Health Policy Commons^™

To Work Or Not To Work? Lessons From Older Adults In Maine, Kimberly Snow, Mary Lou Ciolfi, Sarah Currie, Catherine Taylor

All Cutler Institute Publications

Work in later life is currently widely discussed for myriad reasons including that  many older adults want or need to work well past typical retirement age; employers  want and need the expertise, experience, and reliability of older workers; social and  health benefits often accompany later life work; anti-ageism awareness is  heightening the visibility and value of older workers; and economists and  demographers cite the importance of a dependable workforce that includes older  adults. The topic of later life work intersects with several other disciplines in social  science, business, health, technology, communications, and data collection - among  others - presenting opportunities …

Obesity In The Rio Grande Valley: Applying An Evidence-Based Public Health Approach, Erika Pineda-Horta

Posters - 2026

What structural and social determinants drive elevated adult obesity rates in the Rio Grande Valley, and what evidence-based interventions can reduce adult obesity prevalence in Hidalgo County by 5% by 2030?

Objective: This study applies an EBPH framework to (1) characterize the burden and structural determinants of adult obesity in the RGV, and (2) propose a culturally responsive, evidence-based intervention targeting adults aged 18+ in Hidalgo County.

Adult obesity is clinically defined as a Body Mass Index (BMI) ≥30 kg/m² in adults aged 18 and older (CDC, 2022). It is a chronic, multifactorial non-communicable disease shaped by structural, social, and …

Regulation Of Caffeine, Rileigh Gaddini

Gateway Reader- Individual Papers

• The Problem: Public overconsumption of normalized addictive substances like caffeine and sugar results in significant health risks, dependency, and potential cardiac fatalities.

• The Method: An analysis of regulatory policies, product labels, consumer consumption habits, physiological mechanisms, and documented health event case studies.

• Quantitative Finding: The average American daily intake of caffeine is 193 mg, with more than 87% of U.S. adults reporting regular use; the FDA recommended limit for caffeine is 400 mg per day; a 16-ounce Starbucks coffee contains at least 190 mg of caffeine; 70–85% dark chocolate contains 22.7 mg of caffeine per ounce, while …

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Call To Action Against Sex Trafficking Of Black Women And Girls, Stephany Powell, Tracey Sylvester, Brenda Myers-Powell, Audrey Morrissey, Melanie Thompson

Dignity: A Journal of Analysis of Exploitation and Violence

No abstract provided.

Evaluating The Impact Of Social Determinants Of Health On Outcomes Of Type Ii Diabetes In South Carolina, Alexander G. Downs

Senior Theses

Type II diabetes mellitus (T2DM) represents a significant public health burden in South Carolina, where 13.5% of adults are affected, surpassing the national rate of 12%. This integrative literature review examines the social determinants of health most strongly associated with T2DM morbidity and mortality in South Carolina, including race and ethnicity, socioeconomic status, rural or urban residence, educational attainment, healthcare access, and food insecurity. Evidence drawn from peer-reviewed studies, epidemiological reports, and state health data reveals that African American, rural, and low-income populations bear a disproportionate share of the diabetes burden in the state. These disparities arise through multilevel mechanisms …

Physical And Behavioral Health Diagnoses And Comorbidities Associated With Transition From Military Health System To Veterans Health Care Among Post-­ 9/11 Veterans, Nikki R. Wooten, Megan E. Amaun, Madeline Meyers, Prince Nii Ossah Addo, Jeffery Bowers, Felicia R. Carey, Rudolph P. Rull, Edward J. Boyko, Nathaniel Bell, Ana Defede-Lopéz, Mary Jo V. Pugh

Faculty and Staff Publications

Objective

To identify factors associated with transitioning from Military Health System (MHS) to Veterans Health Administration (VHA) care in post-9/11 veterans.

Study Setting and Design

Retrospective cohort study from the Long-Term Impact of Military-Relevant Brain Injury Consortium Phenotype Study.

