Digital Commons Network^™

A Case Study In Program Evaluation, Sydney Wilcoxson

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

Evaluation is a critical component of a successful evidence-based health promotion program or intervention. In public health, evaluations ensure that interventions are achieving their intended objectives, provide feedback on program strengths and weaknesses, and serve as a mechanism of accountability and transparency to stakeholders so that they know their invested resources are being utilized in the most efficient manner. Without evaluation, it would be much more difficult to understand how well the intervention is working, and communication between stakeholders would be significantly affected.

A recently confirmed Methicillin-resistant staphylococcus aureus (MRSA) outbreak on a Fayette County Public Schools (FCPS) high school …

A Case Study In Program Evaluation: A Prospective Program Evaluation Of Timely Reporting And Action Of An Infectious Disease Outbreak, Destiny Cozart

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

Methicillin-resistant Staphylococcus aureus also known as MRSA is an infection of a staph bacteria. High school athletes are at risk of contracting MRSA through skin to skin contact and/or MRSA contaminated equipment. This case study uses the CDC's six-step framework for program evaluation to measure the effectiveness of the online training modules designed to increase the knowledge of staff and stakeholders about MRSA and infectious disease outbreaks. The findings from this evaluation will advise the potential change(s) implemented in training modules, ultimately to enhance competency for decision makers and prevent MRSA and infectious disease outbreak amongst high school athletic programs.

Recharge Moments, Scott Keel

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

Abstract Title: Recharge Moments

Background: Recent articles from the CDC and other healthcare agencies have demonstrated the detrimental effects that the COVID-19 pandemic is having on the physical and mental health of the healthcare workforce. Unfortunately, they were less informative in regard to those working for local public health departments. Pre-pandemic and concurrent publications on mindfulness-based interventions have demonstrated the positive and protective effects mindfulness-based interventions can have on burnout prevention and resilience promotion. To gain a better understanding of how the current pandemic might be affecting the public health workforce and to assess whether mindfulness-based interventions would be helpful …

Culminating Experience In The Application Of Biostatistics In Public Health: A Report On My Consultation Experiences, Samantha Kennedy

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

Executive Summary

This portfolio is a compilation of three different consulting experiences that I have had to opportunity to work with as a part of University of Kentucky’s Master of Public Health program with a concentration in biostatistics. My portfolio consists of project descriptions, notes, reports, relevant SAS code and output, and other supporting materials for the three projects I worked with. Each of the projects that I worked with were vastly different, as was my role in them. As such the supporting documents for each are very different as well, but each does have a brief description of the …

Evaluation Of A Pharmacist Led Medication Reconciliation Process In Primary Care, Benjamin T. Gatlin

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

Medication safety should be at the forefront of public health initiatives. Medication reconciliations in primary care are key to successful, accurate, and safe medication use. Pharmacists are well positioned and educated to have an impact on medication safety by conducting reconciliations in primary care centers. Guidelines for training pharmacists on how to conduct medication reconciliations would be a useful tool for any health board striving to improve medication safety. This study uses observations from pharmacists currently conducting medication reconciliations in primary care to propose such guidelines in the form of a flow sheet. The resulting flow sheet and observations are …

Identifying Veterans With Opioid Use Disorder That Could Benefit From Referral For Evidence-Based Medication-Assisted Treatment, Emily Hampton

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

Current treatment guideline recommendations published by the American Society of Addiction Medicine for Opioid Use Disorder (OUD) include both psychotherapy and Medication- Assisted Treatment for optimal management of this chronic medical illness. Military veterans are at an increased risk for fatal outcomes related to opioid overdoses due to a higher prevalence of depression/Post-Traumatic Stress Disorder (PTSD) and self-medicated substance use compared to their civilian counterparts. Additionally, many have been diagnosed with OUD but are not being treated in accordance with current treatment recommendations.

