Digital Commons Network^™

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 …

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 …

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 …

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.

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 …

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 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 …

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 …

Birth Cohort Effects In Risk Factors For Alzheimer’S Disease, Kingsley Uzodinma

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

Background and Objectives: The purpose of this study was to assess the presence of birth cohort effects by exploring differences in established risk factors of Alzheimer’s disease (AD) and dementia using case-control designs and also estimate the AD risk among women with respect to their number of biological children.

Methods: This is a case control study design of participants born in 1896 – 1955 and were enrolled in one of the designated Alzheimer’s disease centers (ADCs). The uniform Data Set of the National Alzheimer’s Coordinating center (NACC) include those who had Alzheimer’s disease or mild cognitive impairment (cases) and were …

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 …

Correlates Of Hepatitis C Serostatus Disclosure In Rural Appalachian Kentucky, Megan G. Hofmeister

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

Aim: To identify demographic, behavioral, and interpersonal characteristics associated with hepatitis C (HCV) serostatus disclosure among adult, rural, high-risk people who use drugs (PWUD) in Appalachian Kentucky.

Methods: Laboratory confirmed HCV antibody-positive participants (n=243), drawn from the fifth follow-up assessment of a longitudinal study of rural PWUD, completed interviewer-administered questionnaires eliciting demographic and interpersonal characteristics, risk behaviors, and information on HCV disclosure. Correlates of HCV disclosure were assessed using logistic regression.

Results: Most (69.1%) reported disclosing their HCV-positive status to at least one of their social referents (current or past sex partners, current or past injection drug use (IDU) partners, …

Self-Rated Diet Health: Socioeconomic And Health Related Correlates, Emily B. Bell

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

BACKGROUND: Two-thirds of Americans are overweight or obese, increasing their risk for multiple chronic diseases. Self-rated diet health may be useful in public health efforts to prevent the negative consequences of overweight/obesity. This study aims to identify sociodemographic and health-related correlates of the NHANES self-rated diet health question.

METHODS: The 2009-2010 NHANES data for adults 20 years and older were used. Sociodemographic and health-related variables were investigated with selfrated diet health as the outcome. First, bivariate analyses determined associations of each variable with self-rated diet health. Those associated with pvalues ≤.25 were included in two multiple ordinal logistic regression models. …

Social Network Analysis Of Cellphone Surveillance Data For Ebola In Sierra Leone, Jia B. Kangbai

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

Aim: To explore and visualize the connectivity of suspected Ebola cases and surveillance callers who used cellphone technology in Moyamba District in Sierra Leone for Ebola surveillance, and to examine the demographic differences and characteristics of callers who make more calls as well as more likely to make at least one positive Ebola call.

Methods: Surveillance data for 393 suspected Ebola cases (192 males, 201 females) were collected from October 23, 2014 to June 28, 2015 using cellphone technology. UCINET and NetDraw were used to explore and visualize the social connectivity between callers and suspected Ebola cases. Poisson and logistic …

Drink Switch Program In South La Schools, Lauren Barker

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

Sugary drinks, including sports and energy drinks, are the number one source of added sugar in the American diet.1 Excess sugar consumption can lead to health complications such as overweight and obesity, and obesity-related chronic diseases such as diabetes, high blood pressure, and cardiovascular disease.2 Sugary drink consumption among youth in Los Angeles is particularly high, and teenagers in Service Planning Area (SPA) 6 of Los Angeles have some of the highest consumption rates in the county, with one out of two reporting consuming at least one sugary drink per day.3 Based on the correlation between sugar consumption and health, …

Self Center: Addressing Teen Pregnancy In Wolfe County, Ky, Lindsey Smith

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

Teen pregnancies and births are at an all-time low across the United States. Despite this decline in rates within the last decade, the teen pregnancy rate in Kentucky remains significantly higher than that of the overall United States. Additionally, teen pregnancy still has significant economic and health impacts on both teen parents and their children. In rural communities, such as Wolfe County, KY, teen birth rates are approximately one-third higher than the rest of the country. Self Center is an evidence-based teen pregnancy prevention program that involves school-linked reproductive health services and provides participants with education, counseling, and healthcare services. …

Equine Leptospirosis Seroprevealence In The Central And Bluegrass Regions Of Kentucky From 1993 - 2015, Charlene Siza

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

BACKGROUND

Leptospirosis is a worldwide zoonotic bacterial disease of significant importance for both human and animal health. There are many sources of infection and shedding of the bacteria, including horses. There is a known occupational hazard for leptospirosis, especially in occupations that work directly with animals or animal products. This study examined the prevalence of equine leptospirosis in Kentucky in relation to trends over time and geographical distribution.

