Implementing the Florida KidCare open enrollment communications campaign: a framework for mobilizing community partners to reduce the number of uninsured children

Florida ranks third among states with the lowest children's insurance coverage, due to constraints such as language barriers, multiple programs, documentation requirements, limited outreach, and short enrollment periods. In November 2004, Florida announced a 30-day children's health insurance enrollment period for January 2005 following an 18-month closure. This article describes the development, implementation, and evaluation of a communication plan creating coalitions between community partners, government agencies, and child advocacy groups to inform families. Over 96,000 families applied, almost five times any previous monthly enrollment. This campaign serves as a template for implementing strategies and engaging community partners to reduce the number of uninsured children.     

Assessment of women's empowerment: An exploratory study to develop a valid and reliable Persian-version tool

Abstract

Lack of a valid and reliable women's empowerment tool was reported by previous studies in Iran. The authors of this paper, accordingly, intended to fill this gap by developing a valid questionnaire. 600 women in Dezful city, southeast of Iran, took part in the study in 2014–2015. Multistage sampling method was used to recruit the participants. Our exploratory factor analysis revealed that 18 items of the model loaded on 4 factors. Internal consistency of the questionnaire was suitable as Cronbach's alpha coefficient was 0.77. Considering high validity and shortness of the questionnaire, it can be used as a trustful and comprehensive tool to measure women's empowerment in future studies.     

Tuberculosis control in China: use of modelling to develop targets and policies

It is unclear if current programmes in China can achieve the post-2015 global targets for tuberculosis – 50% reduction in incidence and a 75% reduction in mortality by 2025. Chinese policy-makers need to maintain the recent decline in the prevalence of tuberculosis, while revising control policies to cope with an epidemic of drug-resistant tuberculosis and the effects of ongoing health reform. Health reforms are expected to shift patients from tuberculosis dispensaries to designated hospitals. We developed a mathematical model of tuberculosis control in China to help set appropriate targets and prioritize interventions that might be implemented in the next 10 years. This model indicates that, even under the most optimistic scenario – improved treatment in tuberculosis dispensaries, introduction of a new effective regimen for the treatment of drug-susceptible tuberculosis and optimal care of cases of multidrug-resistant tuberculosis – the current global targets for tuberculosis are unlikely to be reached. However, reductions in the incidence of multidrug-resistant tuberculosis should be feasible. We conclude that a shift of patients from tuberculosis dispensaries to designated hospitals is likely to hamper efforts at tuberculosis control if cure rates in the designated hospitals cannot be maintained at a high level. Our results can inform the planning of tuberculosis control in China.     

Health inequity: the plight of uninsured children in a rural Alabama county and the plan to cure it

Many children in the United States do not have access to health insurance. Providing health insurance for children has been particularly challenging in rural America. This article describes and evaluates a local plan to provide access to health care for school children in a rural Alabama county. A triangulated methodology (personal interviews, ad hoc survey focus groups, US census and health fair data) was used in the evaluation. Gains were made in enrolling children despite some limitations, especially in rural outreach. The most successful aspect of the program was a partnership between local leaders, health providers, and educators to provide impetus for a coordinated plan. The stability of the program is uncertain because of diminishing resources and the negative effects of economic recession.     

Promoting learning on reintegration of children into family-based care: implications for monitoring approaches and tools. Experiences from the RISE learning network

ABSTRACT

Between 2015 and 2018, the RISE Learning Network facilitated learning on approaches, practices, methods, and tools that promote recovery and reintegration of children affected by sexual exploitation. Spanning three regions (Sub-Saharan Africa, South Central Asia, and Latin America and the Caribbean), the RISE Learning Network implemented two learning projects. The first project focused on monitoring (M&E Learning Project) and aimed to generate understanding of approaches and tools that could effectively monitor children and families’ reintegration outcomes. The specific purpose of RISE is to promote learning on reintegration of children affected by sexual exploitation; however, the remit of this Learning Project was to generate evidence on the reintegration of children who have been separated from their families for a range of reasons. This is to ensure that learning from different, but often related, areas of work can be included and compared to strengthen understanding of what successful reintegration of children could look like. The mid- and end-term reviews of the M&E Learning Project have captured lessons learned on how practitioners can approach monitoring of reintegration to mainstream it into their programme cycle. Key lessons learned include the importance of focusing on monitoring outcomes through participatory tools and the benefit of flexible, peer-to-peer learning approaches between practitioners using a variety of monitoring tools. This learning contributes to the nascent evidence base on what effective and efficient capturing of reintegration outcomes on children can look like, in addition to strengthening understanding of what successful reintegration for children and families means. The learnings can inform programming; monitoring, evaluation and learning frameworks; and other interventions around reintegration to ensure the holistic wellbeing of children and families.     

