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Balio CP, Mathis SM, Francisco MM, Meit M, Beatty KE. State Priorities and Needs: The Role of Block Grants. Public Health Rep 2023:333549231205338. [PMID: 37924249 DOI: 10.1177/00333549231205338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2023] Open
Abstract
OBJECTIVES Block grant funding provides federal financial support to states, with increased flexibility as to how those funds can be allocated at the community level. At the state level, block grant amounts and distributions are often based on outdated formulas that consider population measures and funding environments at the time of their creation. We describe variation in state-level funding allocations for 5 federal block grant programs and the extent to which funding aligns with the current needs of state populations. METHODS We conducted an analysis in 2022 of state block grant allocations as a function of state-level characteristics for 2015-2019 for all 50 states. We provide descriptive statistics of state block grant allocations and multivariate regression models for each program. Models include base characteristics relevant across programs plus supplemental characteristics based on program-specific goals and state population needs. RESULTS Mean state block grant allocations per 1000 population by program ranged from $618 to $21 528 during 2015-2019. Characteristics associated with state allocations varied across block grants. For example, for every 1-percentage-point increase in the percentage of the population living in nonmetropolitan areas, Preventive Health and Health Services Block Grant funding was approximately $7 per 1000 population higher and Community Services Block Grant funding was approximately $40 per 1000 population higher. Few supplemental characteristics were associated with allocations. CONCLUSIONS Current block grant funding does not align with state characteristics and needs. Future research should consider how funds are used at the state level or allocated to local agencies or organizations and compare state block grant allocations with other types of funding mechanisms, such as categorical funding.
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Affiliation(s)
- Casey P Balio
- NORC Rural Health Equity Research Center, East Tennessee State University, Johnson City, TN, USA
- Center for Rural Health Research, East Tennessee State University, Johnson City, TN, USA
- Department of Health Services Management and Policy, East Tennessee State University, Johnson City, TN, USA
| | - Stephanie M Mathis
- NORC Rural Health Equity Research Center, East Tennessee State University, Johnson City, TN, USA
- Center for Rural Health Research, East Tennessee State University, Johnson City, TN, USA
- Department of Community and Behavioral Health, East Tennessee State University, Johnson City, TN, USA
| | - Margaret M Francisco
- NORC Rural Health Equity Research Center, East Tennessee State University, Johnson City, TN, USA
- Center for Rural Health Research, East Tennessee State University, Johnson City, TN, USA
- Department of Community and Behavioral Health, East Tennessee State University, Johnson City, TN, USA
| | - Michael Meit
- NORC Rural Health Equity Research Center, East Tennessee State University, Johnson City, TN, USA
- Center for Rural Health Research, East Tennessee State University, Johnson City, TN, USA
- Department of Health Services Management and Policy, East Tennessee State University, Johnson City, TN, USA
| | - Kate E Beatty
- NORC Rural Health Equity Research Center, East Tennessee State University, Johnson City, TN, USA
- Center for Rural Health Research, East Tennessee State University, Johnson City, TN, USA
- Department of Health Services Management and Policy, East Tennessee State University, Johnson City, TN, USA
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Smith MG, Beatty KE, Khoury AJ, Gilliam L, de Jong J. Increases in IUD Provision at Alabama Department of Public Health Clinics From 2016 to 2019. J Public Health Manag Pract 2023; 29:E176-E180. [PMID: 37071028 DOI: 10.1097/phh.0000000000001737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
The Alabama Department of Public Health (ADPH) began allocating Title X funding to intrauterine device (IUD) provision at family planning clinics in 2019, instated more training opportunities, and expanded nurse practitioner scope of practice to include IUD placements. We assessed IUD provision and protocols at ADPH Title X clinics in 2016 and 2019 before and after ADPH policy changes. Generalized binomial regression models assessed differences between years. The proportion of ADPH clinics reporting offering any IUD on-site increased by 61.6 percentage points ( P < .001), stockpiling IUDs on-site increased by 85.9 percentage points ( P < .001), IUD placement/removal training increased by 71.4 percentage points ( P < .001), and same-visit IUD placement trainings increased by 64.1 percentage points ( P < .001). Advanced practice nurses were significantly more likely to place IUDs in 2019 compared with 2016 ( P < .001). These findings highlight the positive impact of policy changes related to Title X funding allocation and scope of practice on provision of a full range of contraceptive methods. These changes in policies and practices at the state and local levels within ADPH have expanded the availability of the full range of contraceptive options across the state of Alabama. This expanded access to contraceptive options is especially important given the rapid changes in reproductive health policies occurring in Alabama and across the United States.
