Public Health Commons^™

Clash Of The Titans: Medicaid Meets Private Health Insurance, Sara J. Rosenbaum

Health Policy and Management Faculty Publications

Throughout its first forty-eight years of life, the federal Medicaid statute lacked a viable insurance pathway for most low-income adults' ineligible for employer-sponsored coverage. In what is arguably the most important public health achievement since the enactment of Medicare and Medicaid fifty years ago, the Patient Protection and Affordable Care Act (ACA) fundamentally alters this picture. Building on earlier breakthroughs for children, the ACA restructures Medicaid to cover poor adults and juxtaposes its new architecture against an affordable and accessible private insurance market for people ineligible for employer-sponsored or government insurance.

Impact Of Health Insurance Expansions On Nonelderly Adults With Hypertension., Suhui Li, Brian K. Bruen, Paula M. Lantz, David Mendez

Health Policy and Management Faculty Publications

Introduction

Hypertension is a risk factor for cardiovascular disease (CVD), the leading cause of death in the United States. The treatment and control of hypertension is inadequate, especially among patients without health insurance coverage. The Affordable Care Act offered an opportunity to improve hypertension management by increasing the number of people covered by insurance. This study predicts the long-term effects of improved hypertension treatment rates due to insurance expansions on the prevalence and mortality rates of CVD of nonelderly Americans with hypertension.

Methods

We developed a state-transition model to simulate the lifetime health events of the population aged 25 to …

Action For Dental Health Year Two Progress Report, American Dental Association

Action for Dental Health

No abstract provided.

The Core Competencies For Mental, Neurological, And Substance Use Disorder Care In Sub-Saharan Africa, Pamela Y. Collins, Seggane Musisi, Seble Frehywot, Vikram Patel

Health Policy and Management Faculty Publications

The 2010 Global Burden of Disease Study points to a changing landscape in which non-communicable diseases, such as mental, neurological, and substance use (MNS) disorders, account for an increasing proportion of premature mortality and disability globally. Despite evidence of the need for care, a remarkable deficit of providers for MNS disorder service delivery persists in sub-Saharan Africa. This critical workforce can be developed from a range of non-specialist and specialist health workers who have access to evidence-based interventions, whose roles, and the associated tasks, are articulated and clearly delineated, and who are equipped to master and maintain the competencies associated …

Should We Put Our Feet In The Water? Use Of A Survey To Assess Recreational Exposures To Contaminants In The Anacostia River., Rianna Murray, Sacoby Wilson, Laura Dalemarre, Victoria Chanse, Janet Phoenix, Lori Baranoff

Health Policy and Management Faculty Publications

The Anacostia River, a tributary of the Potomac River that flows into the Chesapeake Bay, is highly contaminated with raw sewage, heavy metals, oil and grease, trash, pathogens, excessive sediments, and organic chemicals. Despite this contamination, recreation on the river is very popular, including kayaking, canoeing, rowing, and sport fishing. There is currently no information available on the potential health risks faced by recreational users from exposure to the river’s pollutants. A total of 197 recreational users of the Anacostia River were surveyed regarding general demographic information and their recreational behavior over the previous year, including frequency and duration of …

Health Care Access Dimensions And Cervical Cancer Screening In South Africa: Analysis Of The World Health Survey., Tomi F. Akinyemiju, Jasmine A. Mcdonald, Paula M. Lantz

Health Policy and Management Faculty Publications

Background

Cervical cancer is the most commonly diagnosed cancer and the leading cause of cancer mortality among women in sub-Saharan Africa. Recent recommendations for cervical cancer primary prevention highlight HPV vaccination, and secondary prevention through screening. However, few studies have examined the different dimensions of health care access, and how these may influence screening behavior, especially in the context of clinical preventive services.

Methods

Using the 2003 South Africa World Health Survey, we determined the prevalence of cervical cancer screening with pelvic examinations and/or pap smears among women ages 18 years and older. We also examined the association between multiple …

Transforming Health Professions' Education Through In-Country Collaboration: Examining The Consortia Among African Medical Schools Catalyzed By The Medical Education Partnership Initiative., Zohray M. Talib, Elsie Kiguli-Malwadde, Hannah Wohltjen, Miliard Derbew, Yakub Mulla, David Olaleye, Nelson Sewankambo

Health Policy and Management Faculty Publications

BACKGROUND: African medical schools have historically turned to northern partners for technical assistance and resources to strengthen their education and research programmes. In 2010, this paradigm shifted when the United States Government brought forward unprecedented resources to support African medical schools. The grant, entitled the Medical Education Partnership Initiative (MEPI) triggered a number of south-south collaborations between medical schools in Africa. This paper examines the goals of these partnerships and their impact on medical education and health workforce planning.