Medicaid enrollment among elderly medicare beneficiaries: individual determinants,effects of state policy,and impact on service use

OBJECTIVE: To better understand factors associated with Medicaid enrollment among low-income, community-dwelling elderly persons and to examine the effect of Medicaid enrollment on the use of health care services by elderly persons, taking into account selection in program participation. DATA SOURCES: 1996 Medicare Current Beneficiary Survey (MCBS) Access to Care and Cost and Use files. METHODS: Individual-level predictions of the probability of dual enrollment are obtained from equations that estimate jointly the residential status of Medicare beneficiaries (community versus institution) and the probability of Medicaid enrollment among community-dwelling eligible beneficiaries. Predicted values are then substituted into the service use equations, which are estimated via two-part models. PRINCIPAL FINDINGS: Less than half of all community-dwelling elderly persons with incomes at or below 100 percent of the Federal Poverty Level (FPL) were enrolled in Medicaid in 1996. Once selective enrollment was accounted for, there was limited evidence of a dual enrollment effect on service use. Although there were no effects of state Medicaid policy variables on the probability that beneficiaries lived in the community (as opposed to nursing homes), the effects of state's Medicaid generosity in home and community-based services had a sizeable and statistically significant effect on influencing the likelihood that eligible elderly persons enrolled in Medicaid. CONCLUSIONS: Our results provide compelling evidence that Medicaid participation can be influenced by state policy. The observation that "policy matters" provides new insights into how existing programs might reach a larger proportion of potentially eligible beneficiaries.     

Effects of increasing syringe availability on syringe-exchange use and HIV risk: Connecticut, 1990–2001

Syringe-exchange programs (SEPs) in Connecticut operate with caps on the number of syringes exchanged per visit. We investigated the effects of legislation increasing the cap on drug injectors' access to clean syringes through the SEPs in New Haven and Hartford. The mixed design of this study included longitudinal and crosssectional data from individuals and ecological data from program operations. Five parameters—syringe return rate, syringes per visit to the SEP, syringe reuse rate, syringe human immunodeficiency virus (HIV) prevalence, and syringe sharing—were monitored through syringe tracking and testing of SEP syringes and by interviewing injectors. Two increases in the cap—from 5 to 10 and then from 10 to 30—had little effect on the five parameters that measured injectors' access to clean syringes. In contrast, access to clean syringes increased when the New Haven SEP first began operations, when syringes first became available at pharmacies in Hartford, and when the agency running the Hartford SEP changed. Legislation providing piecemeal increases in the cap may not, by themselves, be sufficient to increase injectors' access to clean syringes and decrease the risk of human immunodeficiency virus transmission in this population.     

The epidemiology of severe injuries to children in northern Manhattan: methods and incidence rates

The epidemiology of injury incidence in inner-city children has not previously been described. This study presents the methods used and the incidence rates found for severe injury (causing hospitalisation or death) in a population of 89,000 children under age 17 years in northern Manhattan, a largely poor area of New York City. The average annual incidence rate (measured from 1983 to 1987) for severe injuries to children under 17 was 846/100,000 a year. The vast majority (79%) were classified as unintentional. Nine per cent were due to assault, 3% were self-inflicted and in an additional 9% the intention was unclear. Classified by cause, the highest incidence (per 100,000/year) was found for falls (218), vehicle-related (141, primarily pedestrian), ingestion (119) and burns (110). Guns caused 3% of the injuries (27). The death rate from injury was 18.7/100,000, 36% of which was due to homicide. In an additional 28%, intentional injury was suspected. The suicide rate was 0.4/100,000. The leading causes of injury death included guns and burns (both 2.7/100,000). Compared with childhood injury rates in predominantly rural and suburban populations, the rates reported here for northern Manhattan are higher for overall injury incidence (fatal and non-fatal) and for homicide, but lower for injury mortality not due to homicide.     