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Affiliation(s)
- Michael G Smith
- College of Public Health, East Tennessee State University, Johnson City, Tennessee (Drs Smith, Beatty, and Khoury and Ms de Jong); and Alabama Department of Public Health, Robertsdale, Alabama (Dr Gilliam)
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Beatty KE, Hale N, Khoury AJ, Smith MG, Lee J, Ventura LM. Association of Health Insurance with Contraceptive Use and Interpersonal Quality of Contraceptive Care in the Southeast United States. South Med J 2023; 116:358-364. [PMID: 37011585 DOI: 10.14423/smj.0000000000001543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
OBJECTIVES Health insurance remains an important dimension of contraceptive access. This study investigated the role of insurance in contraceptive use, access, and quality in South Carolina and Alabama. METHODS The study used a cross-sectional statewide representative survey that assessed reproductive health experiences and contraceptive use among reproductive-age women in South Carolina and Alabama. The primary outcomes were current contraceptive method use, barriers to access (inability to afford wanted method, delay/trouble obtaining wanted method), receipt of any contraceptive care in the past 12 months, and perceived quality of care. The independent variable was insurance type. Generalized linear models were applied to estimate prevalence ratios for each outcome's association with insurance type while adjusting for potentially confounding variables. RESULTS Nearly 1 in 5 women (17.6%) was uninsured, and 1 in 4 women (25.3%) reported not using a contraceptive method at the time of the survey. Compared with women with private insurance, women with no insurance had a lower likelihood of current method use (adjusted prevalence ratio 0.75; 95% confidence interval 0.60-0.92) and receipt of contraceptive care in the past 12 months (adjusted prevalence ratio 0.61; 95% confidence interval 0.45-0.82). These women also were more likely to experience cost barriers to access care. The insurance type was not significantly associated with the interpersonal quality of contraceptive care. CONCLUSIONS Findings highlight the need for expanding Medicaid in states that did not do so under the Patient Protection and Affordable Care Act, interventions to increase the number of providers who accept Medicaid patients, and protections to Title X funding as key elements for enhancing contraceptive access and population health outcomes.
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Affiliation(s)
- Kate E Beatty
- From the Department of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Nathan Hale
- From the Department of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Amal J Khoury
- From the Department of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Michael G Smith
- From the Department of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Jusung Lee
- the Department of Public Health, College for Health, Community, and Policy, University of Texas at San Antonio, San Antonio
| | - Liane M Ventura
- From the Department of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee
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Balio CP, Galler N, Meit M, Hale N, Beatty KE. Rising to Meet the Moment: What Does the Public Health Workforce Need to Modernize? J Public Health Manag Pract 2023; 29:S107-S115. [PMID: 36223506 PMCID: PMC10573113 DOI: 10.1097/phh.0000000000001624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study uses findings from the most recent iterations of the Public Health Workforce Interest and Needs Survey (PH WINS) to describe importance, skill level, and gaps of key public health competencies as well as characteristics associated with gaps. DESIGN Repeated cross-sectional analysis of the 2017 and 2021 PH WINS data. SETTING State and local health departments. PARTICIPANTS Nationally representative population of state and local governmental public health workers. MAIN OUTCOME MEASURES Gaps of key public health competencies related to data, evidence-based approaches, health equity and social justice, factors that affect public health, cross-sectoral partnerships, and community health assessments and improvement plans. Gaps reflect areas of high importance and low skill level. Differences in gaps among the traditional public health workforce and those hired specifically for COVID-19 response. RESULTS For most competency areas, more than 20% of the public health workforce perceived a gap. Gaps related to environmental factors that affect public health, social determinants of health and cross-sector partnerships, and community health assessments and improvement plans were the largest. Tenure in public health practice, highest level of education, and having formal public health training were associated with lower odds of gaps in most areas. In a secondary analysis of traditional public health workforce compared with those hired specifically for COVID-19 response, those hired for COVID-19 response reported significantly fewer gaps for all but one competency considered. CONCLUSIONS A substantial proportion of the public health workforce perceives gaps in competency areas that are of high importance to the evolving role of public health. As public health continues to adjust and modernize in response to the COVID-19 pandemic and other historic changes, understanding and addressing training needs of the workforce will be instrumental to public health's ability to respond to the needs of the public.
