Andrew Rucks

SummaryMultilevel/hierarchical obesity studies analyze adolescent and family, neighbourhood and social settings’ characteristics to generate data needed to design prevention interventions. This scoping study summarizes such studies’ characteristics and key findings to provide information to decision makers, which allows them to quickly grasp the state of the evidence and potential policy implications for adolescent obesity prevention. PubMed, CINAHLplus, PsychINFO and Sociological s were searched for peer‐reviewed studies spanning 1 January 2000–31 August 2014. Inclusion criteria included (i) outcome weight status, physical activity and weight status, or physical activity alone if the aim was obesity prevention; (ii) 12‐ to 19‐year‐old participants in a cross‐sectional study, a separate analysis in a cross‐sectional study or a longitudinal follow‐up. Nineteen studies were published in the United States of America; four in Canada; two in Spain, China and Vietnam, respectively; and on...

<strong>Introduction:</strong> Living in the Appalachian Region of the United States (US) has been linked to poorer pediatric health outcomes as well as a lack of emergency department and hospital surge capacity during disasters. <strong>Purpose:</strong> We describe the characteristics of the Appalachian and non-Appalachian pediatric emergency networks in the US to determine if pediatric healthcare networks in Appalachia differ substantively from networks elsewhere in the US focusing on size, whether they were inter- or intra-state networks, and, most importantly, intensity of collaboration – factors impacting on pediatric disaster preparedness capabilities. <strong>Methods:</strong> Data were collected using a two-stage survey process. The first survey was used to identify networks. The second survey assessed the disaster preparedness capabilities and achievements of each identified network, the degree of fund sharing, and the intensity and formality of information sharing among network partners. Networks were separated into Appalachia or non-Appalachia networks based on state location. <strong>Results:</strong> Appalachian networks were more likely to be interstate and operating at the highest stage of network development compared to non-Appalachian networks, but were less likely to share funding among network partners. <strong>Implications:</strong> Despite consistently insufficient pediatric capacity, particularly for disasters, and repeated calls for collaboration among pediatric care providers, only three out of seventeen identified pediatric networks were operating in Appalachia. Operating in Appalachia was associated with less fund sharing, although Appalachian networks were more likely to have achieved the highest stage of network development. Developing new pediatric networks and increasing the intensity of collaboration (i.e., increased levels of fund sharing) among existing networks may improve network operations, collaboration, disaster preparedness, and health outcomes in Appalachian states.

The purpose of this study is to determine the effects of water pollution control on financing municipal water pollution control facilities in selected cities in North Central Texas. This objective is accomplished by addressing the following topics: (1) the cost to municipalities of meeting federally mandated water pollution control, (2) the sources of funds for financing sewage treatment, and (3) the financial implications of employing these financing tools to satisfy water quality regulations. The study makes the following conclusions regarding the impact of water pollution control costs on municipalities in the North Central Texas Region: 1) The financing of the wastewater treatment requirements of the Water Pollution Control Act Amendments of 1972 will cause many municipalities to report operating deficits for their Water and Sewer Fund. 2) A federal grant program funded at the rate of 75 per cent of waste treatment needs will prevent operating deficits in the majority of cities ...

Children's hospitals routinely function at or near capacity, at least during peak seasons of the year. When addressing these capacity limitations, most disaster plans operate with assumptions about how care will be provided to children in a disaster. The first assumption is that pediatric hospitals will be able to expand their capacity in order to adequately respond to any local disaster event. The second assumption is that adult providers are adequate substitutes for pediatric care. There are risks in these assumptions. The most obvious risks are that pediatric providers may be extremely limited in their ability to expand capacity, and that local adult providers will not be able to provide adequate care for children in terms of either volume or quality. Since these risks resonate with the market positioning of pediatric providers, they are likely to influence preparation at pediatric facilities. This may lead to pediatric facilities diverting significant resources on disaster preparation. Another alternative would be regional coordination between pediatric specific providers. Such support might provide the same degree of support for the local population, but at a lower overall cost. For the purposes of this paper, we assume that there are functional limits on local pediatric expansion capabilities during large scale events and that adult providers are not a perfect substitute for pediatric providers. Given these assumptions, this paper utilizes a microeconomic approach to develop a theoretical framework in order to facilitate regional pediatric disaster planning.

