Health Policy Commons^™

Designing Inclusive Newborn Sequencing Research: Insights From Parents In Underrepresented Communities, Maya C Del Rosario, Sheyenne A Walmsley, Barbara W Harrison, Crystal T Stephens, Bethany Zettler, Greysha Rivera-Cruz, Priyal Agrawal, Amy Brower, Stephanie Chigbu, Kurt D Christensen, Casie A Genetti, Richetta Givens, Nina B Gold, Inez V Reeves, Isabella Schichter, Habib Shariat, Sandra Simon, Hadley Stevens Smith, Melissa Uveges, Robert C Green, Ingrid A Holm, Stacey Pereira

Center for Medical Ethics and Health Policy Staff Publications

Background: It is essential that studies of genomic sequencing (GS) in newborns and children include individuals from under-represented racial and ethnic groups (URG) to ensure future applications are equitably implemented. We conducted interviews with parents from URG to better understand their perspectives on GS research, develop strategies to reduce barriers to enrollment, and facilitate research participation.

Methods: Semi-structured interviews with 50 parents from URG.

Results: Nearly all parents said they would be interested in participating in an infant GS study. Parents were interested in participating in GS research for reasons including clinical utility, personal utility, and/or family health benefits. Deterrents …

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

CAEPR Presentations

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

Stakeholder Perspectives On Humanistic Implementation Of Computer Perception In Health Care: Qualitative Study, Kristin M Kostick-Quenet, Meghan E Hurley, Syed Ayaz, John D Herrington, Casey J Zampella, Julia Parish-Morris, Birkan Tunç, Gabriel Lázaro-Muñoz, Jennifer Blumenthal-Barby, Eric A Storch

Center for Medical Ethics and Health Policy Staff Publications

Background: Computer perception (CP) technologies-including digital phenotyping, affective computing, and related passive sensing approaches-offer unprecedented opportunities to personalize health care, especially mental health care, yet they also provoke concerns about privacy, bias, and the erosion of empathic, relationship-centered practice. At present, it remains elusive what stakeholders who design, deploy, and experience these tools in real-world settings perceive as the risks and benefits of CP technologies.

Objective: This study aims to explore key stakeholder perspectives on the potential benefits, risks, and concerns associated with integrating CP technologies into patient care. A better understanding of these concerns is crucial for responding to …

Medicaid Expansion And Breast Cancer Care And Outcomes-What Lies Ahead?, Meghan H. Maceyko, Oluwadamilola M. Fayanju

Department of Surgery Faculty Papers

No abstract provided.

Reported Safety Practices Of Publicly Advertised Psychedelic Retreats, Amy L Mcguire, Logan Neitzke-Spruill, Jill O Robinson, Caroline S Beit, Nikita Singh, David S Mathai, Lynnette A Averill

Center for Medical Ethics and Health Policy Staff Publications

Importance: The availability of psychedelic retreats has grown to meet the demand for access to these substances. Despite centuries of use among Indigenous communities, psychedelics can pose serious risks for some users.

Objective: To determine safety precautions that retreat organizations that offer psychedelic substances currently use.

Design, setting, and participants: This qualitative study included structured interviews conducted by phone or email with representatives from 49 organizations publicly advertising psychedelic retreat offerings from July to October 2023. Organizations were eligible if they marketed their services in English, offered at least 1 psychedelic substance, and made contact information available online. Organizations were …

Comparing The Evolution Of The Advanced Practice Nurse Role: Insights From Switzerland And Kenya, Carole Mackavey, Sara Kohler, Eunice Ndirangu, Rachel Kimani, Constance Shumba, Bernard Mutwiri, Colette Henderson, Anna Jones

School of Nursing & Midwifery, East Africa

The article explores the evolution of Advanced Practice Nurse (APN) roles in Switzerland and Kenya, highlighting their development, challenges, and influence on healthcare delivery. Despite notable differences in income levels and healthcare infrastructure, both countries are committed to strengthening primary care through the deployment of APNs. Switzerland uses APNs to address provider shortages and improve chronic disease management, whereas Kenya uses them to increase access in underserved areas. A comparative analysis explores how regulatory frameworks, educational models, scope of practice, and health system priorities influence the adoption of advanced practice nursing (APN). Switzerland’s established healthcare system supports the integration of …