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Affiliation(s)
- Casey P. Balio
- Center for Rural Health Research (Drs Balio and Beatty, Ms Galler, and Mr Meit) and Department of Health Services Management and Policy (Drs Balio, Hale, and Beatty, Ms Galler, and Mr Meit), College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Nicole Galler
- Center for Rural Health Research (Drs Balio and Beatty, Ms Galler, and Mr Meit) and Department of Health Services Management and Policy (Drs Balio, Hale, and Beatty, Ms Galler, and Mr Meit), College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Michael Meit
- Center for Rural Health Research (Drs Balio and Beatty, Ms Galler, and Mr Meit) and Department of Health Services Management and Policy (Drs Balio, Hale, and Beatty, Ms Galler, and Mr Meit), College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Nathan Hale
- Center for Rural Health Research (Drs Balio and Beatty, Ms Galler, and Mr Meit) and Department of Health Services Management and Policy (Drs Balio, Hale, and Beatty, Ms Galler, and Mr Meit), College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Kate E. Beatty
- Center for Rural Health Research (Drs Balio and Beatty, Ms Galler, and Mr Meit) and Department of Health Services Management and Policy (Drs Balio, Hale, and Beatty, Ms Galler, and Mr Meit), College of Public Health, East Tennessee State University, Johnson City, Tennessee
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Beatty KE, Mathis SM, McCurry AR, Francisco MM, Meit M, Wahlquist AE. The association between grandparents as caregivers and overdose mortality in Appalachia and non-Appalachia counties. Front Public Health 2023; 11:1035564. [PMID: 36908410 PMCID: PMC9992886 DOI: 10.3389/fpubh.2023.1035564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/27/2023] [Indexed: 02/24/2023] Open
Abstract
Objective To assess the association of drug overdose mortality with grandparents serving as caregivers of children in Appalachia and non-Appalachia in the U.S. Methods This study used a cross-sectional design, with percent of grandparents as caregivers and overdose mortality rates being of primary interest. County-level data were combined, and descriptive, bivariate, and multivariable statistics were applied. Multiple sociodemographic and geographic variables were included: median age of the population, percent of the population that is uninsured, percent of the population that is non-Hispanic white, teen birth rate, percent of high school dropouts, and rurality. Results The percent of grandparents as caregivers increased as the overdose mortality rate increased (p < 0.01). For every 1% increase in the overdose mortality rate, the percent of grandparents as caregivers increased by 56% in Appalachian counties compared to 24% in non-Appalachian counties. After adjusting for sociodemographic characteristics, the interaction between overdose mortality and Appalachian vs. non-Appalachian counties was no longer significant (p = 0.3). Conclusions Counties with higher overdose mortality rates had greater rates of grandparents as caregivers, with Appalachian counties experiencing greater rates of grandparents as caregivers than non-Appalachian counties. Sociodemographic characteristics that are often more prevalent in Appalachia may be driving the observed differences. Policy implications Policies and programs are needed to support grandparents providing caregiving for children impacted by substance use disorders including reform to federal child welfare financing to support children, parents, and grandparent caregivers such as kinship navigation, substance use treatment and prevention services, mental health services and in-home supports.
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Affiliation(s)
- Kate E Beatty
- Center for Rural Health Research, East Tennessee State University, Johnson City, TN, United States.,Department of Health Services Management and Policy, College of Public Health, East Tennessee State University, Johnson City, TN, United States
| | - Stephanie M Mathis
- Center for Rural Health Research, East Tennessee State University, Johnson City, TN, United States
| | - Abby R McCurry
- Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN, United States
| | - Margaret M Francisco
- Center for Rural Health Research, East Tennessee State University, Johnson City, TN, United States.,Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, TN, United States
| | - Michael Meit
- Center for Rural Health Research, East Tennessee State University, Johnson City, TN, United States
| | - Amy E Wahlquist
- Center for Rural Health Research, East Tennessee State University, Johnson City, TN, United States
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Smith MG, Hale N, Kelley S, Satterfield K, Beatty KE, Khoury AJ. South Carolina's Choose Well Initiative to Reduce Unintended Pregnancy: Rationale, Implementation Design, and Evaluation Methodology. Am J Public Health 2022; 112:S484-S489. [PMID: 35767793 PMCID: PMC10490316 DOI: 10.2105/ajph.2022.306889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Michael G Smith
