Public Health Commons^™

Child Sexual Abuse And The Impact Of Rurality On Foster Care Outcomes: An Exploratory Analysis, Austin G. Griffiths, April L. Murphy, Whitney Harper

Social Work Faculty Publications

Given the cost of long-term foster care placement in both human and economic terms, few studies have specifically explored if any factors help to predict why this vulnerable population spends significantly more time in foster care. The overarching goal of this exploratory study was to use binary logistic regression to investigate whether any child demographic or environmental characteristics predicted the discharge of a child placed in Kentucky's foster care system for child sexual abuse. Results indicated that children in the most rural areas of the state were over 10 times more likely to be discharged from foster care during the …

Oil & Gas Drilling In National Parks, Elizabeth Ann Glass Geltman

Publications and Research

While a great deal of public attention addresses the Halliburton loophole of the Energy Policy Act of 2005 and Bureau of Land Management efforts to regulate hydraulic fracturing on public lands, less attention has been paid to the National Park Service “9B Regulations,” which provide a national regulatory framework governing the exercise of nonfederal oil and gas rights in national parks. This article begins with a review of law pertaining to oil and gas drilling in national parks. The article examines the tension in striking a balance between environmental protection, conservation of national lands and achieving energy independence, including National …

Enhancing Access To Alcohol Use Disorder Pharmacotherapy And Treatment In Primary Care Settings: Adapt-Pc., Hildi J Hagedorn, Randall Brown, Michael Dawes, Eric Dieperink, Donald Hugh Myrick, Elizabeth M Oliva, Todd H Wagner, Jennifer P. Wisdom, Alex H S Harris

Health Policy and Management Faculty Publications

BACKGROUND: Only 7.8 % of individuals meeting diagnostic criteria for alcohol use disorder (AUD) receive treatment in a given year. Most individuals with AUDs are identified in primary care (PC) settings and referred to substance use disorders (SUD) clinics; however, only a minority of those referred attend treatment services. Safe and effective pharmacological treatments for AUD exist, but they are rarely prescribed by PC providers. The objective of this study is to refine, implement, and evaluate an intervention to integrate pharmacological AUD treatment options into PC settings. This paper provides a detailed description of the intervention design and the evaluation …

Enhancing Access To Alcohol Use Disorder Pharmacotherapy And Treatment In Primary Care Settings: Adapt-Pc., Hildi Hagedorn, Randall Brown, Michael Dawes, Eric Dieperink, Donald Hugh Myrick, Elizabeth Oliva, Todd Wagner, Jennifer P. Wisdom, Alex Harris

Health Policy and Management Faculty Publications

BACKGROUND: Only 7.8 % of individuals meeting diagnostic criteria for alcohol use disorder (AUD) receive treatment in a given year. Most individuals with AUDs are identified in primary care (PC) settings and referred to substance use disorders (SUD) clinics; however, only a minority of those referred attend treatment services. Safe and effective pharmacological treatments for AUD exist, but they are rarely prescribed by PC providers. The objective of this study is to refine, implement, and evaluate an intervention to integrate pharmacological AUD treatment options into PC settings. This paper provides a detailed description of the intervention design and the evaluation …

Building Capacity In Implementation Science Research Training At The University Of Nairobi., George O Osanjo, Julius O Oyugi, Isaac O Kibwage, Walter O Mwanda, Elizabeth N Ngugi, Fredrick C Otieno, Wycliffe Ndege, Mara Child, Carey Farquhar, Jeremy Penner, Zohray Talib, James N Kiarie

Health Policy and Management Faculty Publications

BACKGROUND: Health care systems in sub-Saharan Africa, and globally, grapple with the problem of closing the gap between evidence-based health interventions and actual practice in health service settings. It is essential for health care systems, especially in low-resource settings, to increase capacity to implement evidence-based practices, by training professionals in implementation science. With support from the Medical Education Partnership Initiative, the University of Nairobi has developed a training program to build local capacity for implementation science.

METHODS: This paper describes how the University of Nairobi leveraged resources from the Medical Education Partnership to develop an institutional program that provides training …

Workforce Planning And Development In Times Of Delivery System Transformation, Patricia Pittman, Ellen Scully-Russ

Health Policy and Management Faculty Publications

Background

As implementation of the US Affordable Care Act (ACA) advances, many domestic health systems are considering major changes in how the healthcare workforce is organized. The purpose of this study is to explore the dynamic processes and interactions by which workforce planning and development (WFPD) is evolving in this new environment.

