Medicine and Health Sciences Commons^™

Treatment At An Academic Medical Center Eliminates Survival Disparities For Appalachian Kentuckians With Pancreatic Ductal Adenocarcinoma, Emily Cassim, Hannah Mcdonald, Megan Harper, Quan Chen, Miranda Lin, Reema Patel, Michael Cavnar, Prakash Pandalai, Bin Huang, Pamela C. Hull, Joseph Kim, Erin Burke

Journal of Appalachian Health

Introduction: Rates of cancer mortality in Appalachian Kentucky is among the highest in the nation. It is unknown whether geographic location of treatment for pancreatic ductal adenocarcinoma (PDAC), one of the deadliest cancers worldwide, influences survival in Appalachian Kentuckians.

Purpose: This study compares outcomes among Appalachian Kentuckians with PDAC who received treatment at an academic medical center (AMC) or community facility (CF).

Methods: Using the Kentucky Cancer Registry, patients diagnosed with PDAC between 2003 and 2018 were identified. Patients were categorized according to treatment location (AMC v. CF) and county of residence (Appalachian v. non-Appalachian). Kaplan-Meier curves were constructed to …

Disparities In Mortality Between Appalachian And Non-Appalachian Regions Of Kentucky, Sonali S. Salunkhe, Sahal Alzahrani, Beatrice Ugiliweneza

Journal of Appalachian Health

Introduction: In the opioid epidemic, the U.S. faces a significant public health crisis, with some areas of the country, such as rural and Appalachian regions, suffering more than others. The differential regional impact of the crisis in Kentucky—a state with both non-metropolitan/metropolitan and Appalachian/Non-Appalachian statuses—has not yet been documented despite such knowledge being essential to the success of overdose prevention efforts.

Purpose: This study compares all-cause, drug- and opioid-related mortality between counties in different regions of Kentucky: Appalachian non-metropolitan, Appalachian metropolitan, non-Appalachian non-metropolitan, and non-Appalachian metropolitan.

Methods: Age-adjusted mortality data from the Centers for Disease Control and Prevention’s Wide-ranging Online …

Carbapenem-Resistant Enterobacterales—Kentucky, 2013–2020: Challenges And Successes, Mary Issac, Andrea Flinchum, Kevin Spicer

Journal of Appalachian Health

Introduction: Carbapenem-resistant Enterobacterales (CRE) are considered urgent, antibiotic-resistant threats in the U.S. and are of global concern. Active collaboration between public health authorities and healthcare facilities and providers will be necessary to prevent and contain these organisms.

Purpose: To describe the epidemiology of CRE in Kentucky and to discuss challenges and successes with building and sustaining an effective prevention and containment program.

Methods: Retrospective descriptive summary of CRE isolates reported by healthcare providers, facilities, and laboratories in Kentucky from 2013 through 2020. Data available from case reporting forms and laboratory testing are summarized.

Results: From 2013 through 2020, 1805 CRE …

Self-Reported Consumption Of Bottled Water V. Tap Water In Appalachian And Non-Appalachian Kentucky, Jason W. Marion

Journal of Appalachian Health

Introduction: Quantitative studies on drinking water perceptions in Appalachia are limited. High-profile water infrastructure failures in the U.S. and Eastern Kentucky, coupled with human-made and natural disasters in the Appalachian Region, have likely impacted opinions regarding tap water.

Purpose: To use existing unexplored data to describe baseline tap water v. bottled water consumption in Kentucky.

Methods: Telephone-based cross-sectional data were obtained from the 2013 Kentucky Health Issues Poll (KHIP) directed by the Foundation for a Healthy Kentucky. Among many items in KHIP, self-reported consumption of bottled water over tap water, reasons for bottled water use, and demographic data were obtained. …

Association Of Diabetes Prevalence With Labor Force Participation Rates In Kentucky Counties, Ryan Montgomery

MPA/MPP/MPFM Capstone Projects

Compared to other states in the USA, Kentucky has one of the highest rates of diagnosed diabetes and one of the lowest levels of labor force participation. This project employs a multivariable linear regression model to estimate the correlation between county-level diabetes prevalence and county-level labor force participation rates in Kentucky counties from 2015-2019, using publicly available data from the Centers for Disease Control’s Behavioral Risk Factor Surveillance System (BRFSS) and the U.S. Census Bureau’s American Community Survey (ACS). Labor force participation rates serve as the dependent variable and diabetes prevalence rates serve as the primary independent variable, alongside nine …

Access To And Use Of Technology For Health: Comparisons Between Appalachian Kentuckians And The General U.S. Population, Robin C. Vanderpool, Lindsay R. Stradtman, Anna Gaysynsky, Quan Chen, Meghan Johnson, Bin Huang

Journal of Appalachian Health

Introduction: Technology may increase the availability of health information and enable health promoting behaviors. However, lack of access to and use of technology may also exacerbate disparities, particularly in rural communities with limited Internet access.

