Federal Programs Research Articles

Shaping a 21st century federal noise control program.

Shaping a 21st century federal noise control program.

Community social vulnerability and the 340B Drug Pricing Program: Evaluating predictors of 340B participation among critical access hospital.

The federal 340B Drug Pricing Program allows eligible hospitals, including critical access hospitals (CAHs), to obtain outpatient drugs at a discounted rate. CAHs likely benefit from 340B participation because they are often under-resourced and serve at-risk patient populations. The objective of this study was to understand predictors of 340B program participation among CAHs, and how participation varies with community-level social vulnerability. We used a cross-sectional study design to assess the relationship between 340B participation in 2019 and community vulnerability status using 2018 data from the CDC's social vulnerability index (SVI) among acute care CAHs. Analyses used linear probability models adjusted for hospital-level characteristics. In bivariate analyses, CAHs participating in the 340B program had lower overall social vulnerability scores, relative to nonparticipating, eligible, and ineligible CAHs, respectively (43.8vs. 48.7vs. 64.7, p < 0.10). In adjusted regression models, greater community vulnerability rankings due to socioeconomic status (-0.129, p < 0.05) and minority status and language (-0.092, p < 0.05) were associated with decreased 340B participation. Higher hospital operating margin was associated with increased 340B participation (0.163, p < 0.05). Although the number of for-profit CAHs ineligible for 340B was small, they had the highest community-level social vulnerability score and lowest hospital operating margin on average. CAHs located in areas of high community vulnerability are less likely to participate in the 340B program. Some vulnerable patient populations served by CAHs may be excluded from 340B program benefits.

Perspective: Nutrition Health Disparities Framework: A Model to Advance Health Equity

Disparities in nutrition, such as poor diet quality and inadequate nutrient intake, arise from multiple factors and are related to adverse health outcomes such as obesity, diabetes, cardiovascular disease, and some cancers. The aim of the current perspective is to present a nutrition-centric socioecological framework that delineates determinants and factors that contribute to diet and nutrition-related disparities among disadvantaged populations. The Nutrition Health Disparities Framework (NHDF) describes the domains (biological, behavioral, physical/built environment, sociocultural environment, and healthcare system) that influence nutrition-related health disparities through the lens of each level of influence (that is, individual, interpersonal, community, and societal). On the basis of the scientific literature, the authors engaged in consensus decision making in selecting nutrition-related determinants of health within each domain and socioecological level when creating the NHDF. The framework identifies how neighborhood food availability and access (individual/built environment) intersect with cultural norms and practices (interpersonal/sociocultural environment) to influence dietary behaviors, exposures, and risk of diet-related diseases. In addition, the NHDF shows how factors such as genetic predisposition (individual/biology), family dietary practices (interpersonal/behavioral), and food marketing policies (societal) may impact the consumption of unhealthy foods and beverages and increase chronic disease risk. Family and peer norms (interpersonal/behavior) related to breastfeeding and early childhood nutrition interact with resource-poor environments such as lack of access to preventive healthcare settings (societal/healthcare system) and low usage of federal nutrition programs (societal/behavioral), which may increase risk of poor nutrition during childhood and food insecurity. The NHDF describes the synergistic interrelationships among factors at different levels of the socioecological model that influence nutrition-related outcomes and exacerbate health disparities. The framework is a useful resource for nutrition researchers, practitioners, food industry leaders, and policymakers interested in improving diet-related health outcomes and promoting health equity in diverse populations.

Стратегический анализ реализации пациент-ориентированного подхода к развитию здравоохранения Кузбасса

Achieving the strategic goals of the Russian Federation for preserving the population and ensuring the health and well-being of people requires an effective health care system that can provide necessary medical services and technologies and systematically train residents in healthy lifestyle and disease prevention. &#x0D; This necessitates a transition to patient-oriented medicine based on strategizing, which will ensure the coordination of federal, departmental and regional programs aimed at improving the medical care quality and the population health. The article analyses legislative, regulatory, organizational documents and statistical data at the federal, regional and departmental levels. The authors perform analysis of healthcare statistical indicators in the Siberian Federal District and its subjects in dynamics; OTSW analysis on the strategizing methodology; comparative analysis of long-term healthcare development goals. The expediency of applying strategic planning and management in the transition to patient-oriented medicine is established; interrelations between strategies of different levels are discovered; region’s strategic objectives for the healthcare sector transformation and the conditions for their implementation effectiveness are defined. The authors consider possibilities of implementing a strategy for the patient-oriented medicine development in Kuzbass on the basis of region’s strengths, identify the threats and risks of not achieving strategic objectives and formulate the proposals for their reduction. The article confirms the importance of strategies’ coherence and proactivity within the appropriate priorities; argues the potential for the patient-oriented medicine development in Kuzbass.

