Social and Behavioral Sciences Commons^™

Editorial Comment: Changing The Rules In Vaccine Coverage For Vulnerable Populations, Nancy L. Winterbauer

Frontiers in Public Health Services and Systems Research

Increasing life expectancy through decreasing vaccine preventable deaths is a hallmark of modern public health in the United States (1). Two federal vaccine programs help insure coverage for vulnerable populations. The Vaccines for Children (VFC) Program provides vaccines to eligible children[1] at no cost, removing financial barriers to vaccinations. Close to half of US children and 30 percent of adolescents are vaccinated through the VFC program yearly (2). The federal Section 317 Immunization Grant Program (Section 317) complements VFC by supporting the national immunization infrastructure, primarily immunization workforce, delivery systems, and emergency response, as well as by providing vaccines …

The Effects Of The Changes In Section 317 Rules For Administration Of Federally Purchased Vaccines, Margaret A. Knight, Anne D. Kershenbaum, Martha Buchanan, Janet Ridley, Paul C. Erwin

Frontiers in Public Health Services and Systems Research

Section 317 of the Public Health Services Act is a federal program that provides funds for the purchase of vaccines. These annual Congressional allocations fluctuate from year to year as Congress responds to changes in national needs for immunizations. The Affordable Care Act requires first dollar coverage of immunizations and other preventive care, allowing a reduction in federal funding for vaccine purchase and a reallocation of funds to other uses such as infrastructure development. In fiscal year 2013, Section 317 rules redefined the population eligible for immunization with Section 317 purchased vaccines. In Tennessee, the response was a policy change …

Editorial Comment: A Method For Identifying Positive Deviant Local Health Departments In Maternal And Child Health, Sharla A. Smith, Michael A. Preston, Marylou Wallace

Frontiers in Public Health Services and Systems Research

Improving the well-being of mothers, infants, and children is a vital public health initiative in the United States. Local health departments are designated agents for addressing maternal and child health outcomes. Klaiman and colleagues used a positive deviant (PD) framework in identifying the modifiable activities and approaches for LHDs that contribute to better MCH outcomes.

A Method For Identifying Positive Deviant Local Health Departments In Maternal And Child Health, Tamar A. Klaiman, Athena Pantazis, Betty Bekemeier

Frontiers in Public Health Services and Systems Research

Local health departments (LHDs) are under increasing pressure to improve performance with limited resources. While research has found that financial resources may be associated with better health outcomes, there are some LHDs that maintain exceptional performance, even with limited budgets. Our interest was identifying LHDs that positively deviate in MCH outcomes compared to their peers while taking into account local context including geography and finances. We found that our method for identifying positive deviants was effective, and that LHD expenditures may not be linked to MCH outcomes. The next step in our work is to conduct in-depth analysis with positive …

Editorial Comment: Cost-Effectiveness Analysis For Prioritization Of Limited Public Health Resources - Tuberculosis Interventions In Texas, Kaja M. Abbas

Frontiers in Public Health Services and Systems Research

Public health departments have limited evidence to understand and analyze the costs and benefits of different health programs, including tuberculosis control and prevention programs. The study by Miller et. al addresses this challenge to estimate costs and benefits of tuberculosis prevention programs in Texas and identify cost-effective diagnostic and treatment combinations, thereby improving the evidence-based decision making power of the public health departments.

Playing To Our Strengths: An Academic/Health Department Collaboration To Facilitate Public Protections Against Tuberculosis, Thaddeus L. Miller, Erin K. Carlson, Nuha A. Lackan

Frontiers in Public Health Services and Systems Research

Background:

Economic modeling and analysis can facilitate evidence-based policy and practice. Such analyses may exceed the technical capacity and mission of public health agencies, yet may be critical to sustain health protections such as tuberculosis (TB) control. The net effect of TB prevention is incompletely understood, hampering objective value judgments of national TB elimination policies. This may promote inefficiencies and threaten individual and public health protections.

