Digital Commons Network^™

Aligning Investments To Improve Population Health: A Statewide Strategy To Address The Social Determinants Of Health, Michael E. Swack, Sarah Boege, Kevin Barnett

The Carsey School of Public Policy at the Scholars' Repository

In this report, authors Michael Swack, Sarah Boege, and Kevin Barnett discuss the initiative to develop a statewide strategy to address the social determinants of health in New Hampshire. Launched in 2020, this project is a collaboration between the Center for Impact Finance at the Carsey School of Public Policy at UNH, the Center to Advance Community Health and Equity (CACHE) at the Public Health Institute, the Institute for Health Policy and Practice at UNH, and the New Hampshire Hospital Association/Foundation for Healthy Communities. Michael Swack, director of the Center for Impact Finance at the Carsey School, serves as the …

Augmenting Project Echo For Opioid Use Disorder With Data-Informed Quality Improvement, Owen B. Murray, Marcy A. Doyle, Bethany M. Mcleman, Lisa A. Marsch, Elizabeth C. Saunders, Katherine Cox, Delitha Watts, Jeanne Ryer

Faculty Publications

Background

National opioid-related overdose fatalities totaled 650,000 from 1999 to 2021. Some of the highest rates occurred in New Hampshire, where 40% of the population lives rurally. Medications for opioid use disorder (MOUD; methadone, buprenorphine, and naltrexone) have demonstrated effectiveness in reducing opioid overdose and mortality. Methadone access barriers disproportionally impact rural areas and naltrexone uptake has been limited. Buprenorphine availability has increased and relaxed regulations reduces barriers in general medical settings common in rural areas. Barriers to prescribing buprenorphine include lack of confidence, inadequate training, and lack of access to experts. To address these barriers, learning collaboratives have trained …

Post-Pandemic Privacy Law, Tiffany C. Li

Law Faculty Scholarship

COVD-19, the global pandemic that began in 2019, altered how we live our lives in just about every way imaginable. Some of those changes were obvious-for example, those who were fortunate enough to be able to work from home began working online-while other changes were more subtle. The latter category included unprecedented levels of data collection by governments and organizations purporting to collect information that would help stop the pandemic's spread. Given the deadly nature of COVID-19, few would question any public health efforts, no matter their impact on privacy. However, the lack of attention to privacy issues during the …

Outlaw Operators: Prevention Failures And The Resurgence Of Black Lung In Central Appalachia, Aysha Bodenhamer

The Carsey School of Public Policy at the Scholars' Repository

In this brief, author Aysha Bodenhamer describes how prevention failures in the coal mining industry have resulted in the resurgence of black lung disease. Caused by the chronic inhalation of coal and silica dust, black lung is progressive, incurable, life-altering, and fatal. Despite it being a preventable disease, black lung is resurgent among coal miners in Kentucky, Virginia, and West Virginia. Fieldwork including in-depth interviews with miners, clinic workers, black lung attorneys, government employees, and lay advocates, and a case-study analysis of two black lung clinics in southwest Virginia inform this analysis. These data reveal that coal operators routinely evade …

Youth Homelessness - State Policy Review, Adam Mercer

Student Research Projects

This project was sponsored by Waypoint within their runaway and homeless youth continuum. Waypoint is a private non-profit operating in New Hampshire and supporting homeless youth statewide. The objective of the project was to review state policies affecting youth for the purpose of increasing Waypoint’s ability to advocate for legislative changes that can prevent and bring an end to youth homelessness.

