Community Health and Preventive Medicine Commons^™

No Free Lunch? Current Challenges Facing The National School Lunch And School Breakfast Programs, Eileen Salinsky

National Health Policy Forum

This background paper describes important characteristics of the National School Lunch Program and the School Breakfast Program, reviews U.S. Department of Agriculture rules regarding the nutritional content of school meals, and examines compliance with current nutrition standards. It also considers the dietary status and obesity risk of meal program participants, discusses proposed improvements to nutritional standards and meal requirements, and highlights key legislative issues.

Got Junk? The Federal Role In Regulating “Competitive” Foods, Eileen Salinsky

National Health Policy Forum

A wide variety of food and beverage items are available in schools in addition to the school meals provided through the National School Lunch Program and School Breakfast Program. A long-standing source of controversy, the need for stronger federal restrictions on foods that compete with school meals is again under debate. This issue brief examines the availability and consumption of competitive foods, explores the regulation of these foods at the federal level, considers trends in state and local restrictions, and summarizes perceived barriers to improving the nutritional quality of competitive food options.

The Role Of Ombudsmen In Assuring Quality For Residents Of Long-Term Care Facilities: Straining To Make Ends Meet, Carol O'Shaughnessy

National Health Policy Forum

Assuring quality of care for residents in long-term care facilities has been a serious and continuing concern of policymakers for decades. The Older Americans Act’s long-term care ombudsman program is a consumer advocacy model intended to improve quality of care by helping the 2.5 million residents of almost 67,000 nursing and other residential care facilities resolve complaints about their care and protect their rights. Despite broad recognition of its value in assisting residents and its efforts to complement federal and state oversight of long-term care facilities, some observers are concerned about the program’s ability to meet its legislative mandates. Limited …

E-Therapy As A Means For Addressing Barriers To Substance Use Disorder Treatment For Persons Who Are Deaf, Dennis Moore, Debra Guthmann, Nikki Lynn Rogers, Susan Fraker, Jared A. Embree

Population and Public Health Sciences Faculty Publications

Persons who are deaf face a number of challenges with regard to vulnerability for substance use disorders. Moreover, accessible treatment for this condition can be difficult to establish and maintain. The Deaf community may be one of the most disenfranchised groups in America in regard to appropriate access to substance use disorder (SUD) prevention and treatment services. This article reviews
findings related to substance use disorder and treatment for this condition among persons who are deaf. It also reviews a promising approach for addressing treatment needs via e-therapy, and it highlights the challenges and concerns regarding e-therapy for this population. …

Increasing Access To Prenatal Care: The Impact Of Access Barriers And Proposed Strategies To Overcome Them, Courtney Thomas

XULAneXUS

For a country with such a technologically advanced health care system, the United States has an alarming infant mortality rate. The disparities in birth outcomes for low-income black women compared to white women of the same socioeconomic status are even more disturbing. Prenatal care is considered to be an effective method of reducing poor birth outcomes like preterm birth and low birth weight, but access to prenatal care continues to be an issue. There are several known barriers to care, including demographic, financial, structural, and personal barriers, that pregnant women must overcome to receive adequate prenatal care. With increased access …

Validation Of A Commercial Geographical Information Systems Database Of Walking And Bicycling Destinations, Heather A. Whitcomb, Ellen K. Cromley, Kosuke Tamura, Steven J. Melly, Sayali Kale, Francine Laden, Peter James, Robin Puett, Eran Ben-Joseph, Philip J. Troped

GIS Day

Background: Recent interdisciplinary studies in public health, transportation, and urban planning have shown that stores and other destinations such as banks, post offices, and physical activity facilities within close proximity to residences are positively related to recreational and transportation physical activity. The built environment has been measured several different ways, including conducting field audits and by surveying individuals’ perceptions of their neighborhood. Increasingly researchers are also using geographic information systems (GIS) software and commercially available data sources to create objective measures of the built environment. The advantages of commercial data are that they are relatively easy to access and are …

Environmental Health Service Learning And Water Quality In Gales Point, Belize, Ritchie D. Taylor, Shabbar Ranapurwala, Matthew Hill

Impact Belize

Belize is a country in Central America, formerly British Honduras, located south of Mexico and east of Guatemala on the Yucatan Peninsula. As part of the WKU International Health and Human Service Learning Program, an assessment of the local water supply in Gales Point, Belize was conducted. Gales Point is a small rural village located on the Caribbean Sea coast of Belize. Belize is a developing country thus access to safe drinking water can be problematic, as was observed on the local scale. The lack of technical, managerial and financial capacity coupled with the rural location of the village, create …

Using Primary Care To Bend The Cost Curve: The Potential Impact Of Health Center Expansion In Senate Reforms, Leighton C. Ku, Sara J. Rosenbaum, Peter Shin

