Medicine and Health Sciences Commons^™

Got Junk? The Federal Role In Regulating “Competitive” Foods, Eileen Salinsky

National Health Policy Forum

A wide variety of food and beverage items are available in schools in addition to the school meals provided through the National School Lunch Program and School Breakfast Program. A long-standing source of controversy, the need for stronger federal restrictions on foods that compete with school meals is again under debate. This issue brief examines the availability and consumption of competitive foods, explores the regulation of these foods at the federal level, considers trends in state and local restrictions, and summarizes perceived barriers to improving the nutritional quality of competitive food options.

No Free Lunch? Current Challenges Facing The National School Lunch And School Breakfast Programs, Eileen Salinsky

National Health Policy Forum

This background paper describes important characteristics of the National School Lunch Program and the School Breakfast Program, reviews U.S. Department of Agriculture rules regarding the nutritional content of school meals, and examines compliance with current nutrition standards. It also considers the dietary status and obesity risk of meal program participants, discusses proposed improvements to nutritional standards and meal requirements, and highlights key legislative issues.

The Role Of Ombudsmen In Assuring Quality For Residents Of Long-Term Care Facilities: Straining To Make Ends Meet, Carol O'Shaughnessy

National Health Policy Forum

Assuring quality of care for residents in long-term care facilities has been a serious and continuing concern of policymakers for decades. The Older Americans Act’s long-term care ombudsman program is a consumer advocacy model intended to improve quality of care by helping the 2.5 million residents of almost 67,000 nursing and other residential care facilities resolve complaints about their care and protect their rights. Despite broad recognition of its value in assisting residents and its efforts to complement federal and state oversight of long-term care facilities, some observers are concerned about the program’s ability to meet its legislative mandates. Limited …

Income Inequality And Homicide Rates In Sao Paulo, Brazil., Paulo A. Lotufo, Isabela M. Bensenor

Paulo A Lotufo

Description of the epidemic of homicide among poor people in Brazil. In Sao Paulo, Brazil, homicides to men aged 15-44 years increased with an annual percentage change (APC) of 4.7% from 1996 to 2001, and then decreased from 2001 to 2007 with an APC of -14.6%. Analyzing the intra-urban distribution according to family income, the increase in the homicide rate was restricted to men living in the poorest neighbourhoods. In contrast, the decline in homicide rates was observed to men living in all districts. The reasons for this 'up and down' trend are not clear.

E-Therapy As A Means For Addressing Barriers To Substance Use Disorder Treatment For Persons Who Are Deaf, Dennis Moore, Debra Guthmann, Nikki Lynn Rogers, Susan Fraker, Jared A. Embree

Population and Public Health Sciences Faculty Publications

Persons who are deaf face a number of challenges with regard to vulnerability for substance use disorders. Moreover, accessible treatment for this condition can be difficult to establish and maintain. The Deaf community may be one of the most disenfranchised groups in America in regard to appropriate access to substance use disorder (SUD) prevention and treatment services. This article reviews
findings related to substance use disorder and treatment for this condition among persons who are deaf. It also reviews a promising approach for addressing treatment needs via e-therapy, and it highlights the challenges and concerns regarding e-therapy for this population. …

A Descriptive Review Of Health Care Providers Perspective On Stigmatization Of Hiv/Aids Patients: United States And South Africa, Ana I. Fonseca

Honors Projects

Compares the issue of social stigma affecting people with HIV/AIDS in the United State and in South Africa. Posits that stigma is more of an interpersonal problem in the United States, while it is a huge barrier to access to care in South Africa. Data was compiled through personal conversations and experiences in South Africa during June 2009, interviews with health professional and community members in Rhode Island during the fall of 2009, and reading of the professional literature.

Nothing To Sneeze At! A Study Into Intra-Operative Contamination, David Graham, Benjamin Parkinson, Meghan Evans, Gerben Keijzers, Petra Derrington

Gerben Keijzers

Purpose: We performed a prospective study of sneezes from orthopaedic registrars to assess the potential for intra-operative contamination from a masked surgeon, and to determine if head position can alter the potential for contamination. Type of Study: Prospective controlled trial. Methods: Four orthopaedic registrars from the Gold Coast Hospital each inhaled pepper to precipitate a sneeze. Cultures were taken with and without standard Smith & Nephew™ surgical masks, in positions directly in front and to the sides of a masked registrar. The process was repeated three times for each registrar. A control plate was left exposed to the atmosphere. A …

