Negative Social Determinants Of Health Research Articles

Secondary School Athletic Trainers' Perceptions of the Influence of Social Determinants of Health and Socioeconomic Status on Clinical Management Decisions.

Evidence suggests that lower socioeconomic status (SES) and negative social determinants of health (SDOH) contribute to health care disparities. Due to their accessibility in the high school setting, secondary school athletic trainers (SSATs) may encounter patients who are historically underserved in health care, such as patients with low SES. However, a significant gap in knowledge exists regarding how SDOH and SES may influence SSATs' clinical management decisions. To describe SSATs' perceptions of how patient SDOH and SES influence clinical management decisions and to identify barriers to athletic health care. Cross-sectional study. Online survey. National Athletic Trainers' Association SSATs (6.7% response rate). Secondary school athletic trainers were asked about their perceptions of patient SDOH and SES (content validity index = 0.83 for relevancy). The levels of relevance and agreement were answered on a 4-point Likert scale. Data were summarized using means and SDs, frequencies and proportions (%), and median scores. A total of 380 SSATs participated (mean years of experience = 14.9 ± 11.7 years). When providing care, most (71.3%) SSATs believed their patients' health or health care access to be the most relevant of the 5 SDOH, whereas the other 4 SDOH were less than 60% relevant. Most SSATs agreed or strongly agreed that patient SES affected both referral (67.4%) and the reliance on conservative treatment before referral (71.2%). Secondary school athletic trainers identified patient or guardian compliance (70.2%) and type of health insurance (61.5%) as barriers to providing care to patients with low SES. Secondary school athletic trainers perceived health or health care access as the most relevant social determinant when providing care to patients with low SES. When SSATs further considered the SES of patients, they identified all SDOH as barriers that they were ill equipped to navigate as they delivered care and engaged in patient referral.

Social determinants of health and treatment center affiliation: analysis from the sickle cell disease implementation consortium registry

BackgroundAdults with sickle cell disease (SCD) suffer early mortality and high morbidity. Many are not affiliated with SCD centers, defined as no ambulatory visit with a SCD specialist in 2 years. Negative social determinants of health (SDOH) can impair access to care. Hypothesis: Negative SDOH are more likely to be experienced by unaffiliated adults than adults who regularly receive expert SCD care.MethodsCross-sectional analysis of the SCD Implementation Consortium (SCDIC) Registry, a convenience sample at 8 academic SCD centers in 2017–2019. A Distressed Communities Index (DCI) score was assigned to each registry member’s zip code. Insurance status and other barriers to care were self-reported. Most patients were enrolled in the clinic or hospital setting.ResultsThe SCDIC Registry enrolled 288 Unaffiliated and 2110 Affiliated SCD patients, ages 15-45y. The highest DCI quintile accounted for 39% of both Unaffiliated and Affiliated patients. Lack of health insurance was reported by 19% of Unaffiliated versus 7% of Affiliated patients. The most frequently selected barriers to care for both groups were “previous bad experience with the healthcare system” (40%) and “Worry about Cost” (17%). SCD co-morbidities had no straightforward trend of association with Unaffiliated status. The 8 sites’ results varied.ConclusionThe DCI economic measure of SDOH was not associated with Unaffiliated status of patients recruited in the health care delivery setting. SCDIC Registrants reside in more distressed communities than other Americans. Other SDOH themes of affordability and negative experiences might contribute to Unaffiliated status. Recruiting Unaffiliated SCD patients to care might benefit from systems adopting value-based patient-centered solutions.

Abstract TMP15: Rurality is Associated With Negative Social Determinants of Health and Worse Acute Stroke Metrics, for Patients With Large Vessel Occlusion