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This analysis of reforms being considered in the United States Senate reaches conclusions similar to those of our prior analyses of reforms being considered in the House of Representatives. The combination of expanded health insurance coverage and investments in the expansion of community health centers can produce substantial long-term savings both for the overall health care system and for the federal government. Our analysis of the Senate provisions from the HELP and Finance Committees estimates $369 billion in total medical savings, including $105 billion in federal Medicaid savings. The Senate provisions produce larger savings because they authorize larger funding increases …

Estimating The Economic Gains For States As A Result Of Medicaid Coverage Expansions For Adults, Peter Shin, Leighton C. Ku, D. Richard Mauery, Brad Finnegan, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This policy research brief examines the Medicaid eligibility expansions under the pending legislative proposals, including the House Tri-Committee bill, the Senate Health, Education, Labor and Pensions Committee bill and the Senate Finance Committee bill. Using new Census Bureau data, the researchers find that under both the House and Senate Finance Committee proposals, about 9.6 million nonelderly adults would gain Medicaid eligibility by 2014. Furthermore, the federal and state expenditures are less than Medicaid's positive impact on the economy amounting in a return of three dollars in new business activities for every dollar of state Medicaid investment. Because Medicaid is designed …

The Emergent Generation Gap In Attitudes Toward Khat Use In Urban Ethiopia, Nikki Lynn Rogers, Jared A. Embree, Yigzaw Kebede, Josephine Wilson, Mary J. Huber, Dennis Moore

Population and Public Health Sciences Faculty Publications

No abstract provided.

Responsibility For Disease Management On Rusinga Island: Reconciling The Limitations Of External Aid And The Role Of Community-Based Initiatives, Allyson Russell

Independent Study Project (ISP) Collection

Rusinga Island has been on the receiving end of many non-governmental and government-run health interventions. Though ample money has been invested in disease control, malaria and HIV/AIDS transmission and death rates remain higher than in any other location in Kenya. This study employs the use of interviews, both formal and informal, focus group discussions and observation in order to discover possible factors which have confounded the success of previous disease management programs. The study seeks the community's perspective on these programs as well as ideas for community-based, bottom-up strategies which might be able to curb the high rates of malaria …

How To Build A Health Clinic: Disease Burden, Health Seeking Behavior And Clinic Structures In The Kibera Slums, Samuel Mcgowan

Independent Study Project (ISP) Collection

This study seeks to determine a model for a health clinic to be run by the Kibera School for Girls in the Katwekera village of Nairobi’s Kibera slums. The study examines the disease burden of the school’s initial target population, the health-seeking behavior of the community, and current clinic structures in Kibera. Using these methodological tactics, the study suggests the Kibera School for Girls should start a small, locally-run clinic that offers basic primary health care to a target population of about 5,000 Kibera residents.

Education Is The Key To The Prevention Of Lawnmower Accidents, Sherry R. Lovan

Nursing Faculty Publications

No abstract provided.

Kibera Community Unconscious Of The Silent Disease: Sti, Sindhya Rajeev

Independent Study Project (ISP) Collection

The objective of this study was to conduct a Sexually Transmitted Infections (STI) Awareness Survey that explores knowledge about STIs and attitude towards them, and thereafter, institute and implement an educational intervention in the Kibera slum, of Nairobi. The survey included 120 participants from the 12 villages of Kibera. It revealed that, of those interviewed, 34% are unable to name an STI other than HIV/AIDS and 99% are unaware of any of the syndromes associated with STIs. This demonstrated a clear need for STI Awareness and education, and thus an informative brochure on STIs was created, to be distributed during …

Lamu Sensitive Aid: Barriers To Distribution, Acceptance, And Use Of Malaria Prevention In Lamu District, Kelan Stoy

Independent Study Project (ISP) Collection

his study examines how organizations work locally to distribute malaria aid and education for malaria prevention. Additionally, it analyzes the effectiveness this aid has in improving malaria preventative techniques used by the people of Lamu District. This effectiveness was compared in the contexts of several regions of the district to further understand differences in rural and urban settings. Information was gathered using a variety of interviews with organizations and prominent community leaders to gauge their ideas on malaria in Lamu and strategies used to prevent it, and informal field interviews to observe different communities’ perspectives on malaria and also their …

Conocimientos, Percepciones, Y Prácticas De Mujeres Jóvenes Acerca Del Papiloma Virus Humano, Michelle Marie Picón Ruiz

