Medicine and Health Sciences Commons^™

Salmonellosis In Kentucky Cattle - 2003-2014, Azia Elizabeth Ramirez

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

The group of bacteria known collectively as Salmonella has historically been a major cause of both health and economic hardships. In particular, Salmonella in bovine has been estimated to cause the economy to lose billions of dollars annually, both due to the increased morbidity and mortality rates of the cattle themselves and the indirect loss of potential profits, and also results in the spread of the bacteria to humans to ill effect. Salmonella thus can be quite taxing to agricultural communities, the animals upon which they rely, and the consumers that buy said communities’ commodities. Thus, the importance of an …

Breast Cancer Screening For African American Women, Jennifer Ross

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

INTRO Breast cancer is the most common type of malignancy among women in the United States (U.S.) and the second leading killer. Despite the availability of effective breast screening tools, a disparity has formed. Specifically, white women over the age of 40 experienced a higher incidence rate of breast cancer, while African American women experience higher related mortality rate. The purpose of this study was to examine SES and ethnicity/race factors that may influence breast cancer screening rates, and specifically explore how those factors may differ between African American and white women.

METHODS Women between the ages of 50-74 who …

Factors Predicting Beta-Blocker Treatment After Myocardial Infarction In Patients With Type 2 Diabetes, Ryan P. Hickson

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

OBJECTIVE – Beta-blockers remain important for secondary prevention after myocardial infarction (MI). Despite clinical guideline recommendations, the potential for poor glycemic control and masking warning signs of hypoglycemia limit their utilization in type 2 diabetes. This study evaluated factors predicting post-MI beta-blocker initiation among type 2 diabetic patients.

RESEARCH DESIGN AND METHODS – A retrospective cohort of employed, commercially insured individuals was developed using de-identified enrollment files, medical claims, and pharmacy claims from 2007-2009 in the U.S. Inclusion criteria: (1) type 2 diabetes, (2) ≥18 years old, (3) continuous eligibility, (4) MI. Exclusion criteria: (1) females prescribed metformin exclusively without …

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 …

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 …

Alcohol Sale Status And Violent Deaths In Kentucky, Usa: 2005-2012, Hanan Abdulghafoor Khaleel

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

Alcohol is one of the major public health problems worldwide because of its association with many health and psychological problems. This study adds to the extant literature by examining the association between being a resident in a wet county and having an alcohol related violent death, an alcohol related suicide, or an alcohol related homicide victimization.

The first aim of this study is to determine whether residents of wet counties have a higher odds of alcohol related violent deaths than residents of dry/moist counties after adjusting for other confounding factors. The second aim is to determine whether residents of wet …

Demographic Disparities In Children With Behavioral Or Conduct Disorders, Caitlin Dunworth

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

This study examines the demographic disparities in children with externalizing behavior disorders, such as oppositional defiant disorder and conduct disorder, utilizing secondary data from the 2011/2012 National Survey of Children’s Health (NSCH). Current literature suggests that children with externalizing behavior disorders are more likely to be male, live in a low-­‐income family, receive lower grades in school, and to develop later conditions such as depression. Chi square tests and logistic regression were used to examine the associations of presence of a current behavioral or conduct problems with age group, race/ethnicity, sex, household income level, and insurance type. Additionally, associations were …

Association Between Stressful Life Events And Change Of Maternal Smoking During Pregnancy Using Prams 2011-2012, Shidie Tang

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

Objective: To examine the association between stressful life events during pregnancy and change of maternal smoking behaviors.

Methods: We used data from the CDC’s Pregnancy Risk Assessment Monitoring System (PRAMS) to conduct the research. Our data included 24 states from 2011-2012. We considered 13 stressful life events and grouped them into four categories: emotional, partner-related, financial and traumatic stressors. Change of Maternal Smoking during pregnancy was defined by smoking at the last trimester of pregnancy versus smoking at 3 months prior to smoking. Confounders included maternal age, race/ethnicity, education, marital status, Medicaid coverage upon delivery and income prior …

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 …

Impact Of Kentucky Vaccination Exemption Laws On Pertussis Incidence, Katherine Blain

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

Purpose: According to CDC statistics, prior to pertussis vaccine development in the 1940’s, about 200,000 children contracted pertussis annually. Today, although this number has decreased drastically, pertussis cases began trending upward again in the 1980’s. There are several proposed contributory factors, including vaccination exemption. In Kentucky, there are both medical and religious exemptions to mandatory school vaccines. The purpose of this study was to examine possible correlations between reported school vaccination exemptions and pertussis incidence in Kentucky counties between the years 2004-2012.

