Public Health Commons^™

Hospital Oversight In Medicare: Accreditation And Deeming Authority, Lisa Sprague

National Health Policy Forum

To be eligible to receive payment from Medicare, hospitals must be certified to meet certain conditions. Hospitals may gain such credentials by choosing to be reviewed by a state certification agency under contract to the Centers for Medicare & Medicaid Services or to be accredited by either the Joint Commission on Accreditation of Healthcare Organizations or the American Osteopathic Association. This issue brief looks at how accreditation of hospitals developed and how it continues to change. It considers the legal and practical reasons that a majority of hospitals choose accreditation and why some hospitals do not, along with broader consideration …

Evaluation Of Over-The-Counter Sales As A Syndromic Surveillance Method For Waterborne Disease In New Mexico, Camilla M. Bustamante

Health, Exercise, and Sports Sciences ETDs

This research evaluates the use of Over-the-Counter anti-diarrheal medications as a potential syndromic indicator and surveillance mechanism for waterborne disease in New Mexico. The purpose was to determine the usefulness of such data for either supplemental or stand alone use in a system for waterborne disease surveillance. The use of syndromic indicators for waterborne disease was elevated in 1993 after an outbreak of cryptosporidium was detected in Milwaukee Wisconsin by an alert pharmacist who noticed increased sales of over-the-counter medications over a period of time. In 2001, terrorist threats for anthrax exposure to U.S. populations further prompted funding and research …

Parents' Perception Of Their Children's Asthma, 2002-2008: A Community-Based Study, John M. Pascoe, William Spears, Shalini Forbis, Jessica L. Saunders

Population and Public Health Sciences Faculty Publications

Childhood asthma is a chronic health condition that is one of the leading causes of hospitalizations and missed school days for children. It also affects the lives of both asthmatic children and their families.

Health Insurance Coverage For Small Employers, Dawn Gencarelli

National Health Policy Forum

For workers of small employers, access to affordable health insurance coverage is a growing concern. This paper examines the problems these firms and their employees face in obtaining health insurance coverage they can afford. The degree to which these challenges become obstacles varies greatly, depending on, for instance, the size of the employer and the characteristics of its employees. Reviewed here are these challenges to access, as well as some of the efforts made through state and federal reforms to address them, including rules regarding guaranteed issue and guaranteed renewability. This paper also explores some of the more recent initiatives …

Fundamentals Of Underwriting In The Nongroup Health Insurance Market: Access To Coverage And Options For Reform, Mark Merlis

National Health Policy Forum

Although the majority of Americans with health insurance obtain coverage through their employers, many individuals must negotiate the nongroup insurance market alone. Insurers use a process called medical underwriting to identify applicants with current or recent medical problems. Because these applicants are likely to cost the insurer more in claims than a healthier person, insurers may charge them higher premiums or restrict or deny coverage. This background paper reviews the practice of underwriting, state and federal regulation of insurers offering nongroup health coverage, and several proposed options for improving access to coverage for applicants who are in poor health.

Health Savings Accounts: The Fundamentals, Beth Fuchs, Julie A. James

National Health Policy Forum

This paper explores the fundamentals of health savings accounts (HSAs). While not intended to be an exhaustive review of these accounts, it describes their intellectual and legislative origins and the mechanics of how they work, explores the early returns on how they are faring in the insurance market, and identifies major issues and controversies that they raise. The paper looks specifically at the basic rules for HSAs and the requirements for health insurance that qualifies as a high-deductible health plan (HDHP) for HSA purposes. Also considered are issues related to provider payments under HSAs and the administration of the benefit …

Correlates Of In-Home Smoking Behavior Of Parents With Newborns, James Kyung Jo

Loma Linda University Electronic Theses, Dissertations & Projects

Secondhand smoke has been shown to have adverse health effects on young children. It is associated with various health effects such as respiratory infections, Sudden Infant Death Syndrome (SIDS), and asthma. Because of the dangers secondhand smoke poses to young children, there is a need for educating parents about the dangers of secondhand smoke as well as determining factors associated with secondhand smoke exposure among children. Understanding these factors may be first step toward developing strategies to reduce ETS exposure.

