Digital Commons Network^™

Reframing School Dropout As A Public Health Issue, Nicholas Freudenberg, Jessica Ruglis

Publications and Research

Good education predicts good health, and disparities in health and in educational achievement are closely linked. Despite these connections, public health professionals rarely make reducing the number of students who drop out of school a priority, although nearly one-third of all students in the United States and half of black, Latino, and American Indian students do not graduate from high school on time. In this article, we summarize knowledge on the health benefits of high school graduation and discuss the pathways by which graduating from high school contributes to good health. We examine strategies for reducing school dropout rates with …

Long-Term Effects Of A Physical Activity Intervention In High School Girls, Russell R. Pate, Ruth P. Saunders, Rod K. Dishman, Cheryl L. Addy, Marsha Dowda, Dianne S. Ward

Faculty Publications

Background - Physical activity decreases during childhood and adolescence, and physical activity levels are significantly lower in females than males, particularly during adolescence. Schools are attractive settings in which to implement interventions designed to promote physical activity in girls and young women, but few studies have tested the sustained effects of such interventions.

Design - Cross-sectional. Data were collected in 2002-2003 and analyzed in 2006-2007.

Setting/Participants - 1594 adolescent girls in 22 high schools.

Intervention - The intervention, Lifestyle Education for Activity Program (LEAP), was designed to increase physical activity in 9^th grade girls through two channels: changes in …

Factors Associated With Integrating Self-Management Support Into Primary Care, Richard Crespo, Molly Shrewsberry

Family and Community Health

Purpose

The purpose of this article is to expand the understanding of self-management support by describing factors that contribute to implementing a comprehensive self-management program in primary care.

Methods

Four rural health centers in medically underserved areas participated in a study to document the implementation of a self-management program. This program consisted of a social marketing plan and decision-making tools to guide patients in making self-management behavior changes. The stages of change constructs of the transtheoretical model were used to design the social marketing plan. Key informant interviews were conducted at 6-month and 9-month intervals to document the implementation process. …

Consolidating A Gender Perspective In The Procosi Network, Erica Palenque De La Quintana, Patricia Riveros Hamel, Ricardo Vernon

Reproductive Health

The Integral Health Coordination Program (Programa de Coordinación en Salud Integral, or PROCOSI) in Bolivia developed a program to certify service delivery and management support NGOs as gender-sensitive. The certification system is based on an initial self-assessment by teams consisting of staff from service delivery (clinical) or management support (administrative) NGOs, followed by the development and implementation of activities to improve the gaps found until a minimum of 80 percent of the designated quality and gender standards are met. At the project’s end, 14 of the 15 participating NGOs had reached compliance with at least 80 percent of the proposed …

Download The Pdf Of The Entire Issue: Pehc Vol. 1, Issue 2

Prescriptions for Excellence in Health Care Newsletter Supplement

No abstract provided.

Women’S Health In Developing Countries, Javed Rizvi, Nadeem F. Zuberi

Department of Obstetrics & Gynaecology

Healthcare priorities are different in developing and developed countries. A more effective resource allocation, complemented by efforts to implement only those practices that are effective, should be a priority for improving reproductive health services in developing countries. A large burden of gynaecological disease exists in developing countries and it is difficult to envisage serious reforms and improvements without an increase in public-sector spending. However, communities themselves could assume some responsibility for women's health in ways that prioritize women's own perceptions and primary needs. In this chapter we have compiled existing evidence regarding various gynaecological problems faced by women in developing …

Promoting Physical Activity In Children And Youth: A Leadership Role For Schools: A Scientific Statement From The American Heart Association Council On Nutrition, Physical Activity, And Metabolism (Physical Activity Committee) In Collaboration With The Councils On Cardiovascular Disease In The Young And Cardiovascular Nursing, Russell R. Pate, Michael G. Davis, Thomas N. Robinson, Elaine J. Stone, Thomas L. Mckenzie, Judith C. Young

Faculty Publications

No abstract provided.

New Publications From The Office Of Health Policy And Clinical Outcomes

Population Health Matters (Formerly Health Policy Newsletter)

No abstract available.

Exploring California's Rural Health System: From The Redwood Forests To The Baja Border, Eileen Salinsky, Jessamyn Taylor

National Health Policy Forum

This three day site visit to California explored the state’s rural health system with a particular focus on the financial health of inpatient and outpatient providers and how that affects access to care. The role of telemedicine as a tool for expanding access was explored as well as the special needs of vulnerable populations such as farmworkers. Participants learned how state and federal regulation and payment policies and state budget deficits impact the viability of rural health systems.

