Deconstructing Medicine: The Intersections of Racism and Health Disparities within Pre-Medical Education

The purpose of this project is to evaluate ways in which historical racism and lack of it in pre- medical curriculum shapes future health professionals and results in negative medical treatment of under-represented groups. Research found in the literature review reveals a strong history of racism within medical practice and medical research, as well as unconscious bias that follows knowledge taught during undergraduate education and onwards. An intersectionality approach is used to show the affect of race and class on health disparities and unethical abuse. This research includes data analyzing the pre-medical curriculums of the ten pre-medical universities that produce the most medical school applicants. Through this analysis and a thorough review of literature, there is evidence that there is a lack of interdisciplinary coursework included in pre- medical curriculums and an absence of initiative by these top schools to promote coursework including humanities, or topics regarding class, race, ethnicity, and social factors affecting health. This research done compares similarly to the pre-medical curriculum recommended to students at Cal Poly San Luis Obispo. From this research, possible programs and changes to Cal Poly pre-medical curriculum can be incorporated to include interdisciplinary coursework. Through this suggestion there is hope that it will allow pre-medical students to become aware of social constructs, intersections between race, class, and health, as well as their influence in resolving health disparities and racism within the medical practice

Adherence to clinical follow-up recommendations for liver function tests: A cross-sectional study of patients with HCV and their associated risk behaviors

This study examined whether patients with Hepatitis C virus (HCV) infection adhered to their physicians\u27 recommendation and HCV clinical guidelines for obtaining a regular liver function test (LFT), and whether high-risk behaviors are associated with behavioral adherence. A cross-sectional survey was administered to 101 eligible patients with HCV who were recruited from health centers in New Jersey and Washington, DC. Adherence outcomes were defined as the patients\u27 self-report of two consecutive receipts of LFTs in accordance with their physicians\u27 recommended interval or the clinical guidelines for a LFT within 3-6 months. 67.4% of patients (66/98) reported a receipt of their physicians\u27 recommendation for a LFT. The rate of adherence to physician recommendation was about 70% (46/66), however over 50% (52/101) of patients with HCV did not obtain regular LFTs. 15.8% (16/101) of patients continued to use injection drugs. Patients who used injection drugs had 0.87 (adjusted odds ratio (aOR) = 0.13, 95% confidence interval 0.03-0.59) times lower odds adhering to their physician recommendation, relative to non-users. Patients with HIV co-infection had increased odds of adhering to the clinical guidelines (odds ratio 3.41, 95% confidence interval 1.34-8.70) vs. patients who did not report HIV co-infection. Additionally, patients who had received a physician\u27s recommendation had 7.21 times (95% confidence interval of 2.36-22.2) greater odds adhering to the clinical guidelines than those who had not. Overall, promoting HCV patient-provider communication regarding regular LFTs and reduction of risk behaviors is essential for preventing patients from HCV-related liver disease progression

Content Analysis of Instagram Posts From 2019 With Cartoon-Based Marketing of e-Cigarette-Associated Products.

This research study examines the prevalence of cartoon images promoting e-cigarette–associated products on Instagram and their association with likes from users

Identifying Health-Related Discussions of Cannabis Use on Twitter by Using a Medical Dictionary: Content Analysis of Tweets.

BackgroundThe cannabis product and regulatory landscape is changing in the United States. Against the backdrop of these changes, there have been increasing reports on health-related motives for cannabis use and adverse events from its use. The use of social media data in monitoring cannabis-related health conversations may be useful to state- and federal-level regulatory agencies as they grapple with identifying cannabis safety signals in a comprehensive and scalable fashion.ObjectiveThis study attempted to determine the extent to which a medical dictionary-the Unified Medical Language System Consumer Health Vocabulary-could identify cannabis-related motivations for use and health consequences of cannabis use based on Twitter posts in 2020.MethodsTwitter posts containing cannabis-related terms were obtained from January 1 to August 31, 2020. Each post from the sample (N=353,353) was classified into at least 1 of 17 a priori categories of common health-related topics by using a rule-based classifier. Each category was defined by the terms in the medical dictionary. A subsample of posts (n=1092) was then manually annotated to help validate the rule-based classifier and determine if each post pertained to health-related motivations for cannabis use, perceived adverse health effects from its use, or neither.ResultsThe validation process indicated that the medical dictionary could identify health-related conversations in 31.2% (341/1092) of posts. Specifically, 20.4% (223/1092) of posts were accurately identified as posts related to a health-related motivation for cannabis use, while 10.8% (118/1092) of posts were accurately identified as posts related to a health-related consequence from cannabis use. The health-related conversations about cannabis use included those about issues with the respiratory system, stress to the immune system, and gastrointestinal issues, among others.ConclusionsThe mining of social media data may prove helpful in improving the surveillance of cannabis products and their adverse health effects. However, future research needs to develop and validate a dictionary and codebook that capture cannabis use-specific health conversations on Twitter