The rights and freedoms of minors in unsafe situations are often limited and tied to another person’s guardianship, which may not be the best option for them. Expanding their rights through new policy could improve their safety, quality of …

Ideology Affects Trust In Science Agencies During A Pandemic, Lawrence C. Hamilton, Thomas G. Safford

The Carsey School of Public Policy at the Scholars' Repository

In this perspectives brief, authors Lawrence Hamilton and Thomas Safford discuss the importance of government and public respect for scientific advice in mitigating the impacts of COVID-19. Striking political divisions in attitudes toward science have recently been evident in U.S. government statements and actions regarding the pandemic, and in opinions or behavior reported by general-public surveys. Although the COVID-19 crisis is breaking news, these political divisions in respect for science during a pandemic have deeper roots. A nationwide survey conducted by Carsey School researchers in 2016, immediately after the elections, found 25-point gaps between Trump and Clinton voters, or between …

Evaluation Of Antimicrobial Efficacy In Shelter Cats With Upper Respiratory Infection: A Prospective Study, Jillian R. Broadhurst, Sarah E. Proctor Dvm

Student Research Projects

Feline Upper-Respiratory Infection (URI) is commonplace in most animal shelters, and its endemic presence is problematic for the animals as well as for veterinarians and other shelter personnel. Despite the fact that viruses are responsible for the majority of these infections, many cats with URI in shelters are still treated with antibiotics. Antibiotic treatment in the absence of bacterial infection and the overuse of antibiotics can lead to antibiotic resistance among feline populations. The aim of this research was to compare duration and severity of URI in shelter cats treated with and without antibiotics. Cats showing clinical symptoms were randomly …

Both Rural And Urban Snap Recipients Affected By Proposed Work Requirements, Jessica A. Carson

The Carsey School of Public Policy at the Scholars' Repository

With the expiration of the current Farm Bill on September 30, 2018, the House and Senate are working in conference committee to reconcile their versions of its replacement. A major difference between the two is the House’s inclusion of a more intensive work requirement.

The Opioid Crisis In Rural And Small Town America, Shannon M. Monnat, Khary K. Rigg

The Carsey School of Public Policy at the Scholars' Repository

In this brief, authors Shannon Monnat and Khary Rigg examine rural versus urban differences in opioid mortality and identify challenges for dealing with the opioid crisis in rural areas. They report that, in 2016, opioid mortality rates were higher in urban than in rural counties, particularly in the Midwest, but rates have increased more in rural than in urban counties over the past two decades. Since 2010, the share of drug overdose deaths involving prescription opioids has declined, but the share of deaths involving heroin and synthetic opioids has spiked in both rural and urban areas. The most dramatic increases …

Drug Overdose Rates Are Highest In Places With The Most Economic And Family Distress, Shannon M. Monnat

The Carsey School of Public Policy at the Scholars' Repository

In this brief, author Shannon Monnat examines county-level mortality data from the U.S. Centers for Disease Control and Prevention, pooled for 2006–2015, to gain insight into the U.S. drug overdose problem. She reports that, unlike the news media’s regular portrayal of the drug overdose epidemic being a national crisis, some places have much higher drug mortality rates than others. On average, rates are higher in counties with higher levels of economic distress and family dissolution, and they are lower in counties with a larger per capita presence of religious establishments. These findings hold even when controlling for demographic differences, urban …

Utilization Of Long-Term Care By An Aging Population, Reagan Baughma, Jon Hurdelbrink

The Carsey School of Public Policy at the Scholars' Repository

In this brief, authors Reagan Baughman and Jon Hurdelbrink examine the relationship between macroeconomic conditions, as measured by the national unemployment rate, and utilization of long-term care, as measured by respondents’ reports in the Health and Retirement Study of what type of care they received in the past month to help with daily activities. Long-term care for older adults can take the form of nursing home care, formal (paid) home care, or informal (unpaid) home care. Almost 1 in 5 individuals over the age of 65 gets some type of help with activities of daily living such as bathing, dressing, …

Integrated Analysis Of The Value Of Wetland Services In Coastal Adaptation; Methodology And Case Study Of Hampton-Seabrook Estuary, New Hampshire, Paul Kirshen, Semra Aytur, David M. Burdick, Diane Foster, Tom Lippmann, Ellen Douglas, Sydney Nick, Chris Watson

