Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-03-02T17:30:17Z No. of bitstreams: 1 tatianealmeidadeoliveira.pdf: 2477288 bytes, checksum: 15b038df9be6ebc6f07622a52a53cb3a (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-04-24T01:40:09Z (GMT) No. of bitstreams: 1 tatianealmeidadeoliveira.pdf: 2477288 bytes, checksum: 15b038df9be6ebc6f07622a52a53cb3a (MD5) / Made available in DSpace on 2016-04-24T01:40:09Z (GMT). No. of bitstreams: 1 tatianealmeidadeoliveira.pdf: 2477288 bytes, checksum: 15b038df9be6ebc6f07622a52a53cb3a (MD5) Previous issue date: 2013-04-11 / FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas Gerais / Introdução: o contexto familiar tem um papel importante no processo de envelhecimento, e nos casos em que o idoso é dependente, surge a figura de um cuidador. Uma possibilidade de atendimento ao idoso frágil e de apoio aos seus cuidadores informais é a Assistência Domiciliar (AD). Algumas possíveis vantagens desse modelo são: a melhoria da qualidade de vida e da satisfação dos usuários, o estímulo aos vínculos familiares e profissionais, a redução dos custos gerais, a desospitalização, o aumento da segurança, o trabalho multiprofissional, e a mudança no padrão de atendimento cartesiano do sistema de saúde vigente. Entretanto, as condições sanitárias dos domicílios muitas vezes são incompatíveis para a implantação da AD de acordo com as exigências da resolução da ANVISA nº11 de 01/2006. Dessa forma, este trabalho propõe analisar o acesso da população idosa aos serviços de assistência domiciliar no setor público com base nas condições de saneamento e moradia, e propor uma delimitação para as áreas de abrangência de Equipes Multidisciplinares de Assistência Domiciliar (EMAD) para o município de Juiz de Fora (MG). Metodologia: este estudo utilizou os resultados do censo de 2010 e os dados sobre a cobertura de serviços de saúde pelo município. Foi criada uma variável nominal dicotômica que representou as exigências mínimas para implantação do Serviço de Assistência Domiciliar (SAD) pelo arcabouço legal (domicílios adequados e inadequados). Foram consideradas as características socioeconômicas e demográficas dos indivíduos, as condições de saneamento e moradia e a cobertura por serviços de saúde. A partir disso, realizou-se uma análise bivariada entre a condição domiciliar para AD e as demais variáveis, além de uma distribuição territorial dos resultados por meio de geoprocessamento dos dados. Resultados: as condições domiciliares inadequadas para AD representaram 15,1% de todos os domicílios com idosos e estavam associadas às cores de pele preta e parda, sexo masculino, idade maior que 90 anos, incapacidade funcional básica, baixa renda e baixo nível de instrução. A proporção de domicílios adequados foi maior nas regiões centrais, bem como a oferta de serviços hospitalares. A cobertura pela Estratégia de Saúde da Família foi maior nas regiões de periferia. A divisão territorial proposta para EMAD manteve as características dos grupos populacionais que compunham as áreas de abrangência. Conclusão: Apesar dos princípios e diretrizes dos SAD ressaltarem a ampliação do acesso, este ainda é condicionado por condições sanitárias e de moradias precárias para a população idosa. Para que a AD seja inserida efetivamente no contexto público de saúde, deve-se primar pela intersetorialidade por meio da melhoria das condições básicas de saneamento e moradia, das desigualdades socioeconômicas e do acesso aos diversos níveis de serviços de saúde, com a finalidade de oferecer um atendimento integral e universal pelo SUS. / Introduction: the family background has an important role in the aging process, and in cases where the elderly are dependent, appears the figure of a caregiver. One possibility to take care of the fragile elderly and to support their informal caregivers is Home Care (HC). Some possible advantages of this model are: the improvement of the quality of life and the satisfaction of the users, the stimulus to family and professional bonds, the reduction of overhead costs, dehospitalization, the increase in security, multiprofessional work, and the change in the pattern of cartesian care in the current health system. However, the homes sanitary conditions are often incompatible for the deployment of HC in accordance with the requirements of resolution of ANVISA no. 11 of 01/2006. In this way, this study suggests to analyze the access of elderly