Policy Design, Analysis, and Evaluation Commons^™

Bridging Fiscal Sustainability And Health Equity: A Policy Analysis Of California’S Healthcare Coverage Safeguards, Guadalupe Castaneda Martinez

Master's Projects and Capstones

Without structural policy intervention, approximately 4.6 million Californians remain at risk of being uninsured by 2030, worsening racial and ethnic health disparities and hospital uncompensated care burdens. This policy analysis advocates for a hybrid universal coverage model combining sliding-scale subsidies (California Senate Bill 78) with full-scope Medi-Cal expansion for all income-eligible residents regardless of legal status (California Assembly Bill 133). The framework relies on existing funding mechanisms, including the Managed Care Organization tax and the Health Care Affordability Reserve Fund. Comparative analysis indicates that market-only subsidies leave severe equity gaps, whereas immediate single-payer transitions pose substantial fiscal and administrative risks. …

Governing Algorithmic Attention: Attention Safeguard Models And The Cognitive Attentional Standard As System Level Interventions In Human Computer Interaction, Behavioral Economics, And Artificial Intelligence, Delante Clark

Graduate Scholarship and Creative Works

Algorithmic recommendation systems and interface designs shape attention by combining visually salient cues with uncertain reward timing and low friction interaction. These conditions can sustain anticipatory checking, extend time on task, and reduce natural disengagement points through patterns such as infinite scrolling and autoplay. This paper synthesizes research across neuroscience, human computer interaction, behavioral economics, and artificial intelligence to argue that attention capture is a predictable outcome of incentive driven design rather than an individual failure of self regulation. It advances the Attention Safeguard Models and the Cognitive Attentional Standard as system level interventions that regulate exposure conditions, pacing, and …

When School Culture Excludes: Deficit Discourse, Microaggressions, And The Mental Health Of Marginalized Students – A Conceptual Framework With Implications For School Psychology Practice And Equity Policy, Modupe Mercy Oyewunmi

Publications

Deficit-laden language like ‘behavior problem,’ ‘not college material,’ ‘won’t fit in’, ‘not a cultural fit’, operates as a systemic form of implicit bias and microaggression in school settings. Despite decades of research on school belonging and well-being, school psychology has yet to integrate these exclusionary discursive practices into a coherent health-determinant model that also accounts for the current anti-diversity, equity, and inclusion (DEI) policy environment. This conceptual paper proposes a testable framework linking deficit discourse and school-based microaggressions to student identity suppression, academic impostor phenomenon, and educator moral injury, with downstream effects on school mental health outcomes. We situate these …

Essays On Health And Immigration Policy, Selen Ozdogan

Dissertations, Theses, and Capstone Projects

This dissertation consists of two essays in applied microeconomics, each examining how individuals and institutions respond to policy changes. Both essays leverage natural experiments and recent advances in difference-in-differences estimation to identify causal effects. Both also speak to a common theme in public policy: the gap between intended and actual consequences of government intervention, and the role that policy design plays in shaping those consequences.

The first essay examines the impact of state-level e-cigarette excise taxes on nicotine and tobacco exposure among adults aged 18 and older. A central contribution is its use of individual-level panel biomarker data from urine …

Global Health Financing Of Diagonal Interventions: Building Resilient And Sustainable Health Systems In Sub-Saharan Africa, Lucy Kim

Master in Public Policy Theses

Background: Global health financing has historically prioritized disease-specific “vertical” programs over broader “horizontal” strengthening of general health systems. Vertical programs in HIV have led to unprecedented reductions in mortality worldwide, but HIV remains a significant public health threat in sub-Saharan Africa, where vertical strategies have long been criticized for creating fragmented health systems. In response, global health strategies have shifted towards combining vertical investments with broader horizontal activities, commonly referred to as “diagonal” programming. While evidence suggests that diagonal programming has the potential to create more resilient and sustainable health systems, evaluating its value for money is challenging due to …

Beyond The Ban: Chhaupadi Abolition And The Governance Of Menstrual Autonomy In Western Nepal, Nikita Paudel