Purpose: The purpose of this study was to compare Internet access, device ownership, and use of technology for health between Appalachian Kentuckians and the general U.S. population.
Methods: Findings from the 2017 Assessing the Health Status of Kentucky (ASK) survey were compared to national estimates from the Health Information National Trends Survey (HINTS) 5, Cycle 1 (2017), with a particular focus on degree of rurality. …

An Assessment Of Kentucky Birth Records, Focusing On Early-Onset Hypertensive Disorders Of Pregnancy, Environmental Metal Exposures, And Geocoding Precision, 2008-2017, Courtney J. Walker

Theses and Dissertations--Epidemiology and Biostatistics

Using live and stillbirth records from Kentucky (2008-2017), this dissertation assessed the county-level prevalence and geospatial patterns of early-onset hypertensive disorders of pregnancy (eHDP); examined the geocoding precision of addresses recorded on birth records, and evaluated the association between individual risk factors and environmental metal exposures on eHDP prevalence. After adjusting for maternal demographic factors and pre-existing health conditions, we observed that eHDP prevalence was 38% higher (aPR=1.38, 95%CI:1.16, 1.64) in counties with the highest prevalence of married women (> 53.8%) compared to lower prevalence areas (31.6%) had a 20% higher prevalence of eHDP(aPR=1.20, 95%CI:1.00, 1.44) compared to counties with …

“We’Re, Like, The Most Unhealthy People In The Country”: Employing An Equity Lens To Reduce Barriers To Healthy Food Access In Rural Appalachia, Kathryn Cardarelli, Emily M. Dewitt, Rachel Gillespie, Heather Norman-Burgdolf, Natalie Jones, Janet Tietyen Mullins

Dietetics and Human Nutrition Faculty Publications

Introduction

Obesity disproportionately affects rural communities, and Appalachia has some of the highest obesity rates in the nation. Successful policy, systems, and environmental (PSE) interventions to reduce obesity must reflect the circumstances of the population. We used a health equity lens to identify barriers and facilitators for healthy food access in Martin County, Kentucky, to design interventions responsive to social, cultural, and historical contexts.

Methods

We conducted 5 focus groups in Martin County, Kentucky, in fall 2019 to obtain perspectives on the local food system and gauge acceptability of PSE interventions. We used grounded theory to identify perceived barriers and …

Measuring The Spread Of Covid-19 In Kentucky: Do We Have The Right Data?, Kenneth R. Troske, Paul A. Coomes

Institute for the Study of Free Enterprise Working Papers

We examine various measures of COVID-19 infections, hospitalizations and deaths, with an emphasis on data for Kentucky. We find that: Data on the number of new reported cases of the disease obtained from convenience samples (as opposed to representative random samples) is an inaccurate measure of the spread of the disease in the State. Using CDC data and national studies, it appears that there were ten times the number of infections in March than reported for Kentucky at the time and by September the State is still capturing only one out of two people infected.

A better measure of new …

Preterm Birth Prevention In Appalachian Kentucky: Understanding Barriers And Facilitators Related To Transvaginal Ultrasound Cervical Length Surveillance Among Prenatal Care Providers, Anna Hansen, Mairead E. Moloney, Cynthia Cockerham-Morris, Jing Li, Niraj R. Chavan

Sociology Faculty Publications

Background: Appalachian Kentucky has higher-than-average rates of preterm birth (PTB)—a health disparity associated with increased maternal and fetal/neonatal morbidity and neonatal mortality. Transvaginal ultrasound (TVU) cervical length measurement is the best predictor of PTB risk, but is underutilized in Appalachia. This study explores prenatal care providers' TVU-related knowledge and practices, and identifies barriers and facilitators, which impact the adoption of this evidence-based technology.