Introduction: One-fifth of the US population reside in rural areas (RAs). Large vessel occlusion (LVO), a quarter of ischemic strokes, portends poor outcomes. Only select hospitals have mechanical thrombectomy (MT) capability, worsening stroke care access in under-resourced areas. Methods: With an integrated Get With the Guidelines and Institute for Health Metrics and Evaluation registry (2016-2019), we compared demographics, acute stroke metrics, and social determinants of health (SDH) for patients with LVO stroke residing in RAs to those residing in nonrural areas (NRAs). Rural-urban commuting area codes determined rurality. We used Pearson’s chi-squared test for categorical variables, and Student’s t-test for continuous variables. Results: Of 145,554 patients with LVO, 3% resided in RAs. Of 46,629 patients post-MT, 3% resided in RAs. Patients with LVO residing in RAs were less likely of female gender, Hispanic ethnicity, and more likely of White or Native-Hawaiian/Pacific-Islander race, than patients residing in NRAs (Table 1). They were more likely insured by Medicare, less by Medicaid, and less likely baseline ambulatory, have a Bachelor’s degree, or own a home, with lower median income. Patients with LVO residing in RAs more likely transferred into hospitals from other facilities than arrived from scene, less likely received thrombolysis, and had higher onset-to-arrival time. Door-to-needle time (DTNT) was lower for patients with LVO residing in RAs, but comparable specifically for patients undergoing MT (median (IQR) 38 (25) vs 35 (23), p=0.09), compared to patients residing in NRAs. Conclusions: Patients residing in RAs comprised a small portion of patients with LVO in the integrated registry, and differed demographically to patients residing in NRAs. Rurality was associated with negative SDH and worse acute stroke metrics, except DTNT for patients post-MT. Understanding rural stroke disparities may identify approaches to equity for patients with LVO.

Risks Associated with Quality Care among Hispanic and White Populations-A Cross-Sectional Comparison Study.

Quality care in healthcare is a multifaceted concept that encompasses the execution of effective medical treatments and the patient's overall experience. It involves a multitude of factors, including effectiveness, safety, timeliness, equity, and patient centeredness, which are important in shaping the healthcare landscape. This cross-sectional study used the data from the Health Information National Trends Survey 6 (HINTS 6), which collects data on various aspects of health communication and information-seeking behaviors, to investigate the factors associated with quality care among White and Hispanic populations. All adults who participated in HINTS 6 and visited healthcare service at least once in the past 12 months were included in this study. Multivariable logistic regression was used to determine the association between quality care and delay or discriminated care with the adjustment of all other sociodemographic variables. We analyzed a total of 3611 participants. Poor social determinants of health (SDOHs) (OR 0.61, CI 0.43-0.88, p = 0.008), delayed needed medical care (OR 0.34, CI 0.26-0.43, p < 0.001), and discriminated care (OR 0.29, CI 0.15-0.54, p < 0.001) were all negatively associated with optimal quality care. Negative SDOHs could also be positively associated with delayed care and discriminated care.

The Role of Patient-Reported Social Factors in Promoting Buprenorphine Consistency.

While medications for opioid use disorder (MOUD) reduce overdose risk, inconsistent use can lead to substance use recurrence and compromise achieving optimal opioid use disorder (OUD) treatment outcomes. Research is limited on patient-reported perspectives on consistency of MOUD self-administration at home and its related social factors. The primary aim was to report on rates of patient-reported buprenorphine consistency among a sample receiving outpatient OUD treatment. The secondary aim was to explore differences in social determinants of health (SDOH) between patients reporting and not reporting lapses in buprenorphine dosing. This is a secondary analysis from a cross-sectional survey and medical record abstraction study (N=96). The primary outcome was patient-reported buprenorphine consistency, as defined as no lapses in buprenorphine dosing in a preceding 28-day period. SDOH survey items were adapted from the Healthy People 2030 framework. Participants (n= 96) were three quarters female (74.0%); most identified as white (54.2%) or Black (38.9%). Most reported not missing any buprenorphine doses over the preceding 28-days (88.5%). Demographic and clinical variables were similar between buprenorphine consistency groups. Participants reporting no missed doses reported few negative social determinants of health (examples: 90% not needing help reading hospital materials and not being afraid that they would be hurt in their apartment building or house). These findings reinforce the known role of SDOH as strong predictors of treatment outcomes for chronic diseases (like substance use disorders), beyond contributions by demographic or clinical variables alone. Future MOUD research should incorporate patient perspectives with the goal of informing patient-centered interventions. Promoting consistency in buprenorphine dosing using strategies grounded in patient experience could be an avenue to promote positive OUD treatment outcomes.

