Health Policy Commons^™

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

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 …

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 …

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 …

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 …

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 …

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 …

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 …

Protocol For Culturally Responsive Organizations, Ann Curry-Stevens, Marie-Elena Reyes, Coalition Of Communities Of Color

Center to Advance Racial Equity Publications and Reports

Communities of color have long been marginalized in mainstream service delivery – invisible in terms of their access to resources and services, the adequacy of such services, and in the types of interventions available to members of the community. When available, organizations have been ripe with inequitable outcomes. Today, greater attention to racial equity exists, with local leaders of color having been able to leverage influence to ensure that stronger accountability exists among mainstream organizations in terms of how well communities of color are served, with heightened emphasis on the cultural responsiveness of the entire organization. At the request of …

Protocol For Culturally Responsive Organizations: Literature Review And Standards For Performance, Marie-Elena Reyes, Ann Curry-Stevens

Center to Advance Racial Equity Publications and Reports

At the request of the Coalition of Communities of Color, the Center to Advance Racial Equity (CARE) was asked to assist in the development of a Protocol for Culturally Responsive Organizations (also called the Protocol) that it would use to improve the quality of services available to communities of color in mainstream health and human services. To achieve this, we have researched the literature available that provides evidence of the effectiveness of various interventions. Priority has been given to the literatures on culturally-responsive service delivery (which has been thin) and culturally-competent services (which while abundantly written about, relatively little exists …

The Association Between Insurance Status And Cervical Cancer Screening In Community Health Centers: Exploring The Potential Of Electronic Health Records For Population-Level Surveillance, 2008-2010, Stuart Cowburn, Matthew J. Carlson, Jodi A. Lapidus, Jennifer E. Devoe

Sociology Faculty Publications and Presentations

Introduction: Cervical cancer incidence and mortality rates in the United States have decreased 67% over the past 3 decades, a reduction mainly attributed to widespread use of the Papanicolaou (Pap) test for cervical cancer screening. In the general population, receipt of cervical cancer screening is positively associated with having health insurance. Less is known about the role insurance plays among women seeking care in community health centers, where screening services are available regardless of insurance status. The objective of our study was to assess the association between cervical cancer screening and insurance status in Oregon and California community health centers …

Oral Care & Asian And Pacific Islander Communities In Oregon, Amira Caluya

Center to Advance Racial Equity Publications and Reports

This report attempts to describe the current knowledge of oral health care access within Asian American, Native Hawaiian, and Pacific Islander communities in Oregon based on secondary data from the Oregon Health Authority’s Smile Survey 2007, Smile Survey 2012; and the Coalition of Communities of Color’s 2012 report, The Asian and Pacific Islander Community in Multnomah County: An Unsettling Profile. To be clear, the 2012 survey report draft is cited most, as the 2012 survey reported more data on children of color compared to the 2007 survey. This paper also attempts to highlight the multifaceted aspects of access to care …

Increasing The Relevance Of Research To Underserved Communities: Lessons Learned From A Retreat To Engage Community Health Workers With Researchers, Heather Angier, Noelle Wiggins, Jessica Gregg, Rachel Gold, Jennifer E. Devoe

Community Health Faculty Publications and Presentations

This article presents information on a community retreat developed to seek input from community health workers (CHWs) to increase the relevance of our research to underserved communities in Oregon. Retreats facilitating dialogue between researchers and CHWs could yield important insight to enhance the significance of research for communities.

Motivating Men Who Have Sex With Men To Get Tested For Hiv Through The Internet And Mobile Phones: A Qualitative Study, Magaly M. Blas, Luis A. Menacho, Isaac E. Alva, Robinson Cabello, Edwin Roberto Orellana

School of Social Work Faculty Publications and Presentations

Background: Men who have sex with men (MSM) have the highest HIV prevalence in Peru, yet they are underserved by traditional preventive programs. In Peru, the Internet and mobile phones have emerged as an effective and convenient tool to reach this population.

