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AMA Research Challenge 2022

Impact of socio-demographics, personal experiences, and barriers to care on COVID-19 vaccination hesitancy in Massachusetts

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### Situating Ourselves in Nursing Education: Exploring Emerging Directions
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Welcome to the largest national, multi-specialty research event **featuring research from 750 medical students, residents and fellows, and international medical graduates.**


#### Event Details
The 2022 American Medical Association Research Challenge includes a poster symposium hall and a semifinals hall with the top scored research. Log in at any time throughout the event to:
* **View posters and presentations** on a variety of topics and specialties
* **Score posters in the semifinals** to help decide the top five finalists (AMA member exclusive opportunity)
* **Connect with participants** and provide feedback to help advance their research

At the conclusion of this event, the AMA will announce the top five finalists who will advance to the AMA Research Challenge finals, present their research to an elite panel of judges and compete to win a $10,000 grand prize sponsored by Laurel Road.
 

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**Oct. 20, 6 — 7 p.m. Central**
 **How to plan a career in academic medicine** 
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 **Speakers**
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Ricardo Correa, MD, EdD
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Stuart M. Greenstein, MD
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Stephanie Strohbeen, MD
 
 **Oct. 22, 11 a.m. — Noon Central**
 **How to get published**
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 **Speakers**
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Jessica Li, MD/PhD Candidate
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Charles Lopresto, DO

### Sponsor
AMA would like to thank Laurel Road for sponsoring a $10,000 grand prize for the winner of the AMA Research Challenge. Laurel Road is not involved in the judging or scoring process to select the winner. The winner will be announced on Dec. 7 during the AMA Research Challenge finals. Payment of the grand prize will be directly from Laurel Road. See the AMA Research Challenge Official Rules for terms and conditions.

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**There is no registration fee for this event! **

Register to explore research in a variety of topics. AMA members get exclusive access to score posters in the semifinals.

**Please use the link below to register for free if you have not already done so:**

https://www.ama-assn.org/about/events/ama-research-challenge

Welcome to the largest national, multi-specialty research event featuring research from 750 medical students, residents and fellows, and international medical graduates.


Background: Vaccine hesitancy among minority communities stems from medical misinformation, decreased health literacy, and fear of vaccines. We predict that medical students providing vaccine education through a student-run free clinic (SRFC) would improve immunization rates by increasing access to and understanding of vaccines in underserved populations. 

Methods: Our vaccine program addresses low immunization rates in underserved West Dallas communities by providing individualized education sessions and handouts about vaccines translated to a 5th-grade reading level. First, a validated pre-survey adapted from the World Health Organization is given to gauge a patient’s knowledge and attitudes towards vaccines. Vaccine education derived from the Centers for Disease Control and Prevention (CDC) website is offered, and vaccines are administered if the patient consents. Finally, a post-survey identical to the pre-survey is given. Medical students must complete CDC modules, orientation, and vaccine administration training at a simulation center before volunteering. 

Results: The patients were 67% female and averaged 48 years old. Most patients primarily spoke Spanish. Approximately 43% of the patients educated at the clinic received a vaccination. Most individuals (49.0%) surveyed obtained their vaccine information from the news or media. The second and third most common sources of information were from family or friends (36.7%) and healthcare providers (24.5%). Comparison of pre- and post-surveys revealed a significant difference in patients’ knowledge regarding the mechanism of vaccines (64.3% vs. 90.5%), trust in healthcare workers (90.5% vs. 97.6%), and belief that they received adequate vaccine information from a healthcare provider (73.8% vs. 90.5%) after education sessions. Of note, 32% of eligible patients received a Tdap vaccine through this program, which is not only higher than the national average for all adults (30%) but especially higher than those of national Hispanic populations (23%). 

Conclusion: Our vaccine program demonstrates that medical students can promote vaccine knowledge and increase immunization rates, especially for Tdap. Implementing our vaccine program has allowed patients to address their misconceptions and ultimately overcome barriers like fear, cost, and accessibility. This study thus highlights the importance of a vaccine element in SRFCs and may serve as a model for those hoping to implement similar programs in their own SRFCs.