Jackson Estuarine Laboratory

The present impacts from coastal storms and high tides grow significantly over time due to SLR even over the relatively short period to 2060. Hydrodynamic model simulations of storm surge with and without sea level rise scenarios show that although flooding and inundation increases with increasing subtidal forcing and higher sea level, dissipation of the tide and storm surge in the estuary channel somewhat limits the maximum inundation that might otherwise be expected in the back marsh areas. The estuary is dominated by high marsh, which lies high in the intertidal zone and by 2060 it will convert to mostly …

Healthcare Management Primer, Students Of Health Management 721.01 (2017), University Of New Hampshire, Mark Bonica

Open Educational Resources

This primer was written by students enrolled in HMP 721.01, Management of Health Care Organizations, in the Health Management & Policy Program, College of Health and Human Services, University of New Hampshire. This course was taught by Professor Mark Bonica in Fall 2017.

Substance Use Disorder Treatment Confidentiality Boot Camp, Lucy C. Hodder, Stephanie Cameron, Marcy Doyle, Christina Muñiz, Jeanne Ryer Edd

Law Faculty Scholarship

[Excerpt]: "INTRODUCTION: The Health Law and Policy Programs at UNH School of Law, Institute for Health Policy and Practice, and the NH Citizens Health Initiative have contracted with several of the New Hampshire Building Capacity for Transformation Delivery System Reform Incentive Payment (DSRIP) Integrated Delivery Networks (IDN) to provide technical assistance to the IDNs as they develop confidentiality tools related to substance use disorder services projects.

A UNH Team assisted the IDNs by providing an educational summary of federal and state confidentiality requirements, focusing on 42 CFR Part 2, and hosting IDN interdisciplinary teams in three Substance Use Disorder (SUD) …

More Than 95 Percent Of U.S. Children Had Health Insurance In 2015, Michael J. Staley

The Carsey School of Public Policy at the Scholars' Repository

In this brief, author Michael Staley examines rates of children’s health insurance across the United States, by region and by place type, breaking down rates by private and public coverage. He reports that over 95 percent of all U.S. children under age 18 were covered by some form of health insurance in 2015—the highest share since the American Community Survey began measuring insurance rates in 2008. Rates of coverage increased between 2014 and 2015 in all four U.S. regions, and the greatest growth occurred in the South and West. Growth in public insurance—Medicaid and the Children’s Health Insurance Program— remained …

The Zika Virus Threat: How Concerns About Scientists May Undermine Efforts To Combat The Pandemic, Thomas G. Safford, Lawrence C. Hamilton, Emily Whitmore

The Carsey School of Public Policy at the Scholars' Repository

Using data from the University of New Hampshire’s October 2016 Granite State Poll, authors Thomas Safford, Lawrence Hamilton, and Emily Whitmore investigate how New Hampshire residents view the Zika crisis. They report that most New Hampshire residents believe Zika is only a minor threat to public health in the United States, and they generally trust the CDC as a source of information about the virus. The data also show that, while there is doubt about the government’s ability to control the spread of the virus, the public feels that emergency federal funding to combat Zika should be a priority. They …

Marijuana Regulation And Federalism, John M. Greabe

Law Faculty Scholarship

[Excerpt] "Federal law makes the cultivation and use of marijuana illegal for all purposes. Yet, over the past two decades, 28 states plus the District of Columbia have legalized marijuana for medicinal purposes, and eight states plus the District of Columbia have legalized it for recreational purposes. Marijuana regulation thus provides a useful and timely example for exploring the ways in which the distribution of power between the federal government and the states can facilitate policy change."

Empathy, Casey Golomski

Anthropology

A short poem about suicidal ideation and alcoholism in the United States.

