Impact Of Community-Driven Interventions On Dietary And Physical Activity Outcomes Among A Cohort Of Adults In A Rural Appalachian County In Eastern Kentucky, 2019–2022, Heather Norman-Burgdolf, Emily M. Dewitt, Rachel Gillespie, Kathryn Cardarelli, Stacey Slone, Alison Gustafson

Dietetics and Human Nutrition Faculty Publications

Several environmental level factors exacerbate poor health outcomes in rural populations in the United States, such as lack of access to healthy food and locations to be physically active, which support healthy choices at the individual level. Thus, utilizing innovative place-based approaches in rural locations is essential to improve health outcomes. Leveraging community assets, like Cooperative Extension, is a novel strategy for implementing community-driven interventions. This prospective cohort study (n = 152), recruited in 2019 and surveyed again in 2020 and 2021, examined individual level changes in diet and physical activity in one rural Appalachian county. During this time, multiple …

Adult Asthma Associated With Roadway Density And Housing In Rural Appalachia: The Mountain Air Project (Map)., W Jay Christian, John Flunker, Beverly May, Susan Westneat, Wayne T Sanderson, Nancy Schoenberg, Steven R Browning

UK CARES Faculty Publications

BACKGROUND: Appalachian Kentucky is a rural area with a high prevalence of asthma among adults. The relative contribution of environmental exposures in the etiology of adult asthma in these populations has been understudied.

OBJECTIVE: This manuscript describes the aims, study design, methods, and characteristics of participants for the Mountain Air Project (MAP), and focuses on associations between small area environmental exposures, including roadways and mining operations, and lifetime and current asthma in adults.

METHODS: A cohort of residents, aged 21 and older, in two Kentucky counties, was enrolled in a community-based, cross-sectional study. Stratified cluster sampling was used to select …

Providers’ Stigmas And The Effects On Patients With Opioid Use Disorder: A Scoping Review, Peyton Skaggs, Sarah Beth Bell, F. Douglas Scutchfield Md, Lauren E. Robinson

Journal of Appalachian Health

Introduction: One of the most prevalent, dangerous stigmas in health care is the complex bias toward patients with opioid use disorder (OUD). This stigma damages the vital patient–provider relationship, further perpetuating the opioid epidemic.

Purpose: Unfortunately, research on the relationship between OUD and provider stigma is greatly lacking. To fill this gap, the present in-depth study undertakes a scoping review of research on providers’ stigma toward OUD in order to determine how enacted stigma affects treatment plans.

Methods: Four databases were used to identify articles published from 1999 to 2021. A comprehensive search strategy was developed through a collaborative process …

Association Between Low Health Literacy And Adverse Health Behaviors In North Carolina, 2016, Manan Roy, Adam Hege, Erin D. Bouldin

Journal of Appalachian Health

Introduction: Health literacy (HL) is an urgent public health challenge facing the U.S. HL is a critical factor in health inequities and exacerbates underlying social determinants of health.

Purpose: This study assesses the association between low HL (LHL) and adverse health behaviors, which contribute to poor health.

Methods: Researchers used North Carolina’s 2016 Behavioral Risk Factor Surveillance System data, namely, the Health Literacy optional module which asks respondents to rate how difficult it is for them to get health-related advice or to understand medical information (verbal or written). Health behaviors analyzed were excessive alcohol consumption, lack of adequate exercise and …

The Relationship Between Psychosocial Factors, Self-Care, And Blood Sugar In An Appalachian Population, Brittany L. Smalls, Md. Tofial Azam, Madeline Dunfee, Philip M. Westgate, Susan C. Westneat, Nancy Schoenberg

Journal of Appalachian Health

Introduction: Appalachian residents are more likely than other populations to have Type 2 Diabetes Mellitus (T2DM) and to experience more severe complications from the disease, including excess and premature mortality.

Methods: This study examines health alongside sociodemographic factors, psychosocial factors (including knowledge, empowerment, social support/function, religiosity, distress), and perceived problems in diabetes management that may influence self-care and HbA1c among vulnerable rural residents. A survey of a community–based sample of 356 adults with diagnosed diabetes or HbA1c > 6.5 was conducted in six counties in Appalachian Kentucky.

