Health Policy Commons^™

Attitudes Concerning Sexual Behavior Towards Risky Sexual Behavior Of Sexual Transmitted Infections Among Male Adolescents In Indonesia, Helda Helda, Nurul Muchlisa

Kesmas

There has been an increase of sexually transmitted infections (STIs) such as HIV/AIDS worldwide, especially in Indonesia. Several studies on adolescent behavior, especially the male as the main predictor, reported increased in STIs’ cases due to risky sexual behavior. This study aimed to show the relationship between attitudes, sexual behavior, and the risks of STIs among male adolescents in Indonesia based on the Indonesia Demographic and Health Survey (IDHS) data in 2017. This cross-sectional study involved 10,547 male adolescents using the total sampling method according to the inclusion and exclusion criteria. Data were analyzed using a complex sample logistic regression …

Empowering Health Cadres To Support Drug-Resistant Tuberculosis (Dr-Tb) Patient To Enroll In Treatment, Esty Febriani, Adik Wibowo, Neeraj Kak, Hala Jassim Al Mossawi

Kesmas

Tuberculosis (TB) remains a big challenge globally, while the involvement of health cadres’ constitutes one of the key strategies for the TB program in Indonesia. These roles were further expanded to providing support to DR-TB patients. This study was a qualitative study, conducted in 2015 to explore the various factors which influence the performance of health cadres’ in supporting DR-TB patients to enroll in treatment. A total of 39 informants consisting of 24 health cadres, three nurses, four DR-TB patients, and three family members, two peer support, a head of primary health care, and two TB staffs from the District …

National Health Insurance Scheme: Internal And External Barriers In The Use Of Reproductive Health Services Among Women, Evi Martha, Herna Lestari, Resvi Siti Zulfa, Yoslien Sopamena

Kesmas

Lack of familiarity among the community, medical workers, and administrative staff regarding reproductive health services covered by Badan Penyelenggara Jaminan Sosial (BPJS) or the National Health Insurance (NHI) in Indonesia remained a problem. Therefore, this resulted in sub-optimal use of the medical services, as shown by surveys from the Women's Health Foundation for three consecutive years (2015-2017). This qualitative study was conducted with a Rapid Assessment Procedure design in three cities within Indonesia: Padang Pariaman, Manado, and Kupang. Data were collected through IDIs (n = 47informants) and 6 FGDs (7 persons/group). Participants also consisted of NHI RHS users (mothers and …

Prevalence And Determinants Of Pre-Lacteal Feeding: Insights From The 2017 Indonesia Demographic And Health Survey, Siti Nurokhmah, Siti Masitoh, Kusuma Estu Werdani

Kesmas

Pre-lacteal feeding is widely known as a distraction to exclusive breastfeeding, and the malpractice continues to be prevalent in Indonesia. Therefore, this study aimed to explore the potential determinants of pre-lacteal feeding among mothers of infants below 24 months. A sample of 6,455 mother-infant pairs from the 2017 Indonesia Demographic and Health Survey (IDHS) was used. Also, multivariate logistic regression was employed to identify factors associated with pre-lacteal feeding practice. In Indonesia, 44% of infants were introduced to solid/liquid feeds in their first three days of life. Infant formula was the most common pre-lacteal feed given, followed by any other …

Entitled To Property: Inheritance Laws, Female Bargaining Power, And Child Health In India, Plamen Nikolov, Shahadath Hossain

Economics Faculty Scholarship

Child height is a significant predictor of human capital and economic status throughout adulthood. Moreover, non-unitary household models of family behavior posit that an increase in women’s bargaining power can influence child health. We study the effects of an inheritance policy change, the Hindu Succession Act (HSA), which conferred enhanced inheritance rights to unmarried women in rural India, on child height. We find robust evidence that the HSA improved the height and weight of children. In addition, we find evidence consistent with a channel that the policy improved the women’s intrahousehold bargaining power within the household, leading to improved parental …