The study examined correlates of in-home smoking behavior of parents with newborns by analyzing 657 respondents who filled out the …

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.

How Should Health Departments Manage Prenatal Care?, Julianne Nesbit

Master of Public Health Program Student Publications

Objective: To compare how health departments in the southwest district of Ohio manage prenatal care, defined as preventative care provided immediately preceding, during, and following pregnancy, to determine if there is a better management technique based on cost and/or characteristics of jurisdictions.

Design: Qualitative descriptive analysis of prenatal services at local health departments in the southwest district of Ohio for 2004.

Setting and Participants: Health Departments in the southwest district of Ohio.

Main Outcome Measures: Comparison of the types of services currently being used to provide prenatal care services (i.e., direct, contracted, combination, or no service) including budgeting and cost …

Understanding The Relative Importance Of Positive And Negative Social Exchanges: Examining Specific Domains And Appraisals, Jason T. Newsom, Karen S. Rook, Masami Nishishiba, Dara H. Sorkin, Tyrae Mahan

Community Health Faculty Publications and Presentations

Negative social exchanges have been more reliably related to psychological health than have positive social exchanges. Little research, however, has sought to understand how underlying appraisal processes link such exchanges to psychological health. This study examined the frequencies of occurrence and appraisals of four parallel domains of positive and negative exchanges in relation to positive well-being and psychological distress in a national sample of 916 older adults. Structural equation analyses revealed that negative exchanges were related both to less well-being and greater psychological distress, whereas positive exchanges were related only to positive well-being. Furthermore, results supported a process in which …

The Effects Of Ppa And Nicotine Gum On Cessation Rates And Post Cessation Weight Gain In Women., Theodore Cooper, R. Klesges, M. Debon, S. Zbikowski, K. Johnson, L. Clemens

Selected Works Temporary Series

No abstract provided.

Community-Based Participatory Research: Defining Community Stakeholders, Laurene M. Tumiel-Berhalter, Robert Watkins, Carlos J. Crespo

Community Health Faculty Publications and Presentations

Community-based participatory research requires the participation of community stakeholders to inform the process. The West Side Community Asthma Project, a community-based participatory research program to study the effects of the environment on asthma conducted in Buffalo, N. Y, identified a stakeholders group of community leaders and activists. Creative strategies have been implemented to reach out to other community residents to invite them to participate in the participatory process.

The Effects Of Ppa And Nicotine Gum On Cessation Rates And Post Cessation Weight Gain In Women., Theodore Cooper, R. Klesges, M. Debon, S. Zbikowski, K. Johnson, L. Clemens

Departmental Papers (Psych)

No abstract provided.

Saddle Height Positioning For Triathletes Ssing Road Cyclist Methods, Edith Ann Sherman

Master's Theses and Doctoral Dissertations

Triathlon is the combined sport of swimming, cycling, and running. Cycling is normally the longest portion of the race. Therefore, maintenance of comfort and efficiency while maintaining high power output is essential for success in the cycling portion. Several methods are currently used for determination of height for road cyclists. It has yet to be determined if these methods are applicable to triathletes. Because of the different geometry of a triathlon bicycle, the question remains whether road-saddle fitting techniques can be an applied and work for the triathlon bicycle.

This thesis evaluated the participant’s current saddle height in addition to …

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.

Monstrous Impersonation: A Critique Of Consent-Based Justifications For Hard Paternalism, Thaddeus Mason Pope

Faculty Scholarship

Restricting a person's substantially voluntary, self-regarding conduct primarily for the sake of that person is hard paternalism. Particularly in the public health context, scholars, legislators, and judges are devoting increasing attention to discussing the conditions and circumstances under which hard paternalism is justified. One popular type of argument for the justifiability of hard paternalism takes its normative warrant from the consent of the restricted person.

