Health Policy Commons^™

Assessment Of The Use Of Overdose Education And Naloxone Distribution By Maine Buprenorphine/Naloxone Prescribers, Stephen Kirsch

Muskie School Capstones and Dissertations

Background: Overdose deaths, specifically related to opioids, have been identified as a public health problem both nationally and in the state of Maine. Overdose Education and Naloxone Distribution (OEND) is an innovative model of patient education that has been shown to be effective in increasing knowledge of overdose risk and has the potential to help reduce opiate related overdose deaths.

Methods: A 28-item web-based survey examining clinician attitudes, OEND practices and characteristics was distributed to 196 Maine based physicians with a Drug Enforcement Agency waiver to prescribe burprenorphine/naloxone. Facilitators and barriers to the provision of OEND were also assessed. Surveys …

Cairing4carlisle: A Community Health Needs Assessment, Caitlin Coyle

Center for Social and Demographic Research on Aging Publications

Caring4Carlisle (C4C) is a community initiative aimed at addressing the social, emotional, spiritual and physical health of Carlisle residents. Community Health Network Areas (CHNAs) were created by the Massachusetts Department of Public Health in 1992. There are 27 CHNAs in the Commonwealth, and Carlisle belongs to CHNA 15. In July of 2016, Carlisle was awarded a planning grant ($20,000) from CHNA 15 to engage in a community needs assessment process with the intention of identifying priority community health needs to be addressed in Carlisle.

The Carlisle Board of Health served as the lead Town Department with the Gleason Public Library, …

Engaging Parents To Promote Children’S Nutrition And Health: Providers’ Barriers And Strategies In Head Start And Child Care Centers, Dipti A. Dev, Courtney Byrd-Williams, Samantha Ramsay, Brent A. Mcbride, Deepa Srivastava, Ashleigh L. Murriel, Chrisa Arcan, Anna M. Adachi-Mejia

Department of Child, Youth, and Family Studies: Faculty Publications

Purpose: Using the Academy of Nutrition and Dietetics benchmarks as a framework, this study examined childcare providers’ (Head Start [HS], Child and Adult Care Food Program [CACFP] funded, and non-CACFP) perspectives regarding communicating with parents about nutrition to promote children’s health.

Design: Qualitative.

Setting: State-licensed center-based childcare programs.

Participants: Full-time childcare providers (n ¼ 18) caring for children 2 to 5 years old from varying childcare contexts (HS, CACFP funded, and non-CACFP), race, education, and years of experience.

Methods: In-person interviews using semi-structured interview protocol until saturation were achieved. Thematic analysis was conducted.

Results: Two overarching themes were barriers and …

The International Scientific Association For Probiotics And Prebiotics (Isapp) Consensus Statement On The Definition And Scope Of Prebiotics, Glenn R. Gibson, Robert W. Hutkins, Mary Ellen Sanders, Susan L. Prescott, Raylene A. Reimer, Seppo J. Salminen, Karen Scott, Catherine Stanton, Kelly S. Swanson, Patrice D. Cani, Kristin Verbeke, Gregor Reid

Department of Food Science and Technology: Faculty Publications

In December 2016, a panel of experts in microbiology, nutrition and clinical research was convened by the International Scientific Association for Probiotics and Prebiotics to review the definition and scope of prebiotics. Consistent with the original embodiment of prebiotics, but aware of the latest scientific and clinical developments, the panel updated the definition of a prebiotic: a substrate that is selectively utilized by host microorganisms conferring a health benefit. This definition expands the concept of prebiotics to possibly include non-carbohydrate substances, applications to body sites other than the gastrointestinal tract, and diverse categories other than food. The requirement for selective …

The 1939 Dickinson-Belskie Birth Series Sculptures: The Rise Of Modern Visions Of Pregnancy, The Roots Of Modern Pro-Life Imagery, And Dr. Dickinson’S Religious Case For Abortion, Rose Holz

Women's and Gender Studies Program: Faculty Publications

This multidisciplinary essay examines the hugely influential—yet surprisingly overlooked—Birth Series sculptures. Created in 1939 by Dr. Robert L. Dickinson (obstetrician-gynecologist and leader of the Planned Parenthood Federation of America) and sculptor Abram Belskie, they illustrate the process of human development from fertilization through delivery. First displayed at the 1939–1940 World’s Fair in New York City, they were reproduced in a variety of forms and sent out across the United States and overseas. Hardly a brief fad, their popularity persisted into the 1980s. This essay has four purposes. First, it tells the stories of Dickinson and Belskie to appreciate their contributions …

Racial And Ethnic Differences In Receipt Of Immediate Breast Reconstruction Surgery: Do Hospital Characteristics Matter?, Jaya Shankar Khushalani

Theses and Dissertations

Immediate Breast Reconstruction Surgery (IBRS) is associated with better quality of life among women who undergo a mastectomy. Despite insurance coverage for IBRS, utilization of IBRS remains low. Data from publicly available sources for 2010-2012 are used to examine the association between hospital characteristics receipt of IBRS by patients. Minority-serving status, low bed size, for-profit ownership, non-teaching status, high competition, low density of plastic surgeons in the market and non-metropolitan location are associated with lower likelihood of receipt of IBRS.

