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Global Health

Global health focuses on improving the health and health equity of all people worldwide by collaborating across country boundaries to research and implement multi-sector policies and programs.

Study Reveals Urgent Need for More Data on Performance Measurement and Management Strategies

The United Nations recently created a set of Sustainable Development Goals, including one to achieve good health and well-being for all by the year 2030. Previous research has shown that an effec- tive primary health care system is crucial to the achievement of that goal, especially for low- and middle-income countries. Yet a new study suggests that attempts to transform or redesign primary health care systems often deploy unproven strategies that lack the underlying scientific evidence of effectiveness.

Wolfgang Munar, MD, an associate professor of global health systems at Milken Institute SPH, and his colleagues, began their study by mapping the available evidence on performance measurement and management strategies for primary health care systems in low- and middle-income countries. The team conducted a literature search and looked at 38,088 publications— selecting 155 studies that met the inclusion criteria for the final analysis.

The researchers found that studies typically focused on two types of strat- egies: implementation strategies such as in-service training of health care profes- sionals, or continuing education, and performance-based financing. W ith this strategy, health care providers are given financial incentives to provide high- quality, cost-effective care. Yet this study found that most of the studies were conducted on relatively simple interventions—those unlikely to achieve transformation of a primary health care system.

“Our study suggests that most performance and management strategies are implemented without sufficient knowledge of their impact,” says Munar. “Future efforts to redesign primary health care systems must be undertaken armed with the knowledge of what works and what doesn’t.”

Munar says that such evidence is urgently needed in order to help low- and middle-in- come countries effectively prepare for climate change, environmental disasters, pandemics of infectious diseases and other serious threats to the public health.
The study, “Evidence gap map of perfor- mance measurement and management in primary health care systems in low-income and middle-income countries,” was part of a series of articles published in a special issue of BMJ Global Health.

The special issue culminates a two-year collaborative effort led by Ariadne Labs, a joint center of Brigham and Women’s Hospital and the Harvard T. H. Chan School of Public Health. The Bill and Melinda Gates Foundation funded the project.

Global Project Seeks to Understand Adolescent Well-Being

The GAGE project focuses on the three C’s—capabilities, change strategies and context—to understand how each plays a
role in helping boys and girls reach their full potential.

Adolescence is a critical time when people develop healthy habits, behaviors and relationships that will impact the course of their lives. Sarah Baird, PhD, MS, an associate professor of global health at Milken Institute SPH, is working on the largest global study on adolescents, following 18,000 youth in developing countries to understand what enhances adolescent empowerment and capabilities.

The study, called the Gender and Adolescence: Global Evidence (GAGE) project, is funded by UK AID Direct, a Department for International Development fund of the UK government. Over 35 organizations around the world are participating in the consortium project, which is researching what enables adolescent girls and boys to emerge from poverty and create positive change for their families and communities. Baird serves as the study’s impact evaluation lead, where she oversees randomized control trials in Ethiopia, Rwanda and Bangladesh, and an experimental study in Jordan. GAGE, she explains, explores the gendered experiences of adolescents as they progress through this critical period of their lives into early adulthood. The GAGE project focuses on the three C’s—capabilities, change strategies and context—to understand how each plays a role in helping boys and girls reach their full potential. The framework of the GAGE project is based on six capacity sets that explain adolescent well-being: education and learning, bodily integrity (including freedom from sexual and gender-based violence and child marriage), physicaland reproductive health and nutrition, psychosocial wellbeing, voice and agency, and economic empowerment.

“We are interested in seeing how an adolescent’s location and the context in which he or she lives affects how these outcomes change over time,” Baird says. Baird, a development economist, focuses on the microeconomics of health and education in low- and middle-income countries with an emphasis on gender and youth. She also serves as program director for the Global Health Program Design, Monitoring, and Evaluation MPH Program at Milken Institute SPH.

Global Health Student Amplifies Health Policy Knowledge With Field Experience


Second-year global health policy student Alex Dobek, MPH ’20, knew he wanted to gain field experience to complement his policy education when he stumbled upon Uganda V illage Project (UVP) through a Global Health Department newsletter.

