Health Policy Commons^™

From Structure To Experiences: How Facility Capacity And Staffing Shape The Adoption And Impact Of Lgbt-Affirming Policies In Long-Term Care, Andrew Alberth

Graduate Doctoral Dissertations

Long-term care (LTC) settings – including nursing homes (NHs) and assisted living facilities (ALFs) – provide necessary care for individuals with extreme health and functioning limitations. Sexual and gender minority (LGBT) older adults report challenges receiving effective, person-centered care LTC. Some LGBT older adults may hide their sexual orientation and gender identity when entering LTC settings or delay seeking needed LTC fearing discrimination from staff and other residents. Furthermore, staff in LTC settings indicate little awareness of LGBT-residents and possess inadequate LGBT-cultural competency necessary for providing person-centered care. Therefore, LGBT-residents LTC experiences remain underexplored in the broader research. Adopting LGBT-affirming …

The Effect Of State Policy On Individuals With Mental Illness In Nursing Homes: A Multilevel Analysis, Adrita Barooah

Graduate Doctoral Dissertations

ABSTRACT

THE EFFECT OF STATE POLICY ON INDIVIDUALS WITH MENTAL ILLNESS IN NURSING HOMES: A MULTILEVEL ANALYSIS

August 2026

Adrita Barooah, B.Sc., University of Delhi, India

M.S., University of Massachusetts Boston

Ph.D., University of Massachusetts Boston

Directed by Professor Pamela Nadash

The proportion of individuals living with a mental illness in U.S. nursing homes has grown substantially over the past few decades (Fashaw et al., 2020), raising serious concerns about care quality, resource adequacy, and costs to both nursing homes and government payers. The lack of adequate resources and knowledge has resulted in sub-par mental health care (O'Connor et al., …

Bridging Fiscal Sustainability And Health Equity: A Policy Analysis Of California’S Healthcare Coverage Safeguards, Guadalupe Castaneda Martinez

Master's Projects and Capstones

Without structural policy intervention, approximately 4.6 million Californians remain at risk of being uninsured by 2030, worsening racial and ethnic health disparities and hospital uncompensated care burdens. This policy analysis advocates for a hybrid universal coverage model combining sliding-scale subsidies (California Senate Bill 78) with full-scope Medi-Cal expansion for all income-eligible residents regardless of legal status (California Assembly Bill 133). The framework relies on existing funding mechanisms, including the Managed Care Organization tax and the Health Care Affordability Reserve Fund. Comparative analysis indicates that market-only subsidies leave severe equity gaps, whereas immediate single-payer transitions pose substantial fiscal and administrative risks. …

Governing Algorithmic Attention: Attention Safeguard Models And The Cognitive Attentional Standard As System Level Interventions In Human Computer Interaction, Behavioral Economics, And Artificial Intelligence, Delante Clark

Graduate Scholarship and Creative Works

Algorithmic recommendation systems and interface designs shape attention by combining visually salient cues with uncertain reward timing and low friction interaction. These conditions can sustain anticipatory checking, extend time on task, and reduce natural disengagement points through patterns such as infinite scrolling and autoplay. This paper synthesizes research across neuroscience, human computer interaction, behavioral economics, and artificial intelligence to argue that attention capture is a predictable outcome of incentive driven design rather than an individual failure of self regulation. It advances the Attention Safeguard Models and the Cognitive Attentional Standard as system level interventions that regulate exposure conditions, pacing, and …

Explaining Variation In Medical Aid In Dying Policy Across U.S. States, Abigail Hopper

Undergraduate Theses, Capstones, and Recitals

This paper asks why Medical Aid in Dying (MAiD) policy in the United States does not follow a simple partisan pattern between states. Existing scholarship on morality policy emphasizes ideological conflict and partisan alignment, but this framework cannot fully explain why states with similar political compositions have adopted different MAiD policy outcomes, indicating that some key mechanisms shaping the variation have been overlooked. To address this, this paper combines a national dataset of MAiD policies across all fifty states with a comparative case study of Montana, Colorado, and West Virginia, focusing on differences in institutional venues, framing strategies, and coalition …

Determinants Of Corporal Punishment And Severe Physical Punishment In Egypt: A Mixed-Methods Analysis For Child Protection Policy, Marwa Moustafa Nassef