Materials and Methods: This study recruited providers from three Appalachian Kentucky health care sites. Prenatal care providers took part in semistructured interviews and completed brief survey scales. Questions focused on PTB knowledge, TVU-related barriers, and suggestions for …

Did Social-Distancing Measures In Kentucky Help To Flatten The Covid-19 Curve?, Charles J. Courtemanche, Joseph Garuccio, Anh Le, Joshua C. Pinkston, Aaron Yelowitz

Institute for the Study of Free Enterprise Working Papers

In the absence of a vaccine or more effective treatment options, containing the spread of novel coronavirus disease 2019 (COVID-19) must rely on non-pharmaceutical interventions. All U.S. states adopted social-distancing measures in March and April of 2020, though they varied in both timing and scope. Kentucky began by closing public schools and restaurant dining rooms on March 16th before progressing to closing other non-essential businesses and eventually issuing a “Healthy at Home” order with restrictions similar to the shelter-in-place (SIPO) orders adopted by other states. We aim to quantify the impact of these measures on COVID-19 case growth in the …

Boundaries And Infomediaries: A Qualitative Study Of The Information Practices Of Community Health Workers, Robert M. Shapiro Ii

Theses and Dissertations--Communication

Despite successful efforts to treat and manage diseases, public health officials have recently begun a campaign to refocus efforts toward initiatives to alleviate the pressures that are often referred to as social determinants of health. In eastern Kentucky, and in other geographical regions labeled as health professional shortage areas or medically underserved areas, issues stemming from social determinants are compounded with health care systems that are often lacking the human resources to meet basic medical needs. One strategy has been to utilize volunteers and paraprofessionals such as community health workers to lessen the burden on the primary care and hospital …

The Effects Of Opioids On Kentucky's Workforce, Michael W. Clark, Jenny A. Minier, Charles J. Courtemanche, Bethany L. Paris, Michael T. Childress

CBER Research Report

From the executive summary:

Opioid abuse represents a significant and growing public health issue for both the nation and Kentucky. In 2016, opioids contributed to more than 62,000 deaths nationally and 1,406 deaths in Kentucky. National studies have placed the societal costs of opioid abuse at $55.7 billion in 2007 and $78.5 billion in 2013 (Birbaum et al. (2011) and Florence et al. (2016)). These costs included increased health care expenditures, higher criminal justice costs, and lost earnings due to reduced employment and premature deaths. The While House Council of Economic Advisors (2017) estimated the societal costs of opioid abuse …

The Effect Of Smoking On Kentucky’S Workforce, Michael W. Clark, Jenny A. Minier, Charles J. Courtemanche, Bethany L. Paris, Michael T. Childress

CBER Research Report

Excerpt from the Executive Summary:

Smoking has been estimated to increase health care costs in the United States by $167.5 billion annually (Xu et al. 2015). In Kentucky, smoking adds $2.5 billion in health care expenditures each year. Most of these costs were paid by public programs such as Medicaid and Medicare. While these costs are significant, they represent only a portion of the costs that smoking imposes on society. Smoking also leads to poorer labor market outcomes. Smokers are more likely to be unemployed, earn lower wages, and die prematurely than non-smokers. These negative labor market effects reduce economic …

The Economic Impact Of Diabetes In Kentucky, Michael W. Clark, Jenny A. Minier, Charles J. Courtemanche, Bethany L. Paris, Michael T. Childress

CBER Research Report

Excerpt from the Executive Summary:

The Kentucky Department of Public Health is responsible for improving the health and safety of Kentucky’s residents by preventing disease and injuries and encouraging healthy lifestyles. The department administers nearly 150 programs that address critical health issues affecting Kentuckians. These programs screen newborns for health problems, prevent the spread of infectious diseases, promote oral health, and provide numerous other services.

Diabetes represents a growing health concern for the nation and Kentucky. It is a chronic condition that causes blood sugar levels to rise and contributes to other serious health conditions such as heart and kidney …

Everybody’S Working (But The Weakened): An Assessment Of Medicaid Work Requirements And Their Administrative Burdens, Samuel Misleh

MPA/MPP/MPFM Capstone Projects

Although Medicaid work requirements are currently halted in both Arkansas and Kentucky, this analysis utilizes the data available to make an assessment and estimate of what Kentucky’s Medicaid enrollment will look like if work requirements similar to those Arkansas had are ever implemented. The relative severity of the administrative burden of such requirements provide a tool for comparison, and a difference-in-differences analysis of the change in Medicaid enrollment between Arkansas and West Virginia, a state that has not implemented and currently has no plans to implement Medicaid work requirements, provide the bases for this estimate. After coding the work requirements …

