Population Health Commons^™

The Home Visiting Referral Quality Improvement Initiative (Thrive) Change Package, Elizabeth Yakes Jimenez, Theresa Cruz, Rebecca Craig, Ivan De La Rosa

Population Health Research and Scholarship

Early childhood home visiting programs improve maternal and child health outcomes but remain underutilized. Healthcare providers are well-positioned to connect families to home visiting services; however, structural barriers in clinical settings limit consistent and effective referral practices. The Home Visiting Referral Quality Improvement Initiative (THRIVE) change package was developed to provide a starting point for addressing these challenges. The THRIVE change package outlines actionable improvement strategies to test, such as standardizing referral workflows, training clinical teams, and establishing relationships and feedback loops with home visiting programs. It offers a scalable approach to strengthening clinical–community linkages and improving family engagement with …

Health-Related Quality Of Life In Covid-19 Patients: A Systematic Review And Meta-Analysis Of Eq-5d Studies, Kidu Gidey, Yirga Legesse Niriayo, Solomon Weldegebreal Asgedom, Erica I. Lubetkin

Publications and Research

Background

COVID-19 has affected millions globally, with a significant proportion experiencing long-COVID and impaired health-related quality of life (HRQoL). This systematic review and meta-analysis aimed to synthesize the existing literature on HRQoL in COVID-19 patients.

Methods

We conducted a systematic search of PubMed, Embase, Web of Science, Scopus, and the Cochrane Library for studies published between December 2019 and March 2025. Eligible studies were peer-reviewed and assessed HRQoL in COVID-19 patients using the EQ-5D instrument. Study quality and risk of bias were evaluated using the Newcastle-Ottawa Scale. Pooled health utility values were estimated using a random-effects model, and heterogeneity was …

From Disappointment To Predominance: Medicare Advantage's Ascendancy And Transformation Of Medicare, Rick Mayes, Micah Johnson

Health Studies Faculty Publications

From 2004 to 2024, Medicare Advantage (MA) went from being a “policy disappointment,” covering 12% of all Medicare beneficiaries, to predominance, covering more than one-half (52%), with more growth predicted in the future. Drawing on an extensive review and synthesis of the literature, Medicare Payment Advisory Commission (MedPAC) reports, congressional committee hearings, and Centers for Medicare and Medicaid Services (CMS) data, this paper analyzes the evolution of Medicare and managed care in three parts. First, it briefly traces the early efforts to build an integrated managed care option to the traditional, fragmented fee-for-service Medicare program and highlights four key changes …

2024 Health Equity Impact Report, Children's Health, Stormee Williams

Publications

The Health Equity Impact Report from Children’s Health outlines the organization’s strategy and progress in advancing equitable pediatric care. The report highlights efforts to identify and address social determinants of health—such as food insecurity, housing instability, and access to transportation—through systemwide screening and targeted interventions.

Euroqol Data For Assessment Of Population Health Needs And Instrument Evaluation (Eq-Daphnie): A Study For Enhancing Population Health Assessment, Jeffrey A. Johnson, Mathieu F. Janssen, Fatima Al Sayah, Henry Bailey, Mihir Gandhi, Dominik Golicki, Nils Gutacker, Erica I. Lubetkin, Brendan Mulhern, Fredrick Dermawan Purba, Juan M. Ramos‑Goñi, Desiree Scott, Hilary Short, Trudy Sullivan, Rosalie Viney, Zhihao Yang, Victor Zárate

Publications and Research

Background

Methods for collecting self-reported health status measures in population health surveys vary significantly across countries, presenting challenges to comparability. The EuroQol Data for Assessment of Population Health Needs and Instrument Evaluation (EQ-DAPHNIE) project aims to address this issue by developing infrastructure to generate representative datasets across multiple countries. This initiative aims to standardize data collection methodologies and to evaluate the performance of various health status measures, providing a foundation for reliable population health assessments. This paper describes the rationale, design and data collection methods for the EQ-DAPHNIE project.

Methods/design

EQ-DAPHNIE employs a cross-sectional online survey design targeting the general …

Rural Hospital Closure And Medicaid Expansion, Jason White

Theses, Dissertations and Capstones

Introduction: In the United States, hospitals in rural areas have been under financial pressure and have been closing at an increasing rate.  This reduces access to care for rural citizens.  The Affordable Care Act of 2010 was passed in order to increase access to medical care, partially through an optional expansion of Medicaid coverage to a larger percentage of the population.  As some states adopted the expansion and some states did not, an opportunity was created to examine the policy’s effect on rural hospital stability.

