Public Health Commons^™

Saving Our Sisters: Effects Of A Computer-Based Version Of Sista On The Hiv-Related Behaviors Of African American Women, Krystal Frieson

Theses and Dissertations--Educational, School, and Counseling Psychology

Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) are infectious diseases wreaking irreparable havoc on the lives of millions all around the world. Of those infected and affected by HIV in the United States, African Americans disproportionately bear the burden of this disease, which has resulted in a major crisis within the African American community. In 2010, African Americans accounted for approximately 44% of all new HIV infections among adolescents, 13 years of age and older, and adults [Centers for Disease Control and Prevention [CDC], 2012). These statistics become even more dismal when both race and gender enter the …

An Examination Of Intimate Partner Violence And Cigarette Smoking Among African American Women In 12 States, Eboneka Coleman

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Abstract

Introduction. African American female intimate partner victims (IVP) are more likely to abuse substances, suffer from depression and anxiety, and experience mental health issues, including PTSD, all of which are risk factors for smoking. The purpose of this study is to determine among African American women who have ever experienced IPV the prevalence of smoking and whether it is influenced by education and income.

Methods. Data for this study comes from the 2005 Centers for Disease Control and Prevention (CDC) state-based Behavioral Risk Factor Surveillance System (BRFSS). This primary study population was African American females who answered IPV-related questions …

Public Health System Partnerships And The Scope Of Maternal And Child Services: A Longitudinal Study, Sharla Smith, Glen Mays, Tommy Mac Bird, Michael A. Preston

Frontiers in Public Health Services and Systems Research

Local health departments (LHDs) struggle to serve their communities in the face of ongoing fiscal constraints. Fiscal constraints have led to the elimination and reduction of maternal and child health services (MCH). LHDs have used various strategies to minimize the negative impact fiscal constraints of elimination or reduction of services provided to their communities. Many LHDs have used strategies such as developing partnerships. While these strategies are assumed to increase the delivery of services and improve outcomes, there is limited research on the type of partnerships needed to service delivery. Our interest was identifying the type of partnerships associated with …

Exploring The Process, Models, And Outcomes Of Hospital-Public Health Partnerships, Danielle M. Varda, Jessica H. Retrum, Carrie Chapman

Frontiers in Public Health Services and Systems Research

Health care reform has resulted in changes throughout the health system, including the Affordable Care Act (ACA) requirement that hospitals conduct community health needs assessments, taking into greater consideration the public health of their respective communities. This has led to growing strategies to develop partnerships between hospitals and public health (PH) as a way to meet these needs¹. Meantime, there is a need for data on Hospital-PH partnerships, due to the growing emphasis that these types of partnerships get implemented in practice. In this paper we analyze a secondary data set to explore how hospitals and public health …

A Case Study Of Cross-Jurisdiction Resource Sharing: The Merger Of Two Tuberculosis Clinics In East Tennessee., Anne Kershenbaum, Margaret A. Knight, Martha L. Buchanan, Janet Ridley, Paul C. Erwin

Frontiers in Public Health Services and Systems Research

Cross-jurisdiction resource sharing is considered a possible means to improve efficiency and effectiveness of public health service delivery. A merger of the Tuberculosis (TB) clinics of a rural and a metropolitan jurisdiction in East Tennessee provided an opportunity to study service provision changes in real time. A mixed methods approach was used, including quantitative data on latent TB treatment outcomes and qualitative data from staff interviews, as well as documentation of changes in staffing time in TB services. Results showed a mix of efficiency changes, indicating probable increased pressure on key service providers after the merger, in addition to expected …

Health Communication As A Public Health Training And Workforce Development Issue, Nancy L. Winterbauer, Ann P. Rafferty, Katherine A. Jones, Mary Tucker-Mclaughlin, Colleen Bridger