Data Sources and Analytic Sample

Population-level data were analyzed from MHS and VHA electronic health data (FY2000-2020). Participants received ≥ 3 years of MHS care and separated from the military before October 1, 2016. The primary outcome was transition from MHS to VHA care after military separation. Covariates included demographic, military, and deployment characteristics at military separation; physical, mental, and substance …

Ethical Controversies In Organ Procurement: A National Survey On Public Perceptions Of Thoracoabdominal Normothermic Regional Perfusion, Trevor M Bibler, Jill Oliver Robinson, Adam Omelianchuk, Tariq Nisar, Savitri Fedson, Ariel N Levchenko, Amy L Mcguire

Center for Medical Ethics and Health Policy Staff Publications

Thoracoabdominal normothermic regional perfusion (TA-NRP) would likely expand the quantity and quality of organs procured after controlled circulatory death donation in the United States, yet its ethical permissibility remains contested. We surveyed a representative sample of US adults (n = 975) with the goal of assessing their perspectives on the ethical permissibility of TA-NRP. After reading a neutral description of TA-NRP, participants judged its permissibility, reviewed 5 critic and 5 supporter arguments (in random order), and chose which argument they found most convincing. Multivariable logistic regression examined predictors of agreeing with critics. Before exposure to the arguments, 51.5% stated that …

Quantifying Provider Relief Fund Allocation Trends: A Descriptive Analysis Of Rural And Urban Hospitals, 2014-2023, Wendell C. Mcclurg

MUSC Theses and Dissertations

Rural hospitals operate on thin margins, have limited access to capital, and face a heightened risk of closure. During the COVID-19 pandemic, the Provider Relief Fund (PRF) distributed more than $170 billion to health care providers to offset revenue losses and preserve access to care. Most evaluations of PRF have focused on profitability, which may overstate financial resilience by overlooking liquidity. Using Hospital Cost Reports for hospitals from 2014-2023, we examined trends in Days Cash on Hand (DCOH), operating margin, total margin, and PRF funding intensity by rurality and ownership. Liquidity rose sharply during 2020-2021, coinciding with the peak of …

Minimum Wages And Workplace Injuries, Michael Davies, R. Jisung Park, Anna Stansbury

Upjohn Institute Working Papers

How do minimum wage changes affect workplace amenities? Using the universe of claims from California, the US’ largest workers’ compensation system, over 2000-2019, we exploit geographic variation in state- and city-level minimum wages and local occupation-level variation in exposure to minimum wage changes to estimate whether minimum wage increases affect the rate of workplace injuries. We find a large adverse effect of raising minimum wages on injuries. A 10% increase in the minimum wage increases the injury rate by 7.2% in an occupation-metro area labor market which is fully exposed to the minimum wage increase. Our results imply an elasticity …

How Do Minimum Wages Affect Workplace Injuries?, Michael Davies, R. Jisung Park, Anna Stansbury

Upjohn Institute Policy and Research Briefs

No abstract provided.

Diagnostic Trends And Service Enhancements In Deaf Mental Health: A Longitudinal Analysis, Kent Schafer, Steve Hamerdinger, Frank Wu, Rie Sakai Bizmark, Charlene Crump

JADARA

A longitudinal study investigated mental health diagnostic trends and patterns among Deaf and Hearing individuals using a comprehensive dataset from Alabama Department of Mental Health spanning 2004-2024 (Deaf=4,547; Hearing=2,056,188). Chi-square analysis revealed significant proportional differences in diagnoses between the groups. Deaf individuals showed significantly higher proportions of psychotic (12.93% vs. 8.33% Hearing), mood (20.76% vs. 18.84% Hearing), and personality (0.58% vs. 0.43% Hearing) disorders. These findings suggest that increased access to specialized and competent mental health services for individuals who are Deaf, particularly following the increase of staffing patterns for the Office of Deaf Services in 2015,contributed to more accurate …