Having never before done global health fieldwork, Dobek stepped outside his comfort zone when he accepted a summer internship with UVP. But that’s exactly the kind of challenge he knew he needed in order to make the most of his time at Milken Institute SPH. “I knew that only getting policy experience would not be enough,” he says. “It is one thing to know how to research, understand and write policy, but it is something else entirely to know how health policies and interventions affect real people.”

Dobek’s internship with UVP involves working with a team in the rural Ugandan village of Namunkanaga, which is close to the town of Iganga, to conduct health surveys and promote healthy behaviors in the community. On a typical day, UVP team members either split up into pairs to perform baseline surveys throughout the village or visit with local schools, health centers and other local partners to discuss the various health interventions UVP is attempting to implement. The team also holds meetings with community members to build relationships and teach healthy behaviors.


Dobek says his internship has provided him with important practical skills and has expanded upon the knowledge he has gained from the global health policy curriculum. He is seeing firsthand his Milken Institute SPH experiences being put into practice. “I am able to see global health interventions at work on a daily basis,” he says. “I believe that this experience has really given me the personal connection that I needed to understand the policies and interventions that I will be researching and creating in my future career in global health policy.”For anyone interested in a similar experience, Dobek says to just go for it. While he was nervous going into his first global health field experience, “all of that doubt went away immediately upon arrival,” he says. “There is nothing more rewarding to me than the work that I am doing here. The people that we are helping, the practical skills that I am learning, even the things that I am discovering about myself—these things make it all worth it and have made it one of the best experiences of my life.”

HEALTH POLICY & MANAGEMENT

Health policy involves the decisions, plans and actions undertaken by public and private organizations and governmental bodies to influence and improve individual and public health and health care through the achievement of specific goals. Health administration is focused on leadership and management of health care organizations and systems.
New MHA Program Director Practices What He Preaches

Before joining Milken Institute SPH as Director of the residential Master of Health Administration (MHA) program and Professor in the Department of Health Policy and Management, Robert Bonar, Dr.HA, spent 40-plus years as a health care administrator, creating the kinds of highly functional workplaces where physicians, administrators and medical staff feel cared about and valued. Now he is investing his considerable energies in showing students how to create such workplaces.

“When I worked at hospitals, my opportunity to interact with families and the community was one of the most enjoyable aspects of my job,” says Bonar, who brings the same disarming charm that endeared him to patients and colleagues alike as an administrator to his interactions with his GW students. He is also generous with sharing his connections, which benefits both the program’s students and the many institutions where he has worked that take on administrative fellows each year.

“Dr. Bonar’s extensive background as a successful health care administrator was a key qualification that led us to select him to be our residential MHA program director,” says Jane Hyatt Thorpe, JD, interim chair of the Milken Institute SPH Department of Health Policy and Management. Bonar most recently served as CEO of Children’s Hospital and Clinics of Minnesota from 2014 to 2017, and before that, he served as CEO of Seton Family of Hospitals and Dell Children’s Medical Center in Austin, Texas, from 2003 to 2014. There, his accomplishments include overseeing the design, construction and opening, in 2007, of the first-ever hospital to receive a Platinum certification by the U.S. Green Building Council’s Leadership in Energy and Environmental Design program, the highest level of certification possible.

Over the course of his career, Bonar also taught health care administration at schools nearby or affiliated with the hospitals where he served as an administrator. His most recent position prior to coming to GW was at the University of Minnesota, Twin Cities. He also taught at Old Dominion University/Eastern Virginia Medical School, the University of Oklahoma Health Sciences Center and the University of South Carolina. “I’m just delighted to be here,” says Bonar, who, since coming to Milken Institute SPH, has been working to implement improvements likely to further ratchet up the MHA program’s steadily rising national rank—which just jumped to #12 from #16. He is also finding opportunities to conduct the kind of research that he always wished to have more time to focus on during his career as an administrator.