population to the services of home care in the public sector on the basis of the conditions of sanitation and housing, and propose a definition for the areas of coverage of Multidisciplinary Team of Home care (MTHC) for the city of Juiz de Fora (MG). Methodology: this study used the results of the 2010 census and the data on the coverage of health services by the municipality. It was created a nominal variable dichotomous that represented the minimum requirements for the implementation of the Home Care Services (HCS) according to the legal framework (households appropriate and inappropriate). It was considered the socioeconomic and demographic characteristics of individuals, the conditions of sanitation and housing and the coverage by health services. From this, it was performed a bivariate analysis of the home conditions for HC and the other variables, in addition to a territorial distribution of the results by means of geoprocessing. Results: the home conditions unsuitable for HC accounted for 15.1 % of all households with elderly and were associated with the colors of the black and mulatto, male sex, age greater than 90 years, basic functional incapacity, low income and low level of education. The proportion of households suitable was greater in the central regions, as well as the provision of hospital services. The coverage by the Family Health Strategy was greater in regions of the periphery. The territorial division proposal for MTHC maintained the characteristics of population groups that comprised the areas of coverage. Conclusion: although the principles and guidelines of HCS emphasized the expansion of access, this is still conditioned by sanitary conditions and substandard housing for the elderly population. For that the HC is inserted effectively in the context of public health, we must prioritize intersectoriality by means of improving the basic conditions of sanitation and housing, socio-economic inequalities and access to various levels of health services, in order to offer a comprehensive and universal care by Unified Health System.

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No. of bitstreams: 1 monicacristinamarzullodefreitas.pdf: 8277023 bytes, checksum: 8771c9d54989bc29d385f49365c7a6b2 (MD5) Previous issue date: 2012-03-08 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas Gerais / O Brasil passa por um processo de envelhecimento populacional e, com isso, seu quadro epidemiológico tende a se modificar, com aumento da prevalência de doenças crônicas, especialmente o câncer, em detrimento das infecciosas. Entre as mulheres, incluindo as mais idosas, o câncer de colo de útero caracteriza-se como um problema de saúde pública. Sendo o Papanicolaou o instrumento utilizado para o rastreio precoce da doença, torna-se de extrema relevância a realização de estudos transversais acerca da prevalência do acesso por parte da população idosa feminina a este serviço de saúde e seus fatores de associação, em Juiz de Fora – MG. Em 2010, inserido no Inquérito de Saúde realizado na zona norte do município de Juiz de Fora, foi conduzido um estudo epidemiológico de corte transversal, usando amostragem por conglomerado e simples, com mulheres a partir de 60 anos de idade. O presente estudo fez uso de quatro instrumentos para a coleta de dados: Mini-Exame do Estado Mental (MEEM), escala para avaliação da capacidade funcional para realização das Atividades Básicas de Vida Diária (ABVD’s) e escala para avaliação da capacidade funcional para realização das Atividades Instrumentais de Vida Diária (AIVD’s), além de questionário semi-estruturado subdividido em características sociodemográficas, questões referentes ao estado de saúde geral da idosa, e finalmente, questões relacionadas ao histórico de realização ou não de exames preventivos em saúde da mulher. Do total de questionários aplicados, 252 (90%) mulheres responderam ao desfecho de interesse. Foi construído um modelo teórico hierarquizado agrupando as variáveis distais, referentes às características sociodemográficas, intermediárias, com questões acerca do estado geral de saúde das idosas, e as variáveis proximais, reunidas num terceiro bloco, correspondentes às práticas preventivas em saúde da mulher. A prevalência de realização do exame preventivo de Papanicolaou foi de 84,1% (IC95% 79% - 88,4%). Na regressão multivariada, três variáveis apresentaram significativa associação (p 0,05) à realização do exame