Knowledge Of Lifespan And Healthspan And Interest In Healthy Longevity Medicine Among The General Population In Singapore: The Singapore Healthy Longevity (Helo) Survey, Jonas John Posko Amalaraj, Belinda Wang, Anna Szucs, Louis Island, Laureen Yi-Ting Wang, Liz J. Horberg, Paul A. O'Keefe, Sonny Rosenthal, Yap-Seng Chong, Johannes J. Meij, Andrea B. Maier

Research Collection College of Integrative Studies

Given the growing global interest in Healthy Longevity Medicine (HLM), the field lacks understanding about public knowledge and interest, which are crucial for any public health intervention relying on HLM. This study presents findings from the Healthy Longevity (HELO) survey conducted in Singapore, assessing public knowledge regarding lifespan (number of years a person is alive), healthspan (number of years a person spends in good health), and interest in HLM. This nationwide cross-sectional survey, conducted between June and August 2024, involved 3034 participants. Main domains including questions on demographics, living arrangements, medical information, health behaviours, income and financial status were tested …

Post-Dobbs Realities: Ethical Imperatives For Data Transparency And Trust In Maternal Health Care, Faith E Fletcher, Sophie L Schott, Kelley Akhiemokhali, Kari White

Center for Medical Ethics and Health Policy Staff Publications

No abstract provided.

The Role Of Gynecologic Oncologists In Improving Survival Outcomes Of Epithelial Ovarian Cancer: A Retrospective Cohort Study, Widyorini Lh Hanafy, Bambang Dwipoyono, Asri C. Adisasmita, Yosephine E. Regina, Airine S. Lians, Oktaviani P. Rahayu, Jane G. Auwelia

Kesmas

Epithelial ovarian cancer (EOC) is a leading cause of gynecological cancer mortality and is often diagnosed at an advanced stage, resulting in poor survival outcomes. Access to specialized gynecological oncology services has been associated with improved prognosis; however, data on its impact in Indonesia remain limited. This study aimed to evaluate the association between gynecologic oncologist (GO) services and disease-free survival (DFS) in patients with EOC. This retrospective cohort study included 76 patients with EOC who were treated at a national cancer hospital in Jakarta between 2015 and 2018. Patient data were obtained from medical records and followed for three …

Patterns Of Tobacco Marketing And User Engagement On Social Media In Indonesia: Challenges For Digital Public Health, Resti Yulianti Sutrisno, Nopryan Ekadinata, Sutantri Sutantri, Dinasti Pudang Binoriang, Enrico Aditjondro, Rachfiansyah Rachfiansyah, Yosef Rabindanata, Silvia Dini, Rebecca Perl, Riska Rachmawati, Bertha Tesma Wulandari, Dianita Sugiyo

Kesmas

Large-scale tobacco marketing on social media has resulted in widespread population-level exposure, particularly in Indonesia, which faces growing challenges in digital public health. This study aimed to assess the associations between platform type and marketing tactics and identify correlations of user engagement. An analytical cross-sectional study was conducted using secondary data from the Tobacco Enforcement and Reporting Movement (TERM), collected from January 2022 to August 2023. A total of 21,255 tobacco marketing posts from social media were analyzed. Platform–tactic associations were examined using Chi-square tests, and multivariable Poisson regression was used to identify factors associated with user engagement. The findings …

Low-Dose Prophylaxis Versus On-Demand Treatment For Children With Severe Hemophilia A In Indonesia: A Conceptual Model, Levina Chandra Khoe, Nur Atika, Dhia Ticha Pertiwi, Septiara Putri

Kesmas

Hemophilia A is a rare bleeding disorder caused by a deficiency of clotting factor VIII, leading to recurrent bleeds, joint damage, and disability. Low-dose prophylaxis has been shown to achieve better clinical outcomes than on-demand treatment in reducing bleeding frequency. However, in Indonesia, access and affordability remain key challenges. This study aimed to develop a conceptual model for conducting a health economic evaluation of low-dose prophylaxis treatment for children with severe hemophilia A in Indonesia. This study followed the ISPOR-SMDM Modeling guidelines, outlining two-stage processes: conceptualization of the clinical problem and model development. A systematic literature review was conducted to …