Postpartum medication for opioid use disorder outcomes associated with prenatal treatment and neighborhood-level social determinants

Opioid use disorder is a leading cause of death through the year postpartum. This study aimed to identify the association of neighborhood-level social determinants of health and prenatal opioid use disorder treatment receipt with the outcomes of medication treatment for opioid use disorder through the year postpartum among a cohort of birthing people. This was a population-based retrospective cohort study that used state Medicaid claims and enrollment data for the 1690 individuals who delivered a live infant between July 1, 2016 and December 31, 2020 and received medication for opioid use disorder at delivery. The primary exposure was the state Health Opportunity Index, a composite measure of social determinants of health linked at the census-tract level. Secondary exposures included comprehensiveness of opioid use disorder treatment and duration of medication treatment for opioid use disorder received prenatally. Outcomes included the duration and continuity of postpartum medication treatment for opioid use disorder, operationalized as the time from delivery to the discontinuation of medication treatment for opioid use disorder, and percentage of days covered by medication treatment for opioid use disorder within the 12 months after delivery, respectively. Within the study sample, 711 deliveries were to birthing people in the lowest state Health Opportunity Index tercile (indicating high burden of negative social determinants of health), 647 in the middle state Health Opportunity Index tercile, and 332 in the highest state Health Opportunity Index tercile. Using stepwise multivariable regression (Cox proportional hazards and negative binomial models) guided by a socioecological framework, prenatal receipt of more comprehensive opioid use disorder treatment and/or longer duration of prenatal medication treatment for opioid use disorder was associated with improved 1-year postpartum opioid use disorder treatment outcomes (duration and continuity of medication treatment for opioid use disorder). When the state Health Opportunity Index was added to the models, these significant associations remained stable, with the state Health Opportunity Index not demonstrating an association with the outcomes (duration hazard ratio, 1.39; 95% confidence interval, 0.551-3.512; continuity relative risk, 1.024; 95% confidence interval, 0.323-3.247). Targeted efforts at expanding access to and quality of evidence-based opioid use disorder treatments for reproductive-age people across the life course should be prioritized within the spectrum of work aimed at eradicating disparities in pregnancy-related mortality.

Advancing positive social determinants of health through collective impact and the 100% New Mexico Model

BackgroundCommunities across the U.S. and globally confront the challenge of transforming negative social determinants of health (SDOH) into positive ones. To address this complex social problem, the collective impact (CI) approach has promise but has been critiqued for insufficiently challenging structural inequities. Research applying CI to SDOH is limited. This mixed-methods study examined early adoption of CI in the 100% New Mexico initiative that aims to address SDOH population-wide in a state with strong cultural identity and assets but also persistent socio-economic inequality.MethodsA web-based survey, interviews and focus groups were conducted with initiative participants in June and July 2021. Survey participants rated agreement on a 4-point scale with six items assessing CI foundation adapted from the Collective Impact Community Assessment Scale. Interviews and focus groups centered on motivation to engage, progress achieved in model components, CI core conditions, and contextual factors influencing experiences. Surveys were analyzed using descriptive means and proportions. Qualitative data were analyzed using thematic analysis and an inductive approach followed by stratified analyses and co-interpretation of emergent findings with model developers.ResultsFifty-eight participants completed the survey, and 21 individuals participated in interviews (n = 12) and two focus groups (n = 9). Survey mean scores were highest related to initiative buy-in and commitment, and lower related to shared ownership, having multiple perspectives and voices involved, and adequate resources. Qualitative results showed that the framework’s cross-sector emphasis helped motivate participation. Participants embraced the focus on leveraging existing community assets that is characteristic of CI and the current framework. Counties implemented effective engagement and visibility strategies including mural projects and book clubs. Participants expressed communication challenges across county sector teams which influenced feelings of accountability and ownership. Participants did not report challenges lacking relevant, available, and timely data or tension between funder-driven and community-driven desired outcomes, in contrast with previous CI research.ConclusionMultiple foundational conditions of CI were supported in 100% New Mexico, including evidence for support of the common agenda addressing SDOH, shared measurement framework, and mutually reinforcing activities. Study results suggest that efforts to launch CI to address SDOH, which is by nature multi-sector, should include robust strategies to address communication needs of local teams. The use of community-administered surveys to identify gaps in SDOH resource access contributed to ownership and a sense of collective efficacy that may portend sustainability; however, relying on volunteers in the absence of other resources extensively also threatens sustainability.