“Treat Everybody Right”: Examining Foodways To Improve Food Access, Alex B. Hill

Urban Studies and Planning Faculty Research Publications

Detroit is regularly assumed to be a “food desert” despite contradicting evidence. With fruits and vegetables available at each of Detroit’s 70 independent, full-line grocery stores, there remains a lack of understanding among media and academics of residents’ perception and preferences for food access. A baseline study was initiated during the summer of 2014 to understand residents’ own perceptions of food access and to assess the socio-cultural foodways utilized by residents. A total of 207 Detroit residents participated in focus groups and interviews to discuss food provisioning. Residents identified a wide range of food access points, from home gardens and …

Influenza Vaccine Uptake In Caregivers And Non-Caregivers: Implications For Policy And Practice, Nicholas Mercado

NYMC Student Theses and Dissertations

Background: Caregivers are a critical and highly utilized healthcare resource. Previous research suggests that caregivers experience adverse physical and mental health outcomes and practice less self-care while serving their role. Influenza, or the flu, is a common and infectious disease caused by a virus that is responsible for millions of doctor visits, hospitalizations, and approximately 43,000 deaths annually. The most effective measure for addressing the flu is primary prevention, which includes a seasonal flu vaccine. Methods: Behavioral Risk Factor Surveillance System (BRFSS) data from 2016-2018 were analyzed. The study population included 154,170 respondents from 27 states and the District of …

Food Insecurity Among Military And Veteran Families, Colleen Heflin

Population Health Research Brief Series

Food insecurity is a growing U.S. problem among military and veteran families. Data from 2020-21 suggest that between 1 in 5 and 1 in 3 military families experienced food insecurity in the last year: with disabled veterans experiencing even greater risks. This issue brief describes the policy revisions needed to programs such as SNAP, the Social Security Administration’s Disability Insurance Program, and the Veterans Affairs Disability Compensation Program to ensure our military members are food secure.

Global Journey To Post-Pandemic Normalcy And Revival, Andrzej Sankowski

Journal of Global Awareness

After a year of COVID-19, countries, societies, and individuals are longing for normalcy and beginning to consider what life will be like post-pandemic. Efforts and experiences of countries in the European Union, Asia, Asia-Pacific, Australia, Africa, Latin America, the Caribbean, and the United States are examined as they face challenges to end the pandemic and prepare for the post-pandemic reality. What will be the post-pandemic "new normalcy"? What changes caused by the pandemic are permanent in societies and the world? What are the necessary reforms that have to take place as part of normalcy? Reflections on the impacts of vaccinations, …

Job Satisfaction And Stressors: The Direct Support Professional's Experience, Saralynn Emery

Master's Theses

The current service system for individuals with intellectual and developmental disabilities is provided in the form of community-based support. This support is carried out by Direct Support Professionals (DSPs) who provide one-on-one services to individuals in their homes, workplaces, and communities. The current system is undergoing a turnover crisis and there is an enormous need for a quality and reliable workforce of DSPs to continue to carry out services. Previous research has explored factors that contribute to DSP burnout and ultimately turnover. By researching the DSP role from the DSP experience directly, this study examines other factors that contribute to …

How Should We Set Pandemic Capacity Limits For Restaurants And Bars?, Eric A. Schiff

Population Health Research Brief Series

Restaurants and bars are places where airborne diseases like COVID-19 are easily transmitted from one patron to another. However, the connection between the capacity limits and the community infection rate has not been quantified and can appear arbitrary. This data slice describes calculations that could be used to help government officials determine restaurant and bar capacity limits to help limit risk.

The Financial Implications Of The Chinese Healthcare System, Lilly Schneider, Chi Hung Kenneth Leung

DU Undergraduate Research Journal Archive

In 1949 one of the world’s most powerful and influential countries was born: The People’s Republic of China. Perhaps the greatest challenge the country has consistently faced since its inception has been ensuring a fiscally sound healthcare system. Today, China has the world’s largest population and a rapidly aging society with 330 million citizens over the age of 65 projected by 2050- nearly the same size as the total U.S. population. Living standards across China have been drastically increasing in recent decades and the Chinese people are desiring better, higher quality healthcare to complement their new lifestyles. With this desire …