Theses and Dissertations

Corporal punishment (CP) and severe physical punishment (SPP) remain a major public health, child rights, and child protection policy concern. In Egypt, despite legislative reforms, survey-weighted analysis of the 2021 Egypt Family Health Survey (EFHS) 2021 (CAPMAS, 2022) reveals prevalence rates of 60.5% for CP and 27.4% for SPP among children aged 1–14 (author’s calculations using EFHS-2021, n=7623), yet evidence distinguishing the determinants of routine corporal punishment from escalation to severe physical punishment remains limited in low- and middle-income contexts. Guided by Bronfenbrenner’s ecological framework, this mixed-methods study identifies key drivers of CP and its escalation to SPP among Egyptian …

When School Culture Excludes: Deficit Discourse, Microaggressions, And The Mental Health Of Marginalized Students – A Conceptual Framework With Implications For School Psychology Practice And Equity Policy, Modupe Mercy Oyewunmi

Publications

Deficit-laden language like ‘behavior problem,’ ‘not college material,’ ‘won’t fit in’, ‘not a cultural fit’, operates as a systemic form of implicit bias and microaggression in school settings. Despite decades of research on school belonging and well-being, school psychology has yet to integrate these exclusionary discursive practices into a coherent health-determinant model that also accounts for the current anti-diversity, equity, and inclusion (DEI) policy environment. This conceptual paper proposes a testable framework linking deficit discourse and school-based microaggressions to student identity suppression, academic impostor phenomenon, and educator moral injury, with downstream effects on school mental health outcomes. We situate these …

2026 Research, Policy, And Practice Summit: “Protecting Access To Rural Community Living For People With Disabilities”, Will Hoard, Lillie Greiman, Rtc: Rural

Independent Living and Community Participation

This summit summary examines the critical personal assistance workforce shortage in rural communities, where demand for care increasingly outpaces supply. Drawing on national data and expert panel insights, the event highlighted how structural barriers including low wages, administrative complexity, and limited data undermine the safety, independence, and dignity of disabled people in rural areas. The summit concluded that protecting rural community living requires coordinated policy investments in workforce wages, working conditions, and data systems, recognizing direct care workers as essential to the health and independence of the people and communities they serve.

The Capital Gap: Mitigating Banking Barriers For Nonprofit Providers In Mental Health And Educational Systems, Jinhee Lee, Josefina Martinez

Pepperdine Policy Review

Nonprofit organizations are vital contributors to public welfare, yet they are systematically excluded from conventional banking systems, creating a liquidity crisis that undermines their capacity to deliver essential services. This paper discusses the structural issues of the banking sector that hinder nonprofits in acquiring credit and explains how this problem can be solved. Specifically, it aims at investigating liquidity constraints faced by schools providing mental health services and education programs. With the help of information asymmetry and relationship lending theories, the paper explains why traditional credit approaches cannot work, considering the distinctive features of the financial model of mission-oriented institutions. …

Beyond The Ban: Chhaupadi Abolition And The Governance Of Menstrual Autonomy In Western Nepal, Nikita Paudel

Master in Public Policy Theses

This thesis examines how two decades of efforts to abolish chhaupadi have shaped the everyday conditions under which women and girls experience menstruation in western Nepal. Chhaupadi, commonly understood as menstrual seclusion, has been addressed through Supreme Court directives, national policy, criminal law, municipal implementation instruments, hut demolition campaigns, public health programming, and rights-based advocacy. Yet the practice has persisted, adapted, and in some cases moved into less visible spaces. Rather than treating this as a simple gap between law and practice, this thesis asks how abolition efforts themselves have become part of the regulatory regime through which menstruation is …

Menstruation Behind Bars: A Mixed-Methods Study On Menstrual Product Access And Distribution Practices In Mississippi County Jails, Eron Hendrix

Honors Theses

This study examines menstrual product access and distribution practices in Mississippi county jails. It highlights the impact of period poverty as a critical yet underexplored public health and human rights issue within the corrections system. While existing research documents widespread inequities in access to menstrual products women’s healthcare in the correctional system, limited attention has been given to menstrual health at the local jail level. Using a mixed-methods approach, this study combines qualitative interviews with jail correctional staff and quantitative survey data from formerly incarcerated women to better understand institutional practices and lived experiences.