Methods

Informed by the theory of loosely coupled systems (LCS), we use a case study design to examine how workforce changes are being managed in Kaiser Permanente and Montefiore Health System. We conducted site visits with in-depth interviews with 8 to 10 stakeholders in each organization.

Results

Both …

An Ecological Perspective On Pertussis, Jody Ruth Goard

Walden Dissertations and Doctoral Studies

In 2012, 48,277 cases of pertussis were diagnosed in the United States. Pertussis, otherwise known as whooping cough, is a highly contagious, often debilitating, sometimes deadly, vaccine-preventable disease with an increasing incidence and death rate in the U.S, which may be due to vaccine exemptions. The purpose of this project was to determine if a relationship exists between immunization policies and immunization exemption rates, immunization exemption rates and pertussis rates, and immunization policies and pertussis rates in each state. Bronfenbrenner's bio-ecological framework was used to guide the project. Publically available data from the Centers for Disease Control and Prevention (CDC), …

Examining The Relationship Among Patient-Centered Communication, Patient Engagement, And Patient’S Perception Of Quality Of Care In The General U.S. Adult Population, Jumee Wang

Theses and Dissertations

Introduction: Patient-centered care is a major focus of healthcare organizations, policy makers, and researchers. Patient-centered communication by the provider and patient engagement are important components of patient-centered care. Despite increasing attention to these topics, we do not fully understand how patient-centered communication and patient engagement relate to perceived quality of care as reported by patients. This study takes some initial steps in exploring these relationships. The study also identifies patient-related factors such as sociodemographic, health-related, and health system factors that are associated with patient-centered communication, patient engagement, and perceived quality of care.

Method: This study used survey data …

The New York State Nursing Home Transition And Diversion Medicaid Waiver Program : A Descriptive Cost Comparison, Joe Atsushi Katagiri

Legacy Theses & Dissertations (2009 - 2024)

The New York State Nursing Home Transition and Diversion Medicaid waiver program (NHTD) assists individuals with long-term care needs with the goal of living safely in their communities. This program is founded on two assumptions: it is less expensive to provide long-term care services to Medicaid recipients in the community as opposed to a nursing home and those who are willing and capable of living in a community setting should do so. However, the healthcare environment in the United States is facing the rising cost of long-term care. The first assumption, if true, could be used as a means to …

Neoliberalism Redux: The Global Health Policy Agenda And The Politics Of Cooptation In Latin America And Beyond, Anne E Birn, Laura Nervi, Carlos Eduardo Siqueira

Gastón Institute Publications

This article explores the neoliberal cooptation of social justice-oriented global health policies over the last three decades, from primary health care and ‘health for all’ to various contemporary so-called ‘health equity’ initiatives, such as Universal Health Coverage and ‘health convergence’. The authors illustrate and contextualize the different periods and approaches with examples from a range of Latin American countries, drawing on diverse political experiences and social struggles in the health arena. The analysis concludes with reflections about the region’s experiences of resisting and challenging the neoliberal health agenda, in spite of domestic and global environments that have constrained these efforts, …

The Disease Burden And The Extent Of Drug Therapy Problems In An Underserved Minority Population Receiving Medication Therapy Management At An Ambulatory Care Free Clinic, D. N. Ombengi, F. A. Ndemo, Ayman M. Noreddin, W. T. Harris

Pharmacy Faculty Articles and Research

Objective: To determine the common medical conditions, medications, and associated drug therapy problems in an underserved minority population receiving medication therapy management services at a large Community Free Clinic compared to the findings of the Minnesota Pharmaceutical Care Project.

Methods: Retrospective cohort study of a random sample of 60 minority patients referred for medication therapy management service at a Community Free Clinic from January 2012 to January 2014. Patient data including demographics, medication experience, past medical and medication history, medical conditions, active medications, allergies, immunization history and drug therapy was systematically evaluated to determine the most common conditions, …

The Impact Of The Sentinel Initiative And Faers Surveillance System On Consumer Safety, Sonia Batra

