<p>The 2001 destruction of the World Trade Center and the subsequent anthrax attacks highlighted the inability of an antiquated public health system in the United States to respond effectively to emergencies. Little documentation exists to define how public health agencies can improve performance. The overarching research question was the extent to which drills and exercises improve performance in public health emergencies. Adult learning theory and deliberate practice theory were explored in this context. The research data were from 50 state public health departments, which were required to report performance information to the U.S. Centers for Disease Control and Prevention. The data were examined using Poisson analysis and logistic regression. Results indicated that drills and exercises had no statistically significant impact on public health performance for the 3 performance measures examined; of all predictors, what explained the most variance in reaching performance targets was the number of real emergencies to which a health department had responded in the past. Performing drills and exercises did not predict the likelihood of reaching performance targets. These findings have implications for positive social change for Congressional leaders and other government representatives. Such public servants could use this information to guide their efforts to redirect public health emergency preparedness funds away from drills and exercises and toward other fundamental public health activities. These more focused efforts could facilitate the improvement of public health laboratory capacity, the training of field epidemiologists, and the advancements in technology for enhanced reporting and surveillance. </p>

<p> This dissertation provides an analysis and evaluation of factors influencing states to enact inpatient health care transparency laws between 1971 and 2006 inclusive, using event history analysis. The primary research question investigates "What factors influence a state legislature to enact a health care transparency law?" To narrow the scope of study, I focus on factors influencing states to enact health care transparency laws to collect and publicly report inpatient data. </p><p> The Unified Model of State Policy Innovation, developed by F.S. Berry and W.D. Berry (1990, 1999), provides the framework for the study hypotheses and the analysis of inpatient health care transparency law enactments by states. The Unified Model of State Policy Innovation posits a unified explanation for state policy adoptions. The model unifies the internal determinants and regional diffusion approaches of analysis for state policy adoption. </p><p> This study tests eight hypotheses using event history analysis (EHA). EHA is an analytical technique that allows for the testing of a state government innovation theory that incorporates internal determinants and regional influences on state policy adoption. Although there are numerous methods to conduct event history analysis, this study uses the Cox proportional hazards model (also known as Cox regression). Cox regression is a popular method for studying time-to-event data for policy adoption and diffusion studies. This study's quantitative analysis provides support for legislative ideology and unified party control of state government acting as factors influencing inpatient health care transparency law enactments by states. Additionally, the health care crisis and neighbors variables were statistically significant, but in an opposite direction than predicted. </p><p> The findings of this research suggest that state adopters of an inpatient health care transparency law are more likely to enact an inpatient health care transparency law when the state government is increasing in liberalism and when unified political party control of the governor and the governorship of both houses of the state legislature is increasing. </p><p> To generate new insights into the enactment of inpatient health care transparency laws, I conduct a case study of a national health care data professional association using several techniques, including telephone interviews. The qualitative analysis provides support for professional associations and policy champions as diffusion agents for inpatient health care transparency law enactments by states. </p><p> This dissertation supports variables traditionally used in policy adoption research including legislative ideology and unified political party control in state government. However, it will be interesting to see whether internal determinants such as professional associations gain traction over the traditional regional diffusion influences such as states sharing borders as factors influencing state policy adoption. Meanwhile, as evidenced in this study, there continues to be support for a model incorporating both internal and regional influences to explain policy adoption by states. The theory of policy innovation and diffusion to predict the factors influencing the spread of policies and the use of Berry &amp; Berry's (1990, 1999) Unified Model of State Policy Innovation prosper as their applicability to numerous public policy areas, including health care, are continually demonstrated. Similarly, event history analysis and specifically the Cox regression method continue to gain support as their value as analytical methods and appropriateness for use in public policy studies is repeatedly demonstrated. </p><p> The outlook for the future of the health care transparency movement looks promising. The health care transparency movement promotes improved access to information, patient empowerment, improved patient safety and quality of care, improved provider accountability, and lower health care costs. This movement is not a fad, but rather a permanent change being implemented in all health care settings across the United States. Improved health through reliable, accessible data and data-supported decisions is increasingly becoming the norm and less an idealistic scenario to be realized in the distant future. </p>

