The cost of insuring the uninsured in the U.S.

Objectives: This study included two overarching objectives. Through a systematic review of the literature published between 1990 and 2012, the first objective aimed to assess whether insuring the uninsured would result in higher costs compared to insuring the currently insured. Studies that quantified the actual costs associated with insuring the uninsured in the U.S. were included. Based upon 2009 data from the Medical Expenditure Panel Survey (MEPS), the second objective aimed to assess and compare the self-reported health of populations with four different insurance statuses. The second part of this study involved a secondary data analysis of both currently insured and currently uninsured individuals who participated in the MEPS in 2009. The null hypothesis was that there were no differences across the four categories of health insurance status for self-reported health status and healthcare service use. The alternative hypothesis was that were differences across the four categories of health insurance status for self-reported health status and healthcare service use. Methods: For the systematic review, three databases were searched using search terms to identify studies that actually quantified the cost of insuring the uninsured. Thirteen studies were selected, discussed, and summarized in tables. For the secondary data analysis of MEPS data, this study compared four categories of health insurance status: (1) currently uninsured persons who will become eligible for Medicaid under the Patient Protection and Affordable Care Act (PPACA) healthcare reforms in 2014; (2) currently uninsured persons who will be required to buy private insurance through the PPACA health insurance exchanges in 2014; (3) persons currently insured under Medicaid or SCHIP; and (4) persons currently insured with private insurance. The four categories were compared on the basis of demographic information, health status information, and health conditions with relatively high prevalence. Chi-square tests were run to determine if there were differences between the four groups in regard to health insurance status and health status. With some exceptions, the two currently insured groups had worse self-reported health status compared to the two currently uninsured groups. Results: The thirteen studies that met the inclusion criteria for the systematic review included: (1) three cost studies from 1993, 1995, and 1997; (2) four cost studies from 2001, 2003, and 2004; (3) one study of disabilities and one study of immigrants; (4) two state specific studies of uninsured status; and (5) two current studies of healthcare reform. Of the thirteen studies reviewed, four directly addressed the study question about whether insuring the uninsured was more or less expensive than insuring the currently insured. All four of the studies provided support for the study finding that the cost of insuring the uninsured would generally not be higher than insuring those already insured. One study indicated that the cost of insuring the uninsured would be less expensive than insuring the population currently covered by Medicaid, but more expensive to insure than the populations of those covered by employer-sponsored insurance and non-group private insurance. While the nine other studies included in the systematic review discussed the costs associated with insuring the uninsured population, they did not directly compare the costs of insuring the uninsured population with the costs associated with insuring the currently insured population. For the MEPS secondary data analysis, the results of the chi-square tests indicated that there were differences in the distribution of disease status by health insurance status. As anticipated, with some exceptions, the uninsured reported lower rates of disease and healthcare service use. However, for the variable attention deficit disorder, the uninsured reported higher disease rates than the two insured groups. Additionally, for the variables high blood pressure, high cholesterol, and joint pain, the currently insured under Medicaid or SCHIP group reported a lower rate of disease than the two currently insured groups. This result may be due to the lower mean age of the currently insured under Medicaid or SCHIP group. Conclusion: Based on this study, with some exceptions, the costs for insuring the uninsured should not exceed healthcare-related costs for insuring the currently uninsured. The results of the systematic review indicated that the U.S. is already paying some of the costs associated with insuring the uninsured. PPACA will expand health insurance coverage to millions of Americans who are currently uninsured, as the individual mandate and insurance market reforms will require. Because many of the currently uninsured are relatively healthy young persons, the costs associated with expanding insurance coverage to the uninsured are anticipated to be relatively modest. However, for the purposes of construing these results, it is important to note that once individuals obtain insurance, it is anticipated that they will use more healthcare services, which will increase costs. (Abstract shortened by UMI.)^

