Global and Community Health Research

Exploring the Impacts of Mobile Harm Reduction Services in Oakland County, Michigan

Reba Aldaire, B.A.¹, Jade Ayers, M.S.¹, Deidre Hurse, Ph.D. ²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI}

INTRODUCTION
This project is a qualitative program evaluation of the Oakland County Health Division (OCHD) harm reduction mobile unit which provides services like wound care, sterile syringes, and pipes to individuals affected by substance use disorder (SUD). The research question being posed by this exploratory qualitative evaluation is: what are the impacts of the OCHD mobile unit from the perspective of the individuals utilizing and providing its services, and what are the barriers to improvement and expansion?

METHODS
We used qualitative surveys and interviews administered to clients of the mobile unit and primary staffers, respectively. We employed the RE-AIM framework along with thematic analysis in this program evaluation.

RESULTS
Our findings demonstrate a need for harm reduction services and high rates of satisfaction with the mobile unit among clients. Some participants reported experiencing housing insecurity, food insecurity, and active substance use disorder. After receiving services from the mobile unit, they stated they were familiar with the signs of substance overdose, confident in their ability to administer naloxone, and were no longer reusing or sharing needles. The relationships between staff and clients was characterized by depth and mutual respect. Staffers report the need for legislative change. While this quality project is informative for the organization and not generalizable, the findings are likely consistent with other similar programs based on the literature. 

CONCLUSIONS
The main impediment to the mobile unit that we identified is criminalization of the distribution of drug paraphernalia in the majority of Oakland County. This legal landscape makes the mobile unit’s services illegal outside of the limited area in which it currently operates. Our findings affirm the value of the OCHD harm reduction mobile unit to the community, its unique advantages compared to traditional healthcare models, and the need for further efforts to promote legislative change and secure additional funding. 

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Evaluating Formerly Incarcerated Individuals' Perspectives on Re-entry Programs: A Single-Participant Longitudinal Qualitative Design.

Paoula Choobchian, B.S.¹, Tracy Wunderlich-Barillas, Ph.D.²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Research Training, Oakland University William Beaumont School of Medicine, Rochester, MI}

INTRODUCTION
Reentry after incarceration is shaped by complex barriers that extend beyond legal obligations, including disrupted healthcare, limited employment opportunities, housing instability, and stigma. While reentry programs attempt to address these challenges, the perspectives of formerly incarcerated individuals remain underrepresented. This case study explores the lived experience of one individual navigating reentry across two time points, emphasizing both barriers and sources of resilience.

METHODS
A 30-year-old male participant was interviewed twice, first in March 2024 shortly after release and again in May 2025 after more than a year in the community. He experienced recidivism, having been incarcerated twice in his lifetime. Longitudinal semi-structured interviews focused on healthcare access, employment, housing stability, social support, and legal obligations. Transcripts were de-identified and thematically analyzed to capture the challenges and facilitators of reintegration.

RESULTS
Initially, the participant relied on strong family support but faced significant systemic obstacles, including unsafe medication management during incarceration, suspended health benefits, and damage to his home compounded the challenges of finding employment with pending felony charges. He suffered from financial stress and minimal guidance from correctional systems. Over time, he achieved greater stability – retaining his home, gaining employment as a grocery manager, maintaining sobriety, and strengthening his family relationships. Despite this progress, persistent obstacles remained, including access to ADHD treatment and therapy and navigating probation requirements. Reflecting on his experience, he highlighted the importance of second-chance employers, accessible healthcare, and clear probation guidance, underscoring how re-entry programs and awareness of systemic barriers can make a meaningful difference.

CONCLUSIONS
This case illustrates how reentry outcomes depend on both structural systems and community resources. Healthcare continuity, meaningful employment, and strong support networks emerged as central to reintegration. Findings underscore the importance of trauma-informed, individualized reentry programs that address both structural barriers and personal needs to promote long-term reintegration and reduce recidivism.

