Community Health and Preventive Medicine Commons^™

Role Of Environment And Sex Differences In The Development Of Autoimmune Diseases: A Roundtable Meeting Project, Monica P. Mallampalli, Erika Davies, Debra Wood, Hillary Robinson, Federica Polato, Christine L. Carter

Prevention and Community Health Faculty Publications

Autoimmune diseases (ADs) impose substantial health and financial burdens in the United States and in many parts of the world. Women are disproportionately affected by many of these disorders, which often contribute to lifelong disabilities. While the number of patients with some ADs appears to be rising, the complexities of conducting epidemiological studies prevent a thorough understanding of the prevalence and incidence of these various conditions. Research on environmental influences of these illnesses is limited, although they are generally hypothesized to result from the interaction of environmental agents in genetically susceptible individuals. Further, there is little known regarding the role …

The Relevance Of Social Contexts And Social Action In Reducing Substance Use And Victimization Among Women Participating In An Hiv Prevention Intervention In Cape Town, South Africa, Elizabeth Reed, Andrea N. Emanuel, Bronwyn Myers, Kim Johnson, Wendee M. Wechsberg

Prevention and Community Health Faculty Publications

Objectives: To examine qualitatively how women's social context and community mobilization (eg, mobilizing women to take social action and engaging their community in social change) influence substance use abstinence and victimization among women participating in a human immunodeficiency virus (HIV) intervention in Cape Town, South Africa.
Methods: Thirty women who had participated in a randomized controlled trial of a group-delivered intervention to address substance use, gender-based violence, and associated risk for HIV (The Women's Health CoOp) were selected to participate in semi-structured interviews about their perceived impact of the intervention on their substance use and exposure to victimization. The Women's …

Cms's Proposed Rule Implementing The Aca-Mandated Medicaid Dsh Reductions, Kathryn Linehan

National Health Policy Forum

State Medicaid programs make Medicaid disproportionate share hospital (DSH) payments to hospitals to help offset costs of uncompensated care for Medicaid and uninsured patients. Unlike most Medicaid spending, annual DSH allotments for each state are capped. Under the Patient Protection and Affordable Care Act of 2010 (ACA), DSH payments will decrease starting in fiscal year (FY) 2014 and continuing through FY 2020. This paper describes the proposed rule for reducing these federal allotments, which was released on May 15, 2013, by the Centers for Medicare & Medicaid Services (CMS). Comments on the proposed rule are due July 12, 2013.

2014 …

Quality Of Care In Community Health Centers And Factors Associated With Performance, Peter Shin, Jessica Sharac, Sara J. Rosenbaum, Julia Paradise

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Federally funded community health centers are a key source of comprehensive primary care for medically underserved communities, serving more than 20 million patients in 2011. The Affordable Care Act (ACA) expanded the health center program significantly to help meet the increased demand for health care that is expected as millions of the uninsured gain health coverage, beginning in 2014. Especially given health centers’ growing role, evidence of the quality of care they provide is of keen interest. Most research shows high performance by health centers relative to various standards, but some gaps have also been found, and suitable benchmarks for …

The Role Of Issue Familiarity And Social Norms: Findings On New College Students' Alcohol Use Intentions, Rajiv N. Rimal, Saar Mollen

Prevention and Community Health Faculty Publications

Background. Scholars in a variety of disciplines are interested in understanding the conditions under which social norms affect human behavior. Following the distinction made between descriptive and injunctive norms by the focus theory of normative conduct, the theory of normative social behavior predicts that the influence of descriptive norms on behavior is moderated by injunctive norms, outcome expectations, and group identity. We extended the theory by testing the proposition that the influence of descriptive norms on behavior would be greater under conditions of greater issue familiarity, defined as the ease with which one can cognitively access the behavior or …

The Association Of Caregivers' Educational Level And Their Knowledge Of Children's Nutrition And Exercise Behavior, Hauwa Okorie, Bersabeh Medmim, Nazrat Mirza

GW Research Days 2013

BACKGROUND:

Parents play an instrumental role in modeling their children's health behaviors and exposing them to new foods, and engaging them in physical activities.

OBJECTIVE:

To assess the association of parents' educational level on their nutritional and physical activity knowledge.

METHODS:

This is a cross-sectional study of 72 participants from a nutrition and wellness program targeting parents of African American preschoolers. Socio-demographic, child's nutritional and physical exercise habit survey and anthropometric data were collected from all participants at baseline.

