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The Tuberculosis Behavioral and Social Science Research Forum
Proceedings
Appendix C: TB Behavioral and Social Science Research
Gaps and Needs: Major Research Topics, Subtopics, and Research Questions
Major Research Topics, Subtopics, and Research
Questions
VI. Public Policy
Public policy influences focus on the implications that public
policies have on the behaviors of individuals, groups, communities,
and organizations, with special emphasis on issues relating to government
commitment, funding, health insurance, and immigration policies.
A. Government commitment and funding
Governmental entities, from federal to local, play a critical role
in TB-related services. From federal-level research funding to service
delivery at local health departments, TB control is affected greatly
by policy decisions. Given these arrangements, the development of
a better understanding of the policy process and greater engagement
of decision-makers by those working in TB control may lead to improvement
in TB services.
Forum participants identified as important the need to focus
on identifying appropriate decision makers, potential advocates,
and strategies to influence TB-related policies. They also specifically
addressed funding issues such as the identification of effective
ways to advocate for TB funding as well as possible models for allocation
of funds within the TB framework.
- Who are the TB local, state, and national policy-makers? What
are their interests? How can TB be made a policy agenda item?
- How can state programs be influenced to advocate for TB? Where
are the decisions being made?
- Who are the best advocates for TB control? (i.e., What is the
role of state programs in advocacy?)
- What are the best ways to advocate for TB funding?
- What are some ways to conduct a demonstration in which TB funding
is allocated similarly to Ryan White Care Act dollars? What are
some ways to test an HIV model (e.g., Ryan White Care Act) within
the TB framework?
- Which cultural interventions can be practically integrated
into TB programs with limited resources?
B. Health insurance
As of 2002, data from the U.S. Census Bureau indicated that 43.6
million people were uninsured in the United States.3
The lack of health insurance among people in the U.S. creates a
serious impediment for those who seek or wish to seek health care
for LTBI or TB disease, especially as it relates to TB testing and
treatment. It is unknown to what extent a lack of appropriate insurance
coverage or fear of treatment costs hinder care-seeking, but it
is suspected that this economic deterrent has clear negative implications.
Forum participants identified the need to determine the effect
of health insurance or lack of appropriate coverage for TB services
on health behaviors and health outcomes, including access to TB
diagnosis and treatment. Further research is needed to determine
the impact this has on TB patients and their families, in addition
to finding alternative funding solutions to increasing health care
costs and expenses.
- What is the effect of health insurance (or lack thereof) in
regards to early interventions for the treatment of TB?
- How can the poor get health access (e.g., insurance)?
C. Immigration policies
With over half of TB cases in the United States occurring among
individuals born outside of the country, the link between immigration
and TB services has become increasingly important in recent years.
Efforts to coordinate public health efforts with immigration activities
pose an evolving challenge as changes occur to immigration policy
and enforcement agencies. Understanding the impact of these specific
changes as well as developing a broader body of knowledge of immigrant
issues in general, will likely lead to improved TB services and
better health outcomes.
Forum participants identified as important the need to focus
on the effect of immigration policies, specifically regarding recent
changes to policies, on TB services. Additional discussion focused
on the need to develop strategies for collaboration with immigration
authorities to increase access to immigrant communities.
- What is the effect of new immigration policies on TB case identification,
follow-up, treatment, and adherence? What about their effect on
TB control among Latino immigrants?
- What types of research are needed to maximize the screening
of new and recent arrivals? Issues to address include access to
the population and collaboration with Immigration and Customs
Enforcement.
- How can undocumented persons be helped to overcome their fear
of government agencies and institutions?
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Released October 2008
Centers for Disease Control and Prevention
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