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Prevalence of Eating Disorder Risk Among Medical Students in a United States Medical School

Jessica R. Cummings, B.S.¹, Madison McClune, B.S.¹, Virginia Uhley, Ph.D., RDN^2,3

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI
³Department of Family Medicine and Community Health, Oakland University William Beaumont School of Medicine, Rochester, MI}

INTRODUCTION
Eating disorders (ED) are among the most severe psychiatric illnesses, often conferring increased mortality compared to other psychiatric diagnoses. The high-stress environment of medical school increases medical students’ vulnerability to experiencing symptoms of various psychiatric conditions, including EDs. Few studies have isolated ED risk in assessing medical student wellness. The purpose of this study is to identify the prevalence of ED risk among medical students at Oakland University William Beaumont (OUWB) School of Medicine.

METHODS
All 500 medical students enrolled at OUWB were invited to participate in an anonymous, voluntary online survey in September of 2023. Surveys included two validated questionnaires to assess ED risk, EAT-26 (Eating Attitudes Test-26) and SCOFF (Sick, Control, One, Fat, Food), along with demographic and supplemental questionnaires to assess social and psychological factors potentially associated with increased risk. Statistical analyses included descriptive and standard univariate statistics, Fisher’s exact test, and equal variance two-sample t-test. 

RESULTS
Surveys yielded a response rate of 13.8% (N=69). The majority of respondents were female-identifying (N=46, 66.7%) and White (N=41, 59.4%). A total of 21 (30%) of respondents were determined to be at high risk for an ED based on either EAT-26 or SCOFF (EAT-26: N=10, 14.5%; SCOFF: N=17, 24.6%). Female-identifying students were more likely to be at risk than male-identifying students, composing 85.7% of the at-risk group. At-risk individuals were more likely to have experienced a recent life-stressor outside of school, have a personal history of a mental health condition, and have a family history of anxiety.

CONCLUSIONS
Medical students represent a vulnerable population for the development of EDs. Eating behaviors should be emphasized in discussions addressing burnout and promoting wellness in medical schools. These findings further underscore the importance of enhancing institutional mental health support and implementing structural changes in medical education to help prepare future physicians to successfully navigate their careers.  

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Wastewater Coronavirus Levels and Critical Care Demand

Alex Dunn, B.S.¹, Danika K Evans, D.O.², Zachary R Bergman, M.D.³, Matthew E Prekker, M.D.²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Hennepin County Medical Center, Minneapolis, MN
³University of Minnesota Medical School, Minneapolis, MN}

INTRODUCTION
COVID-19 necessitated veno-venous extracorporeal membrane oxygenation (VV-ECMO) for severe respiratory failure. While SARS-CoV-2 wastewater surveillance correlates with hospitalizations, its relationship with ECMO usage remains unexplored. Early warning systems for ECMO demand could improve equitable care distribution. The purpose of this project was to investigate the correlation between wastewater SARS-CoV-2 viral load and VV-ECMO use in Minnesota during variant-specific periods.

METHODS
A prospective observational study was conducted across 4 Minnesota ECMO centers (January 2021-May 2022). A daily COVID-19 ARDS VV-ECMO census was recorded. Wastewater data was collected from a metropolitan sewershed district, with SARS-CoV-2 variants identified through RNA sequencing. Three periods are defined by predominant variants: alpha/beta/gamma, delta, and omicron. Pre-whitening addressed autocorrelation before cross-correlation analysis.

RESULTS
109 adults received VV-ECMO (mean age 46, 72% male, 33-day average duration, 54% survival). Alpha/beta/gamma and delta periods showed wastewater peaks preceding VV-ECMO peaks by ~3 weeks. Omicron period showed no correlation. Cross-correlations not significant after addressing autocorrelation.

