Public Health Commons^™

The Promise And The Reality Of Long-Term Care Insurance, Randy Desonia

National Health Policy Forum

The aging of the nation’s population will create a surge in the need for long-term care services, putting pressure on existing funding sources and fueling demand for more. This paper examines one financing option—private long-term care insurance—and summarizes its brief history and the several critical precedents that have influenced the products as currently sold. Other topics discussed include the challenges to encouraging sales growth as well as increasing the role of this type of insurance in paying for long-term care.

Living Well And Medicaid: Better Health For Consumers -- Lower Costs For States, Craig Ravesloot Ph.D., University Of Montana Rural Institute

Health and Wellness

The United States has the world’s most expensive healthcare system. In 2002, health spending rose to nearly 15 percent of U.S. Gross Domestic Product. Healthcare policymakers charged with balancing cost containment with quality healthcare for consumers are desperate for solutions (Levit, Smith, Cowan, Sensenig, and Catlin, 2004).

Effects Of A Tailored Follow-Up Intervention On Health Behaviors, Beliefs, And Attitudes, Alissa D. Jacobs, Alice S. Ammerman, Susan T. Ennett, Marci K. Campbell, Katherine W. Tawney, Semra Aytur, Stephen W. Marshall, Julie C. Will, Wayne D. Rosamond

Health Management & Policy

Background: The high rates of relapse that tend to occur after short-term behavioral interventions indicate the need for maintenance programs that promote long-term adherence to new behavior patterns. Computer-tailored health messages that are mailed to participants or given in brief telephone calls offer an innovative and time-efficient alternative to ongoing face-to-face contact with healthcare providers.

Methods: Following a 1-year behavior change program, 22 North Carolina health departments were randomly assigned to a follow-up intervention or control condition. Data were collected from 1999 to 2001 by telephone-administered surveys at preintervention and postintervention for 511 low-income, midlife adult women enrolled …

The Anti-Proliferation Effects Of Lycopene On Breast Cancer Cells, Tixieanna Dissmore

Loma Linda University Electronic Theses, Dissertations & Projects

Background: The incidence and deaths from breast cancer represent the most cause of all cancer deaths among women. Lycopene, the carotenoid in tomatoes has been associated with decreasing risk of prostate, breast, and digestive tract cancers. Various mechanisms of lycopene action have been proposed, including antioxidant activity and pro-differentiation activities. Identifying changes in the expression of proteins modified by lycopene can provide information to study the modulating effects of lycopene carcinogenesis and tumorigenesis development.

Objective: The objective was to study the anti-proliferative effects of lycopene on MCF- 7 human breast cancer cells and to identify changes in protein expression patterns. …

The Economics Of Quality: Changing Incentives In Cincinnati, Lisa Sprague, Nora Super

National Health Policy Forum

This site visit focused on private market dynamics and quality improvement initiatives. Cincinnati is characterized by strong players in all sectors of the market: employers such as Procter and Gamble and General Electric, hospital systems, health plans, and physician groups with the power to “push back” in contract negotiations. The city is a pilot site for Bridges to Excellence, a pay-for-performance initiative spearheaded by GE. Cincinnati Children’s Hospital Medical Center is a grantee under the Robert Wood Johnson Foundation’s Pursuing Perfection program. Among the issues explored were physician supply, incentive structures, specialty hospitals, and information technology.

Consumer Cost Sharing In Private Health Insurance: On The Threshold Of Change, Veronica V. Goff

National Health Policy Forum

Employers are asking employees to pay more for health care through higher premium contributions, share of contribution, and out-of-pocket maximums, along with variations in deductibles, copays, and coinsurance based on choice of providers, networks, drugs, and other services. This issue brief examines consumer cost-sharing trends in private insurance, discusses the outlook for cost sharing in employment-based benefits, and considers public policies to support health care markets for consumers.

Medicare's Chronic Care Improvement Pilot Program: What Is Its Potential?, Nora Super

National Health Policy Forum

This paper describes the voluntary chronic care improvement program under traditional fee-for-service Medicare as authorized by the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 (Public Law 108-173; section 721). This brief analyzes the emerging issues raised by this new program, including which chronic conditions and regional areas will be targeted, the types of entities that may participate, the physician’s role in care management, and the adoption and use of health information technology and evidence-based clinical guidelines.