Racial and ethnic minorities are less likely to receive IBRS. A mixed effects logistic regression model with interactions between Black/Hispanic …

Association Of Provider Communication And Inpatient Hospital Readmissions, Jeremy Dean Faulkenburg

Theses and Dissertations

Introduction: Inpatient hospital readmission rates represent an important clinical and economic problem. Clinical interventions have shown significant decreases in preventable readmissions, but are costly to implement. Another approach is to better equip patients with the knowledge and resources to manage their care after discharge. Patients receive instruction from both nurses and physicians, as well as information pertaining to post-discharge care and instructions for care while at home. This study examines the association between provider communication and inpatient hospital readmissions.

Methods: This study used survey data from the 2013 and 2014 Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). The …

The Socio-Political And Economic Causes Of Natural Disasters, Nicole Southard

CMC Senior Theses

To effectively prevent and mitigate the outbreak of natural disasters is a more pressing issue in the twenty-first century than ever before. The frequency and cost of natural disasters is rising globally, most especially in developing countries where the most severe effects of climate change are felt. However, while climate change is indeed a strong force impacting the severity of contemporary catastrophes, it is not directly responsible for the exorbitant cost of the damage and suffering incurred from natural disasters -- both financially and in terms of human life. Rather, the true root causes of natural disasters lie within the …

Affordability, Utilization And Satisfaction With Care: A Policy Context For Improving Health Care Experiences, Anushree M. Vichare

Theses and Dissertations

Disparate healthcare experiences continue to pose a challenge; vulnerable populations such as low-income and racial and ethnic minorities may not be able to afford or utilize care when needed or receive quality care. The sources of disparities are complex and multi-factorial, which include health care system-level factors such as insurance and health care workforce. It is relatively less known to what extent these contribute to disparities related to a patient’s overall health care experience across three important domains – affordability, utilization and satisfaction with care.

This dissertation has three objectives. First, to assess how insurance benefit design affects health care …

Happiness In Communities: How Neighborhoods, Cities And States Use Subjective Well-Being Metrics, Laura Musikanski, Carl Polley, Scott Cloutier, Erica Berejnoi, Julia Colbert

Journal of Sustainable Social Impact

This essay, the fourth and last of a series published by the Journal of Social Change, is intended as a tool for community organizers, local policy makers, researchers, students and others to incorporate subjective well-being indicators into their measurements and management of happiness and well-being in their communities, for policy purposes, for research and for other purposes. It provides case studies of community-based efforts in five different regions (São Paulo, Brazil; Bristol, United Kingdom; Melbourne, Australia; Creston, British Columbia, Canada; and Vermont, United States) that either developed their own subjective well-being index or used the Happiness Alliance’s survey instrument …

Underutilization Of Federal Benefits In Oregon: Programs And Strategies, Raúl Preciado Mendez

National Policy Consensus Center Publications

The report results demonstrate the dependence low-income Oregon families have on the six federal programs and the challenges families face when attempting to access federal resources. The barriers to access are often structural in that they are embedded in the procedures and structure of the program. Based on its analysis, the report presents a series of reforms and support activities that Oregon state agencies and nonprofits could adopt to improve family access for each program.

A Better Calculus For Regulators: From Cost-Benefit Analysis To The Social Welfare Function, Matthew D. Adler

Faculty Scholarship

The “social welfare function” (SWF) is a powerful tool that originates in theoretical welfare economics and has wide application in economic scholarship, for example in optimal tax theory and environmental economics. This Article provides a comprehensive introduction to the SWF framework. It then shows how the SWF framework can be used as the basis for regulatory policy analysis, and why it improves upon cost-benefit analysis (CBA).

Two types of SWFs are especially plausible: the utilitarian SWF, which sums individual well-being numbers, and the prioritarian SWF, which gives extra weight to the well-being of the worse off. Either one of these …

Changing The Tax Code To Create Consumer-Driven Health Insurance Competition, Regina Herzlinger, Barak D. Richman

Faculty Scholarship

Because current tax laws exclude employer-paid health insurance premiums from employees’ taxable wages and income, employer-sponsored insurance remains the primary source of health insurance for most employed Americans. Economists have long blamed the employer-based insurance tax exclusion for inflating health care costs, and, more recently, for constraining income growth and exacerbating income inequality.