Leader in Health IT Named New Director of HealthInformatics@GW

A leader in the field of health information technology, Patricia MacTaggart, MBA, was named program director of HealthInformatics@GW this past fall. She also took on a new role as Teaching Instructor in Health Policy and Management. Before her official appointment, MacTaggart was a key member of the Health Policy and Management Department, developing, leading and teaching health IT courses in the MHA residential program as well as the MHA@GW and HealthInformatics@GW for many years. She has over 35 years of executive management experience in the health care field and more than 25 years working in state and federal government, overseeing strategic and operational planning and implementation support for health care delivery and payment reform through a range of initiatives, including information technology optimization. MacTaggart also served as the Minnesota Medicaid Director and has supported numerous federally approved health-IT initiatives.

For the last several years, in addition to teaching a range of health IT courses at GW, MacTaggart worked with the Center for Medicare and Medicaid Services and the VA in senior advisory roles, driving culture change through innovative use of information technology. She also provided health IT technical assistance to the state governments of Oregon, Alabama, California, Wisconsin and DC as they transformed their acute, behavioral and long- term care health systems to be health IT-optimized, which includes policy, technical, legal, operational, governance and financing considerations.
“Patricia brings a wealth of knowledge and experience to this new role, a high level of connectivity to the world of health IT management, a firm commitment to students and a strong capacity for leadership,” says Dean Lynn Goldman. “We greatly appreciate her dedication to the Health Policy and Management Department and to the field of health IT as she continues to be a leader in the field and educate future health IT leaders.”

New AHRQ Grant Allows Milken Institute SPH Researchers to Study Economics of Community Health Centers

Milken Institute SPH recently received a $1.1 million grant from the Agency for Healthcare Research and Quality (AHRQ) to analyze the economic costs and sustainability of community health centers. “The nation’s more than 1,300 community health centers play an essential role in the U.S. health care system by delivering primary care to a medically underserved population of approximately 26 million, regardless of patients’ ability to pay,” says Avi Dor, PhD, principal investigator of the project and a professor of health policy and management at Milken Institute SPH.

“The long-term viability of our community health centers is dependent upon their sustained financial health.” AHRQ aims to develop the knowledge, tools and data needed to improve the health care system and help Americans, health care professionals and policymakers make informed health care decisions. The four-year grant will fund the first effort to analyze the financial health of the nation’s community health centers by estimating the economic cost of the services the centers provide. Researchers will assess the cost savings that community health centers produce through their pioneering and widespread integration of primary care and mental health services.

Dor, an expert in health economics, will use an econometric approach to generate and analyze the data. “Conventional accounting methods are unable to assess the quality- adjusted costs of the services offered by community health centers,” Dor says. “Our econometric analysis will explore the trade- offs that community health centers will have to consider as financial pressures grow.”

Data generated from the project could also influence policymakers’ decisions to allocate funding for community health centers, says Dor. “A better understanding of community health centers’ costs and how they are allocated among the various services that centers offer will help to inform the policy debate on the adequacy of public support for the centers’ mission.”

Neurses ‘Uniquely Positioned’ to Address Unmet Health Care Needs of 21st Century

Nurses are uniquely positioned to coordinate partnerships and provide the kind of holistic, patient- centered care that can address the current rise in substance abuse and other diseasesof despair. —Patricia Pittman

Faced with a surge in “diseases of despair,” policymakers and leaders in the health care sector are beginning to see the limitations of the current highly centralized, medicalized system of providing health care. Patricia Pittman, professor of health policy and management and co-director of the Fitzhugh Mullan Institute for Health Workforce Equity at Milken Institute SPH, recently authored a report that highlights the opportunity of the nursing profession to address this public health crisis of the 21st century.

“There is growing recognition that medical care alone is insufficient to address growing health problems of today’s world,” says Pittman. “Nurses are uniquely positioned to coordinate partnerships and provide the kind of holistic, patient-centered care that can address the current rise in substance abuse and other diseases of despair.” Pittman conducted a literature analysis and interviewed nursing leaders, policymakers and others to produce the comprehensive report in which she identifies today’s most innovative nurse-led or nursing models that have evidence of impact. The report, which was commissioned by the Robert Wood Johnson Foundation, also analyzes solutions to current health care needs.

