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Substance-exposed newborns in Arizona: an analysis of medically, ethically, and legally appropriate federal and state responses

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Intake of alcohol, tobacco, and illicit substances such as marijuana and methamphetamine during pregnancy can have significant deleterious effects on a developing fetus and the resulting infant. The existence of substance-exposed newborns also has negative impacts on society as a

Intake of alcohol, tobacco, and illicit substances such as marijuana and methamphetamine during pregnancy can have significant deleterious effects on a developing fetus and the resulting infant. The existence of substance-exposed newborns also has negative impacts on society as a whole; these include financial burdens placed on taxpayers and the additional time and resources required by health care professionals, social workers, and law enforcement authorities to properly care for such infants. Existing literature show a strong correlation between prenatal care and improved birth outcomes, including abstinence from or reduction of prenatal substance abuse. The Health Start Program in the state of Arizona attempts to mitigate the incidence of substance-exposed newborns, among other goals, by employing community health workers who identify high-risk pregnant and postpartum women, inform these women about how to receive prenatal care services, educate them on appropriate prenatal and neonatal care, and provide program and referral services to both pregnant and postpartum women. Community health workers interact directly with women most at-risk for prenatal substance abuse and should be well-versed in the understanding of the complex issues related to substance-exposed newborns. In an attempt to discover, analyze, and compile those complex issues with which community health workers should be knowledgeable, this project explores existing federal regulations regarding substance-exposed newborns, compares Arizona’s regulations to Minnesota’s, Virginia’s, and Washington’s, and analyzes prevailing literature in the field about the various implications associated with screening and reporting substance-exposed newborns to law enforcement authorities. After an intensive literature review, this project concludes that the Health Start Program needs a comprehensive resource document which enumerates federal and select state policies, landmark cases involving substance-abusing pregnant women and the precedence set by each, and recommendations from medical and public health experts. The document should also provide clear guidelines by which each stakeholder should abide and why, and recommend potential best practices the state of Arizona could adopt into law based on other state policies which have proven to be effective.

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2015

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Impact of the Affordable Care Act on Young Adult’s Health Insurance, Employment, and Education: A Three-Essay Dissertation

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The Patient Protection and Affordable Care Act (PPACA or ACA) Public Law No: 111-148, substantially changed health insurance access in the United States. One group that the law particularly affects is young adults, defined as individuals between the ages of

The Patient Protection and Affordable Care Act (PPACA or ACA) Public Law No: 111-148, substantially changed health insurance access in the United States. One group that the law particularly affects is young adults, defined as individuals between the ages of 19 to 26. Specifically, the expansion of young adult dependent coverage was one of the first provisions that went into effect after the ACA’s enactment. This dissertation comprehensively studies the impact of the ACA’s dependent coverage provision on young adults. Across three empirical chapters, the dissertation examines outcomes related to health insurance coverage, labor market outcomes, and educational enrollment. Chapter 1, titled “Impact of the Affordable Care Act on Young Adults Insurance Coverage,” documents the changes in health insurance take-up for the young adults population, which has historically had the lowest rates of such coverage. Changes in coverage are also evaluated separately for sub-groups of young adults. Chapter 2, titled “Labor Market Outcomes for Young Adults,” evaluates whether the law altered employment decisions and earnings for this group. It also assess whether the ACA led to increased job mobility for young adults. Finally, Chapter 3, titled “Does having Dependent Coverage from the ACA impact Educational Enrollment,” evaluated changes in educational enrollment levels for young adults following the expansion of parental dependent coverage. The research conducted in this dissertation provides evidence of the ACA’s impact on health insurance coverage, employment, and education. It also provides support for the claim that the ACA covers insurance gaps that young adults might experience as they go through life transitions when they are likely to lose coverage.

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2017