Health Policy Commons^™

Institutional Betrayal And Military Vaccine Mandates: An Inquiry Into Loss Of Health Autonomy Concerning Unlimited Liability Contractual Employment In The Covid-19 Era, Aaron G. Dehaven

Electronic Theses and Dissertations

The balance between government control and personal liberty is a growing concern in the modern world. Nowhere is this more evident than in discussions surrounding government policy in public health and individual health autonomy. The Covid-19 pandemic forced many institutions to change their standard operating procedures by adapting to rapidly changing health guidance instituted to protect public health. These changes highlighted the role of health autonomy and individuals’ rights to refuse medical treatments. The Department of Defense changed many aspects of how it operated during the pandemic, including the mandate of the Covid-19 vaccine for all service members. For various …

Survival Guide For Queer Families In Heteronormative Healthcare: Liberatory Consciousness And The Paradox Of Dependent Healthcare, A Critical Policy Discourse Analysis, Dwenna A. Holden

Electronic Theses and Dissertations

In this study I explored and analyzed how the queer experiences of an anonymous higher education institution in the western United States’ self-identified queer faculty and staff intersected with the discursive framing of the college’s dependent healthcare structure and documents. Within a critical paradigm I designed research around a high-density theoretical approach to weaving various branches of queer theory together with critical theory around policy and law in relation to queer bodies and hostile heteronormative policy environments. I arrived at solutions based in complaint, survival, and transformation. I used critical policy discourse analyses to interrogate the college’s dependent healthcare documents …

How White Supremacy Travels Through Time: Anti-Literacy Laws, Dei Bans, And The Issue Of Black Self-Determination In Public Health., Nicole V. Ford

Electronic Theses and Dissertations

This dissertation used a qualitative policy content analysis (PCA) of historical anti-literacy laws and modern DEI bans to answer two research questions: What is the connection between anti-literacy laws and DEI bans? How do anti-literacy laws and DEI bans create an environment that maintains white supremacy? A PCA exercise informed the analysis of historical anti-literacy laws in South Carolina (1834), Georgia (1829), North Carolina (1830), Louisiana (1830), Virginia (1831), and Alabama (1833) and modern DEI bans in Texas (2023), Alabama (2024), and Florida (2023) to find the connection between the laws. Findings from this dissertation illustrate how white supremacy operates …

Gender And Disability: An Exploration Of Reflective Practice For Protection And Access Amid Complex Emergencies, Lindsey A. Mandolini

Electronic Theses and Dissertations

Gender and Disability: An Exploration of Reflective Practice for Protection and Access Amid Complex Emergencies is a qualitative research project exploring under what conditions and in what ways disabled persons’ organizations (DPOs) effectively protect and provide access to women and girls with disabilities amid complex emergencies. The study upheld a participatory approach and rights-based framework, emphasizing that authentic inclusion requires centering disabled voices in research. Drawing on extant research, grey literature, and data collected from online practitioner questionnaires and semi-structured interviews, the study conducted a multi-phased reflexive thematic analysis. The research findings culminate in a composite narrative that brings to …

The Purple Heart And Suicidal Behaviors In Post-9/11 U.S. Army Combat Veterans With A Traumatic Brain Injury: A Mixed Methods Study, Jayna Moceri-Brooks

Electronic Theses and Dissertations

Military suicide rates remain high, despite years of targeted efforts to prevent suicide. Specifically, Army Combat Veterans who sustained a traumatic brain injury (TBI) while deployed in support of the Global War on Terrorism are at the highest risk for suicide. This dissertation highlights possible causes for suicidal behaviors within this unique group and provides specific military suicide prevention recommendations. The dissertation is organized into three publishable manuscripts: The first manuscript (Chapter 1) is a mixed-methods dissertation research proposal written according to the National Institute of Health proposal guidelines. The second manuscript (Chapter 2) is an integrative review of the …

Emergency Care For Youth Who Experience Suicidality And Identify As Lesbian Gay Bisexual Transgender Queer/Questioning (Lgbtq+): An Interpretive Phenomenology, Theresa Schultz

Electronic Theses and Dissertations

Purpose: Suicide is a leading cause of death in children; youth who identify as LGBTQ+ are at an exponentially higher risk of suicide. The purpose of this study was to explore the lived experiences of young adults who identify as LGBTQ+ and sought emergency care for suicidality when they were adolescents.