CONCLUSIONS
Visual inspection suggested potential correlation during virulent variants, but statistical analysis didn’t confirm. Inconsistent patterns observed, with one delta-period ECMO surge lacking preceding wastewater peak, and omicron-period wastewater peaks not increasing ECMO use. Study limited by modest statewide VV-ECMO cases. Wastewater SARS-CoV-2 surveillance didn’t consistently correlate with VV-ECMO use for COVID-19 in Minnesota. 

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Health Literacy and Syphilis Knowledge: Findings From a National Survey of U.S. Women of Reproductive Age

Elena GHezzi, B.S.¹, Boyun Kim², Kyeorda Kemp, Ph.D.³, Deidre Hurse, Ph.D.³

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Human Development and Child Studies, Oakland University Rochester, MI
³Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI}

INTRODUCTION
After decades of relative stability, syphilis rates among reproductive-age women in the United States have sharply increased, with maternal cases tripling between 2016 and 2022. This surge has also contributed to a concerning rise in congenital syphilis. Gaps in healthcare access and stigma surrounding sexually transmitted infections have compounded the problem. Focused public health initiatives are needed to strengthen prevention, screening, and treatment efforts.

METHODS
We conducted a national survey to assess health literacy and syphilis knowledge among 643 women aged 18 to 49. Participants completed validated measures, including the Brief Health Literacy Screener and a syphilis knowledge assessment. Recruitment was conducted online to achieve geographic diversity across 48 states, with intentional oversampling of Michigan participants to support future region-specific analyses. 

RESULTS
Overall, 120 (18.7%) screened positive for inadequate health literacy and 523 (81.3%) did not. Among those who screened positive, 72.5% (87/120) were syphilis-knowledgeable versus 89.1% (466/523) among those who did not screen positive. In logistic regression, syphilis knowledge was associated with nearly three times the odds of not screening positive for inadequate health literacy (AOR = 2.99, 95% CI: 1.71-5.22; p < .001). Education was not associated with health literacy (p = .802). Age and race were significant predictors of health literacy, but neither age nor race predicted syphilis knowledge in adjusted models.

CONCLUSIONS
This study highlights the connection between health literacy and syphilis knowledge. It emphasizes the need for integrated health education that targets knowledge and literacy, especially among younger and marginalized groups. Incorporating health literacy and syphilis education into sexual health strategies could improve prevention and reduce disparities in syphilis rates among women of reproductive age and racially marginalized populations. 

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Estimating Health Literacy in the Chaldean Community

Haidar Hojeij, B.A.¹, Nataly Salman, B.S.¹, Mark Kamash, Ph.D.³, Victoria Lucia, Ph.D.⁴

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Internal Medicine, University of Toledo, Toledo, OH
³Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI}

INTRODUCTION
Health literacy is a key determinant of health outcomes and access to care, yet limited research exists on the Chaldean-American population, a distinct Middle Eastern ethnoreligious group residing in Metro Detroit. The Chaldean community’s socioeconomic structure, in which business ownership and financial success often occur independently of formal education, may influence patterns of health literacy differently from other immigrant groups.Objective: To assess health literacy among Chaldean adults in Metro Detroit and examine its relationship with education level and frequency of physician visits.

METHODS
A cross-sectional survey was administered to Chaldean adults recruited from primary care clinics and community centers. Health literacy was measured using a modified BRIEF Health Literacy Screening Tool and the All Aspects of Health Literacy Scale. Participants also reported their highest education level and how often they visit a physician. Pearson’s Chi-Square and Fisher’s Exact Tests were used for categorical analyses, with p < 0.05 considered statistically significant.

RESULTS
A total of 45 individuals completed the surveys.  The mean BRIEF score was 10.16 ± 4.27. Education level was significantly associated with BRIEF category (p = 0.0003), with higher education correlating with adequate health literacy. Frequency of physician visits was not significantly associated with literacy (p = 0.7848). The mean total All Aspects Health Literacy Score was 73.07 ± 14.87, showing no significant difference by education (p = 0.1466) or visit frequency (p = 0.5826).