METHODS

Data was obtained from the University of Kentucky Veterinary Diagnostic Laboratory(UKVDL) on equine leptospirosis from 1993 through September 2015. Overall seropositive prevalence and prevalence stratified by serovar were calculated. Furthermore, distribution …

Epidemic And Opportunity: American Perceptions Of The Spanish Influenza Epidemic, Jonathan Chilcote

Theses and Dissertations--History

During the final months of the Great War, the loss of human life was not confined to the battlefields of Western Europe. The Spanish influenza virus was rapidly spreading around the globe¸ and would ultimately leave millions dead in its wake. Some American groups, both public and private, saw the pandemic as a blessing in disguise. They interpreted the pandemic as a sign that their work, whether religious, political, commercial, or health, was more vital to the world than ever before. Influenza reinforced their existing beliefs in the rightness and necessity of their causes, and used the pandemic as a …

Trends In Drug Use During Suicide, 2005-2012, Kentucky, Jacqueline Seals

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

Objective

With high rates of suicides worldwide more research on suicide is necessary for improved prevention strategies. This study examines the trends of positive drug tests at the time of suicide in Kentucky with respect to region, time, and intrapersonal violence.

Methods

Data from the Kentucky Violent Death Reporting System was used to look at all suicides in Kentucky from 2005 to 2012 amongst individuals 10 or older (n= 4691). Trends of opiates, amphetamines, cocaine, marijuana, benzodiazepine, and barbiturates were examined. The relationship of a positive drug test and time and intrapersonal violence were evaluated with an ANOVA test and …

Injury Prevention In An Industrial Environment Via Strategic Job Placement, Michelle Cooper

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

Objectives. This study investigated the effects of an injury prevention program, specific to work related musculoskeletal disorders (WMSDs), which placed employees into jobs based on their physical abilities compared to the physical demands of their prospective jobs.

Methods. Employee injury data (N=3550) from a large auto manufacturer in the U.S. was analyzed to examine changes in injury rates for employees that were hired pre versus post-strategic placement. Bivariate and multivariate analyses were used to determine dependence between placement, injury within 120 days of hire and gender.

Results. Chi-square tests of independence revealed that injury rates and job placement may be …

The Relationship Of Hispanic Ethnicity, Drug Use, And Bullying With Suicidal Ideation Among Adolescent Females In The 2013 Youth Risk Behavior Surveillance Survey, Erin Camp

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

BACKGROUND: There is little research on the relationship of Hispanic ethnicity, drug use, and bully victimization with suicidal ideation among adolescent females. This study investigates all components and their association with suicidal ideation using the 2013 Youth Risk Behavior Surveillance Survey (YRBSS).

METHODS: Participants were 6,621 adolescent females who completed a self-administered questionnaire (YRBSS). Students answered a series of questions regarding unintentional injuries and violence and alcohol and other drug use.

RESULTS: Results indicated that there was an association between drug use, bully victimization, and suicidal ideation. Bivariate analyses using chi-square tests showed the relationships between these risk factors and …

Correlates Of Depression And Poor Respiratory Health: A Cohort Study In A Rural County, Stephanie Courtney

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

Objective

High rates of depression are widespread globally and are among the leading causes of disability. To better understand the effects of depression on health outcomes, more research is necessary. This study examines the associations between depression and adverse respiratory outcomes among a cohort of Iowa residents living in a rural county. This study also investigates differences in the reporting of chronic and incident respiratory outcomes.

