Background: Primary open angle glaucoma (POAG) is the most common form of glaucoma in the United States and is the leading cause of irreversible blindness in African Americans. Although this is the case, there are no current primary care screening guidelines for this condition. The USPSTF cites that there is insufficient evidence to assess the balance of benefits and harms of screening for POAG in adults. This condition disproportionately affects African American and Hispanic patients. A systematic review performed earlier this year highlighted disparities in research participation among POAG clinical trials. No similar studies have been pursued outside of clinical trials. This is problematic because screening guidelines are heavily influenced by the literature related to the topic. Methods: A rapid scoping review of the literature will be performed with a particular focus on demographic data. Data was sourced from the included studies used in the systematic review performed in 2022 to inform the current USPSTF guidelines. Data collection will consist of the compilation of demographic data within each of the studies on a spreadsheet and will subsequently be analyzed according to subgroup corresponding to study type. Results: A total pooled sample of 16659 participants was obtained from the 16 included studies. After exclusion of an outlier study, total research participation across all studies was 27.9% and 5.5% for Black and Hispanic individuals, respectively. In clinical trials, 26.9% and 6.9% were Black and Hispanic individuals, respectively. Lastly, among nonclinical trials, 28.7% and 3.3% were Black and Hispanic individuals, respectively. Conclusions: Primary open angle glaucoma is a public health issue. The current recommendations for POAG screening are based on the currently available literature. However, it has been previously shown that disparities exist in research participation among Black and Latino individuals in clinical trials. The findings within this study corroborate those findings as well as highlight that disparities in research participation and representation persist among nonclinical trial research studies. This thesis underscores the ongoing need for equitable efforts in POAG research across all studies. With these efforts, recommendations for screening may be properly elucidated to inform more equitable care and identification of this disease. / Urban Bioethics

Diversifying the physician workforce is crucial for addressing healthcare disparities. Despite efforts to promote diversity, residency programs still have low representation of Black/African Americans. Our research, drawn from articles in the Temple University Libraries Database and Google Scholar Database up to March 2024, highlights differences in perceptions of program culture and racial diversity between URIM and non-URIM applicants. URIM applicants consider factors such as the authenticity of diversity, equity, and inclusion (DEI) efforts, as well as the racial climate when evaluating programs. Additionally, representation of URIM faculty and residents along with post-interview communication and events are important factors when assessing residency programs. There is limited literature on how Black/African American applicants' preferences influence diversity recruitment efforts. It is imperative for programs to incorporate feedback from URIM applicants to develop effective recruitment strategies and foster cultural shifts. By doing so, we can contribute to a more diverse and inclusive physician workforce capable of more effectively addressing health disparities that disproportionately affect Black/African Americans. / Urban Bioethics

With food and nutrition insecurity driving diet-related chronic health conditions in urban settings, strategies that facilitate access to fresh fruits and vegetables are imperative. Food is Medicine is a philosophy that embraces the integration of nutrition education and food subsidies into health care. This thesis describes one example of a Food is Medicine program, food prescription programs (FRx), in chronic disease management. While FRx programs vary in length, there are no studies to our knowledge addressing the reasons why patients adhere to FRx long-term. Using a positive deviance approach, we sought to understand positive deviant patient (PDP) practices and characteristics influencing consistent, long-term participation in Temple University's Farm to Families (F2F) fruit and vegetable prescription program. Prior to introducing this case study, I share from an Urban Bioethics lens my reflections on study design, my positionality coordinating research with community members, and how Urban Bioethical principles relate to FRx. I present the F2F case study: we conducted semi-structured, in-depth interviews among 13 PDPs who participated for over three months between 2016 and 2021. Interview transcripts were coded for most common themes. Seven of the 13 PDPs opted to participate in photovoice interviews. I then examine lessons learned from the F2F case study. Lastly, I discuss the sustainability of FRx from an Urban Bioethics lens, starting with considerations of resource allocation of FRx, and ending with integrating FRx into clinical practice and health systems. Despite the complexity of risk factors and sociopolitical forces contributing to food and nutrition insecurity in the United States, food justice is both necessary and achievable. How we as Urban Bioethicists and clinicians choose to approach food insecurity determines our capacity to challenge the status quo and reconstruct the narratives that have perpetuated this issue for far too long. Through a collaborative effort that embraces the experiences of our patients and community members, my aspiration is for food justice to become a reality. / Urban Bioethics

Where you are born, the school you attend, your highest level of education, your race, age, and sex, these are all things that can directly, or indirectly impact your health. The social determinants of health is a phrase that can better be used to sum them all up. It refers to the social situation you exist in, and how that affects your ability to purchase healthy foods or obtain the medical care you need, and so much more. When it comes to certain measurements of health, people who fall within certain groups or populations, for example, minorities, or people of lower socio-economic statuses (SES), tend to have worse results than their white, or higher SES counterparts. These differences in health outcomes are referred to as disparities. As social scientists, healthcare professionals, and anyone with the means to address these disparities, we are ethically obligated to do so. There are already several initiatives aimed at addressing the social determinants of health. Through these initiatives, those in need are provided with things such as food vouchers, ride vouchers, and health education. What is missing, are organized studies with specific goals and appropriate sample sizes to address the efficacy of these initiatives. Once we have more such studies to provide us with data that supports the efficacy of these interventions, we can then advocate for policies that will make these resources widely available and encourage health equity. / Urban Bioethics

