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Journal of Nutrition Education and... May 2020To determine how trauma-informed programming affects household food insecurity (HFI) over 12 months.
OBJECTIVE
To determine how trauma-informed programming affects household food insecurity (HFI) over 12 months.
DESIGN
Change was assessed in HFI from baseline to 12 months in response to a single-arm cohort intervention. Measures were taken at baseline and in every quarter. Two participant groups were compared: participation in ≥4 sessions (full participation) vs participation in <4 sessions (low/no participation).
SETTING
Community-based setting in Philadelphia, Pennsylvania.
PARTICIPANTS
A total of 372 parents of children aged <6 years, participating in Temporary Assistance for Needy Families and the Supplemental Nutrition Assistance Program, recruited from county assistance offices and community-based settings.
INTERVENTION
Trauma-informed programming incorporates healing-centered approaches to address previous exposures to trauma. Sixteen sessions addressed emotional management, social and family dynamics related to violence exposure and childhood adversity, and financial skills.
MAIN OUTCOME MEASURES
Household food insecurity, as defined by the US Department of Agriculture Household Food Security Survey Module.
ANALYSIS
Mixed-effects logistic regression models were used to compare groups from baseline to 12 months, controlling for adverse childhood experiences, depression, and public assistance.
RESULTS
Those with full participation had 55% lower odds of facing HFI compared with the low/no participation group (adjusted odds ratio = 0.45; 95% confidence interval, 0.22-0.90).
CONCLUSIONS AND IMPLICATIONS
Trauma-informed programming can reduce the odds of HFI and may reduce trauma-related symptoms associated with depression and poverty.
Topics: Adolescent; Adverse Childhood Experiences; Child; Child, Preschool; Depression; Empowerment; Female; Focus Groups; Food Assistance; Food Insecurity; Food Security; Humans; Infant; Infant, Newborn; Male; Philadelphia; Pilot Projects; Randomized Controlled Trials as Topic; Socioeconomic Factors; Young Adult
PubMed: 32389241
DOI: 10.1016/j.jneb.2020.02.008 -
BMC Health Services Research Dec 2023Policymakers require precise and in-time information to make informed decisions in complex environments such as health systems. Artificial intelligence (AI) is a novel... (Review)
Review
BACKGROUND
Policymakers require precise and in-time information to make informed decisions in complex environments such as health systems. Artificial intelligence (AI) is a novel approach that makes collecting and analyzing data in complex systems more accessible. This study highlights recent research on AI's application and capabilities in health policymaking.
METHODS
We searched PubMed, Scopus, and the Web of Science databases to find relevant studies from 2000 to 2023, using the keywords "artificial intelligence" and "policymaking." We used Walt and Gilson's policy triangle framework for charting the data.
RESULTS
The results revealed that using AI in health policy paved the way for novel analyses and innovative solutions for intelligent decision-making and data collection, potentially enhancing policymaking capacities, particularly in the evaluation phase. It can also be employed to create innovative agendas with fewer political constraints and greater rationality, resulting in evidence-based policies. By creating new platforms and toolkits, AI also offers the chance to make judgments based on solid facts. The majority of the proposed AI solutions for health policy aim to improve decision-making rather than replace experts.
CONCLUSION
Numerous approaches exist for AI to influence the health policymaking process. Health systems can benefit from AI's potential to foster the meaningful use of evidence-based policymaking.
Topics: Humans; Artificial Intelligence; Health Policy; Policy Making; Medical Assistance
PubMed: 38102620
DOI: 10.1186/s12913-023-10462-2 -
American Journal of Public Health Mar 2016
Topics: Food Assistance; Humans; Medical Assistance; Public Health Practice
PubMed: 26885955
DOI: 10.2105/AJPH.2016.303086 -
International Journal For Equity in... Aug 2023Public assistance recipients have diverse and complex needs for health and social support in addition to financial support. Segmentation, which means dividing the...
BACKGROUND
Public assistance recipients have diverse and complex needs for health and social support in addition to financial support. Segmentation, which means dividing the population into subgroups (segments) with similar sociodemographic characteristics, is a useful approach for allocating support resources to the targeted segments. Clustering is a commonly used statistical method of segmentation in a data-driven marketing approach. This explanatory sequential mixed methods study applied a clustering technique, aiming to identify segments among older public assistance recipients quantitatively, and assess the meaningfulness of the identified segments in consultation and support activities for older recipients qualitatively.