Master in Public Policy Theses

This thesis examines how two decades of efforts to abolish chhaupadi have shaped the everyday conditions under which women and girls experience menstruation in western Nepal. Chhaupadi, commonly understood as menstrual seclusion, has been addressed through Supreme Court directives, national policy, criminal law, municipal implementation instruments, hut demolition campaigns, public health programming, and rights-based advocacy. Yet the practice has persisted, adapted, and in some cases moved into less visible spaces. Rather than treating this as a simple gap between law and practice, this thesis asks how abolition efforts themselves have become part of the regulatory regime through which menstruation is …

Governing Addiction: An Anthropological Comparison Of Care In The United States And The Netherlands, Kiren K. Bagga

Bates College Journal of Political Studies

This article examines addiction care as a form of moral governance through a comparative anthropological analysis of the United States and the Netherlands. Drawing on a Foucauldian theory of biopolitics alongside this study argues that approaches to addiction treatment reveal how states differentially value life, citizenship, and vulnerability. Joan Tronto's relational definition of ethical care is used to move beyond a solely moral context, towards an ethical understanding of both caretakers and those who require care. In the United States, addiction policy has historically functioned as a punitive and moralizing project, shaped by racialized drug criminalization, neoliberal ideals of individual …

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 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, …

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 …

After The Aid Boom: Government Responses To The Global Health Agenda And Political Commitment In Low- And Middle-Income Countries, Sana Abdelkarim

Electronic Theses & Dissertations (2024 - present)

How do governments respond to the global health agenda? Does external health assistance translate to sustained domestic political commitment in low- and middle-income countries? Over the past three decades, development assistance for health has expanded, accompanied by international agreements emphasizing country ownership, alignment, and domestic resource mobilization. Yet domestic fiscal commitment to health remains uneven across countries. These questions have become more pressing as the global aid landscape enters a period of contraction, with a significant decline in development assistance, including health financing, raising concerns about the sustainability of health systems that have become reliant on external support.  This raises …

Addressing Challenges In Accessing Secondary And Tertiary Healthcare Services For Migrants And Refugees In Egypt, Noura Seada, Nehal El-Bakhshawangy, Heba Semary, Fatma Alzahraa Hassan, Ahmed Hammad

Papers, Posters, and Presentations

The growing number of vulnerable migrants and refugees worldwide presents a significant challenge to host countries, particularly in terms of accessing healthcare services. Egypt hosts over 9 million migrants and refugees, with 1.5 million in a vulnerable situation. Despite the country’s efforts in providing adequate healthcare to these vulnerable groups, some challenges persist. This paper addresses the barriers that vulnerable migrants and refugees face when seeking secondary and tertiary healthcare services in Egypt, analyzing the legal, economic, social, and health system factors that contribute to this problem.

In 2018, the Egyptian government began an ambitious journey to reform its healthcare …

Investigating The Relationship Between Noun Classes And Plant Folk Taxonomy In Chasu Language Of Kilimanjaro Region In Tanzania, Peter Rabson Mziray

Journal of Humanities and Social Sciences

The current study investigates the relationship between noun classes and plant folk taxonomy in Chasu (G 22). The study focuses on two objectives: the first objective is to describe the plant folk taxonomy in Chasu and the second objective is to determine the relationship between noun classes and plant folk taxonomy in Chasu. Data were collected from rural villages in Same and Mwanga districts by using free listing, field interviews (jungle-walk-and-identify), and written texts containing Chasu plant names. The findings reveal that Chasu folk taxonomy reflects different ethnobotanical categories; including a unique beginner which is mmea/mimea ‘plant(s)’, and three life …

Options For Modifying The Patient Protection & Affordable Care Act In The United States: An Equitable Perspective, Dr. Amira Elshamy