Legislative Debate-Attributed Suicidality Among Lgbtq+ Adults: The Buffering Effect Of Community Belongingness, Keith J. Watts, Shawndaya S. Thrasher, Laneshia R. Conner, Nicole Campbell, Louis G. Baser, Dekeitra Griffin, Sydney P. Howard, Missy Spears, Justin X. Moore

Counseling & Human Services Faculty Publications

Background: In recent years, the sociopolitical landscape in the United States has shifted due to an increase in state-level legislation regarding LGBTQ+ rights, a trend that has been particularly pronounced in the Commonwealth of Kentucky. While the mental health impacts of enacted laws are increasingly documented, a critical gap remains in understanding the psychological toll of the legislative debates themselves—the prolonged periods of public discourse surrounding the restriction of rights. Methods: Utilizing data from the 2025 Queer Kentucky Survey (N = 817), this exploratory study examined the association between LGBTQ+ community belongingness and acute suicidality attributed specifically to anti-LGBTQ+ legislative …

From Intention To Enactment: Action Planning And Habit Automaticity Distinguish Successful From Unsuccessful Intenders To Engage In Regular Leisure-Time Moderate-To-Vigorous Physical Activity, Yaogang Han, Yubing Wang, Pan Li, Binn Zhang

Human Movement Studies & Special Education Faculty Publications

University students often intend to exercise regularly but fail to translate intention into action. The present study tested which post-intentional processes distinguish successful from unsuccessful intenders in self-reported regular leisure-time moderate-to-vigorous physical activity (MVPA) enactment. Chinese undergraduates from 10 universities completed a three-wave survey administered at roughly two-week intervals. Habit automaticity was assessed at Wave 1, intention together with action planning and coping planning at Wave 2, and self-reported regular-exercise status at Wave 3. Because the dependent variable was assessed using a single stage-based self-report item, the findings should be interpreted as explaining self-reported regular-exercise status rather than objectively measured …

Maternal Healthcare In The United States: An Exploration Of The Organizational And Political Determinants Of Maternal Healthcare Quality And Outcomes, Tamaya S. Browder

College of Graduate Studies: Theses & Dissertations

Despite having an advanced U.S. healthcare system, childbirth remains risky in the US, especially for socially vulnerable populations. Medicaid covers a large portion of births and is equipped to implement large-scale interventions to improve maternity care and patient outcomes. Two studies were conducted to (a) examine the relationship between organizational factors in U.S. hospitals and adverse clinical outcomes among Medicaid-insured maternity patients, and (b) analyze state-level Medicaid bundled payment models for maternity care. Guided by the Donabedian Quality of Care Model, Study One used logistic regression on data from the 2018-2020 National Inpatient Sample to explore how hospital organizational factors …

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

Graduate Scholarship and Creative Works

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

Racial Differences In Adverse Pregnancy Outcomes And Incident Hypertension: A Mediation Analysis, Lucia C. Petito, Xiaoning Huang, C. Noel Bairey, Natalie Bello, Janet Catov, Ernesto Licon, Abbi Lane, David M. Haas, Lisa D. Levine, Rebecca B. Mcneil, Eliza Miller, Uma M. Reddy, Bethany Barone Gibbs, George Saade, Lauren Theilen, Laura E. Wiener, Brian M. Mercer, Hyagriv N. Simhan, Lynn M. Yee, Philip Greenland, William A. Grobman, Sadiya S. Khan

Department of Obstetrics & Gynecology Faculty Publications

Background

Adverse pregnancy outcomes (APOs) are associated with increased hypertension risk. Black women experience higher rates of APOs and hypertension compared with White women, but whether APOs contribute to Black-White hypertension disparities remains unknown.