The FORTRAN Synthetic Program (FSP) facilitates simu lation of a computer workload by providing control of processing time, memory usage, and instruction mix. The FSP features modular design, parameterized control, and internal defaults that enhance flexib ility. The FSP offers the advantages of system independence, ease of use, high flexibility, and the ability to produce verifiable, predictable, and repeatable experiments.

For the years 2004 through 2010, the Mississippi Gulf Coast experienced six major disasters including five, Federal Emergency Management Agency (FEMA) Disaster Declarations and the Deep Water Horizon Oil Spill (Gulf Oil Spill). This paper examines the association of these events and changes in Behavioral Risk Factor Surveillance System (BRFSS) data. The Mississippi State Department of Health (MSDH) collects BRFSS data by Public Health District and District IX contains the six counties that border the Gulf of Mexico and adjacent counties. Selected BRFSS data for MSDH District IX are compared with the same data for MSDH District II, an eleven-county area in the northeast area of the state. Using chi square and time series analysis and controlling for dissimilar events in MSDH District II, analysis of the data for the period 2004 through 2010, reveals that the six events affecting District IX adversely affected health measures and demographics and that these effects were significantly ...

In the event of a natural or man-made disaster involving large numbers of children, resources in the Southeastern U.S. are extremely limited. This article chronicles the efforts of the Alabama Department of Public Health, the Mississippi State Department of Health, and the South Central Center for Public Health Preparedness in conjunction with more than 40 organizations to develop a voluntary network of health-care providers, public health departments, volunteers, and emergency responders from Alabama, Florida, Louisiana, Mississippi, and Tennessee. The purpose of the Southeastern Regional Pediatric Disaster Surge Network (the Network) is to improve the pediatric preparedness response strategies of public health, emergency response, and pediatric providers in the event of large-scale emergencies or disasters that overwhelm local or state pediatric resources. The planning and development of the Network is proceeding through three general phases--information sharing, mutual goal setti...

Since Jan. 1, 2019, the Centers for Medicare and Medicaid Services' (CMS) rule requiring hospitals publish their “standard charges” (also called “charge description masters” or “chargemasters”) in a public, machine-readable format has been in effect. The research at hand assesses hospital compliance with the federal regulation. In addition, a sentiment analysis of the chargemaster webpages compared to hospital homepages is performed to assess the consumer friendliness of the content in terms of language usage. A stratified sample of 212 hospitals was used to conduct observations. Strata were based on patient satisfaction scores drawn from the Hospital Consumer Assessment of health care Providers and Systems survey, and controls for hospital bed size and geographic US census region were utilized from the American Hospital Association Annual Survey. Descriptive statistics are presented, and chi-square testing is used to test for statistically significant differences. Key results a...

Despite mounting evidence that social factors and public policies affect state infant mortality rates (IMRs), few researchers have examined variation in IMRs associated with those factors and policies. We quantified disparities in infant mortality by state social factors and public policy characteristics. We hypothesized that some social factors and public policies would be more strongly associated with infant mortality than others, and that states with similar factors and policies would form clusters with varying levels of infant mortality. We examined associations of women’s economic empowerment, health and well-being, political participation, reproductive rights, and work and family-related policies with state IMRs in 2012 and 2015, using indicators created by the Institute for Women’s Policy Research. Methods included generalized linear models, principal component analysis, and cluster analysis. Health and well-being predicted IMRs (2012, 2015, both p < .05), as did poverty a...