Nurses today have the potential to help transform the health care system to address growing health problems that are deeply rooted in social and economic conditions. To do this, Pittman says nursing leaders must strengthen a core set of nursing functions, embrace the idea of working at the intersection of other professions, and bolster nursing education with a stronger focus on population health, health equity and programs to ensure diversity in the nursing workforce. Educators, employers and policymakers must also be willing to work with nursing leaders to create jobs with roles that allow them to build trust, establish partnerships and provide holistic care that can help individual patients, families and entire communities stay healthy. Government officials and policymakers must align payment and regulatory policies with the goal of transforming the health care system. Pittman also calls for a robust research agenda aimed at spurring the process of change.

Milken Institute SPH Experts Weigh in on Trending Health Policy Issues

This year, faculty members in the Department of Health Policy and Management have been on the forefront of trending health policy issues here in
the nation’s capital and in states around the country. Some examples include the move by the Trump administration and certain states to impose work requirements on Medicaid beneficiaries, a Title X rule that threatens to harm the public health and a policy aimed at preventing future outbreaks of measles, a deadly childhood disease that is on the rise.

California Law Boosts Childhood Vaccination Rates

In a first-of-a-kind analysis published in May 2019, Health Policy Professor Avi Dor found that a 2016 California vaccine law boosted protective coverage against measles. At the same time, the research revealed a sharp increase in medical exemptions to the vaccine mandate for school entry. “The rise in medical exemptions strongly suggests parents who are reluctant to vaccinate their children are shopping for doctors,” said Dor. The United States had all but eliminated measles in the year 2000 due to robust vaccination coverage. Since then, however, small but growing groups of parents are seeking waivers to the vaccines—leading to dangerous pockets of unvaccinated children.

“People forget that measles was and still is a deadly disease, one that could surge again,” Dor said. “State lawmakers who want to protect the public should take a hard look at the lessons learned from California’s experience and tighten educational and certification requirements so that medical exemptions are granted only when appropriate.”

Medicaid Work Requirements: Hundreds of Thousands Would Lose Coverage

A new analysis by Milken Institute SPH researchers suggests that up 811,000 people would lose the protection of Medicaid coverage in just one year if nine states fully implement plans to impose Medicaid work requirements on beneficiaries. Those losses are likely an underestimate because they do not account for monthly premiums or new paperwork requirements that may trigger additional losses, said Professor Leighton Ku, who is the senior author of the analysis.

Many of the people who would lose coverage are working already or are trying to work but are unable to comply with the rules because they cannot find a steady job or they have trouble navigating the procedural requirements, said Ku. That analysis and other research were cited in two recent friend-of-the-court briefs filed in court by 63 public health scholars from across the nation, including Sara Rosenbaum, JD, the Harold and Jane Hirsh Professor of Health Law and Policy at Milken Institute SPH. The scholars are urging the court to block Medicaid work requirements, saying they run counter to Medicaid’s core purpose and would cause harm to many beneficiaries.

“These demonstrations were intended to support experiments that promote Medicaid’s core objective of providing medical assistance to those who need it,” said Rosenbaum. “These experiments do the opposite—they threaten to strip hundreds of thousands of beneficiaries of Medicaid coverage while endangering health care on a community-wide basis.”

Title X “Gag” Rule Threatens Health Care Access for Millions

Health policy and public health scholars from Milken Institute SPH and other universities, along with the American Public Health Association, have filed several amicus or friend-of-the-court briefs in the ongoing battle to block implementation of the Title X so-called “gag” rule. In an amicus brief filed on July 3, 178 public health scholars, including Professor Sara Rosenbaum, urged the courts to block the Title X rule because of the severe impact it would have on access to family planning and preventive health services. Under the rule, physicians are barred from giving patients, including pregnant patients, full and accurate counseling, including information about abortions.