METHODS: Semi-structured interviews were conducted with the Principal Investigators of the first four MEPI programmes that formed an in-country consortium. These …

Adapting Pharmaceutical Reimbursement Policies To Manage Spending On High-Priced Drugs, Elizabeth Docteur, Ruth Lopert

Health Policy and Management Faculty Posters and Presentations

No abstract provided.

The Role Of Occupational Therapy In Primary Care, Priti Patel

Occupational Therapy Doctorate Capstone Projects

The Capstone Project is focused on communicating, influencing and educating other health care professionals regarding the role of occupational therapy in the future model of primary care delivery initiated by the adoption of the Affordable Care Act and the Triple Aim Initiative. Currently, primary care, the largest health care platform in United States, is not inclusive of occupational therapy services. Occupational therapists have the scope, knowledge and understanding to be part of the redesigned team model of primary care. Educating those currently working in primary care about adding occupational therapy services can have a significant impact on the profession of …

Improving The Experiences Of Informal And Formal Alzheimer's Disease And Dementias Caregivers, Roxroy Anthony Reid

Walden Dissertations and Doctoral Studies

Informal and formal caregivers of persons with Alzheimer's disease and related dementias (ADRD) encounter a more difficult and unique set of challenges than do caregivers of individuals with general disabilities. If adequate caregiver supports are not provided, caregivers may experience increased strain as the disease progresses, increasing the likelihood of unnecessary institutionalization of their care recipients and increasing the cost to the public. Using rational choice theory and political systems theory, the purpose of this study was to differentiate between the phenomenological experiences of formal and informal caregivers of ADRD patients. The overall research was a qualitative design that used …

Food Policy: Urban Farming As A Supplemental Food Source, Bessie Didomenica

Walden Dissertations and Doctoral Studies

The distance between farms and cities and the limited access that some residents have to fresh foods can be detrimental to a city's capacity to feed people over time. This study addressed the under-studied topic of urban farming as a secondary food source, specifically by exploring the opportunities and limitations of urban farming in a large Northeastern city. Brundtland's food policy was the pivotal theory supporting food production to end global starvation, and was the link between environmental conservation and human survival. The research question for this study examined the potential food policy opportunities and limitations that assist urban farms …

Correlations Between Childhood Obesity And Obesogenic Environmental Variables Within Durham County, North Carolina, Eureka Capri Daye

Walden Dissertations and Doctoral Studies

The application of geographic information systems was used to map obesogenic conditions by zip code tabulation areas in Durham County, North Carolina and evaluated associations between those conditions and the understudied area of early childhood obesity. Of the thirty one percent of the children in Durham County, North Carolina who were considered obese in 2010, four hundred and thirty three (1:5) 2 - 4 year old children who received supplemental nutrition services for women, infants and children were obese with BMI levels greater or equal to the 95th percentile and were used as the criterion variable in the study (N=433). …

Perceived Factors Contributing To Coronary Heart Disease In African American Women, Funmilola O. Sholanke

Walden Dissertations and Doctoral Studies

African American women (AAW) suffer from disproportionately high death rates due to coronary heart disease (CHD) compared to Caucasian women. Although there have been a number of studies targeting African American adults with CHD in clinical interventions, very few studies have addressed the social determinants of health and the influence of AAW's perceptions of health factors on health outcomes. The purpose of this phenomenological study was to fill the gap in the existing knowledge base by examining the lived experiences of 10 AAW diagnosed with CHD with a focus on the perceptions of environmental, socioeconomic, and cultural factors related to …

Diagnosing An International Health Crisis: A Structural Exploration Of Ebola 2014, Maddison Zayn Jansen

Honors Program Theses

The Ebola crisis of 2014, though concentrated most heavily in three small countries in western Africa, awoke the international community to its lack of effective health crisis infrastructure. As the disease rocked the globe, multinational groups scrambled to help those directly affected and protect the overwhelming majority of people not directly affected. Most preventative measures failed, and pre-existing initiatives to stem the flow of the disease only served to open the floodgates more. After careful examination of the literature surrounding medical, cultural, financial, national, and global circumstances enabling Ebola to flourish, as well as applying individual analysis and examination, it …

Law’S Power To Safeguard Global Health: A Lancet–O’Neill Institute, Georgetown University Commission On Global Health And The Law, Lawrence O. Gostin, John T. Monahan, Mary C. Debartolo, Richard Horton

Georgetown Law Faculty Publications and Other Works

The law-–global, national, and subnational–-plays a vital, yet often underappreciated, role in safeguarding and promoting the public’s health. In this article, we launch the Lancet-O’Neill Institute, Georgetown University Commission on Global Health and the Law. Commissioners from around the world will explore the critical opportunities and challenges of using law as a tool, while evaluating the evidence base for legal interventions. The Commission aims to define and systematically describe the current landscape of law that affects global health and safety.