Frontiers in Public Health Services and Systems Research

Effective communication is one of the core competencies for public health professionals and is required for local health department (LHD) accreditation. Public health communication specialists play a critical role as conduits of health information, particularly with regard to managing relationships with media and the message that is ultimately represented by news outlets. However, capacity for engagement with traditional media in community health improvement at the local level has not been well-described. As part of a larger study examining the use and impact of the County Health Rankings in North Carolina, LHD media staffing and interaction with traditional media were examined …

What “Community Building” Activities Are Nonprofit Hospitals Reporting As Community Benefit?, Erik Bakken, David Kindig, Jo Ivey Boufford

Frontiers in Public Health Services and Systems Research

In 2008, the Internal Revenue Service (IRS) revised and standardized the reporting policy for community benefit expenses for nonprofit hospitals. These expenses are required for tax exemption. At that time, the IRS designated some categories of activities as non-eligible as a community benefit, but still mandated their reporting on hospitals’ Form 990, the annual tax filing for nonprofit organizations. One such category was community building, which encompasses a broad range of nonmedical determinants of health and an important potential source of population health revenue. This is the first study to analyze community-building dollars at any level, examining New York State’s …

Continuing To Confront Copd International Physician Survey: Physician Knowledge And Application Of Copd Management Guidelines In 12 Countries, Kourtney J. Davis, Sarah H. Landis, Yeon-Mok Oh, David M. Mannino, Meilan K. Han, Thys Van Der Molen, Zaurbek Aisanov, Ana M. Menezes, Masakazu Ichinose, Hana Muellerova

Preventive Medicine and Environmental Health Faculty Publications

AIM: Utilizing data from the Continuing to Confront COPD (chronic obstructive pulmonary disease) International Physician Survey, this study aimed to describe physicians' knowledge and application of the GOLD (Global initiative for chronic Obstructive Lung Disease) Global Strategy for the Diagnosis, Management and Prevention of COPD diagnosis and treatment recommendations and compare performance between primary care physicians (PCPs) and respiratory specialists.

MATERIALS AND METHODS: Physicians from 12 countries were sampled from in-country professional databases; 1,307 physicians (PCP to respiratory specialist ratio three to one) who regularly consult with COPD, emphysema, or chronic bronchitis patients were interviewed online, by telephone or face …

The Economics Of Implementing Population Health Strategies: Progress In Public Health Services & Systems Research, Glen P. Mays

Health Management and Policy Presentations

Successful strategies to scale up and spread complex community-level interventions require an understanding of the resources required for implementation, how best to distribute them among supporting institutions, and how resource consumption and distribution varies across settings. This session reviews methods and early findings from the RWJF’s Public Health Delivery and Cost Studies (DACS) Initiative, which includes 12 inter-related studies examining the causes and consequences of variation in the costs of delivering complex community-level prevention strategies across more than 300 community settings in 12 states. Findings from these studies highlight the value of studying the economics of implementation, the measurement and …

Condom-Associated Erection Problems: A Study Of High-Risk Young Black Males Residing In The Southern United States, Cynthia A. Graham, Richard A. Crosby, Stephanie Sanders, Robin Milhausen, William L. Yarber

Health, Behavior & Society Faculty Publications

Previous research indicates that young men may experience condom-associated erection loss and that these problems may lead to inconsistent or incomplete condom use. The primary aim of this study was to assess, using a retrospective recall period of 2 months, correlates of condom-associated erection problems among young Black men attending sexually transmitted infection (STI) clinics. Data were collected in clinics treating patients with STIs in three southern U.S. cities. Males 15 to 23 years of age who identified as Black/African American and reported recent (past 2 months) condom use were eligible. A total of 494 men participated. Nineteen percent reported …

Opportunities And Future Directions For The National Health Security Preparedness Index™, Glen P. Mays

Health Management and Policy Presentations

This presentation examines options and opportunities for future development of the National Health Security Preparedness Index, created through a partnership of national public health and health care organizations led by the U.S. Centers for Disease Control and Prevention (CDC) and the Association of State and Territorial Health Officials (ASTHO).

