Digital Commons Network^™

Improving Dental Students' Knowledge And Confidence In Treating Tobacco Use, Victoria Pierce

DNP Projects

Background: Tobacco use can lead to numerous chronic health conditions. Healthcare professionals in the dental field are in a unique position to broach this issue with patients. Research shows that dental students do not feel equipped to provide tobacco cessation care, citing lack of education on the subject among their top reasons for this.

Purpose: The purpose of this project was to evaluate changes in dental students’ knowledge and confidence related to treating tobacco use after participation in an educational intervention about the 5A’s, behavioral counseling, and first-line prescription medications.

Methods: This quality improvement initiative utilized a quasi-experimental survey design …

Evaluating Healthcare Workers’ Knowledge, Attitudes, And Practices Regarding Language Access Services In The Clinical Setting, Rachel Archibald

DNP Projects

Background: Barriers to accessing and understanding healthcare can place patients with low English proficiency at an increased risk of poor health outcomes. Language-based inequities in healthcare exist due to lack of interpretation and translation services available, lack of healthcare workers’ knowledge of resources, and/or perceptions that these services require too much time or effort. Failing to address barriers affecting this population leaves them vulnerable in the healthcare setting.

Purpose: The purpose of this DNP project was to educate nurses, providers, and staff on an inpatient unit at a rural hospital of the language interpretation resources available, best practices for implementation, …

Provider And Staff Education Surrounding Universal Hcv Screening And Linkage To Care In An Ambulatory Care Setting, Lauren Clifford

DNP Projects

Abstract

Background: In the United States, it is estimated that there are more than 2 million cases of Hepatitis C (HCV), with over 66,000 new cases since 2020 However, an estimated 75% of those with HCV go undiagnosed and less than 35% receive treatment within a year of diagnosis. In 2018, UK Healthcare (UKHC) implemented a universal HCV screening method using a Best Practice Advisory (BPA) for anyone 18 and older who presented to the Emergency Department and had labs ordered. Patients who screened positive were then referred to outpatient clinics for HCV treatment. Approximately ten percent of positive patients …

Adverse Outcomes Of Co-Occurring Methamphetamine And Opioid Use Among Pregnant And Postpartum Women, Hope Tevis

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

Background

Overdose mortality rates increased significantly between 2018 and 2021 in the United States (NIH, 2023). Moreover, pregnant and postpartum women (PPW), who were aged 35 to 44 were observed to have the highest overdose mortality rates (NIH, 2023). Although there is existing research that examines the increase of co-occurring opioid and methamphetamine use, it still remains understudied when specifically focusing on PPW. This analysis intends to explore this gap in research by 1) exploring the history of co-occurring methamphetamine and opioid use among PPW who were seeking residential treatment, 2) highlighting the adverse health outcomes that follow co-use among …

Implementation Of A Postpartum Depression Program In A Rural Kentucky County, Abby Cecil

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

This paper aims to describe the process of implementing a Postpartum Depression (PPD) prevention program in low-income women residing in rural communities. The paper describes the process of recruiting women in this population, where and how the program will be integrated into an existing clinic, and how the program will be sustained. PPD is a significant global public health problem that can be prevented and treated. The ROSE program (Reach Out, Stay Strong, Essentials for new mothers) is a series of classes that provide informational and social support to prevent PPD. This evidence-based program has been previously successful in reducing …

Team Up Against Overdose Deaths, Mary Elizabeth Pendergrass

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

This grant proposal describes a community collaboration strategy for reducing overdose deaths. Utilizing a Community Advisory Board, the goal of the project is to increase awareness, knowledge, and usage of the Good Samaritan Law to obtain emergency medical care.

Improving Black Maternal Outcomes In Christian County, Ky: A Social Marketing Approach To Perinatal Provider Change, Ariel A. Arthur

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

Compared to other states in the country, Kentucky has historically poor population health outcomes. While the statewide maternal mortality rate is 16.1 per 100,000 live births, this statistic belies the stark racial disparities that exist. In 2018, the pregnancy-related death rate for Black women was 40.2 per 100,000 live births compared to 13.1 for White women. This pattern is persistent even after controlling for socioeconomic status, prenatal care, and other protective factors. Research shows that institutional and interpersonal racism when receiving obstetric care contributes to poor childbirth and postpartum outcomes for Black women. Additionally, geography and rural status may compound …

The Performance Of Marginal Modeling Methods For Rare Events With Application To Opioid Overdose Mortality And Morbidity, Shawn Nigam

Theses and Dissertations--Epidemiology and Biostatistics

Opioid misuse is a nationwide epidemic, with Kentucky having one of the highest opioid overdose-related fatality rates across all US states. These rates have increased significantly over the past decade, with particularly large increases during the COVID-19 pandemic. This dissertation aims to study the behavior of these increases and the methods for the marginal modeling of count outcomes related to opioid overdose.