CONCLUSIONS
Higher educational attainment was strongly associated with better health literacy among Chaldean-American adults. Although visit frequency was not statistically significant, trends suggested greater health engagement among more health-literate individuals. Targeted, culturally tailored educational interventions may improve health literacy and healthcare outcomes in this community.

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Advancing Wound Care in Harm Reduction Clinics: A Follow-Up to the 2002 Casa Segura Study

Arooj Imran, B.S.¹, Konain Tayab, B.S.², Fahad Imran, B.S.³, Leigh-Anne Stafford, B.S.⁴, Kate Guzmán, M.S.⁴, Christie Clement, B.S.⁴

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²West Virginia School of Osteopathic Medicine, Lewisburg, WV
³University if Illinois at Chicago, Chicago, IL
⁴Oakland County Health Division, Pontiac, MI}

INTRODUCTION
Soft tissue infections are a frequent complication among people who inject drugs (PWID), often progressing to cellulitis, abscesses, or necrotizing infections. The Casa Segura Wound and Abscess Clinic demonstrated that integrating wound care into syringe exchange programs can provide accessible, low-cost treatment. Since that time, the illicit drug supply has evolved, particularly with the emergence of xylazine, resulting in more complex and necrotic wounds requiring advanced interventions. This study evaluates wound care services within the Oakland County Health Division’s harm reduction program and compares outcomes with prior models.

METHODS
This study was conducted at a syringe exchange–based harm reduction clinic in Oakland County, Michigan serving PWID facing housing instability, stigma, and limited healthcare access. Wound care protocols followed structured triage guidelines. Mild wounds were cleaned and dressed with oral antibiotics as indicated. Mild cellulitis and purulent infections were treated per IDSA-based standing orders, while moderate–severe infections were referred for hospital care. In response to xylazine-related wounds, the clinic incorporated debridement, targeted antibiotic therapy, expanded provider roles, and point-of-care drug testing. Demographic and clinical data were collected over 14 months.

RESULTS
A total of 105 patients were treated for injection-related wounds. Most were managed on-site, preventing over 100 potential emergency department visits; only four required hospitalization. Statewide and county data (2020–2023) show IDU-related infections remain costly (2023 averages: SSTI $52,000; sepsis $103,000; endocarditis $173,000 in Oakland County) and associated with prolonged length of stay (9–10 days vs. 4 days non-IDU) and high discharge-against-medical-advice rates (15–18%).

CONCLUSIONS
Integrating structured wound care into harm reduction programs significantly reduces emergency utilization and healthcare costs. However, emerging drug adulterants such as xylazine necessitate expanded clinical capacity and advanced treatment strategies. Sustainable funding and continued adaptation are essential to address evolving wound care needs among PWID. 

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The Influence of Religiosity, Political Affiliation, and Social Dominance Orientation on Contraceptive Use Among Women

Silvana Iskandar, B.S.¹, Katherine Sheets, M.S.², Lisa Welling, Ph.D.²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Psychology, Oakland University, Rochester, MI}

INTRODUCTION
Contraceptives are critical for fertility control and family planning, allowing women to align reproductive decisions with personal and socioeconomic goals. Oral contraceptive pills (OCPs) are widely used and provide health benefits, including reduced risks of ovarian cancer and pelvic inflammatory disease. Despite these advantages, contraceptive use is influenced by sociocultural factors like religiosity and political orientation. Social dominance orientation (SDO), a psychological construct reflecting preference for social hierarchies, is linked to conservative ideologies but remains understudied in relation to contraception. This study examined associations between religiosity, political orientation, SDO, and OCP use among cisgender women.

METHODS
Methods:
This cross-sectional study surveyed cisgender women aged 18 years and older who were either naturally cycling or using OCPs. Participants were recruited via social media, online platforms, and university courses and completed an anonymous Qualtrics survey. Political orientation was measured using a single-item 5-point scale (1 = extremely conservative, 5 = extremely liberal). Religiosity was assessed using a seven-item Likert scale, and SDO was measured using a 14-item policy-based questionnaire rated on a 7-point scale. Data were analyzed using Excel and SPSS.

