Projects
Senior Fellow Research Projects Sponsored by RWJF Center for Health Policy at UNM
Assessment of Hispanic Specific Attitudes Regarding Health Coverage Reform in New Mexico
Gabriel Sanchez (Political Science), co PIs Richard Santos (Economics) Amelia Rouse (IPP), Amy Goodin (IPP)
Access to adequate and affordable healthcare is an issue receiving a lot of attention to both state and federal governments. In New Mexico governor Bill Richardson established a task force to explore how to provide affordable access to healthcare and the result was a series of recommendations from a study conducted by Mathmatica Policy Institute. These recommendations are not unlike many of the proposals emerging in other states. However, what was missing from the recommendations was a clear picture of how this issue plays out in the minds of New Mexicans. As a result, researchers at the University of New Mexico received funding from the Robert Wood Johnson Foundation Center for Health Policy at UNM for a collaborative effort to examine public preferences for the primary recommendations culminating from the aforementioned study. In addition to illustrating how New Mexicans evaluate the recommendations from the Governor’s study involving single payer systems and the use of vouchers, we also present information about how New Mexicans value healthcare as a public good. Additionally, this study provides insight into perspectives on who should be covered under a state healthcare program and how much New Mexicans are willing to pay for such a program. These issues are analyzed across a variety of demographic, socio-economic and political measures with an emphasis on differences between White, non-Hispanic and Latino populations. From this perspective the authors believe this research provides a clear example of deploying survey research for the public good.
New Mexico School-Based Obesity Prevention Policies: A Study of Community Perceptions in Underserved Minority Populations
Jane McGrath and Eva Caldera (Department of Pediatrics)
The overall goals were to study sustainability of health policy coalitions, the relationship of these coalitions to power structures, and the ability of coalitions to successfully advocate for healthy policies. Specifically, this project studied the power and social relationships between health professionals, political actors and community members engaged with the NM Community Coalition for HealthCare Access (CCHA). Similar case studies are being conducted in several other countries as cross-comparisons of models, sustainability issues, and World Health Organization Health for All policies. Using a qualitative, case study design, twelve key informants where interviewed based on their roles as members of the coalition or as outside stakeholders. Analysis of common themes identified facilitators of the Coalition in the policy development process as the use of power analysis; strategic planning to enhance participation in decision making; and having diverse actors involved from many sectors in the CCHA. Barriers included lack of accountability; lack of skills in working with conflict; the resistance of the power structure to change; and the ability of the power structure to divide advocacy groups and decrease community participation by creating multiple committees. Despite the barriers, some health policies were changed as a result of the CCHA work, supporting improved access to health and reallocated resources for health services paid by taxpayers.
Identifying Factors Related to the Willingness to Pay for Cancer Prevention
Alok K. Bohara (Economics) co PIs Jose Pagan and Michael Milligan
Using survey data from the 2002 Health and Retirement Study, we analyze stated willingness to pay for a hypothetical anti-cancer medication. The survey allows stated willingness to pay to be defined between two thresholds, and we develop a unique economic analysis to take maximum advantage of the information available. In particular, the relationship between willingness to pay and stated perceived probability of contracting cancer in the future is examined.
Child Healthy Weight in Albuquerque: Participatory Assessment for Health Policy
Celia Iriart (Family and Community Medicine) co PIs Thomas Scharmen
The original project was proposed to explore weight problems and associated health disparities in a participatory environment with APS staff and members of the Physical Activity and Nutrition Advisory Committee (PANAC). The data analyzed included a cohort of children (grades k,3, and 5) from La Mesa Elementary School, databases of 4th grade students enrolled in six APS schools, and the New Mexico High School Youth Risk and Resiliency Survey. The participatory process was built based on interactive secessions which the research team presented preliminary results of data analyses which demonstrate the importance of a population-based approach, enriched the analyses with participants input, and engaged them in dialog to elicit policy research questions. The original research team was enlarged with stakeholders who are interested in developing a larger proposal to further the understanding of this important public health problem. The analyzed data showed significant inequalities related to age, sex, ethnicity, and food insecurity to justify the importance of developing a larger proposal using the large database that APS rolled up in 2005 (K, 3rd, 5th, and 8th grades), analyze the implementation of the New Mexico nutrition and wellness policy, and map interventions at the school level to establish reliable baseline information.
