Medicine and Health Sciences Commons^™

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, …

Consultation Experience In Public Health, Hannah Bellamy

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

The following portfolio is an overview of my consulting experience in public health. My experiences include making frequency tables, producing summary statistics, conducting Chi- Square and T-Test, and reproducing a demographics table. Working with investigators, I have conducted a power analysis for a pilot study, assisted with a study design consultation, used the Kappa coefficient to test for inter-rater reliability, presented survey results with answer distributions, and produced summary statistics for an investigator’s research poster.

Working in the Applied Statistics Laboratory and with investigators has taught me the process of consulting. It begins by meeting with an investigator and determining …

Respiratory Function And Associated Risk Factors In The Kentucky Women’S Health Registry, Negash Amsalu

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

From the University of Kentucky Women’s Health Registry Database (KWHRD) a total of 1838 women were voluntarily asked to undergo Spirometric respiratory function tests. These women came to the clinic for various reasons. Various independent variables (risk factors) were also recorded for these women. Among these risk factors were: age, BMI, smoking status, asthmatic status, educational status and ethnicity.

The purpose of the study was to investigate whether any of the risk factors had significant impacts on women’s respiratory health. Appropriate categorizations were tabulated for each risk factor so that comparisons would be possible and easier. The motivation of the …

Construction Fatalities In Kentucky, Tennessee And West Virgina Between 2005 And 2014, Jacob Petrey

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

Background: The construction industry involves many hazards and accounts for the greatest number of work related fatalities in the United States. The objective of this study was to characterize the demographics of people involved in construction fatalities and the causes of these fatalities in Kentucky, Tennessee and West Virginia between 2005 and 2014.

Methods: The Bureau of Labor Statistics Census of Fatal Occupation Injuries (CFOI) was the source of data about the number of fatalities, rates and characteristics about fatalities for each state. The U.S. Census Bureau was also used to find the average annual construction population for each state …

Implementing The Family Check-Up Program To Prevent Initiation Of Opioid Misuse Among Sixth Graders In Pike County, Kentucky, Emily Edmiston

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

The availability of prescriptions for opioids has been increasing since 1996. This type of drug is commonly misused by adolescents ages 12 to 17, making the trends in availability particularly alarming. Adolescence is a crucial point initiation of several risk behaviors, including substance use. During this time, parental monitoring, or awareness of the child’s activities and communication about those activities, is incredibly important for prevention of those risk behaviors. Despite this importance, parental monitoring behaviors often slip during this time. To help strengthen family management and communication leading into adolescence, the Pike County Health Department (PCHD)is proposing the implementation of …

Do Numbers Matter? Comparing Single Homicide Followed By Suicide And Multiple Homicide Followed By Suicide Using The National Violent Death Reporting System, 2003-2012, Courtney Blondino

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

Introduction

Homicide-followed-by-suicide or homicide-suicides were examined to understand the dynamics of acting outwardly and inwardly violent in a single incident. The purpose of this study was to identify if specific circumstances had an association with the number of victims per homicidesuicide incident. This study addresses an important public health issue by encouraging an accurate viewpoint of homicide-suicide in order to properly program prevention efforts.

Methods

Using the restricted access data (RAD) from 17 National Violent Death Reporting System (NVDRS) states, we characterized 1904 homicide-suicide incidents through qualitative and quantitative analysis based on victim and suspect demographic information, method of injury, …

The Role Of Stress In The Relationship Between Shift Worked And Hypertension, Madison Liford

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

Purpose: Individuals working non-daytime shifts have been reported to have an increased risk for many negative health outcomes, including poor cardiovascular health. This study aims to examine the relationship between shift worked and hypertension—a major risk factor for cardiovascular disease. Of particular interest in this study was the role of stress and type of shift worked (day, evening, night, or rotating) in this relationship.

Methods: The study utilized National Health and Nutrition Examination Survey data collected between 2005 and 2010. The study population was limited to adult workers 20 years of age and older (n=9356). Initial descriptive statistics of …

All 4 Hardin County Freshman!, Cortney Lynn Gandy

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

Within this application for funding the Lincoln Trail Health Department proposes an evidenced based intervention for implementation into two high schools in the Hardin County with the long term goals of decreasing the rate of sexually transmitted infections in the county. The LTHD based in Elizabethtown, Kentucky services six counties in central Kentucky. The community health needs assessment and community health improvement plans for the county highlighted the problem of sexually transmitted infections in the community. The Centers for Disease Control also produces data about the higher rate of STIs in Hardin county in respect to Kentucky and the US …

The Effects Of Improved Water And Sanitation Access On Under Five Child Diarrhea In Peru, April Ballard

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

Significance: Diseases related to poor or lack of access to clean water, sanitation, and hygiene negatively impact health, education, and development worldwide and cause millions of deaths in children each year. Health outcomes associated with lack of access to clean water and sanitation are under-evaluated.