In this Article, I argue that scholars and policymakers should abandon consent-based arguments for the justifiability of hard paternalism. Such arguments are torn between incoherence and lacking moral force. Very few consent-based arguments successfully resolve …

Is Public Health Paternalism Really Never Justified? A Response To Joel Feinberg, Thaddeus Mason Pope

Faculty Scholarship

n the preeminent scholarly legal treatise on paternalism, The Moral Limits of the Criminal Law: Harm to Self, Joel Feinberg argues that hard paternalism is never justified because it is superfluous; all reasonable restriction of self-regarding conduct can be justified on (more palatable) soft paternalistic grounds.

In this article, I argue that Feinberg's strategy seems to work only because he "stretches" soft paternalism to justify liberty limitation that is properly described as hard paternalism. I expose Feinberg's strained appeals, and argue for honesty and transparency regarding the bases for paternalistic liberty limitation. If the rationale for public health restrictions on …

Prenatal Care Utilization As A Predictor Of Failure To Thrive, Cynthia L. Allen

MUSC Theses and Dissertations

This case-control study used an academic health sciences center sample to examine differences in prenatal care utilization (defined by the number of prenatal care visits and gestational age at entry into prenatal care) between failure to thrive infants and healthy infants; and test prenatal care utilization as a predictor of failure to thrive. This study described maternal bonding characteristics (prenatal care utilization, infant length of hospital stay, feeding method, frequency of all/visits, and discharge teaching) of hospitalized failure to thrive infants. Using the Medical University of South Carolina Perinatal Information System, Keane System, and Practice Partner databases, a study sample …

Factors That Influence Mammography Use Of Community Health Workers, Cynthia M. Kratzke

Health Services Research Dissertations

Community health worker (CHW) interventions promote early detection of breast cancer and mammography use to help eliminate health disparities for minority and low-income women. Data trends show lower mammography use among this population although CHW interventions have been shown to promote mammography use. However, CHW interventions have not been tested sufficiently to examine the factors that influence mammography use of CHWs.

This cross-sectional study examined the factors that influence mammography use of CHWs and the relationship of self-efficacy, social norms, and mammography use of CHWs. The PRECEDE model served as the framework combining social factors, beliefs, attitudes, behaviors, and accessibility …

Quality Improvement In Maryland: Partnerships And Progress, Judith D. Moore, Lisa Sprague

National Health Policy Forum

This one-and-a-half-day site visit to Easton, Maryland, explored the activities of the Delmarva Foundation, the Quality Improvement Organization (QIO) for Maryland and the District of Columbia. The program reviewed Delmarva’s responsibilities under their Medicare contract and the initiatives they have undertaken with hospitals and other providers to improve health care outcomes and to define, collect, and report quality data. Local hospital officials added their perspective on quality programs and working with Delmarva. Topics of particular interest were health information technology, patient safety, and quality reporting both to government agencies and to consumers.

The Provider System For Children's Mental Health: Workforce Capacity And Effective Treatment, Jane Koppelman

National Health Policy Forum

This issue brief examines two issues that are key to meeting children’s unmet needs for mental health care: ensuring that the provider supply is adequate and that the care delivered is effective. It describes the shortage of qualified providers to address children’s mental disorders, as well its possible causes; it describes how managed care, to a certain extent, drives practice patterns; and it discusses the gray areas in deciding which providers are most qualified to deliver what care. In addition, this paper introduces what is known about evidence-based care in children’s mental health, the extent to which it is being …

Cervical Cancer Screening In Rural South Africa: An Analysis Of The Awareness, Attitudes, And Practices Of Women Served By The Masincedane Clinic, Jordan Schneider

Independent Study Project (ISP) Collection

The aim of this study was to conduct a brief investigation into the awareness, attitudes and practices regarding cervical cancer among women living in Keiskammahoek, a rural area in the Eastern Cape of South Africa. The objectives of this study were to:

• Determine if screening is available within a localized rural community and the methods that are being used.

• Determine if women are coming in for screening, the demographics of these women, and the circumstances that bring them into PHC clinics.