de Papanicolaou: entre as variáveis do nível mais distal (Bloco 1 do organograma), a situação conjugal “sem companheiro” (idosas solteiras, viúvas, separadas ou divorciadas), com RPajustada = 3,642 (IC95% 1,465; 9,057). No segundo bloco, a independência para a realização das AIVD’s, com RPajustada = 6,932 (IC95% 2,022; 23,764). Já no terceiro bloco, referente às práticas preventivas em saúde da mulher, a realização da mamografia foi a variável de maior associação à realização do exame de Papanicolaou, com RPajustada = 2,112 (IC95% 1,140; 3,913). Na análise interblocos estas variáveis continuaram significativamente associadas com a variável de desfecho. O presente estudo sugere que o maior acesso ao exame preventivo pelas idosas apresentou-se associado mais fortemente ao grupo composto por solteiras, viúvas, separadas ou divorciadas, independentes para as AIVD’s e que também realizam ou que já realizaram mamografia. O envelhecimento populacional deve levar à reflexão quanto ao direcionamento de políticas públicas. No caso do câncer de colo de útero, deve haver incentivo à prática do Papanicolaou, a fim de se implementar uma rotina de prevenção secundária às idosas, mesmo não sendo a população alvo do rastreio atualmente. / Brazil is going through a process of population aging, and thus, its epidemiological profile tends to change, with increased prevalence of chronic diseases, especially cancer, over infectious ones. Among women, including older women, cervical cancer is characterized as a public health problem. Since the Pap test is the instrument for early detection of the disease, it is thus extremely relevant to carry out crosssectional studies on the prevalence, for elderly women, of access to this health service, and to investigate the factors associated with screening in Juiz de Fora - MG. In 2010, included in the Health Survey conducted in the northern district of the city of Juiz de Fora, a cross-sectional epidemiological study was conducted, using cluster and simple sampling, with women aged 60 or over. This study made use of four instruments for data collection: a Mini-Mental State Examination (MMSE), a scale to assess functional capacity to perform the Basic Activities of Daily Living (BADLs) and a scale to assess functional capacity to perform the Instrumental Activities of Daily Living (IADLs), and a semi-structured questionnaire divided into sociodemographic characteristics, questions concerning the general health of the elderly woman, and finally, questions related to the history of whether or not having been screened for cervical cancer and breast cancer. Of the total questionnaires administered, 252 women responded to the outcome of interest. A hierarchical theoretical model was built grouping the distal variables, related to sociodemographic characteristics, the intermediate variables, related to questions about the general health of the elderly women, and the proximal variables, gathered into a third block, corresponding to preventive practices in women's health. The prevalence of Pap test screening was 84.1% (CI95% 79% - 88.4%). In the multivariate regression, three variables showed significant association (p 0.05) with getting Pap testing: among the more distal level variables (Block 1 of the chart), the marital status of single, widowed, separated, or divorced, with PRadjusted (CI95% = 3.642 CI95% 1.465; 9.057). In the second block, the functional capacity of carrying out IADLs, with PRadjusted (CI95% = 6.932 CI95% 2.022; 23.764). And, in the third block, regarding preventive practices in women's health, mammography screening was the variable with the highest association with getting Pap testing, with PRadjusted (CI95% = 2.112 CI95% 1.140; 3.913). In the interblock analysis these variables remained significantly associated with the outcome variable. The present study suggests that increased access to preventive screening for elderly women was associated most strongly with the group composed of single, widowed, separated, or divorced, able to perform IADLs, and who also are or had been getting mammography screening. The aging of the population should lead to reflection about the direction of public policy. In the case of cervical cancer, there must be incentives for Pap test screening in order to implement a secondary prevention routine (early diagnosis and prompt treatment) for elderly women, although not the target population of screening today.