Disparities In Hiv Clinical Stages Progression Of Patients At Outpatient Clinics In Democratic Republic Of Congo, Raimi Ewetola, Gulzar H. Shah, Lievain Maluantesa, Gina D. Etheredge, Kristie C. Waterfield, Astrid Mulenga, Apolinaire Kilundu

Health Policy & Community Health: Faculty Publications

Context: In this era of patient-centered care, it is increasingly important for HIV/AIDS care and treatment programs to customize their services according to patients’ clinical stage progression and other risk assessments. To enable such customization of HIV care and treatment delivery, the research evidence explaining factors associated with patients’ clinical stages is needed. Objectives: The primary objective of this study was to produce such scientific evidence by analyzing the most recent data for patients at outpatient clinics in the provinces of Kinshasa and Haut-Katanga and to examine the patient characteristics associated with WHO stages of disease progression. Methods: Using a …

The Relationships Between Stress, Psychosocial Resources, And Mental Health And Adherence Outcomes Among Perinatally Hiv-Infected Adolescents In South Africa, Thabani Nyoni

Brown School Graduate Student Theses and Dissertations

Adolescents living with perinatally acquired HIV (APHs) in sub-Saharan Africa (SSA) constitute a significant population group that is experiencing poor HIV treatment outcomes (CIPHER Global Cohort Collaboration, 2018). Compared to younger children and older adults within the SSA sub-region, APHs experience poorer health outcomes, including retention in care, virologic treatment failure, and mortality rates (Anderson et al., 2019). Among countries in the SSA sub-region, South Africa has 360,000 adolescents living with HIV (ages 10-19), a disproportionate burden, accounting for 20% of the global adolescents living with HIV (UNAIDS, 2019a). The public health costs of suboptimal antiretroviral treatment (ART) adherence in …

Risk Factors For Tb/Hiv Coinfection And Consequences For Patient Outcomes: Evidence From 241 Clinics In The Democratic Republic Of Cong, Gulzar H. Shah, Raimi Ewetola, Gina D. Etheredge, Lievain Maluantesa, Kristie C. Waterfield, Elodie Engetele, Apolinaire Kilundu

Health Policy & Community Health: Faculty Publications

(1) Background: In resource-limited countries, patients with tuberculosis (TB)/HIV coinfection commonly face economic, sociocultural, and behavioral barriers to effective treatment. These barriers manifest from low treatment literacy, poverty, gender inequality, malnutrition, societal stigmas regarding HIV, and an absence of available care. It is critical for intervention programs to understand and assist in overcoming these barriers and any additional risks encountered by patients with TB/HIV coinfection. This study analyzes variation in TB/HIV coinfection and risks of negative outcomes among patients with TB/HIV coinfection compared to those without coinfection. (2) Methods: This quantitative study used data from 49,460 patients receiving ART from …

How America’S Partisan Divide Over Pandemic Responses Played Out In The States, Julie Vandusky-Allen, Olga Shvetsova

Political Science Faculty Publications and Presentations

Throughout the COVID-19 pandemic, a partisan divide has existed over the appropriate government response to the public health crisis. Democrats have been more likely to favor stricter policies such as prolonged economic shutdowns, limits on gathering in groups and mask mandates. Republicans overall have favored less stringent policies.

Measuring The Impact Of The Affordable Care Act Medicaid Expansion On Access To Primary Care Using An Interrupted Time Series Approach, Elizabeth A. Brown, Brandi M. White, Walter J. Jones, Mulugeta Gebregziabher, Kit N. Simpson

Health and Clinical Sciences Faculty Publications

BACKGROUND: The Patient Protection and Affordable Care Act of 2010, commonly referred to as the Affordable Care Act (ACA), was created to increase access to primary care, improve quality of care, and decrease healthcare costs. A key provision in the law that mandated expansion of state Medicaid programme changed when states were given the option to voluntarily expand Medicaid. Our study sought to measure the impact of ACA Medicaid expansion on preventable hospitalization (PH) rates, a measure of access to primary care.