The Dynamics Of Medicaid & Public Health Spending: Implications For Aca Implementation, Glen P. Mays

Health Management and Policy Presentations

We estimate the dynamics and interactions of governmental spending on Medicaid and other public health services in all 50 states over a 15 year period. Using a quasi-experimental design with instrumental variables estimation, we find evidence that increased Medicaid spending leads to reduced governmental spending on other public health services, consistent with a crowd-out effect. Over 10 years, such crowd-out has the potential to diminish the health status improvements generated through health insurance coverage expansions.

Geographic Variation In The Delivery Of High-Value Public Health Services: Exploring Causes & Consequences, Glen P. Mays

Health Management and Policy Presentations

OBJECTIVES: A growing body of evidence indicates that the delivery of public health activities varies widely across states and communities, creating missed opportunities for prevention as well as inequities in health protection. Measures of quality in public health are needed to guide public health improvement initiatives and to support research on the comparative effectiveness of alternative public health strategies. The Multi-network Practices and Outcomes Variation Examination Study (MPROVE), uses the infrastructure of six Public Health Practice-Based Research Networks (PBRNs) across the U.S. to develop and validate a “starter set” of measures and to analyze geographic variation delivery across diverse public …

Cost Estimates Of Foundational Public Health Services: Results From Piloting An Expert Consensus Methodology, C. B. Mamaril, Glen P. Mays

Health Management and Policy Presentations

We review preliminary estimates from pilot testing a cost estimation methodology developed to identify the resources required to implement a set of Foundational Public Health Services as recommended by the Institute of Medicine and defined by the Public Health Leadership Forum.

Medicaid Expansions & Public Health Spending: Cross-Subsidies, Complementarities, And Crowd-Out, Glen P. Mays

Health Management and Policy Presentations

In this paper we estimate the causal impact of state Medicaid enrollment expansions and expenditures on state and local resources allocated to other public health programs and services. Using a quasi-experimental design with instrumental variables estimation, we find evidence that increased Medicaid spending leads to reduced governmental spending on other public health services, consistent with a crowd-out effect. Over 10 years, such crowd-out has the potential to diminish the health status improvements generated through health insurance coverage expansions.

Aca Implementation In Kentucky: Experiences Of An Expansion State, Glen P. Mays

Health Management and Policy Presentations

Kentucky's implementation of the Affordable Care Act has included early successes with insurance coverage expansion through Medicaid and a state-operated health insurance exchange. Signals of improvements in health care accessibility and delivery of preventive services are evident in the first year after coverage expansions. Challenges associated with political opposition, delivery system transformation, and public health financing remain on the state's policy agenda.

Cost Estimates Of Foundational Public Health Services: Results From Piloting The Expert Consensus Methodology In Kentucky, C. B. Mamaril, Glen P. Mays

Health Management and Policy Presentations

We developed a methodology for estimating the resources required to deliver a set of foundational public health capabilities as recommended in the 2012 Institute of Medicine report on public health financing. The capabilities are based on IOM recommendations and defined by a national expert panel convened as part of the Public Health Leadership Forum. This paper presents preliminary estimates from a pilot test of the cost estimation methodology in Kentucky, and outlines plans for the national estimation strategy.

Optimizing Public Health Systems For Population Health Improvement: Institutions, Economics, And Metrics, Glen P. Mays

Health Management and Policy Presentations

This lecture reviews the evidence concerning the institutional and economic characteristics of public health delivery systems and their impact on population health. Emerging findings from these studies suggest promising pathways for transforming the U.S. public health system in ways that strengthen its effectiveness, efficiency and equity in producing health. .

