Low health literacy is highly prevalent in the United States and can significantly impact health outcomes for patients. Prior research has shown that communication is a major mediator between health literacy and health outcomes. However, there has been limited investigation into the quality of communication of patients who attend clinics staffed by medical residents. The patient population attending the resident clinic at Temple University Hospital is made up mostly of African Americans from lower-income neighborhoods of North Philadelphia. This investigation aims to gather data regarding the relationship between health literacy and communication in this previously under-studied patient population. Using a rapidly self-administered health literacy screening tool, the quantitative data reveals a high prevalence of low health literacy in this patient population. Additionally, using a semi-structured interview with a two-staged coding process, the qualitative data describes several ways in which limited health literacy can diminish optimal patient-provider communication. The patients in this study population express a high desire for information about their health status, as incomplete communication was a potential source of anxiety. Suggestions from patients in this population focus on increasing active participation in clinic visits. Study subjects agreed that interventions targeted towards medical residents would help to improve communication with low health literacy patients. Novel approaches to educating medical trainees about health literacy should be investigated in the future. / Urban Bioethics

Childhood trauma greatly impacts the lives of patients and their future health outcomes. Since the discovery of the utility of the Adverse Childhood Experiences (ACEs) screening tool in the 1990s, many providers have attempted to screen and intervene on these past experiences of trauma with mixed results. ACEs have an outsized impact on adult health. There is considerable literature documenting the changing state of screening for ACEs in adult populations, and the compelling rationales for doing so. There are also a number of interventions available currently, but providers face challenges to use them. Ethical considerations and issues with the current state of screening for ACEs exist, due to some of these challenges and differential availability of interventions between populations. Here, I use the principles of urban bioethics to explain the ethical obligation of screening for ACEs despite these challenges and to dispute previous discussions on this topic. This article will show that there are general strategies that providers can take to implement ACEs screening in an ethical manner and specifically discusses trauma-informed care’s utility to help achieve these strategies. Through this discussion, I hope to encourage providers to reconsider ACEs screening and give them strategies to do so. / Urban Bioethics

Understanding gender, sex, and sexuality is required in order to be a competent, patient-centered physician, and, therefore, inclusion of these topics in undergraduate medical education is essential. Current medical education is not producing physicians equipped to manage the complaints and issues that face their patients in these areas. LGBTQ populations are most affected by the inadequacy of training related to these topics. LGBTQ patients face unique issues in healthcare in terms of their normal development, pathology, social determinants of health, and healthcare system practices. Additionally, LGBTQ people and those who engage in behaviors that parallel these identities are prevalent in the general population. The addition of a gender, sex, and sexuality curriculum would simultaneously address LGBTQ disparities as well as the need for improved sexual health education that would benefit all patients. Currently, undergraduate medical curricula have limited, non-standardized education on gender, sex, and sexuality. A few American institutions have published both qualitative and quantitative studies that indicate medical students’ attitudes are malleable and their clinical skills can be improved in these areas. Further, numerous national medical societies have created curriculum guidelines and recommendations in order to aid medical schools looking to bolster their gender, sex, and sexuality related curricula. This paper will synthesize research and these guidelines to propose a robust gender, sex, and sexuality curriculum that is tailored to the environment found at the Lewis Katz School of Medicine at Temple University. / Urban Bioethics

The physician-patient dichotomy is reinforced continuously in medical education and medical practice. The physician possesses knowledge that will be used to help the patient in some way. However, as human beings, physicians are subject to the illnesses and diseases that affect their patients. Physicians moved by this role-reversal may feel compelled to record their experiences, leading to an accumulation of “physician-as-patient literature.” Five examples of “physician-as-patient” literature illustrate five fundamental lessons that can be adapted by physicians: relating to patient vulnerability, fostering hope for patients, mobilizing support systems, recognizing physical consequences of disease, and appreciating patient quality of life. By generalizing these individual stories, it is not necessary for physicians to experience the exact disease or illness they treat. Rather, they can draw from their unique life experiences to practice empathy. The concept of empathetic medicine can be introduced in medical school training by integrating empathy education into scientific curriculum. Current practitioners can benefit from narrative exercises, reflection and physician self-disclosure in efforts to promote empathy. Medical practice requires solid relationships between human beings, physicians and patients. This basic principle is further emphasized in “physician-as-patient” literature and concerted efforts by institutions and individual physicians can lead to a foundation for a culture of empathy. / Urban Bioethics

