Medicine and Health Sciences Commons^™

Racial Disparities In Syringe Exchange Program Access In Kentucky, Ankur Bhargava

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

Non-white Kentuckians use syringe exchange programs (SEPs) at lower rates than white Kentuckians. This analysis begins by documenting this disparity and then explores several potential causes. Access to SEPs is limited by law as only health departments may operate them. Areas of the state in which SEPs face political opposition are therefore underserved. A consequence of this legal limitation is distance to a SEP may be a barrier to access. Analysis of publicly available data indicates non-white drug users in Kentucky are located closer to syringe exchange programs in urban areas but farther away in rural areas. Proximity to a …

The Impact Of Kentucky's Medicaid Expansion Under The Affordable Care Act On Dental Care Visits, Mutlaq Alotaibi

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

Background. Lack of health insurance, cost of dental care services, and shortage of dental workforce are leading barriers to dental care access. Low-income adults and those who reside in areas with low dentist supply are less likely to visits a dental office than their counterparts. Studies have reported that dental visits increased among low-income adults in states that expanded Medicaid under the Affordable Care Act (ACA) and have an adequate number of dentists. However, the impact of Medicaid expansion on income-based disparities and urban-rural disparities in dental care visits is unclear.

Objectives. The aim of this study is to examine …

Alcohol Excise Taxes And Their Effects On The Community, Christopher R. Watts

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

Objectives: This study examines the association of an additional excise tax on alcoholic beverages in Georgetown, Kentucky with alcohol-related motor vehicle accidents. Evaluate the additional benefits of the excise tax on the community of Georgetown, Kentucky.

Methods: Using an interrupted time series design, this study compares alcohol-related crash statistics from two similar cities based on 126 months of data from the Kentucky State Police. Analyses included linear regression and Poisson models to evaluate the data in each city to determine population-wide results.

Results: Alcohol-related motor vehicle crashes immediately declined (-12.5%) in Georgetown following the implementation of the excise tax and …

Maternal Proximity To Mountaintop Removal Mining And Birth Defects In Appalachian Kentucky, 1997-2003, Daniel B. Cooper

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

Background: Extraction of coal through mountaintop removal mining (MTR) alters many dimensions of the landscape, and explosive blasts, exposed rock, and coal washing have the potential to pollute air and water with substances known to increase risk of developmental and birth anomalies. Previous research suggests that infants born to mothers living in MTR coal mining counties have higher prevalence of most types of birth defects.

Objectives: This study seeks to examine further the relationship between MTR activity and birth defects by employing individual level exposure estimation through precise satellite data of MTR activity in the Appalachian region and maternal residence …

Patient Engagement In Patient Portals In Appalachia Versus Surrounding Us Census Regions: An Analysis Of Hints (Health Information National Trends Survey) Data, 2017 - 2020, Heather Lea Tudor

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

OBJECTIVE: Those living in the Appalachian regions face more significant healthcare disparities than those in the US. Patient portals can decrease disparities and increase health outcomes and health literacy. The purpose of this study was to determine if those living in the Appalachian region were offered access to and used their patient portals differently than the surrounding US Census region. Additionally, we aimed to determine if there was a difference in reported reasons for non-use of patient portals.

METHODS: This was a descriptive study using data from the National Cancer Institute’s Health Information National Trends Survey (HINTS) data (2017-2020) to …

Methenamine Prophylaxis For Recurrent Urinary Tract Infections In A Tertiary Referral Center, Cameron A. Wade

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

Purpose: Methenamine hippurate (MH) is a urinary antiseptic, indicated for prophylaxis of recurrent urinary tract infections (UTIs) but with only few and limited studies regarding its efficacy. To help address this knowledge gap we reviewed our experience with MH for UTI prophylaxis, focusing on women with recurrent uncomplicated UTIs.