Drugs, Alcohol, And Suicide Represent Growing Share Of U.S. Mortality, Shannon M. Monnat

The Carsey School of Public Policy at the Scholars' Repository

In this brief, author Shannon Monnat identifies trends in mortality rates from drugs, alcohol, and suicide by race and sex for adults aged 25 to 54, from the years 2000 to 2014. She reports that—nationwide--the mortality rate from deaths involving drugs, alcohol, and suicide rose 52 percent from 2000 to 2014. Drug, alcohol, and suicide mortality rates are highest among middle-aged non-Hispanic white males and are growing fastest among non-Hispanic white females. Nearly half of all young white male deaths are caused by drugs, alcohol, or suicide. A little over a quarter of young Hispanic male deaths and 13 percent …

Opinion: The Mental Health Parity And Addiction Equity Act: What Parity Means For New Hampshire, Lucy C. Hodder

Law Faculty Scholarship

[Excerpt] "New Hampshire lawyers can help clients and colleagues with mental health or substance use disorders by advising individuals how to overcome barriers to insurance coverage for treatment, and encouraging them to pursue state and federally mandated internal, external and expedited appeal opportunities when denied coverage."

Christians’ Cut: Popular Religion And The Global Health Campaign For Medical Male Circumcision In Swaziland, Casey Golomski, Sonene Nyawo

Anthropology

Swaziland faces one of the worst HIV epidemics in the world and is a site for the current global health campaign in sub-Saharan Africa to medically circumcise the majority of the male population. Given that Swaziland is also majority Christian, how does the most popular religion influence acceptance, rejection or understandings of medical male circumcision? This article considers interpretive differences by Christians across the Kingdom’s three ecumenical organisations, showing how a diverse group people singly glossed as ‘Christian’ in most public health acceptability studies critically rejected the procedure in unity, but not uniformly. Participants saw medical male circumcision’s promotion and …

Antimicrobial Resistance (Amr) And Multidrug Resistance (Mdr): Overview Of Current Approaches, Consortia And Intellectual Property Issues, Andrew Jenner, Niresh Bhagwandin, Stanley P. Kowalski

Law Faculty Scholarship

The supply of new diagnostics and treatments is insufficient to keep up with the increase in antimicrobial resistance (AMR) and multidrug resistance (MDR) as older medicines are used more widely and microbes develop resistance to them. At the same time, significant quantities of antibiotics are used on patients and animals that do not need them, while others who do need them lack access.

Effective responses to AMR/MDR require effort by both the public and private sectors to develop and disseminate new diagnostics, vaccines and treatments on a global scale, as well as to adapt them to local needs. This calls …

The Impact Of State Medicaid Expansion Under The Affordable Care Act On Health Insurance Coverage At The County Level, Danielle Rhubart

The Carsey School of Public Policy at the Scholars' Repository

The purpose of Medicaid expansion under the Affordable Care Act was to make health care more accessible to low-income populations. By early 2015, 28 states had expanded Medicaid eligibility. The expansion by some states but not by others provides a unique opportunity to examine the impact of this new policy on changes in health insurance coverage. Moreover, as the newly elected Republican President and the Republican-controlled Congress consider the future of health care reform, understanding the efficacy of components of the Affordable Care Act, such as Medicaid expansion, will be essential for continuing efforts to increase coverage rates and subsequently …

Resource Guide For Addiction And Mental Health Care Consumers: Answering Questions About Insurance Coverage And Parity For Addiction And Mental Health Care Services, Lucy C. Hodder, Michele D. Merritt, Margaret H. Schmidt, Jacqueline Botchman, Caitlyn Ebert, Marguerite Corvini, Kate Crary, Bridget Drake

Law Faculty Scholarship

Navigating the maze of health insurance coverage can be difficult. For individuals with addiction or mental illness, the process of getting treatment approved and paid for by health insurance can be overwhelming. As a result, many people give up when their health insurance company denies coverage for needed services. This Guide can help people learn how to access health insurance and use their coverage to pay for treatment. This Guide also provides a basic explanation of consumers’ rights under the federal Mental Health Parity and Addiction Equity Act.

