison that was developed in 1787 as a way to punish and reform people convicted of crime. It involved a circular building with a central guard tower, from which an omnipresent and omniscient warden would constantly surveille the inmates who were kept in solitary confinement. Although the prison was never physically constructed, elements of the panopticon are present in many aspects of our social structure and power systems. This paper explores Bentham’s original work, the post-modern responses to it, and present day manifestations of the panopticon through a bioethics lens in order to develop a metaphorical tool that can be used examine and explain how power is systematized and functionalized by those who control it, the effects on those who are subject to it, and how the systems are exploited to the point of dysfunction. / Urban Bioethics

Importance – The homeless face higher rates of morbidity and mortality than the general population, and have lower rates of end-of-life care planning. An effective and sustainable intervention, to provide living wills and durable power of attorney, is required to protect the autonomy of a vulnerable population. Objective – To determine if medical student-led 1:1 counseling is as effective as social worker-led counseling as reported in the literature, determined by rate of advanced directive completion. Design – A focus groups and educational sessions on EOL care and ADs were conducted at 2 shelters, after which participants were offered the opportunity to sign up for a 1:1 counseling session with a medical student volunteer. Rates of sign-ups and completion were recorded. Setting – 2 North Philadelphia homeless shelters, requiring either an Axis I or current substance abuse diagnosis for residence. Participants – A convenience sample of 20 homeless men were approached; 10 enrolled in the study. Interventions – Educational sessions, focus groups, and 1:1 AD completion counseling sessions Main Outcomes – Interest in and completion of an advanced directive. Results – 9 participants signed up to complete ADs after an informational session. At the conclusion of the study, 8 of them (88.8%) completed ADs. 40% of the total participants completed an AD. Conclusions – Similar rates of advanced directive completion were achieved with the student-led intervention compared to a previous intervention in the literature. Further study with a larger sample including homeless women should be conducted to provide a generalized conclusion. / Urban Bioethics

Background: The childbearing years place socioeconomically disadvantaged African American women at increased risk for poor diet quality, excess weight gain, and cardiometabolic complications. Little is known about the attitudes, beliefs, values, and contextual constraints that shape these high risk mothers’ dietary and physical activity behaviors. Objective: The purpose of this study was to examine health perceptions of diet quality and physical activity among low-income African American women in the early postpartum period, and how these perceptions manifest as barriers or facilitators to health. Additionally, we examined how they may differ by known predictors of health, such as education, age, parity, and BMI. Methods: We conducted semi-structured, individual interviews with 20 women who were between 3-6 months postpartum. Mothers were approached and recruited in the waiting room of a university-affiliated, outpatient prenatal care clinic in Philadelphia, PA. Enrollment in the study was restricted to women who self-identified as African American, were at least 18 years old, and met the federal income guidelines to qualify for assistance (Medicaid, WIC). Individual interviews were audio recorded and transcribed verbatim, with transcripts verified by research staff. Thematic coding and content analysis were performed by 3 researchers using NVivo 10 software to assist with data management. Results: Barriers and facilitators of healthy eating and physical activity after childbirth fell into 4 major themes of mothers’ lives: 1) new structural reality in the postpartum period; 2) physiologic changes after delivery; 3) correct/incorrect perceptions of healthy eating and activity; and 4) social determinants influencing behaviors. Mothers described the transition from pregnancy to the early postpartum period as having a significant negative impact on their eating and activity behaviors due to heightened fatigue, time constraints, and the monotony of daily life with a newborn. We found more than double the number of perceived barriers to engaging in healthy eating than facilitators with regard to fluctuations in food supply, cost of food, and the built environment. Mothers with obesity and less education were more likely to have misperceptions; these misperceptions additionally served as strong barriers to making healthy lifestyle choices. Changes in mothers’ physical symptoms and health status (e.g., developing diabetes, hypertension), on the other hand, facilitated healthy behaviors. Conclusion: This research deepens our understanding of the primary drivers of health behaviors among low-income African American women in the postpartum period. We identified barriers which limit and facilitators which support these mothers’ ability to engage in healthy behaviors, though there were far fewer facilitators of healthy eating and physical activity. Interventions designed to overcome these barriers and capitalize on these facilitators have the potential to improve health outcomes for this population. / Urban Bioethics

The current fragmented delivery of health care has contributed to unplanned hospital readmissions as a leading problem in the United States. Reducing readmissions to urban teaching hospitals is difficult. Many patients living in urban communities face social, economic, language, and transportation barriers to maintaining their health. Both the patient and the medical center experience the burden of readmission and are challenged with addressing SDoH and social injustices at several levels. Medicare views hospital readmissions as a marker representing lower quality of health care delivery to penalize hospitals providing care to the poor. This thesis addresses multiple social and economic factors associated with hospital readmissions, explores the interrelated components of readmissions at the personal and hospital system level, and delves into the interactions of bioethical principles associated with urban living. Hospital readmissions remain a serious issue nationwide and in order to reduce the rates of re-hospitalization the social and economic inequalities contributing to hospital readmissions are significant and must be addressed. / Urban Bioethics