Purpose of the Study:  This study was designed to examine the effect of …

The Performance Relationship Between The Eq-5d-5l Composite "Anxiety/Depression" Dimension And Anxiety And Depression Symptoms In A Large, General Population Sample, Emily Stella Scott, Erica I. Lubetkin, Mathieu F. Janssen, John N. Yfantopolous, Gouke J. Bonsel, Juanita A. Haagsma

Publications and Research

Purpose

This cross-sectional study aims to understand the relationship between responses on the Anxiety/Depression (A/D) dimension of the EQ-5D-5L and symptoms of anxiety and depression on the GAD-7 and PHQ-9 instruments. In doing so, we investigate the comparative performance of the dimension between diagnostic groups (i.e. anxiety (GAD-7); depression (PHQ-9); anxiety & depression versus none). We additionally investigate the discriminatory performance between sub-populations based on gender, age, education and self-reported chronic conditions.

Methods

19,902 general population participants completed a health survey in May/June 2020, from five European countries and the United States. Performance of A/D was calculated using the Area …

The Frequency And Predictive Factors Of Change In Alcohol Consumption During The Covid-19 Pandemic: Results From A Multi-Country Longitudinal Study, Carolien Verhei, Nadja Alexandrov, Erica I. Lubetkin, Gouke J. Bonsel, John N. Yfantopoulos, Mathieu F. Janssen, Stephanie C.E. Schuit, Suzanne Polinder, Pleunie P.M. Rood, Juanita A. Haagsma

Publications and Research

Background: The COVID-19 pandemic has had multiple health and behavioral effects in the general population worldwide, including effects on nutritional and lifestyle behavior such as alcohol consumption. This study aimed to determine the frequency of and predictors for change in alcohol consumption two years after onset of the COVID-19 pandemic among participants from the general population of six countries. Methods: Longitudinal study design with 4999 participants (47% male; aged 18–75 years) from a general population cohort from six countries: Greece, Italy, the Netherlands, Sweden, the United Kingdom (UK) and the United States of America (US). Measurements: Three web-based surveys at …

Exploring The Comparability Between Eq-5d And The Eq Health And Wellbeing In The General Australian Population, Peter Lee, Lidia Engel, Erica I. Lubetkin, Lan Gao

Publications and Research

Objectives

Methods

An Intersectional Approach To Quantifying The Impact Of Geographic Remoteness And Health Disparities On Quality-Adjusted Life Expectancy: Application To Australia, Peter Lee, Steven J. Bowe, Lidia Engel, Erica I. Lubetkin, Nancy Devlin, Lan Gao

Publications and Research

Objectives

Methods

Cross-Sectional And Longitudinal Comparison Of Health-Related Quality Of Life And Mental Well-Being Between Persons With And Without Post Covid-19 Condition, Emily Stella Scott, Erica I. Lubetkin, Mathieu F. Janssen, John Yfantopolous, Gouke J. Bonsel, Juanita A. Haagsma

Publications and Research

Background:

Still little is known about the impact of post COVID-19 condition (PC) on health-related quality of life (HRQOL) and mental well-being. We compared participants with PC with three groups: an acute COVID-19 infection (AC) only, at least one chronic condition (CC) but no COVID-19, or no condition at all, healthy (PH). Between these disease groups, we also estimated and compared HRQOL and mental well-being change over time.

Methods:

Participants from six countries (Greece, Italy, Netherlands, Sweden, United Kingdom and United States) completed two web-based questionnaires (T1 = April–May 2020 and T2 = April–June 2022). Primary outcomes were HRQOL, measured …

Describing And Assessing A New Method Of Approximating Categorical Individual-Level Income Using Community-Level Income From The Census (Weighting By Income Probabilities), Uriel Kim, Siran M. Koroukian, Kurt C. Stange, James C. Spilsbury, Weichuan Dong, Johnie Rose