A regulação assistencial é um importante instrumento de gestão pública que tem como objetivo viabilizar o acesso dos usuários aos serviços de saúde. No entanto, há estudos que apontam que não há um equilíbrio entre a oferta e a demanda por serviços da atenção secundária no SUS. Na presente pesquisa questiona-se como está efetivamente estruturado o acesso a esse nível de atenção e quais os principais entraves para a efetividade do acesso. O objetivo consistiu em analisar o processo de acesso à atenção secundária da saúde buscando identificar oportunidades de melhoria. O foco desse estudo foi o acesso à especialidade médica de gastrocirurgia dos dois hospitais secundários integrantes do complexo do Hospital das Clínicas de Ribeirão Preto. Foram realizadas entrevistas com gestores, médicos e demais profissionais envolvidos no processo. A partir das informações coletadas foi construído um mapa dos processos utilizando o software Bizagi e a notação de modelagem de processos de negócios (BPMN). A partir da descrição e análise, foi verificado como os processos descritos poderiam ser otimizados. Foi possível identificar que os dois processos estudados, apesar de terem o mesmo objetivo: prover acesso a atenção secundária de saúde, possuem diferenças marcantes. As vagas são distribuídas aos municípios na forma de cotas no processo de acesso ao HEAB enquanto que no acesso ao HERP há uma regulação compartilhada entre o DRSXIII e o próprio hospital. Os principais problemas identificados foram: absenteísmo dos usuários nas consultas; guias de referência incompletas ou ilegíveis; dificuldades de relacionamento entre os profissionais e organizações de saúde; demora para agendar consulta, entre outros. Concluiu-se que existem pontos no processo que não estão coerentes com as normas que o regulam e que há dados que podem ser utilizados para medir o desempenho do processo, como a proporção de casos novos e de pedidos de interconsulta; distribuição de vagas por município e situação após primeira consulta. Concluiu-se ainda que os problemas identificados podem ser solucionados a partir da implantação de melhorias sugeridas como: melhorar a comunicação e a triagem nos municípios, realizar treinamento dos funcionários e divulgar protocolos aos envolvidos. / The assistance regulation is an important public management tool that aims to facilitate users\' access to health services. However, studies show that there is not a balance between supply and demand for services in secondary care in the Unified Health System (SUS). In the present study it casts doubt on how the access is effectively structured to this level of care and what the main obstacles to the effectiveness of access are. The aim was analyze the process of access to secondary health care seeking to identify opportunities for improvement. The focus of this study was the access to medical specialty Gastrosurgery of the two hospitals that are members of the complex of the General Hospital of Ribeirão Preto Medical School (University of São Paulo). Interviews were conducted with managers, doctors and other stakeholders. From the information collected, a map of the processes using the Bizagi software and the notation for business process modeling (BPMN) was constructed. From the description and analysis, it was verified how the described processes could be optimized. It was possible to identify that the two processes studied have the same goal: provide access to secondary health care, have marked differences, such as how the distribution of vacancies. The vacancies are distributed to municipalities for quotas in the process of access to HEAB while access to HERP there is a shared regulation between the DRSXIII and the hospital. The main problems identified were outpatient non-attendance (absenteeism), incomplete or illegible reference guides, relationship difficulties between professionals and health organizations, long wait for schedule consultation, among others. It was concluded that there are points in the process that are not consistent with the rules that regulate, there is data that can be used to measure the performance process, as the proportion of new cases and requests for referral; distribution of vacancies for municipality and situation after first appointment. It was possible concluded also that the problems found can be solved through the implementation of suggested improvements; such as how improve communication and sorting in the municipalities, conduct employee training and disseminate the protocols involved.

In South Africa access to mental healthcare resources is restricted for a number of reasons including language barriers that prevent suitable communication between mental healthcare professionals and African language speaking South Africans. The translation of psychometric tools into African languages has been identified as one method in improving access to psychological services for African language speakers. The Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM) has demonstrated its clinical utility within the United Kingdom (UK) National Healthcare Service (NHS) as a standardised psychotherapy outcome measure that evaluates the degree of psychological distress individuals present with at the start of psychotherapy treatment, and the degree of change that has been effected at the termination of therapy. A measure like the CORE-OM holds valuable clinical utility for the South African context. This thesis argues that the availability of a valid Xhosa version of the CORE-OM would allow for improved access to psychotherapy resources for Xhosa speaking individuals, and allow for the evaluation of the effectiveness of psychotherapy interventions conducted in Xhosa. The CORE-OM developers have provided a translation design and set of guidelines to standardise the translation of the CORE-OM into different languages. However this thesis argues that these guidelines are incomplete. Instead International Test Commission (ITC) guidelines are recommended as a culturally sensitive method to supplement current CORE-OM translation guidelines, in order to generate a valid Xhosa measure of distress. A mixed methods approach is applied which first investigates the construct equivalence and bias of the CORE-OM English version within a South African student population sample, both qualitatively and quantitatively, in order to establish the degree of adaptation required to generate a valid Xhosa version of distress. Next the CORE-OM English version is translated into Xhosa using the five-stage translation design prescribed by the CORE System Trust, supplemented by ITC guidelines. All changes made to the CORE-OM during translation into Xhosa are documented. The CORE-OM Xhosa version is then investigated for reliability and validity. This investigation reveals low internal reliability within the subjective wellbeing domain indicating that these items are less meaningful as depictions of distress within the Xhosa language. A reduced version of the CORE-OM demonstrates strong psychometric properties as a valid Xhosa measure of distress.