<p> There is an emerging consensus among public health practitioners and policymakers alike that, given the existence of shared risk factors, the treatment of food insecurity and obesity requires integrated research and policy action. Referred to as the <i>food systems approach</i>, this perspective applies an ecological public health model for the conceptualization of the shared food environments from which food insecurity and obesity stem, and identifies opportunities for intervention centered on the promotion of healthy and sustainable food systems. One such food systems-based intervention that has garnered significant support is the redemption of the Supplemental Nutrition Assistance Program (SNAP) benefits at farmers' markets. However, the vast majority of studies that have examined the implementation of SNAP at farmers' markets have been conducted within a single market and have been designed to measure program impact, rather than the contextual determinants of program adoption and success. This study operationalizes the food systems approach and ecological model in order to examine the relationship between the implementation of SNAP at farmers' markets and macro-level physical food environment characteristics. Results indicate that the prevalence of SNAP-authorized farmers' markets is positively related to food system characteristics relating to local food production and distribution. The findings of this study contribute to the legitimacy of the food system approach and its application of an ecological public health model in the identification, formulation, and implementation of interventions designed to combat food insecurity and obesity. When enriched by the science of food environment assessment and measurement, the ecological model employed by the food systems approach provides a suitable framework for the systematic analysis of the macro-environmental context in which food systems-based interventions are implemented.</p>

<p> <b>Purpose:</b> Empirical evidence on impact of CABG report cards on the quality of CABG surgery is patchy, mixed and mainly comes from uncontrolled and short term studies. CABG report cards are associated with a small decline in mortality after controlling for an overall declining trend. Whether report card publication has caused this decline is not known. </p><p> <b>Methods:</b> I use difference-in-differences and difference-in-differences-in-differences with fixed and random effects in OLS, Logistic, FGLS and GMM regression frameworks in a quasi-experiment set up in State-level and patient-level HCUP data with risk-adjustment to assess long term impact of CABG report cards on CABG mortality and provider market share and volume. This study uses counterfactuals, and multiple States as treatment and control States. </p><p> <b>Results:</b> CABG shows steadier and 17% steeper decline in in-hospital mortality rate when compared with other equally complex surgeries, and 30% steeper improvement when compared with pneumonectomy. There is a strong secular and statistically significant trend of decreasing CABG mortality. States with and without report cards were similar in terms of CABG mortality at baseline. We do not see long term impact of CABG report cards, State-mandated or voluntary, on CABG in-hospital mortality. Nevertheless, report cards have caused a gain in market share of 6% and 5% for low mortality hospitals and surgeons respectively in face of a secular trend of rising market share of average mortality hospitals and surgeons. CABG report card policy was also associated with decrease in hospital volume by 152 surgeries and decrease in surgeon volume by 14 surgeries a year over and above the secular trend of declining CABG volumes. </p><p> <b>Conclusions:</b> Concurrent Society of Thoracic Surgeons intiative and spillover of effects across States may explain why we do not see impact of CABG report cards in long term on improvements in quality of CABG surgery. National and regional system interventions with State CABG report cards appear to have created a perfect storm leading to a rising tide of CABG quality which has benefitted all States. It appears the report cards are associated with a change in today's culture of medicine biased in favor of interventions and procedures.</p>

<p> As the rates of breast cancer continue to increase, researchers and medical professionals struggle to give a definitive cause of the disease or find a cure. Unfortunately, it seems that the chance of having a cancer diagnosis within one's lifetime is only increasing. Since breast cancer is somewhat unpredictable, the medical field has taken the pathway of attempting to minimize the risk of mortality through regular screening mammograms. Even with multiple initiatives to increase mammogram utilization, multiple demographic factors such as race, income status, and insurance coverage continue to be underserved. The present study will focus on income status and insurance coverage as barriers to regular screening mammograms. It is hypothesized that those women with low-income status and no insurance coverage are less likely to receive regular screening mammograms than those women with higher income and some type of insurance. After completing a statistical analysis, both hypotheses were supported.</p>

<p>This study analyses the relationship between the manner of citizens&rsquo / engagement with the state and the level of service delivery they experience in their everyday lives, as residents of Khayelitsha. The phenomena of so-called &lsquo / service delivery&rsquo / protests across South Africa have now become a fixture of South African politics. Khayelitsha is one of the sites with frequent protests in Cape Town and is inhabited by poor people, 70 percent of whom live in informal settlements. While the lack of municipal services is undoubtedly a major problem for many poor people in South Africa, thus&nbsp / far, few studies have been dedicated to investigate empirically this alleged link between service delivery and protest activity. The study utilizes mostly quantitative analysis techniques such as&nbsp / regression analysis and path analysis to discover the form and strength of linkages between the service delivery and participation forms. While residents of informal settlements and therefore&nbsp / poorer services were more prone to engage in protests and thus reinforcing the service delivery hypothesis, this relationship was relatively weak in regression analysis. What is more important than the service delivery variables such as water services was the level of cognitive awareness exemplified by the level of political engagement and awareness on the one hand and level of community engagement in terms of attendance of community meetings and membership of different organizations. In summary the study found relatively weak evidence to support the service&nbsp / delivery hypothesis and stronger evidence for the importance of cognitive awareness and resource mobilization theories in Khayelitsha as the key determinant of protest activity.</p>