Methods: Heideggerian hermeneutics phenomenology is the research method used in this study. Youth, ages 18-25 years, who identify as LGBTQ+ and sought emergency treatment for suicidality when they were adolescents (13-17 years) were recruited to participate;fifteen youth enrolled. Individuals ranged in age from 20 to 25 years. Participants described …

Weathering The Storm: Navigating Urban Ecologies Of Communication In Times Of Crisis, Austin Hestdalen

Electronic Theses and Dissertations

This project explores cities as urban ecologies of communication in which crises emerge and are given significance within the dialogic relations cultivated among public actors attempting to make a living, together, within the shared historical-cultural contexts of everyday life. To describe cities as urban ecologies of communication is to describe them in terms of urban communication and its interdisciplinary foundations in the study of rhetoric, philosophy, planning, policy, architecture, sociology, geography, and media. The first chapter introduces the challenges of urban risk and crisis management within the complex ecologies of communication constituted by cities and reviews how ‘risk’ and ‘crisis’ …

Meeting The Mental Health Needs Of College-Aged Young Adults: Evaluating The Value And Impact Of Digital Mental Health Interventions., Sara Atherton Choate

Electronic Theses and Dissertations

BACKGROUND: The growing prevalence of common mental health problems poses a serious hindrance to young adults, and the majority of those in need of mental health support do not seek professional psychological services. Digital mental health interventions (DMHIs) that allow for self-management of mental health symptoms could provide a useful adjunctiveto traditional one-on-one counseling or therapy and offer a useful prevention tool for students at risk for experiencing mental health crises. This dissertation explored the efficacy of self-guided DMHIs targeting college students, the factors associated with help-seeking in young adults, and the impact of implementing an evidence-based DMHI at a …

Nurses Leading In Bridging The Culture Gap: Communicating With The Deaf Community, Veronica C. Leftridge

Electronic Theses and Dissertations

Nurses provide patient care in clinics, hospitals, homes, churches, schools, communities, and military, as well as on emergency medical helicopters. When a nurse is assigned to care for a patient, the patient expects the nurse to be culturally competent, communicate effectively, and provide safe quality care. However, cultural incompetence is observed when nurses provide care for Deaf patients, but they are unfamiliar with Deaf culture. In addition, communication is a fundamental skill nurses learn in nursing school, but course content in nursing programs rarely touches on how to communicate effectively with Deaf patients. Of the approximately 325 million people in …

Exploring The Relationship Between Historical Redlining And Place-Based Reproductive Health Inequities: A Qualitative Gis Approach, Kristi L. Roybal

Electronic Theses and Dissertations

Individual-level risk factors and characteristics do not fully explain racial, ethnic, and socioeconomic inequities in preterm birth in the United States, and evidence suggests that medical advancements, increased access to prenatal care, and high per-capita spending on health care have done little to reduce these inequities. Health inequities research has shifted its attention from individual-level factors that influence health outcomes to the social determinants of health. Neighborhoods, considered an important upstream social determinant of health, can influence health outcomes through their social, service, and physical environments, and have been consistently linked to birth outcomes. Despite increased attention to neighborhood influences …

Where Virtual Well-Being Becomes Reality, Colleen M. Reilly

Electronic Theses and Dissertations

Strategies to mitigate the spread of COVID-19, specifically quarantine and social distancing protocols, have exposed a troubling paradox: mandated isolation meant to save lives has inadvertently contributed to a decline in America’s well-being. Prolonged isolation due to more remote work and decentralized workplaces has been associated with widespread loneliness and diminished physical and mental health, with effects compounded by limited face-to-face access to social support systems. While remote communication technologies (e.g., video chat) can connect individuals with colleagues and social networks, remote technologies might have limited effectiveness in business and social contexts. This study uses Roger’s Diffusion of Innovation Theory …

Peer Verbal Sexual Harassment In Early Adolescence: A Feminist And Sexual Scripts Theoretical Approach., Shawn M. Rolfe