Validation Of A Commercial Geographical Information Systems Database Of Walking And Bicycling Destinations, Heather A. Whitcomb, Ellen K. Cromley, Kosuke Tamura, Steven J. Melly, Sayali Kale, Francine Laden, Peter James, Robin Puett, Eran Ben-Joseph, Philip J. Troped

GIS Day

Background: Recent interdisciplinary studies in public health, transportation, and urban planning have shown that stores and other destinations such as banks, post offices, and physical activity facilities within close proximity to residences are positively related to recreational and transportation physical activity. The built environment has been measured several different ways, including conducting field audits and by surveying individuals’ perceptions of their neighborhood. Increasingly researchers are also using geographic information systems (GIS) software and commercially available data sources to create objective measures of the built environment. The advantages of commercial data are that they are relatively easy to access and are …

Environmental Health Service Learning And Water Quality In Gales Point, Belize, Ritchie D. Taylor, Shabbar Ranapurwala, Matthew Hill

Impact Belize

Belize is a country in Central America, formerly British Honduras, located south of Mexico and east of Guatemala on the Yucatan Peninsula. As part of the WKU International Health and Human Service Learning Program, an assessment of the local water supply in Gales Point, Belize was conducted. Gales Point is a small rural village located on the Caribbean Sea coast of Belize. Belize is a developing country thus access to safe drinking water can be problematic, as was observed on the local scale. The lack of technical, managerial and financial capacity coupled with the rural location of the village, create …

Using Primary Care To Bend The Cost Curve: The Potential Impact Of Health Center Expansion In Senate Reforms, Leighton C. Ku, Sara J. Rosenbaum, Peter Shin

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This analysis of reforms being considered in the United States Senate reaches conclusions similar to those of our prior analyses of reforms being considered in the House of Representatives. The combination of expanded health insurance coverage and investments in the expansion of community health centers can produce substantial long-term savings both for the overall health care system and for the federal government. Our analysis of the Senate provisions from the HELP and Finance Committees estimates $369 billion in total medical savings, including $105 billion in federal Medicaid savings. The Senate provisions produce larger savings because they authorize larger funding increases …

Developing A School Functioning Index For Middle Schools, Amanda Birnbaum, Leslie A. Lytle, Cheryl L. Perry, David Murray, Mary Story

Department of Public Health Scholarship and Creative Works

Despite widespread recognition of schools' role in the healthy development of youth, surprisingly little research has examined the relationships between schools' overall functioning and the health‐related behavior of students. School functioning could become an important predictor of students' health‐related behavior and may be amenable to intervention. This paper describes the development and testing of the School Functioning Index (SFI) as a first step in investigating this question. The index was developed for use with middle schools and conceived as a predictor of students' violent behavior, with the potential for extending research applications to additional health and social behaviors. Using social …

Peer-Led, School-Based Nutrition Education For Young Adolescents: Feasibility And Process Evaluation Of The Teens Study, Mary Story, Leslie A. Lytle, Amanda Birnbaum, Cheryl L. Perry

Department of Public Health Scholarship and Creative Works

Peer education has become a popular strategy for health promotion interventions with adolescents, but it has not been used widely in school‐based nutrition education. This paper describes and reports on the feasibility of the peer leader component of school‐based nutrition intervention for young adolescents designed to increase fruit and vegetable intakes and lower-fat foods. About 1,000 seventh‐grade students in eight schools received the nutrition intervention. Of these, 272 were trained as peer leaders to assist the teacher in implementing the activities. Results from a multicomponent process evaluation based on peer leader and classroom student feedback, direct classroom observation, and teacher …

Estimating The Economic Gains For States As A Result Of Medicaid Coverage Expansions For Adults, Peter Shin, Leighton C. Ku, D. Richard Mauery, Brad Finnegan, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This policy research brief examines the Medicaid eligibility expansions under the pending legislative proposals, including the House Tri-Committee bill, the Senate Health, Education, Labor and Pensions Committee bill and the Senate Finance Committee bill. Using new Census Bureau data, the researchers find that under both the House and Senate Finance Committee proposals, about 9.6 million nonelderly adults would gain Medicaid eligibility by 2014. Furthermore, the federal and state expenditures are less than Medicaid's positive impact on the economy amounting in a return of three dollars in new business activities for every dollar of state Medicaid investment. Because Medicaid is designed …

The Emergent Generation Gap In Attitudes Toward Khat Use In Urban Ethiopia, Nikki Lynn Rogers, Jared A. Embree, Yigzaw Kebede, Josephine Wilson, Mary J. Huber, Dennis Moore

Population and Public Health Sciences Faculty Publications

No abstract provided.