Materials and Methods: The University of Kentucky electronic health record was queried to identify adults who were prescribed MH from the Urology clinic between January 2013 and January 2019. Charts were reviewed to assess patient-reported UTI frequency, demographics and relevant health factors. Treatment success was defined as 0-1 UTI in 6 …

Healthy Living People: A Hiv Transmission Intervention In Four Chicago Communities, Angela Wuerger

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

The transmission of HIV within the city of Chicago has been established as a major health concern: however, the lack of adequate resources has created gaps within current programming available for people living with HIV. Healthy Living People (HLP) is an evidence-based program focused on reducing the transmission of HIV through strengthening adherence to antiretroviral therapy and decreasing number of higher risk sexual encounters. The Chicago Department of Public Health will provide the HLP program, which includes fifteen 90-minute sessions over the course of one year. The HLP program will be offered for people living with

HIV in four Chicago …

Implementing The Mothers And Babies Program To Reduce Preterm And Low Birth Weight Deliveries, Tan Frison

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

Georgia ranks fourth (4th) in the nation for the highest low birth weight rate at 10%, and sixth (6th) in the nation for preterm birth rate at 11.7%, among the states. Based on statistical data Bulloch county has maintained an average low birth weight statistic of 10% for over a decade. In 2019, there were 107 preterm and 79 low weight births in Bulloch county, Georgia. These numbers confirm there is a need for more preventive resources for mothers and children within this community. To address this burden, the Bulloch County health department has decided to implement the Mothers and …

Farmer Suicide: Rates, Trends, And Associations To Commodity Production Among States Reporting Violent Deaths, 2003-2017, Paul Norrod

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

Occupational studies show that farmers are at higher risk for suicide with rates at least two-fold those of the U.S. population.2-4 Therefore, the purpose of this study was to (1) determine age- and sex-specific farmer suicide rates, (2) evaluate rate trends, and (3) assess the relationship between commodity production and farmer suicide using the National Violent Death Reporting System (NVDRS) and quinquennial Census of Agriculture. We identified 1,652 farmer suicide cases from the NVDRS. Age-specific rates showed the highest rates among male farmers over 64 at 14.03 per 100,000. Annual rates for the 15-year study period peaked during 2013 at …

Volatile Organic Compound Exposure And Hearing Loss In Children, Brooke Spillman

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

Hearing loss is often associated with repeated exposure to noise levels above 85 decibels. While noise is noted as the largest contributor to hearing loss, some fail to consider the impacts of chemical exposure on the hearing health of children, specifically VOCs. Early detection and prevention of hearing loss in children is important due to the impacts that hearing has on the learning, behavior, speech, and language development of children. This study examined the relationship between VOC exposure and hearing loss in children using NHANES data collected from 2005-2006. This was analyzed with Chi-square analyses and a logistic regression taking …

Secular Trends In Low Birth Weight And Preterm Birth Disparity Between Infants Born To Teenage And Adult Mothers: An Exploratory Analysis, Elizabeth Edwards

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

Introduction. Increased risk of preterm birth and low birthweight for infants born to teenage mothers (15-19), when compared to infants born to adult mothers (20-29), is well documented in the United States. Trends in preterm birth and low birthweight are also well documented over time. Examination of the difference in incidence of preterm birth or low birthweight between infants born to teenage mothers and to adult mothers over time is not present in the literature. This study aimed to fill this gap in the literature and determine how preterm birth and low birthweight differences have changed over time.

Methods. Natality …

Covid Mitigation Strategies And Safety Perceptions Among Workers During Spring 2020 Shutdown, William Mciver

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

A novel coronavirus pandemic radically shifted the working environment of the population in the United States in the spring of 2020. Studies have examined the difference between healthcare workers and the general population, but there exists a gap when looking at mitigation strategies between healthcare workers and other workers that continued working outside the home. This study surveyed workers and asked about employment status, employment field, COVID safety precautions taken in the workplace, and feelings of safety. This study examined that and found statistically significant differences in the mitigation strategies used by healthcare workplaces and all other non-healthcare workplaces. This …

Can Treatment Of Social Isolation And Loneliness Reduce Healthcare Utility? An Analysis Of Social Prescribing, Matthew Mattingly

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

The paper focuses on the practice of social prescribing as it is currently implemented through the National Health Service (NHS) of the United Kingdom. Social Prescribing is an emerging healthcare intervention aimed at referring patients to community-based activities. NHS promotes social prescribing as a method of reducing healthcare utilization in chronically ill patients. Current evidence on social prescribing is subject to significant variation and has not supported NHS’s claims. The potential link between feeling of social isolation, loneliness and chronic illness was further investigated through data from the National Social Life, Health & Aging Project (NSHAP). Data was tested for …