Exploring Evolutionary Medicine Through 19Th Century Medical Collections: Applications In Archival Studies, Taylor Sturgill

Special Collections Research Center Learning Lab Student Research

Evolution has been a paradox in the field of science, but, the study of evolutionary medicine applies both the evolutionary game theory and medicine. This study was conducted to explore evolution by analyzing two 19th century collections of medical formulations and prescriptions while compared to the trend of public health and pathogenic mechanisms. Analysis of organic structure in historical prescriptions, descriptive epidemiology in Kentucky, and the idea of the germ theory will be used explicitly to show the evolutionary change of health and disease. Results of this study provided an outlook on ingredients that stimulate the body as a whole …

Rct Testing Bystander Effectiveness To Reduce Violence, Ann L. Coker, Heather M. Bush, Patricia G. Cook-Craig, Sarah A. Degue, Emily R. Clear, Candace J. Brancato, Bonnie S. Fisher, Eileen A. Recktenwald

Obstetrics and Gynecology Faculty Publications

Introduction: Bystander-based programs have shown promise to reduce interpersonal violence at colleges, yet limited rigorous evaluations have addressed bystander intervention effectiveness in high schools. This study evaluated the Green Dot bystander intervention to reduce sexual violence and related forms of interpersonal violence in 26 high schools over 5 years.

Design: A cluster RCT was conducted.

Setting/participants: Kentucky high schools were randomized to intervention or control (wait list) conditions.

Intervention: Green Dot−trained educators conducted schoolwide presentations and recruited student popular opinion leaders to receive bystander training in intervention schools beginning in Year 1.

Main outcome measures: The primary outcome was sexual …

Living With Traumatic Brain Injury In A Rural Setting: Supports And Barriers Across The Continuum Of Care, Anne L. Harrison, Elizabeth G. Hunter, Heather Thomas, Paige Bordy, Erin Stokes, Patrick H. Kitzman

Physical Therapy Faculty Publications

Purpose: Traumatic brain injury (TBI) is prevalent in Kentucky and comes with a high cost in care and quality of life for individuals and caregivers affected. Many people living with the condition of TBI have unmet needs. Research among people living with TBI in rural areas is limited. The purposes of this study were to (1) increase understanding of the lived experience of people with TBI and caregivers in rural regions of Kentucky across the continuum of their care and (2) provide their perspectives on barriers and facilitators of optimal function and well-being.

Methods: A qualitative descriptive interview study was …

Colorectal Cancer Prevention: Perspectives Of Key Players From Social Networks In A Low-Income Rural Us Region, Nancy E. Schoenberg, Kathryn Eddens, Adam Jonas, Claire Snell-Rood, Christina R. Studts, Benjamin Broder-Oldach, Mira L. Katz

Behavioral Science Faculty Publications

Social networks influence health behavior and health status. Within social networks, “key players” often influence those around them, particularly in traditionally underserved areas like the Appalachian region in the USA. From a total sample of 787 Appalachian residents, we identified and interviewed 10 key players in complex networks, asking them what comprises a key player, their role in their network and community, and ideas to overcome and increase colorectal cancer (CRC) screening. Key players emphasized their communication skills, resourcefulness, and special occupational and educational status in the community. Barriers to CRC screening included negative perceptions of the colonoscopy screening procedure, …

Kentucky’S Public Health Strategic Plan: Strengthening Foundational Services & Improving Population Health, Glen P. Mays

Health Management and Policy Presentations

This session examines recent progress toward the 2012 Institute of Medicine recommendation to identify the components and costs of a "minimum package" of public health services and foundational capabilities to be available across the U.S. Research about the health and economic benefits of Foundational Public Health Services has begun to shape Kentucky's strategic plan for transforming the public health system.

Aca Implementation In The South: The Political Economy Of Full Participation In Kentucky, Glen P. Mays

Health Management and Policy Presentations

This analysis, conducted as part of the ACA Implementation Research Network, examines economic and political forces shaping Kentucky's early experience with implementation of the Patient Protection and Affordable Care Act.

Aca Implementation In Kentucky: Experiences Of An Expansion State, Glen P. Mays

Health Management and Policy Presentations

Kentucky's implementation of the Affordable Care Act has included early successes with insurance coverage expansion through Medicaid and a state-operated health insurance exchange. Signals of improvements in health care accessibility and delivery of preventive services are evident in the first year after coverage expansions. Challenges associated with political opposition, delivery system transformation, and public health financing remain on the state's policy agenda.

