Health Policy Commons^™

Hunger Games: Policies To Address Food Deserts In Rhode Island's Low Income Communities, Jessi Mcneill

Pell Scholars and Senior Theses

This policy paper examines the global, health, and social implications of food deserts in the state of Rhode Island. This paper assesses the inception of the food desert phenomenon and draws attention to three policy options for the state. While there is sufficient research on food deserts in large cities like New York and Philadelphia, little information is available regarding the implications of food deserts and policy options available to provide low-income Rhode Islanders with healthy, affordable food. Research methodology consists of site visits and interviews, as well as research courtesy of the 2017 Rhode Island Food Strategy and nonprofit …

Financial Exploitation Of Maine's Older Adults: An Analysis Of Maine Adult Protective Services And Legal Services For The Elderly Case Records, State Fiscal Years 2010-2016, Eileen Griffin Jd, Catherine Mcguire Bs, Kimberly I. Snow Mhsa, Ba

Disability & Aging

The goal of this study was to capture information about the amount of money Maine’s older adults have lost to financial exploitation, along with information about those exploited, the perpetrators of financial exploitation, the type of loss, and amount of money lost. This report summarizes key findings emerging from this analysis. In particular, we found that, when compared to Maine’s general population of adults age 60 and older, the victims of financial exploitation served by Maine's Adult Protective Services (APS) and Legal Services for the Elderly (LSE) are more likely to be age 80 and older, female; and widowed, single, …

Let Them Eat Lunch: The Impact Of Universal Free Meals On Student Performance, Amy Ellen Schwartz, Michah W. Rothbart

Center for Policy Research

This paper investigates the impact of extending free school lunch to all students, regardless of income, on academic performance in New York City middle schools. Using a difference-in-difference design and unique longitudinal, student level data, we derive credibly causal estimates of the impacts of “Universal Free Meals” (UFM) on test scores in English Language Arts (ELA) and mathematics, and participation in school lunch. We find UFM increases academic performance by as much as 0.059 standard deviations in math and 0.083 in ELA for non-poor students, with smaller, statistically significant effects of 0.032 and 0.027 standard deviations in math and ELA …

Reducing The Rate Of Cesarean Delivery On Maternal Request Through Institutional And Policy Interventions In Wenzhou, China, Yushan Yu, Xiangyang Zhang, Caixia Sun, Huijie Zhou, Qi Zhang, Chun Chen

Community & Environmental Health Faculty Publications

The objective of this study was to evaluate the effect of institutional and policy interventions on reducing the rate of cesarean delivery on maternal request (CDMR) in Wenzhou, China. Institutional interventions included health education, painless delivery introduction, and doula care. Additionally, a series of health policies were developed by the Chinese central and local governments to control cesarean section rates, mostly through controlling CDMR rates. We conducted a pre-/post-intervention study using 131,312 deliveries between 2006 and 2014 in three tertiary-level public hospitals in Wenzhou, China. Chi-square tests and predictive models were used to examine changes in the CDMR rate before …

Healthcare: What Comes Next?, William H. Lane

English Faculty Publications

Where do we go from here on healthcare?

America has been talking about fixing its fragmented and overly expensive healthcare system for quite a while now. At times, it seems as though we simply keep having the same conversation (or argument, if you prefer) over and over again without making much progress in ensuring access to affordable care to all Americans. In fact, however, some significant gains have been made. Twenty million left without insurance (our situation now) has got to be better than forty million left without (our situation a decade ago).

Gender Differences In Virologic Response After Antiretroviral Therapy In Treatment-Naïve Hiv-Infected Individuals: Results From The 550 Clinic Hiv Cohort Study., Andrea Reyes-Vega, Alejandra Loban, Kavitha Srinivasan, Stephen P. Furmanek, Conner English, Mary Bishop, Cathy Spencer, Daniel Truelove, Julio A. Ramirez, Anupama Raghuram, Paula Peyrani

Faculty Scholarship

Background

Controversy still exists regarding gender differences in virologic response between treatment-na•ve HIV-infected individuals. The objective of this study was to evaluate gender difference in virologic and immunologic response to antiretroviral therapy in treatment-na•ve HIV-infected individuals. Methods