<p> Recently, the Centers for Medicare and Medicaid Services (CMS) ranked all hospitals based on Medicare readmission rates for heart attacks, heart failure, and pneumonia. CMS offered subsidies to hospitals ranked in the 4th quartile to develop community support services to reduce the problem of potentially preventable readmissions (PPRs). CMS cited 4 of the 5 hospitals in Prince George's County in the 4th quartile. The purpose of this quantitative research study was to investigate the relationship between community support services and the reduction of PPRs in Prince George's County. The Evans and Stoddart field model of health and well-being guided this study with support from Bertalannffy's general systems theory. This study sought to relate community support services to PPRs in Prince George's County in contrast to other Maryland counties. To evaluate relationships between community support services and the reduction of PPAs, secondary data were provided by CMS in conjunction with the Robert Wood Johnson Foundation and the University of Wisconsin. The data included 26 behavioral community support factors from 53,229 Medicare paid claims in Maryland residents from July 1, 2008 to June 30, 2011. Lack of diabetes screening is a community support factor within quality of care. Using multiple regressions, there was a statistically significant relationship found between diabetic screenings and pneumonia readmission rate. The implication for social change is that reimbursement of key screening recommendations to CMS, local government, and hospitals in Prince George's County may reduce readmission rates, thereby positively affecting patients, improving community health, and decreasing health care costs in Prince George's County.</p>

This paper conducts rankings on political science and public administration journals based on a database of citations for all articles within a set of 200 journals, during 2010-2013. This paper contributes to prior literature within the realm of Political Science, by tabulating journal rankings through non-traditional means. While rankings of political science and public administration journals have traditionally been dominated by a survey-based approach, recent advancements in technology have allowed researchers to conduct more subjective rankings based upon a bibliometric approach. However, the majority of these citational rankings utilize obscure metrics, which do not correspond directly to the number of citations a potential author can expect. This paper attempts to provide readers with more concrete metrics, which translate directly to how many citations an author can expect. This study tabulates journals based on three main metrics: Median Number of Citations, Citation Percentage, and 90th Percentile of Citations. This study identifies Transportation Research Part B, American Political Science Review, International Organization, American Journal of Political Science and Transportation Research Part A, as the top five journals within the set of 200 political science and public administration journals.

<p>Ghana?s democracy has been hailed by scholars, practitioners, and the international community in recent years as a shining example in the West African subregion as a result of the country?s record of organizing successive elections with minimal or no violence. However, the evaluation of Ghana?s democracy has predominantly focused on the elections and disproportionately captures the views of the political elite; conspicuously missing is the perspective of the ordinary Ghanaian. This presents an incomplete picture of Ghana?s democracy, given the relevance of citizens? participation in democratic societies. To address this gap in knowledge, this qualitative case study explored the practice of democracy in Ghana under the fourth republic from the perspective of the citizenry. Data were collected through face-to-face interviews with purposefully sampled ordinary Ghanaian citizens (n = 15), observation, and documents review. The data were then subjected to thematic and content analysis to reveal themes, categories, and patterns. The results revealed that the participating Ghanaians had dichotomous views, opinions, and experiences of democracy. Their experiences and opinions of the electoral system were generally positive, while their experiences and opinions of governance in the intervening years were generally negative. The study?s results should inspire a paradigm shift in the responsiveness of government to citizens and how the government engages with citizens on policy formulation and implementation. This study?s results can encourage positive social change with respect to the manner in which democratic performance is evaluated in Ghana by scholars, practitioners, and the international community.

<p> Obesity in the United States has reached epidemic proportions and is affecting younger generations. Research indicates that media usage contributes to adolescent obesity. Data shows that technology use (television, video games, and computer, etc.) is specifically higher among Latinos than their White counterparts. However, limited research exists on the effects that technology use has on Latino adolescents' adiposity. A cross-sectional baseline analysis was conducted using a sample of (<i>N</i>=131) at-risk Latino middle school adolescents from the Youth Empowerment for Success <i> S&iacute; Se Puede</i> Project. Body fat percent was used as the dependent variable; while television time, video or computer game time, and frequency of personal computer use were the independent variables. Results indicated that only video or computer game time had a positive association with Latino youth body fat percent, even after controlling for socioeconomic status. The implications and limitations of the study are discussed.</p>