Independent Study Project (ISP) Collection

Background: Efforts by the Chilean Ministry of Health to reduce the mortality rates due to cervical cancer by 40% during 2000 - 2010 have successfully impacted every age group except for young women between the ages of 20-24. Cervical cancer is caused by Human Papiloma Virus (HPV), the most common Sexually Transmitted Infection (STI). Both are detected by the Papanicolaou test, or Pap smear. Cervical cancer found in older women most likely developed from an HPV infection contracted in their youth. This study aims to understand the knowledge, practices, and perceptions that young women in Arica, Chile have about their …

Using Primary Care To Bend The Curve: Estimating The Impact Of A Health Center Expansion On Health Care Costs, Leighton C. Ku, Patrick Richard, Avi Dor, Ellen Tan, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This research brief, the third in a series examining the link between national health reform proposals and community health centers, estimates the cost savings that would be realized by making important investments in non-profit health centers as an element of national health reform. Key findings include:

Increasing health center capacity by another 20 million patients by 2019 (to 39 million patients) under health reform can be expected to generate an additional $35.6 billion savings in 2019 and $212 billion in additional savings over the 2010-2019 ten-year time period.

Were the Medicaid prospective payment rate system to be applied to exchange …

Coverage And Payment For Prescription Drugs Under Medicare Part B: A Complex Patchwork, Amanda Cassidy

National Health Policy Forum

As part of the diverse discussions around health care reform, many have looked to refining Medicare payment systems as a way to give health care practitioners and providers greater incentives to deliver care more efficiently, and thus slow health care spending growth. Understanding how Medicare currently pays for Part B services, including drugs covered under Part B, is essential to understanding the potential impact of these types of reforms. Most items and services covered under Part B, including most Part B drugs, are paid individually, which means practitioners and providers generally receive more payments for providing more services. Some reform …

Stimulus Bill Implementation: Expanding Meaningful Use Of Health It, Rob Cunningham

National Health Policy Forum

The American Recovery and Reinvestment Act authorizes an estimated $38 billion in incentives and supports for health information technology (IT) from 2009 to 2019. After years of sluggish health IT adoption, this crisis-driven investment of public funds creates a unique opportunity for rapid diffusion of a technology that is widely expected to improve care, save money, and facilitate transformation of the troubled U.S. health system. Achieving maximal effect from the stimulus funds is nevertheless a difficult challenge. The Recovery Act strengthens the federal government’s leadership role in promoting health IT. But successful adoption and utilization across the health system will …

Health Center Data Warehouses: Opportunities And Challenges For Quality Improvement, A. Seiji Hayashi, Emily Jones, David M. Stevens, Peter Shin, Brad Finnegan, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This Policy Research Brief reports on a pilot effort to leverage the growing presence of health center data warehouses to advance health care quality improvement through data sharing and exchange. This project builds on a partnership between the Michigan Primary Care Association and The George Washington University's Geiger Gibson/RCHN Community Health Foundation Research Collaborative that centers on developing approaches to using existing health center data for quality improvement.

The Medicare Drug Benefit: Update On The Low-Income Subsidy, Mary Ellen Stahlman

National Health Policy Forum

The Medicare drug benefit (Medicare "Part D"), provides federal subsidies to pay premiums and cost sharing for low-income beneficiaries—almost 10 million in 2009. Yet there are several policy issues concerning these low-income beneficiaries under Part D. First, over 2 million individuals who may qualify for the subsidies have not enrolled. Second, in some states, low-income beneficiaries have little choice of plans (while non-low-income beneficiaries have dozens of choices), unless they pay out-of-pocket for premium amounts above what the subsidy covers. And third, millions of those who have enrolled in the benefit face the prospect each year of switching drug plans …

Community Health Centers In Indiana: State Investments And Returns, Avi Dor, Patrick Richard, Ellen Tan, Sara J. Rosenbaum, Peter Shin, Lee Repasch

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Indiana Community Health Centers (I-CHC), including Federally Qualified Health Centers (FQHCs) and State Funded Health Centers (SFHCs), play a vital role in caring for the state's most vulnerable populations. Although their patient base tends to be poorer and experience greater health challenges than the general population, these health centers have generated substantial health care savings while providing high quality, low cost care. In this brief, key findings are presented from a recent study, conducted for the Indiana State Department of Health by GWU faculty and staff that was designed to estimate the cost savings and benefits generated by the state's …

Estimating The Effects Of Health Reform On Health Centers' Capacity To Expand To New Medically Underserved Communities And Populations, Leighton C. Ku, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

Nearly 100 million persons reside in urban and rural communities that can be considered medically underserved as a result of inadequate supply of primary care physicians and elevated health risks. A report by the National Association of Community Health Centers and the Robert Graham Center estimated that 60 million people are "medically disenfranchised" and lack access to adequate primary health care because of where they live, even though many have health insurance. This brief assesses the potential effects of national health reform on health centers and on the number of patients they can serve. Because improving primary care access is …

National Health Reform: How Will Medically Underserved Communities Fare?, Sara J. Rosenbaum, Emily Jones, Peter Shin, Leighton C. Ku

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

This brief examines the factors underlying medical underservice. It finds that the number of Americans living in communities at risk for medical underservice is more than double the number of persons who are uninsured. The report notes that even with health insurance reform, these communities and providers that serve them will continue to be affected by elevated numbers of low income uninsured persons, as well as persons who may be seriously under-insured because of poorer health status and lower family income.