Walden Dissertations and Doctoral Studies

The U.S. Food and Drug Administration (FDA) uses the FDA Adverse Event Reporting System (FAERS) to monitor adverse events resulting from pharmaceutical drug use. However, this system has limitations such as not allowing real-time data collection. To address these limitations, the FDA launched the Sentinel Initiative in 2008. This comparative case study was conducted to describe perceptions of investigating the efficacy of the Sentinel Initiative compared with the FAERS. The study was based on the theory of preemption as it emphasized the need for efficient means for providing unquestionable proof that consumers suffered adverse drug effects. The sample included interivews …

Competitive Food Policy Implementation In Kentucky Schools, Paula Gisler

Theses and Dissertations--Nursing

This study was designed to explore the literature on competitive food policy implementation (CFPI); examines demographic and school factors associated with CFPI; and explores the experiences of school leaders and staff in CFPI using a proposed theoretical framework to guide the research. Competitive foods are those sold in vending machines, a la carte settings, fundraisers, class parties and other venues which compete with foods offered through the national school lunch and breakfast programs. Competitive foods have traditionally been of low nutritional value and high energy density. CFPI may be effective in reducing student calorie intake and BMI. However, evaluation of …

The Consumer Perspective: A Consultation With Senior Health Officials From Developing Countries On Standards Of Evidence For Reproductive And Maternal Health Care, The Evidence Project, Step Up Research Programme Consortium

Reproductive Health

The Population Council (through the STEP UP consortium and the Evidence Project) and the High Impact Practices (HIP) Collaboration, together with other partners, held a series of three consultative meetings around the topic of standards of evidence in reproductive and maternal health. This report details the third and final meeting held in Bellagio, Italy in February 2016. The meeting brought together developing-country decisionmakers to vet, from the research “consumer” perspective, the recommendations that emerged from the second consultation and to elicit further recommendations on how to better generate and package evidence to meet the needs of decisionmakers. Also in attendance …

Routine Screening For Intimate Partner Violence: A Guide For Trainers, Odongo Odiyo, Chi-Chi Undie, Margaret Mak'anyengo

Reproductive Health

This the first regional document devoted to building the capacity of providers to respond to intimate partner violence (IPV). The training guide is a follow-on initiative to the 6th Best Practices Forum in Health of the East, Central and Southern Africa (ECSA) Health Community, held in August 2012. This Forum brought to the fore research findings from the region centering on the acceptability and feasibility of IPV screening, and culminated in the passage of a resolution by Health Ministers that prescribes the integration of gender-based violence screening into healthcare settings in the ECSA region. This training guide responds to this …

Evaluation De La Mise En Oeuvre Et Des Réalisations De L’Approche 3d Au Sein Du Plan D’Action National De Planification Familiale (Panpf) Au Sénégal—Technical Brief, Population Council

Reproductive Health

Leader dans le domaine de la Planification Familiale (PF) en Afrique de l’Ouest francophone, le Sénégal a entrepris diverses initiatives pour atteindre ses objectifs, dont l’élaboration du Plan d’Action National de Planification Familiale (PANPF) 2012–15, basé sur l’Approche 3D (Démocratisation, Démédicalisation, Décentralisation). Au moment où il arrivait à terme, et que l’élaboration d’un nouveau plan était envisagée, il était nécessaire de documenter l’approche, sa mise en œuvre, et ses réalisations. Le Population Council a mené cette étude en collaboration avec la Direction de la Santé de la Reproduction et de la Survie de l’Enfant du Ministère de la Santé et …

Utilization Of National Health Insurance For Family Planning And Reproductive Health Services By The Urban Poor In Uttar Pradesh, India, Arupendra Mozumdar, Kumudha Aruldas, Aparna Jain, Laura Reichenbach, Robin Keeley, M.E. Khan

Reproductive Health

In 2008, the Government of India launched the National Health Insurance Scheme, Rashtriya Swasthya Bima Yojana (RSBY), to enable families living below the poverty line in both urban and rural areas to access a range of private health services. The available evidence suggests several limitations and barriers that may affect the utilization of RSBY services and warrants a more in-depth examination of the contexts of family planning/reproductive health (FP/RH) services. The Population Council, under the Evidence project, conducted a study among the urban poor to: 1) determine RSBY awareness and barriers to enrollment; 2) identify barriers and facilitating factors to …

Demand And Supply Factors Affecting Maternal Healthcare Utilization Pattern In Nigeria, Dumbiri Joy Powell