Opioid overdose-related fatality rates in Kentucky increased significantly during the COVID-19 pandemic. In this chapter, we characterize the changes in opioid overdose fatality rates in Kentucky and identify associations between potential factors and fatality rates. County-level opioid overdose …

Associations Between Physical Activity Levels And Physical And Mental Health In Military Veterans., Troy Hubert

Theses and Dissertations--Psychology

Research suggests that higher rates of health conditions are associated with lower levels of physical activity, but this association is not well characterized in U.S. Military Veterans. The current study utilized a sample of U.S. military veterans (n = 3,989) from the 2019-2020 National Health and Resiliency in Veterans Study (NHRVS). Physical activity levels (insufficient, moderate, and active), physical and mental health were evaluated with a variety of self-report questionnaires. After controlling for covariates, veterans with any disability, asthma, chronic pain, diabetes, high cholesterol, and stroke were significantly less likely to report sufficient physical activity compared to insufficient physical …

Maternal-Adolescent Communication About Sex And Risky Sexual Behaviors: A Cross-Cultural Comparison Of Czech, Spanish, And Taiwanese Youth, Mckinley Hall

Theses and Dissertations--Family Sciences

This present study aimed to test the relationship between perceived maternal-adolescent communication about sex and risky sexual behaviors, while also considering the links between perceived maternal-adolescent closeness and maternal-adolescent conflict with risky sexual behaviors, across three culturally distinct countries, namely the Czech Republic (N=878, mean age of 17.93), Spain (N =1024, mean age of 18.79), and Taiwan (N =1443, mean age of 16.48). Samples of adolescents from each country were used and statistical analyses were conducted to test the hypothesized relationships. Based on path analysis carried out on each sample, the results revealed that Czech adolescents reported the highest levels …

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, …

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 …

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 …

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 …

Fork It, Kylee Pipgrass

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

Obesity prevalence is at an alarmingly high rate within the United States, but especially in rural areas of Kentucky. Obesity can lead to a variety of negative physical health outcomes including heart disease, diabetes, stroke, and some cancers. There are also mental disorders associated with obesity through mechanisms such as weight stigma and self-perception. Similar to obesity rates, prevalence and mortality associated of these health outcomes are also seen at disproportionately higher rates in rural, Appalachian Kentucky. Causes for increased obesity and obesity related consequences include some genetic factors as well as behavioral factors like physical inactivity, poor diet, stress, …

Roadway Density And Lung Cancer Histology In Kentucky, Mahala Pettus

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

The purpose of this article was to examine the relationship between a proxy measure of exposure to automotive exhaust – roadway density – and risk for adenocarcinoma lung cancer. Using data from the Kentucky Cancer Registry and the Kentucky Geoportal Data Clearinghouse, we conducted a cross-sectional study of the distribution of adult lung cancer cases by histological type across the state of Kentucky. The north-central region of Kentucky has a higher prevalence of adenocarcinomas and greater roadway density. Among adenocarcinoma cases in Kentucky, there are more non-smokers than other types of tobacco use. As smoking rates decrease in Kentucky, and …

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 …

Implementation Of A School-Based Adolescent Pregnancy Prevention Program In Harlan County, Kentucky, Jaycea Frederick

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

Kentucky has the 6^th highest rate of adolescent pregnancy in the United States and Harlan County ranks among the highest rates in the state. Adolescent pregnancy is a public health problem and costs taxpayers in the United States around $9.4 billion each year. Overall, there have been declines in adolescent pregnancy but the national average soars above those in other Western industrialized nations such as the United Kingdom. Implementing a comprehensive sexual health education program in a public school setting is an efficient strategy to reach numerous adolescents and influence sexual health knowledge and help to delay the initiation …

Sociodemographic Factors Related To Late-Stage Lung Cancer Diagnosis In Kentucky, Kaylee Stickler

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

Lung cancer is the leading cause of cancer mortality in the United States, and the state of Kentucky has a significant burden of lung cancer morbidity and mortality. The aim of this study is to examine the sociodemographic factors associated with late-stage lung cancer diagnosis in Kentucky. The present study is a retrospective, population-based cohort study that utilizes data from the Kentucky Cancer Registry to examine the associations between late-stage lung cancer diagnosis and sociodemographic factors. Descriptive, bivariate, and multivariable analyses were conducted to estimate the significance of these associations. Significant relationships between the variables of sex, age, Appalachian status, …

Covid-19 Vaccine Acceptance, Hesitancy, And Refusal Among Educators In Spring Of 2021, Jenifer O'Brien

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

The COVID-19 pandemic provided unprecedented vaccine development and deployment. Educators were among the first non-healthcare occupations to become eligible for the vaccine, and were an early predictor of vaccine hesitancy especially among educated females. By the spring of 2021, 87% of teachers had received at least one dose of the COVID-19 vaccine. Among those who expressed hesitancy, no defining demographic factors were found. Those who expressed hesitancy commonly cited a rushed vaccine development process and fear of long term side effects as reasons against vaccination.