Education Is The Key To The Prevention Of Lawnmower Accidents, Sherry R. Lovan

Nursing Faculty Publications

No abstract provided.

Responsibility For Disease Management On Rusinga Island: Reconciling The Limitations Of External Aid And The Role Of Community-Based Initiatives, Allyson Russell

Independent Study Project (ISP) Collection

Rusinga Island has been on the receiving end of many non-governmental and government-run health interventions. Though ample money has been invested in disease control, malaria and HIV/AIDS transmission and death rates remain higher than in any other location in Kenya. This study employs the use of interviews, both formal and informal, focus group discussions and observation in order to discover possible factors which have confounded the success of previous disease management programs. The study seeks the community's perspective on these programs as well as ideas for community-based, bottom-up strategies which might be able to curb the high rates of malaria …

Conocimientos, Percepciones, Y Prácticas De Mujeres Jóvenes Acerca Del Papiloma Virus Humano, Michelle Marie Picón Ruiz

Independent Study Project (ISP) Collection

Background: Efforts by the Chilean Ministry of Health to reduce the mortality rates due to cervical cancer by 40% during 2000 - 2010 have successfully impacted every age group except for young women between the ages of 20-24. Cervical cancer is caused by Human Papiloma Virus (HPV), the most common Sexually Transmitted Infection (STI). Both are detected by the Papanicolaou test, or Pap smear. Cervical cancer found in older women most likely developed from an HPV infection contracted in their youth. This study aims to understand the knowledge, practices, and perceptions that young women in Arica, Chile have about their …

Lamu Sensitive Aid: Barriers To Distribution, Acceptance, And Use Of Malaria Prevention In Lamu District, Kelan Stoy

Independent Study Project (ISP) Collection

his study examines how organizations work locally to distribute malaria aid and education for malaria prevention. Additionally, it analyzes the effectiveness this aid has in improving malaria preventative techniques used by the people of Lamu District. This effectiveness was compared in the contexts of several regions of the district to further understand differences in rural and urban settings. Information was gathered using a variety of interviews with organizations and prominent community leaders to gauge their ideas on malaria in Lamu and strategies used to prevent it, and informal field interviews to observe different communities’ perspectives on malaria and also their …

How To Build A Health Clinic: Disease Burden, Health Seeking Behavior And Clinic Structures In The Kibera Slums, Samuel Mcgowan

Independent Study Project (ISP) Collection

This study seeks to determine a model for a health clinic to be run by the Kibera School for Girls in the Katwekera village of Nairobi’s Kibera slums. The study examines the disease burden of the school’s initial target population, the health-seeking behavior of the community, and current clinic structures in Kibera. Using these methodological tactics, the study suggests the Kibera School for Girls should start a small, locally-run clinic that offers basic primary health care to a target population of about 5,000 Kibera residents.

Kibera Community Unconscious Of The Silent Disease: Sti, Sindhya Rajeev

Independent Study Project (ISP) Collection

The objective of this study was to conduct a Sexually Transmitted Infections (STI) Awareness Survey that explores knowledge about STIs and attitude towards them, and thereafter, institute and implement an educational intervention in the Kibera slum, of Nairobi. The survey included 120 participants from the 12 villages of Kibera. It revealed that, of those interviewed, 34% are unable to name an STI other than HIV/AIDS and 99% are unaware of any of the syndromes associated with STIs. This demonstrated a clear need for STI Awareness and education, and thus an informative brochure on STIs was created, to be distributed during …

Innovation Powered By Partnerships To Transform Health Professions Education In American Indian And Alaska Native Communities - Community/Public Health Education In Native Communities, Round Table Discussion, Tim Dunnagan

Tim Dunnagan

No abstract provided.

Community Empowerment Through An Academic Product: Implications For The Social-Justice, Tamara Leech, Edrose Potts Jr.

Department of Public Health Scholarship and Creative Works

Often, African American community organizations are distanced from government institutional practices. In response, they may approach local academics to help bridge the divide. This think piece explores lessons that one academic scholar learned during the process of writing and distributing an applied report that ultimately helped a community organization to gain access to the governmental decision-making process. In exploring the project, we first focus on the process and value of shifting from a charity orientation to a social justice orientation. Second, we use the report itself to provide examples of essential, concrete aspects of social justice-oriented products. In the end, …

Using Primary Care To Bend The Curve: Estimating The Impact Of A Health Center Expansion On Health Care Costs, Leighton C. Ku, Patrick Richard, Avi Dor, Ellen Tan, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This research brief, the third in a series examining the link between national health reform proposals and community health centers, estimates the cost savings that would be realized by making important investments in non-profit health centers as an element of national health reform. Key findings include:

Increasing health center capacity by another 20 million patients by 2019 (to 39 million patients) under health reform can be expected to generate an additional $35.6 billion savings in 2019 and $212 billion in additional savings over the 2010-2019 ten-year time period.

