Digital Commons Network^™

Evaluation Of Anemia In Communities Served By Shoulder To Shoulder Global: A Cross-Sectional Study In Santo Domingo, Ecuador, Kevin Mercer

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

BACKGROUND: Shoulder to Shoulder Global (STSG) recognizes anemia as a cause of morbidity among patients in Santo Domingo, Ecuador. Little research has been done to assess targetable anemia risk factors to serve as a foundation for future pharmacotherapeutic interventions. This study sought to identify risk factors for anemia in this population.

METHODS: Data obtained from existing patient records from January 1, 2010 to August 31, 2016 included hemoglobin/hematocrit, age, sex, pregnancy status, and presenting community. Chi-square tests compared means to examine risk factors associated with anemia. Poisson regression and incidence rate ratios (IRR) were used to estimate risk factors associated …

Describing Independent And Chain Pharmacies Within The Kentucky Medicaid Network, Kimber Woodrum

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

The shift in healthcare towards cost-savings mechanisms is hindering business operations of pharmacies in Kentucky, especially independent pharmacies. Independent pharmacists have reported that the operations of pharmacy benefit managers within Kentucky Medicaid networks have created financial hardships for their pharmacies and there is a threat of closure that could be associated with a potential access barrier to pharmacy services for Medicaid beneficiaries. During legislative meetings, much focus was on this issue and several bills are currently being drafted to correct this issue. It is important to define independent pharmacy and describe, geographically and in terms of utilization, chain and independent …

Statistical Analysis Of Rabies Submissions In Kentucky And Weather As A Potential Predictor Of Positive Cases, Hannah Free

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

Background

The rabies virus is a zoonotic pathogen that is nearly 100 percent fatal once symptoms occur. Because it is still active in wildlife populations in Kentucky, the need for preventive measures and surveillance is critical. Temperature and precipitation have been shown to affect rabies. This study examined rabies submissions in Kentucky, weather and geographical distribution to both describe and predict cases.

Methods

Data from the University of Kentucky Veterinary Diagnostics laboratory were used to assess rabies submissions from 2005 through 2015. These submissions were anonymously submitted by the public and the Florescent Antibody Test was used to determine infection …

Wayne County Board Of Education Adaptation Of Love Notes Curriculum For Adolescent Pregnancy Prevention, Allison Shea Merritt

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

West Virginia has the 8^th highest rate of adolescent pregnancy in the United States and the rate in Wayne County is significantly higher. Adolescent pregnancies cause negative health outcomes for both the baby and the mother. Adolescent mothers are at an increased risk of anemia, preeclampsia, and preterm labor and babies born to adolescent mothers are more likely to have a low birth weight and to have cognitive impairment. To address this burden, the school board has decided to use the ADAPT-ITT framework on the evidence-based Love Notes adolescent pregnancy prevention curriculum to adapt it to be more culturally …

The Use Of A Video-Based Intervention To Motivate Gay And Bisexual Men On Prep To Use Condoms, Ethan Cardwell

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

Based on need and available resources, gay and bisexual men who have sex with men (GBMSM) in the Castro neighborhood of San Francisco, California represent the target population for this intervention. Through funding by the Center for Disease Control the Strut Clinic in collaboration with the University of California Berkley is proposing a video-based intervention with the following SMART objectives.

Objective 1: Efficiently develop and integrate a video-based intervention in the Strut Clinic within the first six months of the funding cycle.

Objective 2: Sustain an increase of consistent condom use to 30% of participants and up to a 10% …

An Assessment Of Agreement In Detection Methods For Histophilus Somni In Bovine Lungs, Laura Michelle Arnold

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

Objectives: To examine the inter-laboratory agreement between multiplex realtime quantitative polymerase chain reaction (qPCR) assay results and aerobic culture results on bovine lung samples for detection of Histophilus somni (HS), and to assess associations of laboratory-derived factors on test agreement.