“To teach or not to teach- that is the question” The educational and clinical impact of introducing an outcome based, modular curriculum in Social Emergency Medicine (SEM) at a private tertiary care center in Karachi, Pakistan

IntroductionAn enhanced knowledge of Emergency Medicine (EM) personnel regarding negative Social Determinants of Health (SDH) can impact EM service provision in a resource limited country like Pakistan. Interventions to build capacity in identifying and addressing these SDH through education in Social Emergency Medicine (SEM) can be one of the ways in which EM key performance indicators (KPIs) can be improved.MethodA SEM based curriculum was administered to the EM residents at a tertiary care center in Karachi, Pakistan. Pre, post and delayed post-test was conducted for knowledge of EM residents and analyzed using Repeated Measures ANOVA (RMANOVA). Clinical impact of this intervention was assessed through the ability of the residents to identify the patients’ SDH and determining appropriate disposition. Comparison of the bounce-back of patients in the pre-intervention (2020) and post-intervention year (2021) year was appreciated to see the clinical impact of this intervention.ResultA significant improvement was seen in post intervention (p < 0.001) and follow up knowledge (p < 0.001) of residents regarding negative SDH. Bounce-back rate was higher in the pre-SEM curriculum (43%) as compared to the post-SEM curriculum year (27.7%). Post-intervention, the residents were able to identify the unique Pakistani SDH, however appropriate patient disposition needs further reinforcement.ConclusionThe study highlights the beneficial impact of an educational intervention in SEM upon the knowledge of EM residents and the bounce-back of patients in the emergency department (ED) of a low resource setup. This educational intervention can be scaled up to other EDs across Pakistan for potential improvement in knowledge, EM process flow and KPIs.

A Physician's Sense of Responsibility to Address Disparities: Does It Relate to Reported Behaviors About Screening for and Addressing Social Needs?

It is widely accepted that negative social determinants of health (e.g., poverty) are underlying drivers of poor health and health disparities. There is overwhelming support among physicians to screen for patient-level social needs, but only a minority of clinicians actually do so. The authors explored potential associations between physician beliefs about health disparities and behaviors to screen and address social needs among patients. The authors used 2016 data from the American Medical Association Physician Masterfile database to identify a purposeful sample of U.S. physicians (n = 1,002); data obtained in 2017 were analyzed. Chi-squared tests of proportions and binomial regression analyses were employed to investigate associations between the belief that it is a physician's responsibility to address health disparities and perceptions of physician behaviors to screen for and address social needs, accounting for physician, clinical practice, and patient characteristics. Of 188 respondents, respondents who felt that physicians have a responsibility to address health disparities were more likely than their peers (who did not feel that physicians have such a responsibility) to report that a physician on their health care team would screen for social needs that were psychosocial (e.g., safety, social support) (45.5% vs 29.6%, P = .03) and material (e.g., food, housing) (33.0% vs 13.6%, P < .0001). They were also more likely to report that a physician on their health care team would address both psychosocial needs (48.1% vs 30.9%, P = .02) and material needs (21.4% vs 9.9%, P = .04). With the exception of screening for psychosocial needs, these associations persisted in adjusted models. Engaging physicians to screen for and address social needs should couple efforts to expand infrastructure with educational efforts about professionalism and health disparities, especially underlying drivers such as structural racism and the social determinants of health.

Case Studies: Person-Centered Health Coaching in People With Negative Social Determinants of Health

Social determinants of health are the conditions in the environment that influence health outcomes, such as housing, transportation, and neighborhoods. In this report, we examine 3 cases of participants with social risk factors who participated in a health coaching intervention study. The study was a science-based, nurse health coaching model provided to older adult participants in a Midwestern state designed to equip and empower them to achieve and maintain their health and optimum function to support independent living at home. The program was an 8-week virtual coaching method using weekly, 30-minute, 2-way video coaching sessions with participants. For each of the 3 cases, we describe the patterns of engagement, early and later health goals as coaching progressed, and the types of outcomes achieved. From these case studies, we illustrate how social determinants may affect the types of goals, processes, and potential outcomes achieved by participants of health coaching programs. From these insights, we propose directions in health policy and services and future research considerations.