Results: Findings suggest that neither religiosity nor social support/function mediate/moderate the relationship between psychosocial …

Striving For Appropriate Antibiotic Use: A Biomarker Initiative, And Outcomes Associated With Azithromycin Exposure, Amanda Gusovsky

Theses and Dissertations--Pharmacy

The introduction of antibiotics into clinical practice is considered the greatest medical breakthrough of the 20^thcentury. However, the use of antibiotics can contribute to the development of resistance. In the United States (U.S.), approximately 2.8 million people are infected with antibiotic-resistant bacteria each year, and more than 35,000 people die as a result. Moreover, some antibiotics are known to cause cardiac side effects including QT prolongation, hypotension, and ventricular arrythmias. The U.S. Centers for Disease Control and Prevention (CDC) defines appropriate antibiotic use as the effort to use “the right antibiotic, at the right dose, for the right …

Modified Early Warning Scoring (Mews) Versus Epic Deterioration Index (Edi): Battle Royale For Which Has The Best Patient Outcomes In The Inpatient Setting, Dirk A. Church

DNP Projects

Abstract

Background: The increased workload bedside nurses face today requires new tools to assist with the identification of deteriorating patients during hospitalization. The Modified Early Warning Score (MEWS) tool has formed the background of early warning tools. Newer, more complex tools, like Epic’s Deterioration Index (EDI), have been developed to identify patient deterioration earlier. There is lack of evidence in the literature comparing different early warning tools, implementation, and patient outcomes.

Objective: The purpose of the study was to examine models for EWS notification for RRT and patient outcomes between the use of the MEWS and EDI in an adult, …

An Analysis Of The Clear Horizons Program In Perry County, Kentucky On Smoking Cessation, Julia Kollitz

Lewis Honors College Thesis Collection

Perry County is an Appalachian county located in southeastern Kentucky. The population is 28,473 people (United States Census Bureau, 2020). It is a predominately white community, with 95.9% of people falling in this category, which is higher than the national percentage of 75.8% (United States Census Bureau, 2020). Being a rural county, this community uses few news sources, with the primary outlet being WYMT Eastern Kentucky News. This news outlet is a subset of CBS (WYMT, 2023). When comparing statewide and nationwide data, Perry County does consistently worse. They have a high school graduation rate that is lower than the …

Maternal Occupation And Pediatric Brain Cancer In Kentucky, Mary Elizabeth Begley

Theses and Dissertations--Epidemiology and Biostatistics

Pediatric brain cancer is a rare and potentially deadly diagnosis that affects children in Kentucky at a higher incidence than those nationally. Limited exposures in children early in life to warrant the development and progression of brain cancer point to the role parental exposures experienced in the period prior to conception and throughout pregnancy may play in its development. Many of these exposures may be experienced through occupation.

Data on a subset of pediatric brain cancer cases in Kentucky was compared to all cases diagnosed in the state from 1995 to 2019. Survey data of the study sample was collected …

Characterizing Region Iv State Health Agency - Central Office's Workforce Needs: Results From The 2021 Public Health Workforce Interest And Needs Survey (Ph Wins), Ashley Carroll

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

The purpose of this project was to examine the Region IV State Health Agency – Central Office workforce in regards to retention and reasons for leaving; workforce satisfaction levels and how that influences retention; and training gaps among non-supervisors. An extensive review of existing literature was completed and showed that since the great recession, there has been a loss of 40,000 positions at state and local governmental health agencies (Castrucci & Lupi, 2020). In addition, from 2008 to 2019, there has been a 16 percent decline in the national public health workforce, and 47 percent of public health workers plan …

The Impact Of Flooding Events In Kentucky Counties On Preventable Asthma Hospitalizations, Mckaylee Copher

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

Objective: Given the frequency and intensity of flooding, along with the disparities in respiratory illnesses in Kentucky, this study aims to determine if there is an association between flooding and asthma is crucial to the health of the state population.