The purpose of the study was to evaluate the impact of implementing capacity building strategies on the provision of health services in the central region of Malawi. The study intended to determine why a lack of quality services is still prevailing in the health services in the central region despite implementing capacity building strategies aimed at improving the delivery of health services. In addition to this, to come up with recommendations to improve the implementation of the existing capacity building strategies so that the implementation results in the intended impact, that is efficient and effective provision of health services in the central region of Malawi. The studies reviewed what various scholars have written on capacity building in order to ground capacity building in Public Administration and provide the study with a conceptual, theoretical and legislative framework. This enabled the researcher to describe the nature and place of capacity building in Public Administration. It was evident from the review that the implementation of capacity building strategies is a systematic process which requires that chief officials follow all the steps in order to effectively and efficiently implement the capacity building strategies so that the intended impact is achieved. In this regard, capacity building is a management function which requires that chief officials play an enabling role by providing the necessary resources (both human and financial) and policies that support the implementation of capacity building strategies. The study used both quantitative and qualitative research methods whereby thirty-five respondents composed of political office-bearers and chief officials from Lilongwe, Dedza, Mchinji and Dowa districts and Ministry of Health Headquarters in the central region of Malawi were given self-administered questionnaires to complete. Face-to-face interviews and document analysis were also used as research methods. The intention was to determine the problems that are being experienced in the implementation of the existing capacity building strategies and find out if the strategies are resulting in the intended impact. The study findings confirmed that there are indeed problems being experienced in the implementation of the existing capacity building strategies, namely: inadequate human and financial resources, corruption, political interference, lack of consultation with stakeholders and lack of political will to make sure that the implementation of the capacity building strategies is effectively and efficiently done. It was also revealed that the implementation of the existing capacity building strategies is impacting negatively on the provision of health services in the central region of Malawi, hence indicating a need to change in approach. The study concludes that in order for the capacity building strategies to achieve the intended impact there is a need to broaden the scope of the legal framework on health capacity building strategies in Malawi, enforce the use of performance standards and improve the operational framework to gain efficiencies and effectiveness from current investments in capacity building.

Ongoing research in the fields of genetics and biotechnology hold the promise of improved diagnosis and treatment of genetic diseases, and potentially the development of individually tailored pharmaceuticals and gene therapies. Difficulty, however, arises in determining how these services are to be evaluated and integrated equitably into public health care systems such as Canada's. The current context is one of increasing fiscal restraint on the part of governments, limited financial resources being dedicated to health care, and rising costs for new health care services and technologies. This has led to increasing public debate in the last few years about how to reform public health care, and whether we should prohibit, permit or perhaps even encourage private purchase of health care services. In Canada, some of these concerns have crystallized around the issue of gene patents and commercial genetic testing, in particular as illustrated by the case of Myriad Genetics' patented BRACAnalysis test for hereditary breast and ovarian cancer. While most Canadians who currently access genetic services do so through the public health care system, for those with the means, private purchase is becoming an option. This situation raises serious concerns - about justice in access to health care; about continued access to safe and reliable genetic testing supported by unbiased patient information; and about the broader effects of commercialization for ongoing research and the Canadian public health care system. Commercial genetic testing presents a challenge to health care professionals, policy analysts, and academics concerned with the social, ethical and policy implications of new genetic technologies. Using the Myriad case as an exemplar, tools from moral philosophy, the social sciences, and health policy and law will be brought to bear on the larger issues of how as a society we should regulate commercial research and product development, and more coherently decide which services to cover under public health insurance and which to leave to private purchase. Generally, the thesis is concerned with the question of "how best to bring capital, morality, and knowledge into a productive and ethical relationship" (Rabinow 1999, 20). / Graduate and Postdoctoral Studies / Graduate

The purpose of this project is to support health promotion of children entering foster care, ensure that children receive all health care services needed, prevent the trauma of duplication of immunizations, and reduce disruption of health care as children move through the foster care system.