In addition, the rule would withhold federal funding from comprehensive health care clinics. “Title X clinics are a lifeline for low-income women with significant health risks, for whom unintended pregnancy is an especially serious health threat,” said Milken Institute SPH Dean Lynn R. Goldman, one of the scholars on the brief. “If the administration’s rule is allowed to stand, the public health consequences will be enormous.” The brief points out that Title X clinics not only provide affordable family planning services, but they also offer care that can prevent and protect patients from serious health problems like cancer and sexually transmitted diseases.

For more health policy analysis, check out gwhpmmatters.com.

Neurses ‘Uniquely Positioned’ to Address Unmet Health Care Needs of 21st Century

Milken Institute SPH Alumna Tammy Barlet, MPH ’19, was ready to put her knowledge and skills to the test as soon as she graduated. Barlet began her work at the American Legion DC office as a health policy coordinator shortly after she received her MPH in health policy this past May. As a veteran herself, Barlet wanted to help amplify the voices of other veterans as well as active duty members when dealing with the Department of Veterans Affairs and when dealing with health issues that are a concern to this population. In terms of what an average workday looks like for Barlet? Well, it depends.

“Honestly, the focus of my day depends on the Hill and which bills are being marked up or need testimony and prep work for upcoming projects,” she says. “I may also be out of the office at a roundtable representing the American Legion.” She says her time at Milken Institute SPH taking classes in federal policymaking and advocacy helped prepare her for many aspects of her role, including how to design an advocacy plan and a grassroots campaign.
For students looking to find the cause or population they are passionate about, Barlet advises networking and following their interests. “When I wasn’t working on my classwork, I was attending events, hearings, or pretty much anything I thought I might find exciting. Then I reached out to new contacts, followed up with them and kept in touch. By doing so, you’ll soon find your niche,” she says.

Leonard Friedman Named Faculty of the Year by the Association of University Programs in Health Administrationy

Health Policy and Management Professor Leonard Friedman, PhD, MPH, was named faculty of the year by the Association of University Programs in Health Administration. Friedman directs the school’s online Master of Health Services Administration (MHA@GW) program and is also a professor in the residential Master of Health Administration program.

“Receiving this award from the organi- zation that fosters excellence in health management and policy education and scholarship is such a great honor,” says Friedman. His recent achievements include successfully shepherding the MHA@ GW program through the Commission on Accreditation for Healthcare Management Education’s (CAHME) accreditation process. For Friedman, the most gratifying part of being a health administration instructor is seeing what his students are able to achieve. “My goal as an instructor is to impress upon my students the critical role they play as health care leaders to create and sustain the systems that allow clini- cians to do their best work and deliver care that is safe, effective and of the highest possible quality,” he says.

PREVENTION & COMMUNITY HEALTH

The goal of prevention is to help individuals avoid contracting diseases or experiencing adverse health issues through clinical or community services such as immunizations, health screenings, educational programs or health policies. Community health involves the implementation of these strategies within a particular geographic area or demographic of the population.

-Karen McDonnell, Interim Chair

Milken Institute SPH Joins Forces in the Fight for Women’s Economic Empowerment in India

Milken Institute SPH has joined forces with the U.S. Department of State, Georgetown University, U.S. Agency of International Development and the U.S.-India Strategic Partnership Forum to create the U.S.-India Alliance for Women’s Economic Empowerment.

The alliance is a platform that will enable the private sector, academia and civil society in the United States and India to work together to accelerate the growth of women-owned or -operated businesses and women’s workforce participation in India by increasing women’s access to finance, mentoring and technical assistance.

The alliance will take a comprehensive approach and will also focus on addressing key factors associated with meaningful and sustainable economic empowerment of women, including women’s health, education, safety and gender equity.

Milken Institute SPH, and specifically Associate Professor of Prevention and Community Health Amita V yas, PhD, MHS, will lead the initiative to address these upstream factors through its commitment to building interdisciplinary teams of faculty and students across the university to be part of specific activities under this component of the alliance.

“I believe this is a great time to engage, as women in India are transforming their life possibilities. We are excited about the opportunity to play a role in this important bilateral effort to support that transformation as it gets off the ground,” says Vyas.