Methods and Findings: From October 2010 to February 2011, we conducted eight focus groups with gay identified MSM (closeted and out-of-the-closet) and with self-identified heterosexual MSM in order to identify key features and preferences to be used to tailor culturally-appropriate messages that could be delivered through Internet and mobile phones to motivate MSM to get tested …

Short Text Messages To Motivate Hiv Testing Among Men Who Have Sex With Men: A Qualitative Study In Lima, Peru, Luis A. Menacho, Magaly M. Blas, Isaac E. Alva, Edwin Roberto Orellana

School of Social Work Faculty Publications and Presentations

Objective: The objective of this study is to identify features and content that short message service (SMS) should have in order to motivate HIV testing among men who have sex with men (MSM) in Lima, Peru.

Methods: From October, 2010 to February, 2011, we conducted focus groups at two stages; six focus groups were conducted to explore and identify SMS content and features and two additional focus groups were conducted to tailor SMS content. The text messages were elaborated within the theoretical framework of the Information-Motivation-Behavioral Skills model and the Social Support Theory.

Results: A total of …

Entanglement: Health, Healing And Society In Africa, Haley Noel

Anthós

As a continent, Africa has been explored, exploited, and largely abandoned by the West. During the colonial era of the late 19th and early 20th centuries, foreign powers encountered diverse cultures, superstitions and disease before promptly labeling the entire continent a dangerous and primitive place. For early explorers and colonialists, disease and the threat of ill health is what defined Africa. They overlooked the pre-existing strategies and practices that Africans had adapted to guard against certain diseases, either ignoring them or labeling the misunderstood safety nets as primitive. Also overlooked was the importance of societal organization and communal cooperation among …

Health Insurance Coverage Dipped Along With The State, U.S. Economy, Ryan Dann, Jason R. Jurjevich

Publications, Reports and Presentations

A brief examination of the effects that economic downturns have on health insurance coverage in Oregon. Reviews statistical information relating to health coverage, and disparities that exist within the state.

Understanding School Travel: How Residential Location Choice And The Built Environment Affect Trips To School, Yizhao Yang, Marc Schlossberg, Robert Parker, Bethany Johnson

TREC Final Reports

This project investigates issues related to parents’ decisions about children’s school transportation. This has become an important area of research due to the growing concerns that increased reliance on private automobile in school travel has led to adverse health impacts on children and negative impacts on environment. This study examines school transportation in the context of where families live and how families make decisions about school travel in the process of choosing their residence.

Using a middle-sized school district in Oregon State, we conducted a 5500-household survey and a number of interviews and focus groups. The study shows that parents …

Photovoice As Authentic Civic Engagement: Lessons Learned In One Immigrant Community, Meg Merrick, Angie Mejia

Institute of Metropolitan Studies Publications

It is widely acknowledged that equitable and sustainable public policy can only be achieved when it is informed by the concerns, hopes, and experiences of those who are affected. Public agencies wishing to engage recent immigrants can find this to be challenging, however. Effective public participation and civic engagement can be difficult when community members cannot speak English and/or come from very different cultural and political environments. The Chronic Disease Prevention Program (CDPP) of the Multnomah County Health Department and Metro, two public agencies serving the Portland, Oregon region, have actively sought to learn from the experiences of immigrant community …

Self-Help Support Groups: Choices In Participation Among Women Facing Systemic Lupus Erythematosus (Sle), Maria A. Pfeifer

Dissertations and Theses

This research study explored the experiences of 19 women who had been diagnosed with, or were still seeking the diagnosis of SLE (lupus) and their decisions regarding support group participation. The aim of this study was to evaluate the variety of factors influencing their choices in types and sources of support, their coping strategies and the reasons behind their decisions to either choose or not choose lupus support groups as a viable support resource. Those women identified as support groups attendees recalled a more emotion-focused response to their diagnosis and showed stronger reliance on seeking emotional forms of support. Conversely, …