BACKGROUND: The barriers in accessing healthcare for gay, lesbian and bisexuals individuals are not well explored. These challenges as well as a lack of knowledge concerning this understudied group has prompted the Institute of Medicine to create a research agenda to build a foundational understanding of gay, lesbian and bisexual health and the barriers they encounter.1 the primary aim of this study will be to compare the differences in health care access and utilization between gay/lesbian, bisexual and heterosexual individuals using a large, nationally representative dataset of the U.S. population. METHODS: Data from 2001 to 2012 from the National Health and Nutrition Examination Survey was pooled. Using logistic regression, we calculated the unadjusted and adjusted odds ratios of having health insurance, having a routine place and seeing a provider at least one in the past year. RESULTS: We found that gay men were more likely to have health insurance coverage (ORadj:2.13 95%CI: 1.15,3.92), while bisexual men were at a small disadvantage in having health insurance coverage (ORadj:0.82 95%CI: 0.46,1.46). Bisexual men were more likely to have received health care in the past 12 months (ORadj:3.11 95%CI: 1.74,5.55). Lesbian women were less likely to have health insurance coverage (ORadj-lesbian:0.58 95%CI: 0.34,0.97). CONCLUSION: This study contributed to the limited knowledge on understanding the health care access and utilization among gay, lesbian and bisexual individuals, which was classified as a high priority by the Institute of Medicine. Expanding health insurance coverage through the Affordable Care Act and Universal Partnership Coverage may reduce the disparities among gay, lesbian and bisexual individuals.

For many health conditions, African Americans bear a disproportionate burden of disease, injury, death, and disability compared to European Americans. African Americans also use health services less frequently than do European Americans and this underuse of services contributes to health disparities in the United States. Studies have shown that some disparities are present not as a result of poor access to care, but, to a certain extent, as a result of the experiences patients have at their doctors' offices. It is, therefore, essential to understand African American patients' perspectives and experiences with healthcare providers. Past studies have shown that four barriers affect the quality of patient-provider relationships for African Americans: perceived discrimination, medical mistrust, race discordance, and poor communication. The studies, however, have not looked at how these barriers manifest when African Americans speak about their perspectives and experiences with health care providers. This project was a secondary data analysis of qualitative data provided by adult African American community members from Portland, Oregon with diabetes or hypertension or both, each of whom participated in one of 10 focus groups. The focus groups were conducted as part of a study that applied community based participatory research (CBPR) principles to understand patients' experiences with their doctors. Using a deductive approach, this analysis enhanced the understanding of how the barriers play a role in patient-provider relationships. Further, the analysis showed how the barriers are interrelated. In learning African American patients' experiences and perspectives on these four key barriers, the investigator proposes recommendations for healthcare providers as to how they can best deliver quality care for African Americans.

Amid the global pandemic, it becomes more apparent that diabetes is a pressing health concern because racial/ethnic minorities with underlying diabetes conditions have been disproportionately affected. The study proposes a multiyear examination to document the role of the Affordable Care Act (ACA) in racial/ethnic disparities in diabetes health. Using the Behavioral Risk Factor Surveillance System from 2011 to 2019, the study with a pre-post design investigated changes in access to care and diabetes health among non-White minorities compared with Whites before and after the ACA by conducting multivariable linear regression, with state-fixed effects and robust standard errors. Compared with Whites, racial/ethnic minorities showed significant improvements in health insurance coverage, having a personal doctor, and not seeing a doctor because of cost. Blacks (3.2% points,  ≤ 0.000), Hispanics (1.6% points,  = 0.001), and "other" racial/ethnic group (1.5% points,  = 0.003) experienced a greater increase in diagnosed prediabetes than Whites, whereas no and small differences were found in diagnosed diabetes and obesity, respectively. The yearly comparisons of changes in diagnosed prediabetes showed that Blacks compared with Whites had a growing increase from 1.2% points ( = 0.001) in 2014 to 3.3% points ( = 0.001) in 2019. Insurance coverage has declined after 2016, and obesity had an increasing trend across race/ethnicity. The ACA had a positive role in improving access to care and identifying those at risk for diabetes to a larger extent among racial/ethnic minorities. However, the policy impacts have been diminishing in recent years. Continued efforts are needed for sustained policy effects.