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Naturally Non-Compliant: Mandatory Counseling for Methadone Clients in Arizona, 2021

Description

The US is unique in dispensing methadone for opioid dependent people only via opioid treatment programs (OTP), or “methadone clinics”. These OTP are governed by federal regulations which outline rules, such as mandatory counseling. Mandatory counseling in this context is a tool to determine which individuals may gain access to…

The US is unique in dispensing methadone for opioid dependent people only via opioid treatment programs (OTP), or “methadone clinics”. These OTP are governed by federal regulations which outline rules, such as mandatory counseling. Mandatory counseling in this context is a tool to determine which individuals may gain access to a sanctuary for safer drug use and who may not.This dissertation is an analysis of data previously collected from a larger parent study, but which had remained unexamined until now. Utilizing a qualitative thematic approach to data analysis, this study seeks to answer two central research objectives. Firstly, what does the mandatory counseling consist of and what is the professional background of the counselors. When participant responses were analyzed, it was found that clients at OTP were provided scarce details regarding the professional background of their counselors and which, if any, therapeutic modality is offered. Clients have very little control over their treatment plans or counseling, and the role of the counselor is focused more directly on surveillance than therapeutic goals. Secondly, this analysis explores client beliefs about mandatory counseling. While most participants generally held positive views about counseling independent of the mandate, responses bifurcated into two distinct groups. Participants were very supportive of the mandatory counseling, or they expressed a desire for more autonomy and freedom of choice regarding counseling. The findings of this dissertation indicate the need for comprehensive reform of methadone dispensation in the United States.

ContributorsRussell, Danielle Marie (Author) / Quan, Helen L (Thesis advisor) / Meyerson, Beth E (Committee member) / Gomez, Alan E (Committee member) / Daniulaityte, Raminta (Committee member) / Arizona State University (Publisher)

Created2023

COVID-19 Vaccination Hesitancy Among Pregnant People in Arizona

Description

With recent reports indicating that there is a relatively low number of pregnant people vaccinated against COVID-19 in the United States (~30% per the Centers for Disease Control and Prevention, October, 2021), this study aims to understand the reasons for COVID-19 vaccine hesitancy among the pregnant population in the state…

With recent reports indicating that there is a relatively low number of pregnant people vaccinated against COVID-19 in the United States (~30% per the Centers for Disease Control and Prevention, October, 2021), this study aims to understand the reasons for COVID-19 vaccine hesitancy among the pregnant population in the state of Arizona. Using a mixed-methods approach, this cross-sectional study employs both semi-structured qualitative interviews (n = 40) and a quantitative survey instrument (n = 400) to better understand the reasons for COVID-19 vaccine hesitancy among pregnant people, with data collected over the course of a few months. Descriptive statistics and logistic regression are employed to analyze the quantitative data and the semi-structured interviews are inductively coded to analyze themes across participant interviews. The results from this study are not only able to help better address disparities in COVID-19 vaccinations among pregnant people, but they also provide implications for vaccine hesitancy overall in order to develop interventions to address vaccine hesitancy. Future research is warranted to better understand regional differences in vaccine hesitancy and differences across populations.

ContributorsPerez, Valeria (Author) / Gamboa, Jazmin (Co-author) / Hernandez, Christopher (Co-author) / Lopez, Gilberto (Thesis director) / Ingram-Waters, Mary (Committee member) / Barrett, The Honors College (Contributor) / School of Life Sciences (Contributor) / School of Human Evolution & Social Change (Contributor) / School of Transborder Studies (Contributor) / Watts College of Public Service & Community Solut (Contributor)

Created2023-05

ABCTL: The Implicit Modification Of The Patient-Physician Relationship To Reduce Medical Mistrust And Discriminatory Biases

Description

The COVID-19 pandemic has led to high demand for testing. It also has affected minorities at disproportionate rates, and the impact is made worse due to the underlying mistrust minorities hold against medical institutions. A similar theme is observed against physicians, especially Asian American healthcare providers experiencing firsthand discrimination. Therefore,…

The COVID-19 pandemic has led to high demand for testing. It also has affected minorities at disproportionate rates, and the impact is made worse due to the underlying mistrust minorities hold against medical institutions. A similar theme is observed against physicians, especially Asian American healthcare providers experiencing firsthand discrimination. Therefore, there is this reciprocal relationship between the patient and provider rooted in mistrust and discriminatory biases. This thesis aims to analyze how ASU Biodesign COVID-19 Testing Lab (ABCTL) functions to implicitly modify potential effects of a patient-provider relationship based on the concepts of health equity and cultural humility. The analysis then suggests that ABCTL accomplished the concept of health equity through community partnerships and by recruiting community healthcare workers for long-term stability, it successfully achieved cultural humility.