Students’ and Caregivers’ Attitudes and Preferences Toward Screening for Negative Social Determinants of Health in a Predominantly Latinx High School

Students’ and Caregivers’ Attitudes and Preferences Toward Screening for Negative Social Determinants of Health in a Predominantly Latinx High School

Abstract P378: Design of the Equity in Prevention and Progression of Hypertension by Addressing Barriers to Nutrition and Physical Activity (EPIPHANY) Study: A Cluster Randomized Trial

Introduction: High rates of hypertension and poverty in the rural South contribute to health disparities with Black adults experiencing higher rates of cardiovascular disease than White adults. Clinical trials have shown that lifestyle interventions like the Dietary Approaches to Stop Hypertension diet and increasing physical activity reduce the risk for hypertension. However, suboptimal implementation indicates a need to identify mechanisms of prevention in rural populations impacted by negative social determinants of health that can make achieving healthy lifestyle behaviors more challenging. Methods and Results: The EPIPHANY (Equity in Prevention and Progression of Hypertension by Addressing barriers to Nutrition and Physical activitY) Study is a cluster randomized controlled trial testing a multilevel intervention designed to reduce community and individual barriers to a healthy lifestyle to lower blood pressure (BP) among rural, Black adults. EPIPHANY is enrolling and randomizing 20 churches in the Black Belt region of Alabama. Health education fairs offered to all churches are being used to screen and enroll Black adults with elevated BP or stage 1 hypertension (120-139 mm Hg and diastolic BP &lt;90 mm Hg) who are not recommended for antihypertensive medication, according to the 2017 American College of Cardiology/ American Heart Association BP guideline. Participants (n=240) in churches randomized to the control condition are offered access to online resources including cooking demonstrations and exercise classes. Participants (n=240) in churches randomized to the intervention are receiving access to online resources; telephone-based peer support for lifestyle modification, goal setting and problem solving; funding for churches to develop programs to address food access and/or barriers to physical activity; and training of church members to serve as peer health advocates to deliver training for church members on lifestyle modification. We will employ a Type 1 Hybrid Implementation-effectiveness design to assess the effectiveness and implementation of this multi-level intervention, using the RE-AIM framework. BP, social determinants of health, psychosocial factors, physical activity and diet are being assessed. The EPIPHANY trial began recruitment in August 2022 and has enrolled 18 and 25 Black adults in the first two churches randomized to the control and intervention conditions, respectively, and recruited four churches for the next wave of screenings. Conclusion: The EPIPHANY study is designed to prevent hypertension among rural, Black adults by addressing structural and individual barriers to lifestyle modification through peer support. The study could provide evidence for a feasible, scalable and sustainable approach to preventing hypertension in rural, underserved communities.

Abstract P380: Linkage, Empowerment, and Access to Prevent Hypertension: A Novel Program to Prevent Hypertension and Reduce Cardiovascular Health Disparities in Detroit Michigan