Cancer screening behaviors among Asian Americans in Houston, Texas

Background: Cancer is the second-leading cause of death in the United States, and Asian Americans/Pacific Islanders are the only racial/ethnic group for which cancer is the leading cause of death. Regular cancer screenings help to identify precancerous lesions and cancer at an earlier stage, when the cancer is more treatable. Ethnic disparities in participation in cancer screenings are also striking, and evidence indicates that Asian Americans may have lower rates of cancer screening participation than other racial/ethnic groups. The Health of Houston Survey 2010 (HHS 2010) is an address-based survey, administered via telephone, website, and mail, of over 5,000 respondents in Houston and Harris County that provides recent data on the health status and needs of the Houston community. HHS 2010 researchers oversampled for Asians and Vietnamese Americans in order to obtain a sample size large enough to obtain statistical power. This dataset provides a unique opportunity to examine the cancer screening behaviors and predictors of Vietnamese and Chinese Americans living in Houston, Texas.^ Methods: This study was a secondary data analysis of HHS 2010 data. The data were analyzed to compare the breast, cervical, and colorectal cancer screening compliance rates of Vietnamese and Chinese Americans with other racial/ethnic groups in Houston, Texas. Key predictors of participation and barriers to cancer screening were identified.^ Results: The results of this study indicate that in Houston, Vietnamese Americans and Asian Americans as a whole have strikingly lower rates of participation in cancer screenings compared to other ethnic groups. Chinese Americans had the highest rate of noncompliance for mammography of all ethnic groups; Asian Americans and Vietnamese Americans also had high rates of noncompliance. Similarly, Vietnamese and Asian Americans had high rates of noncompliance with colorectal cancer screening recommendations. Importantly, Vietnamese, Chinese, and Asian Americans had by far the worst pap test participation, with noncompliance rates more than double that of all other racial/ethnic groups. In general, the findings indicated several key predictors in cancer screening behaviors, including English language proficiency, years lived in the United States, health insurance, college education, and income; however, the significance and patterns of these variables varied by ethnic group as well as cancer site.^ Conclusions: This secondary analysis highlights the disparities in cancer screening participation among Vietnamese, Chinese, and Asian Americans in Houston, Texas and indicate the need to identify Asian Americans as a high-risk group in need of health promotion attention. Barriers to screening and educational needs appear to be specific to each target ethnic group. Thus, health educators and health professionals in Houston must focus on the specific educational needs of the key ethnic groups that make up the Houston population. Further, more ethnic-specific research is needed to examine the health behaviors and needs of Houston's Asian American subgroups.^

Clostridium difficile infection (CDI) in HIV-positive patients

The main aim of this study was to look at the association of Clostridium difficile infection (CDI) and HIV. A secondary goal was to look at the trend of CDI-related deaths in Texas from 1999-2011. To evaluate the coinfection of CDI and HIV, we looked at 2 datasets provided by CHS-TDSHS, for 13 years of study period from 1999-2011: 1) Texas death certificate data and 2) Texas hospital discharge data. An ancillary source of data was national level death data from CDC. We did a secondary data analysis and reported the age-adjusted death rates (mortality) and hospital discharge frequencies (morbidity) for CDI, HIV and for CDI+HIV coinfection.^ Since the turn of the century, CDI has reemerged as an important public health challenge due to the emergence of hypervirulent epidemic strains. From 1999-2011, there has been a significant upward trend in CDI-related death rates; in the state of Texas alone, CDI mortality rate has increased 8.7 fold in this time period at the rate of 0.2 deaths per year per 100,000 individuals. On the contrary, mortality due to HIV has decreased by 46% and has been trending down. The demographic groups in Texas with the highest CDI mortality rates were elderly aged 65+, males, whites and hospital inpatients. The epidemiology of C. difficile has changed in such a way that it is not only staying confined to these traditional high-risk groups, but is also being increasingly reported in low-risk populations such as healthy people in the community (community acquired C. difficile), and most recently immunocompromised patients. Among the latter, HIV can worsen the adverse health outcomes of CDI and vice versa. In patients with CDI and HIV coinfection, higher mortality and morbidity was found in young & middle-aged adults, blacks and males, the same demographic population that is at higher risk for HIV. As with typical CDI, the coinfection was concentrated in the hospital inpatients. Of all the CDI-related deaths in USA from 1999-2010, in the 25-44 year age group, 13% had HIV infection. Of all CDI-related inpatient hospital discharges in Texas from 1999-2011, in patients 44 years and younger, 17% had concomitant HIV infection. Therefore, HIV is a possible novel emerging risk factor for CDI.^

Associations of perceived body image and subjective social status with levels of physical activity in Mexican American adolescents

