Public Health Commons^™

Sweet Freedom: Smokers’ Rights & The Rebranding Of Philip Morris, Amy Dipierro

Annual Undergraduate Conference on Health and Society

This paper discusses how Philip Morris invoked strong American values to defend its own corporate speech as well as “smoker’s rights.” In particular, it examines Philip Morris Company’s Bill of Rights advertising campaign of the early 1990s, especially focusing on an advertisement featuring Everett Alvarez, a prisoner of war during Vietnam. This strategy reveals how Philip Morris was able to manipulate the public conversation about smoking from one about health and disease to one about human rights and freedoms.

Aids: An Overview, Loretta Mclaughlin

New England Journal of Public Policy

"We stand nakedly in front of a very serious pandemic, as mortal as any pandemic there ever has been," said Halfdan Mahler, director-general of the World Health Organization (WHO). "I don't know of any greater killer than AIDS, not to speak of its psychological, social and economic maiming. Everything is getting worse and worse with AIDS and all of us have been underestimating it, and I in particular. We're running scared. I cannot imagine a worse health problem in this century." When asked to compare AIDS to other epidemics, such as smallpox, that have infected and killed over the course …

Examining Mainecare’S Coverage Options Under The Affordable Care Act, Erika C. Ziller Phd, Trish Riley

Population Health & Health Policy

The Affordable Care Act (ACA) was designed to achieve nearly universal access to health coverage in the United States—in part by standardizing Medicaid eligibility across the country so that each state’s program would cover individuals with incomes below 138% of the federal poverty level (FPL), or $15,856 for an individual and $32,499 for a family of four in 2013 (see Figure 1).i However, in June 2012, the U.S. Supreme Court determined that states could not be required to broaden Medicaid and retained the decision as a state option. States that choose to participate may do so by amending their state …

International And Domestic Student Health-Information Seeking And Satisfaction, Stacy Theodora Austin

Dissertations and Theses

This study examines two groups -international and domestic students at Portland State University (PSU) - in terms of their motivations to seek university-health services, and their satisfaction with university-health services. The Theory of Motivated Information Management (W. A. Afifi & Weiner, 2004) served as the foundation for this study to examine the preferences of students in terms of the ways they seek information about their health concerns. Differences in international and domestic students' anxiety, efficacy, and satisfaction with physicians were supported. International students reported more anxiety than domestic students. Domestic students reported being more efficacious than international students when talking …

Building The Science Of Public Health Delivery: Advances In Public Health Services And Systems Research, Glen P. Mays

Health Management and Policy Presentations

Efforts to improve the health and economic performance of the U.S. health system require evidence about how best to deliver public health strategies that protect health and prevent disease and injury on a population-wide basis. The field of public health services and systems research is building a "science of delivery" in public health that complements the evidence-based practice movement in medical care.

From The Frontier: Translating Research To Practice...A Story Of Economic Survival, Paul C. Erwin

Frontiers in Public Health Services and Systems Research

This article is number two in the series From the Frontier: Translating Research to Practice. The narrative describes the interactions between a local health department director and two academicians in addressing the impact of the 2008 financial crisis. In a first set of activities, practice-academic partners used Financial and Operational Ratio and Trend Analysis to identify periods of a negative total margin and the impact of that on the agency’s declining fund balance. The use of private sector processes of retrenchment, repositioning, and reorganization led to a financial turnaround for the agency. In a second set of activities, practice-academic …

Assessing The Potential Impact Of Sequestration On Community Health Centers, Patients, And Medically Underserved Communities, Peter Shin, Jessica Sharac, Carmen Alvarez, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

A new report by the Peter Shin, Jessica Sharac, Carmen Alvarez, and Sara Rosenbaum examines the potential impact of sequestration on community health centers and their patients and communities. "Assessing the Potential Impact of Sequestration on Community Health Centers, Patients, and Medically Underserved Communities" estimates that the nation's 1,200 federally funded health centers will lose $120 million in grant funding, and that this funding drop can be expected to translate into 900,000 fewer patients served and 3 million fewer visits. The analysis shows that the cuts will disproportionately impact the poorest Americans, children, young families, and members of ethnic and …

Community Health Centers In An Era Of Health Reform: An Overview And Key Challenges To Health Center Growth, Peter Shin, Jessica Sharac, Carmen Alvarez, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Today, over 1,100 federally funded community health centers play a vital role in ensuring access to health care for a predominantly low-income population in medically underserved communities. Health centers’ ability to provide comprehensive primary care and improve access to high-quality care while holding down health care cost growth has been well-documented. As health reform spurs coverage expansion and efforts to improve quality, the nation’s reliance on health centers is likely to grow.