ContributorsCalo, Van Dexter (Author) / Compton, Carolyn (Thesis director) / Cheong, Pauline (Committee member) / Barrett, The Honors College (Contributor) / College of Health Solutions (Contributor)

Created2022-05

COVID-19 Vaccination Hesitancy Among Pregnant People in Arizona

Description

With recent reports indicating that there is a relatively low number of pregnant people vaccinated against COVID-19 in the United States (~30% per the Centers for Disease Control and Prevention, October, 2021), this study aims to understand the reasons for COVID-19 vaccine hesitancy among the pregnant population in the state…

With recent reports indicating that there is a relatively low number of pregnant people vaccinated against COVID-19 in the United States (~30% per the Centers for Disease Control and Prevention, October, 2021), this study aims to understand the reasons for COVID-19 vaccine hesitancy among the pregnant population in the state of Arizona. Using a mixed-methods approach, this cross-sectional study employs both semi-structured qualitative interviews (n = 40) and a quantitative survey instrument (n = 400) to better understand the reasons for COVID-19 vaccine hesitancy among pregnant people, with data collected over the course of a few months. Descriptive statistics and logistic regression are employed to analyze the quantitative data and the semi-structured interviews are inductively coded to analyze themes across participant interviews. The results from this study are not only able to help better address disparities in COVID-19 vaccinations among pregnant people, but they also provide implications for vaccine hesitancy overall in order to develop interventions to address vaccine hesitancy. Future research is warranted to better understand regional differences in vaccine hesitancy and differences across populations.

ContributorsGamboa, Jazmin (Author) / Hernandez Salinas, Christopher (Co-author) / Perez, Valeria (Co-author) / Lopez, Gilberto (Thesis director) / Ingram-Waters, Mary (Committee member) / Barrett, The Honors College (Contributor) / School of Transborder Studies (Contributor) / School of Social Transformation (Contributor) / Watts College of Public Service & Community Solut (Contributor)

Created2022-05

Barriers to Equitable Access and Utilization of Medication-Assisted Treatment for Opioid Use Disorder: An Examination of Rural and Urban Communities in New Mexico

Description

Opioid use disorder (OUD) has been a growing problem in the United States since the start of the 20th century, but a new wave of the “Opioid Epidemic” began in the mid-1990s when the use of opioid analgesics became the premier method for treating acute pain. In response to the…

Opioid use disorder (OUD) has been a growing problem in the United States since the start of the 20th century, but a new wave of the “Opioid Epidemic” began in the mid-1990s when the use of opioid analgesics became the premier method for treating acute pain. In response to the increasing rates of OUD, in 2002 the Federal Drug Administration (FDA) approved a treatment course known as medication-assisted treatment (MAT), which is a combination therapy that uses buprenorphine, a partial opioid analgesic, and behavioral therapy to treat OUD. However, the use of buprenorphine to treat OUD is relatively controversial and as a result, is not widespread in primary care settings. New Mexico is an area that has seen some of the highest rates of OUD, with patient populations that suffer from the disorder prevalent in both rural and urban areas. This paper seeks to identify the barriers that urban and rural medical providers face when it comes to successfully establishing medication-assisted treatment options for opioid use disorder patients. To answer this question, 20 medical practitioners across the state of New Mexico shared their opinions on the subject in semi-structured interviews. A qualitative analysis of the information gathered from these interviews concluded that there are 3 main barriers (patient-related, provider-related, and medical system-related) that contribute to the inconsistent spread of MAT services in New Mexico. These barriers are relatively consistent across both rural and urban communities, however, in specific instances, they manifest differently. The preliminary findings from this study highlight multiple methods for reducing barriers to the implementation of MAT including starting provider education about OUD and MAT earlier (i.e. in residency) and improving the infrastructure and support systems available to vulnerable patient groups (including those in rural areas and homeless individuals).

ContributorsPentecost, Abigail (Author) / Hruschka, Daniel (Thesis director) / Drake, Alexandria (Committee member) / Barrett, The Honors College (Contributor) / School of Human Evolution & Social Change (Contributor) / School of Life Sciences (Contributor)

Created2022-05

Achieving Health Equity: The Role of Community Health Workers in Latinx Communities During the COVID-19 Pandemic in Arizona

Description

The purpose of this study is to describe Community Health Workers’ (CHWs) efforts in meeting unmet needs in underserved populations, especially with added COVID-19 pressures. Five focus groups were conducted with 28 CHWs across three counties. It was found that CHW’s served as puentes/bridges, in which the extent of their…

The purpose of this study is to describe Community Health Workers’ (CHWs) efforts in meeting unmet needs in underserved populations, especially with added COVID-19 pressures. Five focus groups were conducted with 28 CHWs across three counties. It was found that CHW’s served as puentes/bridges, in which the extent of their reach and foundational strength provides a connection between the Latino/a/x population across Arizona and social services, resources, and the healthcare system.