This was a retrospective, observational study of treatment-na•ve HIV-infected individuals managed at the 550 clinic who started antiretroviral therapy (ART) between January 1st, 2010 and December 31, 2015. Patients with available viral load and CD4 counts before and one year after initiating ART were included in this study. Virologic suppression was defined as < 48 HIV-1 RNA copies/mL, and mmunologic recovery was defined as a CD4 count increase of at least 150 cells/mm3. Dichotomous variables were reported in number and percentages and analyzed using Chi-squared tests and Fisher’s exact (whichever was appropriate). Continuous variables were reported as median and interquartile range (IQR) and analyzed using Wilcox rank-sum tests. Multivariate analyses performed were logistic regressions with adjustment for other covariates. P value <0.05 was considered statistically significant. R version 3.3.2 was used for the statistical analysis. Results

A total of 70 women and 90 men were included …

Food Justice In The Trump Age: Priorities For Urban Food Advocates, Nevin Cohen, Janet Poppendieck, Nicholas Freudenberg

Publications and Research

Every constituency – regardless of political ideology – must analyze the effects of the election of Republican majorities in Congress and Donald J. Trump as President of the United States. This is particularly true for advocates involved in eliminating food insecurity and hunger, fighting malnutrition and health inequality, and ensuring sustainable and fair urban food systems with high quality jobs. Anticipating the new administration’s efforts that may undermine food justice enables advocates, researchers, and policy makers to choose priorities and forge strategic partnerships.

Clinician-Investigator Training And The Need To Pilot New Approaches To Recruiting And Retaining This Workforce., Alison K Hall, Sherry L Mills, P Kay Lund

Neurology Faculty Publications

Clinician–investigators, also called physician–scientists, offer critical knowledge and perspectives that benefit research on basic science mechanisms, improved diagnostic and therapeutic approaches, population and outcomes medicine, health policy, and health services, yet few clinically trained health professionals pursue a research career. Sustaining this workforce requires attention to the unique challenges faced by investigators who must achieve clinical and research competence during training and their careers. These challenges include the duration of required clinical training, limited or discontinuous research opportunities, high levels of educational debt, balancing the dual obligations and rewards of clinical care and research, competition for research funding, and the …

Influence Of Pharmaceutical Marketing On Medicare Prescriptions In The District Of Columbia, Susan Wood, Joanna Podrasky, Meghan Mcmonagle, Janani Raveendran, Tyler Bysshe, Alycia Hogenmiller, Adriane Fugh-Berman

Health Policy and Management Faculty Publications

Importance

Gifts from pharmaceutical companies are believed to influence prescribing behavior, but few studies have addressed the association between industry gifts to physicians and drug costs, prescription volume, or preference for generic drugs. Even less research addresses the effect of gifts on the prescribing behavior of nurse practitioners (NPs), physician assistants (PAs), and podiatrists.

Objective

To analyze the association between gifts provided by pharmaceutical companies to individual prescribers in Washington DC and the number of prescriptions, cost of prescriptions, and proportion of branded prescriptions for each prescriber.

Design

Gifts data from the District of Columbia’s (DC) AccessRx program and the …

Key New Hampshire And Federal Statutes Regulating Health Care Delivery And Payment, Lucy Hodder

Law Faculty Scholarship

A summary of New Hampshire and federal regulations by subject matter, chart of New Hampshire state agency responsibilities, federal laws and regulation: An index

Community Paramedicine Pilot Programs: Lessons From Maine, Karen B. Pearson Mlis, Ma, George Shaler Mph

Emergency Medical Services (EMS)

Community paramedicine programs are beginning to flourish across the nation, and the need to provide demonstration or pilot programs is essential to providing a consistent and high-level standard for this model of care. While the overarching goals are to align with the Triple Aim, piloting a community paramedicine program also allows each community to develop and implement a program tailored to the healthcare needs of their specific community. A successful program builds the evidence base that can then be used to create legislative change necessary to financially sustain this model of care across the healthcare delivery system. This article provides …

Caring For Caregivers: Challenges Facing Informal Palliative Caregivers In Western Kenya, Hartlee Johnston