Aim: To assess the effect of improved water and sanitation infrastructure development on child morbidity in Peru by investigating diarrhea in children under five years of age.

Methods: The child, family, and household data from the Peruvian Demographic and Health Surveys (DHS) were used to evaluate the association between access to water …

Diagnostic Prevalence Of Diabetes Among Older Adults In Rural Appalachia, Gabriella Hodges

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

Background

The rural, mountainous Appalachian region continuously has poorer health outcomes than the rest of the United States. This is true for many chronic diseases including diabetes: the 7th leading cause of death in the United States. This study assessed differences in the prevalence of diagnosed diabetes between older adults in rural, Appalachian counties and rural, non- Appalachian counties.

Methods

Data for the year 2013 was extracted from the Centers for Medicare and Medicaid Services (CMS) Public Use Files for Medicare beneficiaries (September 2015), which provides county level prevalence for diabetes as well as several other conditions among Medicare fee-for-service …

Compliance And Treatment Failure Of Hepatitis C With Direct-Acting Antivirals: A 2-Year Retrospective, Observational Study In Kentucky Medicaid Patients, Juequan Nie

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

Background: New generation Direct-acting antivirals (DAAs) for the treatment of chronic hepatitis C infection have been on the market for more than 3 years since late 2013. Whether these medications cure patients at the rates claimed in clinical trials is not clear. Furthermore, as compliance is known to affect treatment outcomes, DAAs compliance rate is worth studying.

Methods: We analyzed the association of social-demographic, DAA use, enrollment with Kentucky Medicaid Managed Care Organizations (MCOs) and comorbidities, and DAA compliance in 1128 Kentucky Medicaid members treated with DAAs between August 07, 2014 and August 06, 2016.

Results: Age, MCOs, liver fibrosis …

Spatial Distribution Of Partner-Seeking Men Who Have Sex With Men (Msm): An Epidemiologic Study Using Msm Geosocial Networking Applications, Angel Blake Algarin

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

Background: Geosocial networking (GSN) applications (apps) have made finding sexual partners easier for partner-seeking MSM, raising challenges for HIV/STI prevention but also providing opportunities for research. To date, little is known about app usage in smaller cities where there may be more stigma surrounding MSM.

Objective: This study uses GSN apps to identify areas with high density partner-seeking MSM, and to characterize these areas using Census block group demographic measures in a Southern mid-sized city.

Methods: Data collection points (n=62) were spaced in two-mile increments along nine routes (112 miles) covering the area. At each point, staff …

Sociodemographic And Clinical Predictors Of Triple Negative Breast Cancer, Madison Ries

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

Background and Objectives

Breast cancer has the highest incidence rates among women and is the second leading cause of death due to cancer in women. Of all breast cancers, triple negative breast cancer (TNBC) accounts for about one-fifth of breast cancer and tends to result in an aggressive form with larger tumors and rates of metastasis and is more frequently found in younger women. This results in an important need in information regarding the risk of diagnosis with triple negative breast cancer over other forms and covariates associated with death and TNBC. This paper studies the relationship between race, tobacco …

Factors Associated With Large Vehicle Collision Fatalities From 2009-2015, An Assessment Of Factors Relevant To The 2014 Implementation Of The National Registry Of Certified Medical Examiners And Strategies For Driver Safety, Melinda L. Carol

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

OBJECTIVE: The Federal Motor Carrier Safety Administration (FMCSA) developed a National Registry of Certified Medical Examiners (NRCME) as a stride toward greater driver safety and public health. This retrospective, observational, cross-section study is intended to trend and analyze driver related factors that are pertinent to FMCSA certifying medical examination performed by NRCME providers in addition to driver behaviors and environmental factors from the years 2009 to 2015. The results of this study are intended to speculate the effectiveness of the NRCME and propose additional public health interventions aimed to reduce large vehicle fatalities.