Fiscal Burdens and Resource Gaps of Children with Chronic Pulmonary Conditions in a Rural State
Marie Lobo (Nursing) and Patricia Marshik (Pharmacy)
Background: Many studies focusing on children with chronic pulmonary conditions examine families living in urban environments. Rural states provide challenges to families caring for children with chronic pulmonary conditions. Access to health care can be difficult due to distance or a lack of providers. The out-of-pocket (OOP) expenses associated with this are not well-documented. This paper describes the financial burden of caring for their child’s chronic illness when families live in a rural environment.
Purpose/Aims: (1) Describe the fiscal burden for families living in a rural state who are caring for a child with a chronic pulmonary illness.
Sample: The sample of 150 families of children with chronic pulmonary conditions was drawn from the Pediatric Pulmonary Clinic (PPC) at major medical center in the SW. English-speaking families were selected from a non-categorical group of families with a child receiving care for a pulmonary condition at the PPC.
Methods: This descriptive study was conducted using a structured interview (30 minutes long) where parents/ primary caregivers were asked about their demographics and fiscal expenses. Families were recruited when they came to the clinic for regularly scheduled appointments. The study was reviewed and approved by the IRB.
Results: Structured interviews were completed in clinic with 150 families from rural and urban areas in New Mexico. The sample included 66 females (42.3%) and 90 males (57.7%), 6 families had two children attending an appointment. The median age was 7 years old (3.5 mo – 17 y). The majority of the families identified themselves as Hispanic (46%); the rest were Caucasian (27%), Other (14%), Native American (9%), African American (3%) and Asian (1%). Most families reported English as the primary language spoken at home (N=137) and 42% of the families reported being bilingual. The most frequently reported pulmonary condition was asthma (69.3%). Other pulmonary conditions were cystic fibrosis (4%), bronchopulmonary dysplasia (2%). The average distance travelled to the PPC was 104.9 miles (a range of 0.5 to 480 miles). OOP expenses were largest for increased costs of utilities, 28 families reported spending an average of $149 on additional utilities in the past month. Other average OOP costs in the past month were trips to the pulmonary clinic (~$63 per trip), meals associated with health care trips ($53), prescriptions ($26) and over-the-counter medications ($17). 44 families made renovations to their homes spending an average of $2,389.
Implications: This study revealed a wide range of economic costs of caring for a child with a chronic pulmonary condition in New Mexico. Findings may be used to influence the development of health policies that affect families who travel long distances to seek health care for their children.
Drug Coverage, Utilization and Health in the Rheumatoid Arthritic Elderly Population
Nasreen Khan, (Pharmacy)
The project evaluates the effect of prescription drug insurance coverage on prescription drug use, and health among elderly patience with Arthritis. Estimates are obtained using multivariate regression and a fixed-effects (within person) research design that controls for unmeasured person-specific effects that may confound the relationships of interest. Analyses were based on Medicare Current Beneficiary Survey for years of 1992-2004. Estimates showed that prescription drug coverage is associated with a 2% to 15% increase in the utilization of prescription drugs depending on the type and generosity of the coverage. In addition, drug coverage had a bigger impact on patience who had other chronic conditions. For instance, drug coverage increased use of diabetic drugs by 20%, whereas it had relatively low impact on the use of medication used for acute illness (2%). We found no evidence that drug coverage improved all cause hospitalization and general health status. The results of the analysis also suggest the importance of controlling for selection bias. Our estimates on drug coverage were reduced markedly when we accounted for selection into plans.
Systematic Review of the Impact of Race/Ethnicity or Type of Health Professional-in Patient Outcomes from Diabetes Lifestyle Interventions
Dennis Raisch (Pharmacy) and co PI Matthew Borrego (Pharmacy)
Objective: The objective of this study was to review the success of delivering interventions aimed at modifying lifestyle behaviors in patience with type 2 diabetes; as measured by reduction in glycosylated hemoglobin (HbA1c), which is a marker of long-term glycemic control. The literature was reviewed and compared by focus of lifestyle intervention regarding the relative success in reducing HbA1c, by health care professional (HCP) and by race/ethnicity of the patient population.
