POLICY EVALUATION USING COST-BENEFIT ANALYSIS: EMPIRICAL RAMIFICATIONS FOR TWO POLICY ISSUES

Using two distinct health policy issues my research examines the relevance and ramifications of using cost-benefit analysis (CBA) to demonstrate real-world impacts of the policies. My dissertation discusses how these two situations represent particular challenges to cost-benefit analysis. The challenges have specific implications for how scholars, agencies, and government entities should use CBA to evaluate policies. Specifically, my research finds that by separating CBA into four different approaches, a much more complete, and less assumption-laden, CBA can be accomplished

The Status of Rural Health in the Southeast United States

Disparities in HIV prevalence reflect multiple disparities in the social determinants of health that affect rural Southern populations. This presentation will review residence and racial/ethnic inequities in education, income and access to care that culminate in differing health outcomes

ASPECTS OF AMERICAN MUSICAL LIFE AS REFLECTED IN THE NEW MUSIC REVIEW AND CHURCH MUSIC REVIEW, 1901-1935

The early twentieth century was a time of growth and important change in American musical life. However, many aspects of our national musical culture during this period remain largely unexplored. Among these is The New Music Review and Church Music Review (NMR) which from 1901 to 1935 offered a detailed chronicle of American musical life in some 404 issues and in over 16,000 pages. During its thirty-year publication run, the NMR was one of the most important music journals published in the United States and one that enjoyed "a high reputation for its able editorials and the excellence of its contributed articles." This dissertation examines the central and, in the main, previously unexplored topics treated in the journal's feature articles including attempts to define an American musical identity, the promotion of American music and composers, and the history and development of the organ and its music in the United States -- i.e., efforts to standardize the organ console, the controversy over unification of organ pipes, transcriptions, service playing, programs, and accompaniment for motion pictures and choirs. The journal also treats the history and accomplishments of the American Guild of Organists, problems relating to early twentieth-century American sacred music, the purposes of church music, musical reforms in the Episcopal and Roman Catholic Churches, the education of the clergy, congregation, choirmaster and organists in their responsibilities for the implementation of sacred music, and the selection of church repertory, especially hymns and anthems. There are four appendices: the first summarizes the NMR's articles on choral music, the second summarizes the NMR's articles on music education, the third lists the NMR's biographical sketches, and the fourth provides a descriptive list of the journal's contributors

The Economic Impact of Changing Water Levels: A Regional Economic Analysis of Lake Thurmond

This article examines the economic impact of declining lake levels on the local economy in six counties near the publically managed Thurmond Reservoir, located along the border of Georgia and South Carolina. A regression analysis of the relationship between lake level elevations and lake front real estate transactions is used in conjunction with an input-output model to estimate the median monthly economic impact of a one-foot increase in lake level in terms of employment, output, disposable income, and net local government revenue on the six counties bordering the lake. Thurmond Lake elevations have a statistically significant impact on regional economic impact activity but the direction and magnitude depend on a variety of factors, including the size and diversity of each county’s economy and the proximity of the commercial centers within each county to the lake

The Impact of Changing Lake Levels on Property Values: A Hedonic Model of Lake Thurmond

This study uses hedonic pricing models to examine the relationship between lake levels and property values for properties adjacent to Lake Thurmond. Lake Thurmond is located along the Savannah River Basin, bordering Georgia and South Carolina. Of the 1,030 properties from 2000-2009 for which data was reliable and available, 388 were lake front homes. The model of the effect of lake level on sales prices also includes home characteristics, home condition variables, lake attributes, and macroeconomic control variables. Results reveal a statistically significant change in sales price when the lake is closer to full pool. Results confirm that declining Lake Thurmond water levels have an impact on real estate values within some ranges below full pool. As climate variability places increasing pressure on communities, future research would benefit from further exploration into the relationship between economic activity and changing lake levels

The Impact of Changing Lake Levels on Property Values: A Hedonic Model of Lake Thurmond