Abstract P483: Food Purchase Priorities and Healthy Food Purchase Supports and Barriers for U.S. General and Low-Income Consumers: A Quantitative Survey

Introduction: Identifying priorities and attributes that influence food purchase decisions will inform interventions and strategies to promote healthy eating. Aim: This study aimed to identify food purchase priorities and healthy food purchase supports and barriers for the general population and those with limited household income. Methods: Participants were recruited by a market research company in May 2023 and were required to be ≥ 18 years old, not work in healthcare/medical/nutrition or advertising/public relations/marketing/market research and be the primary/shared food decision maker for the household. Recruitment quotas ensured age, income, gender and geographic region approximated 2022 US census data (n=1,182) (Census-representative group, CRG). A sample with limited income and participation in federal food or healthcare programs (low-income group, LIG) was also recruited (n=506). The survey was administered online in May and June 2023. Differences between LIG and CRG were assessed using z-tests (p &lt; 0.05). Results: Taste was most commonly rated by CRG as very or extremely important in household food purchasing (87%). Availability, price, ingredients and nutritional value were also important to at least two-thirds of CRG. Taste was similarly important to LIG (85%), but they were more likely to rate price and less likely to rate availability, nutritional value and ingredients as important. When prompted to choose the most important factor, price and taste were the most common responses, chosen by similar proportions of CRG, while price was the most important factor for LIG, followed by taste. CRG versus LIG were more likely to prioritize personal taste over cost, health and nutrition information on labels, buying local and selecting according to nutrition, brand and origin/sourcing information. CRG were less likely than LIG to prefer a lower cost and usually select according to price. LIG were more likely than CRG to state that nothing supports them in selecting healthier foods and less likely to have found support from good-tasting recipes, advance meal or grocery list preparation, cooking equipment access, following influencers, recommendations from organizations or consulting a dietitian/nutritionist. Conversely, LIG were more likely to identify price and availability as barriers to selecting healthier foods, and less likely to see long preparation time, small servings sizes or nothing as barriers. Conclusions: Cost is a strong barrier to healthy eating, especially with limited income, along with taste, while nutrition is not a leading influence on food choice. Strategies to enable healthy eating among low-income households must prioritize taste and cost.

Strengthening nutrition incentive and produce prescription projects: An examination of a capacity building and innovation fund

The Gus Schumacher Nutrition Incentive Program (GusNIP), funded by the U.S. Department of Agriculture (USDA) National Institute of Food and Agriculture (NIFA), is a federal program designed to address financial barriers to fruit and vegetable (FV) purchases among consumers with a low income by using financial incentives. To fur­ther strengthen both nutrition incentive (NI) and produce prescription (PPR) GusNIP projects, the GusNIP Nutrition Incentive Training, Technical Assistance, Evalu­ation, and Information Center (NTAE) and its Nutrition Incentive Hub offer Capacity Building and Innovation Fund (CBIF) awards to GusNIP grantees and their partner organizations. The present study applies multiple methods to systematically understand the types of resources requested by CBIF applicants to expand the capacity and impact of their NI and PPR pro­jects by rigorously analyzing the CBIF proposals submitted from 2020 to 2022. Applicants (N = 130) requested funds to build capacity and innova­tion around one or more domains: leadership and staffing (n = 72); communications (n = 67); diver­sity, equity, and inclusion (DEI; n = 57); and tech­nology (n = 42). Three significant qualitative themes emerged around future needs: (1) staffing and technology to streamline applicants’ projects; (2) training, resources, and funding to enhance DEI in their projects; and (3) improved NTAE support, including improvements to the CBIF funding mechanism. Findings from this study can increase awareness about the capacity building and innovation needs of NI and PPR projects for the NTAE, policymakers, and funders to consider when supporting healthy food financial incentive projects.