Methods: Preventable asthma hospitalizations in adults aged 18-39 were obtained from the Kentucky Cabinet of Health and Family Services, Health and Facility Services Data and included the count of admissions of an ICD-9 diagnosis of asthma, as determined by hospital discharge data. FEMA disaster declarations were used to identify 69 counties that had floods during the period of 2008-2015. A …

Concussion Perceptions And Reporting Behaviors By Individual And Team Sport Participation Among Female Diii Student-Athletes, Bethany L. Stewart

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

Abstract

Purpose. This study aimed to analyze differences between individual and team sport participation and academic year on perception of concussion and reporting behaviors.

Methods. A cross-sectional study was conducted using original data from the Perceptions and Likeliness to Report Concussions in Collegiate Athletes survey distributed to student-athletes from April 2021 to December 2022. The study population was restricted to current residents of the United States, current enrollment in college or university, female-identifying, and between the ages of 18 and 24, yielding a final population of 135 for analysis. Statistical frequency analyses were obtained, then stratified by team and individual …

Psychosocial Outcomes Post-Concussion Of Female Collegiate Athletes, Victoria Farley

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

Concussions are traumatic brain injuries impacting upwards of 3 million athletes per year. Female collegiate athletes are an essential group of athletes to investigate as they account for 47% of all collegiate athletes and often suffer more severe concussions with worse concussion symptoms than their male counterparts. Many symptoms are associated with concussion such as dizziness nausea, headaches, and instability, however, some injury symptoms extend beyond physical symptoms. The symptoms that extend beyond physical often mimic different psychosocial factors like depression and anxiety. This study investigated the associations of injury, the duration of symptoms, and the psychosocial impacts of injury …

Cardinal's Blues: Implementation Of A School-Based Cognitive Behavioral Therapy Program For Jefferson County Public Schools In Louisville, Kentucky, Loui Chang

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

With the increasing rate of adolescent depression and anxiety1 2, developing mental health interventions is necessary. Many adolescents’ times spent in schools increased compared to 20 years ago5, which makes school-based intervention programs suitable for reaching adolescent population effectively. Though there are numerous treatment providers available in Jefferson County, Kentucky, the school-based prevention programs addressing adolescent’s negative mental health outcomes have never been implemented. The Blueprints for Healthy Youth Development developed a program called the Blues Program24. The Blues Program provides an adapted version of group Cognitive Behavioral Therapy sessions to train and educate adolescents coping skills and cognitive restructuring24. …

Maternal Occupation And Pediatric Brain Cancer In Kentucky, Mary Begley

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

Pediatric brain cancer is a rare and potentially deadly diagnosis that affects children in Kentucky at a higher incidence than those nationally. Limited exposures in children early in life to warrant the development and progression of brain cancer point to the role parental exposures experienced in the period prior to conception and throughout pregnancy may play in its development. Many of these exposures may be experienced through occupation. Data on a subset of pediatric brain cancer cases in Kentucky was compared to all cases diagnosed in the state from 1995 to 2019. Survey data of the study sample was collected …

The Effect Of An Educational Handout On Knowledge, Awareness And Attitudes Of Pre-Exposure Prophylaxis (Prep) Among Participants At A Needle And Syringe Exchange Site, Mckenzie Buckel

DNP Projects

Background: In 2018, the total number of HIV cases in the United States was 1.2 million. Almost 186,500 of these cases were attributed to intravenous drug use. With the adherence to pre-exposure prophylaxis (PrEP) there is approximately a 49% decrease in the rates of HIV among people who inject drugs and the most significant barrier to PrEP among this population is a lack of awareness and knowledge.

Objective: The purpose of this study was to determine participants’ of a needle and syringe exchange site knowledge, awareness and attitudes of PrEP after reviewing an educational handout about PrEP.

Methods: A quasi …

Electronic Cigarettes And Young Adults: Use Of Screening Tools And Provider Knowledge, Kayla Erin Chelf

DNP Projects

Background: Electronic Cigarette (e-cigarette) use is now more common than traditional cigarette use in adolescents and young adults (Dinardo & Rome, 2019). There is concern that the lack of screening for use and knowledge about the health consequences of e-cigarette use is driving this growth.

Objective: The purposes of this project were to (1) assess baseline e-cigarette knowledge and screening practices from healthcare professionals, and (2) evaluate changes in knowledge after delivery of an educational intervention about e-cigarettes.