Faculty Scholarship

Objective: To assess a new approach (weighting by “income probabilities [IP]”) that uses US Census data from the patients' communities to approximate individual-level income, an important but often missing variable in health services research. Data Sources: Community (census tract level) income data came from the 2017 5-year American Community Survey (ACS). The patient data included those diagnosed with cancer in 2017 in Ohio (n = 65,759). The reference population was the 2017 5-year ACS Public Use Microdata Sample (n = 564,357 generalizing to 11,288,350 Ohioans). Study Design/Methods: We applied the traditional approach of income approximation using median census tract income …

Health Inequality Analysis In Europe: Exploring The Potential Of The Eq-5d As Outcome, Inge Spronk, Juanita A. Haagsma, Erica I. Lubetkin, Suzanne Polinder, M F. Janssen, G J. Bonsel

Publications and Research

Objective: This study explored the additive value of the multi-item EuroQol 5-Dimension 5-Level (EQ-5D-5L) as an outcome measure in health inequality analyses, relative to the single-item EuroQol visual analog scale (EQ VAS).

Methods: A sample comprising the general population from Italy, the Netherlands, and United Kingdom (UK) completed the EQ-5D-5L and the EQ VAS. The level of education was selected as a proxy for socio-economic status (SES). EQ-5D-5L level sum scores (LSS) were compared against EQ VAS scores. Stratified and multivariable analyses were used to study the associations between SES and the LSS/EQ VAS relative to the presence of chronic …

Health-Related Quality Of Life And Mental Well-Being Of Healthy And Diseased Persons In 8 Countries: Does Stringency Of Government Response Against Early Covid-19 Matter?, Di Long, Juanita A. Haagsma, Mathieu F. Janssen, John N. Yfantopoulos, Erica I. Lubetkin, Gouke J. Bonsel

Publications and Research

Objectives

Our study aimed to (1) assess health-related quality of life (HRQoL) and mental well-being of healthy and diseased persons in the general population during the early stage of the COVID-19 pandemic and (2) examine the relationship between HRQoL and mental well-being and individual characteristics and government response against COVID-19, as measured by the stringency index.

Methods

A web-based survey was administered to a cohort of persons from the general population of eight countries: Greece, Italy, the Netherlands, Russia, South Africa, Sweden, the United Kingdom (UK) and the United States of America (US) from April 22 to May 5 and …

Association Of Chronic Pain With Physical Function And Mortality Among Older Adults In Rural Malaysia, Yee Mang Chan

Student Works (2020-2029)

Older adults are postulated to double in 2017 and 2050 worldwide, including Malaysia. Various challenges are related to ageing population, including poor physical functioning and increase number of chronic diseases. Chronic pain is often associated with chronic disease. Chronic pain affects almost one third of the world’s adult population and higher prevalence reported among older adults. Evidence suggests that chronic pain has undesirable consequences on physical, mental health and premature mortality. In low�and middle-income countries, there are limited studies examining the consequences of chronic pain on physical function and premature mortality. The aim of this study is therefore to determine …

Knowledge, Attitude And Practice Towards Tuberculosis And The Effectiveness Of A Tuberculosis Education Program Among Nurses Employed In Tuberculosis Centers In Libya, Elbahloul Muftah Abdusalam

Student Works (2020-2029)

Nurses make up by far the largest group of healthcare workers in any part of the world, playing an important role in the direct management of tuberculosis (TB) patients and facing a high risk of infection. Therefore, this study was conducted to explore the knowledge, attitude, and practice towards TB among professional nurses in Libya and the impact of an educational intervention on their knowledge, attitude and practice. A cross-sectional design using self-administered validated questionnaire was conducted to explore the nurses’ KAP towards TB. A total of 384 nurses in tuberculosis centres in Libya participated in the study. TB education …

Young-Onset Hypertension In Malaysia: A Mixed-Methods Study, Yi Yi Khoo

Student Works (2020-2029)

The continuous cumulative presence of raised blood pressure (BP) when young is a strong predictor of future cardiovascular risk. This study, which was conducted between June 2018 and December 2019, aimed to elucidate the epidemiology of young-onset hypertension (YOH) in Malaysia during the period 2006–2015, and to explore the underlying experiences and perspectives of young adults living with hypertension. Phase I involved a systematic review to identify variables for the secondary data analysis. In Phase II, data on respondents aged 18–39 diagnosed with YOH according to the 7th Joint National Committee Report (United States) were extracted from three National Health …

Distribution Of Healthcare Resources In Peninsular Malaysia : An Examination Of Equity With Respect To Geography And Allocative Processes, Saw Chien Gan