In an effort to increase access to treatment and combat the opioid epidemic, the Lexington VA Medical …

Epidemiology Of Young Adult Renal Cell Carcinoma In Kentucky: Incidence, Clinicopathologic Features, And Cancer-Specific Survival, Jason R. Bylund

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

Introduction:

Renal cell carcinoma (RCC) is an important cause of morbidity and mortality in our country. Previously reported data suggest that the overall incidence of RCC continues to rise and may be accelerating even faster among younger adult patients.

Methods:

Data for analysis included the combined NPCR-SEER USCS public use database and the Kentucky Cancer Registry dataset. Incidence rates and trends by age group and location were calculated and tested. Clinicopathologic features of disease among Kentucky cases were analyzed by age group. Cancer-specific survival (CSS) analysis was performed, along with Cox proportional hazards regression to test for association of younger …

Retrospective Policy Analysis On The Efficacy Of The Army Hearing Program, Ahmad Brandelle Alexander

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

The present study (1) examined the Army Hearing Program (AHP) and (2) provided a retrospective policy analysis on several of the policies embedded within the AHP, more specifically the hearing readiness policy, to determine their efficacy and impact regarding noise-induced hearing loss (NIHL). The Beaufort Longest Framework was the analytic framework for this project. It was also used to structure the writing and formatting of this report. An extensive literature review of Army Medical Department (AMEDD) journals and Public Health journals were used in addition to several published Army Regulations and Pamphlets for guidance within conducting the Methods section of …

Select Antimicrobial Resistance Trends In Kentucky’S Bovine Population And Antibiogram Development, Jessica Morehouse

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

Introduction: Antimicrobial resistance (AMR) is a complex problem that affects all of society and is driven by many interconnected factors. It is important to monitor AMR trends in veterinary medicine to accurately pursue appropriate antibiotic treatment of ill animals. Antibiogram development is also an important tool in guiding the veterinary practitioner in treating empirically or while a culture and susceptibility is being performed.

Methods: This study compared bacterial susceptibility in voluntary samples submitted to the University of Kentucky Veterinary Diagnostic Laboratory and the Murray State University Breathitt Veterinary Center between 2012 and 2017. Equality of proportions was used to compare …

Impact Of Health Insurance And Sociodemographic Characteristics On Survival For Women Diagnosed With Breast Cancer In Kentucky, Pramila Rai

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

Introduction Objective of the study was to explore the impact of health insurance and socio-demographic factors on survival for breast cancer patients in Kentucky. Breast cancer is the most prevalent cancer among women in the US. Breast cancer survival is affected by various factors including health insurance, residence, age, race, geographical distance, income.

Methods The data were obtained from Kentucky Cancer Registry and included 47,128 women diagnosed with primary breast cancer between 2000 to 2014. The relationship of health insurance and other socio-demographic factors was analyzed using Cox regression.

ResultsThe overall five-year survival proportion was 0.97, 0.76 and 0.71 …

Understanding The Silent Crisis: An Analysis Of Suicide Methods Among Kentucky Females, Charles Hamilton Rhea

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

Background: Suicide has been called the ‘silent crisis’. As rates have increased in recent years, it is now the 10th leading cause of death in the United States. Within the state of Kentucky, females die by suicide most often through the use of firearms, differing from the national trend where poisoning is most common. With a drastic increase in firearm suicides has been observed beginning in 2010. The aim of this study is to investigate why Kentucky females who have died by suicide are using firearms most often, as opposed to other methods, and compare those results to other states …

Characteristics Of Synchronous And Multiple Primary Ovarian Cancer Cases In Seer And Kentucky, Lauren Shelton

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

OBJECTIVES: The primary aim of this study was to investigate whether ovarian cancer patients in Kentucky are more likely to have multiple primary and synchronized primary cancers compared to Non-Kentucky SEER registry cancer patients. A secondary aim of the study was to determine if there are other factors that may be associated with an increased risk of having multiple primary and synchronized cancer as well as determining if having multiple primary and synchronous cancer diagnoses changes survival rates in ovarian cancer patients. Additionally, another objective was to identify the most frequently observed subsequent and synchronous cancers sites that are diagnosed …

Consultation Experience In Public Health, Xiangya Meng

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

This capstone project describes the results of a consultative experience in biostatistics.