Background: Serious health disparities persist across the United States (US) whereby Black communities suffer a disproportionate burden of cardiovascular diseases. A higher prevalence of hypertension along with lower control rates are major contributing factors; while mounting evidence supports that negative social determinants of health (SDoH) play a causal role. Here, we describe a first-of-a-kind approach to reduce health disparities by focusing on preventing hypertension in Black adults with elevated blood pressure (BP) living in socially vulnerable communities. Methods and Results: LEAP-HTN (Linkage, Empowerment, and Access to Prevent Hypertension) is part of the RESTORE (Addressing Social Determinants to Prevent Hypertension) Health Equity Research Network, a $20 Million initiative funded by the American Heart Association. The trial will test if a novel intervention reduces systolic blood pressure (BP) (primary outcome) and prevents the onset of hypertension over one year versus usual care in 500 Black adults with elevated BP (systolic BP 120-129 mm Hg; diastolic BP &lt;80 mm Hg) in Detroit, Michigan. LEAP-HTN improves access to health care by leveraging our groundbreaking platform using geospatial health and social vulnerability data to direct deployment of mobile health units (MHUs) to communities of greatest need. Preliminary data suggest that 10% of patients screened for HTN in the MHUs would meet BP inclusion criteria. All patients are referred to primary care providers. Trial participants in the active limb will receive additional collaborative care delivered remotely by community health workers using an innovative strategy termed PAL 2 (Pragmatic, Personalized, Adaptable Approaches to Lifestyle and Life Circumstance)(Figure). PAL 2 emphasizes the mitigation of negative SDoH, thereby reducing allostatic load while fostering greater success in achieving lifestyle changes. Conclusions: LEAP-HTN aims to lower BP and prevent hypertension by improving access and linkage to healthcare while mitigating negative SDoH. Through an innovative patient-centered intervention, PAL 2 , our program model may represent a sustainable and scalable strategy to help overcome persistent health disparities in socially vulnerable communities across the US.

The Legacy of Slavery and the Socialization of Black Female Health and Human Services Workforce Members in Addressing Social Determinants of Health.

One legacy of slavery and colonialist structures is that minority populations, particularly the Black populations, experience higher rates of poverty, disease, job insecurity, and housing instability today - all indicators of poor health or negative social determinants of health (SDOH). While the historical legacy of slavery may explain why certain populations currently experience social determinants, they may also embody Post Traumatic Slave Syndrome (PTSS) through manifestations of negative health outcomes. Black female health and human services (HHS) workforce members, who have taken SDOH trainings through a medical-legal partnership (MLP), were recruited for an ethnographic study to determine how historical context, specifically PTSS, can help Black female HHS workforce members understand and advocate for their patients as well as challenge the medial and legal institutions. Themes emerged around how Black women in HHS have persisted and resisted, struggled, and strived to protect and raise a resistant community that is perpetually threatened. Black women constantly exist in the past, present, and future, negotiating their identities and reproducing the modeled behavior of the parents, particularly their Black mothers, who taught them how to exist in the world as Black women. As sufferers of negative social determinants, Black women, especially those working in HHS, use their lived experiences and historical trauma to challenge the systems within which they work. They use their intersectional identities and their reimagined definitions of SDOH to rethink how the HHS workforce can move forward in working in the best interests of their patients. Future SDOH trainings may consider integrating historical legacies to challenge medical-legal institutions.

Admitting what is needed: How the health system and society can reduce hospitalizations for children with medical complexity.

Admitting what is needed: How the health system and society can reduce hospitalizations for children with medical complexity.

Lifestyle interventions in the management of substance use disorder.

Substance use disorder (SUD) is a persistent problem within society and an issue of increasing community awareness and concern. SUD is often comorbid with significant mental health challenges, trauma and negative social determinants of health. SUDs contribute to increased burden of chronic disease and can lead to increased mortality and shorter life expectancy, not just through overdose but also through increased rates of mental and physical chronic disease. The aim of this article is to explore the evidence regarding lifestyle interventions as either primary interventions or adjuncts to existing treatments for individuals with SUD. Lifestyle interventions can play a significant part in the management of people with SUD. These interventions play a part in SUD treatment and relapse prevention as well as improving physical and mental health and quality of life. These interventions ideally can be instituted and managed through community services and primary care.

Concordance in Adolescent and Caregiver Report of Social Determinants of Health

Screening youth for negative social determinants of health is a widespread practice across healthcare settings in the U.S., with such systems almost exclusively relying on caregiver reports. Little work has sought to identify the social determinants of health adolescents identify as having the largest influence on their health and well-being or the extent to which adolescents agree with their caregiver. This study sought to (1) identify the most prevalent and influential negative social determinants of health, according to adolescent reports, and (2) assess concordance between adolescent and caregiver reports of social determinants of health. In Fall 2021, the study team conducted a cross-sectional, observational study within a predominately Latinx urban high school. The team invited all students and their caregivers to participate, resulting in 520 adolescent and 66 caregiver respondents (73% and 9% response rates, respectively). Data analyses occurred in 2022. The most frequent adolescent-reported negative social determinants of health was stress (67%), followed by financial hardship (27%). The negative social determinant of health with the highest ranking of preventing adolescents from living their best and healthiest lives was depression, followed by isolation and stress. Concordance between caregiver and adolescent report of negative social determinants of health was very low across all negative social determinants of health (Krippendorf's α= -0.08 to 0.21). Caregivers under-reported adolescents' social and mental health needs, whereas adolescents under-reported material needs. A hybrid informant approach may be a best practice for social determinants of health screening among adolescents, whereby caregivers and adolescents report material needs, and adolescents report social and mental health needs. Future work should evaluate the concordance between adolescent and caregiver social determinants of health reports in other settings.