METHODS: Data was extracted from …

Smart Moves Bright Bodies: A Rural Adaptation To Combat Obesity Among African-American Teenagers In Wilcox And Lowndes Counties, Alabama, Nicole D. Fields

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

Obesity is a significant problem in the United States; however, it is a burgeoning epidemic among youth in the United States. As of 2016, Alabama is the second-most obese state in the nation¹ and 16% of Alabama adolescents are obese². While obesity is a significant problem across all ethnic groups, minorities bear a disproportionate burden in Alabama: one in five African-American adolescents is obese². This disproportionate burden is demonstrated in two Alabama counties: Wilcox and Lowndes. Both counties are predominately African-American and rank in the bottom ten counties, statewide, for overall health outcomes^9,14. …

Vaccine-Preventable Disease Surveillance In Kentucky, Katherine Jay

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

Background: Vaccine-preventable disease (VPD) surveillance is important component to the success of vaccines. This report examines the levels of 13 of these VPDs in the state of Kentucky from 2005 to 2015.

Methods: All reported cases in the state of Kentucky for the years 2005 to 2015 of 13 vaccine-preventable diseases were obtained from the Disease Surveillance Module (DSM) and the National Electronic Disease Surveillance System (NEDSS). Where enough cases were reported, descriptive statistics were prepared. For acute hepatitis B and pertussis, more thorough analysis was performed.

Results: Rates of acute hepatitis B in Kentucky from 2005 …

Association Between Cerebrovascular Pathology And Anti-Hypertensive Treatment In Diabetics, Gary Owen

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

Background

Dementia is a growing public health concern as the population ages. Vascular dementia is the second most common type of dementia behind Alzheimer’s, and is caused by cerebrovascular damage, such as infarcts and hemorrhages. As in systemic cardiovascular disease, diabetes and hypertension are leading risk factors for cerebrovascular pathology. Anti-hypertensive treatment (AHT), therefore, may have a role in preventing cerebrovascular damage.

Methods

A case-control study design was utilized to evaluate any association between AHT during life and cerebrovascular pathology in autopsy in diabetic participants from the National Alzheimer’s Coordinating Centers (NACC). Pathology outcomes included infarcts of various sizes and …

Cadmium Exposure And Residence-To-Road Proximity In Eastern Kentucky, Ellen Flora

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

Background and Objectives

Cadmium is a carcinogenic and toxic metal. The general population can be exposed to cadmium from multiple sources. The purpose of this study is to evaluate the association of urinary cadmium and residence distance-to-road by performing landscape analyses in eastern Kentucky, a region where smoking prevalence is high, coal production has been a primary industry, and the landscape is predominantly undeveloped. Composite dust samples were also collected and analyzed for Cadmium (Cd), Manganese (Mn), and Zinc (Zn). The primary objective of this study is to ascertain if there is an association between participants with elevated accumulated cadmium …

Resources And Well-Being In Amyotrophic Lateral Sclerosis Patients And Caregivers: A Longitudinal, Dyadic Analysis, Suzanne C. Segerstrom

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

Socioemotional selectivity theory predicts that as the end of life approaches, resources that provide immediate, hedonic reward become more important and resources that provide delayed rewards become less important. The present study tested the theory in the context of marital dyads in which one partner had been diagnosed with amyotrophic lateral sclerosis (ALS), a terminal disease. ALS patients (N = 102) and their spouses (N = 100) reported their loneliness, financial worry, and psychological health every 3 months for up to 18 months. In multilevel dyadic models, patients and spouses had similar levels of financial worry and loneliness, but spouses’ …

A Diabetes-Free Breathitt County: Implementation Of The National Diabetes Prevention Program In Pharmacies, Urvi Patel

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

The National Diabetes Prevention Program (NDPP) is a primary prevention program endorsed by the Centers for Disease Control and Prevention (CDC). The program’s purpose is to promote dietary modification and physical activity to reduce the incidence of diabetes. NDPP is currently offered by national organizations such as the Young Men’s Christian Association and Weight Watchers. However, NDPP is not commonly available in geographic areas that are in the most need of such preventive health programming such as rural communities. One such area where NDPP is not widely offered is the Diabetes Belt, an area within the Appalachian region of the …

Revamp It: Utilization Of Socioecological Approach To Combat Adolescent Obesity In Knott County, Kentucky, Jonathan Wang

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

The Kentucky River District Health Department proposes the implementation of REVAMP IT in four selected elementary schools in Knott County, Kentucky to improve subjective attitudes towards various aspects of health knowledge, physical activity, social support, and screen-time, as well as reduce biometrically measured television time and increased step count. REVAMP IT is an evidence-based program that utilizes the socioecological model of Public Health to target aspects of the individual, relational, and community level to facilitate changes from multiple aspects. Screen-time and physical activity goals will be individually set by students, and Knott County Elementary School teachers will be responsible for …