Frontiers In Phssr Is On The Move, F. Douglas Scutchfield

Frontiers in Public Health Services and Systems Research

Recently, Dr. Jenine Harris and her colleagues examined the use of journals by state chronic disease prevention staff to stay up-to-date on public health evidence. We, at Frontiers in PHSSR, are pleased to be included among the journals listed in the survey. Online open-access journals are shifting the paradigm of scientific publication, allowing free and rapid exchange of information. Another illustration of Frontier’s increasing utility is a forthcoming issue of the American Journal of Public Health (AJPH). We are pleased that AJPH has agreed to publish selected abstracts from Frontiers in PHSSR in their regular issue with links to …

Local Health Department Collaborative Capacity To Improve Population Health, Hector P. Rodriguez, Jeffrey Mac Mccullough, Charleen Hsuan

Frontiers in Public Health Services and Systems Research

Local health departments (LHDs) can more effectively develop and strengthen community health partnerships when leaders focus on building partnership collaborative capacity (PCC), including a multisector infrastructure for population health improvement. Using the 2008 National Association of County and City Health Officials (NACCHO) Profile survey, we constructed an overall measure of LHD PCC comprised of the five dimensions: outcomes-based advocacy, vision-focus balance, systems orientation, infrastructure development, and community linkages. We conducted a series of regression analyses to examine the extent to which LHD characteristics and contextual factors were related to PCC. The most developed PCC dimension was vision-focus balance, while infrastructure …

Policymakers Identify Priorities For Phssr, Katherine Froeb Papa

Frontiers in Public Health Services and Systems Research

A major goal for the health services research community is to provide evidence policymakers can use to improve the public’s health. However, it can be difficult to know what evidence policymakers want and how they decide what research to fund.

In order to understand where policymakers turn for evidence and how they make funding decisions amid fiscal and political constraints, AcademyHealth conducted a 3-part Fireside Chat series in the spring of 2014. This editorial summarizes the evidence gaps identified, and provides strategies for communicating with decision makers.

Editorial Comment: Understanding Cost Variation In Std Service Delivery As State And Federal Agencies Reduce Funding, Michael A. Preston, William W. Greenfield, Sharla A. Smith

Frontiers in Public Health Services and Systems Research

As health reform gains momentum, many changes have been seen in the way health services are delivered and financed. In an attempt to address the uncertainties and understand the costs of delivering STD prevention services, the authors examined the cost of STDs in a highly centralized public health agency system (PHAS). This commentary covers several implications that arise from this study.

Understanding Cost Variations In Std Service Delivery As State And Federal Agencies Reduce Funding, William C. Livingood, Lori Bilello, Bonita Sorensen

Frontiers in Public Health Services and Systems Research

Sexually transmitted diseases (STD) continue to be a major health problem in the U.S. Despite the persistence of STDs and the critical role of the public health sector in controlling these diseases, STD services continue to be reduced. A linear regression was performed using county demographic and cost variables. Many of these variables in county public health agencies and the populations they serve were not significantly correlated with cost of service. However, the availability of local tax funding for county health departments (CHDs), which varies extensively across counties within the state, is statistically linked to higher STD expenditure per case. …

Evidence-Informed Guidelines For Pediatric Pandemic Planning And Response, Ginny Sprang, James J. Clark, Miriam Silman, Phyllis W. Leigh, Candice M. Jackson, A. Scott Lajoie

Center on Trauma and Children Reports

From the executive summary:

Pandemic events are unpredictable and inevitable. When they occur, the impact is both all-encompassing and asymmetrical; each pandemic targets specific, vulnerable populations, but ultimately impacts individuals, families and communities throughout the world. Regardless of origin or circumstances, the next pandemic will certainly count infants, children, and adolescents among its most vulnerable targets. As evidenced by the 2009 H1N1 influenza pandemic, children may be at higher risk than populations more typically seen as susceptible to pandemic illness (the elderly, those with weakened immune systems, etc.). Children also can function as disease vectors, spreading the virus through their …

Improving Community Health Through Hospital-Public Health Collaboration: Insights And Lessons Learned From Successful Partnerships, Lawrence Prybil, F. Douglas Scutchfield, Rex Killian, Ann Kelly, Glen P. Mays, Angela Carman, Samuel Levey, Anne Mcgeorge, David W. Fardo