P12 Development of the Medication Access Screening Tool (RXMAST) in Patients with Chronic Diseases: A Qualitative Study

Disparity populations disproportionately experience negative social determinants of health (SDoH) that limit their access to needed medications and medical care. This study aimed to develop a comprehensive understanding of patient experiences with medication access that are grounded in SDoH that drive suboptimal medication use.

Not just biology: Comparing social determinants of health in patients diagnosed with late-stage lung, breast, and colon cancer.

e18582 Background: Lung, colorectal, and breast cancer account for the majority of cancer deaths in the U.S. Patients with late stage lung cancer have the shortest survival of the three, and lung cancer patients are more likely to be diagnosed at later stages. We undertook this study to compare social determinants of health in patients diagnosed with late stages of lung, breast, and colon cancer to assess the impact they have on health and mortality. Methods: Data from the National Cancer Database was used for this study. We compared factors including insurance, income, and residency among late stage cancer patients (Stage III and IV). We also compared baseline health status measured by comorbidity index. Descriptive statistics were used to compare patient characteristics. Statistical significance was determined on the basis of a two-sided p value &lt; 0.05. All statistical analysis was performed using SAS, version 9.4. Results: Between 2004 - 2016, 3,005,513 patients were diagnosed with lung (1,004,999), breast (1,309,796), and colon (690,718) cancer. The racial make-up of the groups was similar. 72.5% of lung cancer patients were diagnosed at late stage compared to 48.8% of colon and 13.8% of breast cancer patients. Patients with late stage lung cancer were more likely to have income &lt; $38,000, reside in rural locations, and less likely to have private insurance. Late stage lung cancer patients were 2 and 4 times more likely to have at least 2 comorbidities than patients with colon and breast cancer respectively. Conclusions: Patients with lung cancer are disproportionately affected by several negative social determinants of health. The association between smoking and lung cancer may help explain this because the highest smoking rates in the U.S. occur in populations with lower income, low education status, less insurance coverage, and significantly more comorbidities (e.g. COPD, Heart Disease). These patients are dealing with the complex interplay of negative social determinants of health and worse baseline health status causing delays in diagnosis and treatment when compared to other cancers. Recognizing this may allow systems to better support this disadvantaged population and improve access to screening, clinical trial inclusion, and personalized treatment options while working longitudinally to reverse the systemic factors affecting disproportionate tobacco use and lack of healthcare access in for this underserved population.

Increasing LGBTQ+ Access to Legal Services via Medical-Legal Partnerships.

This Note details and proposes a solution to the deficit in access to justice and to care faced by the LGBTQ+ community due to historical and ongoing homophobia and transphobia in both the legal and medical fields. The proposed solution is the integration of medical-legal partnerships ("MLPs") into LGBTQ+ resource organizations. These organizations already serve and have the trust of the queer community, which lowers one barrier to access medical and legal services for the LGBTQ+ community: mistrust and negative past experiences. MLPs are the ideal solution to this problem because they would not only allow LGBTQ+ individuals to access medical and legal services, but to receive holistic services that account for their personal circumstances as well as their physical health. Underlying this premise is the concept of social determinants of health, which are environmental and social factors that create systemic roadblocks to wellness. By creating an integrated MLP, professionals can address these social determinants head on and remedy the underlying causes of poor health. This is especially important for LGBTQ+ people whose minoritized identities often lead them to have multiple negative social determinants of health. The integration of MLPs into LGBTQ+ resource organizations would allow queer individuals to get the care they need-not just physically, but socially and environmentally.