Electronic Theses and Dissertations

Until recently, sexual harassment research has focused primarily on adults and college and high school students with little attention given to younger students. While recent research has noted sexual harassment occurs among younger students, the literature addressing sexual harassment among middle school students is still sparse. Additionally, most studies of sexual harassment have focused on sexual harassment generally, with no distinction made between verbal and sexual harassment. In fact, only limited research has been exclusively conducted on verbal sexual harassment. Using self-report data, the current study adds to the literature by examining the nature of verbal sexual harassment as well …

A Mixed-Methods Analysis Of Abortion Attitudes And Perceptions Among Women Living In Alabama And South Carolina, Anthony Peluso

Electronic Theses and Dissertations

Legal induced abortion is a safe option for terminating a pregnancy for women of reproductive age in the United States (U.S.), though access has varied since the Roe v. Wade and Doe v. Bolton cases in 1973. Information is lacking on women’s attitudes toward and perceptions of abortion as well as on related constructs such as pregnancy attitudes and contraceptive use. Exploring these constructs is important in that it can provide much needed context to women’s reproductive life planning. This research aimed to explore perceptions of abortion access and safety and examine the potential associations between attitudes toward abortion access …

Poverty In The United States: An Analysis Of Its Measurement And The Long-Term Social And Economic Costs, Abby Magnus

Electronic Theses and Dissertations

This thesis examines the role of poverty in the United States and how it has impacted social and economic systems. It explores how U.S. poverty measurements developed in the 1960s may not be accurately measuring poverty now, and the ways in which these measures could be improved upon. This work also reviews literature on health and educational inequities stemming from socioeconomic class, and the role these play in long-term economic mobility. Finally, it analyzes how larger social institutions like mass incarceration and capitalism have developed around poverty, and the role they play in maintaining its prevalence today. This thesis finds …

The Ethical Justification Of Increasing Awareness Of Preventive Medicine Among Healthcare Professionals, Patients And The General Public In The United States, Karishma Ether Moazzam

Electronic Theses and Dissertations

While practiced for centuries, preventive medicine has received increased attention during the recent times. Preventive medicine has a distinct mission to protect, promote, and maintain health as well as to prevent diseases, disabilities, and premature deaths. It aims to fulfill its mission through the combined form of clinical intervention and health promotion. In the recent years, preventive medicine has begun to lean more towards the clinical interventions, taking away from the health promotion. This imbalance has caused preventive medicine to lose its effectiveness in fulfilling its mission. One of the leading causes for such imbalance is the lack of proper …

Comparative Spending Of Medicaid Dollars On Child Participants Of Kentucky’S Sobriety Treatment And Recovery Teams Program Versus A Matched Comparison Group., Matthew Thomas Walton

Electronic Theses and Dissertations

Child protective services agencies have long observed the complicating role that parental substance use and addiction plays in cases of child maltreatment. Families who struggle with these problems present unique challenges for child welfare professionals. These families are typically more difficult to engage, more likely to have children removed from the home, and have poorer outcomes when compared to other families. These poorer outcomes often include health problems. Addiction has well-known effects on health, and the specific manifestations of these problems for parents have been documented for years in child protection casework. However, what has been less investigated are the …

Wellness Policy Awareness Among School Leaders And The Impact On Written Policy Scores, Mariah Reil

Electronic Theses and Dissertations

Background: All schools participating in the National School Lunch Program must possess a written School Wellness Policy (SWP) as mandated by the Healthy, Hunger- Free Kids Act of 2010.1 School officials and leaders play a major role in SWP implementation. It is essential to written SWP implementation that school level officials and leaders in the district are aware of the SWP. However, the association between school leader awareness of SWP and policy quality has not yet been studied.
Purpose: The purpose of the present study was to determine if school leader awareness of a SWP impacts the written SWP quality. …

Does Medicaid Increase Emergency Room Use: Evidence From Oregon Health Program?, Md Fourkan