Health Management and Policy Faculty Book Gallery

From the introduction:

Health care expenditures in the United States currently consume over 17 percent of the nation’s gross domestic product, a much larger share than other developed nations. Yet, despite this large investment, studies by Commonwealth Fund, the Institute of Medicine, and other organizations show the USA lags behind other developed nations on multiple metrics of population health such as infant mortality and life expectancy. Moreover, there is extensive evidence of disparities in access, cost, and quality of health care services.

Thus, we are confronted by a striking paradox: the USA spends a large and growing proportion of our …

The Role Of Leadership In Creating A Strategic Climate For Evidence-Based Practice Implementation And Sustainment In Systems And Organizations, Gregory A. Aarons, Mark G. Ehrhart, Lauren R. Farahnak, Marisa Sklar

Frontiers in Public Health Services and Systems Research

There is a growing impetus to effectively implement evidence-based practices (EBPs) in health and allied health settings in order to improve the public health impact of such practices. To support implementation and sustainment of EBPs, it is important to consider that health care is delivered within the outer context of public health systems and the inner context of health care organizations and work groups (3). This article identifies two relevant types of leadership for implementation and recommends steps that leaders can take in developing a strategic climate for EBP implementation and sustainment within the outer and inner contexts of health …

Editorial Comment: What Influences The Use Of Administrative Evidence-Based Practices In Local Health Departments?, Christopher M. Maylahn

Frontiers in Public Health Services and Systems Research

In 2012, Frontiers published an article by Allen et al. about identifying administrative and management practices that make up an evidence-based local health department.¹ They recommended that local health departments (LHDs) consider using such practices to implement sustained evidence-based policies, programs, and interventions. Strategies that should be given ‘high priority’ for implementation were highlighted. My accompanying editorial² acknowledged the value of this practical advice to LHDs in optimizing their performance and achieving desired health outcomes.

What Influences The Use Of Administrative Evidence-Based Practices In Local Health Departments?, Kathleen Duggan, Peg Allen, Ross Brownson, Paul C. Erwin, Robert Fields, Rodrigo S. Reis, Carson Smith, Katherine Stamatakis

Frontiers in Public Health Services and Systems Research

Evidence based public health (EBPH) in local health departments (LHDs) is a process that involves translating the best available scientific evidence into practice. However, EBPH and implementation of evidence based programs and policies in LHDs are not widespread. This report outlines the patterns and predictors of the use of administrative evidence based practices (A-EBPs) in a national sample of LHD directors. LHDs can improve performance, prepare for accreditation and ultimately improve community health by utilizing an administrative evidence based process.

Annual Report Of The National Coordinating Center For Public Health Services & Systems Research, Year Four, Glen P. Mays, F. Douglas Scutchfield, Anna Goodman Hoover

UKCPHSSR Research Briefs and Reports

The National Coordinating Center for Public Health Services and Systems Research (PHSSR), together with the Public Health Practice-Based Research Networks (PBRN) Program, works to expand the production and application of evidence on how best to organize, finance and deliver public health strategies that improve population health. The Center designs and conducts research studies, provides technical assistance and direction for other researchers across the U.S., develops methodological advances in measurement and analysis, and accelerates the translation and dissemination of research findings for policy and practice stakeholders.

Value And Cost-Effectivess Of Chw Programs: Implications For Home Care Workers, Glen P. Mays

Health Management and Policy Presentations

This presentation reviews studies on the health and economic value of strategies to improve the coordination of medical care, public health, and social support services for high-need and high-risk populations. Community health worker (CHW) programs feature prominently in these strategies, particularly for rural and low-resource community settings. Home care workers have the potential to function as CHWs in many settings, and as such present powerful opportunities for scaling up CHW programs that connect medical care, public health, and social services delivery.