Digital Commons Network^™

Determinants Of An Individual's Suicide Intention In South Korea, Nam Keun Choi

MPA/MPP/MPFM Capstone Projects

This study has examined a variety of variables that influence an individual’ s suicide intention, and analyzed the impact of these variables. The data are from the 2014 wave of the Korea Welfare Panel Survey (KoWePS). I analyze data on 13,687 out of 17,134 survey participants.

The dependent variable of my study is suicide intention such as suicidal thoughts and behaviors. The independent variables are classified into three categories: socio-demographic, psychological and mental health. Socio-demographic variables are gender, age, education, marital status, and income. Psychological variables are self-esteem, satisfaction with life, and religion. Mental health variables are depression, alcohol use, …

Promoting Healthy Eating And Physical Activity: A Qualitative Examination Of Community-Based Obesity Interventions In Rural Kentucky, Brooke F. Butterworth

Theses and Dissertations--Nutrition and Food Systems

Rural Americans are medically underserved groups and are at greater risk of becoming obese than urban Americans. The purpose of this qualitative study was to determine the perceived causes of obesity in six counties of rural Kentucky and to determine how to customize strategies to reduce obesity in these areas. University of Kentucky Cooperative Extension Service Agents formed coalitions in each of the six counties to assess their communities’ needs and assets to inform plans for implementing evidence-based obesity interventions. Between February and August of 2015, the coalitions were convened for a total of 11 meetings. Each of the coalition …

Is There A Trade-Off? Infant Health Outcomes And Managed Care Competition, Shana L. Moore

Theses and Dissertations--Public Policy and Administration

This study offers insights into the impact of competition among Managed Care organizations (MCOs) on infant birthing charges and birth outcomes. Kentucky provides one of the nation’s first case studies to determine successes and failures of Medicaid MCOs, and by doing so, provides a prediction of the impact of Patient Protection Affordable Care Act (PPACA) competition on healthcare costs and birth outcomes. An analysis of a natural policy experiment in the state of Kentucky reveals that infants insured by a Medicaid MCO stay longer in hospitals, are less healthy, and cost more than those insured under Traditional Medicaid prior to …

Making Health A Priority: Constrained Choices At The Grocery Store, Christy F. Brady

Theses and Dissertations--Sociology

Mounting evidence of the deleterious health effects of poor diet, obesity, and correlated conditions underscore the need to understand how social factors influence food choices. A variety of factors contribute to the diets that Americans consume including limited time, limited income, lack of cooking skills, food deserts, and cheap, convenient foods in abundant portions in grocery stores and restaurants. These contextual factors serve as constraints that impact an individual’s ability to prioritize health when shopping for food. Using the three paper dissertation format, this project will utilize a Constrained Choice Theory (CCT) framework to investigate sociodemographic trends in priorities in …

Across The States: Do Long Term Services & Supports Policies Affect The Number Of Nursing Home Residents With Low-Care Needs?, Mary Otis

MPA/MPP/MPFM Capstone Projects

Long term care for the elderly has been steadily gaining salience in the public policy realm for many years. The federal government has been vigorously studying and exploring solutions, including the Centers for Medicare and Medicaid Services’ (CMS) efforts to expand access to home and community-based services (HCBS) in order to reduce dependence on institutional care. These federal efforts include various incentive programs and policies recently offered under the Affordable Care Act. However, data on the strength of each state’s long term services and supports system has not been easily accessible until recently. The report “Raising Expectations: A State Scorecard …

Improving Indoor Air Quality For Children In Rural Kentucky, Denerica L. Curry

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Community interventions directed towards improving indoor air quality for children are often implemented after exposure has occurred and focuses on parental smoking cessation. Our proposed project will intervene during the prenatal stage prior to exposure and continue to support families 6 months postpartum. Infants are at an increased risk of secondhand smoke exposure due to the amount of time they spend in the home and proximity to the smoker. We hypothesize that by enhancing care of the current home visitation model to include an early intervention we will increase the amount of smoking bans in the home and decrease maternal …

Chronic Pancreatitis, Pain, And Anxiety In An Alcohol And High Fat Mouse Model, Tiffanie Clinkinbeard

Theses and Dissertations--Gerontology

Homeodynamic space (HDS) shrinks as vulnerability increases with aging and repeated damage to the cells. HDS is lost in alcoholic pancreatitis patients due to overconsumption of alcohol, smoking, and high fat diets. Etiologically relevant animal models for study of chronic pancreatitis (CP) are needed. In order to begin filling this gap a central purpose of this dissertation research was to examine relationships between the alcohol and high fat diet (AHF) and pancreatitis with attention to hypersensitivity and anxiety-like behaviors. The AHF diet induced pancreatitis described here etiologically mimics human risk factors of AHF consumption for advancement to alcoholic CP.