Future Journal of Social Science

The Patient Protection & Affordable Care Act referred to as Affordable Care Act (ACA), is a United States (U.S.) federal statute, signed into law by former President Barack Obama in 2010, it is also known as Obamacare. The law has made health insurance more accessible and affordable for millions of Americans, yet many still remain uninsured or struggle with unaffordable coverage. In addition, the Centers for Medicare and Medicaid Services started receiving a significant increase in complaints from consumers who reported being enrolled in Marketplace coverage without their consent, around 5 million people were wrongly enrolled in subsidized ACA coverage …

An Assessment Of Maine's Capacity To Support Transitions Of Care Through The Substance Use Disorder Continuum, Mary Lindsey Smith Phd, Sarah Mclaughlin Mph, Rachel M. Gallo Mph

Substance Use Research & Evaluation

This report evaluates Maine's capacity to support effective transitions of care across the substance use disorder (SUD) treatment continuum. Using data collected from a statewide survey of 65 SUD providers, conducted from February to April 2025, the study examines organizational practices, inter-provider communication, and coordination strategies related to transitions between levels of care: medically supervised withdrawal, inpatient, and outpatient treatment programs. Key findings reveal strong intra-organizational communication, widespread understanding of ASAM criteria, and a general commitment to patient-centered care. However, gaps persist in coordination between care levels, particularly in withdrawal management programs, which rarely conduct follow-ups or collaborate with outpatient …

Withdrawal Management In Maine: Capacity Challenges And Opportunities For Improvement, Mary Lindsey Smith Phd, Katie Rosingana Ba, Tyler Egeland Ba, Sarah Mclaughlin Mph

Substance Use Research & Evaluation

This summary report presents findings from healthcare provider interviews conducted in 2024 to assess the current landscape of withdrawal management (WM) services in Maine. Sixteen providers, across eight counties and representing a range of substance use disorder (SUD) service types, were interviewed to evaluate capacity, challenges, and opportunities for improvement across the continuum of care. Thematic analysis identified widespread gaps in withdrawal management capacity, especially in ASAM Levels 1.7 to 4.0, with critical shortages in ambulatory and low-intensity residential services. Key barriers included geographic inequities, insufficient infrastructure, long waitlists, inadequate reimbursement, and workforce shortages exacerbated by stigma and provider discomfort. …

Feedback On Withdrawal Management Services In Maine From Persons With Lived Experience, Mary Lindsey Smith Phd, Katie Rosingana Ba

Substance Use Research & Evaluation

This summary report presents findings from interviews with twelve persons with lived experience of substance use disorder (PWLE). The interviews asked persons in recovery about their experiences accessing withdrawal management and broader substance use treatment services across Maine. Participants identified key barriers to treatment including high costs, limited bed availability, long wait times, geographic inaccessibility, and lack of centralized information. Gaps in service infrastructure, particularly for opioid withdrawal management, long-term treatment, and transition supports post-detox, were widely reported. Participants emphasized the critical need for more localized and individualized services, particularly for parents, rural residents, and low-income individuals. Recommendations include expanding …

Bridging The Gap: Exploring The Intersection Of Formal Mental Health Services And Informal Social Supports In Bipoc Communities, Patrice D. Patton-Campbell

Dissertations

Despite growing awareness of mental health disparities, BIPOC (Black, Indigenous, and People of Color) communities continue to face significant barriers in accessing culturally responsive mental health care. This dissertation explores the intersection between formal mental health services and informal social supports such as family, religious institutions, and community networks to understand which systems are more trusted, accessible, and effective for BIPOC individuals. Grounded in Urban Liberation Psychology and guided by decolonial and culturally responsive care frameworks, this qualitative study draws from focus groups and interviews with 33 participants, including both community members and service providers from the Chicagoland area and …

Activity Levels Among Older Adults In A Life Plan Community, Emily D. Winters

OHSU-PSU School of Public Health Annual Conference

This study aimed to analyze resident's knowledge of the health and wellness programs available to them in their facility. It explored activity levels, preferred activity methods, and health and wellness program utilization among older adults residing in a life-plan community. A total of 166 survey respondents, aged 65 and older, were included in the analysis. Data were collected using a self-administered questionnaire designed to assess physical activity patterns, preferences for activity types, and engagement with the facility’s health and wellness offerings. Open-ended questions were assessed qualitatively through thematic analysis to find common themes within data. Results indicated that the most …