The Disproportionate Impact Of Hiv On Young Women In Durban: Exploring Gendered Vulnerabilities And Socioeconomic Barriers, Adrian A. Nolasco

Capstone Collection

South Africa has a high rate of HIV, with young women in Durban especially affected due to social, economic, and cultural challenges. This study looks at the experiences of young women living with HIV and the views of healthcare professionals caring for them in KwaZulu-Natal. Using a qualitative, phenomenological approach, semi-structured interviews were conducted with five women and three medical professionals to explore how HIV affects their lives, the challenges they face, and how they cope.

The findings show that both structural and personal barriers make it hard for young women to stick to treatment. Long waits at clinics, limited …

Self-Medication And Pharmaceutical Dispensing In Egypt: Practices, Policies, And Regulatory Challenges, Lobna Fawzy Ali Shaheen

Theses and Dissertations

Access to safe and appropriate medications is a critical component of public health, particularly in low- and middle-income countries. In Egypt, self-medication and informal pharmaceutical dispensing have become deeply embedded practices shaped by systemic, economic, and cultural factors. This research explores the complex interplay between self-medication behaviors, pharmaceutical regulation, and healthcare access in Egypt. Through qualitative interviews with policymakers, pharmacists, physicians, industry professionals, and citizens, the research uncovers widespread informal dispensing of prescription-only medicines, driven by high out-of-pocket costs, limited insurance coverage, and high public reliance on pharmacists as primary care providers. Despite the presence of regulatory frameworks, weak enforcement, …

The State Of Mental Health In The Mountain West, 2025, Cason Noll, Anirudh Polagani, Taylor Volk, Olivia K. Cheche, Caitlin J. Saladino, William E. Brown Jr.

Health

This fact sheet presents data on the mental health of youth and adults, as well as the availability of mental health care, across the five Mountain West states of Arizona, Colorado, Nevada, New Mexico, and Utah in 2025. The data are derived from "The State of Mental Health in America 2025,” originally published by Mental Health America (MHA).

Abortions In The Mountain West, 2022-2025, Olivia K. Cheche, Caitlin J. Saladino, William E. Brown Jr.

Health

This fact sheet presents data on the number of abortions provided annually in the Mountain West states of Arizona, Colorado, Nevada, New Mexico, and Utah between July 2022 and June 2025. The data are retrieved from the Society of Family Planning’s #WeCount report,  which includes data on abortion volume across all 50 U.S. states and Washington, D.C. This fact sheet focuses on the administration of both in-person and telehealth abortions in the Mountain West.

Artificial Intelligence In Medical Ethics Education: A Descriptive Study Of Eight Models In Multiple Choice Question Generation, John Obeid, Christopher Bobier, Alex Gillham, Adam Omelianchuk, Daniel Hurst

Center for Medical Ethics and Health Policy Staff Publications

Introduction: Integrating artificial intelligence (AI) into medical education poses barriers and opportunities for medical educators. One of those opportunities is content creation for medical ethics assessment. Assessing the performance of AI in generating multiple choice questions (MCQs) in ethics that aligns with United States Medical Licensing Examination (USMLE) is important. The present study evaluates the performance of eight AI models-GPT-4 Turbo, GPT-3.5 Turbo 0125, o1 Mini, o1 Preview, GPT-4, Claude 3.5 Sonnet, Claude 3 Opus, and Gemini-in regard to the relevance, clarity, and accuracy of generated ethics-based MCQs.

