Objectives. To compare HIV risk behaviours of female street youth involved and not involved in prostitution and to identify predictors of initiation into prostitution. / Methods. Female street youth aged 14--25 years were recruited into a prospective cohort study between January 1995 and March 2000. Parametric and non-parametric methods were used to compare risk factors for HIV infection. Girls with no history of prostitution at baseline were followed prospectively to estimate the incidence of prostitution. Cox regression analysis was used to determine predictors of prostitution. / Results. Significantly higher proportions of girls with a history of prostitution reported engaging in behaviours that put them at risk of HIV infection. Such behaviours included non-injection and injection drug use, unprotected sex and risky sexual partnerships. The incidence rate of prostitution among girls not engaged in prostitution at baseline was 11.5/100 person-years. Independent predictors of initiation into prostitution were being 18 years or younger (Hazard Ratio (HR): 2.2; 95% Confidence Interval (CI): 1.0--4.8), using alcohol everyday (HR: 1.3; 95% CI: 1.1--1.5) and using at least three types of drugs (HR: 5.4; 95% CI: 1.6--18.4). / Conclusions. Girls involved in prostitution exhibited more behaviours that may place them at increased risk of HIV infection compared with female street youth. Young age and substance use characterised by the overuse of alcohol and multi-drug use were found to be independent predictors of initiation into prostitution for female street youth.

<p> This dissertation presents a comprehensive framework to analyze municipal water supply reforms in developing countries by adapting the institutional analysis and development framework (IAD) to this sector. It does so by providing a detailed description of all the meaningful components of the IAD framework that apply to municipal water reforms and also provides a structure to evaluate these reforms. It then applies the adapted framework to the municipal water reforms in Jakarta, Indonesia to get a fresh perspective on the situation there. </p><p> The application of the framework to Jakarta yields a number of findings, not widely discussed in the literature. For instance it becomes clear that the success of a system involving a diverse set of institutions requires a thorough understanding of the interactions between the different actors, not just a study of the actors themselves. Also, a variety of factors exogenous to the players&mdash;like biophysical factors, or the characteristics of the community or rules on the ground&mdash;often play crucial roles. These need to be considered while shaping policy. A number of such lessons have been presented in this dissertation. </p><p> Finally, this dissertation draws insights from this adaptation to Jakarta which can provide lessons to similar cases in the developing world.</p>

<p>Scholars have proposed numerous explanations as to why the Department of Homeland Security has struggled to mature as an organization and effectively conduct its core mission. We propose an alternative viewpoint that the department lacks key legal authorities and necessitates key organizational transfer in order to rationalize its portfolio. We examine these points through review of legal authorities in select mission areas and through a resource analysis of activities conducted throughout the federal government to execute the homeland security mission. The analysis leads to specific recommendations for transfers and authorities and suggestions as to how the political environment might coalesce around engendering these changes. </p>

<p> In the last two decades, openness of public budgeting processes garnered the attention of governments, non-governmental organizations and donors, evidenced by a proliferation of budget transparency and accountability initiatives worldwide (McGee &amp; Gaventa, 2010; De Renzio &amp; Angemi, 2012). Designed to facilitate productive citizen-government interaction around resource allocation, open budgeting initiatives should contribute to strengthening public trust in political institutions (Sayogo &amp; Harrison, 2012; Hakhverdian &amp; Mayne, 2012). Using corruption perceptions as a measure of public trust, this study analyzes the relationship between the openness evident in the budgeting processes of 70 countries and corruption perceptions over a five-year period, 2006-2010. As a traditionally obtuse, closed process, public resource allocation and expenditure is an arena particularly ripe for "wealth-maximizing" civil servants to engage in corruption (Spada, 2009; Rose-Ackerman, 2004). Open budgeting processes that improve citizen awareness of, and provide opportunities for their participation in, government budgeting processes should theoretically improve, not only the incidence of actual corruption, but also citizens' perceptions regarding the level of corruption within their government (Anderson &amp; Tverdova, 2003; Martinez-Moyano et al., 2007). It was hypothesized that citizens in countries with greater transparency, consultation and public monitoring in their budgeting processes perceive lower levels of corruption and higher levels of government anti-corruption effectiveness. OLS and fixed effects regressions found suggestive evidence to support the contention that consultation and openness were positively associated with perceived anti-corruption effectiveness. In contrast, once confounding factors were controlled for, there was no clear evidence to support the contention that openness, either as a composite or its three sub-components, was negatively correlated with perceived government corruption. Furthermore, the results imply that the cumulative effect of the components of transparency, consultation and monitoring may have a stronger impact on perceptions of anti-corruption effectiveness and government corruption than they do as stand-alone activities.</p>