Methods

The nuMoM2b-HHS (Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be-Heart Health Study) prospectively recruited nulliparous pregnant people at 8 US centers (2010-2013) with follow-up 2 to 7 years postpartum (2014-2017). Race, which represents a social construct, was self-identified. The primary outcome was incident hypertension at follow-up. APOs included hypertensive disorders of pregnancy, preterm birth, and small-for-gestational age birth. Potential confounders (psychological health, social factors, and health behaviors) …

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

Journal of Earth and Life Science

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

Simulating Social Attitudes With Llms: Accuracy, Demographic Effects, And Refusal Behavior In The Sensitive Domain Of Suicide Prevention, Cristina J. Perez, Michael P. Vasquez Jr., Philippe J. Giabbanelli, Patrick Y. Wu

VMASC Publications

Large language models (LLMs) are increasingly used to simulate public opinion, yet their validity in sensitive policy domains remains underexplored. We evaluate whether LLMs can reproduce attitudes toward suicide prevention policies using 32 questions drawn from seven nationally representative U.S. surveys (2023-2025). We systematically vary demographic conditioning (race/ethnicity, gender, age, education, income, party), prompt framing (direct elicitation, respondent embodiment, specialist embodiment), and model architecture (GPT-5 Nano, DeepSeek V3.2, Meta Llama 3.1 8B, Mistral Small 24B). Across 811,560 prompts, the mean absolute error—the average gap between predicted and human response distributions—is 23 percentage points. We also find that LLM responses to …

Racial Disparities In Maternal Mortality: The Role Of Explicit And Implicit Bias In U.S. Healthcare, Lailah Allen

Capstone Showcase

Maternal mortality in the United States remains a critical public health crisis, with disproportionately high rates among Black and other minority women. Despite advances in obstetric medicine, racial disparities in pregnancy-related deaths persist due to structural inequities, implicit bias in healthcare delivery, unequal access to prenatal and postpartum care, and broader social determinants of health. Nationally, Black women are significantly more likely to experience severe maternal morbidity and mortality compared to White women, reflecting longstanding inequities embedded within the healthcare system. This paper examines the relationship between race, healthcare access, and maternal outcomes through a focused case study of and …

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

Scripps Senior Theses

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

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

Scripps Senior Theses

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

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

Scripps Senior Theses

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

Neighborhood Socioeconomic Deprivation And Physical Activity Associate With Extracellular Vesicle Size And Cargo In A Community-Based Cohort Of Women, Yvonne Baumer, Elizabeth M. Aquino Peterson, Matthew R. Bavuso, Noel Miller, Cristhian A. Gutierrez-Huerta, Nithya P. Vijayakumar, Sam J. Neally, Kaveri Curlin, Valerie M. Mitchell, Billy S. Collins, Neelam R. Redekar, Subrata Paul, Anca D. Dobrian, Tiffany M. Powell-Wiley

Department of Biomedical and Translational Sciences Faculty Publications

African American (AA) women face disproportionate cardiovascular disease (CVD) risk due to adverse social determinants of health (SDoH), including lower socioeconomic status (SES). Physical activity (PA) and plasma extracellular vesicles (EVs) modulate CVD risk, but their relationships with SDoH remain unclear. This study examines associations between SDoH, PA, and plasma EVs in a Washington, DC-based cohort of at-risk AA women. Participants (N = 24, Age: 57 ± 12, BMI: 35 ± 6, ASCVD: 9 ± 5) joined the Step It Up Community-Engaged, Digital Health Physical Activity Intervention pilot study. EVs were isolated from fasting plasma samples. Multivariable regression, adjusted for …

Edible Cannabis Product Information Captured Within Patient Poison Center Records, G. Fulkerson, B. J. Holstege, R. Farah, A. Zmuda, C. P. Holstege

Department Psychiatry & Behavioral Science Faculty Publications

Introduction

United States poison centers are encountering increasing numbers of calls pertaining to edible cannabis exposed patients following state decriminalization. The emergence of these edible products has led to numerous emergency department visits in both adults and children following exposure. The capturing of specific data associated with the product type is imperative as state government regulators attempt to control cannabis products emerging on the market as a growing public health issue.

Objectives

This study was performed to determine if the exact products involved with edible cannabis exposure were being captured in the electronic medicial records and to delineate those specific …

Improving Clinic Workflow To Enhance Rubeola Immunity Screening In Pregnant Patients, Courtney Mcduffie

Doctor of Nursing Practice Final Project Abstract

Purpose: The purpose of this quality improvement (QI) project was to improve provider adherence to Rubeola IgG serum order entry for prenatal care visits by implementing a standardized workflow and an electronic medical record (EMR)-based order-entry process in a high-risk maternal outpatient clinic.