METHODS
We identified the segments of older recipients in two municipalities using probabilistic latent semantic analysis, a machine learning-based soft clustering method. Semi-structured interviews were subsequently conducted with caseworkers to ask whether the identified segments could be meaningful for them in practice and to provide a reason if they could not think of any older recipients from the segment.
RESULTS
A total of 3,165 older people on public assistance were included in the analysis. Five distinct segments of older recipients were identified for each sex from 1,483 men and 1,682 women. The qualitative findings suggested most of identified segments reflected older recipients in practice, especially two of them: female Cluster 1 (facility residents aged over 85 years with disability/psychiatric disorder), and female Cluster 2 (workers). Some caseworkers, however, did not recall older recipients in practice when working with certain segments.
CONCLUSIONS
A clustering technique can be useful to identify the meaningful segments among older recipients and can potentially discover previously unrecognized segments that may not emerge through regular consultation practices followed by caseworkers. Future research should investigate whether tailored support interventions for these identified segments are effective.
Topics: Male; Humans; Female; Aged; Public Assistance; Social Support; Cluster Analysis; Latent Class Analysis; Mental Disorders
PubMed: 37537561
DOI: 10.1186/s12939-023-01959-7 -
Pediatrics Aug 2021Supplemental Nutrition Assistance Program (SNAP) benefits are designed to buffer families from food insecurity, but studies suggest that most benefits are used by... (Observational Study)
Observational Study
BACKGROUND AND OBJECTIVES
Supplemental Nutrition Assistance Program (SNAP) benefits are designed to buffer families from food insecurity, but studies suggest that most benefits are used by midmonth. In this study, we examined whether the home food environment varies across the SNAP benefits cycle among participating families .
METHODS
Participants in this mixed-methods study were 30 SNAP participants who were primary caregivers of a child ages 4-10 years. The home food environment was measured 1 week before SNAP benefit replenishment and again within 1 week after replenishment by using the Home Food Inventory. Household food insecurity was assessed by using the US Department of Agriculture Household Food Security Survey. Wilcoxon rank tests were used to evaluate changes in median Home Food Inventory subscales and food insecurity pre- to post-replenishment. Qualitative interviews with participating caregivers were conducted to explore contextual factors influencing the home food environment across the benefits cycle.
RESULTS
Participants had significantly fewer types of vegetables (median: 7.0 vs 8.5, median difference 1.73, 95% confidence interval: 0.5-2.5, = .03) and higher food insecurity pre- versus post-replenishment (median: 4.0 vs 2.0, median difference 1, 95% confidence interval: 0.1-1.5, = .03). Caregivers described employing a variety of intentional strategies to reduce cyclic variation in food availability.
CONCLUSIONS
Findings suggest that there is relatively limited cyclic variation in the home food environment among families participating in SNAP. This may be explained by a number of assistance programs and behavioral strategies caregivers used to make food last and buffer against scarcity. Future research should evaluate the relationship between the degree of home food environment changes and child health outcomes.
Topics: Child; Child, Preschool; Food Assistance; Food Supply; Humans; Maryland; Time Factors
PubMed: 34330866
DOI: 10.1542/peds.2020-025056 -
Health & Social Care in the Community Jul 2022Motherhood increases women's use of health and social services, presenting opportunities to identify and refer women with substance use disorder (SUD) to treatment. We...
Motherhood increases women's use of health and social services, presenting opportunities to identify and refer women with substance use disorder (SUD) to treatment. We pooled 4 years (2015-2018) of cross-sectional data from National Survey on Drug Use and Health on women of child-bearing age (18-44) in the United States (n = 64,346). (1) We compared the use of services (health, social and criminal justice involvement) by SUD and 'motherhood' (pregnant or has one or more children under 18). We used multivariable logistic regression models to estimate the association between motherhood, SUD and their interaction with the use of services. (2) We estimated the association between the use of different services and SUD treatment use among women with SUD. Among women of child-bearing age, 9.7% had SUD. Mothers who had SUD were more likely to use social services (AOR = 1.48 [95% CI: 1.22, 1.79]) and mental health services compared with non-mothers who did not have SUD (AOR = 1.40 [95% CI: 1.19, 1.65]). The following factors were associated with increased odds of receiving SUD treatment among mothers: mental health treatment utilisation (AOR = 1.94 [95% CI: 1.29, 2.93]); Medicaid coverage (AOR = 2.48 [95% CI: 1.64, 3.76]); and criminal justice involvement (AOR = 3.38 [95% CI: 1.97, 5.80]). To increase treatment access, it is important to address women's different stages in life, including how to best engage women in SUD care across different settings.