- Michael G. Smith, Nathan Hale, Kate E. Beatty, and Amal J. Khoury are with the Department of Health Services Management and Policy and the Center for Applied Research and Evaluation in Women's Health at East Tennessee State University, Johnson City. Sarah Kelley and Katherine Satterfield are with New Morning in Columbia, SC
| | - Nathan Hale
- Michael G. Smith, Nathan Hale, Kate E. Beatty, and Amal J. Khoury are with the Department of Health Services Management and Policy and the Center for Applied Research and Evaluation in Women's Health at East Tennessee State University, Johnson City. Sarah Kelley and Katherine Satterfield are with New Morning in Columbia, SC
| | - Sarah Kelley
- Michael G. Smith, Nathan Hale, Kate E. Beatty, and Amal J. Khoury are with the Department of Health Services Management and Policy and the Center for Applied Research and Evaluation in Women's Health at East Tennessee State University, Johnson City. Sarah Kelley and Katherine Satterfield are with New Morning in Columbia, SC
| | - Katherine Satterfield
- Michael G. Smith, Nathan Hale, Kate E. Beatty, and Amal J. Khoury are with the Department of Health Services Management and Policy and the Center for Applied Research and Evaluation in Women's Health at East Tennessee State University, Johnson City. Sarah Kelley and Katherine Satterfield are with New Morning in Columbia, SC
| | - Kate E Beatty
- Michael G. Smith, Nathan Hale, Kate E. Beatty, and Amal J. Khoury are with the Department of Health Services Management and Policy and the Center for Applied Research and Evaluation in Women's Health at East Tennessee State University, Johnson City. Sarah Kelley and Katherine Satterfield are with New Morning in Columbia, SC
| | - Amal J Khoury
- Michael G. Smith, Nathan Hale, Kate E. Beatty, and Amal J. Khoury are with the Department of Health Services Management and Policy and the Center for Applied Research and Evaluation in Women's Health at East Tennessee State University, Johnson City. Sarah Kelley and Katherine Satterfield are with New Morning in Columbia, SC
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Beatty KE, Smith MG, Khoury AJ, Ventura LM, Ariyo T, de Jong J, Surles K, Rahman A, Slawson D. Telehealth for Contraceptive Care During the Initial Months of the COVID-19 Pandemic at Local Health Departments in 2 US States: A Mixed-Methods Approach. J Public Health Manag Pract 2022; 28:299-308. [PMID: 35334485 PMCID: PMC8966621 DOI: 10.1097/phh.0000000000001481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVES This study examined implementation of telehealth for contraceptive care among health departments (HDs) in 2 Southern US states with centralized/largely centralized governance structures during the early phase of the COVID-19 pandemic. Sustaining access to contraceptive care for underserved communities during public health emergencies is critical. Identifying facilitators and barriers to adaptive service provision helps inform state-level decision making and has implications for public health policy and practice, particularly in states with centralized HD governance. DESIGN Mixed-methods study including a survey of HD clinic administrators and key informant interviews with clinic- and system-level staff in 2 states conducted in 2020. SETTING Health department clinics in 2 Southern US states. PARTICIPANTS Clinic administrators (survey) and clinic- and system-level respondents (key informant interviews). Participation in the research was voluntary and de-identified. MAIN OUTCOME MEASURES (1) Telehealth implementation for contraceptive care assessed by survey and measured by the percentage of clinics reporting telehealth service provision during the pandemic; and (2) facilitators and barriers to telehealth implementation for contraceptive care assessed by key informant interviews. For survey data, bivariate differences between the states in telehealth implementation for contraceptive care were assessed using χ2 and Fisher exact tests. Interview transcripts were coded, with emphasis on interrater reliability and consensus coding, and analyzed for emerging themes. RESULTS A majority of HD clinics in both states (60% in state 1 and 81% in state 2) reported a decrease in contraceptive care patient volume during March-June 2020 compared with the average volume in 2019. More HD clinics in state 1 than in state 2 implemented telehealth for contraceptive services, including contraceptive counseling, initial and refill hormonal contraception, emergency contraception and sexually transmitted infection care, and reported facilitators of telehealth. Medicaid reimbursement was a predominant facilitator of telehealth, whereas lack of implementation policies and procedures and reduced staffing capacity were predominant barriers. Electronic infrastructure and technology also played a role. CONCLUSIONS Implementation of telehealth for contraceptive services varied between state HD agencies in the early phase of the pandemic. Medicaid reimbursement policy and directives from HD agency leadership are key to telehealth service provision among HDs in centralized states.