METHODS: We performed an interrupted time series analysis of quarterly hospitalization rates across eight states from 2012 to …

Medicare Support For Dental And Podiatry Graduate Medical Education Programs., Candice Chen, Yoonkyung Chung, Geoffrey Broadbent, Elizabeth Mertz

Health Policy and Management Faculty Publications

Importance: Oral health care faces ongoing workforce challenges that affect patient access and outcomes. While the Medicare program provides an estimated $14.6 billion annually in graduate medical education (GME) payments to teaching hospitals, including explicit support for dental and podiatry programs, little is known about the level or distribution of this public investment in the oral health and podiatry workforce.

Objective: To examine Medicare GME payments to teaching hospitals for dental and podiatry residents from 1998 to 2018, as well as the distribution of federal support among states, territories, and the District of Columbia.

Design, Setting, and Participants: This cross-sectional …

Small-Family Mindset: An Analysis Of The Impact Of China's Family Planning Policies On Family Culture, Sarah Ansley Croft

Honors Theses

This thesis examines the impact of China’s family planning policies on women’s attitudes towards family culture and the implications on China today. The family planning policies began in the 1970s as an emergency measure intended to create a short-term voluntary small-family culture by decreasing fertility rates. My research, comprised primarily of primary and secondary qualitative sources, discusses the development and implementation of the policies, the economic reforms beginning in the 1980s, and their joint effects on fertility rates, sex ratio at birth, women’s liberation, and changes in family culture, particularly in rural areas. This study found that the family planning …

The Human Services Workforce Crisis: Moving Forward With Intention In Massachusetts, Suzanne Gray Henderson

School of Professional Studies

The human services field is growing rapidly in Massachusetts as it is across the country, and the Commonwealth does not have enough qualified staff to fill vacancies. The workforce shortage has risen to crisis levels due to high turnover, insufficient training, low wages, and a lack of recognition and appreciation for direct support professionals. The individuals receiving services in Massachusetts deserve quality and stability. The state budget – strained by inefficient service models and reactive fixes – also demands systemic change. The human services workforce crisis impacts a variety of stakeholders. Individuals served are directly affected, as are the direct …

Moving From Shelter To A Housing First Reponse, Robyn Kennedy

School of Professional Studies

Massachusetts is a right to shelter state for families who experience homelessness. Based on decisions made several decades ago, the state assigned the response to families who experience homelessness to the Department of Welfare (now the Department of Transitional Assistance) and a shelter, rather than a housing response was adopted. Following national best practice, the state has decided to transition the system to a Housing First response. Through this research, I will be evaluating the trends in the industry and assessing what Massachusetts needs to do to achieve a Housing First approach to serving families who are experiencing homelessness. Unless …

Support For Me: Key Stakeholder Interview Summary, Katie Rosingana Ba, Mary Lindsey Smith Phd, Karen Pearson Mlis, Ma, Evelyn Ali Bs, Tyler Egeland Ba, Mark Richards Bs

Substance Use Research & Evaluation

This summary feedback report is organized to inform the Office of MaineCare Services goal of addressing barriers and finding new and/or improved ways to increase capacity in Maine for people who seek treatment and recovery services for substance use disorder. Interview protocols were designed to assess critical domains of interest for the state, which include: current and potential provider capacity, access to care & service delivery provider willingness, and financial/ administrative policies.

Key Highlights from the stakeholder interviews indicated that:

• While there have been improvements in the integration of care for persons with behavioral health (BH) diagnoses, this integration has …

A Gateway To Economic Success, Nathan R. Boudreau

School of Professional Studies

The Commonwealth of Massachusetts is a leader in the United States, a gleaming example of the American dream and the way life should be. We are always at the forefront of world-class innovation, house arts and culture that rival some of the best cities in the world, and have high-class educational institutes rivaled by almost no other region. Massachusetts leads the way when it comes to progressive ideals that provide for the less fortunate and ensure equality for all while keeping taxes reasonable, unemployment down, and living wage jobs readily available. With all that said, I began to ponder why …

Group Living Environment Responses To Pandemic: A Case Study Of Advocates, And The Covid-19 Crises, Nicole K. Atchue

School of Professional Studies

The literature will take a deeper look in the personal lives of developmentally disabled members and their staff who experienced COVID-19 pandemic in a group living environments. The holistic approach of understanding will navigate the history of care and the level care needed as well as external factors that played a larger role in explanation for the support provided.

