In spite of mass media attention and implementation of international laws in the last two decades, modern-day slavery is still active in communities across the globe. Individuals trapped in forced labor situations endure devastating physical and mental illnesses, with dire consequences that extend into families and neighborhoods. The call has been made for every citizen to join in the anti-human trafficking movement. Lawmakers, police, and border patrol officers are on alert in each major U.S. city. Yet, training some of the most valuable stakeholders who work among some of the most vulnerable populations has been largely overlooked. Rural public health workers, specifically promotoras, serving in Texas-Mexico border communities are a key component to activate in the anti-trafficking awareness and prevention efforts in this region. The current research examined the geographic and socioeconomic situation of the colonias in the Rio Grande Valley and the effect of the drug cartel conflict directly across the border. Through an online survey, this study assessed rural public health workers’ knowledge and awareness of human trafficking and educational needs on human trafficking issues. Results of this research indicate that limited education and training of rural public health workers on the topic of human trafficking contribute to the low rate of victim identification in the rural clinic and community settings. Recommendations for immediate training of this strategic population located on our southernmost U.S. border is proposed along with future research.

The overall purpose of this dissertation was to examine evidence of spillover effects of HIV care and treatment service scale up in sub-Saharan Africa in the past decade. Particularly the focus was to quantify any effect HIV treatment initiation by a person living with HIV (PLHIV) may confer health benefits to the HIV negative population by increasing utilization of non-HIV services or reduce mortality risk. This dissertation had three primary aims. The first aim was to conduct a systematic review of the effect of increasing ART uptake in high HIV prevalence communities on use of non-HIV health services, including maternal, child, in/out-patient, non-HIV laboratory, and TB diagnosis and treatment services. Overall positive effects were found on the majority of health service indicators examined for non-HIV laboratory service utilization and Tuberculosis diagnosis and treatment services. We found negative associations on the majority of indicators examined for child health services. The existing evidence did not point to clear tendencies for maternal health services and outpatient and inpatient services. Restricting the sample to studies with stronger study designs for causal inference, the positive effect on non-HIV laboratory services and the negative impact on child health services held but evidence was mixed for TB diagnosis and treatment services, maternal health services and outpatient and inpatient services. The second aim of this dissertation was to conduct regression discontinuity quasi-experiments to determine whether exposure to health benefits from ART utilization by a person living with HIV (PLHIV) in a household affects uptake of TB, hypertension (HTN) and diabetes mellitus (DM) treatment by other household members with these conditions. The study was conducted in the comprehensive population cohort followed by the Africa Health Research Institute (AHRI) in Kwazulu-Natal (KZN), South Africa. We linked PLHIV engaged in HIV care to their cohabitating household members aged ≥15 years using a unique identifier for homesteads. Household ART utilization significantly increased treatment for diabetes (RR 1.90: 95% CI 1.07-3.40) but not for TB (RR 1.12: 95% CI 0.71-2.03) or hypertension (RR 1.31: 95% CI 0.97-1.77). The third aim of this dissertation was to use the same regression discontinuity design and KZN cohort data as in aim 2 to determine whether exposure to health benefits from ART utilization by PLHIV in a household reduces all-cause mortality of other household members. Overall, household ART utilization did not decrease all-cause mortality (Hazard Ratio (HR) 0.95: 95% CI 0.65-1.4), however, restricting the analysis to a narrow CD4+ cell count range around the regression discontinuity threshold showed reduced all-cause mortality by 67% (HR 0.43: 95% CI 0.22-0.85) among household members of PLHIV on ART; the reduced risk was driven largely by the significant reduction noted among female household members (HR 0.21: 95% 0.08, 0.56).

A key factor to the Scottish Governments' public policy and public service reconfiguration is collaborative working between service providers and service users in a framework of co-production. A second key factor in this reform is a place-based approach. Despite this rhetoric of co-production of health services having been used for some time in health policy, and considering the numerous interpretations of the meaning of both co–production and 'place' in the academic and professional literature, how rural dwellers experience rurality in terms of places and space, and how this may in turn affect health and interactions with co-production, remains underrepresented in health policy planning. In light of changes in health service provision, rural health care poses itself as a potentially emotive and sometimes volatile topic. A co-productive approach may encourage understanding, acceptance and better usage of health services and neighbourhood resources, by the residents registered as patients with local medical practices. This doctoral research study considered the use of participatory mapping techniques to generate, gather and capture the local voice of residents from two rural Scottish communities, regarding the self-perception of their health in relation to the place they call home. Through a participatory action research approach, using iterative co-design, residents were asked how their environment impacted on their health, and in particular their cardiovascular health. Qualitative data were collected through participatory mapping techniques and co- analysed using a thematic analysis process. The application of the concept of therapeutic landscapes revealed the importance of the 'sense of place' and its impact on health, along with the physical, social and cultural environmental aspects traditionally considered in public health disciplines. Results were digitised using geographic information systems (GIS) to illustrate the interactions between place, people and health, through a relational lens. This research demonstrates a working example of how, drawing from the discipline of health geography, a place based approach can make an important contribution to rural health service co- planning within a co-production framework.

Thesis (M.S.)--Massachusetts Institute of Technology, Alfred P. Sloan School of Management; and, (M. Arch.)--Massachusetts Institute of Technology, Dept. of Architecture, 1982. / MICROFICHE COPY AVAILABLE IN ARCHIVES AND DEWEY / Includes bibliographical references (leaves 159-160). / by William Aaron Gilchrist. / M.S. / M.Arch.