Methods: This study retrospectively analyzed data from 120 Kentucky counties between 2004-2012. The Commonwealth of Kentucky School Annual …

Proton Pump Inhibitors And Atrial Fibrillation, Dustin Hughes

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

Background

Proton pump inhibitors (PPIs) are widely used drugs in the United States. Atrial fibrillation (AF) affects 2.7 million people in this country and often leads to other serious medical conditions. There is a growing body of evidence suggesting that PPIs may be proarrhythmic. This study seeks to better appreciate the relationship between these popular drugs and the most common arrhythmia.

Methods

This is a nested case-control study using a large, nationally representative insurance database. Members with an incident AF diagnosis between 2007 and 2009 were identified. Each case was matched with one control member, using incidence density sampling, and …

Adolescent Oral Health In Kentucky, 2007 National Survey Of Childhood Health Analysis, Kory Brinker

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

Research indicates that children raised by their grandparents can have poorer health outcomes than their peers living in mother or father based households. There is, however, little research that indicates how childhood oral health is affected by grandparents raising grandchildren. This study investigated grandparent based family structures, and how this family structure affects oral health of Kentucky children. Using data from the 2007 National Survey of Children’s Health, 113 Kentucky children were identified as living with a grandparent as a primary caregiver. Chi-Square analyses were utilized to assess the oral health status of these children, as well as what role …

Farm To School Programs And Children's Dietary Behaviors, Kathleen Evers

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

There is an increasing promotion of the importance of fruit and vegetable consumption through prevention efforts, specifically in school systems, to control and prevent childhood obesity. Farm to School (FTS) programs offer interactive hands on experiences involving fruits and vegetables. This study examines a specific FTS program including a farmer interaction, and a broccoli taste testing experience for kindergarten and fourth grade students in a rural Kentucky county. By using a digital still photography method of plate waste, the decisions of approximately 115 students to take/not take broccoli and percentage of students’ consumption of broccoli was analyzed. Using chi-square and …

Fatal Injuries Among Young Workers In Kentucky, 2005-2014, Allison Christian

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

Background: Young workers have been more vulnerable to fatal and nonfatal work injuries. To gain a comprehensive understanding of the injuries that led to fatalities in younger workers, the goal of this study was to compare characteristics of young worker fatal injuries in those aged 16-24 to all workers aged 25 and older in Kentucky using a descriptive analysis.

Methods: A retrospective analysis of fatalities among workers under the age of 25 compared to workers aged 25 and older was performed over a ten-year period from 2005-2014 using Kentucky Fatality Assessment and Control Evaluation (FACE) program data.

Results …

Relationship Of Bmi And Weight Perception To Weight Controlling Behaviors In 9th-12th Graders In The United States, Natalie Jones

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

Research indicates that high school students constitute the largest portion of those participating in unhealthy weight control behaviors. There is, however, little research that indicates what this behavior is influenced from. This study investigated the relationship of Body Mass Index (BMI) and (discordant or concordant) weight perception to weight control behaviors among 9th-12th graders in the United States. Using data from the 2013 Youth Risk Behavior Surveillance System (YRBSS), over 40 states and 13,000 surveys completed. Multiple Chi-square tests were performed, examining the association between BMI and weight perception in relation to weight control behaviors. We then examined whether perception …

Needle Stick Injuries And Blood Born Pathogen Exposures Among Health Care Workers In University Of Kentucky Health Care Facilities, Haider Sahmsulddin

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

Objectives:

The number of cases of needle stick and sharps-related injuries among healthcare workers are difficult to estimate due to underreporting. Multiple research studies have been done in this area but the scale of the problem is substantial and requires further attention. This study focuses on the cases of needle stick injuries and blood born pathogen exposure among health care workers at the University of Kentucky. The purpose of this study is to examine the rates of needle stick vs splash related injuries among the University of Kentucky health care workers from 2009 to 2014, and stratify the frequencies of …

Variation In Colorectal Screening Rates In Kentucky Since The Development Of The Colon Cancer Screening Program In 2008, Pranav Rane

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

Objective

The purpose of this study is to analyze colorectal cancer (CRC) screening rates post-enactment of KRS 214.540 through 214.540. More specifically this study seeks to highlight the variation in CRC screening rates post-policy vs. pre-policy among the target population: uninsured individuals between the ages of 50 – 64.

