Health Policy Commons^™

Economic Analysis Of Population-Based Next Generation Sequencing For Breast Cancer, Sapphire Curelaru

University Honors Theses

Breast cancer develops due to accumulated DNA replication insults which causes cancer to uncontrollably proliferate. An individual's predisposition to developing cancer, as well as the composition of a tumor, can be sequenced using genetic tests. Myriad's BRACAnalysis CDx^® seems to be the most utilized genetic test. However, Next Generation Sequencing (NGS) seems to be a better genetic test for breast cancer when compared to Myriad's BRACAnalysisCDx^® in terms of return-time, accuracy, efficiency, and healthcare cost. By using Next Generation Sequencing tests, stakeholders can save money on genetic testing which can be invested in more genetic tests. Payers can …

Women’S Leadership And Covid-19 Pandemic: Navigating Crises Through The Application Of Connective Leadership, Chris Taylor Cartwright, Maura Harrington, Sarah Smith Orr, Tessa Sutton

International & Global Studies Faculty Publications and Presentations

International and national crises often highlight behavioral patterns in the labor market that illustrate women’s courage and adaptability in challenging times. The COVID-19 pandemic and resulting changes in the workplace due to social distancing, remote work, and tele-communications protocols showcased women’s power of authenticity and accessibility (interpersonal and personalized experiences) to engage with their constituents effectively. The catalyzed this research was our desire to underscore the importance of studying the impact of COVID-19 on women leaders. The COVID-19 pandemic brought to light specific challenges and disparities women faced in the workplace. It has been asserted that women leaders substantially benefit …

(Un)Weighted Assumptions: Anti-Fatness & Health, Kieran Chase, Nell Carpenter, Madysen Schreiber

OHSU-PSU School of Public Health Annual Conference

This lecture/discussion session aims to expand and add nuance to public health students’, professors’, and practitioners’ understanding of the interplay between body size and health. We will begin by naming and challenging common assumptions about the relationship between bodyweight and health outcomes. We will then argue for the consideration of weight-related stigma as a Fundamental Cause of Disease as defined by Phelan and Link, and for institutionally embedded anti-fat bias at the policy level (e.g., insurance policy, medical equipment) as a cause of population health inequity as defined in Whitehead’s Health Equity Framework. We offer these frameworks in contrast to, …

Oregon's Senate Joint Resolution 12: Understanding The Implications Of A Constitutional Right To Healthcare, Anna Starr, Mpp

Hatfield Graduate Journal of Public Affairs

Problems persist throughout the U.S. healthcare system including exorbitant costs, poor health scores, high rates of uninsured, and lack of access to services among marginalized groups. Among many proposed solutions is a constitutional provision to healthcare. Largely based in ethics, healthcare as a right is also expected by many to improve health outcomes. However, while constitutional provisions for healthcare are found in countries around the world, empirical research results are limited and mixed at best. In the wake of social justice movements and resurgence of vibrant conversations about human rights, and with international pressure mounting for the U.S. to follow …

Travelling For Abortion Services In Mexico 2016–2019: Community-Level Contexts Of Mexico City Public Abortion Clients, Laura E. Jacobson Mph, Biani Saavedra-Avendano, Evelyn Fuentes-Rivera, Raffaela Schiavon, Blair Darney

OHSU-PSU School of Public Health Faculty Publications and Presentations

Objective: To describe the community context of women who travel to access Mexico City’s public sector abortion programme and identify factors associated with travelling from highly marginalised settings.