The current study is a secondary data analysis of a prospective cohort study that examined demographic and psychosocial variables and their associations with physical activity levels in Mexican-American adolescents in Houston, Texas. Body image, subjective social status, and anxiety were the main variables of interest. The sample included 952 unrelated Mexican-American adolescents in Houston, Texas. The majority (84.2%) of the study population did not meet physical activity standards prescribed by the CDC.^ In a multivariate model controlling for age, socioeconomic status, gender, general body image, preferred body image, subjective social status, and anxiety, gender and subjective social status were found to be the strongest determinants of physical activity levels. Males and those with a high subjective social status were more likely to participate in physical activity than those with low subjective status. Lower levels of anxiety and a more positive body image were also found to be associated with higher levels of physical activity. In multivariate analyses gender and subjective social status showed the strongest associations with physical activity.^

Exploring parental factors and their influence on early adolescent sexual health

Black and Hispanic youth experience the largest burden of sexually transmitted infections, teen pregnancy, and childbirth (Hamilton, Martin, & Ventura, 2011). Minority youth are disporportionately more likely to sexually debut at every age and debut before the age of 13 compared to whites (Centers for Disease Control and Prevention, 2011). However, there is little known about pre-coital sexual activity or protective parental factors in early adolscent minority youth. Parental factors such as parent-child communication and parental monitoring influence adolescent sexual behaviors and pre-coital sexual behaviors in early adolescence. Three distinct methods were used in this dissertation. Study one used qualitative methods, semi-structured, in-depth, individual interviews, to explore parent-child communication in African American mother-early adolescent son dyads. Study two used quantitative methods, secondary data analysis of a cross sectional study, to conduct a moderation analysis. For study three, I conducted a systematic review of parent-based adolescent sexual health interventions. Study one found that mothers feel comfortable talking about sex with adolescents, provide a two-prong sexual health message, and want their sons to tell their when they are thinking of having sex. Study found that parental monitoring moderates the relation between parent-child communication and pre-coital sexual behaviors. Study three found that interventions use a variety of theory, methods, and strategies and that no parent-based programs target faith-based organizations, mother-son or father-daughter dyads, or parents of LGBTQ youth. Adolescent sexual health interventions should consider addressing youth-to-parent disclosure of sexual activity or intentions to debut, addressing both parent-child sexual health communication and parental monitoring, and using a theoretical framework.^

Reciprocidades nas relações de interdependência: cooperação internacional em saúde

O presente estudo visa analisar o contexto internacional na produção estratégica de insumos nucleares para a área da saúde e como o processo de crescente interação política entre os países influencia na tomada de decisão dos gestores dos sistemas nacionais de saúde, tendo em vista a importância de alcançarem maiores graus de autonomia frente aos oligopólios mundiais que dominam a produção de equipamentos para a saúde. Neste contexto, utilizou-se a abordagem teórica fornecida pelo estudo do Complexo Industrial em Saúde (GADELHA, 2003), que fornece elementos para discutir a interação entre o sistema de saúde e o sistema econômico-industrial, mostrando a dicotomia existente na relação entre ambos, que se exprime na deterioração do potencial de inovação do país e na vulnerabilidade externa da política de saúde. Para tanto, a escolha pela investigação do caso empírico de criação do Reator Multipropósito Brasileiro se deu pelo envolvimento de diferentes setores institucionais no processo e que influenciam diretamente na estruturação de um parque de alta densidade tecnológica e científica ligado à área da saúde que poderiam elevar o país a um patamar diferenciado em termos de cooperação internacional e estratégia geopolítica. Os métodos utilizados incluíram pesquisa bibliográfica sobre o tema e análise de dados secundários que circundam o processo de incorporação da tecnologia estudada

Predicting Children’s Early School Outcomes from their Social-Regulatory Profiles: A Person-Centered Approach

Thesis (Ph.D.)--University of Washington, 2016-06

The High Frequency Component of Heart Rate Variability and Delta EEG Power during Sleep in Healthy Women and Women with Irritable Bowel Syndrome

Thesis (Ph.D.)--University of Washington, 2016-06

The consumption of alcohol by Australian adolescents: A comparison of revenue and expenditure