We describe how a HRSA-funded Texas Public Health Training Center (TPHTC) coordinated specialized analytical skills with the needs of a state public health department to create a user-friendly tool to inform planning and resource …

Editorial Comment: Differences In Definitions Of Ebph And Evidence: Implications For Communication With Practitioners, Paul C. Erwin

Frontiers in Public Health Services and Systems Research

Through interviews of 12 members of an expert panel – importantly, involving both practitioners and researchers/academicians – Aronson and colleagues sought to understand how evidence-based public health (EBPH) is defined, what counts as “evidence”, and what EBPH actually looks like when operationalized in a local health department. What Aronson and colleagues have shown us is how critical it is that in both creating and implementing EBPH, especially in practice-based research, practitioner and researcher/academician develop a shared understanding of EBPH before the dance begins, especially for practice-based research.

Differences In Definitions Of Ebph And Evidence: Implications For Communication With Practitioners., Robert E. Aronson, Kay Lovelace, Mark Smith, Gulzar H. Shah

Frontiers in Public Health Services and Systems Research

In this study, we interviewed twelve members of an expert panel to elicit their views on Evidence-based Public Health (EBPH), including how they define EBPH, what constitutes “evidence”, and what LHDs do that can be described as EBPH. Telephone interviews lasting 60 minutes were recorded and transcribed for basic content analysis. Experts differed in their definitions of EBPH and their views of what constitutes evidence. Definitions of EBPH ranged from the adoption and implementation of rigorously tested interventions to the application of evidence to decision making for population health improvement. Views on what constitutes evidence also varied, from strict “evidence …

The Futility Of Insurgent Leader Assassination, Arian Sharifi

Ex-Patt Magazine

Questioning the utility of using drones to kill insurgent leaders. Lessons for policy makers.

Exploring The Association Between Long-Term Hpsa Designation And County Population-To-Physician Ratio, Christopher Duffrin, Natalie A. Jackson

Frontiers in Public Health Services and Systems Research

Federal, state, local and public health officials utilize Health Professional Shortage Area (HPSA) designations to manage health and physician workforce development in underserved regions. HPSA designation length by county was examined to determine if there is significant association with population-to-primary care physician ratio since the inception of HPSA designations in 1978. Counties were grouped in 5 categories based on consecutive designation length and analyzed with demographic variables. This report examines the relationship of long-term HPSA status and changes in primary care physician workforce.

The Effects Of The State Of Tennessee Immunization Policy Change Of 2011 - 2012 On Vaccination Uptake In East Tennessee, Margaret A. Knight, Anne D. Kershenbaum, Martha Buchanan, Janet Ridley, Paul C. Erwin

Frontiers in Public Health Services and Systems Research

In the United States, funding for the purchase of vaccines depend on annual Congressional allocations. These allocations fluctuate from year to year as Congress responds to changes in national needs for immunizations. The Affordable Care Act requires first dollar coverage of immunizations and other preventive care, allowing a reduction in federal funding for vaccine purchase and a reallocation of funds to other uses such as infrastructure development. In fiscal year 2012, the loss of funds allocated from the American Recovery and Reinvestment Act required action by states to ensure appropriate use of remaining funds. In Tennessee, the response was a …

Diffusion Theory And Knowledge Dissemination, Utilization And Integration, Lawrence W. Green, Judith M. Ottoson, César García, Robert A. Hiatt, Maria L. Roditis

Frontiers in Public Health Services and Systems Research

Part of the Community Health and Preventive Medicine Commons, Health and Medical Administration Commons, Health Policy Commons, Health Services Administration Commons, Health Services Research Commons, and the Public Health Education and Promotion Commons

Many accomplishments of public health have been distributed unevenly among populations. This article reviews the concepts of applying evidence-based practice in public health in the face of the varied cultures and circumstances of practice in these varied populations. Key components of EBPH include: making decisions based on the best available scientific evidence, using data and information systems systematically, applying program planning frameworks, engaging the community and practitioners …