Comparing Cpr Ventilation Strategies Within Tualatin Valley Fire And Rescue Using A Retrospective Observational Cohort Study, Jack T. Hindley

OHSU-PSU School of Public Health Annual Conference

Study Objective: This was a registry based retrospective observational cohort study of roughly 1,150 cardiac arrest cases transported by the Tualatin Valley Fire and Rescue emergency medical service (EMS) agency to hospitals in the Portland area from 2018-2019 and from 2022-2023 to compare cardiopulmonary resuscitation (CPR) ventilation policy changes between these two years from continuous chest compressions (CCC) to a compression ventilation ratio of 30:2. Hospital outcomes were linked to EMS records through trauma registries, state discharge and emergency department data. The primary outcome was survival to discharge, and the secondary outcome was positive neurological outcome (Cerebral performance category score …

Academyhealth - 2024 Data Visualization Winners, Chelsea Keating, Emily Boniface, Mina Colon

OHSU-PSU School of Public Health Annual Conference

Social determinants of health, such as income, employment, social contexts, and the built environment, influence the risk of food insecurity. Food insecurity can be defined as uncertain access to food and can lead to negative health outcomes like increased risk for obesity, chronic disease, and adverse effects on a child's development and mental health. Drivers like limited physical access to food, limited transportation options, and the quality and access to food assistance programs within local systems perpetuate health disparities—particularly in those communities with populations who have been systematically marginalized. This descriptive study uses 2022 data from the National Health Interview …

Exploring Health Equity With Culturally Specific Providers Of Permanent Supportive Housing, Judith R. Solomon

OHSU-PSU School of Public Health Annual Conference

Chronic homelessness is an important public health issue. Permanent Supportive Housing (PSH) is a promising opportunity for transitioning people experiencing homelessness into housing, however there remain unaddressed racial inequities in service provision and outcomes. The aim of this study is to better understand the role of culturally specific (CS) providers of PSH in improving health equity. I analyzed interviews with CS PSH providers for themes related to health and healthcare. Providers spoke about the importance of connecting clients to healthcare. Providers stressed the importance of honesty and lived experience, highlighting the strong sense of responsibility to the community. Providers also …

Comparing Acuity Of Patient Care At Student Run Free Medical Clinic Locations, Hana Warmflash, Olivia Krol, Alex Foster

OHSU-PSU School of Public Health Annual Conference

Intro:

Student run free medical clinics (SRFC) are present at roughly 75% of Association of American Medical Colleges member institutions1,2 providing care for underserved populations, such as those experiencing houselessness. 3 Persons experiencing houselessness have a higher burden of illness than housed persons but experience a greater barrier to obtaining care4. Delays in care result in more complex and longer hospitals stays4,5.

Our SRFC, Bridges Collaborative Care Clinic (BCCC), functions to address emergent complaints and monitor chronic health conditions. We aim to demonstrate how relocating from River District Navigation Center (RDNC) to a more accessible location, Resource Center (RC), enabled …

How To Kill A Human: Creating An Immersive Learning Game, Théo Caldwell, Nathan Bonnell

OHSU-PSU School of Public Health Annual Conference

How to Kill a Human is an experiment in teaching through gameplay. The environmental crisis facing the planet, though denied by many, is a collection of well-documented historical environmental catastrophes. The purpose of this project was to design a method of relating the impacts of environmental systems on human health, highlighting the dangers of ill planned human tampering, by presenting hypothetical environmental catastrophes and then relating them to documented historical disasters. In pursuit of this goal, we designed a semi-collaborative game for three to six players with a suggested age rating of 10+, ideal for teaching individuals of middle school …

Differences Between Stem Students And Faculty On Seeing Value In A Classroom Belonging Exercise, Kaisa S. Holt