The CAHPS Health Plan Survey (CAHPS 5.0) collects invaluable information regarding consumer experiences with their health plans, and these data inform healthcare policies at both the state and federal levels. The purpose of this paper was to explore unsolicited comments provided on the CAHPS 5.0 survey of one state's Medicaid program. Secondary data analysis was conducted of unsolicited, written comments received from Medicaid recipients who completed the CAHPS 5.0 adult or child postal survey between 2016 and 2018. The majority of unsolicited comments were moderately or very negative in attitude (or tone) for adult and child surveys. Analysis of unsolicited comments yielded 3 themes: positive experiences with Medicaid, limitations of coverage, and direct requests for assistance. Providing space for Medicaid patients to share comments and receiving further guidance for content analysis would provide valuable context for interpreting overall survey results. Comments may also help...

Objectives: The American Academy of Pediatrics (AAP) calls for the inclusion of office-based pediatricians in disaster preparedness and response efforts. However, there is little research about disaster preparedness and response on the part of pediatric practices. This study describes the readiness of pediatric practices to respond to disaster and delineates factors associated with increased preparedness. Methods: An AAP survey was distributed to members to assess the state of pediatric offices in readiness for disaster. Potential predictor variables used in chi-square analysis included community setting, primary employment setting, area of practice, and previous disaster experience. Results: Three-quarters (74%) of respondents reported some degree of disaster preparedness (measured by 6 indicators including written plans and maintaining stocks of supplies), and approximately half (54%) reported response experience (measured by 3 indicators, including volunteering to serve in disast...

Q-sort methodology is an underutilized tool for differentiating among multiple priority measures. The authors describe steps to identify, delimit, and sort potential health measures and use selected priority measures to establish an overall agenda for continuous quality improvement (CQI) activities within learning collaboratives. Through an iterative process, the authors vetted a list of potential child and adolescent health measures. Multiple stakeholders, including payers, direct care providers, and organizational representatives sorted and prioritized measures, using Q-methodology. Q-methodology provided the Alabama Child Health Improvement Alliance (ACHIA) an objective and rigorous approach to system improvement. Selected priority measures were used to design learning collaboratives. An open dialogue among stakeholders about state health priorities spurred greater organizational buy-in for ACHIA and increased its credibility as a statewide provider of learning collaboratives. Th...

Historically, double data entry (DDE) has been considered the criterion standard for minimizing data entry errors. However, previous studies considered data entry alternatives through the limited lens of data accuracy. This study supplies information regarding data accuracy, operational efficiency, and cost for DDE and Optical Mark Recognition (OMR) for processing the Consumer Assessment of Healthcare Providers and Systems 5.0 survey. To assess data accuracy, we compared error rates for DDE and OMR by dividing the number of surveys that were arbitrated by the total number of surveys processed for each method. To assess operational efficiency, we tallied the cost of data entry for DDE and OMR after survey receipt. Costs were calculated on the basis of personnel, depreciation for capital equipment, and costs of noncapital equipment. The cost savings attributed to this method were negated by the operational efficiency of OMR. There was a statistical significance between rates of arbitration between DDE and OMR; however, this statistical significance did not create a practical significance. The potential benefits of DDE in terms of data accuracy did not outweigh the operational efficiency and thereby financial savings of OMR.

Public health departments provide many services critical to maintaining healthy populations, including communicable disease control, immunizations, primary care, and emergency preparedness. The Public Health Accreditation Board (PHAB) has established an accreditation process for public health departments that measures departmental performance against nationally recognized, evidence-based standards. The goal is to recognize departmental strengths and weaknesses, strengthen partnerships, and promote the prioritization of organizational goals to improve community health. Achieving accreditation from the PHAB requires health departments to develop Community Health Assessment (CHA), Community Health Improvement Plan (CHIP), and Strategic Plan processes. The intent of the CHA is to determine contributing factors for poor health outcomes and assess available resources. Building on the CHA, the CHIP establishes health priorities and improvement strategies, including measurable health outcom...