Aims: To estimate (i) Australian government taxation revenue collected from the consumption of alcohol by adolescents and (ii) the amount spent by the government on interventions aimed at educating adolescents about the potential dangers of alcohol use. Design: Secondary data analysis. Setting: Australia. Findings: Australian adolescents (aged between 12 and 17 years, inclusive) spent approximately $217 million on alcoholic beverages in 2002, netting the Australian government approximately $112 million in tax revenue. This resulted in an average of $195 earned in tax per adolescent drinker. It is estimated that the Government spent approximately $17 million on adolescent drinking interventions in 2002, equating to an expenditure of about $10.51 per adolescent on the delivery of alcohol interventions. For every dollar spent on alcohol interventions aimed at adolescents, it is estimated that the government receives around $7 in alcohol tax revenue. Conclusions: A substantial disparity exists between the amount of tax revenue received by the Australian Government from adolescent drinkers and the overall amount spent in attempting to prevent and relieve some of the problems associated with adolescent problem drinking. (c) 2006 Elsevier Ltd. All rights reserved.

Greening operations: an investigation of environmental decision making

This PhD thesis belongs to three main knowledge domains: operations management, environmental management, and decision making. Having the automotive industry as the key sector, the investigation was undertaken aiming at deepening the understanding of environmental decision making processes in the operations function. The central research question for this thesis is ?Why and how do manufacturing companies take environmental decisions? This PhD research project used a case study research strategy supplemented by secondary data analysis and the testing and evaluation of a proposed systems thinking model for environmental decision making. Interviews and focus groups were the main methods for data collection. The findings of the thesis show that companies that want to be in the environmental leadership will need to take environmental decisions beyond manufacturing processes. Because the benefits (including financial gain) of non-manufacturing activities are not clear yet the decisions related to product design, supply chain and facilities are fully embedded with complexity, subjectivism, and intrinsic risk. Nevertheless, this is the challenge environmental leaders will face - they may enter in a paradoxical state of their decisions – where although the risk of going greener is high, the risk of not doing it is even higher.

Designing post-disaster supply chains:learning from housing reconstruction projects

Post-disaster housing reconstruction projects face several challenges. Resources and material supplies are often scarce; several and different types of organizations are involved, while projects must be completed as quickly as possible to foster recovery. Within this context, the chapter aims to increase the understanding of relief supply chain design in reconstruction. In addition, the chapter is introducing a community based and beneficiary perspective to relief supply chains by evaluating the implications of local components for supply chain design in reconstruction. This is achieved through the means of secondary data analysis based on the evaluation reports of two major housing reconstruction projects that took place in Europe the last decade. A comparative analysis of the organizational designs of these projects highlights the ways in which users can be involved. The performance of reconstruction supply chains seems to depend to a large extent on the way beneficiaries are integrated in supply chain design impacting positively on the effectiveness of reconstruction supply chains.

Investigating the current and future use of it by 3PL providers in europe and the far east

The paper investigates the role of current and future IT applications in 3PL services in Europe and the Far East. For clients' competitive advantage, 3PL providers increasingly contribute IT systems to logistics, helping 3PL providers to enhance supply chain collaboration with business partners. Through qualitative interviews, questionnaires and secondary data analysis, common attributes of both regions' IT systems are identified which enable supply chain partners to collaborate and share information. Most companies already implement IT systems for processing transactions, but recognized motivations and barriers remain, since 3PL providers incompletely understand clients' IT requirements. Long-term productivity gains require sophisticated IT systems to streamline cycles and improve supply chain visibility, thus facilitating planning and decision-making.

Correlates of voluntary HIV testing and counseling among middle aged and older Latinas

