Joyce Essien - Academia.edu (original) (raw)

Papers by Joyce Essien

Research paper thumbnail of OPPORTUNITIES AND DEMANDS IN PUBLIC HEALTH SYSTEMS Understanding Diabetes Population Dynamics Through Simulation Modeling and Experimentation

Health planners in the Di-vision of Diabetes Translation and others from the National Center for ... more Health planners in the Di-vision of Diabetes Translation and others from the National Center for Chronic Disease Prevention and Health Pro-motion of the Centers for Dis-

Research paper thumbnail of Acknowledgments The COMPASS initiative utilizes the National Association of County and City Health Officials’

(NACCHO) Mobilizing for Action through Planning and Partnerships (MAPP) planning model as the fra... more (NACCHO) Mobilizing for Action through Planning and Partnerships (MAPP) planning model as the framework for the development of tools and processes. Through the COMPASS initiative, county health departments and the communities they serve will have access to data via the Community Health Assessment Resource Tool Set (CHARTS), web-based training for skills enhancement, reference materials for community health assessment including field guides and web-based templates and tools, marketing and public information materials for raising awareness of the benefits and impact of assessment, performance benchmarks and quality improvement standards for county health departments, and quantitative and qualitative evaluation reports on processes and outcomes. The MAPP project was developed through a cooperative agreement between NACCHO and the Centers for Disease Control and Prevention (CDC). Additional support was provided by the Health Resources and Services Administration (HRSA). The development of MAPP would not have been possible without the time and commitment of the APEX PH Work Group, which included local health officials, community representatives, academicians, and federal

Research paper thumbnail of Panel discussion

Tobacco Control, 1995

We are not stuck, but certainly we are not, as Dr Orleans said, proceeding at a fast enough pace ... more We are not stuck, but certainly we are not, as Dr Orleans said, proceeding at a fast enough pace to meet the Healthy People 2000 ob jectives. National prevalence is now 25 %-27.7% among males and 22.5% among females. There are several groups that still have a very high prevalence. Education is the major correlate with smoking: people with 16+ years of education have a prevalence rate of 14 %; for high school graduates, it is 29 %; for persons with nine to 11 years of education, it is 37 %. That is a very high risk group. We also have high risk groups on racial and ethnic lines; American Indians and Alaskan natives especially have very high smoking rates. Highest risk groups for men are primarily those with low education, American Indians and Alaskan natives, and African Americans; and for women, American Indians and the Alaskan natives. So we certainly have popula tions that have a very high prevalence, and overall it does not look like we are going to meet the Healthy People 2000 goals.

Research paper thumbnail of CDC's Model Performance Evaluation Program: assessment of the quality of laboratory performance for HIV-1 antibody testing

Public health reports (Washington, D.C. : 1974)

In 1986, the Centers for Disease Control (CDC) implemented the Model Performance Evaluation Progr... more In 1986, the Centers for Disease Control (CDC) implemented the Model Performance Evaluation Program (MPEP) to evaluate the performance of laboratories that test for antibody directed against human immunodeficiency virus type 1 (HIV-1). The impetus for developing this program came from the recognition of a need to assess the quality of existing and changing laboratory technology and to ensure that the quality of testing was sufficient to meet medical and public health needs. To develop the program, CDC chose HIV-1 antibody testing as the first specific application for assessing the quality of laboratory performance because (a) of the importance of accurate and reproducible test results for acquired immunodeficiency syndrome (AIDS) surveillance, prevention, and treatment programs; (b) HIV-1 testing technology is new to many laboratories; and (c) HIV-1 testing practices and applications continue to evolve. Unlike proficiency testing programs, the MPEP is not limited to assessing qualit...

Research paper thumbnail of Using the essential public health services as strategic leverage to strengthen the public health response to diabetes

Public Health Reports, 2004

If current trends continue, health systems will soon be overwhelmed by type 2 diabetes mellitus. ... more If current trends continue, health systems will soon be overwhelmed by type 2 diabetes mellitus. Successful population-based diabetes prevention and control efforts require a sound and continually improving infrastructure. In states and U.S. territories, the Diabetes Prevention and Control Programs supported by the U.S. Centers for Disease Control and Prevention's Division of Diabetes Translation serve as a fulcrum for building and refining the infrastructure that links diverse and dynamic partners dedicated to increasing the years and quality of life and achieving health equity among people with and at risk for diabetes. The National Public Health Performance Standards offer a conceptual framework that articulates the requisite infrastructure and services provided by an interconnected network of intersectoral partners to strengthen the public health response to diabetes. These standards associated with the Essential Public Health Services are valuable tools to assess the status...