Milken Institute SPH-Led Research Shows Storytelling Can Impact Gender Attitudes Among Adolescents in India

Milken Institute SPH researchers recently published a study that analyzes gender attitudes among adolescents in India, where women and girls frequently face gender-based discrimination that can lead to adverse health outcomes including malnutrition, maternal death, suicide
and gender-based violence. It’s during adolescence that boys and girls begin to develop lifelong attitudes about gender.

The study, published in the International Journal of Adolescence and Youth, evaluated the effectiveness of the Girl Rising Gender-Sensitization Program, a comprehensive 24-week curriculum that aims to support adolescent boys and girls in India to identify and share their gender- related experiences through activities and stories. The program is built around the “Girl Rising” feature film, which is part of the global Girl Rising initiative that uses storytelling to change cultural and social attitudes toward women and girls worldwide so they can lead better, healthier lives. Milken Institute SPH is the official academic partner of Girl Rising, and the studies were conducted as part of the partnership.

Associate Professor of Prevention and Community Health Amita V yas, PhD, MHS, helped develop the program and served as the lead author of the study. To examine the effectiveness of the program, researchers administered two comprehensive tests to participants, one before and one after completing the curriculum. Each test examined boys’ and girls’ attitudes toward gender as well as the gender norms they believed and whether the program changed their perception of the issue. Researchers found that after completing the curriculum, both adolescent boys and girls had more positive gender-based attitudes and a greater understanding of gender-based discrimination.

“The notion that interventions that incorporate inspirational storytelling may effectively impact gender attitudes is so promising if we want to achieve long-term sustained change in gender norms, which will ultimately lead to significant changes for girls’ and women’s health and well- being,” says Vyas.

Students and Alumna Promote Awareness Around Gender-Based Violence in India

Two Milken Institute SPH students and one alumna traveled within India this past spring to learn more about local NGO efforts to address and prevent gender-based violence (GBV). The Milken Institute SPH group, led by Prevention and Community Health Associate Professor Amita Vyas, PhD, MHS, worked to pilot GBV prevention workshops at colleges and universities around the country to better understand and address the problem of GBV among this age group. The workshops were conducted by local professionals trained by Girl Rising, an organization that campaigns for girls’ education and empowerment and seeks to change the way that the world values girls.

The first day of the workshop focused on providing clear definitions of GBV and various forms of violence. Students had the opportunity to share their perspectives on social norms around gender roles as well as the consequences of not conforming to those roles. The second day was focused on using the power of storytelling as a platform to create change. Videos from the feature film “Girl Rising” were screened to help students feel empowered to share their personal stories of violence in front of their peers. Many expressed that this was the first time they could talk freely about their encounters with violence. Students were comforted to hear that others had similar experiences and that they are not alone.

By the end of the workshops, participants were motivated and equipped with the tools to make strides towards preventing GBV within their local communities and, more specifically, on their college and university campuses. Through these GBV workshops, the hope is to spark the next generation of India’s youth to stand up, speak up, and stop the violence.

Researchers Awarded Grant to Lower Vaccination Barriers in Nepal

Milken Institute researchers are seeking to increase vaccination rates in Nepal thanks to a $100,000 Grand Challenges Explorations grant—an initiative funded by the Bill & Melinda Gates Foundation. Rajiv N. Rimal, PhD, MA, former chair of the Department of Prevention and Community Health and now professor and chair of the Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health, is the principal investigator of the award. He will pursue an innovative global health and development research project titled “Rejoice Architecture Meets Social Norms to Accelerate Vaccination in Nepal.”

In Nepal, essential health services like vaccinations are often provided in clinics with long waiting lines, usually in a noisy, stressful environment, according to Rimal. Restroom facilities are usually either in need of repair or do not exist. In addition, clinic staff are rushed, overworked and may seem disrespectful to patients, he points out. That unwelcoming environment might erect a barrier for new mothers in terms of follow-up visits for their baby. The end result? Newborns may not get the full complement of vaccines, thus putting them at risk of developing serious diseases like measles, Rimal says.