Theses and Dissertations

Given poor maternal services utilization and associated high maternal mortality risk in Nigeria, we document policy-amenable supply and demand factors impacting women’ use of skilled ANC and institutional delivery services. Using a cross-sectional design, we analyzed data from the Nigeria State Health Investment Project health facility and household surveys on 418 health facilities and 3,726 women with a pregnancy within 24 months prior to survey living in 241 geographic wards of two states. Logistic regression was used to study associations of women’s use of each maternal service with ward facilities’ ANC outpatient satisfaction, healthcare staff job satisfaction, surveyorverified facility infrastructure, …

Across The States: Do Long Term Services & Supports Policies Affect The Number Of Nursing Home Residents With Low-Care Needs?, Mary Otis

MPA/MPP/MPFM Capstone Projects

Long term care for the elderly has been steadily gaining salience in the public policy realm for many years. The federal government has been vigorously studying and exploring solutions, including the Centers for Medicare and Medicaid Services’ (CMS) efforts to expand access to home and community-based services (HCBS) in order to reduce dependence on institutional care. These federal efforts include various incentive programs and policies recently offered under the Affordable Care Act. However, data on the strength of each state’s long term services and supports system has not been easily accessible until recently. The report “Raising Expectations: A State Scorecard …

Local Health Departments’ Activities To Address Health Disparities And Inequities: Are We Moving In The Right Direction?, Gulzar H. Shah, John P. Sheahan

Health Policy & Management: Faculty Publications (2006-2018)

Context: Health disparities are among the critical public health challenges.

Objectives: To analyze the extent to which local health departments (LHDs) perform activities for addressing health disparities, changes in proportion of LHDs’ performing those activities since 2005, and factors associated with variation in such engagement.

Methods: We used the 2013 National Profile of LHDs Survey to perform Logistic Regression of activities LHDs performed to address health disparities.

Results: About 20 percent of LHDs did not perform any activity to address health disparities. Significant decreases occurred since 2005 in the proportion of LHDs that performed health disparity reduction/elimination activities for four …

Determinants Of An Individual's Suicide Intention In South Korea, Nam Keun Choi

MPA/MPP/MPFM Capstone Projects

This study has examined a variety of variables that influence an individual’ s suicide intention, and analyzed the impact of these variables. The data are from the 2014 wave of the Korea Welfare Panel Survey (KoWePS). I analyze data on 13,687 out of 17,134 survey participants.

The dependent variable of my study is suicide intention such as suicidal thoughts and behaviors. The independent variables are classified into three categories: socio-demographic, psychological and mental health. Socio-demographic variables are gender, age, education, marital status, and income. Psychological variables are self-esteem, satisfaction with life, and religion. Mental health variables are depression, alcohol use, …

The Underuse Of Hospice Care In The African American Military Beneficiary Population, Wanda Castleberry Richards

Walden Dissertations and Doctoral Studies

Hospice services provide a holistic approach to end-of-life care to terminally ill patients though there is some evidence to suggest that African American military beneficiary populations may not access hospice care as often as expected. The purpose of this nonexperimental study was to evaluate reasons for the low use of hospice care among the terminally diagnosed members of this population, between the ages of 18 and 64. Kolcaba's comfort theory provided the theoretical framework for this study. The research explored whether a statistically significant difference exist among African Americans military beneficiaries population as compared to non-Hispanic Whites pertaining to their …

Sexual Health Education Policy: Influences On Implementation Of Sexual Health Education Programs, Renata Denise Ellington

Walden Dissertations and Doctoral Studies

High school youth in Grades 9-12 who are in public schools without comprehensive sexual health education (CSHED) are more likely to engage in high-risk sexual behaviors and have higher rates of HIV and sexually transmitted diseases than are their peers in schools with CSHED. The purpose of this correlational study was to explore the statistical relationship between the consistent implementation of CSHED, before and after the enactment of the Chicago Public Schools' (CPS) sexual health education policy, and the sexual risk behaviors of Chicago high school youth in Grades 9-12. The study was based on Antonovsky's salutogenic model of health …

Is There A Trade-Off? Infant Health Outcomes And Managed Care Competition, Shana L. Moore

Theses and Dissertations--Public Policy and Administration

This study offers insights into the impact of competition among Managed Care organizations (MCOs) on infant birthing charges and birth outcomes. Kentucky provides one of the nation’s first case studies to determine successes and failures of Medicaid MCOs, and by doing so, provides a prediction of the impact of Patient Protection Affordable Care Act (PPACA) competition on healthcare costs and birth outcomes. An analysis of a natural policy experiment in the state of Kentucky reveals that infants insured by a Medicaid MCO stay longer in hospitals, are less healthy, and cost more than those insured under Traditional Medicaid prior to …