There is a growing interest in understanding recruitment, retention, and turnover of allied health professionals considering employment trends and workforce mobility, an increased need to understand the healthcare delivery system, and the dynamic nature of the allied health workforce especially for rural areas. A survey was sent to allied health administrators across a variety of allied health disciplines from the state of Tennessee hospitals in order to gauge opinions on retention and recruitment strategies. Overall successful strategies for recruitment and retention of allied health professionals were reported as well as differences between urban and rural areas, differences among allied health disciplines perceptions of strategy effectiveness, and key strategies for rural allied health recruitment.

The rates of non-medical prescription drug use in the United States (U.S.) have increased dramatically in the last two decades, leading to a more than 300% increase in deaths from overdose, surpassing motor vehicle accidents as the leading cause of injury deaths. In rural areas, deaths from unintentional overdose have increased by more than 250% since 1999 while urban deaths have increased at a fraction of this rate. The objective of this research was to test the hypothesis that cultural, economic, and environmental factors prevalent in rural America affect the rate of substance use disorder (SUD) in that population, and that diagnosis of these disorders across rural and urban populations may not be generalizable due to these same effects. This study applies measurement invariance analysis and factor analysis techniques: item response theory (IRT), multiple indicators, multiple causes (MIMIC), and latent class analysis (LCA), to the DSM-IV abuse and dependency diagnosis instrument. The sample used for the study was a population of adult past-year illicit drug users living in a rural or urban area drawn from the 2011-2012 National Survey on Drug Use and Health data files (N = 3,369| analyses 1 and 2; N = 12,140| analysis 3). Results of the IRT and MIMIC analyses indicated no significant variance in DSM item function across rural and urban sub-groups; however, several socio-demographic variables including age, race, income, and gender were associated with bias in the instrument. Latent class structures differed across the sub-groups in quality and number, with the rural sample fitting a 3-class structure and the urban fitting 6-class model. Overall the rural class structure exhibited less diversity and lower prevalence of SUD in multiple drug categories (e.g. cocaine, hallucinogens, and stimulants). This result suggests underlying elements affecting SUD patterns in the two populations. These findings inform the development of surveillance instruments, clinical services, and public health programming tailored to specific communities.

No description available.

Thesis (MBA.) -- University of Limpopo, 2015 / The health profiles and outcomes in South Africa are unsatisfactory, not seeming to improve appreciably, amid the robust reform efforts, policies and strategies. These health challenges comprise largely of preventable conditions, as demonstrated by the quadruple burden of disease. Community participation, including the use of community governance structures in improving community health profiles and outcomes, are alluded to be beneficial in improving these communities` health profiles and outcomes. The main aim of this study was to understand the current and the potential future role and the factors at play, of the community governance structures in managing their communities` health profiles and outcomes, in the Zebediela sub-district, Limpopo, South Africa. A qualitative study was conducted, using the Zebediela sub-district as a case study, where from six out of the potential nine governance structures were interviewed and recorded in focus groups, using a pre-determined discussion guide. The recordings were analysed in-depth for themes, using the consistency matrix and the N-vivo data analysis. The results indicate that, the community governance structures are aware of the unsatisfactory health profiles and outcomes in their communities, but are not doing anything specific towards intervening to improve the situation. However, they are keen and willing to participate in improving the situation and are able to identify the potential role they can play, the skills and resources in themselves and in the communities, including the factors that facilitate and those that impede, their participation together with the recommendations of what can facilitate their participation and efficiency in improving their communities` health profiles and outcomes. The community governance structures represent a good opportunity to improve community health profiles and outcomes, through a specific strategic focus that would empower, support, motivate, strengthen and reinforce their current level of skills, functioning and participation.

Background: As rural hospitals in Kentucky face insolvency, stakeholders must assess the value of rural hospitals as well as alternatives such as rural clinics and private physician offices. Objective: To identify the value of attributes of healthcare facilities based on Kentucky’s rural residents’ willingness-to-pay (WTP). Methods: A survey instrument was created and distributed to ten counties in rural Kentucky. A conditional logit model was used to obtain baseline values and then a mixed logit model was used to address heterogeneity among consumers in estimating WTP. WTP values incorporated respondents’ demographic characteristics and their health status from self-reported frequency of use of medical services and distance from these services. Results: The results indicate that on average respondents were willing to pay $69.90 each year for the attribute of a facility that treats patients whether they have health insurance or not, compared to a facility that only accepts patients with private health insurance. Uninsured residents were willing to pay $81.15 for this attribute level. Conclusion: The study suggests that uninsured residents value this attribute level of a facility that grants them access to care. Stakeholders may justify such welfare benefit amounts in support of the establishment or maintenance of such a facility.

High rates of obesity are seen across the country with rural areas disproportionately affected. Based on the socio-ecological model, policy, system, and environmental approaches targeted at the population level have the potential to create more sustainable health behavior change than individual level approaches. Historically, the Cooperative Extension Service (CES) has provided direct education related to healthy eating and active living in response to high obesity rates. Utilizing the resources and infrastructure of the CES, the Centers for Disease Control challenged CESs across the country to implement PSE strategies in counties with obesity rates greater than 40% through the CDC 1416 High Obesity Project. This qualitative study examined the experiences of Family and Consumer Science (FCS) Cooperative Extension Agents in conducting PSE strategies in addition to their direct education roles within their rural counties in an effort to reduce the high prevalence of obesity. Semi-structured, in-depth interviews with ten FCS Extension agents from Kentucky and Tennessee were conducted upon completion of the project and were analyzed thematically. These FCS agents encountered several barriers while implementing PSE strategies including inadequate training and poor communication regarding responsibilities and available resources. In addition, FCS agents found PSE work to be overwhelming and time consuming. Agents felt that support from project staff and their community partners allowed them to be successful. Findings from this study will be used to better prepare FCS agents in other rural counties across the country to conduct PSE work in an effort to reduce obesity prevalence in their communities.