RESULTS
The final sample included 336 participants (102 OCP users, 234 non-users; mean age = 20 years). In adjusted analyses, political orientation was not significantly associated with OCP use (OR = 1.46, 95% CI: 0.99–2.15; p = 0.053). Higher religiosity was significantly associated with lower odds of OCP use (OR = 0.78, 95% CI: 0.63–0.96; p = 0.020). In contrast, higher social dominance orientation was significantly associated with greater odds of OCP use (OR = 1.06, 95% CI: 1.01–1.11; p = 0.009).

CONCLUSIONS
Religiosity and SDO were significantly associated with OCP use, whereas political orientation was not. These findings underscore the importance of sociocultural and psychological factors in contraceptive decision-making and may inform more tailored reproductive healthcare counseling. 

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Interpreter Use and Healthcare Experiences Among Spanish-Speaking Patients

Sabrina Lee, B.A.¹, Adina Schneeweis, Ph.D.²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Communication, Journalism, and Public Relations, Oakland University, College of Arts and Sciences, Rochester, MI}

INTRODUCTION
Spanish-speaking individuals are among the fastest-growing minority populations in the U.S., with over 41 million speakers. Language barriers continue to challenge patients with limited English proficiency. This study examined how interpreter use influences medical understanding, trust, and healthcare experiences, highlighting how linguistically responsive care strengthens patient–provider relationships and supports equitable healthcare.

METHODS
A qualitative, cross-sectional study was conducted at the Gary Burnstein Community Health Clinic in Pontiac, Michigan. Spanish-speaking adults (ages 18–54) who relied on interpreter services were recruited via snowball sampling. Participants completed a demographic survey and semi-structured interviews assessing satisfaction, trust, comprehension, and quality of care. Interviews were audio-recorded, transcribed verbatim, and analyzed using inductive thematic analysis. Confidentiality was maintained via pseudonyms; translations done by the bilingual author.

RESULTS
Thirteen participants completed interviews, revealing four major themes: communication and understanding, trust and relationship-building, patient experiences and perceived quality of care, and community-level experiences. Interpreter services were essential, enabling patients to share symptoms, ask questions, and understand diagnoses and care plans. Language barriers persisted even among long-term residents. Interpreters fostered trust, emotional security, and confidentiality, increasing confidence in clinicians. Access also enhanced comfort and eased logistical and financial burdens. Without interpreters, patients experienced distress, care avoidance, and relied on family members as informal interpreters, highlighting structural barriers and broader community impact.

CONCLUSIONS
Interpreter services are essential for equitable, high-quality care for Spanish-speaking patients. Without them, communication breaks down, trust weakens, and care quality declines, often requiring reliance on family for translation. On-site interpreters improve satisfaction, engagement, and the patient–provider relationship, supporting health equity at individual and community levels. This study confirms prior findings that interpreters improve communication, trust, and outcomes, and adds insight into the broader community impact, showing that reliable language access reduces disparities and promotes equity within the Hispanic community.

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Association Between Celiac Disease and Uncontrolled Hemoglobin A1c Levels in Type 1 Diabetes Pediatric Patients

Amy Lin, B.S.¹, Michelle Jankowski, M.S.², Shirley Qu, Ph.D.³, Virginia Uhley, Ph.D.⁴, Michael Brennan, D.O.⁵, Ramin Homayouni, Ph.D.⁴

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
² Department of Research, Oakland University William Beaumont School of Medicine, Rochester, MI
³Beaumont Health Research Institute, Royal Oak, MI
⁴Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI
⁵Corewell Health William Beaumont University Hospital, Royal Oak, MI}

INTRODUCTION
Celiac disease (CD) occurs in approximately 6% of individuals with type 1 diabetes (T1D), and may complicate glycemic control due to conflicting dietary needs. Prior studies show mixed results regarding the impact of CD on Hemoglobin A1c (HbA1c), especially in pediatric populations. This study evaluates whether CD is associated with suboptimal glycemic control in pediatric patients with T1D.