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Affiliation(s)
- Kate E. Beatty
- Departments of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health (Drs Beatty, Smith, Khoury, and Ariyo and Mss Ventura, de Jong, Surles, and Rahman) and Community and Behavioral Health (Dr Slawson), East Tennessee State University, Johnson City, Tennessee
| | - Michael G. Smith
- Departments of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health (Drs Beatty, Smith, Khoury, and Ariyo and Mss Ventura, de Jong, Surles, and Rahman) and Community and Behavioral Health (Dr Slawson), East Tennessee State University, Johnson City, Tennessee
| | - Amal J. Khoury
- Departments of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health (Drs Beatty, Smith, Khoury, and Ariyo and Mss Ventura, de Jong, Surles, and Rahman) and Community and Behavioral Health (Dr Slawson), East Tennessee State University, Johnson City, Tennessee
| | - Liane M. Ventura
- Departments of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health (Drs Beatty, Smith, Khoury, and Ariyo and Mss Ventura, de Jong, Surles, and Rahman) and Community and Behavioral Health (Dr Slawson), East Tennessee State University, Johnson City, Tennessee
| | - Tosin Ariyo
- Departments of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health (Drs Beatty, Smith, Khoury, and Ariyo and Mss Ventura, de Jong, Surles, and Rahman) and Community and Behavioral Health (Dr Slawson), East Tennessee State University, Johnson City, Tennessee
| | - Jordan de Jong
- Departments of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health (Drs Beatty, Smith, Khoury, and Ariyo and Mss Ventura, de Jong, Surles, and Rahman) and Community and Behavioral Health (Dr Slawson), East Tennessee State University, Johnson City, Tennessee
| | - Kristen Surles
- Departments of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health (Drs Beatty, Smith, Khoury, and Ariyo and Mss Ventura, de Jong, Surles, and Rahman) and Community and Behavioral Health (Dr Slawson), East Tennessee State University, Johnson City, Tennessee
| | - Aurin Rahman
- Departments of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health (Drs Beatty, Smith, Khoury, and Ariyo and Mss Ventura, de Jong, Surles, and Rahman) and Community and Behavioral Health (Dr Slawson), East Tennessee State University, Johnson City, Tennessee
| | - Deborah Slawson
- Departments of Health Services Management and Policy and Center for Applied Research and Evaluation in Women's Health, College of Public Health (Drs Beatty, Smith, Khoury, and Ariyo and Mss Ventura, de Jong, Surles, and Rahman) and Community and Behavioral Health (Dr Slawson), East Tennessee State University, Johnson City, Tennessee
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Hale N, Tatro K, Orimaye SO, Smith M, Meit M, Beatty KE, Khoury A. Changes in Adolescent Birth Rates within Appalachian Subregions and Non-Appalachian Counties in the United States, 2012-2018. J Appalach Health 2022; 4:31-50. [PMID: 35769510 PMCID: PMC9200451 DOI: 10.13023/jah.0401.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Adolescent births are associated with numerous challenges. While adolescent birth rates have declined across the U.S., disparities persist, and little is known about the extent to which broader declines are seen within Appalachia. Purpose The purpose of this study was to examine the extent to which adolescent birth rates have declined across the subregions of Appalachia relative to non-Appalachia. Methods We conducted a retrospective study of adolescent birth rates between 2012 and 2018 using county-level vital records data. Differences were examined across the subregions of Appalachia and among non-Appalachian counties. Multiple regression models were used to examine changes in the rate of decline over time, adjusting for additional covariates of relevance. Results About 13.4% of all counties in the U.S. are within the Appalachian region. The rate of adolescent births decreased by 12.6 adolescent births per 1,000 females between 2012 and 2018 across the U.S. While all regions experienced declines in the rate of adolescent births, Central Appalachia had the largest reduction in adolescent births (18.5 per 1,000 females), which was also noted in the adjusted models when compared to the counties of non-Appalachia (b= -5.78, CI: -9.58, -1.97). Rates of adolescent birth were markedly higher in counties considered among the most socially and economically vulnerable. Implications This study demonstrates that the rates of adolescent births vary across the subregions of Appalachia but have declined proportional to rates in non-Appalachia. While adolescent birth rates remain higher in select subregions of Appalachia compared to non-Appalachia, the gap has narrowed considerably.