Background: Rubeola infection during pregnancy is associated with significant maternal and fetal complications. Despite recommendations from the American College of Obstetricians and Gynecologists (ACOG) to use serologic testing to determine immunity status, inconsistent provider ordering practices and workflow gaps contribute to missed opportunities for identifying non-immune patients and planning post-partum vaccination.

Methodology: A ten-week intervention period utilized …

The Moderating Role Of Social And Emotional Support In The Association Between Adverse Childhood Experiences And Adult Mental Health Across Racial Groups: The Need For Investing In Social Capital, Syeda S. Jesmin, Aditya Chakraborty

Epidemiology, Biostatistics, & Environmental Health Faculty Publications

Background

The sustained impact of Adverse Childhood Experiences (ACE) on mental health outcomes in adulthood is well documented in the literature. ACE survivors may be especially vulnerable to poor mental health outcomes if they have limited or no social support. This study examined the moderating role of social support on the association of ACEs and mental health across different racial groups.

Methods

Data were obtained from the 2022 Behavioral Risk Factor Surveillance System (n = 14,327). The nine ACE questions about traumatic events in childhood were used to create ACE scores. Chi-square tests were used for bivariate comparisons. Both stratified …

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

CMC Senior Theses

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

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

A Program Evaluation Research Study Of The Implementation Of Mothers With Mentors: A Dissertation On Shelter From The Rain’S Mentorship Program, Danielle Louise Smith

College of Graduate Studies: Theses & Dissertations

This program evaluation study examines the implementation of the 2025 Shelter From the Rain “Mothers with Mentors” program in Savannah, GA. Utilizing a convergent parallel mixed-methods approach, the study evaluates the program’s acceptability, feasibility, and perceived benefit through the theoretical lenses of the Theory of Planned Behavior (TPB), the Health Belief Model (HBM), and Bonding Social Network (BSN). The analysis incorporates quantitative and qualitative data for participant mentees (n=7) and mentors (n=12), with a specialized paired analysis of five mentor-mentee matches.

The findings indicate a complex landscape of convergence and divergence across the groups. Quantitative results depicted high convergence on …

The 2025 American Society Of Pediatric Otolaryngology Workforce And Compensation Survey: Current State And Future Directions, Lyndy J. Wilcox, Cristina M. Baldassari, Amy C. Brenski, Emily Boss, John Carter, David H. Chi, William O. Collins, Charles E. Elmaraghy, Andrew J. Tompkins, Craig S. Derkay, The Aspo 2025 Workforce And Compensation Committee

Department of Otolaryngology (ENT) Faculty Publications

Objective

To provide an updated comprehensive assessment of the Pediatric Otolaryngology workforce in the United States inclusive of compensation, productivity, practice patterns, and on-call burden.

Study Design

Cross-sectional electronic survey.

Methods

A structured electronic survey was developed by members of the American Society of Pediatric Otolaryngology (ASPO) Workforce and Compensation Committee. The survey evaluated six domains: demographics, compensation, workforce dynamics, productivity, on-call burden, and future priorities, and was distributed to all 480 presumedly actively-practicing, domestic ASPO members.

Results

The survey response rate was 68% (327/480). Ninety-one percent of respondents held an academic appointment with relatively equal percentages of each rank …

Air Quality Risks In Public Housing, Brynn Sheehan, Carolyn Caraballo Velez, Vaughan W. Rees, Miasha T. O'Neal, Kristen E. Moore, Katie M. Jones, Jessica Meadows, Sarah Gehlert, Richard Grucza, Andrew Plunk, Kelli J. England

Department Psychiatry & Behavioral Science Faculty Publications

Importance Public housing residents face elevated environmental health risks, yet indoor air quality in these settings remains underexamined. OBJECTIVE: To evaluate indoor air quality in public housing 5 years after implementation of the federal smoke-free housing policy and compare it with outdoor air quality in the same regions.