Research paper thumbnail of Peer Reviewed: Charting Plausible Futures for Diabetes Prevalence in the United States: A Role for System Dynamics Simulation Modeling

Preventing Chronic …, 2007

Healthy People 2010 (HP 2010) objectives call for a 38% reduction in the prevalence of diagnosed ... more Healthy People 2010 (HP 2010) objectives call for a 38% reduction in the prevalence of diagnosed diabetes mellitus, type 1 and type 2, by the year 2010. The process for setting this objective, however, did not focus on the achievability or the compatibility of this objective with other ...

Research paper thumbnail of Positioning for partnerships

Research paper thumbnail of Principles for Forging a National Health Plan

Journal of Health Care for the Poor and Underserved, 1993

One point which has emerged with a resounding voice during this conference is the need to clearly... more One point which has emerged with a resounding voice during this conference is the need to clearly assemble and carefully communicate data and information as a means of empowerment. We hope that the recommendations from this conference will contribute to this end. We urge all to become actively involved in seeking change, and ensuring that the future health of Americans and of our nation will not reflect our inequitable, costly present.

Research paper thumbnail of Book and Media Review: Foundations for Community Health Workers

Health Promotion Practice, 2010

Page 1. Book and Media Review Foundations for Community Health Workers Joyce DK Essien, MD, MBA G... more Page 1. Book and Media Review Foundations for Community Health Workers Joyce DK Essien, MD, MBA Gail G. McCray, MA, CHES 609 Health Promotion Practice September 2010 Vol. 11, No. 5, 609-611 DOI: 10.1177/1524839910375611 ...

Research paper thumbnail of Understanding Diabetes Population Dynamics Through Simulation Modeling and Experimentation

American Journal of Public Health, Oct 10, 2011

Research paper thumbnail of Public/private partners

American Journal of Preventive Medicine, 1999

Background: The rapidly evolving American health system creates economic and societal incentives ... more Background: The rapidly evolving American health system creates economic and societal incentives for public and private health organizations to collaborate. Despite the apparent benefits of collaboration, there is a paucity of information available to help local agencies develop partnerships. This study, itself a collaboration between a school of public health (SPH) and a Georgia health district, was undertaken to identify

Research paper thumbnail of Proactive Organizational Change: Assessing Critical Success Factors Questionnaire

Research paper thumbnail of Positioning for partnerships

Background: Public health organizations are redefining their roles and aligning their structures ... more Background: Public health organizations are redefining their roles and aligning their structures with other components of the evolving American health system. Health departments must proactively and strategically plan how to position themselves for the coming years. Prior to implementing changes in functioning, structure, and/or future strategies, an organization should assess its internal readiness to commit to creating these substantial alterations.Methods: Using a diagnostic tool developed by study investigators, employees of the Cobb and Douglas Counties Boards of Health were surveyed in order to assess their organizational readiness to enter into a strategic partnership with Promina Northwest, a not-for-profit hospital network in the Atlanta, Georgia area. Frequency distributions were conducted for each categorical variable and data were analyzed in aggregate and by job category.Results: The 122 analyzed questionnaires revealed some significant trends. Respondents ranked the si...

Research paper thumbnail of Future directions for research in laboratory medicine: the findings of a Delphi survey of stakeholders

Clinical laboratory management review : official publication of the Clinical Laboratory Management Association / CLMA

In July 1995, we asked 101 experts to anticipate future areas for research in clinical laboratory... more In July 1995, we asked 101 experts to anticipate future areas for research in clinical laboratory medicine using a modified Delphi survey approach. The panel included academicians, clinical laboratory professionals, laboratory managers, practicing physicians public health officials, hospital administrators, and representatives of manufacturing industries, managed care organizations, commercial laboratories, and government health agencies. The participants predicted fewer laboratories, more automation, and fewer skilled staff needed in the future. The consensus was that laboratory quality assurance will focus on patient outcomes and be benchmarked against peer groups. They agreed that quality assurance routinely will be integrated into testing kits. Measures derived from medical informatics, such as outcomes analysis and utilization statistics, will become a standard feature of health care. A major area of concern was the effect that reorganizing health care and striving for cost con...