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Ventura LM, Beatty KE, Khoury AJ, Smith MG, Ariyo O, Slawson DL, Weber AJ. Contraceptive Access at Federally Qualified Health Centers During the South Carolina Choose Well Initiative: A Qualitative Analysis of Staff Perceptions and Experiences. Womens Health Rep (New Rochelle) 2022; 2:608-620. [PMID: 35141709 PMCID: PMC8820399 DOI: 10.1089/whr.2021.0060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 11/20/2022]
Abstract
Introduction: Federally qualified health centers (FQHCs) provide essential contraceptive services to low-income individuals; yet, access to all method options, notably intrauterine devices (IUDs) and implants, may be limited at non-Title X FQHCs. The South Carolina (SC) Choose Well initiative is a statewide contraceptive access initiative that was launched in 2017 and extends into 2022. Choose Well established a collaborative network between training and clinical partners and is aimed at facilitating implementation of contraceptive care best practices through capacity-building and training of clinical and administrative staff in partner organizations. The initiative provided funding for workforce expansion and contraceptive methods. We examined perceptions of staff from Choose Well-participating FQHCs regarding contraceptive access during the first 2 years of the initiative, including factors that facilitated or posed access challenges as well as sustaining factors. This study informs the process evaluation of Choose Well while providing data critical for uncovering and scaling up contraceptive access initiatives. Materials and Methods: Interviews were conducted with FQHC staff (n = 34) in 2018 and 2019 to assess Choose Well implementation and were recorded, transcribed, and double-coded via at least 80% interrater reliability or consensus coding. Data were analyzed according to clinical and administrative factors influencing contraceptive access. Results: Increased capacity for contraceptive counseling and provision through training and external funding for IUDs and implants were the most noted clinical factors facilitating access. Streamlining workflow processes was also a facilitator. Buy-in and engagement among staff and leadership emerged as a facilitator at some clinics and as a barrier at others. Policy/structural factors related to costs of devices and insurance coverage were identified as threats to sustainability. Conclusions: The Choose Well initiative contributed to the perception of an increase in contraceptive access at participating FQHCs in SC. Statewide contraceptive access initiatives have the potential to support FQHCs in meeting their clients' contraceptive needs. Organizational buy-in, sustainability of funding, and training are key to realizing the full potential of these initiatives.
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Affiliation(s)
- Liane M Ventura
- Department of Health Services Management and Policy, Center for Applied Research and Evaluation in Women's Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Kate E Beatty
- Department of Health Services Management and Policy, Center for Applied Research and Evaluation in Women's Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Amal J Khoury
- Department of Health Services Management and Policy, Center for Applied Research and Evaluation in Women's Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Michael G Smith
- Department of Health Services Management and Policy, Center for Applied Research and Evaluation in Women's Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Oluwatosin Ariyo
- Department of Health Services Management and Policy, Center for Applied Research and Evaluation in Women's Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Deborah L Slawson
- Department of Community and Behavioral Health, College of Public Health, East Tennessee State University, Johnson City, Tennessee, USA
| | - Amy J Weber
- Department of Health Services Management and Policy, Center for Applied Research and Evaluation in Women's Health, East Tennessee State University, Johnson City, Tennessee, USA
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Beatty KE, Smith MG, Khoury AJ, Zheng S, Ventura LM, Okwori G. Accessibility of federally funded family planning services in South Carolina and Alabama. Prev Med Rep 2021; 22:101343. [PMID: 33767947 PMCID: PMC7980054 DOI: 10.1016/j.pmedr.2021.101343] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 02/12/2021] [Accepted: 02/20/2021] [Indexed: 11/23/2022] Open
Abstract
This study operationalized the five dimensions of health care access in the context of contraceptive service provision and used this framework to examine access to contraceptive care at health department (HD) (Title X funded) and federally qualified health center (FQHC) (primarily non-Title X funded) clinics in South Carolina and Alabama. A cross-sectional survey was conducted in 2017/18 that assessed clinic-level characteristics, policies, and practices related to contraceptive provision. Provision of different contraceptive methods was examined between clinic types. Survey items were mapped to the dimensions of access and internal consistency for each scale was tested with Cronbach's alpha. Scores of access were developed and differences by clinic type were evaluated with an independent t-test. The overall response rate was 68.3% and the sample included 235 clinics. HDs (96.9%) were significantly more likely to provide IUDs and/or Impants on-site than FQHCs (37.4%) (P < 0.0001). Scales with the highest consistency were Availability: Clinical Policy (24 items) (alpha = 0.892) and Acceptability (43 items) (alpha = 0.834). HDs had higher access scores than FQHCs for the Availability: Clinical Policy scale (0.58, 95% CL 0.55, 0.61) vs (0.29, 95% CL 0.25, 0.33) and Affordability: Administrative Policy scale (0.86, 95% CL 0.83, 0.90) vs (0.47, 95% CL 0.41, 0.53). FQHCs had higher access scores than HDs for Affordability: Insurance Policy (0.78, 95% CL 0.72, 0.84) vs (0.56, 95% CL 0.53, 0.59). These findings highlight strengths and gaps in contraceptive care access. Future studies must examine the impact of each dimension of access on clinic-level contraceptive utilization.
