Health Policy Commons^™

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 …

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 …

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, …

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 …

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 …

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 …

Acceptability, Usability, And Clinical Integration Of A Clinic-Based Digital Game For Hpv Education: Qualitative Perspectives From Adolescents, Parents, And Healthcare Providers, Elizabeth Reifsnider, Satya Subedi, Nouran Ghonaim, Megan Whaley, Angela Chia-Chen Chen

Ellmer School of Nursing Faculty Publications

Background/Objectives: HPV vaccination is safe, effective, and recommended at ages 11–12, yet uptake remains suboptimal. Serious video games may offer an innovative strategy to deliver brief, engaging education during clinic visits. This qualitative paper, embedded within a mixed-methods study, examined adolescents’, parents’, and healthcare providers’ (HCPs’) perceptions of the acceptability, usability, and perceived clinical applicability of HPV Detective, a tablet-based digital game designed to provide HPV-related education to parent–child dyads during pediatric clinic wait times. Methods: Eight adolescent–parent dyads (N = 16) and three HCPs from university-affiliated pediatric clinics participated in 30–60-min semi-structured Zoom interviews. Interviews were audio-recorded, transcribed, and …

The Asymmetric Effect Of Social Connection And The Cumulative Damage Of Comorbidities On Physical And Mental Health Of Older Virginians, Newton Ochoki, Lynn Wiles, Peijia Zha, Vince Falco, Carielle Joy Rio, Jonathan Romero, Leorey N. Saligan

Ellmer School of Nursing Faculty Publications

Objectives

This study explored relationships of social connection with physical and mental health in older adults, specifically examining the effects of comorbidities on these relationships and the influence of sociodemographic variables on the strength of these associations.

Methods

This cross-sectional study enrolled 174 community-dwelling adults aged 60 years and older residing in Hampton Roads, Virginia, USA. Data were collected from April to August 2025. Hierarchical linear regression analyses examined the associations of social connection with physical and mental health. Moderated mediation analysis examined if comorbidities mediated these relationships and whether sociodemographic factors moderate the strengths of these associations.

Results

In …

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 …

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, …

Organ Chips And Translational Research: Identifying And Examining New Ethical Issues, Melanie Jeske

Center for Medical Ethics and Health Policy Staff Publications

Organ chips, also known as organ-on-a-chip devices, tissue chips, or microphysiological systems, have emerged over the last decade as a promising translational technology amidst growing concern about the translational crisis between laboratory research and patient bedside. Pointing to high rates of failure between nonhuman animal models and safety and efficacy in humans, organ chips and similar new approach methods have attracted substantial public and private investment. As human-cell-based alternatives to animal models, organ chips promise more predictive, efficient, and ethical platforms for pharmaceutical and toxicity testing. Engineered cultivation systems that enable cells to assemble into tissue-like structures (e.g. kidney, brain, …

Anything But Endo: Diagnostic Buck-Passing In Endometriosis Diagnosis, Rita Dexter, Megan Kitts, Heather Welty, Melanie Jeske

Center for Medical Ethics and Health Policy Staff Publications

People living with endometriosis, a disease in which tissue similar to the lining of the uterus grows elsewhere in the body, often experience prolonged diagnostic journeys because of symptom variability, normalisation of period pain and other symptoms, and lack of awareness of the condition. In this article, we analyse the endometriosis diagnostic journey through the lens of epistemic injustice. Drawing on in-depth interviews with 52 people living with endometriosis in the United States, we introduce the concept of diagnostic buck-passing to characterise the phenomenon wherein individuals who seek treatment for their symptoms end up stuck in a cycle of seeing …

Can I Get A Witness? The Ethical Dimensions Of Family Presence In Patient Suffering, Jennifer Blumenthal-Barby, Trevor M Bibler, Holland Kaplan, Adam Omelianchuk, Joanna Smolenski

Center for Medical Ethics and Health Policy Staff Publications

For patients who are suffering, the bedside presence of a family member can provide comfort, and many people hold that there is moral value in being present with a conscious, suffering patient. Yet what is the moral significance of the absence of family members when a patient is minimally conscious or unconscious and not aware of their absence? Clinicians are often troubled when family members and surrogate decision-makers who are able to spend a significant amount of time at an unconscious, seriously ill patient's bedside do not do so. Clinicians feel frustrated that they must bear the burden of witnessing …

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 …

Policy Snapshot : Health Insurance Trends Among Child Care Educators, Sara Amadon

Straus Institute for Thriving Children & Families

This brief compares the health insurance status of child care educators in 2019 and 2024—spanning the COVID-19 pandemic and preceding 2026H.R.1’s implementation—to highlight shifting coverage patterns and state-level solutions to safeguard this essential workforce.

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 …

Association Between Neighborhood Social Determinants Of Health And Stillbirth, Tetsuya Kawakita, Misa Hayasaka, Ann M. Harper, John Brush, George Saade

Department of Obstetrics & Gynecology Faculty Publications

OBJECTIVE:

To examine the association between neighborhood-level social determinants of health and stillbirth.

METHODS:

We performed a retrospective cohort study of deliveries that occurred at a gestational age of at least 20 weeks within a five-hospital system (2012-2022). Electronic health record data mapped to the Observational Medical Outcomes Partnership Common Data Model were geocoded using addresses at the time of delivery and linked to neighborhood health indices, which included the Area Deprivation Index (ADI), Maternal Vulnerability Index (MVI), and Social Vulnerability Index (SVI) at the Census tract level. Stillbirths were adjudicated by medical record review. Modified Poisson regression generated relative …

Mediating Effect Of Social Determinants Of Health Between Race And Phthalate Biomarkers In Pregnancy, Tetsuya Kawakita, Misa Hayasaka, Carole Barake, Trinity Soto, Jillian Fleming, Amir Lueth, Stevens Danielle, Alfred Abuhamad, Ann Pryzybylska, Elena Sinkovskaya, Kelly K. Ferguson, George Saade

Department of Obstetrics & Gynecology Faculty Publications

Introduction

Prenatal phthalate exposure is linked to adverse reproductive and developmental outcomes and is consistently higher among non‐Hispanic Black compared to non‐Hispanic White pregnant individuals, yet the factors responsible for these disparities are poorly characterized. We sought to quantify Black–White differences in repeated urinary concentrations of phthalate biomarkers during pregnancy and to estimate the extent to which neighborhood‐level social determinants of health (SDoH) mediate these disparities.

Methods

This secondary analysis used data from the Human Placenta Project Study, a prospective observational cohort study conducted at two academic institutions between 2016 and 2018. Eligible participants had singleton pregnancies, were recruited before …