Student Works (2020-2029)

On a country’s pathway to Universal Health Coverage, it is important to ensure equitable healthcare provision and financing. There was a lack of evidence in equity of healthcare provision and financing across geographic areas in Peninsular Malaysia. This was despite the evidence that geographic factors directly and indirectly affect population health and healthcare services are mostly delivered at immobile healthcare facilities. In Malaysia’s mixed public-private healthcare system, Ministry of Health Malaysia (MOH) has a geographically comprehensive provision network and the MOH resources are distributed through geographic-bound MOH administrative structures. The private sector, which concentrated on more affluent geographic areas, also …

Development And Evaluation Of Hearing Conservation Program Among Vector Control Workers, Supramanian Rama Krishna

Student Works (2020-2029)

Noise-induced hearing loss (NIHL) is one of the highest recorded occupational disease despite being preventable. In 2018, occupational noise-induced hearing loss was the highest reported occupational disease experienced by workers in Malaysia accounting for 87.7% of all occupational diseases. The aim of this study is to develop, implement and evaluate the effectiveness of a Hearing Conservation Program (HCP) in preventing noise�induced hearing loss among vector control workers. This study is divided into two phases: development of HCP (phase 1) and implementation and evaluation of HCP (phase 2). The development phase (phase 1) included a review, interview with key stakeholders and …

Association Of Mental Health Literacy And Depression Symptoms Among Young Adolescents In Selangor, Lakha Singh Sarbhan Singh

Student Works (2020-2029)

Mental health literacy (MHL) relating to depression (depression literacy) is a multifaceted concept comprising of knowledge of depression, help seeking and stigma components, that plays an important role in depression outcomes. The aim of this study was to examine the association of depression literacy components namely knowledge of depression, help seeking, stigmatising attitudes and adequacy of depression literacy with depression symptoms among adolescent in Malaysia. This study reports on the common tools used to examine depression literacy, validation of the MHL and Stigma questionnaire and Centre for Epidemiological Studies Depression scale (CES-D) Malay version questionnaire, findings of the depression literacy …

Psychiatric Morbidity Among Orang Asli In Bukit Lanjan, Iberahim Muhammad Ilham

Student Works (2020-2029)

Prevalence of Psychiatric Morbidity Among Orang Asli In Bukit Lanjan, Selangor, Malaysia Introduction Orang Asli, the indigenous people of peninsular Malaysia, are those peoples who were born among Orang Asli, lives according to their distinguished culture and beliefs, and spoke their native languages. Malaysia has evolved rapidly over the years in the socioeconomic development especially in the rural areas. More jungle areas are open up for land development scheme such as Federal Land Development Authority (FELDA), housing projects, commercial farms and many more. Indigenous people are forced to face this rapid urbanization. The questions arise whether they are able to …

Association Between Stigma, Psychological Distress, And Quality Of Life Among People Living With Hiv In Federal Territory Of Kuala Lumpur, Ibrahim Khairiah

Student Works (2020-2029)

Quality of life is an important component in the evaluation of the well-being of PLHIV. However, HIV stigma and psychological distress (depression, anxiety and stress) continue to be a barrier to obtain a good quality of life among PLHIV globally. This study assesses the level of QOL, stigma and psychological distress among PLHIV in Kuala Lumpur by determining the association between QOL, stigma and psychological distress. A cross-sectional study was conducted, involving 305 PLHIV attendees of the infectious disease clinic in a teaching hospital, primary health clinic and three Community-Based Organisations (CBOs). The sampled respondents completed face to face interviews …

Prevalence And Determinants Of Tabacco Use Among Adolescents In Khartoum - Sudan, Mohammed Alshaikh Mohammed Othman

Student Works (2020-2029)

Globally, 25 million adolescents aged 13-15 years, smoke cigarettes while 13 million use smokeless tobacco. In 2014, 22.8% of adolescents had ever smoked cigarette in Sudan while current cigarette smokers were 4.5%; moreover, studies about shisha smoking and smokeless tobacco were limited in Sudan. The aim of this study is to estimate the prevalence of tobacco use among adolescents and to describe determinant factors associated with tobacco use. Descriptive school based cross-sectional study was conducted, and multistage random sampling was used to recruit participants from secondary schools in Khartoum State, Sudan. Self-administered questionnaire of Arabic version of Global Youth Tobacco …