<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> The federal government provides an uncapped reimbursement of state Medicaid spending. In theory, states can use the federal Medicaid funds as a replacement for state funds or the federal funds, which take the form of a matching grant that reduces the relative price of Medicaid, can increase (or stimulate) spending on Medicaid with state-raised tax revenue. In the first dissertation paper, <i> Subsidizing Medicaid Growth: The Impact of the Federal Reimbursement on State Medicaid Programs,</i> I use a state panel data set from 1992 to 2006 to assess the impact of the federal reimbursement on the size of state Medicaid programs. I find that a one point increase in a state's Medicaid reimbursement percentage increases state per capita Medicaid spending between $5 and $16 and increases the percentage of the state's population receiving Medicaid benefits by 0.04 percent to 0.29 percent. </p><p> The first paper also utilizes a case study that shows significant growth in Alaska's Medicaid program after its effective federal Medicaid reimbursement increased 50 percent between 1998 and 1999. The large growth in Alaska's Medicaid program after this increase provides evidence that states respond to large increases in the federal Medicaid subsidy in a stimulative manner by increasing spending with state-raised revenue. Overall, the results in the first paper are consistent with the hypothesis that decentralization in the form of intergovernmental matching grants increases the size of government. I also find that states with wealthier and more liberal populations tend to have larger Medicaid programs and that states with Democratic legislatures tend to have more Medicaid beneficiaries than states with Republican legislatures all else equal. </p><p> Since 2008, states have experienced significant budgetary pressure; in large part, because of rising Medicaid enrollment due to the recession and weak recovery. Between 2009 and 2011, many states enacted health care provider taxes as a way to bring in additional revenue through the federal Medicaid reimbursement. Provider taxes are generally supported by health care providers since states often give providers an implicit or explicit guarantee of a return of at least as much funding through higher payment rates or supplemental payments. In the second dissertation paper, <i>Impact of Hospital and Nursing Home Taxes on State Medicaid Spending,</i> I assess the impact of the two largest provider taxes, the hospital tax and the nursing home tax, on state Medicaid expenditures using a panel dataset of 42 states from between 2007 and 2011. I find significantly larger Medicaid spending growth for hospitals in states that added hospital taxes and significantly larger Medicaid spending growth for nursing homes in states that added nursing home taxes within the first two years of the enactment of the tax. I also find some evidence that states with hospital taxes were able to increase their total Medicaid spending more than states without hospital taxes during the economic downturn and initial recovery period. This paper also contains evidence that nursing home taxes diverted Medicaid spending from home and community based services to nursing homes. </p><p> In the third dissertation paper, <i>Statewide Health Impact of Tennessee's Medicaid Expansion,</i> I utilize a quasi-experimental approach to assess the impact of a large statewide public health insurance expansion on access to health care services, health care utilization, and health outcomes. In 1994, Tennessee expanded its state Medicaid program, called TennCare, by about ten percent of the state's population. Along with a major Medicaid expansion, Tennessee increased government subsidies for individuals to purchase health insurance coverage and emphasized managed care. Using a difference-in-difference methodology with Tennessee's neighboring states as controls, I found that TennCare's impact on utilization was mixed as blood pressure and cholesterol checks increased but regular physician check-ups decreased relative to the surrounding region. Surprisingly, both self-reported health and mortality rates were less favorable in Tennessee relative to the control states after TennCare. Ultimately, the evidence in this paper suggests that health reform built around a significant public insurance expansion is likely to result in minimal, if any, overall health gains measured in the entire population, at least in the short run. </p><p> The final dissertation section summarizes the findings from the three dissertation papers, discusses the economic efficiency of the uncapped federal Medicaid reimbursement and state provider taxes, and makes several predictions related to the Medicaid expansion in the Patient Protection and Affordable Care Act.</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> The purpose of this project was to locate a potential funding source and write a grant to support funding for the Emergency Response Team (ERT) program. The ERT will use solution-based practices within the Mendocino County Health and Human Services Agency to support family stabilization. An ERT would enable children and families to access multidisciplinary team services, including mental health and alcohol/drug services, immediately after a referral to Child Protective Services. This approach will allow families to address their needs for stabilization and ensure streamlined support, thus reducing the potential for children to be removed from the home or shorten the duration of the removal. Ultimately, this approach will ensure families access to appropriate levels of mental health and alcohol or drug service supports to enhance the well being of children, families, and the community. The actual submission and/or funding of this grant were not a requirement for the successful completion of this project.</p>

<p> The focus of this qualitative study was to explore the parental experience of raising an undocumented child, particularly during the transition from high school. The sample consisted of 11 parents. Parents reported several negative feelings, including <i>impotencia</i>, guilt, fear, worry, and frustration. Many stated that their undocumented children's challenges increased as they entered high school. These challenges included school trips, driving without a license, and planning for further education. Coping methods for parents included hope, faith and spirituality, and seeking information about educational and immigration options. Parents spoke of instilling in their children a drive to not give up despite the barriers ahead of them. Several mentioned that their undocumented children's experiences inspired their other children to succeed. The results suggest that social workers should provide information and counseling to these families and should advocate for policy changes to help this vulnerable population.</p>

<p> Fathers are affronted with consistent and systematic barriers and frequent discrimination in their interactions with child welfare entities. The unique set of challenges that these fathers face in parenting evidences a need for father-specific services. A local agency by the name of Families Uniting Families has made attempts to provide for these needs and began implementing the Project Fatherhood program in the greater Long Beach, California area in 2010 to support these fathers. The hope of this agency is to offer a Spanish-language section to their current program to meet the ever-increasing need for providing services to Latino fathers. A review of current and past literature was performed to highlight the need for programs that focus on the unique needs that fathers face, specifically Latino fathers. Neither successful receipt of funding nor submission of the grant proposal is a requirement for successful completion of this thesis project.</p>