Veterans' Health Care: Balancing Resources And Responsibilities, Lisa Sprague

National Health Policy Forum

This paper looks at the health care benefits and services administered by the U.S. Department of Veterans Affairs. It examines management strategies adopted within the department to allocate resources, structure benefits, and improve quality. Some recommendations made by the General Accounting Office and the President’s Task Force to Improve Health Care Delivery for Our Nation’s Veterans are reviewed, in particular the emphasis of the latter on increased collaboration with the Department of Defense. Long-term proposals to balance service commitments and financing also are considered.

Necessary But Not Sufficient? Physician Volunteerism And The Health Care Safety Net, Eileen Salinsky

National Health Policy Forum

This paper examines the role of physician-sponsored charity care in meeting the health care needs of the uninsured. The paper provides an overview of current charity care levels by medical specialties and geographic regions, discusses limitations in available data, and describes the settings in which charity care is provided. The paper also summarizes the factors that motivate physicians to provide volunteer services, as well as the barriers that hinder volunteer activities, including malpractice insurance concerns. Also discussed are a range of public policies, both existing and considered, that support volunteer activities, with a particular emphasis on the expansion of Federal …

The Influence Of Social Status On Token Women Leaders’ Expectations About Leading Male-Dominated Groups, Theodore W. Mcdonald, Loren L. Toussaint, Jennifer A. Schweiger

Public and Population Health Faculty Publications and Presentations

Prior research has shown that women report mostly negative expectations about being a gender-token in male-dominated work groups. We speculate that this is partially caused by the socially-ascribed status devaluation of women. In the present study we investigated the degree to which elevated social status may lessen negative expectations of gender-token women assigned to leadership positions. Sixty-three undergraduate women participated in one of three tokenism conditions: 1) nontoken, 2) gender-token, and 3) high-status gender-token. In all conditions participants were led to believe that they would be leading a group of men in a decision-making exercise. Leader expectations were then assessed. …

The Health Care Safety Net In South Carolina: A Test Of Tenacity, Jennifer Ryan, Randy Desonia

National Health Policy Forum

This site visit to the state of South Carolina provided an opportunity to experience and understand the unique makeup of the health care safety net in a southern state. Site visitors had the opportunity to interact with health care providers, state officials, faith-based organizations and leaders of provider-driven volunteer initiatives. They also learned about the challenges of access to care in rural areas and among diverse population groups. The group visited the Sea Island Medical Center and Our Lady of Mercy Community Outreach and Wellness House; a migrant farm worker camp on Johns Island; and a “medical home” site, Medical …

The Prevalence And Treatment Of Pain Among Rural Medicaid Beneficiaries With Disabilities, Craig Ravesloot Ph.D., University Of Montana Rural Institute

Health and Wellness

Pain has an enormous impact on the lives of many people with disabilities. Recent research suggests that nearly 80% of people whose primary disability is not a pain disorder are still limited by pain as a secondary condition. As many as half of those people report that their pain is ongoing, intractable and limiting (Ehde, Jensen, Engel, Turner, Hoffman & Cardenas, 2003). Our research suggests strong associations between an individual’s pain and his or her quality of life, depression and the number of hours worked.

Pain As A Secondary Condition Experienced Byrural Medicaid Beneficiaries With Disabilities, Craig Ravesloot Ph.D., University Of Montana Rural Institute

Health and Wellness

Secondary conditions are disability-related problems that further limit a person’s ability to engage in daily activities. People who live independently in the community and who have mobility impairments consistently report being limited by 14 secondary conditions annually.

Living Well With A Disability: An Update, Tom Seekins Ph.D., University Of Montana Rural Institute

Health and Wellness

As many as one of every five Americans has a disability or chronic health condition. In rural areas, that proportion (23%) is even higher. As the U.S. population ages, the numbers of people with disability and chronic conditions will predictably increase, which accounts for a growing national interest in the health and wellness of individuals with disabilities. While composing about 20% of the population, individuals with disabilities account for nearly half of all medical expenditures.

Correlates Of Adherence With Transdermal Nicotine., Theodore Cooper, M. Debon, M. Stockton, T. Steenbergh, D. Sherrill-Mittleman, L. Jennings, R. Klesges

Selected Works Temporary Series

No abstract provided.

Precautionary Approaches For Health And The Environment: Making The Case For A Toxics Reduction Strategy At Multnomah County And City Of Portland, Stephanie Farquhar, Molly Chidsey, Neha Patel

Community Health Faculty Publications and Presentations

This report summarizes an overview of the problem, local concerns, model policies, and best practices for toxic pollution prevention and provides recommendations for next steps to protect human health and the local environment in Portland and Multnomah County. This report accompanies the Multnomah County and City of Portland resolutions to "Recognize National Pollution Prevention Week and develop a Toxics Reduction Strategy jointly with City of Portland / Multnomah County using the Precautionary Principle."

