The Healthy Schools-Healthy Students program works with school districts to encourage students to eat more nutritious lunches more often. The program in Iowa is administered by the Iowa Department of Education and evaluated by the University of Iowa College of Public Health. Its goal is to use strategies proven by research to reduce childhood obesity, provide fresh fruits and vegetables to students who may not have regular access to them, and establish good eating habits for life.
“Research has shown that if you get kids eating spinach and broccoli and other nutritious foods when they’re young, they’re more likely to eat them for life,” says Natoshia Askelson, assistant professor of community and behavioral health in the College of Public Health who oversees the program at UI. She and a group of UI students have been working with 10 high schools, 10 middle schools, and 10 elementary schools in two-year cycles since 2013 to implement strategies and measure results. The program wraps up in May 2019.
The Cancer Prevention and Control Research Network (CPCRN) recently issued a report based on a survey that was conducted to assess which evidence-based colorectal cancer screening interventions are currently being utilized in Federally Qualified Health Centers (FQHCs) and which implementation strategies are being employed to ensure that the interventions are executed as intended.
The University of Iowa was one of eight FQHCs that participated in the survey which was coordinated onsite by the Prevention Research Center at the UI College of Public Health. The UI team was also a part of the CPCRN workgroup that published the brief and included Edith Parker, Natoshia Askelson, and Laura Seegmiller.
The survey found that while colorectal cancer screening rates have been increasing, there is still work to be done in order to reach the national goal of 80% by 2018.
According to a report
The majority (77%) of surveyed FQHCs were either fully or partially implementing evidence-based interventions (EBIs) to improve colorectal cancer (CRC) screening.
Health centers were actively using a range of implementation strategies to incorporate EBIs into practice.
EBIs that were underutilized include: patient reminders, patient navigation, small media, and group education.
Implementation strategies that were underutilized include: community assessments, formation of implementation teams, formal commitments to recommend CRC screening, and incentive or penalty systems for providers and organizations.
University of Iowa investigators are beginning a yearlong study to better understand why HPV (human papillomavirus) vaccine coverage in rural areas of the state lags behind other adolescent immunizations.
The study, funded by the National Cancer Institute through the Holden Comprehensive Cancer Center, will be led by a team from Holden. Natoshia Askelson, assistant professor of community and behavioral health in the UI College of Public Health, is the project director. Other partners include the Iowa Primary Care Association, Iowa Department of Public Health, American Cancer Society, Iowa Cancer Consortium, and local public health agencies.
The HPV vaccine protects against a number of diseases and HPV-related cancers such as cervical cancer and oral cancer, but vaccination rates across Iowa are below the national average. According to the most recent data available, only 21 percent of 13- to 15-year-olds in Iowa had completed the HPV vaccination series in 2015. Federal health officials have a goal of 80 percent vaccination completion for adolescents by 2020.
The UI researchers will look at rural counties to explore the various factors that may influence uptake of the HPV vaccine in rural areas.
“This vaccine is nearly 100 percent effective at preventing cancer, so we want to make sure that all adolescents in Iowa have the opportunity to benefit from this vaccine when they are getting their other adolescent vaccines,” says Askelson. “Our work will identify how we can better support rural communities and clinics so that all children will have access to this vaccine.”
A study by University of Iowa researchers found that only a small number of Iowa Medicaid beneficiaries knew about and took part in a new incentive program designed to waive health insurance premiums for enrollees who complete certain healthy activities.
As part of Iowa’s Medicaid expansion efforts, the state created the Healthy Behaviors Program, an optional service designed to waive monthly premiums for Medicaid beneficiaries who get an annual physical and complete a health risk assessment. Launched in 2014, the program was designed to reduce the state’s Medicaid costs by encouraging preventive health practices among beneficiaries.
But Natoshia Askelson, assistant professor of community and behavioral health, and Brad Wright, assistant professor of health management and policy, along with coauthors from the University of Iowa Public Policy Center, found that no more than 17 percent of those enrolled in the Healthy Behaviors Program had a physical examination and a health risk assessment in the program’s first year. The research findings, based on examinations of claims data and interviews with clinic managers and Medicaid expansion enrollees, were published in the journal Health Affairs.
Certain populations, including younger members, men, non-whites, members with fewer interactions with the health care system, and those who have been enrolled in the program for fewer months, were found to be less likely to complete the healthy activities.
“Given that failure to complete these activities is likely to result in members being charged premiums, and non-payment of premiums can result in disenrollment from the program, these findings raise concerns about the possibility of exacerbating disparities in insurance coverage and, ultimately, health outcomes,” says Wright.
When researchers interviewed Medicaid members and clinic managers, they found few people were even aware of the program. The UI research raises questions about whether the incentive program can succeed without expanded communication and promotional efforts.
“If you’re going to do some kind of incentive program, you really need to work hard at developing awareness,” says Askelson.
In addition, the researchers say the findings raise questions about whether a program promoting personal responsibility can be viable in the face of the significant challenges facing many beneficiaries covered under Medicaid expansion.
Researchers discovered that some members couldn’t find an available appointment or a provider to accept their health plan. Others had trouble finding the time or transportation to attend an appointment. This population also tends to be more transient and have lower levels of literacy, says Askelson.