Electronic Theses and Dissertations

This thesis paper strives to identify the relationship between Medicaid expansion and Emergency Department use. I use a Monte Carlo simulation for demonstrating the endogeneity problem and a copula model using the Oregon Health Program (OHP) data to show the previous literature has exaggerated the causal relation between Medicaid expansion and Emergency Department use. This paper can be divided into two parts. First, it tries to focus on the under-identification of multiple endogenous variables problem in typical econometrics papers, where researchers correct for a single endogenous variable but intentionally or unintentionally ignore the endogeneity of one or more other independent …

The Core Relation Between Hospitality (Philoxenia), Dignity And Vulnerability In Orthodox Christian Bioethics: A Contribution To Global Bioethics, Rabee Toumi

Electronic Theses and Dissertations

In a pluralistic world, reaching consensus in matters of bioethics has proved to be difficult, especially with the political polarization that nurtures inimical differences. This dissertation argues that a middle ground can be identified between the plurality of value systems in contemporary bioethics based on an anthropological approach. This middle ground that reflects commonalities of the human condition can be explored in relation to the foundational principles of Orthodox Christian anthropology. To identify this middle ground the analysis discusses the core relation between hospitality, dignity, and vulnerability as a contribution to global bioethics.

In general, based on Orthodox Christian theology …

Cost Burden Of Social Isolation For Wheelchair Users In Louisville, Kentucky., Connie Light

Electronic Theses and Dissertations

Background: Social isolation is an important predictor for poor health status, chronic diseases, and healthcare utilization and costs. There is a growing number of Americans with one or more disabilities, and evidence suggests that many are also socially isolated. This is especially true for those with immobility, as the built environment including housing structures are not universally designed to be accommodating. Immobility describes those who use walkers, canes, or wheelchairs, with the latter suffering the most impact. The cost of social exclusion can be measured by the exacerbation of disease in wheelchair users, whose fragile health status and social networks …

Examining The Influence Of Personal And Environmental Factors On Treatment Outcomes In Opioid Dependent Medication-Assisted Treatment Patients., Vierne Placide

Electronic Theses and Dissertations

Opioid abuse has become a global epidemic and is now a huge public health concern here in the US. Non-medicinal use of opioid prescription drugs is at the forefront of the epidemic and considered the "gateway" drug to other illicit opioid use. As opioid prescribing has increased over the last decade in the US, so has opioid-related deaths, surpassing car accidents and suicide as the leading cause of injury-related deaths. Medication assisted treatment (MAT) is fundamental in decreasing opioid abuse overdose and mortality. Therefore, the research study aims to determine if counseling adherence, opioid abstinence, and retention in MATs are …

Risk In Privacy Breach Determination: The Application Of Prospect Theory To Healthcare Privacy Officers, Amanda Walden

Electronic Theses and Dissertations

A significant concern in healthcare is that of patient privacy and how organizations protect against unauthorized access to protected health information. The federal government has responded by instituting policies and guidelines on requirements for protection. However, the policy language leaves areas open to interpretation by those following the guidelines. Reporting to the Office for Civil Rights and/or the patient can open an organization to risk of financial and possible criminal penalties. There is a risk of harm to their reputation which could impact patient visits and market share. Therefore, Privacy Officers might view risk in different ways and therefore handle …

Social Media As A Healthcare Tool: Case Study Analysis Of Factors Influencing Pediatric Clinicians' Behavioral Intent To Adopt Social Media For Patient Communication And Engagement, Rachel Mustonen

Electronic Theses and Dissertations

Social media aids communication among users worldwide. However, a notable gap exist among social media users, healthcare professionals utilizing social media in the work place. While the concept of harnessing social media as a professional tool is not novel, healthcare professionals have yet to embrace the practice as standard workflow. This study identifies factors influencing clinicians' behavioral intent to adopt social media for patient engagement and communication. A new framework, the Healthcare Social Media Adoption Framework (HSMA), guided this mixed-method approach to assess 7 factors identified by theory and literature as adoption influencers. A custom, web-based survey collected data from …

Constructing And Validating An Integrative Economic Model Of Health Care Systems And Health Care Markets: A Comparative Analysis Of Oecd Countries, Jesse Helligso