METHODS
This retrospective chart review analyzed pediatric patients (<18 years) diagnosed with T1D between 2012–2023 across Corewell Health East. Patients were identified via ICD-10 codes and stratified by CD status and glycemic control (controlled HbA1c <7% vs. uncontrolled HbA1c ≥7%). Statistical analyses include Chi-Square or Fisher’s Exact tests for categorical variables, Wilcoxon tests for continuous variables, and logistic regression for multivariable analysis.

RESULTS
Among 2,203 pediatric patients with T1D, 101 (4.6%) had CD. Patients with both conditions were younger at T1D diagnosis (median age 9 vs. 12 years, p<0.0001) and had more HbA1c measurements. A higher proportion of CD patients had uncontrolled diabetes (89.1% vs. 73.8%, p=0.0006). CD was independently associated with uncontrolled HbA1c (adjusted OR: 2.59; 95% CI: 1.37–4.90; p=0.003) after adjusting for age, sex, and race. Younger age and Black race were also associated with higher odds of uncontrolled diabetes.

CONCLUSIONS
CD is significantly associated with poorer glycemic control in pediatric patients with T1D, independent of age, race, and sex. These findings suggest the need for closer monitoring, individualized dietary counseling, and targeted interventions in this high-risk group.  

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Pre-pregnancy Obesity and Peripartum Cardiomyopathy

Doria Morante, B.S.¹, Sara Jaber, M.D.²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Obstetrics and Gynecology, Corewell Health East William Beaumont University Hospital, Royal Oak, MI}

INTRODUCTION
Peripartum cardiomyopathy is a life-threatening condition characterized by left ventricular systolic dysfunction (ejection fraction (EF) <45%) diagnosed in the last month of pregnancy or within 5 months postpartum. Although rare, (0.1% incidence), it carries a high morbidity and mortality rate. Pre-pregnancy obesity is linked to adverse pregnancy outcomes but its association with peripartum cardiomyopathy remains understudied. The aim of this project is to determine the relationship between body mass index (BMI) at pregnancy and the risk of developing peripartum cardiomyopathy, break this down by severity, and look at racial, socioeconomic, and health factors. 

METHODS
We conducted a retrospective cohort study identifying patients diagnosed with peripartum cardiomyopathy who delivered at Corewell Health William Beaumont University Hospital. The study was approved by the Institutional Review Board. The time frame included was January 1st, 2015 through September 12th, 2024. Eligible patients meeting strict peripartum cardiomyopathy definition were divided by BMI (<35 Group 1 versus ≥ 35 kg/m2 Group 2). Analysis was performed using the Fishers exact test and two-sample t-test. 

RESULTS
Twenty patients met inclusion criteria during the study period. Baseline demographics and pregnancy outcomes were not statistically different between the groups. Patients in Group 1 had a higher mean EF (34.6%) compared with patients in Group 2 (mean EF 29.3%), but difference was not statistically significant. In group 2, 38.5% had a severe EF (≤ 29%), while only 14.3% of group 1 patients had an EF ≤ 29%, although not a statistically significant difference. 

CONCLUSIONS
The small sample size caused by the rare occurrence of peripartum cardiomyopathy did not allow for sufficient power to reach statistical significance. However, despite this, a positive dose response relationship between higher BMI categories and worsening EF severity was detected. To strengthen the hypothesis and refine recommendations, future studies should use a larger sample size and an extended time frame. 

