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At least 19 recordsLinked to original sources
PubMed1993

Restructuring federalism: the impact of Reagan policies on the family planning program.

Through fiscal cutbacks and structural changes, Reagan's federalism assaulted the ethos of public health. In assessing the effects of Reagan policies on a basic public health program, family planning services, we find a substantial decrease in spending for this program, a reduction in the numbers of patients served, and increased variation among the states in the provision of services to low-income women. These effects are comparable with findings from other studies on the impact of Reagan's federalism upon social programs and have manifold implications for public health.

Capital Financing↗
PubMedDate not supplied

Fertility intentions and subsequent behavior: a longitudinal study in rural India.

This report compares fertility and family planning intentions of rural Indian women in 1975 with actual outcomes in 1987. Ninety-four of 103 respondents who had fewer children than they wanted in 1975 and had stated definite intentions with respect to future fertility and contraceptive use were reinterviewed in 1987. Overall, women had fewer children than desired and stopped childbearing when they reached or closely approximated their ideal number of sons. Since sons were clearly the determinant of "reproductive success," it is argued that only a significant change in the status of rural women can bring about widespread compliance with the official family planning program's two-child norm.

Adolescent↗
PubMed1983

Public policy and female sterilization in Costa Rica.

For 20 years, female sterilization has been increasing in popularity as a contraceptive method in Costa Rica. However, contraceptive sterilization has never been allowed explicitly under Costa Rican law. In 1976 the Costa Rican National Assembly instituted more stringent guidelines regarding medical sterilizations in order to eliminate contraceptive sterilizations, which had been occurring under relatively loose interpretations of national policy. Data from the 1976 National Fertility Survey and the 1981 Contraceptive Prevalence Survey indicate that the change in policy had only a short-term effect. Period sterilization rates fell substantially after 1976 but rebounded considerably by 1980, and the estimate of the proportion of married women who will ultimately be sterilized was approximately .5 for the periods both before and after 1976.

Adolescent↗
PubMed1999

Role of physical activity in the prevention of obesity in children.

The increasing prevalence of childhood obesity and its concomitant health risks justify widespread efforts toward prevention. Although both diet and physical activity have been emphasized as appropriate interventions, the current paper focuses on the role of physical activity in obesity prevention. Children's levels of physical activity are highly variable, and may be influenced by a multitude of factors including physiological, psychological, sociocultural and environmental determinants. Although the relationship between physical activity and obesity is controversial and the protective mechanism unclear, physical activity is hypothesized to protect individuals from the development of obesity by increasing energy expenditure and resting metabolic rate (RMR) and leading to a favourable fuel utilization. The beneficial effect of physical activity in children is supported by controlled exercise intervention programs. Several broad-based public health interventions designed to increase children's levels of physical activity have been implemented in schools, families and communities, with results suggesting promising strategies for the prevention of childhood obesity. It is likely that successful prevention of childhood obesity through physical activity promotion will involve theory-based, culturally appropriate school, family and community interventions. Through policy changes, environmental planning and educational efforts in schools and communities, increased opportunities and encouragement for physical activity can be provided.

Adolescent↗
PubMed1989

The first forty years: a personal view.

Discussed below are some of the great public health issues and trends of the period that has elapsed since the foundation of the World Health Organization. They were dominated by the new Malthusian nightmare, the tussle with malaria, the eradication of smallpox, the improved control of some other serious infections, the struggles for family planning, breast-feeding, immunization, and clean water, among other things, and above all, perhaps, by the decline of the doctor and the rise of the planner and manager. More recently there have been the policy changes affecting international health which came from the Declaration of Alma-Ata, and the emergence of primary health care.

Family Planning Services↗
PubMedDate not supplied

Family nursing in community-oriented primary health care.

Renowned for its innovative approach to community health promotion and the key role of the nurse in treatment, prevention, teaching and research, the Philip and Sally Lown Hadassah Community Health Centre in Jerusalem is a model where the nurse is a member of a comprehensive multidisciplinary team that comprises family and paediatric physicians, epidemiologists, psychologist, statistician, social worker, health educator, health recorder, dietician and other public health specialists. As such, the nurse actively participates in the planning, implementation and evaluation of all new programmes, improvements and policy changes. Below, how the nurse works as a team member in the community centre.

Community Health Centers↗
PubMed1989

Research as an impetus for change in a state psychiatric hospital.

This article presents recommendations resulting from a study of barriers to discharge from a state psychiatric hospital. The results of this study became the impetus and basis for this particular hospital's definition of its mission within a community support system and for the development of a hospital plan responding to the study recommendations. The programmatic and policy changes initiated by the hospital have demonstrated that a traditional state psychiatric hospital can become more responsive to the needs and desires of consumers and families by utilizing the entire mental health delivery system and other community resources. It is evident that the hospital need not be bound by the physical limits and facility-based resources that have historically restricted its responsiveness.