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Affiliation(s)
- Kate E Beatty
- Center for Applied Research and Evaluation in Women's Health, Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, P.O. Box 70264, Johnson City, TN 37614, United States
| | - Michael G Smith
- Center for Applied Research and Evaluation in Women's Health, Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, P.O. Box 70264, Johnson City, TN 37614, United States
| | - Amal J Khoury
- Center for Applied Research and Evaluation in Women's Health, Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, P.O. Box 70264, Johnson City, TN 37614, United States
| | - Shimin Zheng
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, 149 Lamb Hall, P.O. Box 70259, Johnson City, TN 37614, United States
| | - Liane M Ventura
- Center for Applied Research and Evaluation in Women's Health, Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, P.O. Box 70264, Johnson City, TN 37614, United States
| | - Glory Okwori
- Center for Applied Research and Evaluation in Women's Health, Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, P.O. Box 70264, Johnson City, TN 37614, United States
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Hale NL, Klaiman T, Beatty KE, Meit MB. Local Health Departments as Clinical Safety Net in Rural Communities. Am J Prev Med 2016; 51:706-713. [PMID: 27344107 DOI: 10.1016/j.amepre.2016.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/28/2016] [Accepted: 05/16/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The appropriate role of local health departments (LHDs) as a clinical service provider remains a salient issue. This study examines differences in clinical service provision among rural/urban LHDs for early periodic screening, diagnosis, and treatment (EPSDT) and prenatal care services. METHODS Data collected from the 2013 National Association of County and City Health Officials Profile of Local Health Departments Survey was used to conduct a cross-sectional analysis of rural/urban differences in clinical service provision by LHDs. Profile data were linked with the 2013 Area Health Resource File to derive other county-level measures. Data analysis was conducted in 2015. RESULTS Approximately 35% of LHDs in the analysis provided EPSDT services directly and 26% provided prenatal care. LHDs reporting no others providing these services in the community were four times more likely to report providing EPSDT services directly and six times more likely to provide prenatal care services directly. Rural LHDs were more likely to provide EPSDT (OR=1.46, 95% CI=1.07, 2.00) and prenatal care (OR=2.43, 95% CI=1.70, 3.47) services than urban LHDs. The presence of a Federally Qualified Health Center in the county was associated with reduced clinical service provision by LHDs for EPSDT and prenatal care. CONCLUSIONS Findings suggest that many LHDs in rural communities remain a clinical service provider and a critical component of the healthcare safety net. The unique position of rural LHDs should be considered in national policy discussions around the organization and delivery of public health services, particularly as they relate to clinical services.
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Affiliation(s)
- Nathan L Hale
- Department of Health Services Management and Policy, East Tennessee State University, Johnson City, Tennessee.
| | - Tamar Klaiman
- Health Policy and Public Health, University of the Sciences, Philadelphia, Pennsylvania
| | - Kate E Beatty
- Department of Health Services Management and Policy, East Tennessee State University, Johnson City, Tennessee
| | - Michael B Meit
- Public Health Research Department, NORC at the University of Chicago, Chicago, Illinois
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Beatty KE, Wilson KD, Ciecior A, Stringer L. Collaboration among Missouri nonprofit hospitals and local health departments: content analysis of community health needs assessments. Am J Public Health 2015; 105 Suppl 2:S337-44. [PMID: 25689184 DOI: 10.2105/ajph.2014.302488] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We identified the levels of joint action that led to collaboration between hospitals and local health departments (LHDs) using the hospital's community health needs assessments (CHNAs). METHODS In 2014, we conducted a content analysis of Missouri nonprofit hospitals (n = 34) CHNAs, and identified hospitals based on previously reported collaboration with LHDs. We coded the content according to the level of joint action. A comparison sample (n = 50) of Missouri nonprofit hospitals provided the basic comparative information on hospital characteristics. RESULTS Among the hospitals identified by LHDs, 20.6% were "networking," 20.6% were "coordinating," 38.2% were "cooperating," and 2.9% were "collaborating." Almost 18% of study hospitals had no identifiable level of joint action with LHDs based on their CHNAs. In addition, comparison hospitals were more often part of a larger system (74%) compared with study hospitals (52.9%). CONCLUSIONS The results of our study helped develop a better understanding of levels of joint action from a hospital perspective. Our results might assist hospitals and LHDs in making more informed decisions about efficient deployment of resources for assessment processes and implementation plans.