Methods: We performed a systematic review of the literature to identify articles through July 2007 using the medical databases: MEDLINE, CINAHL, PsychINFO, and IPA. Our terms specified glycosylated hemoglobin, diabetes mellitus, type 2; type 2 diabetes; type 2 diabetics; non-insulin dependent diabetes mellitus; education; health education; lifestyle; intervention; control; glucose; glycemic; HbA1c; structured diabetes care; outcome; outcome assessment; and outcome and process assessment. We reviewed the article titles and abstracts to determine relevance for inclusion in the health professional review and/or the race ethnicity review. After assessing each relevant article for quality, we summarized them into tables and formulated conclusions.
Results: There were 1053 articles examined from our search criteria. After applying our selection criteria, there were 23 articles which specified the impact of lifestyle interventions among specific races or ethnicities and 45 articles which specified outcomes by types of health professionals. Among HCPs, there were no differences between involvement of more than 1 type of HCP versus a single HCP (pharmacists, nurses, and dieticians) and no differences between HCPs. Regarding race/ethnicity articles, only one article compared the effectiveness of interventions by race/ethnicity. More commonly, only specific races were included in the studies. Interventions that were culturally-designed were primarily used.
Conclusion: The literature regarding lifestyle interventions to improve diabetes control is rich. However, often interventions are aimed at patients who are in very poor diabetes control. Thus, results are not generalizable to patients who are moderately well-controlled and in whom the benefit may be more incremental but still clinically important. Although ethnic-relevance is recognized as an important factor in providing diabetes lifestyle interventions, few studies have demonstrated a differential effect by ethnicity and no studies have compared ethnically-relevant versus other types of interventions.
The Power and Sustainability in Health Policy Development
Nina Wallerstein (Family and Community Medicine)
The overall goals were to study sustainability of health policy coalitions to power structures, and the ability of coalitions to successfully advocate for healthy policies. Specifically, this project studied the power and social relationships between health professionals, political actors and community members engaged with the NM Community Coalition for HealthCare Access (CCHA). Similar case studies are being conducted in several other countries as cross-comparisons of models, sustainability issues, and World Health Organization Health for All policies. Using a qualitative, case study design, twelve key informants were interviewed based on their roles as members of the Coalition or as outside stakeholders. Analysis of common themes identified facilitators of the Coalition in the policy development process as the use of power analysis; strategic planning to enhance participation in decision-making; and having diverse actors involved from many sectors in the CCHA. Barriers included lack of accountability; lack of skills in working with conflict; the residence of the power structure to change; and the ability of the power structure to divide advocacy groups and decrease community participation by creating multiple committees. Despite the barriers, some health policies were changed as a result of the CCHA work, supporting improved access to health and reallocated resources for health services paid by taxpayers
Grants in Progress
The Socioeconomic Impacts of Teenage Pregnancy: Disparities by Race and Ethnicity
Philip Ganderton (Economics)
Disciplinary Discretion in a Diverse Albuquerque High School: A Study of Racial, Ethnic and Gender Disparities
Nancy Lopez (Sociology) co PI Jane Hood (Sociology)
Understanding the Social Costs of Natural Disasters
Wendy Hansen (Political Science) and Alok Bohara (Economics)
Local Variation in Immigrant Demographic Growth and Helath Policy Trends
Lisa Cacari Stone (RWJF Center/Family and Community Medicine)
Assessment of Hispanic Specific Attitudes Regarding Health Coverage Reform in New Mexico
Gabriel Sanchez (Political Science), co PIs Richard Santos (Economics) Amelia Rouse (IPP), Amy Goodin (IPP)
Do Vulnerable Populations E njoy Improved Health During Peiods of Economic Growth
Matias Fontenla (Economics)
Saying No to Abstinence Only Education Funds
Deborah McFarlane (Political Science)
Long Term Consequences of Bank Disinvestment in Neighborhood Crime
Maria Velez, co PI Chris Lyons (Sociology)
The County as Fundamental Unit of Health Access in the United States
Harold Waitzkin (Sociology), co-PI Lisa Cacari Stone (Family & Community Medicine)