An analysis of migration processes in the Murmansk Oblast: Problems and strategic prospects of single-industry towns

Subject. This article examines the single-industry town as a factor determining the economic situation in the Far North of Russia. Objectives. The article aims to analyze migration processes in the Far North and assess the impact of migration processes on population changes. Methods. For the study, we used the methods of comparative and systems analyses. Results. The analysis of the changes in demographic indicators of the Murmansk Oblast shows a high level of resistance of the region to changes in the external environment. The trends in birth and death rates in the Murmansk Oblast generally corresponds to the trends in these indicators in the country as a whole. Conclusions. Initiatives to unlock the economic potential of the Murmansk Oblast should be linked to federal development strategies and programmes.

Learn about new legislation regarding medical care for individuals with disabilities

In February 2024, the U.S. House of Representatives passed H.R. 485, the so‐called Protecting Care for All Patients Act, with a vote of 211 to 208. (https://republicans‐­energycommerce.house.gov/posts/house‐votes‐to‐ban‐metric‐used‐to‐deny‐care‐for‐people‐with‐disabilities‐and‐chronic‐illnesses). The legislation was designed to eliminate discriminatory metrics known as “Quality‐Adjusted Life Years” (QALYs) from federal health programs.

Good Governance and the Partisan Wars: The Effects of Divided Government on Administrative Problem Solving and Oversight Agenda Setting in Congress

Abstract Congress’s constitutional responsibility to oversee and investigate the executive branch of government demands that instances of waste, fraud, and abuse in the administrative state be checked via both legislation and nonlegislative committee hearings. In this article, I establish an oversight agenda for Congress using the nonpartisan Government Accountability Office's (GAO) biennial identification of the most vulnerable federal agencies and programs. I then assess whether and how government-wide partisanship affects Congress’s ability to address this slate of issues. I find that, when government is divided, Congress is more legislatively productive on high-risk issues, and the House of Representatives is more likely to prioritize investigative hearings on high-risk issues. My results suggest a silver lining to the reality of partisan agenda control: preexisting administrative problems identified by well-positioned and well-informed observers at GAO may get more attention when there is a partisan incentive for the legislature to investigate an opposition-controlled government.

Food is Medicine Initiative for Mitigating Food Insecurity in the United States.

While several food assistance programs in the United States tackle food insecurity, a relatively new program, "Food is Medicine," (FIM) initiated in some cities not only addresses food insecurity but also targets chronic diseases by customizing the food delivered to its recipients. This review describes federal programs providing food assistance and evaluates the various sub-programs categorized under the FIM initiative. A literature search was conducted from July 7, 2023 to November 9, 2023 using the search term, "Food is Medicine", to identify articles indexed within three major electronic databases, PubMed, Medline, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Eligibility criteria for inclusion were: focus on any aspect of the FIM initiative within the United States, and publication as a peer-reviewed journal article in the English language. A total of 180 articles were retrieved; publications outside the eligibility criteria and duplicates were excluded for a final list of 72 publications. Supporting publications related to food insecurity, governmental and organizational websites related to FIM and other programs discussed in this review were also included. The FIM program includes medically tailored meals, medically tailored groceries, and produce prescriptions. Data suggest that it has lowered food insecurity, promoted better management of health, improved health outcomes, and has, therefore, lowered healthcare costs. Overall, this umbrella program is having a positive impact on communities that have been offered and participate in this program. Limitations and challenges that need to be overcome to ensure its success are discussed.