Themes in TikTok Videos Featuring Little Cigars and Cigarillos: Content Analysis

BackgroundLittle cigars and cigarillos (LCCs) are popular tobacco products among youth (ie, adolescents and young adults). A variety of LCC-related promotional and user-generated content is present on social media. However, research on LCC-related posts on social media has been largely focused on platforms that are primarily text- or image-based, such as Twitter and Instagram. ObjectiveThis study analyzed LCC-related content on TikTok, an audio and video–based platform popular among youth. MethodsPublicly available posts (N=811) that contained the LCC-related hashtags #swishersweets or #backwoods were collected on TikTok from January 2019 to May 2021. Metadata were also collected, including numbers of likes, comments, shares, and views per video. Using an inductive approach, a codebook consisting of 26 themes was developed to help summarize the underlying themes evident in the TikTok videos and corresponding captions. A pairwise co-occurrence analysis of themes was also conducted to evaluate connections among themes. ResultsAmong the 811 posts, the LCC presence theme (ie, a visible LCC) occurred in the most prominent number of posts (n=661, 81.5%), followed by music (n=559, 68.9%), youth (n=332, 40.9%), humor (n=263, 32.4%), LCC use (n=242, 29.8%), flavors (n=232, 28.6%), branding (n=182, 22.4%), paraphernalia (n=137, 16.9%), blunt rolling (n=94, 11.6%), and price (n=84, 10.4%). Product reviews had the highest engagement, with a median 44 (mean 2857, range 36,499) likes and median 491 (mean 15,711, range 193,590) views; followed by product comparisons, with a median 44 (mean 1920, range 36,500) likes and median 671 (mean 11,277, range 193,798) views. Promotions had the lowest engagement, with a median 4 (mean 8, range 34) likes and median 78 (mean 213, range 1131) views. The most prevalent themes co-occurring with LCC presence were (1) music (434/811, 53.5%), (2) youth (264/811, 32.6%), (3) humor (219/811, 27%), (4) flavors (214/811, 26.4%), and (5) LCC use (207/811, 25.5%). ConclusionsLCC-related marketing and user-generated content was present on TikTok, including videos showing youth discussing, displaying, or using LCCs. Such content may be in violation of TikTok’s community guidelines prohibiting the display, promotion, or posting of tobacco-related content on its platform, including the display of possession or consumption of tobacco by a minor. Further improvement in the enforcement of TikTok community guidelines and additional scrutiny from public health policy makers may be necessary for protecting youth from future exposure to tobacco-related posts. Observational and experimental studies are needed to understand the impact of exposure to LCC-related videos on attitudes and behaviors related to LCC use among youth. Finally, there may be a need for engaging antitobacco videos that appeal to youth on TikTok to counter the protobacco content on this platform

Association Between Exposure to Tobacco Content on Social Media and Tobacco Use: A Systematic Review and Meta-analysis.

ImportanceExposure to tobacco-related content on social media may foster positive attitudes toward tobacco products and brands, and influence the likelihood of initiating or continuing use of tobacco, especially among adolescents and young adults.ObjectiveTo perform the first systematic review and meta-analysis, to our knowledge, on studies that examined the association between exposure to tobacco content on social media and lifetime tobacco use, past 30-day tobacco use, and susceptibility to use tobacco among never users.Data sourcesTobacco, social media, and marketing search terms were entered into online databases, including MEDLINE, ISI Web of Science, Scopus, and PsychINFO. Study characteristics, including research design and methods, sampling strategy, and demographics, were assessed for each study.Study selectionStudies reporting odds ratios (ORs) for self-reported exposure to, or experimentally manipulated, tobacco content on social media and lifetime tobacco use, past 30-day tobacco, and susceptibility to use tobacco among never users. The systematic search produced 897 independent articles, of which 29 studies met inclusion criteria.Data extraction and synthesisA 3-level random-effects meta-analysis was used to estimate ORs, 95% CIs, and heterogeneity (I2) for each tobacco use outcome. Study quality and publication bias were assessed.Main outcomes and measuresLifetime tobacco use, past 30-day tobacco use, and susceptibility to use tobacco among never users. Tobacco use included e-cigarettes, cigarettes, and other (cigar, hookah, smokeless tobacco).ResultsThe total sample size across the 24 included datasets was 139 624, including 100 666 adolescents (72%), 20 710 young adults (15%), and 18 248 adults (13%). Participants who were exposed to tobacco content on social media, compared with those who were not exposed, had greater odds of reporting lifetime tobacco use (OR, 2.18; 95% CI, 1.54-3.08; I2 = 94%), past 30-day tobacco use (OR, 2.19; 95% CI, 1.79-2.67; I2 = 84%), and susceptibility to use tobacco among never users (OR, 2.08; 95% CI, 1.65-2.63; I2 = 73%). Subgroup analyses showed similar associations for tobacco promotions, active engagement, passive engagement, lifetime exposure to tobacco content, exposure to tobacco content on more than 2 platforms, and exposure to tobacco content among adolescents and young adults.Conclusions and relevanceFindings suggest that a comprehensive strategy to reduce the amount of tobacco content on social media should be developed by federal regulators. Such actions may have downstream effects on adolescent and young adult exposure to protobacco content, and ultimately tobacco use behaviors

Leading Topics in Twitter Discourse on JUUL and Puff Bar Products: Content Analysis.

