Vulnerable Populations: Research

The Impact of AIDS Treatment on Savings and Human Capital Investment in Malawi

Feb. 21, 2018

Victoria Baranov and Hans-Peter Kohler

In American Economic Journal: Applied Economics, Hans-Peter Kohler and Victoria Baranov study the impact of antiretroviral therapy (ART), a treatment for AIDS, on savings and human capital investment in Malawi. In particular, they use spatial and temporal differences in ART availability to evaluate the impact of ART provision on cash savings, education expenditures, and children’s schooling.

The authors find that ART availability increases savings, expenditures on education, and children’s schooling significantly, even amongst those who are HIV-negative and thus, do not...

Integrating Social Needs Into Health Care: A Twenty-Year Case Study Of Adaptation And Diffusion

Feb. 14, 2018

Rebecca D. Onie, Risa Lavizzo-Mourey, Thomas H. Lee, James S. Marks, and Rocco J. Perla

In Health Affairs, Rebecca Onie and colleagues, including Risa Lavizzo-Mourey, conduct a twenty-year qualitative case study of Health Leads, an organization that partners with health care institutions and communities to address patients’ basic resource needs, and its funders. The case study demonstrates the successful stages of diffusion, defined as the process by which an innovation is communicated over time within a social system, leading to increased exposure and adoption. The authors segmented the process for Health Leads into five distinct phases:

  1. Testing and
  2. ...

Child Mortality In The US And 19 OECD Comparator Nations: A 50-Year Time-Trend Analysis

Feb. 12, 2018

Ashish P. Thakrar, Alexandra D Forrest, Mitchell G. Maltenfort, and Christopher B. Forrest

In Health Affairs, Christopher Forrest and colleagues analyze mortality trends in the United States and 19 comparator nations for children ages 0-19 from 1961 to 2010. Membership in the Organisation for Economic Cooperation and Development (OECD) was used as a proxy for countries with similar levels of economic development and political structure as the United States.

The authors observed a decline in child mortality in all 20 countries over the 50-year period. Despite this achievement, reductions in mortality rates were not evenly distributed across nations; childhood...

Evaluating the association between the built environment and primary care access for new Medicaid enrollees in an urban environment using Walk and Transit Scores

Jan. 24, 2018

Krisda H. Chaiyachati, Jeffrey K. Hom, Rebecca A. Hubbard, Charlene Wong, and ...

In Preventive Medicine Reports, Krisda Chaiyachati and colleagues, including Jeffrey Hom and David Grande, describe the association between the quality of an individual’s built environment, as reflected by Walk Score™ (a measure of walkability to neighborhood resources) and Transit Score™ (a measure of transit access), with having a usual source of care among low-income adults in Philadelphia. They ascertained usual source of care (other than a hospital or emergency department) with the question: “Is there a particular doctor's office, clinic, health center, or other place that...

Effects Of State Insurance Mandates On Health Care Use And Spending For Autism Spectrum Disorder

Oct. 30, 2017

Colleen L. Barry, Andrew J. Epstein, Steven C. Marcus, Alene Kennedy-Hendricks, Molly K. Candon, Ming Xie and David S. Mandell

In Health Affairs, Colleen Barry and colleagues, including Andrew Epstein, Steven Marcus and David Mandell, examine whether state mandates requiring commercial insurers to cover treatment for children with autism spectrum disorder (ASD) altered service use or spending among commercially insured children with ASD. To date, 46 states and the District of Columbia have enacted such mandates.

The authors compared children age 21 or younger who were eligible for mandates to children not subject to mandates using 2008–12 claims data from three national insurers. They found that...

Early Medicaid Expansion Associated With Reduced Payday Borrowing in California

Oct. 25, 2017

Heidi Allen, Ashley Swanson, Jialan Wang, Tal Gross

In Health Affairs, Heidi Allen and colleagues, including Ashley Swanson, analyzed the impact of California’s early Medicaid expansion under the Affordable Care Act (ACA) on the use of payday loans, a form of high-interest borrowing often used by low- and middle-income households. No studies to date have focused on how health insurance coverage affects the use of alternative financial products. This research is especially important given the documented relationship between poverty, medical debt, and bad credit outcomes.

Using a difference-in-differences research design, the...

Progressive rural-urban disparity in acute stroke care

Aug. 29, 2017

Sergio Gonzales, Michael T. Mullen, Leslie Skolarus, Dylan P. Thibault, Uduak Udoeyo, and Allison W. WIllis

In Neurology, Sergio Gonzales and colleagues, including Michael Mullen and Allison Willis, examine differences in tissue plasminogen activator (tPA) utilization between rural and urban stroke patients. As with many health services, disparities in care based on geographic location or income exist, and rural populations often have little access to medical care. The authors used ten years of hospital discharge data from the National Inpatient Sample and indicators of tPA utilization for acute strokes. They find that, of 914,500 cases, tPA use in urban hospitals was quadruple that of...