The Unmet Need For Care: Vulnerability Among Older Adults, Rebecca K. Glauber, Melissa Day

The Carsey School of Public Policy at the Scholars' Repository

In this brief, authors Rebecca Glauber and Melissa Day explore factors that exacerbate the unmet need for care among the noninstitutionalized older population and seek to deter­mine who is likely to need care but go without. They find that unmarried individuals and those who live alone are more likely than others to need care but not receive it. These older adults are frail, have difficulty meet­ing their daily needs, and do not have family members or friends to whom to turn in times of need. This group of vulnerable older adults requires an array of social supports.

Privacy And Accountability In Black-Box Medicine, Roger Allan Ford, W. Nicholson Price Ii

Law Faculty Scholarship

Black-box medicine—the use of big data and sophisticated machine learning techniques for health-care applications—could be the future of personalized medicine. Black-box medicine promises to make it easier to diagnose rare diseases and conditions, identify the most promising treatments, and allocate scarce resources among different patients. But to succeed, it must overcome two separate, but related, problems: patient privacy and algorithmic accountability. Privacy is a problem because researchers need access to huge amounts of patient health information to generate useful medical predictions. And accountability is a problem because black-box algorithms must be verified by outsiders to ensure they are accurate and …

Rural Adolescents Are More Likely Than Their Urban Peers To Abuse Prescription Painkillers, Shannon M. Monnat, Khary K. Rigg

The Carsey School of Public Policy at the Scholars' Repository

In this fact sheet, authors Shannon Monnat and Khary Rigg examine prescription painkiller abuse for over 32,000 youth aged 12–17 using data from the National Survey on Drug Use and Health, an annual nationally representative survey of the non-institutionalized U.S. population. They report that over 1.1 million adolescents aged 12 to 17 (4.7 percent of this population) abused prescription painkillers in 2014. Prescription painkiller abuse was more common among rural than urban adolescents. In 2014, 8.6 percent of rural adolescents, 8.1 percent of adolescents in small urban areas, and 6.5 percent of adolescents in large urban areas reported ever abusing …

Oral Health Care Access In New Hampshire, Eleanor M. Jaffee, Joan Widmer, Lisa Speropolous

The Carsey School of Public Policy at the Scholars' Repository

In this brief, authors Eleanor M. Jaffee, Joan Widmer, and Lisa I. Speropolous provide an overview of the current state of oral health care in New Hampshire. They report that although New Hampshire is rated above the national average on most measures of pediatric oral health, performance varies substantially by county and by region. Access to adequate oral health care for both children and adults is particularly challenging for low-income families in the sparsely populated northern region of the state. Programs that address oral health care access issues by bringing services to those with the greatest need, such as school-based …

Generational Inversions: 'Working' For Social Reproduction Amid Hiv In Swaziland, Casey Golomski

Anthropology

How do people envision social reproduction when regular modes of generational succession and continuity are disrupted in the context of HIV/AIDS? How and where can scholars identify local ideas for restoring intergenerational practices of obligation and dependency that produce mutuality rather than conflict across age groups? Expanding from studies of HIV/AIDS and religion in Africa, this article pushes for an analytic engagement with ritual as a space and mode of action to both situate local concerns about and practices for restoring dynamics of social reproduction. It describes how the enduring HIV/AIDS epidemic in Swaziland contoured age patterns of mortality where …

Health Insurance Among Young Adults Rebounds Post Recession: More Become Dependents On A Parent's Plan After Aca Extends Coverage To Adult Children, Michael J. Staley, Jessica A. Carson

The Carsey School of Public Policy at the Scholars' Repository

While much of the existing research explores young adults' insurance only in the post-recession period (that is, 2010 to present), authors Michael Staley and Jessica Carson assess young adults' rates of coverage within and beyond the context of the recession by examining changes across the entire 2007 to 2012 period.