Interviews were conducted with sheriffs, jail …

Community-Based Substance Use Prevention Handbook, Rachael M. Kupper

Capstone Projects and Master's Theses

In Santa Cruz County, too many youth have issues with substance use and abuse. These issues extend beyond Santa Cruz County, but the county exhibits trends similar to those observed nationwide. Community members face challenges related to knowledge and the ability to organize effectively. The YEAH unit (Youth Empowerment Action for Health) and CPP (Community Prevention Partners) are working to address youth substance use, but need help from community members in the smaller jurisdictions across the county. This requires building workgroups across the county, composed of community members, parents, and professionals. The project is a roadmap handbook for forming a …

Abortion Politics And Policy: Stigma And Access In The Silver State, Celene Fuller

Lincy Institute Events

In the aftermath of the Supreme Court’s Dobbs v. Jackson Women’s Health Organization (2022) overturning Roe V. Wade, states have taken divergent paths in regulating access to abortion services. In 2024, Nevada voters overwhelmingly passed Question 6 proposing to codify abortion rights into the state constitution. In November 2026, Question 6 will again be on the ballot for final confirmation. If it passes, these rights will be protected from future legislative action.

Despite Nevadans’ strong support for abortion rights, the state’s dearth of abortion providers limits access to these services. As this lecture explores, both providers and individuals seeking abortions, …

Governing Addiction: An Anthropological Comparison Of Care In The United States And The Netherlands, Kiren K. Bagga

Bates College Journal of Political Studies

This article examines addiction care as a form of moral governance through a comparative anthropological analysis of the United States and the Netherlands. Drawing on a Foucauldian theory of biopolitics alongside this study argues that approaches to addiction treatment reveal how states differentially value life, citizenship, and vulnerability. Joan Tronto's relational definition of ethical care is used to move beyond a solely moral context, towards an ethical understanding of both caretakers and those who require care. In the United States, addiction policy has historically functioned as a punitive and moralizing project, shaped by racialized drug criminalization, neoliberal ideals of individual …

Call To Action Against Sex Trafficking Of Black Women And Girls, Stephany Powell, Tracey Sylvester, Brenda Myers-Powell, Audrey Morrissey, Melanie Thompson

Dignity: A Journal of Analysis of Exploitation and Violence

No abstract provided.

Self-Medication And Pharmaceutical Dispensing In Egypt: Practices, Policies, And Regulatory Challenges, Lobna Fawzy Ali Shaheen

Theses and Dissertations

Access to safe and appropriate medications is a critical component of public health, particularly in low- and middle-income countries. In Egypt, self-medication and informal pharmaceutical dispensing have become deeply embedded practices shaped by systemic, economic, and cultural factors. This research explores the complex interplay between self-medication behaviors, pharmaceutical regulation, and healthcare access in Egypt. Through qualitative interviews with policymakers, pharmacists, physicians, industry professionals, and citizens, the research uncovers widespread informal dispensing of prescription-only medicines, driven by high out-of-pocket costs, limited insurance coverage, and high public reliance on pharmacists as primary care providers. Despite the presence of regulatory frameworks, weak enforcement, …

The State Of Mental Health In The Mountain West, 2025, Cason Noll, Anirudh Polagani, Taylor Volk, Olivia K. Cheche, Caitlin J. Saladino, William E. Brown Jr.

Health

This fact sheet presents data on the mental health of youth and adults, as well as the availability of mental health care, across the five Mountain West states of Arizona, Colorado, Nevada, New Mexico, and Utah in 2025. The data are derived from "The State of Mental Health in America 2025,” originally published by Mental Health America (MHA).

Abortions In The Mountain West, 2022-2025, Olivia K. Cheche, Caitlin J. Saladino, William E. Brown Jr.

Health

This fact sheet presents data on the number of abortions provided annually in the Mountain West states of Arizona, Colorado, Nevada, New Mexico, and Utah between July 2022 and June 2025. The data are retrieved from the Society of Family Planning’s #WeCount report,  which includes data on abortion volume across all 50 U.S. states and Washington, D.C. This fact sheet focuses on the administration of both in-person and telehealth abortions in the Mountain West.