Predictors Of Pm 2.5 And Radon Concentrations In Residences Of Central Kentucky: A Cross Sectional Study, Kyle T. Hancock

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

Aim: To measure levels of respirable particles (PM 2.5) and radon in homes in Central Kentucky and assess modifiable risk factors that could reduce the morbidity and mortality of cardiovascular and respiratory disease.

Methods: PM 2.5 and radon samples were taken in homes (n=21) in Central Kentucky. An in- home checklist was completed for each home that assessed a variety of potential environmental respiratory exposures.

Results: The geometric mean of PM 2.5 for all 21 homes was 8.4 μg/m³ which was well below the EPA air quality standard of 35 μg/m³. Smoking status, burning candles, and general …

Hepatitis C Screening And Treatment Of Prisoners: Analysis Of Policy And Practice In Kentucky, Charity Faith Kranz

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

INTRODUCTION

The United States and the Commonwealth of Kentucky are currently overwhelmed by a triad of complex epidemics—incarceration, opioid overdose deaths secondary to substance use disorders, and hepatitis C. Research has suggested hepatitis C screening and treatment of prisoners may be a cost-effective strategy to address the hepatitis C epidemic. Since Kentucky has been particularly impacted by these interrelated health threats, further exploration of hepatitis C in Kentucky prison populations and their potential role in addressing these epidemics is warranted.

Primary Objective

The main goal of this research was to examine hepatitis C screening and treatment policy and practice within …

Breathe Easy Mississippi, Christian Rashad Campbell

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

Asthma disproportionately affects rural minority children and is the leading reason for all school absences in our nation. Breathe Easy Mississippi is a multi-level intervention designed to improve long term control of asthma in youth. Breathe Easy Mississippi components include: 1) Home Visits by asthma counselors to identify asthma triggers and remediate the child’s environment, and 2) School Based Curriculum (Asthma Education) to promote ideal asthma management knowledge and foster more effective relationships between children, parents, healthcare professionals and paraprofessionals. Breathe Easy Mississippi will be implemented in a total of six schools that make up the entire elementary school district …

Implementing The Alive! Behavioral Intervention Program In Phillips County, Arkansas, Raeschell Williams

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

The Arkansas Department of Health proposes implementing the Alive! behavioral intervention program in Phillips County, Arkansas to decrease the prevalence of obesity in this community. Alive!, A Lifestyle Intervention Via Email, is an evidence-bases, email-derived, worksite intervention focused on reducing saturated fats, increasing fruit and vegetable intake, and increasing physical activity. As an email-based program, participants will receive weekly emails tailored to their individual goals with reminder emails delivered during the week with small-step goals to help the participant achieve their larger goal. As the country with the highest prevalence of obesity and second highest prevalence of obesity in 2014, …

Filling The Gap In Obesity Prevention: Implementation Of The General’S Activity Program (Gap) In Carroll County, Kentucky, Brent Emerson

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

As obesity rates continue to rise, there is a significant need for public health programs that are able to effectively increase physical activity at the community level. Regular physical activity can help reduce the risk of negative health outcomes associated with obesity including cardiovascular disease, type 2 diabetes, and some forms of cancer while also strengthening muscles, improving mental health and mood, and increasing average life expectancy. Previous research has supported that one way to increase physical activity at the community level is through social marketing of state and local parks. Through the promotion of parks, community residents are able …

Shaping Our Appalachian Region (Soar): Beginning To Now, Samantha Zarycki

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

Introduction

Appalachian Kentucky has been and is currently facing difficult times including low employment rates, low education rates and less-than-favorable healthcare and health status for the people of the region (Estep, 2014). There have been multiple government and non-government agencies who have implemented interventions with the purpose of lifting up the region. Shaping Our Appalachian Region, or SOAR, is a bipartisan organization which began in 2013, and was established for the purpose of caring for the region.