The social and structural determinants play a significant role in community health, and differences in the experience of these factors facilitate some of the health disparities that are seen in the US along racial and socioeconomic lines. In this manuscript, I propose a conceptual model of the social determinants of health hierarchy and discuss the positioning of the structural determinants of the built environment within that hierarchy. I discuss the research connecting some of the structural determinants to health outcomes. Finally, I review several opportunities for local government to alter the built environment in ways that can promote community health and mitigate health inequity. / Urban Bioethics

Global surgery describes the systematic way to reduce health disparities and realize accessibility and sustainability in surgical care. Nearly five billion individuals lack access to adequate and necessary surgical and peri-surgical care. The contemporary model of global surgery is that of short-term surgical trips, which have origins in European and North American colonialism. The current state of global surgery in the surgical subspecialty of otolaryngology and head & neck surgery (OHNS) care fails to meet an adequate ethical threshold based on traditional bioethical principles. In order to improve the system of global OHNS care to promote sustainability and long-term impact, global OHNS care needs to shift away from providing direct clinical care. This work presents an ethical framework composed of four primary domains—(1) preparation and understanding the local context, (2) education, (3) partnership and exchange, (4) research and evaluation. This model can be used to shephard a future with stronger ethical global OHNS care. / Urban Bioethics

This thesis is a pilot analysis of five Afghan physicians who recently evacuated Afghanistan and are hoping to reenter the medical field in the United States. To this investigator’s knowledge, there has not been a study focusing on physicians who were part of the 2021 evacuation from Afghanistan. Through participant interviews, this thesis aims to illuminate the opportunities and challenges facing these physicians. Additionally, a board member of the Afghan Medical Professionals Association of America was interviewed to better understand the resources provided to newly arrived Afghan physicians. We found that socioeconomic status, lack of social support and guidance, United States Medical Licensing Exams, and limited English proficiency were barriers to reentering the medical field for these physicians. Policy recommendations include allotting residency spots for forcibly displaced physicians and enabling opportunities for physicians to work in other positions in the medical field. / Urban Bioethics

The following thesis will set out to argue that misinformation, disinformation, and conspiracies, in tandem with today’s advanced communication technology, pose a dire threat to the future of public health, biotechnological advancement, safe medical procedures, and ethical evidence-based legislation and policy. Each chapter will explore different points in public health and medicine that misinformation, disinformation, and conspiracies have already begun to shift or disrupt in ways that are eroding safe and effective care. Misinformation, disinformation, and conspiracy theories should be seen more broadly outside of the spheres of Big Tech and First Amendment discourse, and instead understood as a public health concern of which there are ways to inoculate, treat, and mitigate public spread. Much as we have come to understand that gun violence requires more than a judicial approach, so too must we come to understand misinformation, disinformation, and conspiracy theories as an indicator of failing health in a population. / Urban Bioethics

With racism driving perinatal health disparities, antiracist tools and trainings are necessary for WIC nutrition professionals who serve as frontline providers for Black and Indigenous families of color. Black families, in particular, are the most likely to experience harms from discrimination in health care and health services, even from well-intentioned providers in caring professions. This thesis investigates the role of racism, both interpersonal and structural, and how it may influence WIC enrollment, participation and culture of care. After providing a basic overview about WIC including recent participation and demographic statistics and trends, I share my own ethnographic observations and reflections on my positionality in the WIC clinic setting. I review research on the most commonly identified barriers to and benefits from WIC participation, including how those benefits intersect with contributing factors in the crisis in Black perinatal health in the United States, and make the case for including experiences of bias and racism as an overlooked barrier. With a focus on improving the client experience, I use an urban bioethics lens to inform strategies (including antiracism training for WIC staff) to increase and sustain WIC participation and the concomitant benefits participation can incur, particularly for Black mothers and birthing people and their families. I review the literature that informed our training, describe key components of the training, and summarize the findings from the evaluation and assessment of the WIC nutrition professionals who attended. Lastly, I posit how the convergence of COVID-19 and the racial justice uprisings of 2020, both accelerated the acceptance of the need for innovations in how WIC is implemented, and created the conditions to facilitate rapid changes towards more equitable policies and procedures at both the local and federal level. Many of these changes were previously thought to be desirable but unattainable, and I reflect on the need to seize this opportunity to intentionally build upon that progress by applying a racial equity framework to envision a post-pandemic WIC. / Urban Bioethics

Data consistently shows that firearm violence affects minority populations disproportionately. In the 1970s, firearm injury related death was the 13th leading cause of death in America. The problem has only worsened, costing the US economy almost $230 million a year and is now the second-leading cause of injury related death. Gun violence should be considered a public health crisis given its costs in terms of morbidity, mortality, and economics, but also can be considered a social determinant of health as it contributes significantly to minority populations’ medical histories and health outcomes. Homicide is the leading cause of death in Black males between the ages of 15 and 34, with 91% of these deaths being the result of firearm injury. However, the way gun violence is portrayed in the media inaccurately generalizes White populations fulfilling the victim role while Black populations in the criminal role. The media considers shootings involving Black populations as “commonplace,” and therefore these incidents receive less attention from media sources. The constant impact of firearm violence places on healthcare providers is also significant, as the incidence of post-traumatic stress disorder is three times higher for trauma surgeons than the general population. Many healthcare organizations have recognized the devastating impact of firearm injury by coming out with position statements, developing patient education and advocacy resources, and community engagement initiatives to help support populations most affected. While more is to be learned in terms of research about the impact of this public health issue, we need to take a multifaceted approach to work towards equitable care for our most vulnerable populations. / Urban Bioethics