ABSTRACT The ASPH/CDC Pandemic Influenza Collaboration Group includes 32 individuals from 24 academic institutions, public health organizations, and the Centers for Disease Control and Prevention. Over a period of eight months, the Group developed a Pandemic Influenza Preparedness Resource Kit for Academic Institutions. The Resource Kit is an extensive document intended to be adaptable for use by any academic institution. It is an obvious illustration of the successes possible when organizations mutually work towards common goals. This presentation is co-authored by four diverse members of the Collaboration Group. Together we will outline the Resource Kit, its applications, plan development, operability, and maintenance. Lessons learned, issues to consider, obstacles overcome, and activities accomplished will be highlighted. The Resource Kit can be used by organizations at any stage of planning and will undoubtedly strengthen existing all-hazards as well as public health emergency plans. A borderless approach to planning provides users with the opportunity to meaningfully conduct a risk analysis and avoid the pitfalls of fill in the blanks planning. Whereas standard templates are found in abundance, the Resource Kit is a rare document that inspires action by operationalizing preparedness at a personal level.

The ASPH/CDC Pandemic Influenza Collaboration Group includes 32 individuals from 24 academic institutions, public health organizations, and the Centers for Disease Control and Prevention. Over a period of eight months, the Group developed a Pandemic Influenza Preparedness Resource Kit for Academic Institutions. The Resource Kit is an extensive document intended to be adaptable for use by any academic institution. It is an obvious illustration of the successes possible when organizations mutually work towards common goals. This presentation is co-authored by four diverse members of the Collaboration Group. Together we will outline the Resource Kit, its applications, plan development, operability, and maintenance. Lessons learned, issues to consider, obstacles overcome, and activities accomplished will be highlighted. The Resource Kit can be used by organizations at any stage of planning and will undoubtedly strengthen existing all-hazards as well as public health emergency plans. A b...

For more than 100 years professionals in medicine, law, and management have relied on case studies as a highly effective didactic pedagogy. Although public health professional training has employed cases and exercises extensively to develop functional and interagency coordination skills, it has been slow to utilize the case method to develop budgeting and financial analysis skills. Often, public health professionals have a difficult time linking decision making and project management to financial reports that measure financial performance. Case studies are an ideal pedagogy to practice professional financial decision making and leadership skills because they place participants in real situations with all the information, conflicts, and confusion inherent in the difficult financial decisions that were faced. The case method places learners in the role of decision makers who must evaluate the financial implications of their decisions and assess financial results. Because cases, especi...

The creation of a continuity of operations plan (COOP) widely recognized as a key element of disaster preparedness and disaster response strategies and has been an accepted part of the emergency preparedness landscape since 1955. In 2009, the Federal Emergency Management Agency (FEMA) issued Continuity Guidance Circular 1 (CGC 1) as guidance for non-Federal entities; however, did not offer an effective means of translating the content into a practical disaster plan. The South Central Preparedness and Emergency Response Learning Center developed Focused Continuity of Operations Planning (FCOOP) to develop an effective plan in a short period of time. Focused COOP or “FCOOP” has been successfully used by agencies in Alabama, Georgia, Oregon, and other states. In 2010, FEMA released Continuity Guidance Circular 2 (CGC 2). Although CGC 2 remedied some of the shortcomings of CGC 1, it too failed to offer sufficient worksheets and templates for the development of a complete plan. Therefore...

The key to the effective utilization of the Strategic National Stockpile (SNS) lies in the distribution system or PODs (Points of Distribution). In the event of an emergency, these PODs need to be staffed in part by volunteers whose training will be the difference between an effective and efficient distribution system and a slow and ineffective one. This paper describes a simple functional exercise that was developed for both training and evaluating the functionality of volunteers within the POD structure. To increase training efficiency this exercise is designed to be administered as part of the training of volunteers. Further, the evaluation of the exercise is designed to assist state health departments in identifying volunteer training needs and deficiencies. In this example case, the exercise revolves around an Influenza Pandemic (H5N1). Participants are organized into POD Teams, with the number of such teams determined by the number of volunteers and trained/expert staff partic...