Methods: A survey of records from the University of Kentucky Veterinary Diagnostic Laboratory (UKVDL) was conducted to evaluate test results from grossly pneumonic bovine lung samples submitted during the period April 1, 2015 through August 31, 2018. Cohen’s kappa coefficient with 95% confidence interval (CI) was calculated to describe the extent of agreement. Animal, environmental and laboratory factors were examined …

Microclinic International Social Network Behavioral Health Intervention In Mongolia, Kalli A. Beasley

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

Diabetes is a chronic communicable disease that is projected by 2030 to be the seventh leading cause of death worldwide. In Mongolia diabetes and cardiovascular disease are the number one reason for disability-adjusted life years and trends of diabetes is starting to be observed in the poorer populations. Diabetes in countries like Mongolia are extremely costly to treat using insulin, costing $200 USD per month while the average annual income sits only at $1,466.85 USD. Mongolia has a total population of 2,959,000 and half of its population resides in the capital city of Ulaanbaatar. 60% of residents in capital live …

Prospective Policy Analysis Of The Kentucky Health Demonstration Waiver, Keahna Akins

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

In January 2018, the Centers for Medicare & Medicaid Services approved Kentucky’s Section 1115 Medicaid demonstration waiver, which gave the state approval to require work/community engagement as a condition of Medicaid eligibility, charge premiums of up to 4% household income, and add an incentive account for dental and vison services. The waiver projected nearly 100,000 fewer enrollees and $2.4 billion less in spending over the five-year demonstration period. Two days short of the waiver July 1st implementation date a federal judge ruled the waiver invalid. This finding held that the Health and Human Services Secretary’s judgement was arbitrary and capricious. …

A Program Evaluation Of A Colon Cancer Screening Program Using At-Home Fecal Immunochemical Tests With Certified Patient Navigators, Candace E. H. Brunk

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

Colorectal cancer is the second leading cause of cancer-related death in this country, but 33% of these deaths could be prevented by screening. While colonoscopy is an effective screening tool, it is expensive, invasive, and prone to encounter considerable patient resistance. An alternative is to first screen those at-risk using at-home fecal immunochemical test (FIT) kits. This study determined factors associated with the return of these kits distributed by Kentucky CancerLink, a non-profit organization, and its affiliates to participants in a colon cancer prevention program.

Objectives: To identify factors associated with: completing a FIT kit, completing the kit with minimal …

The Financial Impact Of A Healthy Eating Intervention In A Government Worksite Cafeteria, Andrew M. Wheeler

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

Unhealthy eating habits are associated with a greater risk of obesity and many chronic diseases. Historically, public health nutrition interventions have focused on education of the individual to induce dietary behavior change. However, given that many factors influence food choices, more comprehensive interventions that address these multiple factors are needed. Worksite cafeterias provide a unique opportunity to intervene at multiple levels of influence on employees eating habits. In this paper we used cafeteria sales data to evaluate the changes in purchases and the financial impact of implementing a healthy eating intervention using an environmental change and various promotional efforts to …

Overdose Prevention And Naloxone Distribution In Jefferson County, Brittany Coleman

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

The United States in battling an opioid epidemic, and rates of overdose fatality have soared to record highs. Kentucky is among the states with highest rates of opioid overdose fatality, and Jefferson County is responsible for about a quarter of all cases. Overdose Prevention and Naloxone Distribution (OPND) programs have been shown to decrease fatality rates by providing a medication that literally reverses opioid overdose. The programs provide other services such as education and connection to recovery facilities.

Currently, the Kentucky Harm Reduction Coalition provides naloxone kits to the residents of Jefferson County, but they do not have a regular …

“You’Re Not Alone In This”: Navigating Patients To Colorectal Cancer Screening In Appalachian Kentucky Communities, Audrey Bachman

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

In eastern Kentucky, some communities experience colorectal cancer (CRC) mortality rates as high as 25.9 deaths per 100,000 people as compared to the national rate of 14.8 deaths per 100,000 people (NCI, 2018; Kentucky Cancer Registry, 2018). Innovative screening mechanisms, coupled with patient navigation services, may be the key to increasing screening rates and preventing unnecessary deaths in the region. The current study focuses on the accounts of patient navigators (n = 9) to identify the essential ingredients for addressing barriers to CRC screening cited by Appalachian Kentucky patients. Using the core tenants of effective patient navigation programs (Freeman & …