Challenges In Alaskan Rural Pharmaceutical Delivery, Faith Ozer Green, Michael S. Jones

CAEPR Presentations

In remote Alaska, aviation supply chains are critical to maintaining timely flow of food and medicines to communities. We map these supply chains, and present preliminary findings from a pharmaceutical shipment data partnership with a state Tribal Health Organization. Mean and distributional shipment time are presented for communities on versus off the road system, and a multiyear regional map is presented outlining propensity for shipment times over one week. Ongoing work will incorporate multiple additional Tribal Health Organization datasets in a comprehensive econometric framework.

The Attention Safeguard Models: Governing Digital Harm Without Restricting Lawful Speech, Delante Clark

Graduate Scholarship and Creative Works

Digital platforms increasingly govern contemporary social, civic, and psychological life through systems optimized for attention capture, amplification, and monetization. While lawful expression remains protected under the First Amendment, the infrastructural mechanisms that determine how speech circulates have produced a range of attention‑based harms, including cyberbullying, engagement farming, compulsive doom scrolling, emotional dysregulation, and civic polarization. This research paper introduces the Attentional Safeguards Model (ASM), coined and formalized by Delante Clark, as a novel governance framework that mitigates such harms by regulating systems of amplification rather than restricting expression itself. Building on attention economy theory, technological mediation, constitutional free‑speech doctrine, …

Educational Inequality In Health Insurance Coverage Before And After The Affordable Care Act, Madelaine R. Adamich

Journal of Earth and Life Science

Health insurance and health care accessibility have historically been ongoing issues within the United States. Two key factors associated with the likelihood of an individual being insured are educational attainment and income. The 2010 Affordable Care Act (ACA), which has been the largest overhaul of health care in the US to date, aimed to reduce disparities in health insurance coverage and health care accessibility. My research analyzes the extent to which the ACA succeeded in reducing disparities related to educational attainment. To examine the ACA’s effects, I utilize the US Census Bureau’s American Community Survey data from 2008 and 2015 …

The Effect Of The Affordable Care Act Medicaid Expansion On The Risk Of Hospital Closure And Adolescent Hpv Immunization In Rural Counties, Juliette Des Rosiers

Scripps Senior Theses

From 2005 to 2025, over 200 rural hospitals shut their doors, often citing increased operational costs, staffing shortages, low patient volume, regulatory barriers, financial challenges exacerbated by the COVID-19 pandemic, and uncompensated care as common contributors to the closures. Rural patients are often referred by their primary care physician to a hospital for regular immunizations, since smaller clinics have less capacity to provide immunizations due to a shortage of pediatricians and limited vaccine stock. A crucial vaccine that is not required by schools and underutilized in rural areas is that against human papillomavirus (HPV), a virus that infects cutaneous and …

Improving Maternal Health: Investigating The Early Impacts Of Medicaid Coverage Of Doulas In Oregon, Miriam Akhmetshin

Scripps Senior Theses

While the U.S. spends more per-capita than any country on healthcare, we experience the worst maternal health outcomes of high-income nations. In addition to hefty healthcare bills, an overwhelming majority of mothers experience pregnancy-related health issues that decrease productivity and utility. Thus, it is critical to research cost-effective solutions that can improve maternal health and promote equitable outcomes. Doulas are trained non-medical professionals who support mothers and families before, during and after birth. As a growing body of medical literature points to the role of doulas in decreasing costly medical interventions, insurance companies have begun covering their services. In 2014, …

Food Stamp Participation And Health Outcomes In Ca Immigrants, Esther Kang

Scripps Senior Theses

The U.S. social welfare system includes programs aiming to increase access to nutritious food to reduce nutrition insecurity. However, studies suggest that immigrants continue to face disproportionate risks of nutrition insecurity and may face barriers to enrollment due to legal status. This study, using secondary data from the 2023 California Health Interview Survey, examines the associations between food stamp participation, food insecurity, and clinical diagnosis of diabetes among adult U.S.-born, naturalized, and non-citizen adults in California. The findings suggest that those enrolled in food stamps are more likely to report food insecurity than those who are not enrolled, and that …

Understanding The Flow: Deconstructing The Link Between Immigrants And Fentanyl, Madeline F. Nesbitt

CMC Senior Theses

This thesis explains how a false link between undocumented immigration and fentanyl becomes widely accepted in the United States. Empirical data show that most fentanyl enters through legal ports of entry and that U.S. citizens account for the majority of those caught transporting it. Why, then, do 41% of Americans attribute overdose deaths to migrants trafficking fentanyl? This project examines how this myth is built, repeated, and sustained, and what policy consequences follow from it.