ContributorsHernandez Salinas, Christopher (Author) / Oh, Hyunsung (Thesis director) / Marsiglia, Flavio (Committee member) / Barrett, The Honors College (Contributor) / Department of English (Contributor) / School of Life Sciences (Contributor) / Edson College of Nursing and Health Innovation (Contributor) / School of Social Transformation (Contributor) / School of Human Evolution & Social Change (Contributor) / School of Transborder Studies (Contributor)

Created2022-05

US Healthcare’s Equity Barrier: An Analysis of Neighborhood and Built Environment Impacts on Health Outcomes

Description

Many would contend that the United States healthcare system should be moving towards a state of health equity. Here, every individual is not disadvantaged from achieving their true health potential. However, a variety of barriers currently exist that restrict individuals across the country from attaining equitable health outcomes; one of…

Many would contend that the United States healthcare system should be moving towards a state of health equity. Here, every individual is not disadvantaged from achieving their true health potential. However, a variety of barriers currently exist that restrict individuals across the country from attaining equitable health outcomes; one of these is the social determinants of health (SDOH). The SDOH are non-medical factors that influence the health outcomes of an individual such as air pollution, food insecurity, and transportation accessibility. Each of these factors can influence the critical illnesses and health outcomes of individuals and, in turn, diminish the level of health equity in affected areas. Further, the SDOH have a strong correlation with lower levels of health outcomes such as life expectancy, physical health, and mental health. Despite having influenced the United States health care system for decades, the industry has only begun to address its influences within the past few years. Through exploration between the associations of the SDOH and health outcomes, programming and policy-making can begin to address the barrier to health equity that the SDOH create.

ContributorsWaldman, Lainey (Author) / Zhou, Hongjuan (Thesis director) / Zicarelli, John (Committee member) / Barrett, The Honors College (Contributor) / School of Mathematical and Statistical Sciences (Contributor) / Economics Program in CLAS (Contributor)

Created2023-05

The Ineffective Cure Hepatitis C and the Drug That Never Got Its Chance

Description

Hepatitis C is an infectious disease that affects 71 million people worldwide and causes liver failure and death if untreated. In 2013, a direct acting antiviral drug, sofosbuvir, revolutionized treatment of the disease. Sofosbuvir showed immense promise, but the high price point at which it was launched created access barriers…

Hepatitis C is an infectious disease that affects 71 million people worldwide and causes liver failure and death if untreated. In 2013, a direct acting antiviral drug, sofosbuvir, revolutionized treatment of the disease. Sofosbuvir showed immense promise, but the high price point at which it was launched created access barriers that prevented it from reaching its full public health potential. By 2016, fewer than 1% of Hepatitis C patients worldwide had received treatment. In the United States (US), concerns about the cost of the drug led public and private payers to implement rationing and treatment restrictions that prevented some of the most vulnerable populations from accessing Hepatitis C treatment at all. Through interviews with researchers, patients and providers, and a literature review of grants, patents, papers, court documents, and news articles, I examine the history of sofosbuvir with attention to the ways in which federal funding practices and intellectual property law encouraged the high initial pricing of the drug. I then examine the impact of this drug on healthcare systems in the United States and abroad, and discuss how the fragmented nature of the United States healthcare system has exacerbated price-based barriers to access. Finally, I discuss intellectual property laws as potential mechanisms to increase access. My study underscores how the political reluctance to use well-established federal funding and intellectual property laws has resulted in a drug development system that delivers medications that are so highly priced that the fragmented US healthcare system cannot compensate for the expense. This leads to low access and poor public health outcomes, and a continued failure to contain or control diseases for which effective therapies exist.

ContributorsTiffney, Theora (Author) / Cook-Deegan, Robert M. (Thesis advisor) / Collins, James P. (Thesis advisor) / Ross, Heather M (Committee member) / Chew, Matthew K (Committee member) / Arizona State University (Publisher)

Created2020

Pediatric Dental Health Care Utilization Among AHCCCS Recipients

Description

Arizona children covered by AHCCCS experience increased poor oral health outcomes in comparison to their higher-income counterparts despite receiving comprehensive dental service coverage under the state Medicaid program. The dental health disparities consistently present among this population allude that other barriers are in place preventing pediatric AHCCCS recipients from accessing…

Arizona children covered by AHCCCS experience increased poor oral health outcomes in comparison to their higher-income counterparts despite receiving comprehensive dental service coverage under the state Medicaid program. The dental health disparities consistently present among this population allude that other barriers are in place preventing pediatric AHCCCS recipients from accessing guaranteed dental care. This thesis addresses the gaps faced by AHCCCS recipients in utilizing dental insurance coverage on behalf of provider availability in proximity and time. A “secret shopper” study was executed to reveal the accessibility barriers experienced by AHCCCS patients in comparison to privately insured patients and the adequacy of AHCCCS contracted providers in maintaining availability for this population. Based on the collected data, AHCCCS patients generally experience increased lengths of time until the next available appointment in comparison to the privately insured, suggesting that despite AHCCCS contracting, there are not currently adequate protective standards ensuring that child AHCCCS patients receive equitable opportunity for good dental health. Furthermore, this study revealed the significant obstructions to accessing dental care for rural Arizonans covered by AHCCCS, as four separate counties were notably found to not have a single AHCCCS provider. State policy must evolve to better support this demographic in achieving equitable oral health, working towards the relief of social determinants oppressing the wellbeing of lower-income families regarding distance to contracted practices and provider availability for the population of AHCCCS recipients.

ContributorsZiegler, Madison Brooke (Author) / Reddy, Swapna (Thesis director) / Speer, Matthew (Committee member) / School of International Letters and Cultures (Contributor) / School of Human Evolution & Social Change (Contributor) / Barrett, The Honors College (Contributor)

Created2020-05