The Impact Of Adjuvant Chemotherapy On Survival For Patients With Stage Ii Colon Cancer Portfolio, Li Ding

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

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

Community Of Hope: A Comprehensive Suicide Prevention Intervention At Mit, Kyra Patel

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

Suicide is the second leading cause of death for most age groups in the United States. The current rate of suicide among college students is 7.5 per 100,000 with the rate remaining fairly steady over the past 30 years. While the rate is lower on college campuses, compared to the general population ages 18-24, the issue is still much larger on a college campus due to suicide bereavement or the number of people affected and to what degree they were impacted. As of 2015, MIT (Massachusetts Institute of Technology) had the highest suicide of all reporting colleges. The primary objective …

Bronchiolitis In The Bluegrass: Epidemiology, Disease Burden And Resource Utilization At Kentucky Children’S Hospital, Ashwin Krishna

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

Background: Every year Kentucky Children’s Hospital (KCH) admits infants and toddlers with respiratory disease due to viral bronchiolitis. This disease is characterized by viral-induced inflammation and edema of the lower airways. The resulting disease is characterized by increasing mucus production, acute bronchospasm, necrosis of the respiratory epithelium and functional obstructive lung disease. Patients usually present with symptoms consistent with an upper respiratory tract infection, but can progress to marked respiratory distress and ultimately respiratory failure, as well as poor oral intake and dehydration. While Respiratory Syncytial Virus (RSV) is the pathogen classically described cause of viral bronchiolitis, other viruses have …

Implementing Counseling African Americans To Control Hypertension Intervention In Louisville Metro, Raven Robbins

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

Hypertension disproportionately affects Africans Americans more than their White counterparts. Counseling African Americans to Control Hypertension (CAATCH) is an intervention program that is targeted at African American adults to decrease uncontrolled hypertension. The CAATCH intervention has three components, which includes 1) computerized hypertension education, 2) at home blood pressure monitoring, and 3) behavioral counseling. The CAATCH intervention will be implemented in three sites in the northwest portion of Jefferson County in Louisville, KY. The overall goals of the CAATCH intervention are to decrease the number of participants who suffer from uncontrolled hypertension, increase knowledge of hypertension among participants, increase the …

Increasing Colorectal Cancer Screening In Kentucky’S Buffalo Trace Area Development District With A Mailed Fit Program, Carrie Anne Burt

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

This program involves a partnership among eight primary care clinics in the Buffalo Trace Area Development District (BTADD) of Kentucky and proposes implementing a mailed Fecal Immunochemical Test (FIT), or FIT Pack, program to increase colorectal cancer screening (CRCS) rates in this region. Mailing FIT tests to eligible patients is an evidence-­‐based program that has been shown to increase CRCS among patients included in studies. The program will occur at the clinic level. Clinics will mail FITs and information leaflets to patients based on patient eligibility criteria identified in clinic electronic health records. The program’s short-­‐term goals are to increase …

Commercial Driver License Examinees’ Misreport On Their Federal Motor Carrier Safety Administration Certification Evaluation, Adam Pascoe

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

Commercial Driver’s License (CDL) examinees report their medical history during their Federal Motors Carriers Safety Administration (FMCSA) medical certification exams ≤2 years. When the examinees report diagnoses which may impact the control and operation of commercial motor vehicles (CMV), they face scrutiny with decreased medical certification or may be Adam PascoePascoe Page 2 7/18/2018 considered unfit to control and operate a CMV. Medical examiners may have access to the examinees’ electric medical records (EMRs) to generate a deeper appreciation, independent from the examinees’ self-report, of their risk for sudden and/or gradual incapacitation. We do not know how often diagnoses are …

Latino Worker Reported Respiratory Symptoms And Stall Bedding On Thoroughbred Horse Farms, Lacy Jinks

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

Objective: The purpose of this study is to assess the association between self-reported respiratory symptoms in Latino workers and bedding type used in stalls on thoroughbred horse farms.