Implementation and Operation of a Student-Run Vaccine Educational Program

Background: Colorectal cancer (CRC) is the most common cause of cancer-related deaths in Hispanics in the U.S. Hispanics are screened for CRC at a much lower rate. Implementing mailed fecal immunochemical tests (FITs) is a cost-effective intervention to increase CRC screening rates in vulnerable populations. We aim to describe the effect of using introductory calls coupled with mailed in-home FIT kits on CRC screening completion in two federally qualified health centers (FQHCs) in a US-Mexico border county.

Methods: This was a prospective pragmatic two-arm intervention study with participants randomized to receive a FIT kit by mail or a FIT kit mailed with an introductory call. The primary outcome was the percentage of patients who returned the FIT kit.

Results: Participants who returned the FIT were primarily unemployed (51.1%), had less than a high school education(51.8%), had lived in the U.S. for at least 20 years (71.2%), and had poor self-reported health(48.9%). In addition, we observed a statistically significant absolue rate increase (6.1%, P = 0.003) in CRC screening return rates when a mailed FIT kit was preceded by an introductory compared to no initial call.

Conclusion: This study demonstrates that adding an introductory phone call significantly improves the screening completion rate in a mailed-out CRC screening intervention in a US-Mexico border population.



Implementing systems change to improve colorectal cancer screening among clinics providing care for underserved Hispanic populations

Background
Disparities in oncological outcomes persist despite it being a prevalent research locus. Therefore, the aim of this study is to investigate whether the use of varied databases can identify previously underreported pitfalls driving this disparity.
Methods
The most recent Census Data for the entire nation and South Carolina (2020) was acquired from census.gov. The National Cancer Database (NCDB) was queried for all cancer sites by race. Prisma Health System was selected as a representation of localstateNCI usage by race. The latest 5-year trends in new cancer diagnoses per the Surveillance, Epidemiology, and End Results (SEER) program database was obtained by querying South Carolina’s cancer profile by all sites and race via https://statecancerprofiles.cancer.gov/. The same timeframe and parameters were selected for query within the South Carolina Department of Health’s cancer database utilizing the South Carolina Community Assessment Network (SCAN) tool. 
Results
Query of the NCDB revealed that nationally, white Americans make up 76.53% of the patient data and black Americans make up 11.25%. Within the national census database, 76.53% of Americans identify as white, while 13.4% of Americans identify as black. At Prisma Health System, 83.76% of the oncologic patients were white, while 12.95% were black. In the state census, 68.6% of residents identify as white, while 27.0% identify as black.SEER database query for South Carolina shows 451.7 (CI 448.8-454.5) incidence of cancer (per 100,000) in white residents and 441.1 (CI 436.1-446.2) in black residents.SCAN query reveals an incidence of cancer in white residents of 689.1 (CI 684.28-692.12)and an incidence of 500.4 (CI 495.15-505.65) in black residents.
Conclusion
When observing the distribution of racial diversity in the U.S., it is apparent that population data within the NCDB is not a representative sample. Monolithic use of the NCDB and SEER program database for disparity research, especially in more rural states, may contribute to a public health “blind spot.” State-maintained databases may be able to target that missing data. South Carolina’s SCAN is one such effort. Query of this database within the same parameters yields significantly different incidence rates across races. This implies that some groups lack access to NCI’s.


In the “NCI” of time: How Lack of a Representative Cancer Database May Drive Cancer Care Inequity

Long-Term Medication-Assisted Treatment for Opioid Use Disorder is Associated with a Reduction in History of Non-Fatal Overdoses

Objectives. To identify the role Medicaid coverage might play in mitigating financial stresses during the COVID-19 pandemic.

Methods. We used data from the U.S. Census Bureau’s PULSE survey collected from April 2020 - March 2021 in 12 Southern states (expansion: AR, KY, LA, VA, WV; non-expansion: AL, FL, GA, MS, NC, SC, TN). We conducted logistic regression analyses to estimate food sufficiency and receipt of free food in the prior week and confidence in ability to pay next rent/mortgage. Regression analyses were adjusted with respondent sociodemographic information, 7-day COVID-19 case count averages, and a stringency index to account for COVID-19 related interventions. We computed the marginal probability of each outcome based on whether the respondent lived in an expansion state. 

Results. Respondents living a non-expansion state were less likely to report food sufficiency (92.0%) and less likely to report receiving free food in the prior 7 days (6.2%) compared to their counterparts in a Medicaid expansion state (92.3% and 6.6%, respectively). Similarly, respondents in non-expansion states reported less confidence in paying their next month’s rent or mortgage on time (82.4% vs. 84.3%). 

