Background and Objectives: Postgraduate education in cultural competence and community health is a key strategy for eliminating health disparities in underserved populations. Evidence suggests that an experiential, rather than knowledge-based approach equips physicians with practical and effective communication tools that generalize to a greater diversity of patients and cultures. However, there is limited data about the efficacy of a longitudinal, experiential residency curriculum. This study details the results of a longitudinal underserved community curriculum for family medicine residents training in a federally qualified health center. Methods: All residents in the first 5 years of a new residency participated in a longitudinal curriculum of workshops and seminars focused on social determinants of health and cultural competency for underserved patients. Pre- and postcurriculum surveys assessed knowledge gain. Self-reported Likert scale ratings assessed attitudes and confidence related to underserved care. Results: Pre/post learning evaluations after each seminar documented average knowledge increase of 31.0% and 28.8%, respectively. At the end of the 3-year curriculum, 81.8% of residents reported confidence in their ability to incorporate culturally relevant information into a treatment plan and 57.1% of residents reported feeling very aware of obstacles faced by underserved populations seeking health care and of the relationship between sociocultural background, health, and medicine. Conclusions: A longitudinal, experiential curriculum in underserved community health and cultural competence can improve resident knowledge and attitudes with respect to health disparities and delivering health care to diverse patient populations.

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Less than 20% of smokers received any type of therapy to assist in smoking cessation. We observed a race disparity in type of smoking cessation therapy provided to white and African American primary care patients. Further research is needed to increase treatment rates and eliminate disparities.

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Background: Results from studies using medical record data indicate chronic (>90 days) opioid analgesic use (OAU) is associated with new depressive episodes (NDE), worsening depression and risk for depression recurrence. This body of evidence is based on retrospective cohort studies and medical record data. Limitations of existing research are overcome in a new prospective cohort study of the opioid-depression relationship. Methods: Prospective cohort of 1500 adult patients recruited from two health care systems. Eligible subjects started a new period of OAU and have 30 to 90 days of OAU at baseline. Diagnostic assessments for psychiatric disorders, structured measures of pain, pain functioning, opioid use, social support, sleep and impulsivity will be obtained at baseline, 6-month and 12-month follow-up. Baseline participants will be invited to 12 monthly brief assessments of pain-related functioning, depression symptoms and opioid use. Innovation: Robust control for confounding by indication and detailed phenotyping of depression and opioid use disorder. Anticipated results: Chronic OAU will be associated with new onset of a depression phenotype characterized by anhedonia and somatic symptoms. This relationship will be partly, but not completely explained by impaired functioning and low social support.