Community Mental Health Centers↗
PubMed1999

Emergency contraception in Nairobi, Kenya: knowledge, attitudes and practices among policymakers, family planning providers and clients, and university students.

To gauge knowledge, attitudes, and practices about emergency contraception in Nairobi, Kenya, we conducted a five-part study. We searched government and professional association policy documents, and clinic guidelines and service records for references to emergency contraception. We conducted in-depth interviews with five key policymakers, and with 93 family planning providers randomly selected to represent both the public and private sectors. We also surveyed 282 family planning clients attending 10 clinics, again representing both sectors. Finally, we conducted four focus groups with university students. Although one specially packaged emergency contraceptive (Postinor levonorgestrel tablets) is registered in Kenya, the method is scarcely known or used. No extant policy or service guidelines address the method specifically, although revisions to several documents were planned. Yet policymakers felt that expanding access to emergency contraception would require few overt policy changes, as much of the guidance for oral contraception is already broad enough to cover this alternative use of those same commodities. Participants in all parts of the study generally supported expanded access to emergency contraception in Kenya. They did, however, want additional, detailed information, particularly about health effects. They also differed over exactly who should have access to emergency contraception and how it should be provided.

Contraceptives, Postcoital↗
PubMed1997

Attitudes about AIDS education and condom availability among parents of high school students in New York City: a focus group approach.

This paper describes parents' views of the New York City Public High School's AIDS Education and Condom Availability Program. It presents findings from 12 focus groups with 81 parents of students at six representative high schools. Focus groups were conducted as part of an independent, comprehensive 3-year evaluation of the program, consisting of both qualitative and quantitative components. Participants were mostly supportive of the program, citing intense concern about AIDS among adolescents, fear that teenagers do not adequately perceive themselves as being vulnerable, and personal experiences with infected relatives and friends. Implications of these findings for program development are discussed and recommendations for social policy changes are presented.

Acquired Immunodeficiency Syndrome↗
PubMed1995

General practitioner fundholding: weighing the evidence.

A new development in the British National Health Service is fundholding, whereby certain general practitioners are given budgets from which they purchase services for patients. Our knowledge about fundholding is rudimentary. Many important questions remain unanswered. These include: the impact of fundholding on the efficiency of overall resource utilisation; its effect on strategic planning; its effect on equity; its impact on the role of the doctor and the doctor-patient relationship; and its consequences for practice organisation and the culture of primary care. Even the scant results we do have must be interpreted cautiously. Fundholding was introduced during a period of great turbulence for general practice. Its strategic function was uncertain and its impact has been confounded by the effects of a series of earlier and concurrent policy changes. Few reliable conclusions about fundholding, either positive or negative, can be drawn from existing research.

Costs and Cost Analysis↗
PubMed1998

[Overweight. II. Determinants of overweight and strategies for prevention].

High risk groups for overweight can be defined according to features such as ethnicity, pregnancy, smoking cessation, sudden changes in lifestyle and activities, low socioeconomic status and low educational level, and a positive (family) history of diabetes mellitus and obesity. Coronary heart death is to be attributed for 15-30% to overweight (body mass index (BMI) > or = 25 kg/m2) and for 4-25% to obesity (BMI > or = 30 kg/m2). For diabetes mellitus these percentages are 64-82% and 33-75%, respectively. Population-based preventive and therapeutic measurements have to be aimed at less (fatty) food, more bodily activity, less consumption of alcohol, and better education and income. This requires policy changes at the ministries involved.

Adolescent↗
PubMedDate not supplied

The impact of recent policy changes on fertility, abortion, and contraceptive use in Romania.

A national household survey of 4,861 women aged 15-44 on reproductive health issues was conducted in Romania in 1993. The survey provided the opportunity to study the impact of policy changes by comparing selected aspects of fertility, abortion, and contraceptive use before and after the December 1989 revolution, when the laws restricting abortion and contraceptive use were abolished. After abortion became legal, the total fertility rate dropped to below replacement level, while the induced abortion rate doubled. Contraceptive prevalence increased 20 percent, but augmentation of the use of traditional methods, rather than the change in legislation, accounted for 70 percent of the increase. Limited sex education and contraceptive information, mistrust and misinformation about modern methods, a lack of adequately trained providers, and a shortage or uneven distribution of contraceptive supplies are major reasons for the continued high rates of unintended pregnancy.

Abortion, Induced↗
PubMed1995

Policy change and its application to Safe Motherhood programming.

The status of women's health and nutrition is affected by the absence or presence of government and private sector policies to promote women's rights to access quality maternal and family planning services. While both family planning and child survival literature pays substantial attention to the 'policy environment', little information is available with regard to the promotion of policies to support Safe motherhood Initiatives. Through a review of the family planning and child survival literature and from lessons learned from experiences of MotherCare country projects, this paper explores the issues and processes of policy formulation, implementation and sustainability. The paper also highlights specific Safe Motherhood strategies requiring policy attention with suggestions and examples of advocacy activities, research and demonstration projects which have been successful in creating and/or stimulating policy formulation. While there is no magic formula for policy promotion, experience has shown that a 'body of constituents', including women themselves as beneficiaries, is the key to moving the political process in the favor of Safe Motherhood.