When complex social problems lack clear culprits, political actors often manufacture them through scapegoating. Current literature documents how political actors link immigrants to drug crimes, …

After The Aid Boom: Government Responses To The Global Health Agenda And Political Commitment In Low- And Middle-Income Countries, Sana Abdelkarim

Electronic Theses & Dissertations (2024 - present)

How do governments respond to the global health agenda? Does external health assistance translate to sustained domestic political commitment in low- and middle-income countries? Over the past three decades, development assistance for health has expanded, accompanied by international agreements emphasizing country ownership, alignment, and domestic resource mobilization. Yet domestic fiscal commitment to health remains uneven across countries. These questions have become more pressing as the global aid landscape enters a period of contraction, with a significant decline in development assistance, including health financing, raising concerns about the sustainability of health systems that have become reliant on external support.  This raises …

Addressing Challenges In Accessing Secondary And Tertiary Healthcare Services For Migrants And Refugees In Egypt, Noura Seada, Nehal El-Bakhshawangy, Heba Semary, Fatma Alzahraa Hassan, Ahmed Hammad

Papers, Posters, and Presentations

The growing number of vulnerable migrants and refugees worldwide presents a significant challenge to host countries, particularly in terms of accessing healthcare services. Egypt hosts over 9 million migrants and refugees, with 1.5 million in a vulnerable situation. Despite the country’s efforts in providing adequate healthcare to these vulnerable groups, some challenges persist. This paper addresses the barriers that vulnerable migrants and refugees face when seeking secondary and tertiary healthcare services in Egypt, analyzing the legal, economic, social, and health system factors that contribute to this problem.

In 2018, the Egyptian government began an ambitious journey to reform its healthcare …

Investigating The Relationship Between Noun Classes And Plant Folk Taxonomy In Chasu Language Of Kilimanjaro Region In Tanzania, Peter Rabson Mziray

Journal of Humanities and Social Sciences

The current study investigates the relationship between noun classes and plant folk taxonomy in Chasu (G 22). The study focuses on two objectives: the first objective is to describe the plant folk taxonomy in Chasu and the second objective is to determine the relationship between noun classes and plant folk taxonomy in Chasu. Data were collected from rural villages in Same and Mwanga districts by using free listing, field interviews (jungle-walk-and-identify), and written texts containing Chasu plant names. The findings reveal that Chasu folk taxonomy reflects different ethnobotanical categories; including a unique beginner which is mmea/mimea ‘plant(s)’, and three life …

Diaper Insecurity In Nevada And The Mountain West, 2024, Mia Tschan, Olivia K. Cheche, William E. Brown Jr.

Health

This fact sheet presents data on diaper insecurity in the Mountain West states of Arizona, Colorado, Nevada, New Mexico, and Utah. It also presents data on the diaper gaps faced by fifteen Nevada counties: Carson City, Churchill, Clark, Douglas, Elko, Humboldt, Lander, Lincoln, Lyon, Mineral, Nye, Pershing, Storey, Washoe, and White Pine. Esmeralda County and Eureka County are not included due to a lack of data. The 2025 Urban Institute report, “Mapping Diaper Insecurity in the US,” highlights 2024 data on diaper insecurity across all 50 U.S. states and the District of Columbia.

Nevada's Healthcare And Education Workforce Pipelines, David Damore, Caitlin J. Saladino, William E. Brown Jr.

Policy Briefs and Reports

With ongoing workforce shortages in K-12 education, healthcare, and mental and behavioral health—occupations central to the HEAL (health, education, administration, and literacy) economy—this brief utilizes the Nevada P-20 to Workforce Research Data System (NPWR) and data from the U.S. Bureau of Labor Statistics to explore the current and projected landscape for these workforces in Nevada. Examining the demographic characteristics of those participating in focused career and technical education training and those earning relevant postsecondary credentials illuminates gender disparities in Nevada’s healthcare and education workforce pipelines. After reviewing the current state of these workforces and assessing the available NPWR data, we …