In its third round of funding, the Center for Health Research is pleased to award 8 new small research grants to 14 different investigators in the amount of $41,425. These investigators come from a wide variety of schools and disciplines, including public health, business, sociology, and UC DATA. Their topics range from mental health services to organizational behavior, and from maternal health to AIDS/HIV prevention in sub-Saharan Africa. A full listing of the awards and their investigators is provided below.
It is thought that health care organizations that are poised to embrace change-those who rank high on a "change readiness" scale-are generally more likely to convert strategic changes into specific practices and behaviors sooner and more completely than those who are lower on this scale. Jennifer Chatman (Business; chatman@haas.berkeley.edu) and her Stanford colleague, David Caldwell, hope to develop an "ideal" change readiness profile that could identify the specific conditions under which change efforts are most likely be successful, and to anticipate resistance to such change. By assessing the gaps between the ideal and actual change readiness profile of a large health care organization, they hope to predict patient and physician satisfaction as well as patient health outcomes. The recommendations they will develop for closing these gaps could help other health care organizations become agile and able to change quickly and effectively.
Despite their more disadvantaged, high-risk socioeconomic and health profiles, Mexico-born women residing in California have pregnancy outcomes that are comparable to, or better than, those of white, non-Latina Californians. While the roles of maternal health behavior and lifestyle have been amply explored, the contribution of maternal morbidity has received scant attention. In a collaboration with Alejandro Reyes at the Instituto Mexicano del Seguro Social (IMSS), Sylvia Guendelman (Public Health; sylviag@berkeley.edu) will test the contribution of severe maternal morbidity during labor and delivery to the epidemiological paradox of favorable pregnancy outcomes of Mexico-born women residing in California. She and her team will also address the impact of selective migration from Mexico to the U.S. on maternal morbidity and pregnancy outcomes and the impact of acculturation on maternal morbidity and pregnancy outcomes among Mexican immigrants to the U.S. Guendelman and her colleagues at IMSS have established a long-term collaborative relationship aimed at advancing research that promotes health monitoring and informs policy-makers and program planners about the health conditions of the Mexican population in California and Mexico. This project will ultimately provide recommendations for health policy, programming, and resource allocation to promote the health of pregnant women on both sides of the border.
With good insurance or self-insurance, a child's health does not depend on shocks to his or her parents' health. In past studies, David Levine (Business; levine@haas.berkeley.edu) found that health declines in Indonesia often reduce consumption. Moreover, this effect does not appear to be due to state-dependent preferences. Levine will test how well this model holds in Mexico using longitudinal data from the first five waves of the evaluation of the PROGRESA welfare program. He will also examine child health outcomes such as height-for-age and weight-for-height (BMI) and will specifically examine the role of the PROGRESA program in helping or hindering protection against shocks. Intuitively, having a safety net should help; however, some have argued that a safety net can help destroy a tradition of mutual insurance.
As a researcher of comparative systems, Kamran Nayeri (UC DATA; knayeri@berkeley.edu) has had a longstanding interest in the Cuban health care system, which has held the interest of health care researchers and advocates because of its accomplishments in providing broad-based effective health care. Yet there has been little access to detailed administrative, survey, epidemiological, and other types of primary data on Cuban health care. As a result, much of U.S.-based research of the Cuban health care system has relied only on the aggregate data available. The University of California Data Archive & Technical Assistance (UC DATA) has recently initiated an institutional collaboration with the Instituto de Informacion Cientifica y Tecnologica (IDICT), which holds all Cuban public use data. In the coming months, Nayeri will visit the IDICT offices to confirm the University's interest in archiving Cuban health care data, initiate communication leading to identification of datasets involved, and set up a series of meetings with Cuban stakeholders and archivists to finalize negotiations and effect the transfer of some of these public use health care data files to UC DATA. All acquired data will subsequently be archived and their availability publicized in the UC community, including through the websites of UC DATA and the Center for Health Research. UC DATA is UC Berkeley's principal archive of computerized social science and health statistics information. Its holdings are primarily machine-readable datasets, although many of its materials, such as codebooks or census reports, are available for browsing at its Berkeley offices.