BackgroundIn response to the recent government restrictions, flavored JUUL products, which are rechargeable closed-system electronic cigarettes (e-cigarettes), are no longer available for sale. However, disposable closed-system products such as the flavored Puff Bar e-cigarette continues to be available. If e-cigarette consumers simply switch between products during the current government restrictions limited to 1 type of product over another, then such restrictions would be less effective. A step forward in this line of research is to understand how the public discusses these products by examining discourse referencing both Puff Bar and JUUL in the same conversation. Twitter data provide ample opportunity to capture such early trends that could be used to help public health researchers stay abreast of the rapidly changing e-cigarette marketplace.ObjectiveThe goal of this study was to examine public discourse referencing both Puff Bar and JUUL products in the same conversation on Twitter.MethodsWe collected data from Twitter's streaming application programming interface between July 16, 2019, and August 29, 2020, which included both "Puff Bar" and "JUUL" (n=2632). We then used an inductive approach to become familiar with the data and generate a codebook to identify common themes. Saturation was determined to be reached with 10 themes.ResultsPosts often mentioned flavors, dual use, design features, youth use, health risks, switching 1 product for the other, price, confusion over the differences between products, longevity of the products, and nicotine concentration.ConclusionsOn examining the public's conversations about Puff Bar and JUUL products on Twitter, having described themes in posts, this study aimed to help the tobacco control community stay informed about 2 popular e-cigarette products with different device features, which can be potentially substituted for one another. Future health communication campaigns may consider targeting the health consequences of using multiple e-cigarette products or dual use to reduce exposure to high levels of nicotine among younger populations

Leading Topics in Twitter Discourse on JUUL and Puff Bar Products: Content Analysis.

BackgroundIn response to the recent government restrictions, flavored JUUL products, which are rechargeable closed-system electronic cigarettes (e-cigarettes), are no longer available for sale. However, disposable closed-system products such as the flavored Puff Bar e-cigarette continues to be available. If e-cigarette consumers simply switch between products during the current government restrictions limited to 1 type of product over another, then such restrictions would be less effective. A step forward in this line of research is to understand how the public discusses these products by examining discourse referencing both Puff Bar and JUUL in the same conversation. Twitter data provide ample opportunity to capture such early trends that could be used to help public health researchers stay abreast of the rapidly changing e-cigarette marketplace.ObjectiveThe goal of this study was to examine public discourse referencing both Puff Bar and JUUL products in the same conversation on Twitter.MethodsWe collected data from Twitter's streaming application programming interface between July 16, 2019, and August 29, 2020, which included both "Puff Bar" and "JUUL" (n=2632). We then used an inductive approach to become familiar with the data and generate a codebook to identify common themes. Saturation was determined to be reached with 10 themes.ResultsPosts often mentioned flavors, dual use, design features, youth use, health risks, switching 1 product for the other, price, confusion over the differences between products, longevity of the products, and nicotine concentration.ConclusionsOn examining the public's conversations about Puff Bar and JUUL products on Twitter, having described themes in posts, this study aimed to help the tobacco control community stay informed about 2 popular e-cigarette products with different device features, which can be potentially substituted for one another. Future health communication campaigns may consider targeting the health consequences of using multiple e-cigarette products or dual use to reduce exposure to high levels of nicotine among younger populations

E-cigarette imagery in Netflix scripted television and movies popular among young adults: A content analysis.

IntroductionResearch is needed to understand the frequency of e-cigarette impressions in scripted television and movies, especially in scripted content with characters and storylines that may appeal to young adults. This study aimed to determine the extent of e-cigarette-related imagery and dialogue in Netflix content popular with young adults. We also determine the demographics and character qualities of actors shown holding e-cigarettes.MethodsNielsen ratings data were used to compile a list of the most popular Netflix original films and TV shows among U.S. viewers 18-24 years old between June 1, 2020, and May 31, 2021. We used a sample of 12 films and 113 TV episodes from 12 series. Three coders were trained to analyze a total of 101 h of content for the presence of e-cigarettes, level of use, type of characters holding e-cigarettes, brand visibility, and the presence of vaping-related dialogue. Twenty percent of all episodes/films were double coded to ensure reliability.ResultsOut of 125 titles, 16 (13%) had e-cigarette-related content. Thirteen titles (10%) showed at least one character holding an e-cigarette, and three others mentioned vaping without showing e-cigarettes. The total time of e-cigarettes onscreen amounted to 399 s and the average screen time for e-cigarettes was 31 s. Ninety-nine percent of the time an e-cigarette appeared on screen it was being held by a character.ConclusionThis study documented recent e-cigarette imagery found on Netflix and demonstrates the need for health communication campaigns to denormalize e-cigarette use, particularly among susceptible populations, such as young adults