Public Health Services Most Commonly Provided By Local Health Departments In The United States, Gulzar H. Shah, Huabin Luo, Sergey Sotnikov

Frontiers in Public Health Services and Systems Research

The primary purpose of this research is to identify the most commonly performed public health services by local health departments (LHDs) and highlight variation by LHD characteristics. Data were drawn from the 2008 and 2010 National Profile of LHDs, conducted by the National Association of County and City Health Officials (NACCHO). The descriptive analysis aims to further the essential dialogue triggered by a recent Institute of Medicine (IOM) report about the standard minimum set of services that all LHDs should provide. This study identified a set of 22 activities performed by LHDs that are common in jurisdictions of all sizes. …

Community Health Assessment By Local Health Departments: Future Questions, Kay Lovelace

Frontiers in Public Health Services and Systems Research

This "Letter to the Editor" is a response to the article "Community Health Assessment by Local Health Departments: Presence of Epidemiologist, Governance, and Federal and State Funds are Critical" published in volume 2, issue 6 of this journal. It considers how LHDs develop CHAs in complex jurisdictions, the roles of other professionals in the development of CHAs, and the conduct, quality, and use of CHAs.

State Child Welfare Policy: Causes And Consequences, Dana D. Connelly

Theses and Dissertations--Public Policy and Administration

On any given day almost 400,000 children in the United States are living in an out-of-home care placement due to government intervention. Federal law allows for substantial variance in state child welfare policy on a number of topics. These policy decisions, however, are understudied both in terms of the forces driving them and also the impacts the policies have on actual outcomes for children in care.

Utilizing a unique panel data set comprised of thirteen child welfare policies that vary both between states and over time we examine how well redistributive theory (constituent, institutional, paternalistic and resource pressures) explains state …

Science And Public Policy Of Earthquake Hazard Mitigation In The New Madrid Seismic Zone, Alice M. Orton

Theses and Dissertations--Earth and Environmental Sciences

In the central United States, undefined earthquake sources, long earthquake recurrence intervals and uncertain ground motion attenuation models have contributed to an overstatement of regional seismic hazard for the New Madrid Seismic Zone on the National Seismic Hazard Maps. This study examined concerns regarding scientific uncertainties, overly stringent seismic mitigation policies and depressed local economy in western Kentucky through a series of informal interviews with local businessmen, public officials, and other professionals in occupations associated with seismic mitigation. Scientific and relative economic analyses were then performed using scenario earthquake models developed with FEMA’s Hazus-MH software. Effects of the 2008 Wenchuan …

The Health And Nutrition Effects Of Snap: Selection Into The Program And A Review Of The Literature On Its Effects, Marianne Bitler

University of Kentucky Center for Poverty Research Discussion Paper Series

The goal of this paper is to assess the existing state of knowledge about whether SNAP improves health and nutrition outcomes, and if so, which ones and by how much.

In an era of fiscal crisis, knowing whether SNAP has any significant causal effect on health and nutrition is crucial for informing policy decisions and policy makers. In this review, I pay particular attention to the challenges researchers face in overcoming selection bias and identifying causal effects of the program, and I will assess the literature through that lens. The fundamental challenge in program evaluation in general and in assessing …

Continuing Resolutions: The Influence Of Temporary Spending Restrictions On Monthly Expenditure Patterns Of Federal Agencies, Thomas Alexander Jacobs

Theses and Dissertations--Public Policy and Administration

The federal fiscal year runs from October 1 to September 30, and many federal agencies rely on annual appropriations to fund activities and programs. Nonetheless, the federal government often enters a new fiscal year without a fully approved budget, which actuates the requirement for a temporary means of funding government operations. Congress and the president provide provisional resources by way of continuing resolutions which enable the operation of government programs until regular appropriations are enacted. However, continuing resolutions are restrictive by design and may have unintended effects on government spending behavior beyond the timeframe to which the resolutions apply.