Accelerating Reproductive And Child Health Program Development: The Navrongo Initiative In Ghana, James F. Phillips, Ayaga A. Bawah, Fred N. Binka

Poverty, Gender, and Youth

Successive global health and development agendas have been embraced by African governments—Alma Ata in 1978, the Bamako Initiative in 1987, the 1994 Cairo International Conference on Population and Development, and more recently the Millennium Development Goals (MDGs)—only to be followed by widespread implementation failure. This paper presents an approach to program development in Ghana that is using research to accelerate policy implementation. Originally launched in 1994 as a participatory pilot project of the Navrongo Health Research Centre, a controlled experimental study was initiated in 1996 to assess the fertility and child-survival impact of alternative community health and family planning service …

The Effect Of Community Nurses And Health Volunteers On Child Mortality: The Navrongo Community Health And Family Planning Project, Brian Wells Pence, Philomena Nyarko, James F. Phillips, Cornelius Debpuur

Poverty, Gender, and Youth

This report presents the child mortality impact of a trial of primary health-care service-delivery strategies in rural Ghana. After adjustment for sociodemographic factors, under-five mortality in areas with village-based community-nurse services fell by 16 percent during the five years of program implementation compared with mortality before the intervention. Reductions were observed in infant (6 percent), early child (20 percent), and late child (41 percent) mortality. Community involvement and training of a local health volunteer were associated with an 11 percent increase in mortality, primarily driven by a 124 percent increase in early child mortality. Areas with both nurses and volunteers …

Poverty And Children's Schooling In Urban And Rural Senegal [Arabic], Mark R. Montgomery, Paul C. Hewett

Poverty, Gender, and Youth

This paper presents findings of an investigation into the effects of living standards and relative poverty on children’s schooling in urban and rural areas of Senegal. To measure living standards, we apply a multiple-indicator, multiple-cause (MIMIC) factor-analytic model to a set of proxy variables collected in the 2000 Multiple Indicator Cluster Survey and extract an estimate of the relative standard of living for each household. Using this estimate, we find that in Senegal’s urban areas, living standards exert substantial influence on three measures of schooling: Whether a child has ever attended school; whether he or she has completed at least …

Active Life Expectancy And Functional Limitations Among Older Cambodians: Results From A 2004 Survey, Zachary Zimmer

Poverty, Gender, and Youth

This study’s aims are to: (1) determine the prevalence of functional limitations among older adults in Cambodia using activities of daily living (ADLs); (2) compare limitation prevalence with other countries in the region; (3) estimate active life expectancy; (4) examine standard correlates of functional status and assess whether they are associated with limitation in expected ways. Elderly Cambodians appear more likely to report limitations than their counterparts in neighboring countries. A contribution of the analysis is the examination of a basic measure of health among a population that until recently has been isolated from the rest of the world.

Population And Sustainability, Geoffrey Mcnicoll

Poverty, Gender, and Youth

Sustainability refers to the preservation of human-valued natural capital—the resources that provide environmental services—at a level sufficient to assure the well-being of future generations. This Population Council working paper assess the effects on the total and per capita availability of those services. The degradation of environmental services—exemplified by the overuse of aquifers or (at a global level) of the atmospheric carbon sink—is a significant threat to sustainable development, one that is often exacerbated by population growth. The critical management issue in such cases is the design of effective governing institutions to restrain service demand and safeguard supply. Uncertainties arising from …

Education Of Adult Children And Mortality Of Their Elderly Parents In Taiwan, Zachary Zimmer, Linda G. Martin, Mary Beth Ofstedal, Yi-Li Chuang

Poverty, Gender, and Youth

Research shows an older adult’s education is strongly associated with mortality. But in societies such as Taiwan, where families are highly integrated, the education of family members may be linked to survival. Such may be the case in settings where there are large gaps in levels of education across generations and high levels of resource transfers between family members. This Population Council study employs 14 years of longitudinal data from Taiwan to examine the combined effects of education of older adults and their adult children on mortality outcomes of older adults. Results indicate that educational levels of both parent and …

Reciprocal Effects Of Health And Economic Well-Being Among Older Adults In Taiwan And Beijing, Kristine R. Baker, Mary Beth Ofstedal, Zachary Zimmer, Zhe Tang, Yi-Li Chuang