Correlates Of Adherence With Transdermal Nicotine., Theodore Cooper, M. Debon, M. Stockton, T. Steenbergh, D. Sherrill-Mittleman, L. Jennings, R. Klesges

Departmental Papers (Psych)

No abstract provided.

Determinants Of Prenatal Care And Supplement Use: The Case Of Honduras, Catherine E. Henze

Theses and Dissertations

Context: Literature suggests that prenatal care and prenatal supplement use improves pregnancy outcomes. However, we do not know the factors associated with prenatal care and supplement use in Honduras.Objective: To identify characteristics of Honduran women who are the least and most likely to use prenatal care and supplements.Methods: Data from a 2001 Honduras cross-sectional survey of women was used to assess their use of prenatal care and supplements. All data was weighted, resulting in a sample size of n = 5647 women who had a live birth since January 1996. Bivariate and multivariate analyses were used to examine factors associated …

Rabies In Virginia, 1989-2003: With Particular Attention To Animals, Geographic Distribution, And Virus Variant, William Andrew Holzgrefe

Theses and Dissertations

Objectives: The description of the raccoon rabies epizootic in Virginia over fifteen years (1989-2003). Methods: Using simple statistical methods and a geographic information system (GIS)-based approach, and fifteen years worth of animal surveillance data, the progress of this epizootic has been charted in terms of the geographic spread of the disease, the major animal species affected by the disease and its spread, and the exposure and risk to humans and livestock animals presented by the expansion of the geographic range. Results: The resulting descriptive study illustrates the eastward expansion of the epizootic, the mushrooming of the disease in the northern …

Evaluation Of The Hayes E. Willis Health Center In South Richmond -- Has It Served Its Targeted Population?, Shannon Nicole Shaw

Theses and Dissertations

Objective: The Hayes E. Willis Health Center (HWHC) was opened in a neighborhood of South Richmond in October 1993 to remove the barriers that prevented South Richmond residents from accessing primary healthcare services. The major objective of this study was to determine the effectiveness of the HWHC in providing primary care to the South Richmond Community deemed to be in need. An additional objective was to describe the changes in characteristics of clinic users and illnesses seen over time.Methods: Patient data was compared from the HWHC�s first full year of operation in which patient data was collected (1995) to the …

Antioxidants As Risk Factors For Gingival Bleeding, Hee-Jeong Bahng

Theses and Dissertations

Background: Studies of gingival bleeding and the effects of antioxidants on extracellular matrix and immunologic and inflammatory responses provide a rationale for hypothesizing that antioxidants reduce the risk for gingival bleeding.Methods: This study evaluated the role of antioxidants as contributing risk factors for gingival bleeding utilizing the Third National Health and Nutrition Examination Survey (NAHNES III). A sample of 18,825 adults (20 to ≥ 90 years of age), with dental measurement and assessment of serum levels of antioxidants were included in the study. Gingival bleeding was defined as those who had more than 30 percent of gingival bleeding in 28 …

Is Number Of Pregnancies A Risk Factor For Heart Attack In Women?, Pavan Kumar Irukulla

Theses and Dissertations

Background: Studies regarding number of pregnancies and coronary heart disease have shown inconsistent results. In the present study, we assessed the association between number of pregnancies and heart attack (HA) in women.Methods: Using data from NHANES III a cross sectional data analysis of 10634 women aged 17 and above was conducted. We considered socio-demographic factors and other potential risk factors including physical activity, smoking, alcohol, diabetes, hypertension, hypercholesterolemia, BMI, age, and family history of heart attack. We conducted Bivariate analysis to determine prevalence and crude odds ratios. Multivariate logistic regression analysis was used to adjust for confounding variables using SPSS. …

Targeting The Male In Teen Pregnancy Prevention, Terri Burgan

Theses and Dissertations

Study Objectives: To examine demographic characteristics and contraceptive habits of young men.Methods: A descriptive study was conducted utilizing data analyzed from three waves of the National Survey of the Adolescent Male (NSAM) administered in 1988, 1991, and 1995. The first wave consisted of 1,880, never-married, noninstitutionalized 15-19 year old men living in the United States. The second wave consisted of 1,676 re-interviewed respondents who were 17-22 years old. The third wave consisted of 1,377 re-interviewed respondents who were 22-27 years old. Descriptive statistics were used to compare personal and demographic characteristics across each year group. Odds ratios, and their corresponding …

