Dissertation Title: "Chronic Illness and Public Health: Evaluating Influential Intersections Between Politics and Policy"The first paper investigates the political bias of the U.S. news media in its coverage of two recent health controversies: the 2009 USPSTF mammography guidelines and state HPV vaccination mandates. We analyzed the content and sources cited in newspaper articles and opinion pieces to determine the position towards these controversial cancer prevention practices expressed in print news. Our results demonstrate the variation in the position of news articles and opinion pieces towards these controversial cancer prevention practices between newspapers with conservative and liberal political leanings. We find that conservative-leaning and liberal-leaning newspapers differed in the frequency with which they published opinion pieces from some sources compared to others. We conclude that policymakers and public health agencies may consider developing a political communication and media strategy for disseminating policy recommendations, especially when government health authorities may face challenges from opposing parties in contentious health debates.
The second paper uses a large administrative commercial claims database to assess the impact of state breast density notification laws in the U.S. on the use of supplemental breast imaging to detect breast cancer. As of January 2016, 24 states had passed laws requiring that women found to have dense breast tissue through mammography be notified that dense breast tissue is associated with increased risk of breast cancer and lowered efficacy of mammograms. The impact of breast density notification laws on the use of supplemental breast imaging across the U.S. is currently unknown. We studied women aged 40-64 years with employer-sponsored insurance whose claims are aggregated in the Truven MarketScan claims database. After identifying women who underwent mammography in 2008-2014, we use a differences-in-differences approach to compare additional breast imaging (ultrasound, MRI, 3D mammography, scintimammography, and thermography) among women living in states that implemented breast density notification laws and those in matched comparison states without notification laws. Among women who underwent an initial mammography exam, rates of additional breast imaging increased in states with notification laws in comparison to matched control states, with larger increases in Connecticut, who mandated insurance coverage of supplemental breast imaging. As breast density notification laws are implemented or considered in additional states, policymakers and clinicians should be aware of the potential effects on care and the cost burden associated with these laws.
The third paper analyzes nationally representative surveys of 1,081 African-American and 1,478 Hispanic adults, age 18 and older to examine their perspectives on living with chronic illness in their families and the challenges they experience in multiple areas of their lives. We perform a weighted analysis of survey responses from African-American and Hispanic adults living with chronic illness. African Americans and Hispanics living with chronic illness in their families report experiencing challenges with the health care delivery system, with financial/economic insecurity, and in their communities that may influence how they deal with their chronic diseases. Policymakers and clinicians should be aware that some African-American and Hispanic patients face obstacles within and beyond the health care system that are relevant to how they live with the chronic conditions affecting their families. Additional tools and supports may need to be appropriately identified and supplied to effectively manage chronic illness in these communities. Furthermore, the payment system for physicians should account for the supplementary supports and services that these patients might require.