Methods: We used data from the Interrupción Legal de Embarazo (ILE) programme (2016–2019) and identified all abortion clients who travelled from outside Mexico City. We merged in contextual information at the municipality level and used descriptive statistics to describe ILE clients’ individual characteristics and municipalities on several measures of vulnerability. We also compared municipalities that ILE clients travelled from with those where no one travelled from. We used logistic regression to identify …

The Relationship Between Regulation And Care Access In The Doula Industry, Charissa Billings

University Honors Theses

Birth doulas are unregulated service providers in the United States, who provide informational, emotional, and physical support before, during, and after birth. Currently, the United States has the highest maternal mortality rate amongst the most developed nations, as well as a serious racial gap, with Black women being twice as likely to die due to pregnancy-related complications when compared to White women. Birth doulas can help close the gaps with trained support and advocacy. Since over 40% of the births in the US are covered by Medicaid, providing birth doula services to Medicaid recipients could result in improved birth outcomes. …

Aligning Food Environments With Institutional Values: A Mixed Methods Study Of Oregon Health Care Organizations, Elizaveta Walker

Dissertations and Theses

A major driver of the obesity epidemic is obesogenic food environments, characterized by nutrient-poor and energy-dense foods that saturate the collective physical, economic and sociocultural conditions that influence nutritional status. Food environments in organizations such as hospitals and public health agencies warrant special consideration given their health-focused mission. Improving food environments within health care settings has been highlighted by the Centers for Disease Control and Prevention (CDC) as one of seven key strategies to prevent obesity. However, most of the refereed literature examining healthy food environment policies (HFEPs) within hospitals focuses on the inpatient dietary environment, leaving a paucity of …

Employer-Reported Access To Paid Parental Leave: A Study Of San Francisco’S Paid Parental Leave Ordinance, Julia M. Goodman, Holly Elser, William H. Dow

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: A growing body of research finds that paid leave policies have significant population health benefits for workers and their families, but the lack of a national paid leave policy in the United States leaves most workers without access to any paid leave. In 2017 San Francisco implemented the nation’s first fully paid leave policy, mandating that covered employers provide up to six weeks of leave to care for a new child. The objective of our study is to examine how the San Francisco Paid Parental Leave Ordinance (PPLO) affected paid leave access, including among workers in low-wage industries. Methods: …

A Public Health Recommendation Countering The Online Anti-Vaccination Movement, Grace M. Neumann

University Honors Theses

The anti-vaccination movement had posed a threat to the health of communities, since the inception of the smallpox inoculation practice. As the anti-vaxx movement continues to grow in strength and reach, public health officials must be prepared to combat the flow of misinformation, with sound scientific data in a way that connects with individuals from all communities. Online platforms such as blogs and social media, allow newfound access to vaccine opinions and information, posing an even greater risk of vaccine misinformation being spread to the public. Different communities hold different reasons for vaccine hesitancy and avoidance. An effective public health …

Organizational Risk In Multi-Sector Health Partnerships: A Case Study Of Oregon's Accountable Health Communities, Shauna Jean Nicole Petchel

Dissertations and Theses

The literature on collective action has documented that the perception of organizational risk -- both the uncertainty of potential outcomes and the meaning attached to them -- is an important factor in whether and how organizations engage in cross-sector collaborations. Yet there are few examples to date that document how health and social service leaders perceive organizational risks in cross-sector health partnerships focused on social determinants of health, or how their perceptions influence organizational commitment and willingness to engage in these partnerships over time.

This research aimed to fill this gap through a mixed methods case study of health and …

Healthcare Spending Mandate Modeling Report, Northwest Economic Research Center, Peter Hulseman, Adam Rovang, Devin Bales, Nicholas Chun

Northwest Economic Research Center Publications and Reports

Governor Brown’s health care financing package, which was released with the 2019-21 recommended budget included several revenue components which provide broad-based, sustainable revenue for health care coverage in Oregon for the next six years. One component of that package is the Subsidized Employer Participation Program, which would be similar to the San Francisco Health Care Security Ordinance (HCSO). The new requirement would compel employers of a certain size who otherwise do not qualify for any exemption to contribute to their employees’ health care costs. An employer’s contribution could be in one of three ways: (1) in the form of directly …

Making The Business Case For An Addiction Medicine Consult Service: A Qualitative Analysis, Kelsey C. Priest, Dennis Mccarty

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background

As the drug poisoning crisis worsens in North America and opioid use disorder (OUD)-related hospital admissions increase, policymakers and hospital administrators are beginning to recognize the important role of hospitals in the OUD care continuum. This study explores and describes how U.S. addiction medicine physicians created and presented business propositions to hospital administrators to support the development of addiction medicine consult (AMC) services.