Research paper thumbnail of The USA Centers for Disease Control: current priorities

Microbiological sciences, 1985

Since it was first established (during World War II) the US Centers for Disease Control (CDC) has... more Since it was first established (during World War II) the US Centers for Disease Control (CDC) has modified and extended its responsibilities as a major public health agency. Its current activities include the provision of professional training/development and the provision of epidemiologic aid and consultation. AIDS, Legionnaires' disease and toxic-shock syndrome are a few examples of the challenges faced by today's CDC.

Research paper thumbnail of Charting plausible futures for diabetes prevalence in the United States: a role for system dynamics simulation modeling

Preventing chronic disease, 2007

Healthy People 2010 (HP 2010) objectives call for a 38% reduction in the prevalence of diagnosed ... more Healthy People 2010 (HP 2010) objectives call for a 38% reduction in the prevalence of diagnosed diabetes mellitus, type 1 and type 2, by the year 2010. The process for setting this objective, however, did not focus on the achievability or the compatibility of this objective with other national public health objectives. We used a dynamic simulation model to explore plausible trajectories for diabetes prevalence in the wake of rising levels of obesity in the U.S. population. The model helps to interpret historic trends in diabetes prevalence in the United States and to anticipate plausible future trends through 2010. We conducted simulation experiments using a computer model of diabetes population dynamics to 1) track the rates at which people develop diabetes, are diagnosed with the disease, and die, and 2) assess the effects of various preventive-care interventions. System dynamics modeling methodology based on data from multiple sources guided the analyses. With the number of new ...

Research paper thumbnail of Erratum to: Save 100 Babies©: Engaging Communities for Just and Equitable Birth Outcomes Through Photovoice and Appreciative Inquiry

Maternal and Child Health Journal, 2014

Research paper thumbnail of Save 100 Babies©: Engaging Communities for Just and Equitable Birth Outcomes Through Photovoice and Appreciative Inquiry

Maternal and Child Health Journal, 2014

This paper presents a community engagement model designed to advance social justice and equity fo... more This paper presents a community engagement model designed to advance social justice and equity for African American birth outcomes through the combined techniques of Photovoice and Appreciative Inquiry. In response to the persistent racial disparities in birth outcomes, Save 100 BabiesÓ was constructed as a 2-day summit where the emphasis was placed on individual and community assets rather than deficits. The engagement was designed to create a level of readiness among individuals working within and outside the field of Maternal and Child Health to envision strategies to attain equitable birth outcomes. The goal of the conference was to facilitate higher level consciousness by guiding the participants though a process aimed at articulating assets, possibilities and the potential for co-creating the desired future where racial disparities in birth outcome are eliminated. As the result of the guided discourse that began with photographs of the lives of African American women, participants articulated the strengths they detected from the pictures, their recommendations for multifaceted changes in policies and practices, and their individual and organizational commitments for a changed future. Since the summit, participants have indicated ways they have fulfilled their vows that include informing families and communities about pregnancy risks, working with youth programs, supporting fatherhood involvement in pregnancy and birth, and advancing case management that is more attuned to women's strengths. Save 100 BabiesÓ is evolving into a network and clearinghouse for sharing and disseminating information and resources for collaboration.

Research paper thumbnail of Systems Thinking: A Practical Application Participant Exercises

Research paper thumbnail of The CDC's diabetes systems modeling project: developing a new tool for chronic disease prevention and control

… Conference of the …

The analytic tools presently used for planning and evaluating health policy are not well suited t... more The analytic tools presently used for planning and evaluating health policy are not well suited to capture the dynamic complexity of chronic diseases, which involve long delays between causes and health consequences. To explore the potential of system dynamics for addressing chronic disease policy, the U.S. Centers for Disease Control and Prevention (CDC) commissioned a dynamic model of diabetes prevalence and complications that can be used for designing and evaluating intervention strategies. The rapid growth in diabetes in the U.S. and elsewhere has been driven by a similarly rapid growth in obesity, which is a leading risk factor. The model was developed through a series of meetings over several months with participants from the CDC Division of Diabetes Translation and other Divisions with relevant expertise. The CDC and other public health stakeholders may use the model for policy analysis at the national, state, and local levels.