Conclusions. Our analysis suggests that Medicaid expansion may confer additional financial security during the COVID-19 pandemic. On a population level, these differences translate to 25,553 fewer food-insufficient households and 161,835 fewer households worried about their next rent or mortgage payment. Although Medicaid expansion may serve as a proxy for a more generous social safety net, previous research on Medicaid expansion has demonstrated that it provides considerable financial security.

Medicaid Expansion & Financial Security During the COVID-19 Pandemic

Study Overview
Black patients are underrepresented in most clinical gastroenterological studies, particularlythose related to inflammatory bowel disease (IBD). In most recent therapeutic trials, Black patients accounted for less than 5% of participants. One potential barrier among Black patients may be a lack of trust, due, at least in part, to historical abuses such as the Tuskegee syphilis study. The underrepresentation of Black patients in clinical trials impedes the generalizability of study findings. Moreover, because Black patients often suffer severe peri-anal, fistulizing
disease, their absence from clinical trials poses problems for medical research about IBD. Limited research has been performed to determine the presence of barriers among Black IBD patients in clinical trials. We conducted a survey, in which Black IBD patients comprise 83% of the sample, to assess trust in physicians, clinical trials, and other related factors.

Methods
We developed a survey to evaluate aspects of patients’ trust, experience with healthcare, clinical trials, and perception of disease. Links to the survey were distributed via email and text to all participants of the Color of Crohn’s and Chronic Illness Patient Symposium, a conference held in Washington, D.C., in September 2021. Emails and texts were sent to attendees before, during, and after the event, and our study was highlighted in event announcements.

Results
Of the 75 patient attendees registered for the conference, a total of 48 IBD patients responded to the survey. The sample’s mean age of participants was 42, with ages ranging from 20 to 76. Participants were well educated (60% with a college degree or more) and their median yearly household income was $65,000. 83% of the sample identified as Black, and 79% identified as women. Nearly half of the sample (43%) reported experiencing racism when receiving medical services. 80% of the Black IBD patients knew about the Tuskegee study, but only 20% of them indicated that the Tuskegee study would impact their decision to participate in a clinical trial.
Participants expressed a general level of trust in primary care doctors (77%) but a little less trust with (66%) their GI doctors.

Conclusion
Overall, most of the Black IBD patients in the sample expressed trust in their medical
community. However, more specifically, less-educated Black IBD patients had higher levels of trust but were also less likely to be invited to participate in clinical trials.

Medical Mistrust among Black IBD Patients: How Big is the Problem?

Mental Health Outcomes among Racial and Ethnic Groups in United States

Abstract Title: Racial Discrepancies in Pulse Oximetry Reading and Their Effects on Self-Monitoring Devices Usage and Clinical Decision-Making

Background
As technology use rises and the use of pulse oximetry data increases, the demand for accurate oxygen saturation (SpO2) readings is paramount to ensure health equity among all populations. Self-monitoring devices, such as SMART devices, allow for portable and cost-effective utilization; therefore, self-monitoring device usage and pulse oximetry data are quickly becoming more available to patients and their providers. Pulse oximetry is a critical component used when evaluating the severity of arterial deoxygenation and is used by providers to determine treatment options. Recent studies have found discrepancies in pulse oximeter reading among Black patients, posing a problem for both patients and their providers. It is hypothesized that self-monitoring devices can affect mortality rates among Black patients if these disparities are not addressed.

Methods
The design of this study is a systematic review and data extraction of relevant articles that discuss the use of self-monitoring devices to determine oxygen saturation and relevant racial disparities associated with health outcomes.A search 

Results
Researchers identified 123 citations with relative pulse oximetry data in relation to race. The data extraction showed that self-monitoring or portable pulse oximetry devices are less accurate than devices used in the hospital. Furthermore, these devices' accuracy decreases as oxygen saturation decreases.2 Researchers suggest a number of ways to improve accuracy; however, these suggestions do not address the racial disparities.6 Data also shows that Black patients with hidden hypoxemia experienced increased mortality and organ dysfunction lab values.1

Conclusion
The aim is to investigate how racial discrepancies in pulse oximetry reading among self-monitoring devices can affect mortality rates among Black patients in the United States. 
The standard of care involves obtaining pulse oximetry values as part of vital signs and must be accurate to ensure the best patient outcomes in healthcare. The results do not definitively support that self-monitoring devices lead to increased mortality rates among Black patients; however, we did find that pulse oximetry technology, as a collective, does not provide values that accurately represent hypoxic levels in Black patients. These inaccurate readings could contribute to higher mortality rates amongst Black patients warranting further research studies.