Methods

A qualitative data analysis using confidential interviews with six people involved with SOAR was used for this project. Using the deductive approach …

Planet Health: A School-Based Health Promotion Program, Jane Katherine Landon

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

The Kentucky River District Health Department (KRDHD) proposes implementation of Planet Health, a school-based intervention aimed at increasing healthful nutrition and fitness behaviors in middle- and high-school aged students. Planet Health’s core messaging (increasing fruit and vegetable intake, increasing physical activity, decreasing screen time, decreasing sugar-sweetened beverage and trans-fat intake) contributes to our long-term goal of decreasing childhood obesity in our service area. Planet Health will be offered to 3 counties in our service area (Lee, Letcher and Wolfe) with planned expansion to all counties in the KRDHD service area within 5 years of the original pilot. This project will …

A Comprehensive Multi-Level Approach To Increasing Hpv Vaccination Rates In Rural Kentucky, Jim Weygandt

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

The Graves County Health Department (GCHD) proposes implementation of a multi-level approach to increase Human Papillomavirus (HPV) vaccination rates in Graves County, KY. The approach utilizes multiple evidence-based strategies, including Assessment, Feedback, Incentive, Exchange (AFIX), Vaccines for Children (VFC), Kentucky Immunization Registry (KIR), Comprehensive Clinic Assessment Application (CoCASA), and vaccines per protocol. This proposed project utilizes family medicine and pediatric clinics, pharmacies, and school nurses to deliver the intervention to the target population, which includes 11-12-year-old adolescents residing in Graves County. The objectives of this HPV vaccination-focused intervention align with Healthy People 2020 goals and objectives, the 2012-2013 President’s Cancer …

Community Based Sexual Education In Hamilton County Ohio, Jennifer Winbigler

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

This project proposes the implementation of a community-based sexual education program in Hamilton County Ohio. The proposed program is Focus on Youth + ImPACT. FOY + ImPACT is an evidenced based intervention focused on providing knowledge and skill based education to both youth (during FOY sessions) and parents (during the ImPACT session). The educational program will be implemented at three sites: the Boys and Girls Club of Greater Cincinnati, Lighthouse Youth Services, and Caracole. Each site was selected for its current infrastructure conducive to youth programming. This included ease of access to youth as well as experience in the provision …

A Population-Based Survival Analysis Of Mesothelioma And Smoking In Appalachian And Non-Appalachian Kentucky, Peter Van Wie

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

Mesothelioma is one of the most aggressive cancers in the United States and around the world, with a grim 5-year survival rate of only 8%. After diagnosis there is little that can be done to stop the progression of the disease. Smoking has been negatively associated with mesothelioma survival. This may be due to several factors including increased oxidative stress or sequestration of tobacco-related carcinogenic compounds by asbestos fibers trapped in the lung. This study investigated the association between smoking and mesothelioma survival in the Kentucky population. It examines the risk of living in the low socioeconomic region of Appalachian …

Spatio-Temporal Analysis Of Childhood Retinoblastoma And Cns Tumors In Kentucky, From 1995 Through 2014, Jennifer A. Khoury

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

Objectives

Childhood cancer poses a significant public health burden, both globally and in the United States (US). The most common childhood cancers affect the brain and central nervous system (CNS). Age-adjusted childhood brain tumor (CBT) incidence rates in Kentucky are larger than in the rest of the US; these rates are also higher in Appalachian Kentucky than in the rest of the state. This study determined if high-rate clusters of either CNS tumor or retinoblastoma existed in Kentucky.

Methods

Data for this study were retrieved from the Kentucky Cancer Registry for the years 1995 through 2014. Cases were individuals between …

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 …

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 …

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 …

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 …