Association Between The Frequency Of Physical Education Classes And The Prevalence Of Overweight/Obesity In Adolescents, Collin N. Rice

Theses and Dissertations

Background/Objective: Overweight and obesity has been steadily on the rise in the United States for all groups. The prevalence of obesity for adolescents has tripled since 1980. The purpose of this study is to determine an association between the frequency of physical education classes and the prevalence of overweight/obesity in adolescents in the United States.Methods: This was a cross-sectional study that used the 2001 Youth Risk Behavior Survey (YRBS) of the Center for Disease Control. The outcome variable for the study was Body Mass Index (BMI). A BMI of 25 or greater was considered overweight or obese. The main independent …

Toothbrushing, Flossing, And Preventive Dental Visits By Richmond-Area Residents In Relation To Demographic And Socioeconomic Factors, Kim T. Isringhausen

Theses and Dissertations

Purpose. This study was conducted to identify factors that influence preventive dental behaviors and, from the results, target groups for intervention.Methods. Data were collected using the 1997 Behavioral Risk Factor Surveillance System (BRFSS) resulting in a probability sample of 399 dentate adults living in Richmond City, Henrico, Chesterfield and Hanover Counties in Virginia. All analyses were performed using the statistical software program STATA. Initial hypothesis testing was performed using univariate logistic regression models. Multivariate logistic regression models were used to test the significance of independent variables while controlling for other possible predictors of behavior.Results. Females were more likely than males …

Effect Of Repeated Dosing Of Delta 9-Tetrahydrocannabinol, The Major Psychoactive Ingredient Of Marijuana, On Memory In Mice, Floride Niyuhire

Theses and Dissertations

Purpose: Marijuana is the most widely used illicit drug in the United States. However, marijuana and cannabinoid derivatives have potential therapeutic uses. Studies in cannabis users have yielded contradictory results with regard to long-term effects on cognitive functions. There is no prospective study assessing this issue, and such studies may raise ethical issues in humans, whereas mice have been shown to exhibit similar cannabinoid-mediated behaviors as humans. The purpose of this study was to assess the consequences of chronic administration of Δ9-THC, the major psychoactive component of marijuana, in a mouse memory model. Methods: In Experiment 1, the dose-response relationship …

Bridging Silos, Part Ii: Di, Ssi, Medicare, And Medicaid Issues And Initiatives, Karen Matherlee

National Health Policy Forum

The second of two papers on the general topic of public disability and health benefits, this background paper lays out some key issues confronting the Social Security Disability Insurance, Supplemental Security Income, Medicare, and Medicaid programs. It also discusses major initiatives to address those issues, in light of growing administrative, fiscal, and other problems.

Bridging Silos, Part I: Linkages Among The Di, Ssi, Medicare, And Medicaid Programs, Karen Matherlee

National Health Policy Forum

This paper, the first of two on the general topic of public disability and health benefits, centers on the fundamentals of the Disability Insurance and Supplemental Security Income programs and their relationships with Medicare and Medicaid. In addition to looking at the programs’ definitions, distinctions, and overlaps, it reviews the effects on them of the Ticket to Work and Work Incentives Improvement Act of 1999 and, to a lesser extent, the Personal Responsibility and Work Opportunity Reconciliation Act of 1996.

Sailing Schip Through Troubled Waters, Jennifer Ryan

National Health Policy Forum

As the State Children’s Health Insurance Program (SCHIP) enters its sixth year of operation, states have continued their commitment to children’s coverage and to reaching out to the uninsured. This issue brief explores the current status of SCHIP in light of fiscal pressures that have been created by the state budget crisis. It highlights some of the key successes in the program thus far and notes several examples of state initiatives to serve particularly vulnerable populations and collect outcomes data and information about access to care.

Rural Health Care In The Electronic Age (Danville, Pa), Lisa Sprague, Nora Super

National Health Policy Forum

This site visit to the Geisinger Health System in central Pennsylvania explored the use of technology in providing health care to an aging, rural population with a high index of chronic-care needs. The agenda included an in-depth examination of Geisinger’s electronic medical record and its use in various domains of care, including outpatient clinics, disease management, and non-Geisinger medical practices and community hospitals. The program also highlighted specific care management initiatives in the areas of radiology, stroke, and obesity. Geisinger’s advantages as an integrated system dominant in its market, with the resources to invest in technology were weighed in considering …