This study uses hedonic pricing models to examine the relationship between lake levels and property values for properties adjacent to Lake Thurmond. Lake Thurmond is located along the Savannah River Basin, bordering Georgia and South Carolina. Of the 1,030 properties from 2000-2009 for which data was reliable and available, 388 were lake front homes. The model of the effect of lake level on sales prices also includes home characteristics, home condition variables, lake attributes, and macroeconomic control variables. Results reveal a statistically significant change in sales price when the lake is closer to full pool. Results confirm that declining Lake Thurmond water levels have an impact on real estate values within some ranges below full pool. As climate variability places increasing pressure on communities, future research would benefit from further exploration into the relationship between economic activity and changing lake levels

Digital Information Technology Use and Patient Preferences for Internet-Based Health Education Modalities: Cross-Sectional Survey Study of Middle-Aged and Older Adults With Chronic Health Conditions

Background: Health information, patient education, and self-management (health information and advice, HIA) tools are increasingly being made available to adults with chronic health conditions through internet-based health and mobile health (mHealth) digital information technologies. However, there is limited information about patient preferences for using specific types of health information and advice resources and how preferences and usage differ by age group and education. Objective:The objective of this study was to examine how use of digital information technologies and preferred methods for obtaining health information and advice varies by age group and education among middle-aged and older adults with chronic health conditions. Methods: The study used cross-sectional survey data for 9005 Kaiser Permanente Northern California members aged 45 to 85 years who responded to a mailed and Web-based health survey conducted during 2014 and 2015 and indicated having at least 1 chronic health condition. Bivariate analyses and logistic regression models with weighted data were used to estimate and compare the prevalence of digital information technology use, past-year use of internet-based health information and advice resources, and preferences for using internet-based, mHealth, and traditional health information and advice modalities for adults aged 45 to 65 years, 66 to 75 years, and 76 to 85 years. Results: The percentages of adults who used digital information technologies (computers, smartphones, internet, email, and apps), had obtained health information and advice from an internet-based resource in the past year, and who were interested in using internet-based and mHealth modalities for obtaining health information and advice declined with age. Within age group, prevalence of digital information technologies use and interest in internet-based and mHealth modalities was lower among adults with no college education versus college graduates. Differences in preferences for internet-based health information and advice modalities between the oldest and younger groups and those with lower versus higher education were substantially diminished when we restricted analyses to internet users. Conclusions: Health care providers and organizations serving middle-aged and older adults with chronic health conditions should not assume that patients, especially those who are older and less educated, want to engage with internet-based and mHealth resources. In addition, increasing the engagement of nonutilizers of digital devices and the internet with internet-based health information and advice and mHealth apps might require both instrumental (eg, providing digital information technology devices, internet, and skills training) and social support. As part of patient-centered care, it is important for providers to ascertain their patients’ use of digital information technologies and preferences for obtaining health information and patient education rather than routinely referring them to internet-based resources. It is also important for health care providers and consumer health organizations to user test their Web-based resources to make sure they are easy for older and less educated adults to use and to make sure that it remains easy for adults with chronic conditions to obtain health information and patient education using offline resources

Digital Information Technology Use and Patient Preferences for Internet-Based Health Education Modalities: Cross-Sectional Survey Study of Middle-Aged and Older Adults With Chronic Health Conditions