Veterans' Perceptions Of Military Stigma And The Shame Associated With Combat-Related Posttraumatic Stress, Alexander J. Buelna

Walden Dissertations and Doctoral Studies

Military stigma is a heavy burden of social stigma internalized by veterans who are diagnosed with posttraumatic stress disorder (PTSD) during post-deployment psychological screening. PTSD is classified as a mental disorder associated with widespread reluctance to seek medical assistance. Among military veterans who suffer from combat-related posttraumatic stress (PTS), military stigma is considered a widespread problem. The purpose of this phenomenological study was to explore veterans' perceptions of various aspects of military stigma, including post-deployment psychological screening, the diagnosis of PTSD, and factors associated with reluctance to seek medical assistance for PTS. In-depth interviews were conducted with a convenience sample …

Environmental Factors Associated With Body Mass Index Among Long Haul Truck Drivers, Charlotte Hughes Huntley

Walden Dissertations and Doctoral Studies

In 2009–2010, the prevalence of obesity among U.S. adults was 40%, and the prevalence was 69% among long haul truck drivers. Researchers have not established a clear relationship between working environment and weight among truck drivers. This quantitative cross-sectional study, using an ecological framework, evaluated the relationship between the working environment (sleep performance, food choices, driving environment, and activity level) and weight severity (e.g., body mass index [BMI]) among long haul truck drivers. One hundred and twenty six adults (46 + 10, years of age), including both genders (male = 97 and females = 29) completed an online questionnaire evaluating …

Influence Of Public Insurance On Healthcare Access And Cancer Care, Wafa W. Tarazi

Theses and Dissertations

Medicaid expansion under the Affordable Care Act (ACA) facilitates access to care among vulnerable populations, but 21 states have not yet expanded the program. Tennessee’s Medicaid program experienced a dramatic Medicaid contraction when the program disenrolled approximately 170,000 nonelderly adults in 2005. Pre-ACA expansions were associated with better access to and utilization of healthcare services. However, little is known about the effect of these policy changes on improvement in health outcomes for women diagnosed with breast cancer, access to care for cancer survivors, and the effect of generosity and duration of expansion on access to care.

This dissertation has three …

A Community's Perception Of Pregnancy And Sexually Transmitted Infections And Prevention Programs, Felecity Nicole Burns

Walden Dissertations and Doctoral Studies

The United States has the highest rates of teenage pregnancies, births, abortions, and sexually transmitted infections in the industrialized world. African American teen pregnancies and sexually transmitted infections are on the rise in many rural southwest school districts in the State of Georgia where the sex education curriculum is nonexistent or solely focuses on abstinence. Georgia ranked 4th in cases of primary and secondary syphilis, 6th in AIDS, 12th in gonorrhea, 14th in teen pregnancies, and 17th in chlamydia in the United States in 2012. The purpose of this qualitative study was to evaluate the perceptions of residents of a …

Issues Affecting Sexual Decisions Among Black Women In The Era Of Hiv/Aids, Saecilia Jackson

Walden Dissertations and Doctoral Studies

HIV/AIDS became a significant concern in the United States (U.S.) during the 1980s and in recent years has increased the most among people living in underserved urban areas, particularly impacting Black women ages 24-35. Guided by the social learning theory, this phenomenological study explored the lived experiences and behaviors of Black women in the south in order to understand their sexual health decisions and how those decisions impact the spread of HIV/AIDS among this group. The central research question focused on understanding the sexual decision making of Black women in Georgia, from the perspective of the client and provider. Convenience …

Political, Economic, And Health Determinants Of Tuberculosis Incidence, Ashley Rutherford

Electronic Theses and Dissertations

The epidemiologic transition has shifted major causes of mortality from infectious disease to chronic disease; however, infectious diseases are again re-emerging as a major global concern (Diamond, 1997; Karlen, 1995; McNeil, 1976). This research aimed to identify potential areas of infectious disease influence that are not health-related in order to help governments and policymakers establish new policies, correct current policies, or further address these issues in order to effectively prevent and combat infectious disease. This study employed a retrospective, cross-sectional, non-experimental design via structural equation modeling (SEM) and examined tuberculosis incidence rates at the country-level. Secondary data from open-source, international …