Category 8
Healthy Equity, Racism and Social Injustice, Population Health, Immigration and Health

Background: This quality improvement project implemented an evidence-based tool to increase student awareness and education regarding the risk of meningococcal B infection on a college campus and increased the uptake of meningococcal B vaccine at the student health center.

Goal: Increase the uptake of meningococcal B vaccine (MBV) at a student health center using multi-modal evidence-based strategies.

Objectives: Implementation of multi-modal evidence-based strategies to educate patients at a university student health center will increase the uptake of MBV to protect the campus and population health.

Approach/Methods: Increase access to vaccine, Improve education regarding meningococcal risk and disease, Enhance vaccination systems to prevent missed opportunity to vaccinate., Motivate health care providers through the use of immunization champion.

Results: 75% of students targeted for inclusion received MBV education, 900% improvement in MBV uptake over the same time the previous year. (fall 2019 11/7,257; fall 2020 10/524*) COVID significantly decreased the number of patients seen in the student health clinic

Importance to Public Health: Implementation of multi-modal evidence-based practice transformation has the potential to increase MBV uptake rate and prevent missed opportunity to vaccinate in a student health center to protect population and campus health

Background: Structural stigma, in the form of restrictions on the broad political, economic, and macro-social determinants of health, is a critical factor in understanding negative health outcomes among minority populations (Hatzenbuehler & Link, 2014). However, very little work positions LGBT+ Americans comparatively within a broader global context: comparative studies of LGBT+ health outside of the European Union lack a unified well-recognized indicator for health equity.

Goal: The overarching goal of this work was to gain an understanding of the social and legal climates affecting the health of LGBT+ Americans by applying ILGA-EU indices to a United States Rainbow Index (US-RI).

Objectives: The objectives that this project intended to explore were as follows: to assess the overall state of LGBT+ rights in the United States, to evaluate state and national US-RI scores in terms of their European counterparts, and to examine the impacts of federalism and government structure on public health policy.

Approach/Methods: Scoring was conducted based on the 2018 edition of the Rainbow Europe Index, which includes 69 criteria with predetermined weighting in six categories. RI point values represent a combination of federal and state legislation, as well as Supreme and Circuit court decisions, municipal ordinances, administrative rules, state referenda, Department of Justice policy, and historical events. When calculating the final score for the state, each criterion’s point value was multiplied by the proportion of state residents with the ability to access the associated right without impediment, using the populations for municipalities recorded in the 2010 Census.

Results: The national US-RI score of the United States is .5829, roughly equivalent to those of European federations, such as Germany (.5900). 21.77% of the national score was derived from state and local-level protections not offered at the federal level, and LGBT+ exclusion from the 1964 Civil Rights Act contributed to at least 25% of point reductions in the index.

Discriminatory state legislation was often supplanted by circuit court decisions enforced on multiple states, as well as municipal ordinances, both features of American federalism.

State-level scores were highly correlated with the partisanship of state policymakers and the duration of their length in government. Progressive legislation for gender minorities tailed sexual minorities in several criteria, and a near-total absence of protective policy for intersex Americans in all states but California negatively impacted scores considerably. Many criteria considering gender minorities were buried within non-binding administrative policy, or were outdated to the 20th or 19th centuries.

Importance to Public Health: This work indicates that changing political landscapes related to LGBT+ rights contribute to structural stigma. The US-RI represents an important step towards the construction of a unified human rights index for sexual and gender minorities across the Global North, allowing for innovative, comparative research of LGBT+ populations at the national and international levels.

Background: The PHOEBE laboratory is conducting The GENTS Study to analyze the impact of Transit-Induced Gentrification (TIG) on health outcomes (e.g., anxiety and hypertension) and social determinants of health (SDOH) (e.g., crime). The Purple Line, a new Light Rail Transit line launching in 2022, will pass through Prince George’s County (PG), Maryland, a suburb comprised of over 80% African American and Hispanic residents. The GENTS Study will analyze the PG County residents’ perceptions of TIG related to the new Purple Line and its associated health and SDOH impacts. This particular study will focus on how perceived TIG can impact cardiovascular health and disease due to lifestyle changes brought upon by gentrification.

Goal: Using data from the GENTS Study, this study will focus on the impact of perceived TIG on cardiovascular health, specifically hypertension, among PG County residents before the operation of the Purple Line.

Objectives:

1. To access perceived TIG

2. To access prevalence of hypertension

3. To access association of perceived TIG with race/ethnicity

4. To access association of perceived TIG with hypertension

Approach/Methods: Data was collected from respondents using an online survey. Descriptive statistics and the Chi-Square test were conducted on data collected in order to analyze heart health, race, and TIG.

Results: According to preliminary analysis data from 106 respondents, nearly half (42%) of respondents were hypertensive. A third, 33%, of respondents were prescribed hypertension medication, and approximately 14% of respondents reported having congestive heart failure. According to the Chi-Square Test, statistically significant differences were observed in TIG by race as well as by heart health. Nearly half of the respondents, mostly male, were hypertensive and smokers (46%). Overall, perceptions consistent with TIG were greater for White (80%) residents and residents prescribed hypertension medication (>55%).

Importance to Public Health: Certain impoverished neighborhoods are at a greater risk of TIG (e.g., loss of housing, work, and safety). Studying the effects of TIG on health and SDOH posed by neighborhood and lifestyle changes, is vital for public health efforts towards health equity. This natural experiment will allow public health officials to gauge how perceived gentrification related to transit developments impacts heart health and thus overall health and quality of life.