In the Affordable Care Act (ACA), Congress invested $11 billion over five years to expand the health center program, to broaden access to care in lower-income communities as …

First Steps Phase I Initiative: Improving Immunizations For Children And Adolescents, Kimberley S. Fox Mpa, Carolyn E. Gray Mph

Population Health & Health Policy

This evalution report, authored by research staff at the USM Muskie School, assesses the change in immunization rates in participating pediatric and family practices that serve a high volume of children insured by MaineCare (Maine's Medicaid system). The authors also summarize lessons learned in implementing changes in practices and challenges in using the immunization measures at the practice-level to inform quality improvement.

Describing Teacher–Student Interactions: A Qualitative Assessment Of Teacher Implementation Of The 7th Grade Keepin’ It Real Substance Use Intervention, Jonathan Pettigrew, Michelle Miller-Day, Young Ju Shin, Michael L. Hecht, Janice L. Krieger, John W. Graham

Communication Faculty Articles and Research

Variations in the delivery of school-based substance use prevention curricula affect students' acquisition of the lesson content and program outcomes. Although adaptation is sometimes viewed as a lack of fidelity, it is unclear what types of variations actually occur in the classroom. This observational study investigated teacher and student behaviors during implementation of a middle school-based drug prevention curriculum in 25 schools across two Midwestern states. Trained observers coded videos of 276 lessons, reflecting a total of 31 predominantly Caucasian teachers (10 males and 21 females) in 73 different classes. Employing qualitative coding procedures, the study provides a working typology …

Tobacco Endgame Strategies: Challenges In Ethics And Law, Bryan P. Thomas, Lawrence O. Gostin

Georgetown Law Faculty Publications and Other Works

There are complex legal and ethical tradeoffs involved in using intensified regulation to bring smoking prevalence to near-zero levels. The authors explore these tradeoffs through a lens of health justice, paying particular attention to the potential impact on vulnerable populations. The ethical tradeoffs explored include the charge that heavy regulation is paternalistic; the potentially regressive impact of heavily taxing a product consumed disproportionately by the poor; the simple loss of enjoyment to heavily addicted smokers; the health risks posed by, for example, regulating nicotine content in cigarettes—where doing so leads to increased consumption. Turning to legalistic concerns, the authors explore …

Palliative Care And The Health Care Crisis In The United States: A Candid Conversation With Dr. Diane Meier, Diane E. Meier

Center for Policy Research

This paper is a synthesis of the 2012 Lourie Lecture, framed as a series of questions and responses, and supported by images used in the lecture. I’m going to focus on the growth of this new field called palliative care and will make the connection that the crisis afflicting healthcare in the United States cannot be addressed without widespread scaling and implementation of palliative care across the system. My subject is not end-of-life care, but rather care during serious illness. A serious illness is something a person can live with for many years, such as emphysema, or end-stage renal disease …

Perceptions Of Herbal Remedies Among California Polytechnic University, San Luis Obispo Students, Maria Cacciatore, Kimmie Layland, Nicole Morrisey

Social Sciences

Many practitioners now recognize that herbal remedies can be an effective and natural alternative to the standard American, western biomedicine. The objective of our research project is to discover the perceptions about herbal remedies as alternative medicine among Cal Poly students. Specifically we ask, why are they chosen and how students gauge their effectiveness. We seek to see if students have experimented with these herbal remedies, why they chose this route for wellness, and how they value the use of herbal alternative. If we are successful in this project, we will have a greater understanding of how young educated adults …

Young Athletes Must Learn To Balance Health, Challenges, Lisa Barkley

UCF Forum

We all want sports heroes and we all want to win – but that desire comes with a price. Just as there will always be winners in sports, there will always be injuries and losers. Often the lines are blurred between what is in the best interest of an athlete’s health and well-being and what it takes to win.

Less Talk, More Action: Accelerating Innovative Strategies To Eliminate Health Disparities

Population Health Matters (Formerly Health Policy Newsletter)

No abstract provided.

Evidence-Based Decision Making To Improve Public Health Practice, Ross C. Brownson, Jonathan E. Fielding, Christopher M. Maylahn

Frontiers in Public Health Services and Systems Research

Despite the many accomplishments of public health, greater attention on evidence-based approaches is warranted. This article reviews the concepts of evidence-based public health (EBPH), on which formal discourse originated about 15 years ago. Key components of EBPH include: making decisions based on the best available scientific evidence, using data and information systems systematically, applying program planning frameworks, engaging the community in decision making, conducting sound evaluation, and disseminating what is learned. Core competencies for EBPH are emerging, including not only technical skills but also attention to administrative practices in public health agencies. To better bridge evidence and practice, the concepts …

Public Health Delivery Systems And Population Health: What We Know And Need To Learn, Glen P. Mays

Health Management and Policy Presentations

Despite high overall health expenditures, the U.S. continues to fall behind other high-income countries on many measures of population health. While health care delivery systems are now studied intensively for solutions to U.S. cost and quality problems, the nation's delivery systems for public health programs and policies are only now becoming the subject of rigorous empirical study. This presentation examines recent studies of public health delivery systems and important directions for future inquiry.