Independent Study Project (ISP) Collection

Chronic illnesses like cancer, HIV, and other non-communicable disease are increasing globally, especially in developing countries, necessitating development of palliative care and symptom management systems. In Kenya, the burden of care for chronically ill patients often falls to unpaid, informal caregivers like family members or friends. Thirty-five current or past informal caregivers from Kisumu, Kenya were interviewed about their experience, challenges they faced, and interventions they felt would be helpful. Major challenges identified included lack of finances for treatment and other living expenses; inadequate, unaffordable, or interrupted medical care; emotional stress exacerbated by juggling many responsibilities, pressure to emotionally support …

Women Of Leh Town, Ladakh: An Overview Of Perceptions Of Health, Health-Seeking Behaviors, And Access To Health Care, Sophia Marion

Independent Study Project (ISP) Collection

The following study seeks to investigate access to health care services and perceptions of health care among women residing in traditional farming communities around the Ladakh region, and to analyze perspectives on health, health-seeking behavior, and access to health care. This project was prompted by the fact that health care in this region is understudied. This study also focuses on marginalized communities including local women and immigrant women. Methods used for the collection of data were qualitative interviews conducted with 24 women, as well as an amchi worker, doctors, and informal and formal conversations with people from different nongovernmental Organizations …

When Knowledge Flows: A Case Study Of Village Health Workers’ Motivations In Jamkhed, Selaem Hadera

Independent Study Project (ISP) Collection

Across the field of global health, there have been many attempts to cater to the health needs of the most marginalized populations. Community health workers (CHWs) are individuals that live in the communities they serve and are typically low-­‐income women with little to no formal education. After a period of training by their program, they enter their communities equipped as a bridge between the community and the health system. Although CHWs do play a substantial role in health delivery and education, the structure of CHW programs varies widely, but a common characteristic of these programs is that the CHWs are …

When The Health System Fails You: Maternal Care Under Kenya’S 2017 Nurses' Strike, Tessa Coughtrey-Davenport

Independent Study Project (ISP) Collection

This study focuses on the 2017 nurses’ strike and how the crippling of the public health system impacted maternal care in Kisumu, Kenya. Kenya has one of the highest maternal mortality ratios in the world, and there have been many efforts to reduce this, such as delivery with a Skilled Birth Attendant and attending antenatal care visits, all of which are centered around a functioning health system. The research team used a combination of interviews with key populations and analysis of service delivery data at local health centers to evaluate the effects of the strike on maternal care. The study …

Understanding Sanitation Preferences: An Exploratory Study In The Sirohi District Of Rajasthan, Karen Mac

Independent Study Project (ISP) Collection

Of all the countries in the world, India has the highest number of people practicing open defecation, causing adverse health outcomes from the unconfined spread of faecal matter. The Government of India is ambitiously aiming to end this practice through the construction of 12 million toilets by 2019, but historically, many toilets across India have gone unused. This study focused on understanding: (1) the reasons why people continue to openly defecate despite having toilets and (2) the requirements of a toilet that rural households would be willing to use. Along with 36 observations of household toilets, semi-structured group (n=8) and …

Community Perception Of The Hiv Vaccine In Western Kenya: Acceptability, Potential Behavior Changes, And Views On Compulsory Vaccination, Deborah Keen

Independent Study Project (ISP) Collection

Human Immunodeficiency Virus (HIV) suppresses the immune system by attacking T cells, leading to the development of acquired immunodeficiency syndrome (AIDS). HIV affects over 30 million people around the world and 1.6 million people in Kenya. On August 18, 1987, the FDA sanctioned the first human testing of a candidate vaccine for HIV. Currently, multiple HIV vaccines—projected to be on the market in five to ten years—are being tested for efficacy and safety. The goal of this study was to explore opinions related to the HIV vaccine so that there is a guide for future policy development in Western Kenya. …

The Latex Journey: A Narrative Approach To Exploring Condom Use, Stigma, And Education From The Perspective Of Women In Masxha, Kylie Yocum

Independent Study Project (ISP) Collection

Although the South African National Department of Health (NDOH) is spending increasing amounts of money on improving their HIV programs (including the rollout of new, scented condoms for their condom distribution program), the rates of condom use at last sexual encounter are declining. This inquiry focused on young women in the neighborhood of Masxha, Cato Manor, and their opinions surrounding how condoms are being used or misused, as well as the gender norms that perpetrate this (mis)use. This inquiry demonstrated the narratives of these young women on factors such as condom acquisition, gendered stigma, and condom education, including the Life …