Commissioners were chosen from disciplines that range from health, policy, and law to economics and governance. The Commission aims …

Domestic Violence In The North Dakota Oil Patch: Barriers To Identifying And Serving Female Victims, Kristi Rendahl

School of Business Student Theses and Dissertations

This study explored domestic violence in energy boomtowns to answer the questions: What issues are confronting social service professionals who are in a position to identify and respond to female victims of domestic violence in rural North Dakota? What opportunities do professionals cite in identifying and responding to female victims of domestic violence in rural areas and boomtowns? Further, how has the professionals’ experience of the oil boom changed their methods of identifying and responding to female victims of domestic violence? The study used a qualitative approach through a focus group and interviews with the program directors of rural domestic …

Supplemental Nutrition Assistance Program And Home Food Availability : The Role Of Depression And Household Characteristics, Marta D. Hernandez

Legacy Theses & Dissertations (2009 - 2024)

Although about 47 million low-income people participated in the Supplemental Nutritional Assistance Program (SNAP) program at the end of 2012, the effect of SNAP participation on some nutrition related outcomes is controversial or unknown. Particularly, the effect of SNAP on food availability at-home has not been examined despite its association with food consumption. In addition, little is known about individual and social factors influencing this relationship. This study examined the effects of the interaction between SNAP participation and depression and the effects of the interaction between SNAP participation and the presence of children under 17 years of age on food …

Kenya Adolescent Sexual And Reproductive Health Policy, Ministry Of Health Kenya

Reproductive Health

This document is a review and revision of the National Adolescent Sexual and Reproductive Health Policy of Kenya, which involved in-depth consultations with a wide range of stakeholders through literature review, interviews, consultative meetings, and reviews of the various drafts. Many changes took place at the national and international levels that needed to be taken into account as the policy was reviewed, including the Constitution of Kenya (2010) with its attendant devolved governance structure as well as demographics, and social, economic, and technological environment. The government has made concerted efforts as part of Vision 2030 to respond to adolescents and …

Expanding Access To Education For Teenage Mothers In Homa Bay County: What ‘Might’ Work, Chi-Chi Undie

Reproductive Health

No abstract provided.

The Impact Of Disability: A Comparative Approach To Medical Resource Allocation In Public Health Emergencies, Katie Hanschke, Leslie E. Wolf, Wendy F. Hensel

Faculty Publications By Year

It is a matter of time before the next widespread pandemic or natural disaster hits the United States (U.S.). The international response to the 2009 H1N1 influenza stands as a cautionary tale about how prepared the world is for such an emergency. Although the pandemic fortunately proved to be less severe than initially anticipated, it nevertheless resulted in shortages of medical equipment, overburdened hospitals, and preventable patient deaths, particularly among young people.

A pandemic will inevitably lead to difficult decisions about the allocation of medical resources, such as who will have priority access to ventilators and critical care beds when …

Toward Coherent Federal Oversight Of Medicine, Patricia J. Zettler

Faculty Publications By Year

The conventional wisdom in U.S. health law and policy holds that states regulate medical practice – the activities of physicians and other health care professionals – while the federal government regulates medical products. But relying on states as the principal regulators of medical practice has, at times, driven law and policy in directions that are problematic from a public health perspective, as demonstrated by a deadly 2012 outbreak of fungal meningitis that was linked to a state-regulated practice known as drug compounding. This Article argues that the federalism concerns underlying the conventional wisdom are misplaced. It demonstrates that, contrary to …

Gender Difference When Processing Death By Suicide: Attitudes Amongst Third Level Students Aged 18-25 Attending Cork Institute Of Technology And College Support Professionals, Sandra Conroy

Masters

Rationale behind research: Survivors of suicide/ suicide bereaved face unique challenges in their grief, resulting in a greater risk of conditions such as complicated grief, PTSD and suicidal ideation developing (Young, Iglewicz, Glorioso, Lanouette, Seay, llapakurti & Zisook, 2012). In dealing with or 'processing' the loss of a loved one by suicide, Wertheimer details that, "suicidal thoughts are not uncommon during the early months of bereavement" (1991: 178). The incidence of young men dying by suicide is notably higher than that of women in this country; a stubborn gender difference persists in Ireland with males representing on average 80% of …