The new project seeks to create a welcoming environment in these health clinics with the hope that vaccination rates will increase and caregivers will regularly seek essential health care services for their children and families. “We observed that clinic settings were very stressful and unappealing,” Rimal says. “A busy new mother would often leave and not bring her baby back for the full immunization cycles if she felt unwelcome at the clinic.” Rimal and his team will work in the Makwanpur District in Nepal, where the vaccination rate is 83 percent. The two-pronged study will involve 10 government-owned health clinics. Five will receive updates, including fresh paint to the walls, bathrooms equipped with proper cleaning materials like toilet paper and hand soap, and chairs in the waiting area. These five clinics will also be enhanced to provide visitors with additional services, such as the ability to do laundry or purchase groceries while waiting for vaccinations to be completed. The other five clinics in the study will not be changed. Through surveys and medical records, Rimal and his team will observe if the vaccination rate increases among those who visit the upgraded clinics.

“For many people in this region, traveling to the health clinic can be an all-day task. They often travel long distances and are balancing a million other life priorities,” Rimal says. “If we make it an appealing and productive trip, they will be more likely to return for follow-up visits.”

After Hurricane Maria, Researchers Investigate the Natural Disaster’s Toll on Community Pharmacies

After a natural disaster occurs, community pharmacists can help patients access crucial health care services, including filling medications that treat illnesses and chronic conditions. However, an analysis by Prevention and Community Health Associate Professor Carlos Rodríguez-Díaz found that after Hurricane Maria hit Puerto Rico in 2017, the island’s pharmacists were challenged to adequately respond to patients’ needs due to various structural and individual barriers.

Rodríguez-Díaz, in collaboration with his mentee, Kyle Melin, an assistant professor at the University of Puerto Rico School of Pharmacy, argued that pharmacists could not properly respond to patients’ needs after Hurricane Maria because of medication shortages, extended loss of power on the island, and limited telecommunications for contacting prescribers, disaster relief agencies, and insurance companies. “This put pharmacists in the difficult position of needing to dispense maintenance medications without prescriptions, authorized refills, or an emergency protocol to guide practice,” Rodríguez-Díaz and Melin wrote in the analysis. “As the vast majority of community pharmacies in Puerto Rico are independent small businesses, the necessity of dispensing much-needed medications to patients without any guarantee of reimbursement further led to significant concerns of financial survival.”

Rodríguez-Díaz and Melin are working together to reduce the negative impact of natural disasters through research and evaluation after what Puerto Rico experienced in the aftermath of Hurricane Maria. The authors call for further research to understand the individual, interpersonal, and environmental factors that affect community pharmacies after natural disasters so officials can develop policies and emergency protocols that better help pharmacists serve patients in future disasters. Their paper, titled “Community pharmacy response in the aftermath of natural disasters: Time-sensitive opportunity for research and evaluation,” was published online in the Journal of Primary Care and Community Health.

Milken Institute SPH Researcher Studies Social Marketing Campaign on Female Genital Cutting in Africa

A study conducted by Milken Institute SPH researchers finds that a campaign in Sudan to change the social norms around female genital cutting (FGM) is a promising way to protect girls from this harmful practice. W. Douglas Evans, PhD, professor of prevention and community health, and his colleagues studied the Saleema Initiative in Sudan, a public health campaign to raise awareness of the harm caused by FGM and to change the way the public thinks about this practice.

When a social norm such as FGM is in place, families and individuals engage in the practice because they view it as a common and expected of them, Evans says. The Saleema Initiative aims to change that norm by providing messages aimed at getting people in Sudan, a country in Northeast Africa, to view girls who have not been circumcised as whole, healthy and intact. The Saleema Initiative was launched in 2008 by the National Council for Child Welfare in collaboration with UNICEF Sudan.

In this study, researchers found people who were exposed more to Saleema Initiative’s messages were more likely to view FGM as unacceptable. Evans says further research is needed to see if the campaign will change the social norm enough to help eradicate FGM in Sudan. “This study demonstrated that Saleema’s social marketing strategy is effective in changing the belief that FGM is an accepted practice in Sudan,” Evans says. “Viewing FGM as outside of the social norm is the first step towards eliminating the practice.”