Design, Setting, and Participants A 1-year cohort study of indoor air quality (particulate matter ≤2.5 μm in diameter [PM2.5]) across 12 multifamily public housing communities in southeastern Virgina for individuals 65 years and older or persons with disability in cities with the highest rated outdoor air quality. Indoor PM2.5 was continuously measured …

From Coverage To Care: Evaluating The Effects Of Aca Medicaid Expansion On Birth Outcomes, Bailey R. Lengfelder

Economics Honors Projects

I examine the impact of the Affordable Care Act’s Medicaid expansion on maternal and fetal health outcomes using National Center for Health Statistics Natality data from 2006 to 2023. I exploit staggered state adoption as a quasi-experiment, and the staggered differences-in-differences estimates indicate an increase in the share of Medicaid births but broadly no impact on maternal prenatal care, maternal health, and fetal health. The absence of statistically significant effects is consistent across heterogeneity groups. These null findings indicate that expanded insurance access through the Affordable Care Act may be insufficient to improve health outcomes. I do find a statistically …

Incorporating New Guidelines Into School-Based Asthma Management, Jessica Michala Jindra, Angela Duff Hogan

Department of Pediatrics Faculty Publications

Purpose of the Review

The aim of this review is to identify barriers and provide solutions to the implementation of inhaled corticosteroid-formoterol as rescue therapy within schools.

Recent findings

GINA guidelines in 2019 and NAEPP in 2020 recommended inhaled corticosteroids combined with formoterol for a rescue inhaler over the traditional short-acting beta-agonist.

Summary

The findings discussed in this article describe the barriers to the implementation of inhaled corticosteroids combined with formoterol for a rescue inhaler in school systems. Traditional asthma action plans, school nursing and parental education, and differences in dosing are some barriers identified. This paper provides solutions for …

A Scoping Review To Conceptualize Social Privilege For Studying Patients' Health Outcomes And Health Disparities, Elizabeth A. Brown, Priyanka Patel, Esther May B. Sarino, Vladimir Markovic, Carles Muntaner

Health Behavior, Policy & Management Faculty Publications

Background

The continued reliance on single-category self-reported demographic data (e.g., race/ethnicity) reflects conceptual limitations that hinder the study and understanding of health outcomes research. There is a pressing need for more precise measures of social privilege that conceptualize privilege and oppression while enabling the examination of their effects on health outcomes in the United States (US) healthcare system.

Objective

The purpose of this scoping review was to review the literature, determine how researchers have measured aspects of privilege and oppression, and develop a conceptual framework to study patients' social privilege in the US healthcare system and public health research.

Methods …

Insurance Disparities In Hidradenitis Suppurativa: A Comprehensive Review Of Demographics, Outcomes, And Access To Care, Alim Osman, Alexandra R. Nigro, Michael C. Povelaitis, Marc Z. Handler

Department of Medicine Faculty Publications

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that disproportionately affects women, African Americans, and individuals of biracial descent. It is associated with substantial physical and psychiatric morbidity, reducing quality of life.

Objective: This review analyzed disparities in treatment outcomes, disease progression, and healthcare access among HS patients based on insurance type.

Methods: Using PRISMA guidelines, a comprehensive literature search identified 7 studies meeting inclusion criteria. Owing to data heterogeneity, studies were qualitatively analyzed.

Results: Findings consistently demonstrated that Medicaid patients experienced worse outcomes than those with private insurance or Medicare. Medicaid patients had higher rates of comorbid …

Exploring Management Strategies To Reduce Workplace Violence: Perceptions Of Illinois Healthcare Professionals, Mary Mack

All Student Theses and Dissertations

This qualitative study examined how managers of nonprofit healthcare facilities in the Chicago metropolitan area implement strategies to reduce workplace violence, what these strategies are and how they are carried out, and what organizational factors facilitate or impede their implementation. Semi-structured interviews were conducted with seven healthcare professionals in management or safety-oriented roles across seven facilities, purposefully sampled through the researcher's professional network. Findings revealed four recurring patterns across the sample. Prevention infrastructure was installed reactively, following specific triggering incidents rather than anticipating documented risk. Facilities consistently favored lower-cost mitigation measures over more resource-intensive prevention strategies. Reliance on short-tenure contract …