Race and Gender Differences in Medical Student Perspectives on Social Determinants of Health Education: A Single-Institution Survey Study.

PURPOSE: The field of medicine is becoming increasingly aware of the role that social determinants of health (SDH) play in shaping health and health outcomes. Organized medicine - including prominent physician groups and accreditation bodies - has endorsed SDH education as an integral component of medical school curricula. This study sought to describe medical student perspectives on the current state of SDH in preclinical curricula. METHODS: The authors developed a 9-item survey to assess time being spent on SDH and attitudes toward the current level of SDH content in preclinical curricula. All medical students at both campuses of a large public medical school were invited to participate between December 2019 and February 2020. RESULTS: Of 1010 medical students invited to participate, 515 (51.0%) responded. Of the 515 respondents, 480 (93.2%) reported spending at least 40 hours per week on medical school, and of those, 405 (84.4%) said they spend 0-2 hours on SDH. The majority of all respondents (62.1%; 320/515) felt the current level of focus on SDH is "not enough", while only eleven students (2.1%; 11/515) felt it is "too much". In a multiple logistic model, Black students were over four times as likely as white students (aOR 4.19; 95% CI 1.37-18.38) to feel the current level of focus on SDH is "not enough". Likewise, women were 2.3-times (aOR 2.30; 95% CI 1.52-3.49) as likely as men to feel the level of focus on SDH is "not enough". CONCLUSION: In practice, medical students are spending considerably less time learning SDH than is advised by consensus of expert educators and administrators. Over sixty percent of medical students do not feel the current level of focus on SDH is sufficient. Further study is needed to determine why women and racial minority students are significantly more likely to feel this way.

Classification Accuracy of Biomarkers of Compliance.

Objectives: Evaluate the classification accuracy of biomarkers of nicotine exposure for identifying noncompliance in randomized controlled trials (RCTs) of very low nicotine content (VLNC) cigarettes. Methods: We combined data from 2 studies to evaluate the classification accuracy of biomarkers of nicotine exposure for identifying noncompliance in RCTs of VLNC cigarettes. Using a novel approach that did not require knowledge of each participant's compliance status, we modeled the distributions of total nicotine equivalents (TNE), total cotinine, and anatabine in compliant and noncompliant participants using a mixture model. Estimates of the classification accuracy were derived from the estimated densities. Results: TNE and total cotinine had near-perfect classification accuracy, but TNE had better classification accuracy than total cotinine (p = 0.03) and anatabine (p = 0.014). The classification accuracy of TNE and total cotinine decreased as self-reported study cigarettes increased; anatabine was similar, but the results were more statistically variable. Conclusions: TNE and total cotinine are better classifiers of compliance than anatabine. These results will be useful in determining biomarker thresholds for identifying noncompliance and will aid in the interpretation of future RCTs of VLNC cigarettes.