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Affiliation(s)
- Kate E Beatty
- Kate E. Beatty is with the Department of Health Services Management & Policy, College of Public Health, East Tennessee State University, Johnson City. Kristin D. Wilson is with the Health Management and Policy Masters in Public Health Program, Department of Health Management and Policy, Saint Louis University College for Public Health and Social Justice, St. Louis, MO. Amanda Ciecior is with the Department of Vermont Health Access, Vermont Agency of Human Services, Winooski. Lisa Stringer is with the Department of Health Management and Policy, Saint Louis University College for Public Health and Social Justice, St. Louis
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Eddens KS, Kreuter MW, Morgan JC, Beatty KE, Jasim SA, Garibay L, Tao D, Buskirk TD, Jupka KA. Disparities by race and ethnicity in cancer survivor stories available on the web. J Med Internet Res 2009; 11:e50. [PMID: 19945948 PMCID: PMC2802561 DOI: 10.2196/jmir.1163] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Revised: 05/28/2009] [Accepted: 08/06/2009] [Indexed: 01/10/2023] Open
Abstract
Background The rapid growth of eHealth could have the unintended effect of deepening health disparities between population subgroups. Most concerns to date have focused on population differences in access to technology, but differences may also exist in the appropriateness of online health content for diverse populations. Objective This paper reports findings from the first descriptive study of online cancer survivor stories by race and ethnicity of the survivor. Methods Using the five highest-rated Internet search engines and a set of search terms that a layperson would use to find cancer survivor stories online, we identified 3738 distinct sites. Of these, 106 met study criteria and contained 7995 total stories, including 1670 with an accompanying photo or video image of the survivor. Characteristics of both websites and survivor stories were coded. Results All racial minority groups combined accounted for 9.8% of online cancer survivor stories, despite making up at least 16.3% of prevalent cancer cases. Also notably underrepresented were stories from people of Hispanic ethnicity (4.1%), men (35.7%), survivors of colon cancer (3.5%), and older adults. Conclusions Because racial/ethnic minority cancer survivors are underrepresented in survivor stories available online, it is unlikely that this eHealth resource in its current form will help eliminate the disproportionate burden of cancer experienced by these groups.
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Affiliation(s)
- Katherine S Eddens
- Health Communication Research Laboratory and Center for Cultural Cancer Communication, George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO 63112-1408, USA.
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Gunthorpe D, Beatty KE, Taylor MV. Different levels, but not different isoforms, of the Drosophila transcription factor DMEF2 affect distinct aspects of muscle differentiation. Dev Biol 1999; 215:130-45. [PMID: 10525355 DOI: 10.1006/dbio.1999.9449] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
mef2 genes encode alternatively spliced transcription factor isoforms that function in muscle differentiation in both Drosophila and vertebrates. Drosophila mef2 (Dmef2) has been shown to be required for the differentiation of a variety of distinct muscle types. However, many possible aspects of its function in muscle remain unexplored. There has also been no analysis in vivo of the activity of different MEF2 isoforms in any species. Our investigation centred on the role of different levels of DMEF2 in the Drosophila embryo in regulating diverse events of muscle differentiation and on the functional significance of Dmef2 alternative splicing. We used the GAL4/UAS system to both misexpress and overexpress individual DMEF2 isoforms and to rescue the different aspects of the Dmef2 mutant phenotype. Ectopic ectodermal expression of DMEF2 activated muscle gene expression and inhibited epidermal differentiation. Overexpression of DMEF2 in the mesoderm disrupted differentiation of the somatic and visceral muscle and the heart. The use of different DMEF2 levels in the rescue experiments revealed an activity range compatible with differentiation of the different muscle types: the consequence of too little or too much DMEF2 activity was disrupted differentiation. These rescue experiments also revealed that distinct DMEF2 thresholds are required for different properties within a cell and also for different cells within a muscle type and for different muscle types. Finally, each isoform functioned equivalently in these experiments, including in the stringent test of rescue of the Dmef2 mutant phenotype.
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Affiliation(s)
- D Gunthorpe
- Department of Zoology, University of Cambridge, Downing Street, Cambridge, CB2 3EJ, United Kingdom
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Taylor MV, Beatty KE, Hunter HK, Baylies MK. Drosophila MEF2 is regulated by twist and is expressed in both the primordia and differentiated cells of the embryonic somatic, visceral and heart musculature. Mech Dev 1995; 50:29-41. [PMID: 7605749 DOI: 10.1016/0925-4773(94)00323-f] [Citation(s) in RCA: 81] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We describe a group of Drosophila cDNAs that encode MADs box proteins and which are members of the MEF2 (myocyte enhancer-binding factor 2) family of transcription factors. Drosophila has a single MEF2 gene, DMEF2, that is alternatively spliced to produce different transcripts and which is expressed in the mesodermal primordium before gastrulation. The mechanisms responsible for the subsequent subdivision of the mesoderm are unknown. However, DMEF2 may play a role in this important event because our experiments show that it is a downstream target for twist and that its early expression pattern modulates as the mesoderm is organising into cell groupings with distinct fates. DMEF2 is also expressed in both the segregating primordia and the differentiated cells of the somatic, visceral and heart musculature. It is the only known gene expressed in these three main types of muscle throughout differentiation.
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Affiliation(s)
- M V Taylor
- Department of Zoology, University of Cambridge, England
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