Milken Institute SPH Researcher Finds Parents of Lesbian, Gay, Bisexual Kids Struggle

Parents may take up to two years to adjust to the news that their child identifies as gay, lesbian or bisexual, according to a recent study by David Huebner, PhD, MPH, a professor of prevention and community health. It’s an important finding because previous studies suggest parents who have trouble adjusting to the news of their child’s sexual orientation are more likely to disapprove or adopt negative behaviors that can, in turn, put youth at risk of serious health problems.

“Two years is a very long time in the life of a child who is faced with the stress of a disapproving or rejecting parent,” Huebner says.
This study is one of the first and largest to survey parents themselves and includes data from parents who only learned their child identifies as lesbian, gay or bisexual in the past month. Huebner and his colleagues studied more than 1,200 parents of lesbian, gay and bisexual youth who are between the ages of 10 and 25. The researchers asked parents who visited a website with resources to fill out a questionnaire. The researchers found parents who had learned about their child’s sexual orientation two years ago reported struggling just as much as parents who had been told very recently; African-American and Latino parents reported greater trouble adjusting compared to white parents; and fathers and mothers reported similar levels of difficulty, as did parents of boys and girls.

Huebner says parents who have trouble accepting the news may worry that their child might face a more difficult life, one that includes bullying or harassment. Others may need time to adjust because they imagined a heterosexual future for their child, he elaborates. Still, Huebner says most parents, even those in shock when first learning the news, care deeply about their children and eventually do adjust. “Our results suggest interventions to speed up the adjustment process would help not only the parents but also their children,” Huebner said. “LGB youth with accepting families are more likely to thrive as they enter adulthood.”

MPH Alumna Awarded for Community-Based Research on Youth Sports Injuries

Parents may take up to Colleen Packard, BSPH ’17, MPH ’19, was awarded the Nashman Prize during GW’s 2019 Research Days for her study looking at parent and student perceptions of youth sports injuries. The Nashman Prize recognizes excellence in community-based participatory research.

For her study, Packard worked with Beacon House, a community-based nonprofit organization located in Washington, DC’s Ward 5. Beacon House strives toward eliminating the education achievement gap of area kids, and its athletics program is a signature offering, with the tackle football program the largest and most successful of the sports offered.

However, given increased awareness around concussion risk for youth sports, especially within tackle football, Beacon House wanted to learn more about parents’ knowledge of and attitudes toward youth sports injuries.

The organization called on Packard, who was working as an evaluation intern as part of her practicum experience, for help.

For Packard, who has always been interested in the intersection of clinical medicine and public health, the study provided her with an opportunity to put her research training into practice. “As a community-oriented primary care student, I understood the importance of community input in research, and I hoped to be able to encapsulate the community’s experience with this issue so that we could create both a community-based and an evidence-based solution,” she says.

To conduct the study, Packard used surveys and focus groups to assess parents’ decision processes for getting their children involved in sports as well as their awareness of concussion risks and their opinions on expanding Beacon House’s athletics programming. Study results indicate that Beacon House parents’ knowledge and attitudes toward concussion are similar to other parents’ across the country, but Beacon House parents reported that they want to keep the football program while focusing on increased safety. “Football was found to be integral to the identity and sense of community within the organization, and there was very low acceptability of expanding other athletic programs if it meant getting rid of the football program,” Packard says.

She adds that data collection for youth athletes is currently underway, and it will also measure concussion knowledge and attitudes as well as interest in other athletics programming. Ultimately, Packard hopes Beacon House will be able to use the data from her research to help inform its future sports programming. She also hopes studies like this help demonstrate the importance of incorporating community voices in research. “Beacon House athletes have been shown to have high levels of resilience and social-emotional well-being,” Packard says. “These positive effects, arguably
a result of the community identity tied to football, cannot be ignored just because external stakeholders, including researchers, believe that they know what is best for the community.”

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