Estimation and testing based on data subject to measurement errors: from parametric to non-parametric likelihood methods

Measurement error (ME) problems can cause bias or inconsistency of statistical inferences. When investigators are unable to obtain correct measurements of biological assays, special techniques to quantify MEs need to be applied. Sampling based on repeated measurements is a common strategy to allow for ME. This method has been well addressed in the literature under parametric assumptions. The approach with repeated measures data may not be applicable when the replications are complicated because of cost and/or time concerns. Pooling designs have been proposed as cost-efficient sampling procedures that can assist to provide correct statistical operations based on data subject to ME. We demonstrate that a mixture of both pooled and unpooled data (a hybrid pooled-unpooled design) can support very efficient estimation and testing in the presence of ME. Nonparametric techniques have not been well investigated to analyze repeated measures data or pooled data subject to ME. We propose and examine both the parametric and empirical likelihood methodologies for data subject to ME. We conclude that the likelihood methods based on the hybrid samples are very efficient and powerful. The results of an extensive Monte Carlo study support our conclusions. Real data examples demonstrate the efficiency of the proposed methods in practice.     

Research on medical migration from sub-Saharan medical schools: usefulness of a feasibility process to define barriers to data collection and develop a practical study

CONTEXT: The maldistribution of physicians in sub-Saharan Africa is having serious impacts on population health. Understanding the effect requires investigation from both donor and recipient countries. However, investigation from the perspective of donor countries has been lacking. METHODS: This brief communication describes a model process for the design of a research project that addresses medical migration issues from the perspective of eight African medical schools. During an international meeting, the participants designed an initial "ideal" study, and then rapidly tested its feasibility through a brief survey, and group discussion through a listserv, teleconferences and one face-to-face meeting. FINDINGS AND PRACTICAL IMPLICATIONS: Innovative research ideas can be followed-up with surveys to test the feasibility of an "ideal" research design, modifying the design accordingly. This is currently occurring with our medical migration survey study.     

Persuasive food marketing to children: use of cartoons and competitions in Australian commercial television advertisements

While there is a recognized link between high levels of exposure to advertising of unhealthy foods and overweight and obesity among children, there is little research on the extent to which these exposures include persuasive marketing techniques. This study aimed to measure children's exposure to the use of persuasive marketing within television food advertisements. Advertisements broadcast on all three commercial Australian television channels were recorded for an equivalent 1 week period in May 2006 and 2007 (714 h). Food advertisements were analysed for their use of persuasive marketing, including premium offers, such as competitions, and the use of promotional characters, including celebrities and cartoon characters. Advertised foods were categorized as core, non-core or miscellaneous foods. Commercial data were purchased to determine children's peak viewing times and popular programs. A total of 20 201 advertisements were recorded, 25.5% of which were for food. Significantly more food advertisements broadcast during children's peak viewing times, compared to non-peak times, contained promotional characters (P < 0.05) and premium offers (P < 0.001). During programs most popular with children, there were 3.3 non-core food advertisements per hour containing premium offers, compared to 0.2 per hour during programs most popular with adults. The majority of advertisements containing persuasive marketing during all viewing periods were for non-core foods. Persuasive marketing techniques are frequently used to advertise non-core foods to children, to promote children's brand recognition and preference for advertised products. Future debate relating to television advertising regulations must consider the need to restrict the use of persuasive marketing techniques to children.     

Availability of long-acting and permanent family-planning methods leads to increase in use in conflict-affected northern Uganda: Evidence from cross-sectional baseline and endline cluster surveys

Abstract

Humanitarian assistance standards require specific attention to address the reproductive health (RH) needs of conflict-affected populations. Despite these internationally recognised standards, access to RH services is still often compromised in war. We assessed the effectiveness of our programme in northern Uganda to provide family planning (FP) services through mobile outreach and public health centre strengthening. Baseline (n=905) and endline (n=873) cross-sectional surveys using a multistage cluster sampling design were conducted in the catchment areas of four public health centres in 2007 and 2010. Current use of any modern FP method increased from 7.1% to 22.6% (adjusted odds ratio [OR] 3.34 [95% confidence interval (CI) 2.27–4.92]); current use of long-acting and permanent methods increased from 1.2% to 9.8% (adjusted OR 9.45 [95%CI 3.99–22.39]). The proportion of women with unmet need for FP decreased from 52.1% to 35.7%. This study demonstrates that when comprehensive FP services are provided among conflict-affected populations, women will choose to use them. The combination of mobile teams and health systems strengthening can make a full range of methods quickly available while supporting the health system to continue to provide those services in challenging and resource-constrained settings.