... 1. The military-business analogy Technology Political Factors Organization of Business Weather Basic Mission Strategic Plans Organization Marketing ... For instance, Cushen constructed a model based on the characteristics of an agricultural products firm that demonstrated the ...

To compare the likelihood of receiving an influenza immunization in older adults before and immediately after a cancer diagnosis occurring in 2001 and for the same time periods with older adults not diagnosed with cancer. Retrospective analysis comparing influenza immunization rates of Medicare beneficiaries with and without a diagnosis of cancer. Surveillance, Epidemiology, and End Results-Medicare Data. Propensity score matching matched a group of 35,229 persons without cancer with 35,257 individuals diagnosed with cancer in 2001. Receipt of influenza vaccination based upon Medicare Claims Data. A difference-of-difference analysis revealed that influenza immunization rates increased over time for persons diagnosed with cancer (46.8% before to 50.8% after cancer diagnosis), but the increase was greater in beneficiaries without a cancer diagnosis (42.6% to 79.7%) (P < .001; 95% confidence interval = 0.320-0.324). Logistic regression analysis revealed that individuals without a cancer diagnosis were 7.25 times as likely to receive an influenza immunization. Older adults who have been recently diagnosed with cancer receive influenza immunizations at much lower rates than older adults who have not been diagnosed with cancer despite interaction with healthcare providers. Opportunities exist to improve influenza immunization in this population, who are susceptible to influenza because of compromised immune systems.

The purpose of this study was to examine the effects of a tornado disaster on the personal preparedness of local residents to determine (1) to what extent the tornado outbreak experience had altered preparedness awareness, willingness to act, and levels of personal preparedness of residents as measured by possession of a preparedness kit; and (2) what effect this experience had on the variables associated with having a complete disaster preparedness kit. Two random digit-dialed surveys were completed following the Behavioral Risk Factor Surveillance System protocols. The pre-tornado survey was conducted between October and December 2010 and the post-tornado survey was conducted between January and March 2012. After the April 2011 tornado outbreak, 86.08% of the respondents (n = 1364) reported that they had thought more about personal or family preparedness and 59.65% (n = 907) reported that they had taken actions to increase their level of preparedness. Overall, general awareness of preparedness media campaigns increased significantly (almost 24%; P < .0001), as did the percentage of those having a complete disaster preparedness kit (a 66% increase, not quite doubled from 2010 to 2012; P < .0001). Findings of the study indicate that the disaster had a significant impact on the local residents' (1) awareness of preparedness campaigns, (2) awareness of the need to be prepared, (3) willingness to become better prepared, and (4) possession of a disaster and emergency preparedness kit and its associated items.

Beginning in 2010, the U.S. Department of Health and Human Services, Health Resources and Services Administration, made provisions in its Public Health Training Center cooperative agreements for field placements. This article describes best practices and lessons learned establishing and managing the South Central Public Health Partnership's Interns and Mentors Program for ACTion (IMPACT) Field Placement Program, which was initially funded through the Centers for Disease Control and Prevention's Centers for Public Health Preparedness Cooperative agreement in 2002. The IMPACT program is based on a six-step process that has been developed and refined over its 10-year history: (a) identifying field placement opportunities, (b) marketing field experience opportunities to students, (c) selecting students seeking field experience opportunities, (d) placing students with practice partners, students with practice partners, (e) evaluating student progress toward field experience objectives, and (f) evaluating the program. This article describes the program's structure and processes, delineates the roles of its academic and practice partners, discusses evidence of its effectiveness, and describes lessons learned from its decade-long history. Hopefully, this information will facilitate the establishment, management and evaluation of internship and field placement programs in other Public Health Training Centers and academic public health programs.