In …

Modeling Dementia Risk, Cognitive Change, Predictive Rules In Longitudinal Studies, Xiuhua Ding

Theses and Dissertations--Epidemiology and Biostatistics

Dementia is increasing recognized as a major problem to public health worldwide. Prevention and treatment strategies are in critical need. Nowadays, research for dementia usually featured as complex longitudinal studies, which provide extensive information and also propose challenge to statistical methodology. The purpose of this dissertation research was to apply statistical methodology in the field of dementia to strengthen the understanding of dementia from three perspectives: 1) Application of statistical methodology to investigate the association between potential risk factors and incident dementia. 2) Application of statistical methodology to analyze changes over time, or trajectory, in cognitive tests and symptoms. 3) …

Evaluating A Bystander Intervention Program On Reproductive Coercion: Using Quasi-Experimental Design Strategies To Address Methodologic Issues In Randomized Community Prevention Trials, Catherine P. Starnes

Theses and Dissertations--Epidemiology and Biostatistics

Community (or cluster) randomized trials are trials in which communities or groups of individuals (clusters) are randomized to receive the intervention of interest. Community randomized trials frequently more closely resemble a natural experiment than a randomized controlled trial (RCT) following intervention allocation. In particular, the effects of non-compliance can pose methodologic challenges in estimating the intervention effect which may require a quasiexperimental approach in order to minimize bias.

The motivating example to illustrate these issues is the Green Dot High School (GDHS) study. The GDHS study was a longitudinal, cluster-randomized controlled trial designed to assess the effectiveness of a bystander …

Comprehensive Sexuality Education In Kentucky, Luciana D. Hockersmith

Theses and Dissertations--Community & Leadership Development

Discussions of sex education of any kind can be controversial in a given setting. Traditional approaches to sex education prompt debate regarding effectiveness. Key indicators central to the effectiveness of sex education continue to be rates of teen pregnancy and transmission of sexually transmitted diseases (STDs). With discontentment surrounding the effectiveness of “traditional approaches,” a more wide-ranging method is worthy of being explored. The curriculum approach of Comprehensive Sexuality Education (CSE) includes six key concepts, and subsequent sub-concepts, intended to provide a broad and even all-inclusive range of topics for a similarly broad and even all-inclusive range of ages of …

Communicating Social Support: Understanding Complexities Of Breastfeeding Communication Among African American Mothers, Nicole Rachael Peritore

Theses and Dissertations--Communication

Breast milk is the best choice for meeting the nutritional needs for an infant whenever possible. Despite the knowledge that this nutritional choice is the best choice for an infant, data demonstrates that there is a sharp decline in the rates of breastfeeding mothers. Among African Americans, breastfeeding rates are significantly lower than the national averages. Despite many of the applications of social support in communication research, there is a gap in knowledge on the social support systems in the context of breastfeeding, especially for African Americans. With the social ecological model as a framework, social support theory provides understanding …

Evaluation Of Guideline-Recommended Combined Antiretroviral Treatment Regimens In Commercially-Insured Patients Living In The United States Between 2007 And 2009, Joye Brigitte Allen

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Background: Randomized clinical trials of combination antiretroviral therapy (cART) inform the use of specific antiretrovirals (ARV) and their combination for optimizing therapeutic efficacy. It is critical that patients have access to and receive the most appropriate first-line treatment.

Objective: To examine factors that impact receiving initial guideline-recommended cART within a cohort of commercially insured patients in the United States (US)

Research Design: A population based cohort study.

Data Sources: A secondary administrative insurance claims database.

