There is a lot of variation in health outcomes when it comes to individual states in America. Some states, such as Hawaii, have the life expectancy equivalent to that of developed countries, whereas states like Mississippi have the life expectancy equivalent to that of third world countries. This raised the questions of which states are doing well in health and why, and if their health has to do with their performance in the primary, secondary, tertiary, and/or quaternary prevention levels. The purpose of this research was to investigate if there is a correlation between performance in any of the prevention levels and the overall health status of a state, and if there is, which prevention level would be most beneficial for states to prioritize. The hypothesis of this research was: states that prioritized primary and secondary levels of prevention would have better health than states that prioritized tertiary and quaternary levels of prevention, since basic health measures contribute more to health outcomes than advanced medicine. To investigate this question, indicators were chosen to derive the ranking of each state in health and each of the four prevention levels. Six states were then chosen to represent the high, average, and low health statuses respectively. The six states were ranked for all indicators, and the data was analyzed and compared to determine a potential relationship between the prevention level rankings and the overarching health ranking. It was found that there is a correlation between performance in the primary and secondary prevention levels and a state’s overall health status, whereas there was no such correlation for the tertiary and quaternary levels. A model for health was proposed for states looking to improve their health status, which was to invest in primary prevention, followed by secondary, tertiary, then quaternary prevention and only moving to the next prevention level once the previous level reached a satisfactory threshold.

SUMMARY: A failed attempt to conduct a systematic review of disparities in racial inclusivity in stroke rehabilitation research: A call to action Group Members: Adeline Beeler & Mikayla McNally Faculty Mentor(s): Dr. Sydney Schaefer & Dr. Keith Lohse Topic Overview: Stroke is responsible for the death of an individual every four minutes in the United States. While all Americans are gravely affected by this statistic, Black Americans are at a significantly increased risk of first stroke incidence when compared to their white counterparts, majorly due to heightened prevalence of stroke risk factors. Not only does race contribute as a factor in stroke incidence, but it also has a considerable impact in the physical impairment of Black Americans following stroke occurrence. While it still remains unclear as to whether or not stroke plays a significant role in stroke rehabilitation efforts, there is a clearly demonstrated need for increased reporting or participation of Black Americans in stroke rehabilitation clinical trials to have the ability to conduct a systematic review of these racial disparities in the near future. In the analysis of 36 stroke rehabilitation-related clinical research studies, 80% of selected trials failed to report any participant racial demographics, with 77.3% of the NIH-funded trials not reporting, as well. Out of the 7 trials that did provide some sort of participant racial information, only 5 successfully provided statistically significant racial data compared to the remainder that simply categorized participants’ race as “white” or “other.” In order to fully investigate the effects of race on stroke rehabilitation, it is imperative that researchers collect and report equally distributed and diverse participant racial data when publishing clinical research. Potential methods of improvement for researchers to include more racially diverse subject populations include more comprehensive and in-depth advertising and recruitment strategies for their studies. Research Methods: In order to produce accurate analyses of the current state of the relationship between race and stroke rehabilitation efforts, 36 stroke rehabilitation clinical research trials from various locations across the United States were identified using the Centralized Open-Access Rehabilitation Database for Stroke (SCOAR). These trials were evaluated in order to extract relevant data, such as number of trial participants, average age of participants, if the research trial was funded by the National Institute of Health (NIH) or not, and any reported participant racial demographic details. Trends across these categories were compared between all trials to determine if any disparities existed in providing data sufficient to support the relationship between varying racial populations and stroke rehabilitation efforts. Future Project Efforts: Future efforts will include the completion of submitting a Point of View/Directions for Research article for publication to offer an opportunity for clinical and basic researchers to examine the discrepancies surrounding racial inclusivity in stroke rehabilitation clinical research. The aim is to improve the ability of clinicians to interpret the literature, translate research studies into practices, and better direct future experiments. Further identification of stroke rehabilitation clinical research trials will be necessary, as well as modifications to current written work content.