RESULTS:

77% of the participants were grandmothers or mothers; the mean age was 44.8 and 13% of participants were college graduates. …

Factors Associated With Early Sexual Debut Among Ghanaian Women From The Manya – Krobo District, – Ghana, 2011, Omoro Faye Omoighe, Amanda D. Castel, Jeffrey Bingenheimer

GW Research Days 2013

Affiliation: Department of Epidemiology and Biostatistics GW, School of Public Health and Health Services

Title: "Factors associated with early sexual debut among Ghanaian women from the Manya – Krobo district, – Ghana, 2011"

Background: The dipo, a Krobo puberty initiation rite practiced annually among an estimated 2,000 Ghanaian females ages 2–20, is a cultural rite of passage into womanhood that is intended to promote abstinence from sexual activity until marriage.

Objectives: This study examined the risk of early sexual debut among dipo-initiated Krobo females versus uninitiated Krobo females. This study also assessed Manya–Krobo societal opinions regarding the sexual health outcomes …

The Characteristics Of Women Seeking Funding From The Dc Abortion Fund, Karin Elizabeth Bleeg

GW Research Days 2013

Objectives: To determine whether the population DCAF serves, based on current research, are those most in need of its financial services. Describe the population that DCAF is supports by age, race and ethnicity, poverty, educational attainment, union status, contraceptive method used, referral source, and number of prior pregnancies.

Methods: An adapted version of The Guttmacher Institute's National Patient Survey will be used to collect data from women who contact DCAF for financial assistance for their abortion (n=150). The data will be collected for one month and then analyzed in SPSS.

Results: Between January and March 2013 approximately 400 women contacted …

Developing Standardized Language For Use In Lgbt Health Research, Vaibhav Jain, Marisa Workman, Sara Mostafa, Abigail Wolfe, Stefania Davia, Natalie Terens, Keith Li, Blaine Parrish

GW Research Days 2013

BACKGROUND: In the past two decades, the LGBT community in the United States has been more visible, active, and positively accepted by society. As acceptance progresses, research interests on the LGBT population have increased, driving the need for standard language for researchers to share for comparative and community-based participatory research. "What term is right?" is often the question researchers ask a very diverse LGBT community. In August 2012, the District of Columbia's Office of LGBT Affairs identified incongruent language in a number of published reports commissioned by the Mayor's Office. The Office realized the importance of standardized language for health …

Annual Report 2012, Forum Staff

National Health Policy Forum

This annual report describes the activities of the Forum during the 2012 calendar year, and provides a snapshot of our resources.

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 …

Improving Access To Children's Mental Health Care: Lessons From A Study Of Eleven States, Donna Behrens, Julia Graham Lear, Olga Acosta Price

Prevention and Community Health Faculty Publications

No abstract provided.

The "Coopetition" Model: Caring For San Diego's Low-Income Population, Lisa Sprague, Jessamyn Taylor

National Health Policy Forum

This site visit explored aspects of health care delivery for Medicaid beneficiaries and the uninsured in a California county marked by a diverse population, dominant managed care, and stakeholder dedication to solving problems in a spirit of "coopetition." The program looked at the impact of California's Bridge to Reform (the state's Medicaid section 1115 waiver) on federally qualified health centers and the people they serve. Eligibility and enrollment expansions in the Low Income Health Program and Medi-Cal, health information technology adoption and its use to improve care delivery and health, and patient-centered medical homes and care coordination were discussed. The …

Assisted Living: Facilities, Financing, And Oversight, Carol O'Shaughnessy

National Health Policy Forum

This publication briefly describes assisted living facilities that provide long-term services and supports to people with functional or cognitive impairments who do not need the level of skilled nursing care offered in nursing homes but cannot live independently. It also describes selected resident characteristics, reviews cost and financing arrangements, and reviews state responsibilities for regulation and oversight of assisted living facilities.

Family Caregivers: The Primary Providers Of Assistance To People With Functional Limitations And Chronic Impairments, Carol O'Shaughnessy

National Health Policy Forum

An extensive body of research conducted over the past several decades has documented that family or other unpaid caregivers provide the majority of care to people who need assistance because of functional limitations or multiple and complex chronic conditions. Families play a central role not only in assisting impaired family members with personal care needs, but also in helping them coordinate health care and supportive services, and, increasingly, providing and/or supervising home-based medical care. This paper presents background information on family caregiving, briefly describes federal programs that provide direct assistance to caregivers, and discusses possible future policy and practice directions.

The Community Living Assistance Services And Supports (Class) Act: Major Legislative Provisions, Carol O'Shaughnessy

National Health Policy Forum

Update (January 3, 2013) — In 2010, Congress enacted the Community Living Assistance Services and Supports (CLASS) Act as part of the Patient Protection and Affordable Care Act (P.L. 111-148). The CLASS Act was repealed as part of the American Taxpayer Relief Act of 2012 signed by the President on January 2, 2013.