Subjects: Employed, commercially insured individuals with HIV who were continuously eligible for insurance coverage from January 2007 through December 2009 and received a new ARV …

Correlates Of Antibiotic Diversion In The Philippines: Misconceptions And Community-Level Access To Nonmedical Sources Of Antibiotics, Daniel Alexander Barber

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Aim: To identify sociodemographic, knowledge, and attitudinal correlates to antibiotic diversion among a community-based sample of adults (age 18 and older) in a low-income setting of the Philippines and to explore community-level data on informal antibiotic distribution in sari-sari stands.

Methods: Participants (n=307) completed self-administered surveys. Correlates to antibiotic diversion were assessed using logistic regression with Firth’s bias-adjusted estimates. Availability and characteristics of antibiotics in the sari-sari stands (n=106) were observed through site visits.

Results: A majority (78%) had shared antibiotics in their lifetime, most often with family members. In multivariable analysis, agreement with the belief that it is safe …

Undiagnosed Pulmonary Obstruction And Restriction And Dust Exposure: Pilot Investigations Examining The Relationship Among Agricultural Workers, Caroline E. Holsinger

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Chronic obstructive pulmonary disease (COPD) is a progressive disease that is characterized by limited airflow.1 In the United States (U.S.) alone, COPD is the third leading cause of death.2,3 While smoking remains the strongest risk factor for COPD, 20 percent of patients who die from COPD have never smoked.5–7 The American Thoracic 3 Society showed that about 15% of COPD cases might be attributable to workplace exposure.8 Agricultural dust exposure has long been recognized as a cause of decreased respiratory function, and exposures to both forms of dust may exacerbate other important risk factors of COPD and lead to the …

Increasing Colorectal Cancer Screening Rates In Shelby County, Tennessee Through The Implementation Of Flu-Fit In Community Clinics And Pharmacies, Samantha Wang

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

The Shelby County Health Department (SCHD) proposes implementing of Flu-FIT in community clinics and pharmacies to increase colorectal cancer screening (CRCS) rates in Shelby County, Tennessee. Flu-FIT is an evidenced-based program that involves health care providers offering patients between 50 and 75 years of age the fecal-immunochemical test at the time the patients receive their annual influenza vaccine along with counseling on colorectal cancer and reminder phone calls. Flu-FIT aligns with the mission of SCHD to “promote, protect, and improve the health and environment of all Shelby County residents.” The project’s short term outcomes include increasing CRCS rates in patients …

Hiv/Sti And Teen Pregnancy Prevention Within Mclennan County Texas, Kayla M. Storrs

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

In response to the Center for Disease Control and Prevention (CDC) funding announcement, the McLennan County Health Department proposes to implement Be Proud! Be Responsible!, an evidence-based HIV/STI and teen pregnancy prevention program into the pre-existing health curriculum of the sixth grade classes within the county. With the highest rates of chlamydia and gonorrhea within the state of Texas, and $7 million per year of teen pregnancy related costs spent in Waco, Texas alone, this intervention aims to increase HIV/STI knowledge, increase positive perceptions of safe sexual behaviors, increase parent-student communication about safe sexual behaviors, prolong first sexual initiation, and …

Wnc Healthy Teens: A Multi-Level Teen Pregnancy Prevention Initiative, Katharine Macmillan

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

WNC Healthy Teens is a multi-component, community-based teen pregnancy prevention initiative. The program will be targeted in rural areas of Buncombe and Henderson Counties that have aggregate rates showing that over half the population of women aged 15-19 years are giving birth. Sexual education is necessary, but not sufficient to preventing risky sexual behaviors1. Tying multiple levels of evidence-based school interventions together with standardization of adolescent sexual health care will provide a well-rounded approach to address teenage pregnancy. Starting the initiative at age 14, it is anticipated the majority of teens will have yet to initiate sexual activity. Reducing the …

Comparing The Non-Cystic Fibrosis Bronchiectasis Patients With Non-Tuberculous Mycobacteria (Ntm) And Non-Ntm Infections, Maninder Bir Singh

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Objective

The objective of the study is to compare the Non-Cystic Fibrosis Bronchiectasis patients with Non Tubercular Mycobacteria (NTM) and Non-NTM infection and determine if the NTM and Non-NTM groups are different.