We execute a simulation to test the effect of permitting employees to receive their employers’ premium contribution directly and then purchase health insurance themselves, using tax-free funds. Employees could deduct for income tax purposes the amount used for insurance and, if they spend less than the amount …

N.C. Medicaid Reform: A Bipartisan Path Forward, Barak D. Richman, Allison Rice

Faculty Scholarship

The North Carolina Medicaid program currently constitutes 32% of the state budget and provides insurance coverage to 18% of the state’s population. At the same time, 13% of North Carolinians remain uninsured, and even among the insured, significant health disparities persist across income, geography, education, and race.

The Duke University Bass Connections Medicaid Reform project gathered to consider how North Carolina could use its limited Medicaid dollars more effectively to reduce the incidence of poor health, improve access to healthcare, and reduce budgetary pressures on the state’s taxpayers.

This report is submitted to North Carolina’s policymakers and citizens. It assesses …

Poison In Pink, Sydney V. Cook

Graduate Student Theses, Dissertations, & Professional Papers

Humans slather, spray, mist, and cleanse their bodies with personal care products like lotion, hairspray, cologne, and shampoo every day. Our cupboards are stocked full of them, but few of us understand what is in those jars and bottles. We trust that if it’s on the shelf at the store, it’s safe. However, this is not always the case, and many personal care products contain chemicals that are harmful to human and environmental health.

My multi-disciplinary Environmental Studies thesis project combines evidenced-based research, interviews, nonfiction narrative, and science communication to create part of a book manuscript intended to educate general …

The Indirect Consequences Of Expanded Off-Label Promotion, Patricia J. Zettler

Faculty Publications By Year

The U.S. Food and Drug Administration’s (FDA) policies have been a battleground for litigation about First Amendment protections for commercial speech. In the last five years, the FDA’s position that “off-label” promotion of approved prescription drugs—when a manufacturer promotes a drug for a use for which the FDA has not approved it—leads to violations of the Federal Food, Drug, and Cosmetic Act has been subject to successful legal challenges. Although the merits of these off-label promotion decisions are well traversed in the literature, this Article explores the potential indirect consequences of recently-recognized protections for off-label promotion. This Article demonstrates that—as …

Cyberbullying And Self-Perceptions Of Students Associated With Their Academic Performance, Maham Muzamil, Gulzar H. Shah

Health Policy & Community Health: Faculty Publications

The aim of this study is to explore the factors influencing students’ academic achievements in secondary school level (grades 09 and 10). Those factors include students’ self-reported psychological and issues (e.g. being bullied through social media) as well as socioeconomic status. Study participants included610 students at senior secondary level (237 male and 363 female) randomly selected from ten different government schools. The schools were randomly selected from the lists provided by their respective Education District Officer (EDO). The data were collected by researchers with the help of teachers. Participants’ were offered as incentives a drawing for a gift certificate. Bivariate …

Stroke Outreach In The Lao Community, Noor A. Dythavon

Master's Projects and Capstones

CNL Abstract

A community health needs assessment for the service area prompted concern regarding access to quality healthcare for non-English speaking Southeast Asians (SEA) in the area. Goals of an initial investigation and subsequent implementation of sustainable stroke health fairs for non-English speaking communities were evaluated to assess primary healthcare concerns that the SEA community face and to suggest long-term solutions to these issues. Initial investigation required researching population-specific minority health statistics to quantify the prevalence of chronic diseases and conditions which were prioritized in terms of needs versus disparities. Research came from evidence base practice guidelines and personal concern …

The Effect Of Health Insurance On Young Adults' Labor Market Outcomes: Evidence From The Affordable Care Act's Dependent Coverage Expansion, Quazi Hassan

Theses and Dissertations

The Affordable Care Act’s dependent coverage mandate extended young adults’ parental coverage to age 26. I study the expansion’s impact on young adults’ labor market outcomes using a control function method. Following the expansion, I find dependent coverage lowered labor force participation, lowered incomes, and mixed evidence regarding labor supply.

Fresh Air: The Impact Of Reformulated Gasoline On Infant Health, Mohammed Husain

Theses and Dissertations

This paper considers a 1996 Reformulated Gasoline program, where gasoline emissions were regulated in California, to observe the effects on infant health indicators. I use a cross-county analysis to find significant effects from the policy that suggests an improvement in birth weight, gestational length, and infant mortality.