Research paper thumbnail of OPPORTUNITIES AND DEMANDS IN PUBLIC HEALTH SYSTEMS Understanding Diabetes Population Dynamics Through Simulation Modeling and Experimentation

Health planners in the Di-vision of Diabetes Translation and others from the National Center for ... more Health planners in the Di-vision of Diabetes Translation and others from the National Center for Chronic Disease Prevention and Health Pro-motion of the Centers for Dis-

Research paper thumbnail of Acknowledgments The COMPASS initiative utilizes the National Association of County and City Health Officials’

(NACCHO) Mobilizing for Action through Planning and Partnerships (MAPP) planning model as the fra... more (NACCHO) Mobilizing for Action through Planning and Partnerships (MAPP) planning model as the framework for the development of tools and processes. Through the COMPASS initiative, county health departments and the communities they serve will have access to data via the Community Health Assessment Resource Tool Set (CHARTS), web-based training for skills enhancement, reference materials for community health assessment including field guides and web-based templates and tools, marketing and public information materials for raising awareness of the benefits and impact of assessment, performance benchmarks and quality improvement standards for county health departments, and quantitative and qualitative evaluation reports on processes and outcomes. The MAPP project was developed through a cooperative agreement between NACCHO and the Centers for Disease Control and Prevention (CDC). Additional support was provided by the Health Resources and Services Administration (HRSA). The development of MAPP would not have been possible without the time and commitment of the APEX PH Work Group, which included local health officials, community representatives, academicians, and federal

Research paper thumbnail of Panel discussion

Tobacco Control, 1995

We are not stuck, but certainly we are not, as Dr Orleans said, proceeding at a fast enough pace ... more We are not stuck, but certainly we are not, as Dr Orleans said, proceeding at a fast enough pace to meet the Healthy People 2000 ob jectives. National prevalence is now 25 %-27.7% among males and 22.5% among females. There are several groups that still have a very high prevalence. Education is the major correlate with smoking: people with 16+ years of education have a prevalence rate of 14 %; for high school graduates, it is 29 %; for persons with nine to 11 years of education, it is 37 %. That is a very high risk group. We also have high risk groups on racial and ethnic lines; American Indians and Alaskan natives especially have very high smoking rates. Highest risk groups for men are primarily those with low education, American Indians and Alaskan natives, and African Americans; and for women, American Indians and the Alaskan natives. So we certainly have popula tions that have a very high prevalence, and overall it does not look like we are going to meet the Healthy People 2000 goals.

Research paper thumbnail of CDC's Model Performance Evaluation Program: assessment of the quality of laboratory performance for HIV-1 antibody testing

Public health reports (Washington, D.C. : 1974)

In 1986, the Centers for Disease Control (CDC) implemented the Model Performance Evaluation Progr... more In 1986, the Centers for Disease Control (CDC) implemented the Model Performance Evaluation Program (MPEP) to evaluate the performance of laboratories that test for antibody directed against human immunodeficiency virus type 1 (HIV-1). The impetus for developing this program came from the recognition of a need to assess the quality of existing and changing laboratory technology and to ensure that the quality of testing was sufficient to meet medical and public health needs. To develop the program, CDC chose HIV-1 antibody testing as the first specific application for assessing the quality of laboratory performance because (a) of the importance of accurate and reproducible test results for acquired immunodeficiency syndrome (AIDS) surveillance, prevention, and treatment programs; (b) HIV-1 testing technology is new to many laboratories; and (c) HIV-1 testing practices and applications continue to evolve. Unlike proficiency testing programs, the MPEP is not limited to assessing qualit...

Research paper thumbnail of Using the essential public health services as strategic leverage to strengthen the public health response to diabetes

Public Health Reports, 2004

If current trends continue, health systems will soon be overwhelmed by type 2 diabetes mellitus. ... more If current trends continue, health systems will soon be overwhelmed by type 2 diabetes mellitus. Successful population-based diabetes prevention and control efforts require a sound and continually improving infrastructure. In states and U.S. territories, the Diabetes Prevention and Control Programs supported by the U.S. Centers for Disease Control and Prevention's Division of Diabetes Translation serve as a fulcrum for building and refining the infrastructure that links diverse and dynamic partners dedicated to increasing the years and quality of life and achieving health equity among people with and at risk for diabetes. The National Public Health Performance Standards offer a conceptual framework that articulates the requisite infrastructure and services provided by an interconnected network of intersectoral partners to strengthen the public health response to diabetes. These standards associated with the Essential Public Health Services are valuable tools to assess the status...