The Safe Motherhood Initiative, jointly launched by the World Health Organization, the United Nations Children's Fund, and other organizations, set an ambitious goal: to reduce maternal mortality by 75 percent between 1990 and 2015. Unfortunately, little progress has been made to date, for three reasons. First, there is a lack of evidence-based knowledge of the effectiveness of safe motherhood interventions, such as the prevention, detection, and treatment of anemia during pregnancy. Second, the international health community failed to fully implement known effective practices and subsequently improve the coverage and quality of maternal health services. Finally, developing countries-which account for the majority of maternal and neonatal deaths but have scarce resources-lack the information required for mobilizing commitment and affecting policy. Malcolm Potts (Public Health; potts@socrates.berkeley.edu) will address this last factor by developing safe motherhood targets for three model countries, and by gathering and analyzing existing data-such as the Mother Baby Package Costing Spreadsheet-to determine the cost-effectiveness of safe motherhood interventions. This study will be a valuable contribution to policy decision makers, donors, and international agencies working to improve maternal health.
Various pathways between community-level social capital and mental health status have been proposed, including access to medical care, diffusion of healthy behaviors, and psychosocial support. However, no research to date has attempted to examine the effects of community-level social capital on mental health in the United States. Measures of social capital will include indices of social trust, diversity in friendships, and group involvement. Richard M. Scheffler (Public Health; rscheff@berkeley.edu) and his colleague Timothy Brown will investigate whether any correlation exists between social capital and mental health status after controlling for medical care use, healthy behaviors, and social ties. They expect to find that social capital is significantly and positively associated with mental health status and is largely mediated by the strength of an individual's social ties.
Attention deficit hyperactivity disorder (ADHD) is a mental health disorder that presents a major public health problem. A 2002 CDC Report estimates that 3.5 percent of primary school children in the U.S. have been diagnosed with ADHD. ADHD children frequently suffer from serious impairments in relationships with parents, teachers, and peers, as well as difficulties in academic functioning. A considerable amount is known about individuals who have ADHD, but less is known about how well such individuals are treated and accommodated. Richard M. Scheffler (Public Health; rscheff@berkeley.edu) and his colleagues Helen Citkina and Daniel Eisenberg will examine how being diagnosed with ADHD impacts a child's academic performance. The study will also provide information about how well ADHD children are being accommodated in school settings and how individual and contextual factors mediate this process. The results should prove valuable to policymakers, educators, families, and researchers interested in health and academic outcomes of school-age children.
Why has Botswana, the best governed country in Africa, with a capable public health system, a strong economy, and a reputation for administrative competence, nonetheless failed to stem the AIDS epidemic? Ann Swidler (Sociology; swidler@berkeley.edu) will travel to Botswana this summer to continue her broad-based inquiry into that question. There, she will interview AIDS activists, government officials, and NGO workers, and attend a seminar on the role of condoms in AIDS prevention. Her goal is to understand what AIDS prevention activities were launched and when, how these were carried out, and what response they generated. The evidence suggests that no technocratic solution imposed by public health experts-neither abstinence campaigns nor public health advocacy of condom distribution-can succeed in the absence of widespread social movement activity, active mobilization of NGOs, churches, and community-based organizations, and the drawing of a moral connection between individual health behaviors and the survival of the wider community. Her analysis of developments in Botswana will be a crucial part of solving a critical intellectual puzzle and has the possibility of significantly influencing public policy.
The Kenyan Kisumu Medical and Education Trust (K-MET) began in 1995-96 by training private-sector professionals in safe abortion practices and post-abortion care; it subsequently expanded to include a health network with 206 private providers, peer education programs, research, child and maternal health, home-based care for people living with HIV/AIDS, and other programs. While the K-MET network has had well-established success in increasing the overall availability of reproductive health care services, no evaluation of client incomes has been done of its effectiveness at reaching difficult-to-serve groups. The Center's grant will enable Julia Walsh (Public Health; jwalsh@socrates.berkeley.edu) and her colleague Dominic Montagu conduct such an evaluation that includes a matched sample of non-K-MET providers for comparison of provider facilities and clients. This comparison will add important information regarding the "value added" of the K-MET organization in improving structural quality among members and in targeting at-risk groups for services.
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