Methods

Data were obtained from the Keokuk County Rural Health Study (1994-2004) for individuals 18 years of age or older (N=1012). The primary outcome, poor respiratory health (PRH), was based on self-reported diagnoses for …

Healthcare Industry Injuries By Patient Contact Status In Kentucky, 2012-2014, Kristen Ranzenberger

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

Objectives

The healthcare industry continues to have a high number of reported injuries. The purpose of this study was to 1) characterize healthcare industry injuries by patient contact status; 2) identify the occupations associated with healthcare injuries by patient contact status; and 3) determine healthcare injury rates by occupation, to gain a better understanding of healthcare industry compensated injuries , and better target healthcare industry safety practices and programs.

Methods

Workers’ Compensation first reports of injuries (FROI) from the healthcare industry in Kentucky were categorized into injuries involving in direct patient contact vs. injuries without direct patient contact using narrative …

The Role Predictors Of Socioeconomic Status Play In Receipt Of The Shingles Vaccination In Adults Aged 50 Years Of Age And Above In The United States, Lesley Williams

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

Introduction: Vaccinations help to prevent deleterious diseases or lessen their side effects, saving millions in healthcare expenditures. While we associate most vaccinations with children, there are specific vaccinations that are indicated in the elderly. The shingles, or herpes zoster, vaccination is indicated in all adults over the age of 50 years of age to prevent the development of or lessen the severity of shingles – the re­‐emergence of chickenpox in the form of painful blisters on the body, however, statistics indicate that only around 20% of the indicated population has ever received that vaccination. Why have so few been …

Concealed Weapon Proliferation And The Impact On Firearm-Related Fatalities And Injuries Due To Assault In Kentucky, 2005-2013, Travis Young

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

Objectives: The objective of our research was to look broadly at firearms and health in the state of Kentucky, where annual gun purchases are rising and laws eliminating restrictions on concealed carry have empowered more than 300,000 citizens to carry firearms in virtually any public setting. As guns become more prevalent, and more readily accessible, will violent crime decrease as some have predicted, or will the potential for conflict escalation cause the opposite effect?

Methods: Utilizing death records for firearm-related homicides and hospitalization and emergency department visit data for injuries occurring due to firearm-related assault, we correlated the rate of …

Pulmonary Function Among Latino Thoroughbred Workers - A Pilot Study, John C. Flunker

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

Background/Objectives

Evidence suggests working in horse barns is associated with adverse respiratory effects among Latino thoroughbred workers, yet no studies to date have measured pulmonary function. We examined the prevalence of self-reported respiratory symptoms, abnormal pulmonary function, and associated occupational factors among Latino thoroughbred farmworkers.

Methods

Participants were recruited via a community-based, purposive sampling strategy and participated in an interview-administered survey and spirometer test. Surveys and spirometry tests were administered to 80 participants by two trained health promoters (Promotoras) in July-September 2014. Pulmonary function (abnormal/normal) was classified by a pulmonologist. Demographic and occupational factors were assessed for associations with respiratory …

The Comorbidity And Temporal Relationship Between Anxiety Disorders, Eating Disorders, And Personality Disorders, Mitchell C. Duross

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

Background - Population-level data on the prevalence of comorbidity between anxiety-, eating-, and personality disorders remain relatively unexplored. Additionally, the potential existence of a temporal relationship among these three classes of mental disorder is also of interest.

Methods - Lifetime prevalence of, and temporal relationships among, anxiety-, eating-, and personality disorders were assessed using Part II WHO Composite International Diagnostic Interview data from the National Comorbidity Survey- Replication, a nationally representative household survey (n=5692).

Results - Lifetime prevalence estimates for any anxiety-, eating-, and personality disorder were 59.8%, 2.8%, and 13.5%, respectively, among those diagnosed with at least one core …

The Impact Of Physical And Psychosocial Factors On Workplace Injuries In Nursing Assistants, Colleen Roberts

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

Objective: The objectives of this study were to 1) Describe the nature and prevalence of workplace injuries in nursing assistants (NAs) and 2) Assess the impact of physical and psychosocial works factors on the occurrence of back injuries and muscle strains in these nursing assistants.

Methods: Data for this study are from the 2004 National Nursing Assistant Survey (NNAS), which was conducted as a supplement to the National Nursing Home Survey (NNHS). The original dataset contained 3,017 records. The data were analyzed as a case-control for this study’s purpose. Cases were defined as participants who had experienced a …