Gender Differences In Barriers To Entering Substance Use Treatment, Casey A. Baker

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

Background

Nationally representative data have indicated that less than one in ten individuals with a substance use disorder (SUD) have received recent treatment, suggesting a need for research to examine potential barriers to SUD services. Although research has been conducted to identify some barriers to treatment, there is little research focused on gender differences. To address this gap in research, the present study aimed to examine gender differences in barriers to entering SUD treatment, as well as differences in factors that may impact decisions to enter treatment.

Methods

Participants (N = 62) were recruited from the community as part of …

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 …

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 …

Food Insecurity On College Campuses: Addressing The Issue Through A Student-Centered Perspective, Thomas Ard

Theses and Dissertations--Kinesiology and Health Promotion

Research indicates food insecurity (FI) has become a consistent challenge for college students. However, more is needed regarding the students' lived experiences of food insecurity following the COVID-19 pandemic. Universities play a vital role in assisting students with food insecurity through food assistance programs, on-campus resources, and financial help, which impacts their physiological needs and academic performance. A better understanding of what influences students' perceptions and decisions about whether to engage in these resources is essential.

This dissertation's purpose was to explore how college students living with food insecurity experience engaging in food assistance programs (FAP). The study used a …

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 …

Genetic And Pharmacogenetics Associations Of Cancer Disparities In Appalachia, Nan Lin

Theses and Dissertations--Pharmacy

Individuals residing in Appalachian regions have significant health disparities, including higher cancer incidence and mortality rates. Previous studies have addressed the impact of socioeconomic status and environmental risk factors on Appalachia cancer disparities, while few studies have evaluated genetic risk factors.

Germline whole exome sequencing samples from 7,078 individuals with cancer (759 Appalachians) were evaluated. Demographics and relatedness were assessed using KING. Ethnicity was verified by principal component analysis using TRACE, which included 6,034 individuals (85%) of European genetic ancestry. After QC filtering, 5,980 individuals were analyzed. To assess the overall predisposition of hereditary disease, gene level frequency of likely …

Maximal Strength Training Increases Metabolic Energy Expenditure In Sedentary Adults Classified As Obese, Robert E. Anderson Iii

Theses and Dissertations--Nutrition and Food Systems

Background: Metabolic adaptations reduce resting and non-resting energy expenditure to account for approximately 120 kcal/day. Weight loss promotes greater skeletal muscle efficiency, reducing the energy cost of physical activity and is correlated with declines in skeletal muscle glucose oxidation. Maximal Strength Training (MST) has the potential to upregulate glucose utilization and may offset these metabolic adaptations. Objective: To determine if MST offsets markers of metabolic adaptation by increasing resting and non-resting energy expenditure in sedentary individuals classified as obese. Methods: Five (5) participants (2 females, 3 males), ages 18-35 years, with obesity (BMI 30–45 kg/m2) were enrolled in an 8-week …

An Examination Of Three Transitional Events In The Substance Misuse Trajectories Of Women With Criminal Legal System Involvement, Martha Tillson

Theses and Dissertations--Sociology

Research has consistently demonstrated that criminal legal system (CLS)-involved women are distinct from men in initiation and course of drug use, with important differences on biological, environmental, and sociocultural levels. Thus, the unique pathways and transitions into and out of drug use for women with CLS involvement are critical to consider from a research perspective, but also from a need to develop and support evidence-based, women-centered services in correctional contexts. This dissertation project uses a three-paper format to investigate three aims: (1) to understand CLS-involved women’s initiations to injection drug use and their experiences providing injection initiation assistance (IIA) to …

Opioid Use Disorder Treatment With Buprenorphine: Analysis Of Treatment Utilization And Associated Outcomes In Kentucky, Feitong Lei

Theses and Dissertations--Epidemiology and Biostatistics

Opioid use disorder (OUD) is chronic opioid use that results in clinically significant suffering, impairment, or even death. The opioid epidemic in the United States has become a public health and economic crisis, affecting patients' well-being and the nation's overall health and welfare. Eastern Kentucky was among the first regions affected by the opioid crisis, and Kentucky has historically ranked among the top five states for age-adjusted drug overdose mortality rate.

There are three medications (buprenorphine, methadone, naltrexone) approved by the U.S. Food and Drug Administration to treat OUD. As a partial opioid agonist, buprenorphine is a safe medication for …