This …

Charter School Locations Across The U.S. And Their Influence On Public School District Revenues, Peter A. Jones

Theses and Dissertations--Public Policy and Administration

Since Minnesota passed the first charter school law in 1991, charter schools have become one of the most prominent school reforms in the U.S. While charter schools educate a small portion of public school enrollments, their existence has prompted various responses from traditional public school districts. For example, districts may change expenditure patterns or work to increase test scores in an effort to retain enrollments. In this sense, a charter school’s most significant impact on public school students may work indirectly through the traditional public school reactions they invoke.

This dissertation explores education finance implications for charter schools and their …

Natural Phenomena As Potential Influence On Social And Political Behavior: The Earth’S Magnetic Field, Jackie R. East

Theses and Dissertations--Political Science

Researchers use natural phenomena in a number of disciplines to help explain human behavioral outcomes. Research regarding the potential effects of magnetic fields on animal and human behavior indicates that fields could influence outcomes of interest to social scientists. Tests so far have been limited in scope. This work is a preliminary evaluation of whether the earth’s magnetic field influences human behavior it examines the baseline relationship exhibited between geomagnetic readings and a host of social and political outcomes. The emphasis on breadth of topical coverage in these statistical trials, rather than on depth of development for any one model, …

Family Support Caseloads--Determinants Of Kentucky's Division Of Family Support Personnel Allocation, David Bachert

MPA/MPP/MPFM Capstone Projects

This paper is an examination of the determinants of Family Support employee allocation. Specifically, related to Kentucky, the goal of this research is to determine if public assistance caseloads are equitable across nine geographic regions. A review of relevant literature provides a larger context to this topic. Literature primarily suggests three mechanisms by which Family Support resources might be allocated: legal regulations, postcode lottery, and Tiebout migration.

Supported by literature the larger context for this paper leads to the examination of five independent variables: (1) percent of Supplemental Nutrition Assistance Program recipients \, (2) total population, (3) percent of the …

Study Of Thoroughbred Workers: Physical Health, Mental Health, And Income, Marina Byrd

MPA/MPP/MPFM Capstone Projects

Horse racing is a well-known sport and the part of the horse industry best known to the public; however, there is little information on the health status and health needs of people who work in this business. Past research shows that the thoroughbred worker population faces a myriad of health challenges. Swanberg et al. (2013) studied demographics, working conditions, and health of Latinos who work on thoroughbred farms in the United States by analyzing phone interviews, face-to-face interviews, and injury logs. The majority of injuries in this study are general injuries such as getting kicked or injuring fingers.

This study …

Do Municipal Stat Programs Improve Services And Reallocate Resources? Evidence From Louiestat, Jamie Giles

MPA/MPP/MPFM Capstone Projects

Performance metrics and municipal stat programs are becoming increasingly popular to measure performance of city departments in order to improve services and save taxpayers’ dollars. The intent of this research is to give decision makers a better understanding to what extent municipal stat programs make an impact on the departments being measured, using an analysis of Metro Louisville’s LouieStat as evidence. Understanding the effect of PerfomanceStat tools will provide insight for the Louisville Administration and for other cities considering using a similar tool.

The literature finds performance management tools to be more widely used as a management tool to influence …

Public Retirement Systems: An Examination Of Governance Characteristics And Their Impact On The Funded Ratio, Chris Groves

MPA/MPP/MPFM Capstone Projects

By almost all accounts, the fiscal health and stability of the United States public retirement system at all levels is in peril. Collectively, local and state public retirement systems are underfunded at a rate of $700 billion as a low estimate to $3 trillion as a higher estimate. While plenty of research has been conducted to identify the reasons that programs are underfunded, the system would be best served if more attention were paid to identifying program characteristics that improve performance. In turn, these characteristics could be evaluated and implemented if not already present. If programs do not want to …