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Gaining Insights into Clinical Trial Recruitment Engaging Underserved Communities

Derrik X Nghiem, B.S.¹, Eric Daar, M.D.²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²The Lundquist Institute, Torrance, CA}

INTRODUCTION
Underrepresentation of minority populations in clinical research limits generalizability and perpetuates health inequities. Although federal mandates encourage inclusive enrollment, barriers persist. During Phase 3 coronavirus disease 2019 vaccine trials conducted at The Lundquist Institute at Harbor-UCLA Medical Center, collaboration with a community advisory panel enhanced minority participation. Following trial completion, we sought to identify stakeholder-prioritized factors influencing minority recruitment to inform future enrollment strategies.

METHODS
We developed a structured 20-item survey assessing perceived importance of factors influencing minority participation, categorized as logistical, information and engagement, and cultural and community domains. Responses were rated on a 5-point Likert scale (1 = not important, 5 = very important). The survey was distributed electronically to infectious disease investigators, clinical research staff, and members of a community advisory board involved in Phase 3 vaccine trials. Descriptive statistics were calculated, including means and medians. Factors were rank-ordered within each stakeholder group.

RESULTS
Thirty-nine stakeholders participated, including investigators (n=7, 100% response), research staff (n=12, 100%), and advisory board members (n=20, 95%). Logistical factors were consistently rated highly across groups (mean range 4.0–4.3). Investigators ranked information and engagement factors lower than research staff and advisory board members. Cultural and community factors were prioritized more highly by investigators and research staff compared to advisory board members. Childcare was ranked among the least important factors across all groups. Notable differences in top-ranked priorities emerged between advisory board members and research teams.

CONCLUSIONS
Stakeholder perspectives on barriers to minority clinical trial participation differ across groups. Logistical access remains a universal priority, while community representatives emphasize transportation and knowledge-related factors. Integrating structured community input into trial design may improve recruitment strategies and promote equitable representation in clinical research.

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Mate Retention in the Digital Age: Social Media Behaviors, Personality, and Relationship Dynamics

Tannoz Norouzi, B.S.¹, Dr. Lisa Welling, Ph.D.²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Psychology, Oakland University, Professor of Psychology, Rochester, MI}

INTRODUCTION
Mate retention behaviors are strategies individuals use to maintain romantic relationships and prevent partner defection. These behaviors can influence relationship satisfaction and aggression; however, most research has focused on offline contexts, leaving a gap in understanding how these dynamics operate in online environments such as social media. As social media increasingly shapes romantic interactions, examining online mate retention behaviors may provide important insight into relationship functioning and potential risk factors for conflict. This study investigates how online mate retention behaviors relate to personality traits, relationship satisfaction, and intimate partner violence (IPV).

METHODS
Using a cross-sectional design, adult participants (18+) in romantic relationships of at least three months were recruited via Prolific and completed an online Qualtrics survey. Measures included the HEXACO-60 (personality), Relationship Assessment Scale (relationship satisfaction), a modified Facebook Mate Retention Tactic Inventory (online behaviors), Mate Retention Inventory–Short Form (offline behaviors), Revised Conflict Tactics Scales (relationship aggression), and Composite Abuse Scale–Revised Short Form (IPV). Multiple regression analyses were conducted to examine associations among variables.

RESULTS
 Cost-inflicting behaviors consistently predicted adverse relationship outcomes, including lower relationship satisfaction and higher abuse frequency. In contrast, benefit provisioning was positively associated with relationship satisfaction but did not predict abuse outcomes. Personality traits, particularly lower Honesty–Humility and Conscientiousness, were associated with greater engagement in cost-inflicting and mate retention behaviors, whereas higher Emotionality and Agreeableness were linked to benefit provisioning. No significant sex differences or moderation effects were observed.

CONCLUSIONS
 Findings highlight the importance of distinguishing between positive and harmful mate retention strategies in online contexts. Cost-inflicting behaviors appear to be a key risk factor for negative relationship outcomes, whereas benefit provisioning supports relationship satisfaction. Personality traits play a central role in shaping these behaviors, underscoring the need to consider individual differences in understanding modern relationship dynamics.