This study identifies and describes HIV Voluntary Counseling and Testing (VCT) of middle aged and older Latinas. The rate of new cases of HIV in people age 45 and older is rapidly increasing, with a 40.6% increase in the numbers of older Latinas infected with HIV between 1998 and 2002. Despite this increase, there is paucity of research on this population. This research seeks to address the gap through a secondary data analysis of Latina women. The aim of this study is twofold: (1) Develop and empirically test a multivariate model of VCT utilization for middle aged and older Latinas; (2) To test how the three individual components of the Andersen Behavioral Model impact VCT for middle aged and older Latinas. The study is organized around the three major domains of the Andersen Behavioral Model of service use that include: (a) predisposing factors; (b) enabling characteristics and (c) need. Logistic regression using structural equation modeling techniques were used to test multivariate relationships of variables on VCT for a sample of 135 middle age and older Latinas residing in Miami-Dade County, Florida. Over 60% of participants had been tested for HIV. Provider endorsement was found to he the strongest predictor of VCT (odds ration [OR] 6.38), followed by having a clinic as a regular source of healthcare (OR=3.88). Significant negative associations with VCT included self rated health status (OR=.592); Age (OR=.927); Spanish proficiency (OR=.927); number of sexual partners (OR=.613) and consumption of alcohol during sexual activity (.549). As this line of inquiry provides a critical glimpse into the VCT of older Latinas, recommendations for enhanced service provision and research will he offered.

Substance use and sexual risk behaviors among adolescent detainees

There is a commonly presumed link among sexual risk behavior, substance use, and other psychosocial factors among adolescents. However, these relationships have been relatively understudied in detained, low-income, minority, substance abusing adolescents. This study addresses this gap in the literature with a secondary data analysis based on a sample of adolescent offenders in two detention and treatment centers in Miami-Dade County. Univariate, bivariate statistical analysis and multivariate logistic regressions were conducted on baseline data from structured interviews with 455 adolescents participating in an NIH funded prevention intervention. Data were analyzed to assess relationships among self-reported substance use, STD history, HIV/AIDS knowledge, condom use, condom use attitudes, and skills, peer and parental approval to use condoms, and race/ethnicity. The adolescent sample was 74.1% male, and 25.9% female and 35.4% African American, 25.1% non-African American Latino, 11.2% White, and 28.4% of other race/ethnicity categories. The mean age was 15.6 years. Results suggested that alcohol use (p < 0.001) and use of marijuana, cocaine and other drugs (p < 0.001) are significant variables when explaining the variability in sexual risk behaviors. Results also suggested that unprotected vaginal, anal, and oral sex increased with higher alcohol and drug use (p < 0.001) and that positive attitudes about personally using condoms (p < 0.001) were also significantly related to condom use. Logistic regressions showed that race/ethnicity was a significant control variable when explaining the variability of condom use. Being White and Latino were significantly associated with less condom use during oral and anal sex when compared to other racial/ethnic groups. These results indicated that risky sexual behavior and HIV infection risk are significantly associated with substance use, particularly alcohol use. Therefore, proper screening and identification of alcohol use, and condom use attitudes could maximize the efficacy of referrals to programs targeting both issues and increase the potential for appropriate primary and secondary prevention and treatment among adolescent detainees.

Socioemotional outcomes of children sexually abused during early childhood

This study investigated the nature and impact of the sexual abuse of children ages birth through 6 years. The purpose was to enhance knowledge about this understudied population through examination of: (1) characteristics of the abuse; (2) socioemotional developmental outcomes of young victims; and (3) potential moderating effects of family dynamics. An ecological-developmental theoretical framework was applied. Secondary data analysis was conducted using data collected from the consortium Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). A sample of 250 children was drawn from LONGSCAN data, including children who were sexually abused (n=125) and their nonabused counterparts (n=125), matched on demographic variables. Results revealed that young victims of sexual abuse were disproportionately female (91 girls; 73%). The sexual abuse committed against these youngsters was severe in nature, with 111 children (89%) experiencing contact offenses ranging from fondling to forcible rape. Sixty-two percent of child victims demonstrated borderline, clinical, or less than adequate functioning on normative, expected socioemotional outcomes. Child victims reported low degrees of perceived competence and satisfaction in the social environment. When compared with their nonabused counterparts, child victims demonstrated significantly poorer socioemotional functioning, as evidenced by aggressive behaviors, attention and thought problems. Sexually abused youngsters also reported lower self-perceptions of cognitive and physical competence and maternal acceptance. Family dynamic factors did not significantly moderate the relationships between abuse and socioemotional outcomes, with one exception. The caregivers’ degree of empathy for their children had a significant moderating effect on the children’s social problems. This study contributes to an otherwise scant body of literature on the sexual abuse of preschoolers. Findings provide implications for social work practice, especially in the development of assessment and prevention strategies.