Methods

Behavioral Risk Factor Surveillance System (BRFSS) was utilized to obtain individual-level data regarding CRC screening in Kentucky from 2004-2012. Statistical Analysis System (SAS) version 9.1 was utilized to compile data and the variables for home blood-stool and for sigmoid/colonoscopy were combined into one variable to identify individuals who had received …

Financial Strain, High Stress And Smoking Among United Way Missouri 2-1-1 Callers, Brandon Cofield

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

Objectives.

We evaluated the influence of financial strain and perceived stress on smoking status among United Way Missouri 2-1-1 callers of predominantly low socioeconomic status.

Methods.

Data for this study were collected as part of a randomized, controlled intervention trial integrating cancer control referrals into regular United Way 2-1-1 Missouri services. Those who consented, completed the assessment and had at least one cancer control need were invited to participate in a longitudinal study that included completing the baseline assessment used in this study. We conducted chi-square analyses to assess the bivariate relationships between each financial strain variable and smoking status, …

Assessment Of Breastfeeding Policies In A Sample Of Inner City Child-Care Centers In North-Central Kentucky, Ana Maria Machado

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

Protection, promotion, and support of breastfeeding (BF) are critical public health needs. Breastfeeding has been proven to provide the healthiest start in life and has been shown to have a myriad of health benefits for infants, mothers and society at large. Exclusive and long term breastfeeding has been found to have protective function against the prevalence of obesity as well as many other adverse health outcomes. Higher levels of breastfeeding support in the child-care setting have been associated with higher likelihood of duration of breastfeeding for mothers and infants. The primary objective of this study was to assess the current …

Palliative Care: Evaluating And Designing Process Improvements For An Inpatient Consultative Program, Shawn M. Crouch

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

The purpose of this capstone project paper and study was to evaluate an inpatient palliative care consultation service and then make recommendations for improving the program. This paper includes a literature review related to palliative care models and best practices in structuring a successful inpatient palliative care service. The project included an analysis of how the program at one university based hospital measured success of the program and SWOT analysis based on interviews with members of the program’s team and leadership. Data sources used for the analysis included palliative care consultation utilization data from the identified hospital; other metrics used …

Using Public Health Accreditation (Phab) Standards To Improve Efficiency And Effectiveness In A Local Health Department (Bourbon County, Kentucky), Helen Karrick Sauer

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

Objectives: Small and rural local health departments face unique challenges in maintaining their operations amongst budget cuts. Accreditation of local health departments by the Public Health Accreditation Board (PHAB) has been identified as a strategy to help struggling health departments improve their efficiency and effectiveness. These health departments may be able to enjoy the benefits of accreditation even without ultimately achieving it by deliberately aligning themselves with PHAB standards. Methods: This capstone report presents a case study of the Bourbon County Health Department (BCHD). Using PHAB accreditation standards as a playbook, the public health director (PHD) reorganized BCHD to focus …

Policy Analysis Of Kentucky Senate Bill 192, Sierra Nicole Dantzler

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

Needle sharing has become an important factor in the prevalence of HIV and viral hepatitis rates as injection drug use of illicit substances, such as heroin and prescription opioids, has increased across the United States. Kentucky, much like the rest of the nation, has also been devastated by the recent surge of injection drug use. In 2010, drug overdose rates ranked Kentucky as the third highest state in the nation. Hepatitis B (HBV) and Hepatitis C (HCV) rates within Kentucky have been consistently higher than the national rate since 2007 and 2003, respectively. Hospital discharge costs related to HCV infections …

Organizational Effectiveness Frameworks In Public Health Nonprofit Systems: A Case Study, Morgan Floyd

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

Problem: Nonprofits, especially in public health, have become more and more prevalent in recent years. With that increase in support, come greater awareness from stakeholders evaluate nonprofits as effective and impactful on the communities they serve. Frameworks of Organization Effectiveness allow investigators to predict how effective an organization might be in their work. The aims of this study were to identify key Organizational Effectiveness frameworks that could be used to evaluate Nonprofits and use them in practice. Therefore, individuals wishing to become involved with effective nonprofits will be empowered to make good investments of volunteer time and donations

Method: This …