OHSU-PSU School of Public Health Annual Conference

Efforts to enhance belonging in undergraduate STEM classrooms are believed pivotal for student success. However, we must not only promote belonging interventions but also understand STEM students and faculty perceptions of their value and utility. We gathered perspectives of faculty and undergraduates regarding the implementation and efficacy of a belonging exercise (Our Lives Lived, OLL) used in multiple STEM classes at one university over two years. We hypothesized that students would see more value in the exercise than faculty. We sent a survey instrument with an OLL summary and a series of open-ended responses to faculty. We recruited for focus …

Universal Health Care, Oregon, Jennifer S. Arnold, Bethany Clouse, Alec Martin

OHSU-PSU School of Public Health Annual Conference

Historically, the US has chosen not to fund universal health care at every opportunity, leaving our nation as the only industrialized country without some system of health coverage for our citizens and with the worst health care outcomes of any high-income nation in the world. Health care in Oregon is no exception. Our current health care system is financially unsustainable, harmfully complex, and socially unjust, as well as inequitably delivered. Too many Oregonians, because of their race, age, income, geography, or insurance, endure vastly different health care access, varied health care quality, and wide-ranging health outcomes. In 2019, the Oregon …

Behind The Walls: The Implications Of Assisted Living Building Codes On Resident Safety, Adam Pennavaria, Lindsey Smith, Paula Carder, Cassandra Hua, Eric Jutkowitz, Kali Thomas

OHSU-PSU School of Public Health Annual Conference

As the US population collectively ages, issues related to assisted living (AL) resident safety have become an increasingly pressing issue for the general public, reflected by major media reporting in the last year. The building codes that govern ALs play an important role in mitigating the risks associated with falls, wandering, and other hazards, especially for residents living with Alzheimer’s disease and related dementias. We sought to understand how states vary in their approaches to building code regulations that might impact resident safety. We used search term-based text retrieval to identify areas of text relevant to locks, alarms, and egress …

Expanded Patient Reach At New Student Run Free Medical Clinic Location, Olivia Krol, Hana Warmflash, Alex Foster

OHSU-PSU School of Public Health Annual Conference

Background: Critical to modern medical education, student run free medical clinics (SRFCs) are present at more than 75% of AAMC member institutions. SRFCs educate students while providing low-barrier, free healthcare to underserved populations. SRFCs provide unique leadership and health systems management opportunities not traditionally emphasized in training, including leading logistical and operational changes.

In this project, we highlight the impact of a student-led operational initiative that transitioned our clinic from the River District Navigation Center (RDNC) to the Resource Center (RC), improving accessibility.

Methods:

Deidentified patient data from medical clinics from January 2024 to February 2025 were analyzed using RStudio …

Evaluating The Current State Of Quality Measure Reporting In The Merit-Based Incentive Payment System, Kinan Sawar, Geoffrey Potts Md

Medical Student Research Symposium

The Merit-Based Incentive Payment System (MIPS) requires physicians to report quality measures along with other metrics that are used to determine an annual percentage adjustment to physician Medicare Part B payments. Unfortunately, physicians have been forced to choose from an ineffective, limited set of quality measures. This has led to an overreliance on process measures, which fail to stratify physician performance effectively; it has also led to differences in the number of reporting options across specialties, resulting in unequal opportunity for physicians to succeed in MIPS. Using Centers for Medicare and Medicaid Services (CMS) public use file data from 2021-2024, …

H.B. 22-1326: Analysis Of Colorado’S Fentanyl Policy, William Morris

Undergraduate Theses, Capstones, and Recitals

Fentanyl is one the most potent drugs on the market, its synthetic nature makes it is one of the deadliest at the lowest quantities. Many of its injectors are entirely unaware of its existence when they consume cocaine, methamphetamine, Xanax, ecstasy, and heroin. Nationwide and within Colorado, the use of synthetic fentanyl has perpetuated a crisis that threatens the health and safety of numerous communities, with both fatal and non-fatal overdoses continually on the rise. In 2022, Colorado passed H.B. 22-1326, aimed at curbing fentanyl deaths and non-fatal overdoses, by further criminalizing fentanyl possession. Understanding the effectiveness of felony-heavy drug …