Relationship Between Modality And The Degree Of Knowledge Retention In Bioterrorism Training, Gaylon Rashun Crawford

Walden Dissertations and Doctoral Studies

A public health workforce must be trained to react quickly, especially in the case of terrorist attack. Political leaders and emergency management experts have often cited inadequate emergency training as a contributing factor in the public health system's failed preparations for a bioterrorist event. As a result of these failures, billions of dollars have been allocated towards correcting infrastructure deficiencies including training for public health nurses (PHNs), who are critical to a communitywide medical response. This quantitative study used Pearson's correlation and a multivariate regression analysis to evaluate the most effective modality of bioterrorism training (BTT) for PHNs working in …

Knowledge Of Overdiagnosis And The Decision To Participate In Breast Cancer Screening, Kimberly T. Nembhard

Walden Dissertations and Doctoral Studies

In 2014, breast cancer was the second leading cause of death among Canadian women, with women over age 50 years making up 82% of the identified cases. To address this issue, the Ontario Breast Screening Program developed a media campaign that promoted the benefits of mammogram screening, but not the associated risks (i.e., false-positive, false-negative, radiation exposure, and overdiagnosis). This study was designed to determine whether there was a statistically significant relationship between knowledge of overdiagnosis and participation in mammogram screening. This cross-sectional, correlational study used schema theory supported by the effective health communication model. Forty-one women were invited to …

Expanding Access To Secondary School Education For Teenage Mothers In Kenya: A Baseline Study Report, Chi-Chi Undie, Harriet Birungi, George Odwe, Francis Obare

Reproductive Health

Carried out in Homa Bay County, Kenya, this study provides a baseline assessment involving the following data collection components: a household survey with out-of-school teenage girls (regardless of whether they had ever been pregnant or not), teenage mothers, and their household heads; and a school survey with secondary school principals and students. The objectives of the study were to: 1) foster an understanding of the current situation and context in regard to out-of-school teenage mothers and their potential support systems for school re-entry at the household and school levels; 2) clarify possible solutions for promoting school re-entry on the part …

Education Sector Response To Early And Unintended Pregnancy: A Review Of Country Experiences In Sub-Saharan Africa, Harriet Birungi, Chi-Chi Undie, Ian Mackenzie, Anne Katahoire, Francis Obare, Patricia Machawira

Reproductive Health

In Sub-Saharan Africa (SSA), early and unintended pregnancy leads to a colossal loss of educational opportunities for girls. Existing studies that show associations between early/unintended pregnancy and school dropout lead to critical questions about how the education sector is responding to the issue in SSA. Conducted from August 2014 to April 2015, this review was devoted to an examination of such responses across six countries: Botswana, Kenya, Malawi, Tanzania, Uganda, and Zambia. The review focused on several key issues, including: education-sector policies for pregnant students and adolescent mothers; integration of pregnancy prevention into sexuality education curricula; the school environment as …

Strengthening School Health Programming In Nairobi City County, Joyce Mumah

Reproductive Health

No abstract provided.

The Education Sector Response To Early And Unintended Pregnancy (Eup): A Review Of Selected Sadc Countries, Chi-Chi Undie, Harriet Birungi, Francis Obare, Patricia Machawira

Reproductive Health

No abstract provided.

Understanding Youth Sexual And Reproductive Health-Seeking Behaviors In Ethiopia: Implications For Youth-Friendly Service Programming, The Evidence Project

Reproductive Health

In Ethiopia, significant attention has been given to improving youth sexual and reproductive health (SRH) services, including the establishment of youth-friendly services (YFS). Yet high rates of child marriage, unmet need for family planning, and adolescent childbearing persist, particularly in rural areas where over 84 percent of the population lives. Reaching rural youth with timely SRH information and services that are relevant to their varying ages and life stages remains a challenge. The Evidence Project is examining the coverage and reach of public and NGO-supported youth SRH services in several rural regions of Ethiopia. As this activity brief notes, the …

Utilization Of National Health Insurance For Family Planning And Reproductive Health Services By The Urban Poor In Uttar Pradesh, India, The Evidence Project

Reproductive Health

In 2008, the Government of India launched the National Health Insurance program, Rashtriya Swasthya Bima Yojana (RSBY), to enable families living below the poverty line in urban and rural areas to access a range of private health services. Enrolled families can access packages of services from RSBY-participating private hospitals, including family planning (FP) and other reproductive health (RH) services. Despite the availability of insurance coverage, poor families’ utilization of RSBY for FP/RH services is believed to be negligible. The Evidence Project is conducting a study in three cities in Uttar Pradesh to better understand the factors affecting utilization of RSBY …