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Indiana University-Purdue University Indianapolis (IUPUI) / The emergence and development of electronic health records have contributed to an abundance of patient data that can greatly be used and analyzed to promote health outcomes and even eliminate health disparities. However, challenges exist in the data received with factors such as data inconsistencies, accuracy issues, and unstructured formatting being evident. Furthermore, the current electronic health records and clinical information systems that are present do not contain the social determinants of health that may enhance our understanding of the characteristics and mechanisms of disease risk and transmission as well as health disparities research. Linkage to external population health databases to incorporate these social determinants of health is often necessary. This study provides an opportunity to identify and analyze health disparities using geographical information systems on two important sexually transmitted diseases in chlamydia and gonorrhea using Marion County, Indiana as the geographical location of interest. Population health data from the Social Assets and Vulnerabilities Indicators community information system and electronic health record data from the Indiana Network for Patient Care will be merged to measure the distribution and variability of greatest chlamydia and gonorrhea risk and to determine where the greatest areas of health disparities exist. A series of both statistical and spatial statistical methods such as a longitudinal measurement of health disparity through the Gini index, a hot-spot and cluster analysis, and a geographically weighted regression will be conducted in this study. The outcome and broader impact of this research will contribute to enhanced surveillance and increased effective strategies in identifying the level of health disparities for sexually transmitted diseases in vulnerable localities and high-risk communities. Additionally, the findings from this study will lead to improved standardization and accuracy in data collection to facilitate subsequent studies involving multiple disparate data sources. Finally, this study will likely introduce ideas for potential social determinants of health to be incorporated into electronic health records and clinical information systems.

Background: Gender inequality is widespread throughout Latin America, in large part due to a ‘machista’ culture in which women tend to be regarded as inferior to men. In Colombia, especially in low-income areas, women and girls are consistently excluded and marginalized. As a result of this, adolescent girls are susceptible to gang recruitment, teen pregnancy, and substance abuse. In similar settings globally, sport has been shown to be an effective tool for development and for the socialization and inclusion of youth. Few studies have taken place in Latin America, however, and hardly any of them have focused specifically on marginalized girls. This study aims to address this gap in literature by exploring how sport can break down barriers of exclusion and promote inclusion of marginalized, adolescent girls in Colombia. Methods: This qualitative, multi-methods study involved the analysis of data collected from semi-structured and key informant interviews, as well as participant observation sessions. All data collection was conducted in Cazucá, Colombia with participants from local NGO Tiempo de Juego (TDJ). Semi-structured interviews were conducted with adolescent girls between the ages of 11-18 who were participating in at least 1 sport at TDJ. Key informant interviews were conducted with TDJ staff and a guardian of several girls who participate in TDJ. Interview transcripts and participant observation memos and reflections were reviewed and coded to identify themes through thematic analysis. Results: All participants interviewed indicated that sport had a positive impact on their day to day lives. Three main themes and two sub-themes were identified during data analysis: 1) ‘Machismo’ in Colombia with sub-themes: i) Gender Roles and ii) Gender Norms, 2) Exclusion and marginalization, and 3) Empowerment through sport. Most participants spoke about the prevalence of machismo in Colombian society and how gender roles and norms limit the types of opportunities that are available to them. Participants expressed how, although they are marginalized based on where they live, sport provided them with a healthy activity to engage in as an alternative to the negative behaviours that they are susceptible to in their neighbourhoods. Sport provided them with an outlet to escape from their daily problems, and they felt that through sport, they were able to realize their self-worth and gain confidence in themselves. Conclusion: These findings suggest that sport can become a useful tool for promoting the inclusion of marginalized girls through empowerment. While sport was shown to break down some barriers of exclusion, further work must be done to explore its potential role in breaking down gender stereotypes that remain prevalent in Colombian culture. These results highlight the need for more sport programs that focus on marginalized girls in Latin American countries where women and girls remain a neglected population.

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