Estimating The Health And Economic Effects Of Public Health Spending, Glen P. Mays

Health Management and Policy Presentations

Preventable health conditions account for more than 75% of the $2.7 trillion spent annually on health care in the U.S., yet less than 5% of these expenditures are devoted to public health programs and services that are designed to prevent and control disease and injury rather than to treat the downstream consequences of these conditions. Such limited expenditures in public health may contribute to the higher rates of preventable morbidity, mortality and excess medical costs experienced in the U.S. compared to other high-income countries. In this presentation, I update previous estimates of the health effects and medical cost offsets associated …

Functional Impairment, Illness Burden, And Depressive Symptoms In Older Adults: Does Type Of Social Relationship Matter?, Joshua P. Hatfield, Jameson K. Hirsch, Jeffrey M. Lyness

ETSU Faculty Works

Objective: The nature of interpersonal relationships, whether supportive or critical, may affect the association between health status and mental health outcomes. We examined the potential moderating effects of social support, as a buffer, and family criticism, as an exacerbating factor, on the association between illness burden, functional impairment and depressive symptoms.

Methods: Our sample of 735 older adults, 65 years and older, was recruited from internal and family medicine primary care offices. Trained interviewers administered the Hamilton Rating Scale for Depression, Duke Social Support Inventory, and Family Emotional Involvement and Criticism Scale. Physician-rated assessments of health, including the Karnofsky Performance …

Sexual Orientation And Functional Pain In U.S. Young Adults: The Mediating Role Of Childhood Abuse, Andrea L. Roberts, Margaret Rosario, Heather L. Corliss, David Wypij, Jennifer R. Lightdale, S. Bryn Austin

Publications and Research

Objective: Pain without known pathology, termed ‘‘functional pain,’’ causes much school absenteeism, medication usage, and medical visits. Yet which adolescents are at risk is not well understood. Functional pain has been linked to childhood abuse, and sexual orientation minority youth (gay, lesbian, bisexual, ‘‘mostly heterosexual,’’ and heterosexual with same-sex sexual contact) are more likely to be victims of childhood abuse than heterosexuals, thus may be at greater risk of functional pain.

Methods: We examined sexual orientation differences in past-year prevalence of functional headache, pelvic, and abdominal pain and multiple sites of pain in 9,864 young adults (mean age = …

Models In Dissemination And Implementation Research: Useful Tools In Public Health Services And Systems Research, Rachel G. Tabak, Elaine C. Khoong, David Chambers, Ross C. Brownson

Frontiers in Public Health Services and Systems Research

Dissemination and implementation (D&I) science seeks to understand how to systematically facilitate utilization of evidence. Theories and frameworks (hereafter called models) augment D&I research by enhancing efforts to spread evidence-based interventions (EBIs). D&I models are relevant for public health services and systems research, which also explores the uses of evidence. This report: 1) develops an inventory of models; 2) synthesizes this information; and 3) provides guidance on how to select a model. The research team used snowball sampling to collect models. This article uses three author-defined variables: construct flexibility, focus on dissemination and/or implementation activities, and socio-ecological framework level to …

Commentary: Changing The Channel: Public Health Communication In The 21st Century, Anna Goodman Hoover

Frontiers in Public Health Services and Systems Research

This commentary asserts the need for research examining the use and efficacy of social media as a tool for meeting public health stakeholders’ information needs. The author points to several potential research questions for the field, situates studies addressing these questions within the PHSSR Research Agenda, and introduces the work of Harris et al. that is included in this issue of Frontiers. The commentary closes with a call for horizontal stakeholder communication that supports evidence-based decision-making.