Research paper thumbnail of Peer Reviewed: Charting Plausible Futures for Diabetes Prevalence in the United States: A Role for System Dynamics Simulation Modeling

Preventing Chronic …, 2007

Healthy People 2010 (HP 2010) objectives call for a 38% reduction in the prevalence of diagnosed ... more Healthy People 2010 (HP 2010) objectives call for a 38% reduction in the prevalence of diagnosed diabetes mellitus, type 1 and type 2, by the year 2010. The process for setting this objective, however, did not focus on the achievability or the compatibility of this objective with other ...

Research paper thumbnail of Positioning for partnerships

Research paper thumbnail of Principles for Forging a National Health Plan

Journal of Health Care for the Poor and Underserved, 1993

One point which has emerged with a resounding voice during this conference is the need to clearly... more One point which has emerged with a resounding voice during this conference is the need to clearly assemble and carefully communicate data and information as a means of empowerment. We hope that the recommendations from this conference will contribute to this end. We urge all to become actively involved in seeking change, and ensuring that the future health of Americans and of our nation will not reflect our inequitable, costly present.

Research paper thumbnail of Book and Media Review: Foundations for Community Health Workers

Health Promotion Practice, 2010

Page 1. Book and Media Review Foundations for Community Health Workers Joyce DK Essien, MD, MBA G... more Page 1. Book and Media Review Foundations for Community Health Workers Joyce DK Essien, MD, MBA Gail G. McCray, MA, CHES 609 Health Promotion Practice September 2010 Vol. 11, No. 5, 609-611 DOI: 10.1177/1524839910375611 ...

Research paper thumbnail of Understanding Diabetes Population Dynamics Through Simulation Modeling and Experimentation

American Journal of Public Health, Oct 10, 2011

Research paper thumbnail of Public/private partners

American Journal of Preventive Medicine, 1999

Background: The rapidly evolving American health system creates economic and societal incentives ... more Background: The rapidly evolving American health system creates economic and societal incentives for public and private health organizations to collaborate. Despite the apparent benefits of collaboration, there is a paucity of information available to help local agencies develop partnerships. This study, itself a collaboration between a school of public health (SPH) and a Georgia health district, was undertaken to identify

Research paper thumbnail of Proactive Organizational Change: Assessing Critical Success Factors Questionnaire

Research paper thumbnail of Positioning for partnerships

Background: Public health organizations are redefining their roles and aligning their structures ... more Background: Public health organizations are redefining their roles and aligning their structures with other components of the evolving American health system. Health departments must proactively and strategically plan how to position themselves for the coming years. Prior to implementing changes in functioning, structure, and/or future strategies, an organization should assess its internal readiness to commit to creating these substantial alterations.Methods: Using a diagnostic tool developed by study investigators, employees of the Cobb and Douglas Counties Boards of Health were surveyed in order to assess their organizational readiness to enter into a strategic partnership with Promina Northwest, a not-for-profit hospital network in the Atlanta, Georgia area. Frequency distributions were conducted for each categorical variable and data were analyzed in aggregate and by job category.Results: The 122 analyzed questionnaires revealed some significant trends. Respondents ranked the si...

Research paper thumbnail of Future directions for research in laboratory medicine: the findings of a Delphi survey of stakeholders

Clinical laboratory management review : official publication of the Clinical Laboratory Management Association / CLMA

In July 1995, we asked 101 experts to anticipate future areas for research in clinical laboratory... more In July 1995, we asked 101 experts to anticipate future areas for research in clinical laboratory medicine using a modified Delphi survey approach. The panel included academicians, clinical laboratory professionals, laboratory managers, practicing physicians public health officials, hospital administrators, and representatives of manufacturing industries, managed care organizations, commercial laboratories, and government health agencies. The participants predicted fewer laboratories, more automation, and fewer skilled staff needed in the future. The consensus was that laboratory quality assurance will focus on patient outcomes and be benchmarked against peer groups. They agreed that quality assurance routinely will be integrated into testing kits. Measures derived from medical informatics, such as outcomes analysis and utilization statistics, will become a standard feature of health care. A major area of concern was the effect that reorganizing health care and striving for cost con...