Describing health insurance expansion as the single most important strategy to alleviate medical underservice, the Brief also identifies a …

Boosting Health Information Technology In Medicaid: The Potential Effect Of The American Recovery And Reinvestment Act, Brad Finnegan, Leighton C. Ku, Peter Shin, Sara J. Rosenbaum

Geiger Gibson/RCHN Community Health Foundation Research Collaborative

The American Recovery and Reinvestment Act of 2009 (ARRA) will invest approximately $49 billion to expedite health information technology (HIT) adoption through Medicare and Medicaid. Our analysis of 2006 NAMCS data found that approximately 15 percent of the practicing office-based physicians in the country would qualify for up to $63,750 over six years in Medicaid financial incentives for HIT adoption. Included within the 45,000 eligible physicians are about 99 percent of all community health center physicians. If all qualifying physicians apply for the Medicaid incentives and receive the maximum level of payments, the federal government would invest more than $2.8 …

A Health Insurance Exchange: Prototypes And Design Issues, Mark Merlis

National Health Policy Forum

Many reform proposals call for the creation of one or more health insurance exchanges, intermediaries that can help individuals or small employers navigate the insurance market. An exchange might be public or private, national, or local. It might serve simply as a clearinghouse for plan information or could play an active role in setting benefit packages, choosing high-quality plans, and negotiating premium rates. This paper begins with a summary of recent experience with insurance exchanges and similar systems. It then reviews basic issues in the design of an exchange.

Underwriting In The Non-Group Health Insurance Market: The Fundamentals, Kathryn Linehan

National Health Policy Forum

Non-group health insurance is coverage that individuals purchase on their own rather than as part of a group. Most states currently permit non-group insurers to underwrite, a process whereby an insurer assesses the health and other characteristics of individuals to determine their likely utilization of health services or risk; insurers then use this assessment to determine whether they will offer coverage and the premium they will charge. Policymakers have identified underwriting and related practices in non-group markets as a target for reform to enable broader access for the currently uninsured. This publication reviews the characteristics of non-group markets and insurers' …

Bridging The Gaps: Biomedicine, Complementary And Alternative Medicine In A Holistic Approach, Hatim A. Omar, Joav Merrick

Pediatrics Faculty Publications

The 4^th international conference on holistic health and medicine was held during September 24-26, 2008 in Lexington, Kentucky in the United States of America. This conference brought many participants from 23 countries, both mainstream health care providers as well as holistic health practitioners to address the latest in knowledge and research, and in turn to find ways to collaborate and work together to provide the best possible care for their patients and clients. These conferences are held to build bridges between the various fractions of medicine and health care providers. The scientific program included plenary sessions, keynotes, workshops and …

Detecting, Preventing, And Treating Sexually Transmitted Diseases Among Adolescent Arrestees: An Unmet Public Health Need, Steven Belenko, Richard Dembo, Matthew Rollie, Kristina Childs, Christopher Salvatore

Department of Justice Studies Faculty Scholarship and Creative Works

Studies of detained and incarcerated adolescent offenders in the United States indicate that these juveniles have an elevated risk of sexually transmitted diseases (STDs). However, many more arrestees enter the “front end” of the juvenile justice system that is detained or incarcerated, and research into the STD risk profiles and service needs of this larger group is lacking. An expansion of STD testing (including of asymptomatic youths), prevention, and treatment is needed, as is improved knowledge about gender- and race-specific services. A pilot program in Florida has shown that juvenile justice and public health systems can collaborate to implement STD …

Tuberculosis In San Bernardino County, 1993-2004 : Lifestyle And Environmental Factors, Anuj Bhatia

Loma Linda University Electronic Theses, Dissertations & Projects

An observational retrospective study was conducted for tuberculosis (TB) cases between San Bernardino County (SBC), Riverside County, and the state of California from 1996 to 2004. A univariate comparison between San Bernardino County and California indicated a higher proportion of U.S. born cases in SBC. Additionally, it was found that San Bernardino had a higher proportion of non-injection drug using TB cases, compared with California in 1996. Further comparisons were made along country of birth between TB cases in San Bernardino County from 1993 to 2004. Notable differences were observed for injection drug use, non injection drug use, alcohol abuse, …