Self-Reported Memory Complaints: Implications From A Longitudinal Cohort With Autopsies, Richard J. Kryscio, Erin L. Abner, Gregory E. Cooper, David W. Fardo, Greg A. Jicha, Peter T. Nelson, Charles D. Smith, Linda J. Van Eldik, Lijie Wan, Frederick A. Schmitt

Sanders-Brown Center on Aging Faculty Publications

OBJECTIVE: We assessed salience of subjective memory complaints (SMCs) by older individuals as a predictor of subsequent cognitive impairment while accounting for risk factors and eventual neuropathologies.

METHODS: Subjects (n = 531) enrolled while cognitively intact at the University of Kentucky were asked annually if they perceived changes in memory since their last visit. A multistate model estimated when transition to impairment occurred while adjusting for intervening death. Risk factors affecting the timing and probability of an impairment were identified. The association between SMCs and Alzheimer-type neuropathology was assessed from autopsies (n = 243).

RESULTS: SMCs were …

Health Reform Implementation: Update And Implications For Kentucky, Glen P. Mays

Health Management and Policy Presentations

This talk reviews the progress of health reform implementation in Kentucky with a focus on opportunities for aligning systems for medical care, public health, and social support delivery to improve population health.

Relationship Between Clandestine Methamphetamine Laboratory Seizures And Burns In Kentucky, David A. Wittmer

MPA/MPP/MPFM Capstone Projects

Methamphetamine is a highly addictive stimulant that is synthetically produced using equipment and chemicals available in the community. Its burden to society may be determined through a number of mechanisms, including the imposed strain on healthcare systems. The evolution of methamphetamine use and production methods has led to reports of increased methamphetamine related burn admissions among hospital burn units[1-3] . Current literature identifies an increase in injury severity, comorbid complications, and cost of care associated with methamphetamine related burn injuries[1-5]. The intent of this study is to identify burn injuries in Kentucky and assess whether a statistically significant association exists …

Kentucky Pharmacist Opinions Of The Potential Reclassification Of Pseudophedrine As A Legend Drug, Kathleen E. Monson

MPA/MPP/MPFM Capstone Projects

Methamphetamine is a drug of abuse, which is often produced in clandestine laboratories. Recent efforts to curb methamphetamine abuse are aimed at controlling access to precursors, including pseudoephedrine (PSE), used in illicit methamphetamine production. Currently, access to PSE is controlled in Kentucky by placement behind pharmacy counters, retail quantity limitations and electronic tracking. Recent legislation proposed in Kentucky to change PSE from non-prescription to a legend medication was unsuccessful and highly controversial. The objective of this project is to collect and analyze pharmacists’ opinions on the effectiveness of current precursor controls, proposed legislation to make PSE a legend drug and …

Cross-Cultural Comparison Of Perceptions About School Feeding Programs From Ghanaian And U.S. Adults, Yolanda L. Jackson

Theses and Dissertations--Nutrition and Food Systems

Because of an increase in food insecurity over the past decade, the U.S. and many developing countries are focusing efforts on issues relating to child hunger. School feeding programs have been in existence for roughly 220 years but modifications have been made over the years to improve the quality of food they serve. Little research has been conducted about adult perceptions of school feeding programs and the impact it has on the community in the U.S. as well as developing countries such as Ghana, West Africa. Because of the gap in literature on school feeding programs and adult perceptions about …

The Incidence Of Hip Fracture Associated With Proton Pump Inhibitor (Ppi) And/Or H2 Receptor Antagonist (H2ra) Use In The Kentucky Medicaid Population, Timothy C. Umeh

MPA/MPP/MPFM Capstone Projects

No executive summary.

Quality Of Life And Adolescents In Rural Kentucky, Hatim A. Omar, Søren Ventegodt, Joav Merrick

Pediatrics Faculty Publications

In many rural areas in Kentucky, adolescents lack the basic assets for a good quality of life, such as having caring adults, a safe place and useful activities after school. In this chapter we analyze data from middle and high school students referred to a comprehensive school based health promotion center (SBHPC). From August 2006 to February 2008, a total of 382 students (200 female, 182 male, aged 12-18 years) were referred to the SBHPC for help. Only two (0.5%) students had two parents living with them and 12 (3.1 %) had safe, organized after school activities. 19.9% of the …