Economic aspects of the cardiology program expansion of additional drugs provision by effective lipidlowering drugs for hypercholesterolemia control

The federal program of preferential drug provision in cardiology shows its effectiveness. However, hypercholesterolemia (HCH) remains a significant problem in patients in whom high-dose statin therapy does not provide the target level of low-density lipoprotein cholesterol (LDL cholesterol). The solution to the problem lies in the plane of prescribing lipid-lowering drugs of a different mechanism of action, for example, inhibitors of the PCSK9 enzyme. To recommend the inclusion of such kind drugs in the program, it is necessary not only to have evidence of their life-saving effect, but also the economic feasibility of their use. Aim: to evaluate the economic efficacy of alirocumab (INN) including in the federal program for patients who have suffered an acute coronary event, are receiving statins and have an LDL CH level of 5.0 mmol/l and higher.Materials and methods. Modeling was applied in a target group of 3029 patients of working age who had undergone ACS during the previous 12 months with severe, including familial, HCH, with LDL cholesterol 5.0 mmol/l and higher, receiving statins taking into account previously determined outcomes when using alirocumab + statins for 5 years. Direct medical and non-medical costs, as well as indirect costs, are identified. The cost-effectiveness analysis was applied from the point of view of the effectiveness of treatment (effects on mortality, temporary disability, disability) and direct health care costs (additional drug provision and outpatient follow-up, specialized, including high-tech, medical care in a 24‑hour hospital). Two healthcare technologies were compared: statin therapy and use of alirocumab + statins. The calculations used according to domestic methods used the cost of medical treatment, temporary disability, hospitalizations, loss of GDP and other parameters.Results. Modeling has shown a decrease in mortality, morbidity and disability when using alirocumab in even the first year of use. The economic effect of alirocumab from a decrease in temporary disability in the 1st year is 304.5 mln rub., in the 2nd — 301.5 mln rub., in the 3rd — 321.1 mln rub., in the 4th — 333.1 mln rub. The estimated amount of prevented GDP losses from mortality in the target group for 4 years in the case of alirocumab use amounted to 1,260.2 mln rub. The annual amount of avoidable GDP losses from mortality in the target group in the case of alirocumab is 27–30 %. The annual average savings per patient in the case of alirocumab use are from 7 to 17 %. The greatest impact on reducing losses from disability and mortality of the target group is noted in the group of people aged 40–59 years. Only for this group, if alirocumab is used, it is possible to reduce losses from disability and mortality by 159.2 million rubles per year (83 % of the total economic effect). Starting from the 4th year of alirocumab use, it is possible to obtain a positive economic effect in terms of hospitalization costs.Conclusion. When alirocumab is included in the program of additional drug provision in cardiology, the share of costs for the purchase of alirocumab for the target group may be only 0.01 %. At the same time, the economic effect of inclusion in the first year alone will amount to at least 393.4 million rubles of budget funds. The total amount of avoidable losses due to the alirocumab usage may amount to 1,638 million rubles over 4 years.

Dollars and megabits: A comparative analysis of Telecom and Healthcare Connect Fund

Two federal programs in the United States subsidize internet access for rural healthcare providers, namely, Healthcare Connect Fund (HCF) and the Telecom Program. HCF uses a subsidy mechanism that strongly incentivizes healthcare providers to shop for faster or cheaper internet. Telecom does not incentivize shopping. Theoretically, this predicts that HCF must achieve faster or cheaper internet than Telecom. I empirically test this question and find that Telecom subsidy recipients pay 132-179% more than HCF subsidy recipients on similar internet plans. Evidence point to Telecom's poor incentive design as the root cause. Eliminating this price gap would save American taxpayers $143 million annually. The findings highlight the power of program design, showcase the unintended consequences of misaligned incentives, and encourage policymakers to thoroughly examine program features, the impact on consumer behavior, and the effect on competition and market outcomes.

Development of the Far Eastern Territories of Russia: from the Origins to Modern Realities