Methods

Fifteen qualitative interviews were completed with board-certified or board-eligible addiction medicine physicians from 14 U.S. hospitals. The interviews occurred as part of a broader mixed methods study exploring hospital service delivery for patients admitted with …

Periodic Atlas Of The Metroscape: The Geography Of Health, Joshua Ollinger, Ashley Donald, Randy Morris

Metroscape

Our ability to lead a fulfilling life and pursue our goals is largely shaped by our health. Although we experience these conditions such as illness and disabilities at a very personal level, factors outside of our control are often what determines our health. Known as the Social Determinants of Health, where we are born, work, live, and spend our lives is considered equally if not more important to our health status than medical care and personal health behaviors. As a result, certain communities and populations disproportionately experience burdens. Identifying and increasing awareness of health disparities is an essential step toward …

Oregon's Medicaid Reform And Transition To Global Budgets Were Associated With Reductions In Expenditures, K. John Mcconnell, Stephanie Renfro, Neal T. Wallace, Deborah J. Cohen, Richard C. Lindrooth, Michael E. Chernew

OHSU-PSU School of Public Health Faculty Publications and Presentations

In 2012 Oregon initiated an ambitious delivery system reform, moving the majority of its Medicaid enrollees into sixteen coordinated care organizations, a type of Medicaid accountable care organization. Using claims data, we assessed measures of access, appropriateness of care, utilization, and expenditures for five service areas (evaluation and management, imaging, procedures, tests, and inpatient facility care), comparing Oregon to the neighboring state of Washington. Overall, the transformation into coordinated care organizations was associated with a 7 percent relative reduction in expenditures across the sum of these services, attributable primarily to reductions in inpatient utilization. The change to coordinated care organizations …

Underutilization Of Federal Benefits In Oregon: Programs And Strategies, Raúl Preciado Mendez

National Policy Consensus Center Publications and Reports

The report results demonstrate the dependence low-income Oregon families have on the six federal programs and the challenges families face when attempting to access federal resources. The barriers to access are often structural in that they are embedded in the procedures and structure of the program. Based on its analysis, the report presents a series of reforms and support activities that Oregon state agencies and nonprofits could adopt to improve family access for each program.

Smart Cities: Improving The Roadside Environment With Distributed Sensor Systems, Christine M. Kendrick

PSU Transportation Seminars

The City of Portland is exploring how distributed "Internet of Things" (IoT) sensor systems can be used to improve the available data that is usable by city engineers, planners, and the public to help inform transportation operations, enable assessments of public health and equity, advance Portland’s Climate Action Plan goals, and create opportunities for economic development and civic engagement.

The City is currently looking at how low-cost air quality sensors can be used to improve and increase real-time understanding of transportation-related pollutants. However, the state of low-cost air quality sensor technology is not usable off the shelf due to sensitivity …

The Associations Between Environmental Quality And Mortality In The Contiguous United States, 2000-2005, Yun Jian, Lynne C. Messer, Jyotsna S. Jagai, Kristen M. Rappazzo, Christine L. Gray, Shannon C. Grabich, Danelle T. Lobdell

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: Assessing cumulative effects of the multiple environmental factors influencing mortality remains a challenging task.

Objectives: This study aimed to examine the associations between cumulative environmental quality and all-cause and leading cause-specific (heart disease, cancer, and stroke) mortality rates.