Electronic Theses and Dissertations

This dissertation argues that there are three basic types of health care systems used in industrial nations: free market (private insurance and provision), universal (public insurance and private provision), and socialized (public insurance and provision). It examines the role of market forces (supply and demand) within the health care systems and their effects on health outcomes by constructing an integrative model of health care markets and policies that is lacking within the scientific and academic literature. The results show that, free market systems have decreased access to care, good quality of care, and are economically inefficient resulting in 2.7 years …

The Effect Of Registered Nurse Supply On Population Health Outcomes: A Distributed Lag Model Approach, Carla Jackie Sampson

Electronic Theses and Dissertations

Registered nurses (RNs) are essential to providing care in the healthcare system. To date, research on the relationship between healthcare provider supply and population health has focused on physician supply. This study explored the effect of RN supply on population health outcomes in the U.S. This is a retrospective, cross-sectional study of U.S. counties and county equivalents using national data. Seven population health outcomes (total and disease specific mortalities and low infant birth weight rate) were the response variables. The predictor variable, RN supply, and some control variables were anticipated to have an asynchronous effect on the seven outcome variables …

Interaction Between Income, Health Insurance, And Self-Rated Health: A Path Analysis., Atalie Ashley West

Electronic Theses and Dissertations

The political focus of equitable health outcomes in the United States have long centered on access to medical care. However, there is compelling evidence that access to medical care is only the bare minimum necessary to achieve health, and the true influence of health insurance on health is still unclear. Widely accepted models of health estimate that less than 20% of health outcomes can be attributed to clinical care, while greater than 50% is related to social and economic determinants of health, with income being the most consistent predictor. As a result, this study investigated whether earned income is related …

Access To Healthy Foods: A Descriptive Analysis Of Farmers’ Markets, Food Deserts & Usda Food Assistance Programs In Tennessee Census Tracts, Twanda D. Wadlington

Electronic Theses and Dissertations

Food deserts are a growing problem in the United States, and occur in areas of low-income where people have limited access to healthy foods. In response, the presence of farmers’ markets has grown exponentially, and improved healthy food access. Additionally, the USDA has strived to connect families to healthy foods through food assistance programs such as the Supplemental Nutrition Assistance Program (SNAP), the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and the Senior Farmers’ Market Nutrition Program (SFMNP). This study investigated the relationship between farmers’ markets, their acceptance of food assistance benefits, and their locations within Tennessee …

Local Health Department Adoption Of Health Information Technology And Its Impact On Population Health, Tina Yeung

Electronic Theses and Dissertations

Since the enactment of the HITECH Act in 2009, the US has invested billions in building a robust health information technology (HIT) infrastructure that is secure, capable of the electronic transfer of data and allows for real-time access of patient medical data, among others. This empirical study explored the driving forces (coercive, mimetic, and normative) in the adoption of HIT (i.e. EHRs and HIEs) by local health departments (LHDs) and how it has impacted the population health of counties in the US. The researcher conducted a cross-sectional, quantitative study using secondary data sources. The study included data on 505 local …

Determinants Of Hospital Efficiency And Patient Safety In The United States, Madhu Shettian

Electronic Theses and Dissertations

Hospitals engage in undertakings on a continual basis to enhance IT capabilities, diffusion of innovations, hospital-physician integration, and standardization to improve their performance. This empirical study explored the interdependence of three macro-level structural factors and their independent impact on the hospital performance measures efficiency and patient safety, with standardization as an important mediator. The researcher conducted a cross-sectional analysis of multiple data sets from public user files on the acute care hospital industry. The theoretical underpinnings of the study included the structure-process-outcome theory and institutional isomorphism theory. The statistical analysis comprised confirmatory factor analysis (CFA) and covariance structural equation modeling …

Jail Mental Health Innovations: Factors Influencing Mental Health Services Innovations For Jails, Orville Clayton

Electronic Theses and Dissertations

The U.S. is recognized for uniquely high incarceration rates. Over recent decades, there has been a concurrent dramatic increase of jail detainees with mental disorders. Provision of adequate mental health services for jail inmates is constitutionally mandated, and has legal, ethical, quality of care, and fiscal implications for jails, families, communities, and detainees. Significant variation exists in the provision of mental health services across jails, and increased understanding of the factors that influence the adoption of such services may help guide jails to implement beneficial services, and ensure that such services reflect, reflect quality standards. This study used a mixed …