Academic Asset Or Instructor’S Indulgence? The Effect Of Arts & Cultural Institutions On Academic Achievement, Hank Harned

MPA/MPP/MPFM Capstone Projects

Across the country arts and cultural institutions seek to preserve our past and use it to educate our future. As their exhibits expand these institutions have become treasures in their own rights; places like the Smithsonian Institute are landmarks that attract visitors from around the world. In addition to travelers they also attract school groups. For decades schools have been using “field trips” to museums as a way to supplement their curriculum. But do these trips actually benefit the students or are they a waste of resources? This project aims to evaluate whether these institutions are an asset to academics …

Does Overhead Spending Affect Fiscal Performance Of Nonprofits?, Shan Sandee Huang

MPA/MPP/MPFM Capstone Projects

Overhead spending has been used to view nonprofits for decades. Donors consider overhead cost as extra “price” of a donation’s impact and would like to apply limits on overhead costs, thus improving impact ratios. However, nonprofit practitioners and researchers claim that constraints on overhead spending may hinder organizational development. This paper aims to analyze whether overhead spending affects positive fiscal performance.

The research employs the NCCS (National Center for Charitable Statistics) database containing all the data reported on IRS 990 Forms from 1,397 arts, culture and humanities organizations from 2000 to 2003. This paper uses two regression models to evaluate …

Crossing The Border For The Pill: An Analysis Of The Decision To Purchase Oral Contraceptives Over-The-Counter From Mexican Pharmacies, Nadine Johnson

MPA/MPP/MPFM Capstone Projects

In 2012, the American College of Obstetricians and Gynecologists published an opinion statement in which they acknowledged that oral contraceptives were safe to be sold over the counter. Although there are several arguments that the lack of insurance of over the counter birth control would create a bigger cost barrier, research shows that women are in fact willing to pay for contraception if it is available over the counter. Some countries, such as Mexico, have this option available and because of the proximity to the United States, many women who live on the southern border take advantage of this. However, …

Cost Analysis Of A Pharmacy Intern Program At A Tertiary Academic Medical Center, Bridgette Kanz

MPA/MPP/MPFM Capstone Projects

In the modern world of healthcare, the role of the pharmacy intern is growing as hospitals look to decrease cost and increase care. The University of Kentucky Pharmacy Intern Program (UKPIP) employs pharmacy interns as pharmacist extenders to help complete the clinical task of medication reconciliation (med recs). The purpose of this study was to quantify the value of completing this task and determine whether it is cost effective to have interns or pharmacists in this role.

The Institutional Review Board approved this study. UK’s electronic medical record database identified admission med recs completed by pharmacy interns and pharmacists in …

Does Tax Revenue Diversification Help States Weather Economic Downturns? Evidence From The Great Recession, Nick Kilby

MPA/MPP/MPFM Capstone Projects

This capstone seeks to build on previous research to assess the validity of the claim that revenue diversification is an effective policy tool for states to use during recessions in order to stabilize their revenue flow. Revenue diversification is defined as the degree to which states take advantage of various tax sources, rather than reliance on a few or one in particular. Previous research, especially by Carroll (2005) and Suyderhound (1994), has shown that states with higher revenue diversification rates experience lower revenue shortfalls during recessions and other economic downturns on average.

This paper will reassess these claims in terms …

The Effect Of Direct Payments To Rice Farming Households In Korea, Jaehyung Kim

MPA/MPP/MPFM Capstone Projects

1) Background

Rice farming is a very important agricultural policy issue for the Korean government not only because rice is a staple food for the Korean population but because rice production is also an important source of income for those involved in rice farming. The importance of rice production to the agricultural sector of Korea is indicated by the fact that 49% of Korea’s agricultural land is devoted to rice production. Therefore, Korean agricultural policy has focused on rice production issues as well as the income of farmers involved in rice production.

To support rice farming income, the Korean government …