Methods: We used the overall Environmental Quality Index (EQI) and its five domain indices (air, water, land, built and sociodemographic) to represent environmental exposure. Associations between the EQI and mortality rates (CDC WONDER) for counties in the contiguous United States (n=3109) were investigated using multiple linear regression models, and random intercept, random slope hierarchical models. Urbanicity, climate and their combination were …

Social Learning Through Stakeholder Engagement: New Pathways From Parcipitation To Health Equity In U.S. West Coast Hia, Nicole Iroz-Elardo, Moriah Mcsharry Mcgrath

Urban Studies and Planning Faculty Publications and Presentations

While some contend that extensive public engagement activities are necessary to meet Health Impact Assessment (HIA) practice standards, other work suggests that an HIA of any type hasthe potential to inform decision-making in ways that embody HIA’s value of democracy (Cole & Fielding, 2007; Harris-Roxas et al., 2012; Negev, 2012). These divergent perspectives on how to realize democracy through public participation represents an area of evolving debate in the ongoing development of HIA practice in the US. Looking to the relatively diverse HIA practice on the west coast of the US, we explore the interplay between engagement strategies and HIA …

Developing High-Resolution Descriptions Of Urban Heat Islands: A Public Health Imperative, Jackson Voelkel, Vivek Shandas, Brendon Haggerty

Urban Studies and Planning Faculty Publications and Presentations

Extreme heat events affect the most vulnerable human populations and are a lethal health hazard to urban dwellers globally; in the United States, extreme heat causes more deaths annually than all other weather events and natural hazards combined (1). Previous studies described urban heat islands as isolated, static, monolithic areas of cities. We challenged this contention by hypothesizing that diurnal temperature cycles and diverse landscape features create variation in places that amplify heat (2). A temporal description of urban heat islands would identify populations that are susceptible to heat stress, particularly at night, when most people are asleep and unable …

Impact Of A State Evidence-Based Practice Legislative Mandate On County Practice Implementation Patterns And Inpatient Behavioral Health Discharge, Carl William Foreman

Dissertations and Theses

Evidence-based practices and comparative effectiveness research are salient topics in public policy. Empirical validation of agency operating processes provides agencies and policy-makers the opportunity to address uncertainty surrounding effectiveness. While this is an increasingly accepted rational approach to public policy, the exact mechanism for how this operates is less known. In order to evaluate several theoretical assumptions and normative rational expectations inherent in this approach, the implementation of a state legislative mandate stating policy expectations for behavioral health evidence-based practices is assessed. This study sought to assess whether implementation patterns and associated outcomes reflect "rational mechanism" policy expectations. While the …

Improving Police Officer Responses To Persons With Mental Illnesses: A Review Of The Literature, Portland State University. Criminology And Criminal Justice Senior Capstone

Criminology and Criminal Justice Senior Capstone Project

Addressing mental illness in the American criminal justice system is necessary in order to ensure both citizens and officers are safe. According to Centers for Disease Control and Prevention (2011), published studies show approximately 25 percent of all adults in the U.S. have a mental illness and nearly 50 percent of adults in the U.S. will develop at least one mental illness during their lifetimes. The U.S. Department of Justice’s Bureau of Justice Statistics also indicates nearly 25 percent of state prisoners and jail inmates with a mental health problem have three or more prior incarcerations (as cited in Glaze …

Child And Maternal Health In The Slavic Community: Insights On Assets And Priorities, Marie-Elena Reyes, Ann Curry-Stevens

Center to Advance Racial Equity Publications and Reports

The Slavic community’s health is impacted by race and ethnicity, and also by issues that flow from being a newcomer community, and also from their status as refugees. They also bring to the U.S.A. cultural orientation that is collectivist, and shared experiences of persecution and deep distrust of the government. As is detailed in this report, these experiences have an impact on health and wellbeing, and simultaneously have a detrimental effect on the economic stature of the community.

This Community Needs Assessment on the Health of Slavic Children (ages 0-5 years) was conducted to produce a “needs assessment” report outlining …

Community Assessment Of African Maternal Health In The Portland Region: Drivers For Community, Health Services And Institutional Change, Marie-Elena Reyes, Ann Curry-Stevens

Center to Advance Racial Equity Publications and Reports

This community needs assessment surfaces a range of health priorities faced by the African community. While the scope of the study is limited by time and resources, and strategically focused on maternal health, there are a wider set of upstream and downstream health challenges that impede the community’s wellbeing. We encourage policy makers to remember these whenever health policies, and in fact all manner of policies and programs tied to the social determinants of health, are being considered.