During 2011 the Department of Health and Human Services (HHS) conducted an analysis of possible CLASS implementation options consistent with the statutory requirements that the program be actuarially solvent over a 75-year period and self-funded. After a 19-month period of analysis, HHS officials stated in testimony before …

Provider Imposed Restrictions To Clients' Access To Family Planning In Urban Uttar Pradesh, India: A Mixed Methods Study, Lisa S. Calhoun, Ilene S. Speizer, Rajiv N. Rimal, Pooja Sripad, Nilesh Chatterjee, Pranita Achyut, Priya Nanda

Prevention and Community Health Faculty Publications

Background

Medical barriers refer to unnecessary policies or procedures imposed by health care providers that are not necessarily medically advised; these restrictions impede clients' access to family planning (FP). This mixed methods study investigates provider imposed barriers to provision of FP using recent quantitative and qualitative data from urban Uttar Pradesh, India.

Methods

Baseline quantitative data were collected in six cities in Uttar Pradesh, India from service delivery points (SDP), using facility audits, exit interviews, and provider surveys; for this study, the focus is on the provider surveys. More than 250 providers were surveyed in each city. Providers were asked …

Treatment-As-Prevention In Aids Control: Why Communication Still Matters, Rupali J. Limaye, Jeffrey Bingenheimer, Rajiv N. Rimal, Susan Krenn, Claudia Vondrasek

Prevention and Community Health Faculty Publications

Treatment-as-prevention is a term used to describe an HIV prevention method that uses antiretroviral treatment to minimize the chance of HIV transmission, with the idea that treatment can decrease the viral load of those infected to a level where transmission risk is minimal. However, for treatment-as-prevention to be a success, individuals must get tested, know their status, seek care, and adhere to their antiretroviral regimen. Communication plays a role in each of these steps, as communication can be used to create demand for health-seeking behavior and as a means to increase quality and support on the supply side, at the …

Development And Assessment Of Traditional And Innovative Media To Reduce Individual Hiv/Aids-Related Stigma Attitudes And Beliefs In India, Caricia Catalani, Diego Castaneda, Freya Spielberg

Prevention and Community Health Faculty Publications

Although stigma is considered a major barrier to effective response to the HIV/AIDS epidemic, there is a lack of evidence on effective interventions. This media intervention took place among key HIV-vulnerable communities in Southern India. Two HIV stigma videos were created using techniques from traditional film production and new media digital storytelling. A series of 16 focus group discussions were held in 4 rural and 4 urban sites in South India, with specific groups for sex workers, men who have sex with men, young married women, and others. Focus groups with viewers of the traditional film (8 focus groups, 80 …

Changes In Latitudes, Changes In Attitudes: Fqhcs And Community Clinics In A Reformed Health Care Market, Jessamyn Taylor

National Health Policy Forum

The Patient Protection and Affordable Care Act of 2010 and the Supreme Court’s related decision have significantly shifted the health care landscape for safety net providers. Federally qualified health centers (FQHCs) are a mainstay of primary care for the uninsured and those with limited access to care. This paper focuses on the impact of health reform on FQHCs given the significant federal investment in them through grants, Medicaid, and Medicare reimbursement. Where noteworthy, the effect on non-FQHC community clinics is also discussed. The implications of Medicaid coverage expansions (or lack thereof in states that choose not to expand), Medicaid disproportionate …

Pilot Evaluation Of The Text4baby Mobile Health Program, William D. Evans, Jasmine L. Wallace, Jeremy Snider

Prevention and Community Health Faculty Publications

Background

Mobile phone technologies for health promotion and disease prevention have evolved rapidly, but few studies have tested the efficacy of mobile health in full-fledged programs. Text4baby is an example of mobile health based on behavioral theory, and it delivers text messages to traditionally underserved pregnant women and new mothers to change their health, health care beliefs, practices, and behaviors in order to improve clinical outcomes. The purpose of this pilot evaluation study is to assess the efficacy of this text messaging campaign.

Methods

We conducted a randomized pilot evaluation study. All participants were pregnant women first presenting for care …

Developing A Business Plan For Sustaining School Mental Health Services: Three Success Stories, Donna Behrens, Julia Graham Lear, Olga Acosta Price

Prevention and Community Health Faculty Publications

No abstract provided.