Social Support Networks And The Mental Health Of Runaway And Homeless Youth, Eric Wright, Brandon K. Attell, Erin Ruel

GHPC Articles

In response to growing concerns about the rising number of runaway and homeless youth (RHY) in the U.S., researchers have sought to improve the scientific understanding of health and mental health needs, as well as the social resources available to these youths. In this paper, we examine the relationship between personal support network resources and the mental health status of a sample of RHY (N = 693) surveyed in metro-Atlanta, Georgia. The results suggest that having more supportive network ties reduces the risk of youth experiencing significant symptoms of a severe mental illness. We also find that older youth and …

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) …

Charting A Pathway Forward: Redesigning And Realigning Supports And Services For Maine's Older Adults, Eileen Griffin Jd, Elizabeth C. Gattine Jd

Disability & Aging

The current growth of the population age 65 and older is one of the most significant demographic trends in the history of this country and is especially significant for Maine, where the number of people age 65 and older is growing even faster than the rest of the nation. By 2025, over a quarter of Maine’s population is expected to be age 65 and older. Because the cost of long term paid support is out of reach for many Mainers, public financing—particularly Medicaid financing—is an essential tool for addressing the long term support needs of older adults. But Medicaid is …

2484: Establishment Of The Tennessee-Sickle Cell Disease Network As A Mechanism For Engaging A Rare Disease Population In Patient Centered Outcomes Research, Tilicia Mayo-Gamble, Velma Mcbride Murry, Michael R. Debaun

Department of Health Policy and Community Health Faculty Publications

OBJECTIVES/SPECIFIC AIMS: Despite the high prevalence of individuals diagnosed with sickle cell disease (SCD) in Tennessee, comprehensive care and education for patients with SCD is not as widely available as healthcare services for individuals managing other chronic illnesses. We aimed to engage SCD stakeholders in patient-centered outcomes research (PCOR) as a mechanism for advancing care and translational research for this rare disease population. METHODS/STUDY POPULATION: Through a partnership with the Sickle Cell Foundation of Tennessee, we implemented Community Health Ambassadors to systematically engage patient partners with SCD and their caregivers, aged 18–50 from rural and urban communities throughout Tennessee, in …

Trends In The Environmental Health Job Market For New Graduates, Jason W. Marion, Timothy J. Murphy Phd, Anne Marie Zimeri Phd

EKU Faculty and Staff Scholarship

The question of whether the job market can support future graduates of environmental health programs remains an important and difficult question for environmental health programs, current and prospective students, parents, and other stakeholders. Our previous report using 2014 data from the U.S. Bureau of Labor Statistics demonstrated anticipated growth and higher than average pay in the profession through at least 2022 for baccalaureate degree holders (Marion & Sinde, 2015). Growth in the profession does not necessarily translate into job availability if the market is saturated with job candidates. While university programs produce graduates, local health departments (LHDs) have suffered tremendous …

Barriers And Facilitators To The Integration Of Mental Health Services Into Primary Health Care: A Systematic Review Protocol., Edith K Wakida, Dickens Akena, Elialilia S Okello, Alison Kinengyere, Ronald Kamoga, Arnold Mindra, Celestino Obua, Zohray M Talib

Health Policy and Management Faculty Publications

Background

Mental health is an integral part of health and well-being and yet health systems have not adequately responded to the burden of mental disorders. Integrating mental health services into primary health care (PHC) is the most viable way of closing the treatment gap and ensuring that people get the mental health care they need. PHC was formally adapted by the World Health Organization (WHO), and they have since invested enormous amounts of resources across the globe to ensure that integration of mental health services into PHC works.

Methods

This review will use the SPIDER (Sample, Phenomenon of Interest, Design, …

A Mixed Methods Study Of Hiv-Related Services In Buprenorphine Treatment, Hannah K. Knudsen, Jennifer Cook, Michelle R. Lofwall, Sharon L. Walsh, Jamie L. Studts, Jennifer R. Havens

Behavioral Science Faculty Publications

Background: Opioid use disorder (OUD) is a major risk factor in the acquisition and transmission of HIV. Clinical practice guidelines call for the integration of HIV services in OUD treatment. This mixed methods study describes the integration of HIV services in buprenorphine treatment and examines whether HIV services vary by prescribers’ medical specialty and across practice settings.