Relevance. In the conditions of the new world order, issues of state migration policy are of particular importance. The rapid development of the Far Eastern Federal District in the 21st century is determined by “absolute priority”. Therefore, the problems and prospects for technological and infrastructural development of the Far East require scientific understanding and social correction from all levels of state and municipal government. As prospects for minimizing the consequences of population outflow, a set of management measures is proposed, primarily at the federal level, which involves: providing a package of social preferences to all socio-demographic groups of residents of the Far Eastern Federal District; attracting human resources within the framework of the annually held competition “Leaders of Russia” and implementing in-depth scientific research on all socially significant projects. The purpose is to identify promising areas of managerial influence to minimize the outflow of population from the Far Eastern territories of modern Russia. Objectives: characterize the historical retrospective of the development of the Far Eastern territories; reveal cause-and-effect relationships, conditions and factors of population outflow; outline directions for minimizing negative migration consequences. Methodology. Research procedures are based on a synthesis of theoretical principles of the sociology of management and economics, using general scientific methods of comparison, analysis and synthesis. Results. A set of quantitative and qualitative sociological measurements was carried out, which made it possible to determine the "pain points" of migration policy in the Far East and the prospects for their resolution. Conclusions. Stratification differences between Russian regions in terms of basic socio-economic indicators require the federal level of government to take specific measures to minimize their consequences. Underfunding of technological and infrastructure projects in the Far Eastern territories leads to fragmentation of their implementation. Deep scientific expertise and public approval are necessary when developing federal and regional development programs for the Far Eastern territories.

Perspective: Promoting Healthy Aging through Nutrition: A Research Centers Collaborative Network Workshop Report

Within 20 y, the number of adults in the United States over the age of 65 y is expected to more than double and the number over age 85 y is expected to more than triple. The risk for most chronic diseases and disabilities increases with age, so this demographic shift carries significant implications for the individual, health care providers, and population health. Strategies that delay or prevent the onset of age-related diseases are becoming increasingly important. Although considerable progress has been made in understanding the contribution of nutrition to healthy aging, it has become increasingly apparent that much remains to be learned, especially because the aging process is highly variable. Most federal nutrition programs and nutrition research studies define all adults over age 65 y as “older” and do not account for physiological and metabolic changes that occur throughout older adulthood that influence nutritional needs. Moreover, the older adult population is becoming more racially and ethnically diverse, so cultural preferences and other social determinants of health need to be considered. The Research Centers Collaborative Network sponsored a 1.5-d multidisciplinary workshop that included sessions on dietary patterns in health and disease, timing and targeting interventions, and health disparities and the social context of diet and food choice. The agenda and presentations can be found at https://www.rccn-aging.org/nutrition-2023-rccn-workshop. Here we summarize the workshop’s themes and discussions and highlight research gaps that if filled will considerably advance our understanding of the role of nutrition in healthy aging.

“They Can Never Take it Away from You”

Abstract This article uses the contradictions and complicity of conclusions to think through the United States’ collective student loan burden while grounding this burden at its historical roots in the mid-twentieth century. In particular, it is concerned with the impasse surrounding the Biden administration's conclusion of the federal student loan payment pause and demands for full student loan debt cancellation. Reading with Lauren Berlant's Cruel Optimism, it suggests that this impasse entails a relation of optimistic cruelty: the active infliction of the affective and material conditions of capital as a means of leverage over oneself and others to maintain a status quo. Attendantly, this article draws attention to the centrality of liquidity/discipline to the conditions of indebtedness within financial capital, highlighting three foundational developments in the emergence of student loan debt: the creation of the Guaranteed Student Loan Program as the country's first universal program of student loans in 1965; the establishment of the Student Loan Marketing Association as a government-sponsored enterprise to provide private liquidity for the federal program in 1972; and the successful push to enact bankruptcy reforms to protect the viability of Sallie Mae from the early 1970s on. The establishment of liquidity/discipline at the industry's inception has allowed student loan indebtedness to flourish into the present and highlights the optimistic cruelty of concluding the federal payment pause to enforce a wholly insufficient status quo.

Do some prefer to pay? Identifying bias against free COVID-19 tests

ObjectivesIn the United States, a federal emergency program has made SARS-CoV-2 self-test kits available at no cost. It is unclear how widely free tests are preferred. We conducted a survey to estimate the proportion of respondents who do not prefer a free test. We hypothesized that free tests would not be preferred universally, and that a preference for paying would be more common among those with conservative politics than with liberal politics, regardless of income. DesignObservational study design. MethodsA national sample of US adults completed an online survey. To reduce potential enrollment bias, the survey’s focus was not specified beforehand. To prioritize a high-risk group, participation was limited to those who were unvaccinated or were incompletely vaccinated in the primary series against COVID-19. Participants reported their testing preferences and socio-demographic characteristics, including political affiliation. The main outcome assessed if a participant preferred to pay for a self-test or receive a free one (subsidized by the US government). ResultsAmong 1215 participants, (73%, n = 886) preferred free self-testing, while 27% (n = 329) preferred to pay for the same testing. After adjusting for income, the odds of preferring to pay for self-testing were 66% higher in “strong” Republicans compared to “strong” Democrats (odds ratio = 1.66, 95% confidence interval = 1.07–2.62). ConclusionsMore than a quarter of individuals preferred paying for these tests. This preference was more likely among those with right-wing politics. Policy implications are discussed, along with future research directions.