Methods: In this quasi-experimental study a seven-question survey on screening practice and knowledge concerning e-cigarettes in young adults was posted on the …

Implementing A Mobile Saliva Rinse Screening For P16 Markers For Hpv (Human Papillomavirus) Positive Head And Neck Cancers In Central Kentucky, Madeline Brown

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

Rates of HPV-related head and neck cancers are increasing across the nation and more specifically, there has been a significant increase in the state of Kentucky. This study focuses on the implementation of a mobile clinic saliva-rinse screening program. This program will be set up at UK Athletics Men's basketball and football games in hopes of recruiting middle aged men ages 45-60, who are the target audience of the study. This is the population with highest prevalence for HPV positive head and neck cancers and also the population least likely to visit their health providers regularly. A quick saliva rinse …

Breastfeeding Promotion In The Workplace, Katie C. Nettesheim

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

Breastfeeding is one of the best things a mother can do for her baby. It has many protective qualities including a reduced risk of sudden infant death syndrome (SIDS), asthma, obesity, type 1 diabetes, respiratory infections, ear infections, and stomach bugs for the baby (CDC, 2022). There are also protective qualities for the mother as well, including a reduced risk of high blood pressure, breast and ovarian cancer, and type II diabetes. Breastfeeding exclusively, the infant only receives breastmilk and no other supplementation for 6 months, which maximizes the many benefits that breastfeeding has.

Rural areas of the United States …

Development Of A Community-Based Plan For An Effective Behavioral Intervention To Reduce Childhood Obesity In A Rural Appalachian Community, Jennifer Stacy Wells

Theses and Dissertations--Nutrition and Food Systems

Rural children experience increased rates of obesity and reduced access to specialized weight management facilities, which makes receiving the recommended frequency of care difficult. Clinical-community partnerships, recommended by the American Academy of Pediatrics (AAP) to expand access, have been shown to be a feasible strategy of care delivery. Examination of literature and stakeholder interviews were used to inform the development of a collaborative pediatric weight management program in a rural, Appalachian community. Screening articles as well as intervention articles were reviewed. Outcomes of screening articles reviewed included BMI measures (3), screening practices (7), and referral practices (4). Common outcomes of …

Impact Of Insurance Payer On Stage At Diagnosis Of Prostate Cancer, Hunter M. Stiff

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

Objectives: Prostate cancer (CaP) is the most common site of cancer in men in the United States and is very treatable when diagnosed in localized and regional stages. While there are widely available forms of screening that can detect CaP in its early stages, factors that can affect healthcare access such as health insurance, race, and Appalachian residency have been linked with differences in rates of distant-stage CaP diagnosis. This study aimed to explore the relationships between health insurance, race, Appalachian residency, and late-stage CaP diagnosis in the state of Kentucky.

Methods: A sample of 26,622 men from the state …

A Case Study In Program Evaluation: Evaluation Of A Hypertension Self Management Program, Bailey N. Schenk

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

The CDC's program evaluation process framework is a six-step approach that guides public health practitioners in the evaluation of public health programs. The framework includes engaging stakeholders, describing the program, focusing the evaluation design, gathering credible evidence, justifying conclusions, and ensuring use and sharing of lessons learned. Each step is important in developing a comprehensive and effective program evaluation. This evaluation discusses the application of the six steps of the CDC's program evaluation process framework and how it was utilized in evaluating a hypertension self-management program at a local health department.

Prevalence Of Multimorbidity In The Atherosclerosis Risk In Communities Study At Baseline, Katie Highfill

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

Aim: The aim of this study is to examine the prevalence of multimorbidity among middle-aged adults in the Atherosclerosis Risk in Communities Study at baseline by examining the demographic and socioeconomic characteristics of the participants.

Methods

I included 15,698 participants from the Atherosclerosis Risk in Communities (ARIC) baseline visit. Participants were randomly selected from 4 different locations in the United States. Multimorbidity was defined as the prevalence of 2 or more chronic conditions in an individual. Three different multimorbidity definitions (MM1, MM2, and MM3) were created with different inclusion criterion. Prevalence of each multimorbidity definition was analyzed among participants using …

Epidemiology Of Sars-Cov-2 Breakthrough Infections In Kentucky March 1st 2021 - December 31st, 2022, Harrison Hynes

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

Objective: Provide epidemiologic overview of SARS-CoV-2 breakthrough infections in Kentucky considering both demographic and geographic variables.