Deteriorating Access To Women's Health Services In Texas: Potential Effects Of The Women's Health Program Affiliate Rule, Leighton C. Ku, Lara Cartwright-Smith, Jessica Sharac, Erika Steinmetz, Julie Lewis, Peter Shin

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Based on an earlier study and an in-depth analysis of five market areas, the authors find that Texas' plan to bar Planned Parenthood clinics from participating in the state Women's Health Program (WHP) would leave tens of thousands of women without a source of care, because Planned Parenthood clinics are the dominant WHP providers in those areas and other local family planning clinics lack the capacity to absorb a large number of additional patients.

Trends In Condom Use Among Female Sex Workers In Andhra Pradesh, India: The Impact Of A Community Mobilisation Intervention, Jennifer T. Erausquin, Monica Biradavolu, Elizabeth Reed, Rebekah Burroway, Kim M. Blankenship

Prevention and Community Health Faculty Publications

Background

Community mobilisation interventions for HIV prevention among female sex workers (FSWs) aim to organise FSWs for collective action and challenge the structures of power that underlie HIV risk. Assessing intervention impact is challenging because the importance of direct individual exposure to intervention components may decrease over time as change occurs at social-normative, policy and other structural levels. In this paper, the authors examine changes over time in consistent condom use among FSWs in Rajahmundry, Andhra Pradesh, the location of a long-standing community mobilisation intervention.

Methods

The authors analyse cross-sectional data collected among FSWs at three time points (n=2276) using …

Community Health Workers: A Front Line For Primary Care?, Lisa Sprague

National Health Policy Forum

Among the potential changes invoked in discussions on health system transformation, a need to revitalize primary care remains paramount. One way of doing this, most agree, is to move more in the direction of team-based care. Professionals such as physician assistants and nurse practitioners may be able to ease some of the physician’s clinical care load, but some populations also need help accessing services and basic health education in a familiar setting. Enter the community health worker (CHW), known by many titles and playing a variety of roles, who comes from the community he or she is serving and therefore …

Are Dutch Patients Willing To Be Seen By A Physician Assistant Instead Of A Medical Doctor?, Luppo Kuilman, Roos M.B. Nieweg, Cees P. Van Der Schans, Jaap H. Strijbos, Roderick S. Hooker

Prevention and Community Health Faculty Publications

Background

The employment of physician assistants (PAs) is a strategy to improve access to care. Since the new millennium, a handful of countries have turned to PAs as a means to bridge the growing gap between the supply and demand of medical services. However, little is known about this new workforce entity from the patient’s perspective. The objective of this study was to assess the willingness of Dutch patients to be treated by a PA or a medical doctor (MD) under various time constraints and semi-urgent medical scenarios.

Methods

A total of 450 Dutch adults were recruited to act as …

How The Supreme Court's Medicaid Decision May Affect Health Centers: An Early Estimate, Katherine J. Hayes, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

The nation's federally funded health centers are the principal source of primary health care for medically underserved populations. In CY 2011, more than 1,200 health centers, operating in more than 8,500 urban and rural locations, served 20.2 million patients, 36 percent of whom were uninsured and 93 percent of whom had family incomes below twice the federal poverty level. Federal grants provide core support to health centers, but Medicaid represents the largest single health center financing mechanism, accounting for 39 percent of revenues. Medicaid revenue growth allows health centers to preserve their core grant funding to reach uninsured patients while …

Perceptions Of The Food Shopping Environment Are Associated With Greater Consumption Of Fruits And Vegetables, Jonathan L. Blitstein, Jeremy Snider, W. Douglas Evans

Prevention and Community Health Faculty Publications

Objective

The present study examined whether characteristics such as quality, selection and convenience are associated with dietary intake of fruits and vegetables independent of perceived costs in an inner-city, low-income population.

Design

Secondary analysis of baseline data from a social marketing intervention designed to change household dietary practices among parents of 3- to 7-year-old children.

Setting

A community sample drawn from six low-income, primarily minority neighbourhoods in Chicago, IL, USA.

Subjects From the parent study, 526 respondents completed the baseline survey and were eligible for inclusion. Of this number, 495 provided complete data on sociodemographic characteristics, fruit and vegetable consumption, …

An Early Assessment Of The Potential Impact Of Texas' "Affiliation" Regulation On Access To Care For Low-Income Women, Peter Shin, Jessica Sharac, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This analysis provides an initial assessment of the implications for low-income women of Texas' "affiliation regulation," which would bar Planned Parenthood Federation of America (PPFA) clinics from participating in the Texas Women's Health Program (WHP). In 2010, more than 183,000 women were enrolled in the WHP, which provides health screening, family planning and birth control to low-income women, and nearly 106,000 received care through the program. In our analysis of WHP provider data, we find:

• Planned Parenthood (PPFA) clinics are by far the dominant source of care under the WHP. In FY 2010, PPFA clinics accounted for approximately 49 percent …