The main body of this report contains the insights of the 56 African women who participated in six focus groups. Their voices …

Inclusive Planning To Evaluate Improved Non-Emergency Medical Transportation Services For Patients With End Stage Renal Disease, Jenny Liu, August Benzow

TREC Final Reports

The objective of this project is to design a framework that could be used to evaluate the effectiveness and efficiency of non-emergency transportation services (NEMT) for better livability. In addition to the development of the framework, this project aimed to establish connections between Portland State University (PSU) researchers with regional connections involved in public health research, non-emergency medical transportation, medical services, and medical insurance provision. With the rising costs of transportation and medical costs generally in the United States, it is increasingly important to develop new tools and strategies to reduce these costs while maintaining and improving upon the level …

Links Between Public Transportation And Physical Activity, Brian Saelens

PSU Transportation Seminars

This seminar will explore the empirical evidence regarding the links between the use of public transportation and physical activity, with a specific focus on using integrated device and self-report methods to identify travel modes and physical activity.

Equality, Trust And Universalism In Europe, Canada And The United States: Implications For Health Care Policy, P. Christopher Palmedo

Dissertations and Theses

A number of theoretical explanations seek to describe the factors that have led to the position of the United States as the last industrialized Western nation without a universal health care program. Theories focus on institutional arrangement, historic precedent, and the influence of the private sector and market forces. This study explores another factor: the role of underlying social values. The research examines differences in values among ten European countries, the United States and Canada, and analyzes the associations between the values that have been seen to contribute the individualism-collectivism dynamic in the United States. The hypothesis that equality and …

The Oregon Health System Transformation: Preliminary Report Of Coordinated Care Organizations In The First Year Implementation, Carlos J. Crespo, Ellen Smit

Community Health Faculty Publications and Presentations

Because of the US Affordable Care Act, 16% of Oregonians without health insurance will be able to obtain coverage through Coordinated Care Organizations (CCO).

Assessing Impacts Of Time Use On Children's Physical Fitness In Relation To Risk For Obesity And Diabetes, Jessica Guo

PSU Transportation Seminars

Researchers from the transportation, planning and health fields share the common goal of promoting physically active lifestyle. One challenge that researchers often face is the measurement of physical activity, particularly among children. This is because the sporadic nature of children’s physical activity patterns makes it difficult to recall and quantify such activities. Additionally, children’s lower cognitive functioning compared to adults prevents them from accurately recalling their activities. This presentation will describe the design and application of a novel self-report instrument - the Graphs for Recalling Activity Time (GReAT) - for measuring children’s activity time use patterns. The instrument was applied …

Citizenship Documentation Requirement For Medical Eligibility: Effects On Oregon Children, Brigit A. Hatch, Jennifer E. Devoe, Jodi A. Lapidus, Matthew J. Carlson, Bill J. Wright

Sociology Faculty Publications and Presentations

BACKGROUND AND OBJECTIVES: The Deficit Reduction Act (DRA) of 2005 mandated Medicaid beneficiaries to document citizenship. Using a prospective cohort (n=104,375), we aimed to (1) determine characteristics of affected children, (2) describe effects on health insurance coverage and access to needed health care, and (3) model the causal relationship between this new policy, known determinants of health care access, and receipt of needed health care.

METHODS: We identified a stratified random sample of children shortly after the DRA was implemented and used state records and surveys to compare three groups: children denied Medicaid for inability to document citizenship, children denied …

Measuring Urban Bicyclists' Uptake Of Traffic-Related Pollution, Alexander Y. Bigazzi

PSU Transportation Seminars

Urban bicyclists’ uptake of traffic-related air pollution is still not well quantified, due to a lack of direct measurements of uptake and a lack of analysis of the variation in uptake. This paper describes and establishes the feasibility of a novel method for measuring bicyclists’ uptake of volatile organic compounds (VOC) by sampling breath concentrations. Early results from the data set demonstrate the ability of the proposed method to generate findings for transportation analysis, with statistically significant exposure and uptake differences from bicycling on arterial versus bikeway facilities for several traffic-related VOC. These results provide the first empirical evidence that …