Background: We believe descriptive information of breakthrough cases for a defined population will provide public health practitioners with useful information relating to SARS-CoV-2 infection control and vaccination efforts.

Methods: We obtained SARS-CoV-2 case data from the Kentucky Department for Public Health COVID-19 case repository, which mirrors National Electronic Disease Surveillance System (NEDSS) data. The study sample used for analysis comprised 147,000 individuals who tested positive for SARS-CoV-2 in Kentucky between the dates of March 1^st, 2021 and December 31^st, 2022. …

Real-Time Surveillance Of The Drug Epidemic: An Assessment And Comparative Visualization Of Substance Abuse In The Commonwealth Of Kentucky, Julia Van Hosen

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

The purpose of this study was to implement and examine a new surveillance system for Kentucky State Police’s forensics unit to track trends of illicit drugs and drug trafficking, and to see if the implementation of this new system was associated with a decrease in overall drug counts over a period of five months. An extensive review of the literature showed that the drug epidemic in the United States continues to worsen, with public health and law enforcement institutions leading the fight in attempting to end the epidemic, but little evidence showing these two joining forces to work together.

Results …

Changes In Severity Of Diabetes At Diagnosis Following The Onset Of The Sars-Cov-2 Pandemic, Annelise King

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

During the SARS-CoV-2 pandemic it was seen that diabetes was a risk factor for severe COVID-19. The objective of this study is to assess the severity of diabetes at diagnosis during the COVID-19 pandemic compared to pre-pandemic to see how the pandemic and SARS-CoV-2 infection impacted the severity of diabetes. This study used University of Kentucky electronic health records of 13,794 patients who developed diabetes. The majority of patients were female, white non-Hispanic, 65+, and living in an urban area. There were differences seen between the COVID-19 positive and negative cohorts in the DKA and HbA₁c variables, with …

Saint Louis, Missouri Maternal Mortality Prevention Program: Rose Program, Abbi Peck

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

In the United States, maternal mortality has become a growing public health concern after recent studies revealed significant disparities in maternal health outcomes when compared to other high-income countries (The Commonwealth Fund, 2020). The World Health Organization (WHO) defines maternal mortality as the death of a pregnant woman or the death of a woman within 42 days of delivery, miscarriage, termination, or ectopic pregnancy (Centers for Disease Control and Prevention, 2022a). From 2017-2019, the maternal mortality in Saint Louis, Missouri, the state’s largest and most populated metropolitan area, was determined to be 36.4 maternal deaths per 100,000 live births. This …

Health Management And Policy Capstone: A Case Study In Program Evaluation, Kelsey R. Gatton

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

Program evaluation of a hypothetical comprehensive hypertension self-management program as directed by the CDC Framework for Program Evaluation in Public Health.

The Prepare Mobile Program For Hiv Prevention In Washington D.C., Gabrielle Cochran

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

Incidence rates of HIV have decreased in the United States in the past decade, but the southern United States has higher rates of HIV than other regions, and cities in the south, like Washington D.C., have some of the highest rates of HIV incidence in the nation. Risky sexual behavior, needle sharing, and substance use increase the risk of transmitting or acquiring HIV, and these behaviors are more common among unhoused people (CDC, 2021; CPPH, 2022).

Expansion of community resources in cities with high levels of HIV have allowed for many people at high risk for HIV to comply with …

Rapid Scoping Review Of The Epidemiological Evidence For Mercury Exposure And Prevalence Of Alzheimer’S Disease, Rebecca Mattingly

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

This rapid scoping review examines the current body of epidemiologic research evaluating the potential linkage between environmental exposure to mercury and Alzheimer's disease (AD). Alzheimer’s disease accounts for 60-80% of all neurodegenerative disease in the United States and was the seventh leading cause of death in Kentucky in 2020. The exact etiology of AD needs further investigation; however, environmental factors such as pesticides, arsenic, cadmium, lead, and mercury have been correlated with development of AD lesions, cognitive decline, and AD. Mercury is a toxic metal that can be found in air, water, and soil, both from natural and human-made sources. …