The United States has the highest incarceration rate in the world. The millions of people in prison across the country experience numerous health disparities and injustices despite having a constitutional right to health care. In chapter 1, the issues surrounding health inequity in prison are highlighted through two case studies on patient autonomy. From a bioethical standpoint, patient autonomy is integral to a person’s health, yet it is frequently violated in prison in multiple ways, including a lack of informed consent and the censorship of health literature. Greater awareness and advocacy efforts are needed to safeguard patient health within the carceral system.Chapter 2 highlights the importance of incorporating prison health into medical education, where currently few opportunities exist. In recent years, medical school curricula have placed increasing emphasis on the social determinants of health, which include prison health. Service-learning offers a potential means for incorporating prison health education into medical school curricula, as it represents an experiential learning modality that facilitates the formation of relationships between medical students and the surrounding community. The Lewis Katz School of Medicine’s prison health service-learning program was established in collaboration with Prison Health News and serves as one example for how students can learn about the social determinants of health and play a direct role in advocating for marginalized patient populations. / Urban Bioethics

The field of bioethics relies on the voices of nonexperts when finding solutions for bioethical issues. However, there are many factors that influence an individual’s capacity to participate in bioethics. These include one’s understanding of bioethics or the relevant jargon, one’s awareness of an issue, one’s ability to relate to an issue, and one’s desire to participate with an issue. Therefore, it is imperative that bioethicists communicate directly with nonexperts to minimize these barriers. After all, if discussions surrounding bioethical issues only include people with high ethical literacy, our solutions will be tainted by sampling bias.There are currently few strategies aimed at communicating bioethics directly to nonexperts. I propose that musical narratives might serve as a useful communication tool. Narratives are relatable, inspiring, and easier to understand than logical-scientific language. By adding music, it is possible that these narratives will evoke deeper emotions, and improve retention of the topic being discussed. Musical narratives could be a powerful tool for presenting bioethical issues in plain language, in a way that increases awareness, inspires reflection, and encourages productive discussions. / Urban Bioethics / Accompanied by two .mp3 audio files: 1) Compassionate Care Release.mp3 2) Harm Reduction.mp3

The gun violence epidemic is a deeply complex crisis in America’s cities and urban settings. Despite concerted efforts by government agencies, law enforcement, community organizations, and advocacy groups, gun violence remains a persistent and pervasive problem in the city of Philadelphia. The aims of this writing include a comprehensive analysis of the factors contributing to gun violence in Philadelphia and identification of multi-disciplinary strategies for prevention and intervention. By evaluating existing efforts in Philadelphia, including community-based programs, law enforcement initiatives, and policy reforms, as well as the generation of a theoretical multidisciplinary framework and proposal for gun violence mitigation, this study aims to contribute to the ongoing discourse on gun violence prevention and to inform evidence-based policy and practice in Philadelphia and beyond. / Urban Bioethics

The opioid epidemic in Philadelphia has evolved into a complex polysubstance crisis with the emergence of xylazine alongside fentanyl, reshaping substance use dynamics. Xylazine's rising prevalence introduces unique health risks due to its sedative properties, compounded when combined with fentanyl, leading to heightened potency and toxicity. This combination contributes to severe medical complications, notably injection-related infections driving hospitalizations. Ethical care for individuals with substance use disorder necessitates prioritizing patient autonomy in healthcare decision-making. Critical discussions on care goals with hospitalized drug users are imperative, encompassing pain management, withdrawal mitigation, and medication for opioid use disorder, aligning with patient preferences. Open and transparent communication fosters trust, enabling healthcare providers to effectively support substance use disorder patients and enhance their overall quality of life. / Urban Bioethics

It is well known that people who use drugs (PWUD) leave the hospital via patient directed discharge (“PDD”; also known as against medical advice “AMA”) more often than people who do not use drugs. The introduction of xylazine – a veterinary tranquilizer – into the United States (US) synthetic opioid supply has only exacerbated this situation. The following paper reviews the literature on xylazine, hospitalization with opioid use disorder (OUD), and how xylazine has changed the experience of hospitalization with OUD. The research revealed that xylazine causes respiratory depression, sedation, and the formation of necrotic wounds. There is currently no treatment for xylazine dependence, overdose, or withdrawal. The literature further revealed that inadequate management of withdrawal and pain, along with stigma from health professionals, are major reasons why PWUD leave the hospital PDD before completing treatment. The difficulty the health system faces with the management of xylazine withdrawal and the necrotic wounds it produces only exacerbates this problem and necessitates increased attention to this topic. Using opioid agonists to treat withdrawal decreases rates of PDD for PWUD in the hospital. This paper will argue that the treatment of PWUD in the hospital with opioid agonists in order to address withdrawal and pain is ethically necessary; and that the introduction of xylazine into the synthetic opioid supply in the US only further necessitates the collective adoption of this viewpoint. / 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