Research paper thumbnail of The USA Centers for Disease Control: current priorities

Microbiological sciences, 1985

Since it was first established (during World War II) the US Centers for Disease Control (CDC) has... more Since it was first established (during World War II) the US Centers for Disease Control (CDC) has modified and extended its responsibilities as a major public health agency. Its current activities include the provision of professional training/development and the provision of epidemiologic aid and consultation. AIDS, Legionnaires' disease and toxic-shock syndrome are a few examples of the challenges faced by today's CDC.

Research paper thumbnail of Charting plausible futures for diabetes prevalence in the United States: a role for system dynamics simulation modeling

Preventing chronic disease, 2007

Healthy People 2010 (HP 2010) objectives call for a 38% reduction in the prevalence of diagnosed ... more Healthy People 2010 (HP 2010) objectives call for a 38% reduction in the prevalence of diagnosed diabetes mellitus, type 1 and type 2, by the year 2010. The process for setting this objective, however, did not focus on the achievability or the compatibility of this objective with other national public health objectives. We used a dynamic simulation model to explore plausible trajectories for diabetes prevalence in the wake of rising levels of obesity in the U.S. population. The model helps to interpret historic trends in diabetes prevalence in the United States and to anticipate plausible future trends through 2010. We conducted simulation experiments using a computer model of diabetes population dynamics to 1) track the rates at which people develop diabetes, are diagnosed with the disease, and die, and 2) assess the effects of various preventive-care interventions. System dynamics modeling methodology based on data from multiple sources guided the analyses. With the number of new ...

Research paper thumbnail of Erratum to: Save 100 Babies©: Engaging Communities for Just and Equitable Birth Outcomes Through Photovoice and Appreciative Inquiry

Maternal and Child Health Journal, 2014

Research paper thumbnail of Save 100 Babies©: Engaging Communities for Just and Equitable Birth Outcomes Through Photovoice and Appreciative Inquiry

Maternal and Child Health Journal, 2014

This paper presents a community engagement model designed to advance social justice and equity fo... more This paper presents a community engagement model designed to advance social justice and equity for African American birth outcomes through the combined techniques of Photovoice and Appreciative Inquiry. In response to the persistent racial disparities in birth outcomes, Save 100 BabiesÓ was constructed as a 2-day summit where the emphasis was placed on individual and community assets rather than deficits. The engagement was designed to create a level of readiness among individuals working within and outside the field of Maternal and Child Health to envision strategies to attain equitable birth outcomes. The goal of the conference was to facilitate higher level consciousness by guiding the participants though a process aimed at articulating assets, possibilities and the potential for co-creating the desired future where racial disparities in birth outcome are eliminated. As the result of the guided discourse that began with photographs of the lives of African American women, participants articulated the strengths they detected from the pictures, their recommendations for multifaceted changes in policies and practices, and their individual and organizational commitments for a changed future. Since the summit, participants have indicated ways they have fulfilled their vows that include informing families and communities about pregnancy risks, working with youth programs, supporting fatherhood involvement in pregnancy and birth, and advancing case management that is more attuned to women's strengths. Save 100 BabiesÓ is evolving into a network and clearinghouse for sharing and disseminating information and resources for collaboration.

Research paper thumbnail of Systems Thinking: A Practical Application Participant Exercises

Research paper thumbnail of The CDC's diabetes systems modeling project: developing a new tool for chronic disease prevention and control

… Conference of the …

The analytic tools presently used for planning and evaluating health policy are not well suited t... more The analytic tools presently used for planning and evaluating health policy are not well suited to capture the dynamic complexity of chronic diseases, which involve long delays between causes and health consequences. To explore the potential of system dynamics for addressing chronic disease policy, the U.S. Centers for Disease Control and Prevention (CDC) commissioned a dynamic model of diabetes prevalence and complications that can be used for designing and evaluating intervention strategies. The rapid growth in diabetes in the U.S. and elsewhere has been driven by a similarly rapid growth in obesity, which is a leading risk factor. The model was developed through a series of meetings over several months with participants from the CDC Division of Diabetes Translation and other Divisions with relevant expertise. The CDC and other public health stakeholders may use the model for policy analysis at the national, state, and local levels.