Background: Health information, patient education, and self-management (health information and advice, HIA) tools are increasingly being made available to adults with chronic health conditions through internet-based health and mobile health (mHealth) digital information technologies. However, there is limited information about patient preferences for using specific types of health information and advice resources and how preferences and usage differ by age group and education. Objective: The objective of this study was to examine how use of digital information technologies and preferred methods for obtaining health information and advice varies by age group and education among middle-aged and older adults with chronic health conditions. Methods: The study used cross-sectional survey data for 9005 Kaiser Permanente Northern California members aged 45 to 85 years who responded to a mailed and Web-based health survey conducted during 2014 and 2015 and indicated having at least 1 chronic health condition. Bivariate analyses and logistic regression models with weighted data were used to estimate and compare the prevalence of digital information technology use, past-year use of internet-based health information and advice resources, and preferences for using internet-based, mHealth, and traditional health information and advice modalities for adults aged 45 to 65 years, 66 to 75 years, and 76 to 85 years. Results: The percentages of adults who used digital information technologies (computers, smartphones, internet, email, and apps), had obtained health information and advice from an internet-based resource in the past year, and who were interested in using internet-based and mHealth modalities for obtaining health information and advice declined with age. Within age group, prevalence of digital information technologies use and interest in internet-based and mHealth modalities was lower among adults with no college education versus college graduates. Differences in preferences for internet-based health information and advice modalities between the oldest and younger groups and those with lower versus higher education were substantially diminished when we restricted analyses to internet users. Conclusions: Health care providers and organizations serving middle-aged and older adults with chronic health conditions should not assume that patients, especially those who are older and less educated, want to engage with internet-based and mHealth resources. In addition, increasing the engagement of nonutilizers of digital devices and the internet with internet-based health information and advice and mHealth apps might require both instrumental (eg, providing digital information technology devices, internet, and skills training) and social support. As part of patient-centered care, it is important for providers to ascertain their patients’ use of digital information technologies and preferences for obtaining health information and patient education rather than routinely referring them to internet-based resources. It is also important for health care providers and consumer health organizations to user test their Web-based resources to make sure they are easy for older and less educated adults to use and to make sure that it remains easy for adults with chronic conditions to obtain health information and patient education using offline resources

Prevalence and Factors Influencing Use of Internet and Electronic Health Resources by Middle-Aged and Older Adults in a US Health Plan Population: Cross-Sectional Survey Study

Background: Health care organizations are increasingly using electronic health (eHealth) platforms to provide and exchange health information and advice (HIA). There is limited information about how factors beyond internet access affect use of eHealth resources by middle-aged and older adults. Objective: We aimed to estimate prevalence of use of the internet, health plan patient portal, and Web-based HIA among middle-aged and older adults; investigate whether similar sociodemographic-related disparities in eHealth resource use are found among middle-aged and older adults; and examine how sociodemographic and internet access factors drive disparities in eHealth resource use among adults who use the internet. Methods: We analyzed cross-sectional survey data for 10,920 Northern California health plan members aged 45 to 85 years who responded to a mailed and Web-based health survey (2014-2015). We used bivariate and multivariable analyses with weighted data to estimate prevalence of and identify factors associated with internet use and self-reported past year use of the health plan’s patient portal and Web-based HIA resources by middle-aged adults (aged 45 to 65 years; n=5520), younger seniors (aged 65 to 75 years; n=3014), and older seniors (aged 76 to 85 years; n=2389). Results: Although approximately 96% of middle-aged adults, 92% of younger seniors, and 76% of older seniors use the internet to obtain information, about 4%, 9%, and 16%, respectively, require someone’s help to do so. The percentages who used the patient portal and Web-based HIA resources were similar for middle-aged adults and younger seniors but lower among older seniors (59.6%, 61.4%, and 45.0% and 47.9%, 48.4%, and 37.5%, respectively). Disparities in use of the internet, patient portal, and Web-based HIA across levels of education and between low and higher income were observed in all age groups, with wider disparities between low and high levels of education and income among seniors. Multivariable analyses showed that for all 3 age groups, educational attainment, ability to use the internet without help, and having 1 or more chronic condition were significant predictors of patient portal and Web-based HIA use after controlling for gender, race/ethnicity, and internet use. Conclusions: Internet use, and especially use without help, significantly declines with age, even within a middle-aged group. Educational attainment is significantly associated with internet use, ability to use the internet without help, and use of patient portal and Web-based HIA resources by middle-aged and older adults. Even among middle-aged and older adult internet users, higher educational attainment and ability to use the internet without help are positively associated with patient portal and Web-based HIA use. Organizations serving middle-aged and older adults should take into account target population characteristics when developing and evaluating uptake of eHealth resources and should consider offering instruction and support services to boost patient engagement