Robotization of processes in the field of agro-industrial complex on the example of disinfection of surfaces with infrared radiation

Russia today is committed to accelerated robotization and digitalization of the agricultural sector in the foreseeable future. A number of federal programs are being developed aimed at supporting agricultural production and the country's rural population. Currently, robotic disinfectors are appearing on the market for disinfecting premises for keeping farm animals and poultry, which destroy various types of pathogenic microorganisms and bacteria. Shown is a general view of a robotic cart for disinfecting surfaces with infrared radiation, which is in-tended for treating surfaces for various purposes - surfaces in premises for keeping animals (poultry), grain and vegetable storage facilities, greenhouses, etc. Keywords: ROBOTIZATION, DISINFECTION, INFRARED RADIATION, HEATING, SURFACE, PROGRAM CONTROL, LIVESTOCK BUILDINGS, AGRO-INDUSTRIAL COMPLEX, PATHOGENS, INFECTIONS

UNDERSTANDING GOVERNMENT AGRARIAN PROGRAMS AND SMALLHOLDER PERSPECTIVES ON FOREST COVER DYNAMICS IN MEXICO’S MESOAMERICAN BIOLOGICAL CORRIDOR*

ABSTRACT Agrarian programs implemented since the 1990s in Mexico (for example, PROCAMPO, a cash transfer program to increase production) often promote agricultural intensification, permanent land use, and regulations for shifting agriculture, making broad claims that these practices improved livelihoods and supported forest conservation. Meanwhile, smallholders in Mexico’s Mesoamerican Biological Corridor interpreted and implemented federal program goals based on their own experiences of how local land use supports sustainable production and forest maintenance. This paper examines if one community’s understanding of land use, forest cover dynamics aligns with that of Mexico’s recent federal agroforestry program, Sembrando Vida (“sowing life”). Using in-depth discourse analysis of agrarian program documents and smallholder interviews, we highlight a misalignment between federal agricultural programs and smallholder perspectives over land use and forest cover dynamics. Implications include increased forest fragmentation and loss of access to regions of traditional land use, suggesting a need for meaningful and inclusive smallholder engagement throughout agrarian program development.

Impacts of the Relocation Program on Native American Migration and Fertility

This paper estimates the migratory and fertility effects of the federal Relocation Program, which attempted to move Native American individuals to urban areas under the promises of financial assistance and job training. I find the Relocation Program increased the Native American population in the target cities by more than 100,000 people. I also find that second- and third-generation Native American women living in cities have a 50 percent lower fertility rate than those living in areas with historically large Native American populations. These findings indicate that this program meaningfully shifted the spatial distribution of the Native American population.

An evaluation of the federal Transition Incentives Program on land access for next-generation farmers

Next-generation farmers face immense challenges in securing land. In recent years, some state- and federal-level land access policy incentives (LAPIs) have been implemented to address these chal­lenges. In this paper, we assess the Transition Incentives Program (TIP), an initiative of the U.S. Department of Agriculture’s Conservation Reserve Program that is funded by Congressional farm bills. TIP offers landowners two years of financial incen­tives for leasing or selling to a beginning or socially disadvantaged farmer or rancher (categories of farmers defined by the U.S. Department of Agri­culture). In our study, we characterize TIP partici­pants to understand where and how TIP assists beginning and socially disadvantaged farmers and ranchers. Our findings demonstrate that TIP serves some landowners and next-generation farmers, primarily in the Midwest and Mountain West. We demonstrate a spatial mismatch between where next-generation farmers live and high rates of TIP participation. Variable participation may be due to inconsistent outreach and limits to the program design. We identify key barriers and provide insights to improve TIP and other land access programs for next-generation farmers.