The Global Impact Of The Covid-19 Pandemic On Women’S Careers, Allison Bach

School of Professional Studies

This paper explores the impact that the COVID-19 pandemic has had on women’s careers on a global scale in the past year. It begins by focusing on the many pre-existing barriers that existed in realizing gender equality in the workplace prior to the pandemic, such as inadequate access to proper childcare, uneven participation in household labor between the genders, and pay inequality. The paper then continues to examine the impact that the pandemic has had on women’s careers across a variety of industries, countries, and specific groups. It was hypothesized that the COVID-19 crisis had created worse effects for women’s …

Title Ix: Perceptions And Utilization On U.S. College Campuses, Emma Narkewicz

School of Professional Studies

The research study investigated student perceptions and utilization of Title IX services on U.S. university and college campuses, testing the hypothesis that if students hold negative perceptions of Title IX offices, then they will not report campus sexual violence they experience to Title IX offices. There are currently high rates of sexual violence on college campuses but very low rates of reporting. Current or former U.S. college students aged 18-30 (N = 47) completed a mixed methods anonymous survey composed of Likert scale and open response questions. Participants were asked about prior interactions with Title IX offices and their perceptions …

Bail Discrimination: Racial Disparities In The United States Bail Determination Process, Collin Porter

School of Professional Studies

Nationwide, there is a systemic problem with bail determination: the process that a citizen goes through after they are arrested and before they go to trial to determine guilt or innocence for the crime they have been accused of committing. The United States leads all other countries with approximately half a million individuals detained before trial each year, a number nearly double the next highest country (China) (Nejdl, 2017). The high rate of pre-trial detention in the United States is due to both widespread use of monetary bail and the limited financial resources of most defendants; specifically, African American men. …

A Comprehensive Analysis Of Food Insecurity And Solutions In Worcester, Massachusetts, David Sullivan

School of Professional Studies

Worcester, Massachusetts is a postindustrial city with high levels of potential that faces the persistent obstacle of food insecurity for its low-income and ethnic minority communities. This research thesis examines food insecurity in general and explores data and trends in Worcester, then combines this with conceptual frameworks which explain how socioeconomic factors play into food security. It also explains the systemic inequalities present as a result of food insecurity and critiques academic assumptions surrounding food insecurity. One of these assumptions is that food deserts on their own can explain food insecurity in Worcester and elsewhere, though it has been found …

Happening In Plain Sight: An Evaluation Of Sexual Harassment In Municipal Government Through A Case Study Of Newark, New Jersey, Hoween R. A. Flexer, Caitlin R. Louie

School of Professional Studies

In the city of Newark, New Jersey, Sebrevious Scott, a participant in the New Jersey Reentry program was hired as part-time office assistant in the city's re-entry office. After being transferred to the city’s Parks and Grounds Departments, she started being sexually harassed, inappropriately touched and propositioned by her supervisor, Richard Kirkland. Scott made repeated attempts to report these actions through the appropriate channels. She was met with dismissal, resistance, and later retaliation. While working in this hostile environment she was also pursuing a full-time employment opportunity with the city upon the completion of the reentry program. Unfortunately, this never …

Understanding Modern History Of International Food Law Is Key To Building A More Resilient And Improved Global Food System, Michael T. Roberts

Journal of Food Law & Policy

This article advocates the need for a history of the development of modern international food law and suggests an analytical approach to complement the chronicling of events. Comprehension of this history will help elucidate the evolution of a complicated modern global food system, including its resiliency and vulnerability as demonstrated by Covid-19, thereby providing valuable context for change in the system where needed. This essay makes the case for such a history in three parts. First, it briefly demonstrates the need for a historical perspective through a critical examination of a journal article that speaks to Covid-19 food security in …