• Investigate the level of knowledge and education about cervical cancer and prevention among women within the …

Electronic Health Records: How Close? How Far To Go?, Lisa Sprague

National Health Policy Forum

This paper looks at the central role of the electronic health record (EHR) in health information technology. It considers the extent to which EHRs are in use and initiatives designed to increase their prevalence, as well as barriers to the widespread adoption of EHRs and efforts to surmount them. Particular attention is given to such obstacles as cost, the professional culture of physicians, standardization, and legal questions.

Medicaid's Disproportionate Share Hospital Program: Complex Structure, Critical Payments, Robert E. Mechanic

National Health Policy Forum

This background paper describes the history and political evolution of Medicaid’s disproportionate share hospital (DSH) program and examines DSH as it exists today. It highlights the importance of DSH payments for the viability of safety net hospitals and considers the consequences of states’ creative financing strategies for maximizing federal Medicaid matching funds. Finally, this paper reviews several options for improving the structure and effectiveness of the DSH program.

Physical Activity In A Cohort Of Medicaid Beneficiaries With Physical Impairments: Recruitment And Outcomes, Craig Ravesloot Ph.D., James Laskin Ph.D., Melody Huskey M.A., Sara Laney, Nancy Cherot, Huw Griffiths, Barbara Cowan, Lisa Brennan M.L.S., Catherine Ipsen, Sheri Martinez, Ann Szalda-Petree Ph.D., Rod Brod, University Of Montana Rural Institute

Health and Wellness

This document reports on research conducted by the University of Montana for the Office of Disability and Health at the Centers for Disease Control and Prevention. The research project, conducted between September 30, 2000 and September 29, 2004 was accomplished in three separate but related studies. The research was conducted at the New Directions programs, a community-based health promotion and wellness clinic operated through the rural Institute on Disabilities at the University of Montana. We collaborated with the State Department of Medicaid to recruit Medicaid beneficiaries with mobility impairments in Missoula County to participate in the research. We recruited 368 …

Fundamentals Of Community Health Centers, Jessamyn Taylor

National Health Policy Forum

This background paper examines the dominant model of federal grant funding for primary care in the health care safety net: the community health center. It describes the history of the health center program and highlights key policy issues influencing health centers, such as Medicaid payment policies and medically underserved area designations. The paper also examines the recent presidential initiative to expand health centers, including a review of the process used to identify new grantees, an assessment of remaining gaps in capacity, an exploration of continuing challenges, and a discussion of unresolved policy questions.

A Report From The Forum Session "Implementing The New Medicare Drug Benefit: Challenges And Opportunities For States", Judith D. Moore

National Health Policy Forum

The National Health Policy Forum convened a meeting on July 22, 2004 to discuss state-based challenges associated with implementing the Medicare Prescription Drug, Improvement, and Modernization Act (MMA). The meeting brought together an extremely insightful and experienced group of current and former state officials and other experts to discuss key issues. In keeping with its tradition of promoting a frank, off-the-record exchange on health policy issues, NHPF does not normally prepare written summaries or reports of meetings. However, because this meeting provided vivid illustrations of the importance of state-federal collaboration for the successful implementation of the new Medicare drug benefit, …

Fundamentals Of The Prescription Drug Market, Christie Provost Peters

National Health Policy Forum

This background paper is a primer on the prescription drug market. It provides information on the fundamentals of the pharmaceutical industry and various marketplace stakeholders, including manufacturers, retailers, consumers, regulators, researchers, and purchasers. This paper also examines the various ways the federal government interacts with the pharmaceutical market. Due to the breadth of material addressed, some complex issues and relationships are presented in broad conceptual terms without extensive technical detail.

Tick-Tock: Preparing For The Next Influenza Pandemic, Eileen Salinsky

National Health Policy Forum

This paper describes the nature of pandemic influenza and highlights key challenges for responding to this disease threat. It explains how an influenza pandemic would differ from annual influenza outbreaks and examines how a pandemic virus could emerge. It also explores important issues involved in pandemic preparedness capabilities, including disease surveillance, vaccine production and distribution, antiviral stockpiling, health care system readiness, and public health containment measures. The national pandemic preparedness plan is briefly reviewed, and unresolved policy issues related to the plan’s implementation are identified.