Methods: Data were obtained via qualitative interviews with buprenorphine experts (n = 21) and mailed surveys from US buprenorphine prescribers (n = 1174). Survey measures asked about screening for HIV risk behaviors at intake, offering HIV education, recommending all new patients …

Creating A Taxonomy Of Local Boards Of Health Based On Local Health Departments’ Perspectives, Gulzar H. Shah, Sergey Sotnikov, Carolyn J. Leep, Jiali Ye, Timothy W. Van-Wave

Department of Health Policy and Community Health Faculty Presentations

Objectives: To develop an LBoH classification scheme and empirical definitions to provide a coherent framework for describing variation in the LBoHs.

Data and Methods: This study is based on data from the 2015 Local Board of Health Survey, conducted among a nationally representative sample of LHD administrators, with 394 responses. The classification development consisted of the following steps: (a) theoretically guided initial domain development, (b) mapping of the survey variables to the proposed domains, (c) data reduction using principal component analysis and group consensus, and (d) scale development and testing for internal consistency.

Results: The final classification scheme included 60 …

Does Liberalizing State Nurse Practitioner Scope Of Practice Laws Affect The Primary Care Provider Composition And Productivity In Community Health Centers?, Jeongyoung Park, Xinxin Han, Ellen T. Kurtzman

Health Workforce Research Center Publications

The state scope of practice (SOP) laws determine the range of services nurse practitioners (NPs) can provide and the extent to which they can practice independently. This has been a hot topic amid concerns about primary care provider shortages in light of health reform coverage expansion. Many states consider liberalizing NP SOP laws in an effort to expand primary care capacity. As the demand for primary care increases, NPs are expected to have an active role in meeting primary care needs. The purpose of this study was to examine the effects of expanded nurse practitioner (NP) scope of practice (SOP) …

How Canada Can Help Global Adolescent Health Mature, Ashley Vandermorris, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: There is an emerging focus on adolescent health within the global health community as we come to recognize that the adolescent years are formative in determining health and health-related behaviours across the life-course. Such attention is not only relevant on the global scale but is imperative in Canada as well.

Main body: This commentary provides a brief review of recent investments targeting global adolescent health and presents five potential avenues for action which emerged out of the recent Canadian Partnership for Women and Children’s Health (CanWaCH) Global Adolescent Health conference. These avenues are: (1) Demand data; (2) Embrace complexity; …

Pregnancy Medicaid Expansions And Fertility: Differentiating Between The Intensive And Extensive Margins, Lincoln H. Groves, Sarah Hamersma, Leonard M. Lopoo

Center for Policy Research

The theoretical and empirical links between public health insurance access and fertility in the United States remain unclear. Utilizing a demographic cell-based estimation approach with panel data (1987-1997), we revisit the large-scale Medicaid expansions to pregnant women during the 1980s to estimate the heterogeneous impacts of public health insurance access on childbirth. While the decision to become a parent (i.e., the extensive margin) appears to be unaffected by increased access to Medicaid, we find that increased access to public health insurance positively influenced the number of high parity births (i.e., the intensive margin) for select groups of women. In particular, …

Supporting And Retaining Village Health Teams: An Assessment Of A Community Health Worker Program In Two Ugandan Districts., Daniel C Mays, Edward J O'Neil, Edison A Mworozi, Benjamin J Lough, Zachary J Tabb, Ashlyn E Whitlock, Edward M Mutimba, Zohray M Talib

Health Policy and Management Faculty Publications

Background

Uganda’s national community health worker program involves volunteer Village Health Teams (VHTs) delivering basic health services and education. Evidence demonstrates their positive impact on health outcomes, particularly for Ugandans who would otherwise lack access to health services. Despite their impact, VHTs are not optimally supported and attrition is a growing problem. In this study, we examined the support needs and existing challenges of VHTs in two Ugandan districts and evaluated specific factors associated with long-term retention. We report on findings from a standardized survey of VHTs and exploratory interviews with key stakeholders and draw conclusions that inform efforts to …