Methods: Self-reported community-based questionnaire data from 225 Latino horse farm workers in the southeastern US collected from October 2013-April 2014 were used to investigate associations between upper and lower respiratory symptom prevalence and the type of bedding used in stalls (straw, sawdust, or straw plus wood shavings or sawdust). Analysis was performed by chi-square to compare frequencies of symptoms and demographic and exposure risk factors. Logistic regression was used to adjust …

Modeling The Impact Of 13rs-Hb358: Hpv Vaccination For School Entry In A High-Prevalence State, Stacy Lee Ware

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

Prophylactic cancer vaccination presents novel opportunities to improve the health and well-being of populations. Since the approval of a cervical cancer vaccine against human papillomavirus (HPV) in 2006, only three states have passed legislation adding it to their school-entry schedules of required vaccinations. Despite ample evidence of its safety and efficacy, the vaccine remains controversial, and national vaccination rates among both girls and boys remain low. Risk for HPV-related cancers varies by population, and Appalachian Kentucky has among the highest HPV-related morbidity and mortality in the nation. Annual attempts to pass HPV vaccine legislation in Kentucky have so far failed …

Impact Of The School Health Innovations Grant Act On Healthcare Access, Outcomes, And Cost In The District Of Columbia, Robert West

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

This paper provided a prospective policy analysis of the Washington, D.C. School Health Innovations Grant Act. This act establishes a grant program to facilitate the formation of school-based telehealth centers to provide mental health services to District school children. The purpose of this act is to improve access to mental health services for children, especially children in disadvantaged populations, such as those low-income, predominantly African American neighborhoods in eastern Washington, D.C., where a high burden of need is compounded by a shortage of health professionals.

This analysis was guided by the Bardach framework of policy analysis. The various factors affecting …

Association Between Reproductive Factors And Breast Cancer Subtypes: A Meta-Analysis, Xihua Mao

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

Introduction: Hormone-related reproductive factors have been reported to be associated with breast cancer subtypes. However, the direction and magnitude of these associations were inconsistent. Additionally, for breast cancer defined by estrogen receptor (ER) and progesterone receptor (PR): ER+PR+, ER+PR-, ER-PR+, and ER-PR- subtypes, no meta-analysis was available for ER+PR-and ER-PR+ subtypes. For ER+PR+ and ER-PR- subtypes, only a few reproductive risk factors have been examined in meta-analyses.

Methods: Primary studies published from 2011 to 2017 were retrieved from PubMed, Embase, and Scopus. Following PRISMA guidelines, a total of 98 eligible studies investigated the association between reproductive factors and breast cancer …

The Relationship Between Access To Healthcare And Heart Disease Mortality In Kentucky, 2012-2014, Nima Farsi

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

Cardiovascular disease is the cause for a large portion of the mortalities in the United States. Furthermore, Kentucky has one of the highest heart disease mortality rates out of all 50 U.S. States. This study hypothesized that heart disease mortality in Kentucky counties has a positive relationship with lack of accessibility to healthcare. Furthermore, this ecological study hypothesized that because there is no available usual source of a healthcare providers and ultimately a lack of accessibility to receive diagnostic/preventative services for this population, the high rate of cardiovascular disease mortality in Kentucky is dependent on access to healthcare services.

This …

An Ecologic Study Of Access To Acute Stroke Care, Mortality And Its Correlates In The Stroke Belt, Jeffrey E. Levy

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

Importance: Stroke is leading cause of death in the United States, but quick access to treatment has been shown to result in better outcomes and improved mortality. Among the many barriers to access, geographic proximity to hospitals certified in stroke care may also play a role.

Objectives: To calculate county-level measures of accessibility to certified stroke hospitals using GIS, and to examine its relationship with county stroke mortality while controlling for other county-level potential confounders.