Poverty, Gender, and Youth

The objectives of this Population Council study are threefold: 1) to examine whether socioeconomic status disparities in health are found in non-Western settings; 2) to assess whether socioeconomic status gradients in health endure into older ages; and 3) to evaluate the direction of causality between health and socioeconomic status. Findings provide evidence for reciprocal effects of economic well-being and health among older adults in both Taiwan and Beijing. Those with higher levels of economic well-being have lower levels of functional limitation over time, and those with higher levels of functional limitation have lower levels of economic well-being over time. Consistent …

The Impact Of Childhood Mortality On Fertility In Six Rural Thanas Of Bangladesh, Mian Bazle Hossain, James F. Phillips, Thomas K. Legrand

Poverty, Gender, and Youth

This Population Council working paper examines the causal structure of the relationship between child mortality events and subsequent fertility during a time of rapid decline in fertility in Bangladesh. Results lend support to the hypothesis of an insurance effect, while demonstrating that its demographic significance is likely to be less prominent than that of replacement behavior. Findings indicate that the insurance motive remains intact even after total fertility declined to fewer than three children per woman. The well-documented role of gender bias as a determinant of child health and survival is also a factor in child-replacement decisionmaking. Although the rapid …

Bridging The Gap Between Evidence-Based Innovation And National Health-Sector Reform In Ghana, John Koku Awoonor-Williams, Ellie S. Feinglass, Rachel Tobey, Maya Vaughan-Smith, Frank K. Nyonator, Tanya C. Jones, James F. Phillips

Poverty, Gender, and Youth

Although experimental trials often identify optimal strategies for improving community health, transferring operational innovation from well-funded research programs to resource-constrained settings often languishes. Because research initiatives are based in institutions equipped with unique resources and staff capabilities, results are often dismissed by decisionmakers as irrelevant to large-scale operations and national health policy. This article describes an initiative undertaken in Nkwanta District, Ghana, focusing on this problem. The Nkwanta District initiative is a critical link between the experimental study conducted in Navrongo, Ghana, and a national effort to scale up the innovations developed in that study. A 2002 Nkwanta district-level survey …

Urban Poverty And Health In Developing Countries: Household And Neighborhood Effects [Arabic], Mark R. Montgomery, Paul C. Hewett

Poverty, Gender, and Youth

In the United States and other high-income countries, where most people live in cities, there is intense scholarly and program interest in the effects of household and neighborhood living standards on health. Yet very few studies of developing-country cities have examined these issues. This paper investigates whether in these cities the health of women and young children is influenced by both household and neighborhood standards of living. Using data from the urban samples of 85 Demographic and Health Surveys, and modeling living standards using factor-analytic MIMIC methods, we find, first, that the neighborhoods of poor households are more heterogeneous than …

Popular Perceptions Of Emerging Influences On Mortality And Longevity In Bangladesh And West Bengal, Sajeda Amin, Alaka Malwade Basu

Poverty, Gender, and Youth

Although new environmental and pathological threats to human survival and longevity have been documented, relatively little is known about how these threats are perceived in the popular imagination. During fieldwork in rural Bangladesh and West Bengal, India, researching the changing costs of and motivations for reproduction, the authors included survey questions on respondents’ perceptions of changing mortality. Child-mortality levels were perceived to have fallen drastically in recent times, but for the middle-aged and the elderly, the past was seen as a better time in terms of health and survival. The decline in adult health is attributed to environmental deterioration and …

Does Dowry Improve Life For Brides? A Test Of The Bequest Theory Of Dowry In Rural Bangladesh, Luciana Suran, Sajeda Amin, Lopita Huq, Kobita Chowdury

Poverty, Gender, and Youth

In recent years, dowry levels in Bangladesh have risen to previously unforeseen levels—sometimes three or four times a family’s total assets. Some recent economic writings suggest that dowry functions as a bequest or pre-mortem inheritance, implying it persists because it is “good for the bride.” Using panel data from an adolescent study in rural Bangladesh, this Population Council working paper explores the association between dowry and the prevalence of domestic abuse to test the bequest theory of dowry. Contrary to the prediction of the bequest theory, married females who paid dowry at marriage have a higher likelihood of reporting domestic …