Community Health Worker Support For Disadvantaged Patients With Multiple Chronic Diseases: A Randomized Clinical Trial

Research Brief
Aug. 21, 2017

Community health worker interventions hold promise for improving outcomes of low-income patients with multiple chronic diseases.

Substance Use Disorder in America: Research to Practice, and Back Again

Issue Brief
Aug. 3, 2017

These proceedings summarize the insights shared by nationally renowned panels of experts and overall themes discussed throughout the conference. The conference included experts from academia and public and private sectors, who came together to discuss the gaps in evidence-based substance use policy and practice, with particular emphasis on the opioid epidemic. The conference concluded with an interactive session focused on the exchange of ideas and solutions to curb the opioid epidemic​. Those ideas are included here.  

Continuity of Care in Infancy and Early Childhood Health Outcomes

Jul. 14, 2017

Elizabeth Enlow, Molly Passarella, Scott A. Lorch

In Pediatrics, Elizabeth Enlow and colleagues, including Scott Lorch, assess the relationship between provider continuity in infancy, and use of both urgent and preventative health services. Continuity of care is a key aspect of the patient-centered medical home and has been shown to improve pediatric outcomes. The authors hypothesize that increased provider continuity in infancy decreases urgent health care use and increases preventative services use in early childhood. They measured continuity across all primary care encounters during the first year of life for 17,773 infants...

Understanding High Utilization of Unscheduled Care in Pregnant Women of Low Socioeconomic Status

Jul. 14, 2017

Pooja K. Mehta, Tamala Carter, Cjloe Vinoya, Shreya Kangovi, Sindhu K. Srinivas

In Women’s Health Issues, Pooja Mehta and colleagues, including Shreya Kangovi and Sindhu Srinivas, seek to understand maternal preference for unscheduled hospital-based obstetric care, in order to inform interventions and improve value of publicly funded care during pregnancy. Previous research has shown that pregnant high utilizers of unscheduled care may be at particular risk for poor perinatal outcomes; however drivers of this association are unknown. The authors conducted a comparative qualitative analysis of in-depth semi structured interviews. Low-income pregnant women...

Treatment seeking as a mechanism of change in a randomized controlled trial of a mobile health intervention to support recovery from alcohol use disorders

Jul. 10, 2017

Joseph E. Glass, James R. McKay, David H. Gustafson, Rachel Kornfield, Paul J. Rathouz, Fiona M. McTavish, Amy K. Atwood, Andrew Isham, Andrew Quanbeck, Dhavan Shah

In Journal of Substance Abuse Treatment, Joseph Glass and colleagues, including James McKay, assessed the efficacy of an Addiction-Comprehensive Health Enhancement Support System (A-CHESS) in increasing the use of services for addiction. This model is an electronic health framework that has been applied to a diverse set of health problems, including pediatric asthma and breast and lung cancer, and was previously adopted to alcohol addiction in a randomized-controlled trial. The authors conducted secondary data analyses of this trial, including 349 adults with alcohol use disorders...

Training social work students to recognize later-life depression: Is standardized patient simulation effective?

Jul. 5, 2017

Zvi D. Gellis and Eunhae Grace Kim

In Gerontology & Geriatrics Education, Zvi Gellis and Eunhae Grace Kim assess the affect of an educational intervention on social work students' understanding of later-life depression. The authors note that, although social workers are the largest provider of mental health services in the nation, they receive little coursework or clinical training in late-life depression unless they are in a gerontology specialization. The authors developed and completed a Standardized Patient Simulation course with 104 students, and assessed whether the simulation improved student knowledge...

An Assessment of Global Oral Health Education in U.S Dental Schools

Jul. 5, 2017

Janet Sung and Joan I. Gluch

In Journal of Dental Education, Janet Sung and Joan Gluch assess how global health education is currently incorporated into pre-doctoral dental training in the U.S.  In 2015-2016, the authors surveyed 64 accredited U.S dental schools regarding their global health education and competencies, and received responses from 52 of those schools. Most dental school curricula covered social determinants of oral diseases and conditions, how to identify barriers to use of oral health services, and how to work with patients who have limited dental health literacy. But other key areas of...

Coercion or Caring: The Fundamental Paradox for Adherence Interventions for HIV+ People With Mental Illness

Jul. 3, 2017

Marlene M. Eisenberg, Michael Hennessy, Donna Coviello, Nancy Hanrahan, Michael B. Blank

In AIDS and Behavior, Marlene Eisenberg and colleagues, including Nancy Hanrahan and Michael Blank, examine if a high-intensity HIV-treatment intervention would be perceived as coercive by HIV-positive individuals with serious mental illness. Previous research has shown that potentially coercive mandates during the earliest stages of mental health treatment are associated with later treatment benefits. Furthermore, the prevalence of HIV is significantly higher among populations with mental illness. The authors developed an HIV management regimen that utilized advance practice...

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