The Association Between Connectedness Towards Religion, Family, And School, And The Symptoms Of Depression, Anxiety, And Stress Among Malaysian Adolescents, Samian Siti Sabariah

Student Works (2020-2029)

The unmet alignment between reality and expectation in addition to immaturity in the development of the prefrontal area means adolescents have tendencies to embark on poor decisions, making them vulnerable to acquiring mental health problems. Abiding by their religion and strong connections with family and school has been proven in European/Western nations to promote adolescent mental well-being, provide ventilation to release stress and protect the youngsters from acquiring anxiety and depression. Given the vast differences between European/Western social norms and Eastern culture, this study was conducted to examine the association between adolescent connectedness towards religion, family and school on the …

Indian Health Service Strategic Plan 2006-2011, Indian Health Service

Native Health Database Full Text

The main health challenges currently faced by American Indian and Alaska Native people are the increasing health conditions and chronic diseases that are related to lifestyles issues such as obesity, physical inactivity, poor diet, substance abuse, and injuries. To help meet these challenges, the Indian Health Service (IHS) has launched a Health Promotion and Disease Prevention (HPj DP) Initiative to develop a coordinated and systematic approach to enhance preventive health approaches at the local, regional, and national levels. This Initiative is aligned with the President's HealthierUS, HHS Steps to a HealthierUS, and Healthy People 2010.

Examining The Structural Covariates Of Methamphetamine Use: A Social Disorganization Perspective, Justin Smith

Masters Theses

There have been many anecdotal accounts describing the characteristics of individuals involved in methamphetamine use, trafficking and production. However, prior to the current study there was yet to be a macro-level analysis of methamphetamine use. The extant macro-level literature on drug use has suggested that areas with high levels of social disorganization experience high rates of drug use. It was expected that school-districts with low SES and high rates of ethnic heterogeneity, residential instability and family disruption will experience high rates of methamphetamine use. In addition, it was expected that rural school districts would show higher rates than urban and …

Cancer In Alaska Natives 1969-2003: 35-Year Report, C. Homan, J. Kelly, A. Lanier, J. Maxwell, T. Mcevoy

Native Health Database Full Text

Cancer incidence rates for all Alaska Natives (Eskimo, Indian, Aleut) were first reported in 1976. Since then numerous publications have documented the unusual cancer patterns in this population. These are the latest statistics for which there is complete data statewide, and provide the best estimates of cancer incidence in the Alaska Native population. Numbers of new (incident) cases and rates are given for all cancers and for specific sites. These numbers are presented by age, sex, ethnicity, geographic region, and service unit. Data have been collected, tabulated, and analyzed in accordance with procedures established by the National Cancer Institute Surveillance, …

Cancer Information Seeking Preferences Among Health Professionals Serving American Indians In Minnesota, North Dakota, And Wisconsin, K. Knutsen, R. Strickland, J. Matloub, P. Remington, J. Kaur

Native Health Database Full Text

This article identifies cancer information resources used by health professionals in tribal health departments or Indian Health Service clinics serving American Indian communities in Wisconsin, Minnesota and North Dakota.

2005 Navajo Middle And High School Youth Risk Behavior Survey Report, Primary Navajo Yrsb Team

Native Health Database Full Text

From 1997 to 2005, the Navajo Youth Risk Behavior Surveilance System (YRBS) was implemented to be used to monitor health-risk behaviors among youth in middle and high schools. Unhealthy risk behaviors can lead to unhealthy health conditions or injuries, and could enventually lead to health or social problems as chronic diseases, disability and drug or alcohol addictions.

People With Disabilities On Tribal Lands: Education, Health Care, Vocational Rehabilitation, And Independent Living, A. Kauffman, M. Whelshula, V. Paternoster, T. Spellman, W. Thompson, A. Walline

Native Health Database Full Text

This project examined research on health, rehabilitation, independent living, and education issues that affect people with disabilities living in Indian Country. The report discusses views and perspectives of American Indialaska Native people with disabilities, tribal leaders, and federal agency representatives identified as productive in meeting the needs of people with disabilities residing in tribal lands. This report also assesses and recommends government-to-government (state to sovereign tribal to U.S. government) improvements in relationships needed for effective coordination across existing federally funded projects/programs. In addition, a Toolkit guide providing resource information was developed for use by consumers, tribal communities, and people at …