Were the Medicaid prospective payment rate system to be applied to exchange …

Coverage And Payment For Prescription Drugs Under Medicare Part B: A Complex Patchwork, Amanda Cassidy

National Health Policy Forum

As part of the diverse discussions around health care reform, many have looked to refining Medicare payment systems as a way to give health care practitioners and providers greater incentives to deliver care more efficiently, and thus slow health care spending growth. Understanding how Medicare currently pays for Part B services, including drugs covered under Part B, is essential to understanding the potential impact of these types of reforms. Most items and services covered under Part B, including most Part B drugs, are paid individually, which means practitioners and providers generally receive more payments for providing more services. Some reform …

Stimulus Bill Implementation: Expanding Meaningful Use Of Health It, Rob Cunningham

National Health Policy Forum

The American Recovery and Reinvestment Act authorizes an estimated $38 billion in incentives and supports for health information technology (IT) from 2009 to 2019. After years of sluggish health IT adoption, this crisis-driven investment of public funds creates a unique opportunity for rapid diffusion of a technology that is widely expected to improve care, save money, and facilitate transformation of the troubled U.S. health system. Achieving maximal effect from the stimulus funds is nevertheless a difficult challenge. The Recovery Act strengthens the federal government’s leadership role in promoting health IT. But successful adoption and utilization across the health system will …

Health Center Data Warehouses: Opportunities And Challenges For Quality Improvement, A. Seiji Hayashi, Emily Jones, David M. Stevens, Peter Shin, Brad Finnegan, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This Policy Research Brief reports on a pilot effort to leverage the growing presence of health center data warehouses to advance health care quality improvement through data sharing and exchange. This project builds on a partnership between the Michigan Primary Care Association and The George Washington University's Geiger Gibson/RCHN Community Health Foundation Research Collaborative that centers on developing approaches to using existing health center data for quality improvement.

Issues For Dsm-V: The Role Of Culture In Psychiatric Diagnosis, Renato D. Alarcón, Anne E. Becker, Roberto Lewis-Fernández, Robert C. Like, Prakash Desai, Edward Foulks, Junius Gonzales, Helena Hansen, Alex Kopelowicz, Francis G. Lu, María A. Oquendo, Annelle Primm

Publications from Provost Junius J. Gonzales

No abstract provided.

The Medicare Drug Benefit: Update On The Low-Income Subsidy, Mary Ellen Stahlman

National Health Policy Forum

The Medicare drug benefit (Medicare "Part D"), provides federal subsidies to pay premiums and cost sharing for low-income beneficiaries—almost 10 million in 2009. Yet there are several policy issues concerning these low-income beneficiaries under Part D. First, over 2 million individuals who may qualify for the subsidies have not enrolled. Second, in some states, low-income beneficiaries have little choice of plans (while non-low-income beneficiaries have dozens of choices), unless they pay out-of-pocket for premium amounts above what the subsidy covers. And third, millions of those who have enrolled in the benefit face the prospect each year of switching drug plans …

Community Health Centers In Indiana: State Investments And Returns, Avi Dor, Patrick Richard, Ellen Tan, Sara J. Rosenbaum, Peter Shin, Lee Repasch

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Indiana Community Health Centers (I-CHC), including Federally Qualified Health Centers (FQHCs) and State Funded Health Centers (SFHCs), play a vital role in caring for the state's most vulnerable populations. Although their patient base tends to be poorer and experience greater health challenges than the general population, these health centers have generated substantial health care savings while providing high quality, low cost care. In this brief, key findings are presented from a recent study, conducted for the Indiana State Department of Health by GWU faculty and staff that was designed to estimate the cost savings and benefits generated by the state's …

Estimating The Effects Of Health Reform On Health Centers' Capacity To Expand To New Medically Underserved Communities And Populations, Leighton C. Ku, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Nearly 100 million persons reside in urban and rural communities that can be considered medically underserved as a result of inadequate supply of primary care physicians and elevated health risks. A report by the National Association of Community Health Centers and the Robert Graham Center estimated that 60 million people are "medically disenfranchised" and lack access to adequate primary health care because of where they live, even though many have health insurance. This brief assesses the potential effects of national health reform on health centers and on the number of patients they can serve. Because improving primary care access is …