Population Aging And The Rising Cost Of Public Pensions, John Bongaarts

Poverty, Gender, and Youth

Rapid population aging is raising concerns about the sustainability of public pension systems in high-income countries. The first part of this study identifies the four factors that determine trends in public pension expenditures: population aging, pension benefit levels, the mean age at retirement, and the labor force participation rate. The second part presents projections to 2050 of the impact of demographic trends on public pension expenditures in the absence of changes in pension benefits, labor force participation, and age at retirement. These projections demonstrate that current trends are unsustainable, because without reforms population aging will produce an unprecedented and harmful …

Shaping Public Programs Through Medicare, Medicaid, And Schip Waivers: The Fundamentals, Cynthia Shirk

National Health Policy Forum

This background paper examines the use of research, demonstration, and program waiver authorities to test new approaches to the delivery of and payment for health care services in federally financed health coverage programs such as Medicare, Medicaid, and the State Children’s Health Insurance Program. The paper also looks at the mechanics of waivers as well as their history and political context in shaping public programs. In addition, it explores the ways the changing state-federal relationship and the ever-growing demand for state flexibility have driven waiver policy.

Evidence-Based Development Of Health And Family Planning Programs In Bangladesh And Ghana, James F. Phillips, Tanya C. Jones, Frank K. Nyonator, Shruti Ravikumar

Poverty, Gender, and Youth

This paper describes two initiatives that have used experimental studies to guide the development of community-based health and family planning programs. In Bangladesh and Ghana, factorial experiments were implemented in stages. An exploratory phase developed a service system for community-based health care; an experimental phase assessed the demographic impact of the system; a replication phase examined the transferability of the experimental program to a non-research setting; and a scaling-up phase facilitated the extension of the new system to the national health care program. All stages were guided by research, with questions, mechanisms, and outcomes shifting as the process developed. Large-scale …

The Ghana Community-Based Health Planning And Services Initiative: Fostering Evidence-Based Organizational Change And Development In A Resource-Constrained Setting, Frank K. Nyonator, John Koku Awoonor-Williams, James F. Phillips, Tanya C. Jones, Robert A. Miller

Poverty, Gender, and Youth

Research projects demonstrating ways to improve health services often fail to have an impact on what national health programs actually do. An approach to evidence-based policy development has been launched in Ghana that bridges the gap between research and program implementation. The Community-based Health Planning and Services (CHPS) initiative employs strategies tested in the successful Navrongo experiment to guide national health reforms that mobilize volunteers, resources, and cultural institutions to support community-based primary health care. Over the 1999 to 2002 period, 100 out of the 110 districts in Ghana adopted a CHPS initiative. This paper reviews features of the initiative …

Marriage In Transition: Evidence On Age, Education, And Assets From Six Developing Countries [Arabic], Agnes R. Quisumbing, Kelly Hallman

Poverty, Gender, and Youth

Marriage is an event of great social and economic significance in most societies. Despite the centrality of marriage in an individual’s life history, the literature on marriage patterns pays little attention to men. This paper examines trends in schooling, age, and assets at marriage for both men and women, and spousal differences in these variables in six countries-Bangladesh, Ethiopia, Guatemala, Mexico, the Philippines, and South Africa-using comparable data sets and methodologies.

Evaluation Of Rink Link Alpha One – Center For Independent Living, Josephine M. Laplante

Disability & Aging

No abstract provided.

Building Jefferson's Future, Douglas J. Macmaster Jr., Paul C. Brucker

Thomas Jefferson University Administrative Documents and Reports

2002 Annual report of Thomas Jefferson University.

Comparison Of Domestic Violence Outcomes Among Emergency Department Nurses, Pamela S. Neal

Theses, Dissertations and Capstones

Purpose: The purpose of this study was to examine the relationships between domestic violence education, organizational support, screening, danger assessment, safety planning, and referral practices among professional registered nurses in two ED settings.

Sample & Setting: A convenience sample of 63 professional registered nurses provided data from two EDs. An ED located in Kentucky where state mandated continuing education in domestic violence was required (n = 33) and an ED in West Virginia (n = 30) where mandated continuing education in domestic violence was not required was the setting for the study. The samples were separated based on nurses who …

Managed Healthcare And Integrated Delivery Systems: A Model For Getting Ahead Of The Change Curve, Philip Sheridan Carney

Theses Digitization Project

Managed care became the dominant model for moderating healthcare costs in the 1990's. The later half of this past decade witnessed early signs of a return to escalating premiums. Providers and consumers have reacted negatively to perceptions of health plan micro-management and restriction of choice.