Developing Countries↗
PubMed2001

State welfare reform policies and maternal and child health services: a national study.

OBJECTIVES: Welfare reform (Personal Responsibility and Work Opportunity Reconciliation Act of 1996) resulted in dramatic policy changes, including health-related requirements and the administrative separation of cash assistance from Medicaid. We were interested in determining if changes in welfare and health policies had had an impact on state MCH services and programs. METHODS: We conducted a survey in fall 1999 of state MCH Title V directors. Trained interviewers administered the telephone survey over a 3-month period. MCH directors from all 50 states, Washington, DC, and Puerto Rico participated (n = 52; response rate = 100%). RESULTS: Among the most noteworthy findings is that similar proportions of respondents reported that welfare policy changes had either helped (46%) or hindered (42%) the agency's work, with most of the positive impact attributed to increased funding. MCH data linkages with welfare and other social programs were low. Despite welfare reform's emphasis on work, limited services and exemptions were available for mothers with CSHCN. Almost no efforts have been undertaken to specifically address the needs of substance abusers in the context of new welfare policies. CONCLUSIONS: Few MCH agencies have developed programs to address the special needs of women receiving TANF who either have health problems themselves or have children with health problems. Recommendations including increased MCH and family planning funding and improved coordination between TANF and MCH to facilitate linkages and services are put forth in light of reauthorization of PRWORA.

Adolescent↗
PubMed1995

A comparison of the determinants of safe injecting and condom use among injecting drug users.

A sample of 582 injecting drug users were interviewed as part of an evaluation of an AIDS prevention programme for drug users. This paper examines the biographic and predispositional determinants of five HIV preventive behaviours--equipment sharing (not receiving and not giving) and and condom use (with regular partners, casual partners and sex clients). A two-stage sequential approach was adopted for a logistic regression analysis. Initially, to model each of the five preventive behaviours, biographical and drug use variables were entered. In a second set of models, behavioural predisposition factors were included. Age, drug use and prison experience correlate with variables in both models, although not consistently in the same direction. While a predisposition to reject sharing correlates with safer rejecting and condom use, the predisposition to safer sex only correlates with condom use. Needle exchange programmes that only target the individual would seem to be inadequate. To enhance targeted interventions changes in public and agency policy that create a social environment conductive to behaviour change are required.

Acquired Immunodeficiency Syndrome↗
PubMed2001

Impact of payment method on behaviour of primary care physicians: a systematic review.

OBJECTIVE: To review the impact of payment systems on the behaviour of primary care physicians. METHODS: All randomised trials, controlled before and after studies, and interrupted time series studies that compared capitation, salary, fee-for-service or target payments (mixed or separately) that were identified by computerised searches of the literature. Methodological quality assessment and data extraction were undertaken independently by two reviewers using a data checklist. Study results were qualitatively analysed. RESULTS: Six studies met the inclusion criteria. There was considerable variation in the quality of reporting, study setting and the range of outcomes measured. Fee-for-service resulted in a higher quantity of primary care services provided compared with capitation but the evidence of the impact on the quantity of secondary care services was mixed. Fee-for-service resulted in more patient visits, greater continuity of care, higher compliance with a recommended number of visits, but lower patient satisfaction with access to a physician compared with salary payment. The evidence of the impact of target payment on immunisation rates was inconclusive. CONCLUSIONS: There is some evidence to suggest that how a primary care physician is paid does affect his/her behaviour but the generalisability of these studies is unknown. Most policy changes in the area of payment systems are inadequately informed by research. Future changes to doctor payment systems need to be rigorously evaluated.

Capitation Fee↗
PubMedDate not supplied

Children's health insurance, access to care, and health status: new findings.

Despite various policy initiatives, a substantial number of children in the United States remain uninsured, have problems with access to health care, or are in fair or poor health. These difficulties are not evenly distributed across the population. Hispanic children, those whose parents have little education, and those who live in families without an employed parent are at disproportionately high risk of encountering these problems. Although multivariate analyses would be required to disentangle the complex relationships among these factors, these descriptive data reveal the segments of the population to which new health-related programs, such as CHIP-funded state plans, might most productively be directed. Issues concerning children's health are likely to remain on the national policy agenda for some time to come. Because MEPS is a continuing data collection effort, it will enable researchers and policymakers to follow trends in these issues over time. For example, MEPS data will support evaluations at the national level to determine whether children who lack health insurance or a usual source of care will actually face fewer barriers after CHIP-funded programs are implemented. This paper provides a baseline against which to evaluate the impact of CHIP and other policy changes on the health and well-being of America's children.

Adolescent↗