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Alone or Abused? Fear of Being Single, Attachment Insecurity, and IPV Risk in Young Adults

Manasa Pavuloori, B.S.¹, Yvonne Kieleszewski, B.S.², Lisa Welling, Ph.D.²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Oakland University Department of Psychology. Rochester, MI}

INTRODUCTION
Domestic violence remains a critical public health issue, accounting for approximately 1,500 deaths annually in the United States. Fear of being single (FBS), or distress associated with lacking a romantic partner, is linked to insecure attachment styles; however, its role in tolerance of intimate partner violence (IPV) remains under-explored. This study examined the associations between FBS, attachment insecurity, partner preferences, and IPV-related experiences to inform IPV prevention strategies.

METHODS
Participants were recruited via the Prolific online survey participant platform and students in undergraduate psychology courses at Oakland University. Eligible participants were cisgender adults (18+ years old) who had been in a romantic relationship for at least three months. Validated measures assessed FBS, attachment style, relationship-contingent self-esteem, aggression, preference for a dominant partner, and IPV-related experiences. Hierarchical regression analyses were conducted for the full sample and separately for partnered and single participants.

RESULTS
Attachment-related anxiety was the strongest and most consistent predictor of FBS across all the models. Preference for a dominant partner significantly predicted higher FBS scores in the full sample and partnered participants, but not among singles. Participant-perpetrated aggression was negatively associated with FBS in the full and partnered samples. Relationship-contingent self-esteem did not independently predict FBS in any model. Age and relationship length were negatively associated with FBS. Notably, FBS was unrelated to the likelihood of ending a relationship following partner aggression in both groups.

CONCLUSIONS
FBS is associated with attachment insecurity and relational dynamics relevant to IPV risk. These findings highlight FBS as a potential risk factor for remaining in unhealthy or unsafe relationships, supporting its consideration in IPV prevention and intervention efforts targeting young adults.

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Mental Health Care Provider Experience with African Immigrants and Refugees in the United States

Kyara Sosa, B.S.¹, Betty Tonui, Ph.D, MSW.²

_{¹Oakland University William Beaumont School of Medicine, Rochester, MI
²Department of Sociology, Anthropology, Social Work, & Criminal Justice, Oakland University, Rochester, MI}

INTRODUCTION
African immigrants and refugees have increased mental health needs due to higher rates of trauma, discrimination, and post-migration stressors when compared to general populations. At the same time, many individuals draw on strong cultural values, faith traditions, family networks, and community connections that promote resilience and coping. Despite these protective factors, barriers to accessing culturally responsive mental health care remain. This study explored the experiences of mental health care providers in delivering services to African immigrants and refugees, with the aim of identifying barriers this population faces when seeking out mental health care. 

METHODS
This study employed an inductive qualitative design, with data analyzed using Braun and Clarke’s six-step thematic analysis. Following Institutional Review Board approval, five mental health care providers who work with African immigrants and refugees participated in one-time, audio-recorded interviews consisting of open-ended questions about their experiences delivering mental health services. 

RESULTS
The findings revealed six main themes. Cultural stigma and norms hinder open discussions about mental health. There is a strong preference for community-based mental health services, which participants believe can enhance support and connection. Additionally, the demand for culturally competent counselors is evident, as individuals seek professionals who can relate to their experiences and build trust. Language barriers further complicate access to mental health services. Lastly, participants highlighted unique adversities related to war and displacement while demonstrating resilience in navigating their challenges. 

CONCLUSIONS
Findings underscore the need for mental health services that address cultural stigma directly, integrate community-based supports, and provide culturally competent care. Language accessibility and tailored interventions for trauma-affected populations are critical. By centering provider insights, this study highlights both barriers and strengths, offering actionable guidance to improve mental health care delivery for African immigrants and refugees in the United States. These results contribute to a nuanced, culturally informed understanding of migrants’ mental health and can inform policy, practice, and future research. 

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