Topics: Child; Criminal Law; Cross-Sectional Studies; Female; Humans; Medicaid; Mental Health Services; Pregnancy; Substance-Related Disorders; United States
PubMed: 34363426
DOI: 10.1111/hsc.13534 -
South African Medical Journal =... Feb 2024
Topics: Humans; South Africa; Medical Assistance; Suicide, Assisted; Canada
PubMed: 38525568
DOI: 10.7196/SAMJ.2024.v114i2.1857 -
Pediatrics Feb 2022The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federal program that improves the health of low-income women (pregnant and...
OBJECTIVES
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federal program that improves the health of low-income women (pregnant and postpartum) and children up to 5 years of age in the United States. However, participation is suboptimal. We explored reasons for incomplete redemption of benefits and early dropout from WIC.
METHODS
In 2020-2021, we conducted semistructured interviews to explore factors that influenced WIC program utilization among current WIC caregivers (n = 20) and caregivers choosing to leave while still eligible (n = 17) in Massachusetts. By using a deductive analytic approach, we developed a codebook grounded in the Consolidated Framework for Implementation Research.
RESULTS
Themes across both current and early-leaving participants included positive feelings about social support from the WIC clinic staff and savings offered through the food package. Participants described reduced satisfaction related to insufficient funds for fruits and vegetables, food benefits inflexibility, concerns about in-clinic health tests, and in-store item mislabeling. Participants described how electronic benefit transfer cards and smartphone apps eased the use of benefits and reduced stigma during shopping. Some participants attributed leaving early to a belief that they were taking benefits from others.
CONCLUSIONS
Current and early-leaving participants shared positive WIC experiences, but barriers to full participation exist. Food package modification may lead to improved redemption and retention, including increasing the cash value benefit for fruits and vegetables and diversifying food options. Research is needed regarding the misperception that participation means "taking" benefits away from someone else in need.
Topics: Adolescent; Adult; Caregivers; Child, Preschool; Female; Food Assistance; Humans; Infant; Male; Poverty; Surveys and Questionnaires; United States; Young Adult
PubMed: 35039867
DOI: 10.1542/peds.2021-053889 -
American Journal of Public Health Jan 2021
Topics: Diet, Healthy; Food Assistance; Fruit; Health Promotion; Humans; Motivation; Poverty; United States; Vegetables
PubMed: 33326275
DOI: 10.2105/AJPH.2020.305987 -
BMC Health Services Research May 2021New Public Management (NPM) has been widely used to introduce competition into public healthcare. Results have been mixed, and there has been much controversy about the...
BACKGROUND
New Public Management (NPM) has been widely used to introduce competition into public healthcare. Results have been mixed, and there has been much controversy about the appropriateness of a private sector-mimicking governance model in a public service. One voice in the debate suggested that rather than discussing whether competition is "good" or "bad" the emphasis should be on exploring the conditions for a successful implementation.
METHODS
We report a longitudinal case study of the introduction of patient choice and allowing private providers to enter a publicly funded market. Patients in need of hip or knee replacement surgery are allowed to choose provider, and those are paid a fixed reimbursement for the full care episode (bundled payment). Providers are financially accountable for complications. Data on number of patients, waiting lists and times, costs to the public purchaser, and complications were collected from public registries. Providers were interviewed at three points in time during a nine-year follow-up period. Time-series of the quantitative data were exhibited and the views of actors involved were explored in a thematic analysis of the interviews.
RESULTS
The policy goals of improving access to care and care quality while controlling total costs were achieved in a sustained way. Six themes were identified among actors interviewed and those were consistent over time. The design of the patient choice model was accepted, although all providers were discontent with the level of reimbursement. Providers felt that quality, timeliness of service and staff satisfaction had improved. Public and private providers differed in terms of patient-mix and developed different strategies to adjust to the reimbursement system. Private providers were more active in marketing and improving operation room efficiency. All providers intensified cooperation with referring physicians. Close attention was paid to following the rules set by the purchaser.
DISCUSSION AND CONCLUSIONS
The sustained cost control was an effect of bundled payment. What this study shows is that both public and private providers adhere long-term to regulations by a public purchaser that also controls entrance to the market. The compensation was fixed and led to competition on quality, as predicted by theory.
Topics: Cost Control; Government Programs; Humans; Medical Assistance; Private Sector; Quality of Health Care
PubMed: 33933075
DOI: 10.1186/s12913-021-06392-6