Racial Discrepancies in Pulse Oximetry Reading and Their Effects on Self-monitoring Devices Usage and Clinical Decision-Making

Background
Race is a social construct which impacts health outcomes. Race is under-reported in clinical trials making it difficult to identify and address health inequities. In this study, we analyze studies pertaining to cerebrovascular accidents (CVA) with the primary purpose to assess the inclusion of racial data in CVA clinical trials. Our secondary outcome is to assess the racial and gender diversity in CVA clinical trials.

Methods
This meta-analysis consisted of CVA clinical trial data from ClinicalTrials.gov. Two researchers extracted data independently. Microsoft Excel was used for data collection and analysis. The search term “stroke” was used to search clinical trials from 1995-2021. The primary outcome is the prevalence of trials with racial data reported. The secondary outcome is the racial and gender diversity among trial participants.

Results
7004 trials were identified. After excluding non-interventional trials, 468 trials remained of which, 233 studies (49.8%) reported race. The 233 trials with race data totaled 291,876 participants of which 72% were White, 5.05% Black and 19.5% “combined other.” 37.9% were female and 62.0% were male. There were 423,694 participants in 167 trials with pharmacologic intervention, of which 136,847 (32.2%) were female and 286,860 (67.7%) were male. 78 (46.7%) of the 167 trials had race reported resulting in 253,281 (59.8%) participants with race reported. 73.0% of participants were White, 3.76% Black and 19.8% “combined other.”

Conclusions
Of the stroke clinical trials reviewed, only 49.8% reported race. Furthermore, only 46.7% of stroke studies with pharmacologic intervention reported race. Moreover, women and non-White subjects were significantly underrepresented in the stroke clinical trials. The under-representation of women and non-White subjects in these clinical trials raises concern regarding access to stroke clinical trials and the need to further study these disparities.

Racial Disparities Among Stroke Clinical Trials Between 1995-2021

Background:
Digital health technologies have become widely adopted, improving healthcare accessibility and monitoring. However, more clinical trials are needed to establish their standards of care. Clinical trials have historically underrepresented women, older adults, and racial/ethnic minorities; the extent of these inequities in digital health trials remain unknown. Here, we examined gender-, race-, and ethnicity-reporting and enrollment among digital health trials.

Methods:
We searched all trials registered on ClinicalTrials.gov from 2010-2020 that utilized digital health technologies, including medical devices, smartphone applications, computer applications, and telehealth services. Representation of demographic groups was determined by censoring trials that did not report demographic information and comparing enrollment among remaining trials to US population census data; Clopper-Pearson binomial confidence intervals were reported. Prevalence of common chronic conditions were estimated for each ethnicity using the National Center for Health Statistics and compared to representation in trial enrollment. This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.

Results:
Of 547 identified US-based trials, 537 (98%) reported gender, 353 (64.5%) reported race, and 252 (46%) reported ethnicity. With respect to the US population, Black individuals (22.9%; 95% CI, 22.5-23.2%) were overrepresented, while Hispanic (16.1%; 95% CI, 15.7-16.5%) and Asian (3.3%; 95% CI, 3.2-3.5%) individuals were underrepresented in digital health trials. Additionally, adults >65 years were overrepresented (18.1%; 95% CI, 9.1-9.8%) while female participants (47%; 95% CI, 46.6-47.3%) and children (9.5%; 95% CI, 9.1-9.8%) were underrepresented. When compared to the share of the prevalence of specific diseases, Hispanic enrollment was low in all measured conditions except for obesity, such as diabetes (20.1% vs 11.4%), hypertension (18.1% vs 7.1%), cancer (15.2% vs 4.7%). 

Conclusion:
Our findings demonstrate the underrepresentation in enrollment of female, Hispanic, and Asian participants in digital health clinical trials. Further efforts to increase the inclusion of these populations in trials evaluating digital health interventions should be considered.


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Impact of socio-demographics, personal experiences, and barriers to care on COVID-19 vaccination hesitancy in Massachusetts

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