Methods

Data from the COPD Foundation’s Bronchiectasis Research Registry (BRR) was used in the study (n=1660).Logistic regression, Cox proportional hazards regression, and Kaplan Meier survival analysis were used to analyze the data.

Results

The study found odds ratio for having NTM infection for age to be 1.02 and for gender to be 2.34, after adjusting for all other variables in the multivariate logistic regression, with the p-value of …

“Exchange Northern Ky”: An Evidence-Based Needle & Syringe Exchange Program Serving The Northern Kentucky Area Development District, Amanda Hunter

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Intravenous drug users (IDUs) account for nearly 16% of new HIV infections in the United States and almost one half (48%) of newly reported acute hepatitis C virus (HCV) infections have been found to be IDU related.1 Within the Northern Kentucky Area Development District, hepatitis C infections have soared with an incidence of more than 1,000 newly reported cases during 2015 alone.⁴ Rigorous scientific evidence complied by the U.S. Department of Health & Human Services has indicated that one of the most unique and effective strategies for the curtailing HIV incidence among IDUs is by ensuring users’ access to …

Documentation Of Smoking History And Adherence To The Uspstf Recommendation For Lung Cancer Screening: A Retrospective Chart Review, Laura A. Golden

DNP Projects

Purpose: The purpose of this project was to evaluate provider compliance with documentation of smoking history and, if criteria met, referral for lung cancer screening as recommended by the United States Preventive Services Task Force in 2013.

Methods: A retrospective chart review was conducted using an electronic medical record (EMR) at a large, rural community family practice clinic. Patients meeting inclusion criteria of having a smoking history (current or past) of 30 pack years, aged 55 to 80 years, and no history of lung cancer diagnosis were included for randomization. One hundred patients were selected from 300 randomized charts; five …

Baseline Of Copd Management In A Norton Healthcare Primary Care Clinic, Angela Goldring

DNP Projects

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of death in the United States (U.S), with rates in Kentucky among the highest in the nation. Quality care in the primary care setting is key to optimizing the health outcomes of those with COPD.

Purpose: The objective of this study was to establish a baseline of COPD patient care in a primary care clinic. The specific aims of this study were to: 1) describe the demographic and health-related characteristics of patients with COPD who have a primary care provider (PCP) at one Norton Healthcare primary care clinic; 2) …

An Evaluation Of The Screening And Management Of Childhood Overweight And Obesity In The Primary Care Setting, Diane L. Crutcher

DNP Projects

Background: Worldwide, the World Health Organization (2016) estimates that forty-two million children from two to five years of age are overweight or obese. In the United States, Kentucky ranks sixth for the highest rate of overweight youth in the nation (Partnership for Fit Kentucky, 2009). The long term consequences of overweight and obesity are early onset of adult chronic diseases as well as social and psychological issues in childhood and adulthood.

Purpose: The objective of this gap analysis was to assess BMI screening and weight management of children ages two to five who presented for a well-child check …

The Utilization Of Models Of Care Transition To Reduce Medicare Beneficiaries’ Hospital Readmission Rates In Kentucky: A Case Study, Audra Putt

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Problem: Unsuccessful care transitions for Medicare beneficiaries have resulted in high health expenditures and a diminished quality of care as the 30-day hospital readmission rate has increased. This has prompted the Centers for Medicare and Medicaid Services to require hospitals with high readmission rates to pay penalties. As a result, the Community-based Care Transitions Program was established under Section 3026 of the Affordable Care Act to provide health organizations funding to utilize models of care transition to improve the care transition process. The purpose of this capstone project was to identify whether two community-based organization programs, the Kentucky Appalachian Transition …

Hispanic Agricultural Workers: The Nexus Of Demographics, Employment Characteristics, And Health, Ashley Michelle Bush

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Agriculture, which is home to elevated occupational injury and illness rates, has a substantial demographic makeup of Hispanic workers. Hispanic farmworkers are at increased risk of poor occupational health outcomes due to the precarious nature of work and other socio-ecological influences. These adverse occupational health outcome counts are inadequate and undercounted, failing to capture the true scope of agricultural work. To gain more knowledge about agriculture, this capstone will focus on the personal and work characteristics of agricultural workers to help further understand disparities within the agricultural sector by: providing a literature review of agricultural worker health; examining missed work …