Methods: Ecologic study using county mortality rates and census data to recreate stroke death counts for use in traditional, and a geographically …

Implementing The National Diabetes Prevention Program In Mason County, Kentucky, Cassandra Yelton

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

The National Diabetes Prevention Program (DPP) is sponsored by the Centers for Disease Control and Prevention (CDC). The program’s goal is to reduce the incidence of diabetes through dietary modification and physical activity. On one hand, the DPP is currently offered by various organizations through the country. On the other hand, the DPP is mostly unavailable in rural areas, especially the Diabetes Belt. The Diabetes Belt is in the eastern Appalachian region of the United States. People who live in this area of the country are more likely to develop diabetes than those who do not. Mason County, Kentucky has …

Implementation Of An Evidenced-Based Opioid Treatment Program To Improve Maternal-Child Outcomes In Eastern Kentucky, Jordan Rice

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

The Kentucky River Area District Health Department proposes implementation of CHARM-Kentucky, a treatment program for pregnant women with opioid use disorder (OUD), in eastern Kentucky. Over 115 Americans die each day from an opioid overdose, resulting in approximately 42,000 deaths in 2016. In addition to an overall increase in opioid use in recent years, the use of opioids in pregnancy has also increased from 1.19 per 1,000 hospital births in 2000 to 5.63 in 2009. Opioid use during pregnancy results in poor neonatal outcomes including: low birth weight, preterm delivery, small head circumference, increased child maltreatment, and risk for long-term …

Reducing Depression And Suicide Ideation Among College Students, Andrew Ritzel

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

Suicide rates have been on the rise for the past 30 years; 42,773 Americans dying every year by suicide. Suicide is the tenth leading cause of death among all ages, but the second leading cause of death among Americans ages 15-24. College students traditionally fall within this age group, and are especially at risk for suicide due to stressful life conditions. The University of Kentucky, located centrally within Kentucky in the city of Lexington, is an ideal location for a suicide prevention intervention. Students demonstrated an increased rate of depression compared to the national population (15.13% of students surveyed reported …

Aps’Aalooke Led Diabetes Prevention Program, Lucy Hollingsworth Williamson

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

The primary objective of this proposed program is to decrease the burden of diabetes mellitus type II among the Crow Indian tribe members in Montana by preventing the progression of prediabetes to diabetes. Type II diabetes mellitus (DMII), is a debilitating disease that contributes to increased morbidity and mortality, in addition to billions of healthcare costs annually. In the United States, minority populations carry a higher burden of DMII, however American Indians have the highest prevalence of all. In fact, American Indians are 2.4 times more likely to be diagnosed with diabetes than white people.

In Montana, the Crow Indian …

Reducing Stigma Associated With Mental Illness And Mental Health Treatment Services In Racial And Ethnic Minority College Students, Joseph Christodoulou

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

Depression and Suicide

Mental health is a determining factor in how individuals function throughout their daily lives, encompassing an individual’s physical, emotional, and social well-being (U.S. Department of Health and Human Services, 2013). Mental illnesses such as depression, hinder daily functioning and lead to a range of negative outcomes. These include increased risk of mortality from suicide, chronic diseases such as heart disease, other conditions/behaviors such as anxiety and substance use disorders, and high economic burden (Centers for Disease Control and Prevention, 2016b). Depression is a major contributor to disability and burden of disease in the U.S., contributing to 3.7% …

The Effect Of Rescheduling Of Hydrocodone On Prescription Writing Among University Of Kentucky Dentists, Robert Taylor

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

Opioid abuse has become a public health crisis over the last two decades. Hydrocodone is the most frequently prescribed opioid to patients whose deaths are related to prescription drug abuse. On October 6, 2014, Federal law changed hydrocodone, an opioid-based analgesic, from Schedule III to Schedule II. This limits the number of ways it can be prescribed, including eliminating refills. This study examined hydrocodone and oxycodone prescriptions written across all dental clinics associated with the University of Kentucky College of Dentistry and analyzed three different dental disciplines that perform procedures that require pain management. Prescription data was obtained through axiUm, …