Commentary: Hospital Tax-Exempt Policy: A Comparison Of Schedule H And State Community Benefit Reporting Systems, Laura L. Hitchcock

Frontiers in Public Health Services and Systems Research

In Hospital Tax-Exempt Policy: A Comparison of Schedule H and State Community Benefit Reporting Systems, Rosenbaum et aldescribe the numerous variations between current state law in 24 states and federal requirements regarding nonprofit hospitals’ community benefit activities. The potential for nonprofit hospitals to help shape community health is great, and how states choose to address requirements regarding community benefit, and potentially reinforce the new federal requirements to incentivize hospital participation in addressing root causes of poor health, should be of significant interest to the public, policy makers and public and population health experts, given the large percentage of …

Hospital Tax-Exempt Policy: A Comparison Of Schedule H And State Community Benefit Reporting Systems, Sara Rosenbaum, Maureen Byrnes, Amber M. Rieke

Frontiers in Public Health Services and Systems Research

The Patient Protection and Affordable Care Act (ACA) revises federal tax exemption standards for nonprofit hospitals by clarifying and augmenting their community benefit obligations. The ACA amendments followed the 2009 launch of Schedule H – the form on which hospital community benefit, financial, and institutional activities are reported and which must be appended to each facility’s annual Form 990 nonprofit institution information return. Schedule H effectively creates a nationwide, standardized, facility-specific, transparent, and fully publicly accessible reporting system covering the nation’s more than 2,900 nonprofit hospitals. Schedule H delineates financial assistance and bad debt, and requires identification of community health …

Learning By Doing For Public Health Improvement, Glen P. Mays

Frontiers in Public Health Services and Systems Research

All too often, the knowledge gained through learning-by-doing in public health fails to be fully harvested and disseminated because of missed opportunities to carefully study the experiences and innovations occurring in practice. The field of public health services and systems research (PHSSR) has emerged to capitalize on these opportunities before they are missed.

Public Health Expenditures, Public Health Delivery Systems, And Population Health, Glen P. Mays

Health Management and Policy Presentations

This seminar examines a series of approaches for estimating the health and economic effects attributable to public health expenditures in the U.S., along with a novel method for estimating economies of scale and scope in the delivery of public health services. The use of instrumental-variables techniques and network analytic methods are described in these research approaches.

Exploring Four Barriers Experienced By African Americans In Healthcare: Perceived Discrimination, Medical Mistrust, Race Discordance, And Poor Communication, Adolfo Gabriel Cuevas

Dissertations and Theses

For many health conditions, African Americans bear a disproportionate burden of disease, injury, death, and disability compared to European Americans. African Americans also use health services less frequently than do European Americans and this underuse of services contributes to health disparities in the United States. Studies have shown that some disparities are present not as a result of poor access to care, but, to a certain extent, as a result of the experiences patients have at their doctors' offices. It is, therefore, essential to understand African American patients' perspectives and experiences with healthcare providers. Past studies have shown that four …

Effectiveness Of A Portable, Large-Area Ultraviolet Germicidal Device, Mark P. Buttner, Thomas Yee, Patricia Cruz, Vanessa Stevens

Nevada Journal of Public Health

Effective disinfection of the hospital environment is a key component in the prevention of healthcare-associated infections. The objective of this project was to evaluate the effectiveness of an ultraviolet germicidal device in reducing the concentrations of culturable bacteria on indoor surfaces. The ultraviolet germicidal device was installed and operated in four experimental trials conducted in a microbiology research chamber. Agar plates inoculated with known concentrations of two test microorganisms were placed on benches inside the chamber at two distances, 1.5 meters and 3.0 meters from the machine, for exposure times of 5 minutes, 10 minutes, and 20 minutes. With test …

Atrazine And Nitrate In Public Drinking Water Supplies And Non-Hodgkin Lymphoma In Nebraska, Usa, Martha G. Rhoades, Jane L. Meza, Cheryl L. Beseler, Patrick J. Shea, Andy Kahle, Julie M. Vose, Kent M. Eskridge, Roy F. Spalding

School of Natural Resources: Faculty Publications

A secondary analysis of 1999–2002 Nebraska case-control data was conducted to assess the risk of non-Hodgkin lymphoma (NHL) associated with exposure to nitrate- and atrazine-contaminated drinking water. Water chemistry data were collected and weighted by well contribution and proximity of residence to water supply, followed by logistic regression to determine odds ratios (OR) and 95% confidence intervals (CI). We found no association between NHL risk and exposure to drinking water containing atrazine or nitrate alone. Risk associated with the interaction of nitrate and atrazine in drinking water was elevated (OR, 2.5; CI, 1.0–6.2). Risk of indolent B-cell lymphoma was higher …

State Foodborne Illness Surveillance And Response Laws: Compilation And Analysis, Stephanie David, Jenna Burton, Chris Chadwick, Rebecca Katz

Health Policy and Management Faculty Publications

Objective

To document and assess the variation in state legislation relating to foodborne disease surveillance and outbreak response for all 50 states and the District of Columbia by creating a database and appendix of laws and regulations that will be made available to researchers and policymakers.

Introduction

Foodborne illnesses sicken 48 million and kill 3,000 Americans every year, presenting an enduring threat to the public’s health. In just the past three years alone, the United States has experienced at least four major multistate outbreaks in food. Despite this growing problem, efforts to prevent foodborne illness pose a particular public health …