Competitive Food Policy Implementation In Kentucky Schools, Paula Gisler

Theses and Dissertations--Nursing

This study was designed to explore the literature on competitive food policy implementation (CFPI); examines demographic and school factors associated with CFPI; and explores the experiences of school leaders and staff in CFPI using a proposed theoretical framework to guide the research. Competitive foods are those sold in vending machines, a la carte settings, fundraisers, class parties and other venues which compete with foods offered through the national school lunch and breakfast programs. Competitive foods have traditionally been of low nutritional value and high energy density. CFPI may be effective in reducing student calorie intake and BMI. However, evaluation of …

Characterization Of Foreign-Born Vs. U.S. Native-Born Worker Fatalities In Kentucky, 2001-2014, Yailet Cruz Galardy

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Background: Foreign-born workers may be more vulnerable to fatal and nonfatal work injuries. Available information on the differences that exist between foreign-born and U.S. native-born worker fatal injuries is scarce. This study aims to describe and characterize occupational fatal injuries in foreign-born and U.S. native-born workers in Kentucky.

Methods: A retrospective descriptive analysis of foreign-born vs. U.S. native-born worker fatalities was performed over a 14-year period from 2001-2014 using Kentucky Fatality Assessment and Control Evaluation (FACE) program worker fatality surveillance data.

Results: From 2001-2014, there were a total of 87 foreign-born and 1,361 native-born worker fatalities. The average age of …

Risk Factors Associated With Severe Injuries In Inland Aquaculture Farms, Amah Martin

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Objective: The main objective of this study was to analyze risk factors associated with severe occupational injuries among inland aquaculture farms.

Methods: Survey results were compiled in a data set that consisted of qualitative data from 51 farmers who were interviewed between 2008 and 2011 in 10 states and the Canadian province of British Columbia. Chi-square and Fisher’s exact test were used to assess the differences in the dichotomous level of severity among several farm and injury variables. Logistic regression was used to predict the outcome of a severe injury event.

Results: Injury observations that indicated the use of raceway …

Identifying Predictors Of Functional Limitations Associated With Depression, Anxiety, And Emotional Problems In Us Adults, Jillian Richardson

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Depressive disorders are characterized as sharing affected mood, and somatic (e.g. sleep pattern, appetite, and unintentional changes in weight) and cognitive alterations from previous normal daily functioning that are clinically significant. Anxiety disorders are characterized by excessive fear, general or specific anxiety, and related behavioral disturbances that are also clinically significant. This project attempts to identify risk factors that may predict what groups are most likely to be affected by depression and/or anxiety.

Sponsored by the CDC, the National Health Interview Survey collects general health information for non-institutionalized individuals living in the US. Variables for use in logistic regression model …

Focas Appalachia: A Cervical Cancer Prevention Program For The Women Of The Kentucky River Area Development District, Chrisanthi M. Masero

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

In response to the National Institute of Health’s (NIH) funding announcement, the Kentucky River District Health Department (KRDHD) proposes to implement an evidence-based cervical cancer prevention program in the Kentucky River Area Development District (KRADD) in southeastern Appalachian Kentucky. The proposed evidence-based program was part of the National Cancer Institute’s (NCI) “Public Health Approaches to Breast and Cervical Cancer” research initiative and is one of nine cervical cancer Research Tested Intervention Programs (RTIPs) on the NCI’s RTIP database. The Forsyth County Cancer Screening Project (FoCaS) was designed to improve the beliefs, attitudes, and behaviors regarding breast and cervical cancer screening …

The Link Between Smoking, Lung Cancer And Socioeconomic Factors In Kentucky, Shreya Berlia

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Background and Purpose

Lung cancer is the leading cause of cancer death and the second most diagnosed cancer in both men and women in the United States. An estimated 158,080 deaths from lung cancer are expected to occur in 2016, which will account for approximately 1 in 4 of all cancer deaths. The 1- and 5-year relative survival rates for lung cancer are 44% and 17%, respectively. The incidence rate for lung cancer has been declining since the mid-1980s in men, but only since the mid-2000s in women. Tobacco smoke is the leading cause of preventable disease and death in …