Methods: Each of the eight models was tasked with generating two sets …

Analysis Of Coverage Of Tuberculosis Prevention Therapy (Tpt): Literature Review, Septia Rahmalina, Ede Surya Darmawan

Journal of Indonesian Health Policy and Administration

Tuberculosis Preventive Therapy (TPT) is a crucial intervention for tuberculosis (TB) control, particularly among high-risk groups such as household contacts of TB patients and people living with Human Immunodeficiency Virus (HIV). Despite being recommended by the World Health Organization (WHO), TPT implementation still faces challenges at the primary care level. This study employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method to review 11 articles published between 2021 and 2025 that were relevant to TPT implementation in various high-TB burden countries, including Indonesia. The main barriers identified were input (logistics, training), process (tracing, education, monitoring), and output …

The Relationship Between Accessibility Factors And Post-Inpatient Control Visits Among Non-Jkn Participants At Hospital X, Putri Candaika, Desy Kartika Ningsih, Risky Kusuma Hartono

Journal of Indonesian Health Policy and Administration

The rate of post-inpatient control visits remains relatively low due to various factors, including accessibility. At Hospital X, 220 of non-Jaminan Kesehatan Nasional (JKN) participants scheduled for post-inpatient control visits between January and March 2025, 71.82% attended, and 28.18% did not. Patients who did not attend control visits were twice as likely to be readmitted. This study aimed to determine the relationship between accessibility and post-inpatient control visits for non-JKN participants at Hospital X. This quantitative study employed an analytical cross-sectional design, with a population of 220 patients and a sample of 142 patients selected using probability sampling. Bivariate …

Private Sector Healthcare Investment In Indonesia: Leveraging Australia-Indonesia Partnerships For Health System Transformation, Susan Josephine Neuhaus

Journal of Indonesian Health Policy and Administration

Australia and Indonesia are strategic partners with expanding bilateral trade valued at AUD 26.7 billion (2022-23). Health care partnerships between the two countries offer significant opportunities for private sector engagement. Indonesia’s large population, rapidly growing middle class, and implementation of Universal Health Coverage (UHC) through the Jaminan Kesehatan Nasional (JKN) present partnership opportunities to strengthen health system capacity, address infrastructure gaps and workforce shortages, and contribute to shared economic and prosperity goals. This study explores how Australian private healthcare investment can complement government initiatives in supporting Indonesia’s UHC while advancing Australia’s regional engagement. A descriptive qualitative analysis was conducted using …

Prophylactic Antibiotic Analysis In Obs-Gyn, Orthopedics, Gastrointestinal Surgery At A South Tangerang Hospital, January-March 2024, Evelina Endang Nurjaman, Helen Andriani

Journal of Indonesian Health Policy and Administration

Inappropriate use of prophylactic antibiotics (PAs) remains a primary driver of antimicrobial resistance (AMR); however, global adherence to established prescribing guidelines remains suboptimal. This study aimed to analyze the compliance and rationality of PA prescription and to evaluate the underlying causes of physician non-adherence in obstetrics, orthopedic, and gastrointestinal surgeries at a hospital in South Tangerang City, Indonesia. Adopting a mixed-methods approach, this investigation combined a quantitative assessment of 208 surgical patient records (January–March 2024) with qualitative exploratory interviews conducted with three specialist peer group heads. This design allowed the triangulation of prescribing data with underlying clinical perspectives. PA rationality …

Harmonization And Ambiguity In Regulations For Physicians With Family Medicine Competence Post-Law No. 17 Of 2023, Danar Wahyu Giwang Katon, Dumilah Ayuningtyas, Purnawan Junadi, Wahyu Sulistiadi, Roberth J. Pattiselanno, Fitria Fitria, Ika Fitri Alfiani

Journal of Indonesian Health Policy and Administration

Strengthening primary care services in Indonesia requires that community health centers, namely Pusat Kesehatan Masyarakat (Puskesmas), involve medical personnel with family medicine competence. However, the fulfillment of physicians with this competence, especially Primary Care Family Medicine Specialists or Spesialis Kedokteran Keluarga Layanan Primer (Sp.KKLP), still face significant obstacles. This qualitative research uses the integrated Easton's System Model and Buse's Policy Framework to analyze the dynamics of this policy. The findings reveal a gap between the strong legal foundation and weak implementation mechanisms on the ground. First, there is ambiguity in terminology and lack of harmonization among regulations, especially concerning the …

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.