Assessment Of The University Of Kentucky's Nutrition Education Program's Smarter Lunchrooms Pilot Plate Waste Project In Three Kentucky Schools, Natalie Jones

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

School-based approaches utilizing policy, systems, and environmental strategies are needed to address the complex factors driving childhood obesity. The purpose of this pilot study is to implement Smarter Lunchroom strategies in three participating Kentucky middle schools in 2019 and then assess two outcomes: (1) determine the impact of the intervention on fruit and vegetable purchases and waste, and (2) determine how purchases or waste varied by interventions selected for each setting. After the 6-week intervention, combined we found no statistical significant increases in fruit and vegetable purchasing from pre to post-intervention. No statistical significant decreases in fruit and vegetable plate …

Prevalence And Correlates Of Secondary Syringe Exchange (Sse) Among People Who Inject Drugs (Pwid) In Rural Kentucky, Jordan R. Wilson

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

Aim: To describe the prevalence of secondary syringe exchange (SSE) in a sample of syringe service program (SSP) clients in rural Appalachian Kentucky and to identify the correlates of SSE.

Methods: Participants (n=338) completed interviewer-administered questionnaires. Only those who reported having ever exchanged syringes at a SSP (n=140) were included in analysis. SSE was measured through self-report of obtaining syringes for someone else at a SSP in the past 6 months. Prevalence and correlates of SSE were examined using bivariate analysis and multiple logistic regression.

Results: Overall, 30% of participants reported SSE. Participants in the second [aOR= 3.83; 95% CI: …

Impact Of Smoking And Hpv Status On Cervical Cancer Survival In Women Living In Kentucky, 2004-2005 And 2014-2015, Brittany M. Mckinley

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

BACKGROUND/ OBJECTIVE: Cervical cancer is the fourth most commonly occurring malignancy in women worldwide, with an estimated 530,000 new cases and 270,000 new deaths each year (Small et al, 2017). While the incidence of cervical cancer has decreased by approximately 1.9% per year between 2007 and 2011, the death rate has remained stable (Bernard et al, 2014). Studies have shown that nearly all cervical cancer cases are associated with the Human Papilloma Virus (HPV). Many studies support the association of smoking with increased risk of invasive cervical cancer in women with high-risk HPV (Castle et al, 2002; Fang et al, …

Prevalence And Exacerbation Of Asthma Within Two Counties In Eastern Kentucky, Rachid Souleye

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

Background: Central Appalachia residents have one of the highest rates of serious respiratory diseases in the nation. Appalachian Kentuckians are 50% more likely to be diagnosed with adult asthma compared to the overall U.S. population. Yet, few epidemiologic studies have assessed risk factors for respiratory disease in this population. Using a community-based approach, the investigators of the Mountain Air Project (MAP), one of the largest adult cohorts from two disadvantaged communities in Central Kentucky, collected data to estimate the prevalence of asthma and assess various socioeconomic and environmental risk factors to determine their effect on asthma.

Methods: A cross-sectional epidemiologic …

Impact Of Mental Health And Financial Status Of Essential And Non-Essential Workers That Continued Working Outside The Home During The Spring 2020 Covid-19 Shutdown, Adrianne Deveira

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

Objective: A global pandemic caused businesses in the United States to shutdown based on essential vs. non-essential criteria. There has been a lot of research discussing the impact of the shutdown on healthcare frontline workers. Little is known about other essential and non-essential workers, that continued working outside the home during the shutdown. The purpose of this paper is to examine the financial and mental health issues encountered by essential and non-essential workers that continued working outside the home during the Spring 2020 shutdown.

Methods: Snowball sampling of an online survey that was available from May 8 – June 6, …

An Evaluation Of Injurious Falls And Fall-Risk-Increasing-Drug (Frid) Prescribing Behaviors In A Nationally Representative Sample & The Pharmacist’S Role In Fall Prevention, Taylor Elliott, Susan Westneat, Shama Karanth, Erin Abner, Anna Kucharska-Newton, Daniela C. Moga

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

Background: Falls are a major public health problem affecting millions of older adults each year. Little is known about FRID prescribing behaviors after injurious falls occur.

Objective(s): The primary objective of this study was to investigate whether an injurious fall impacts the odds of being prescribed a new FRID.

Methods: We conducted a cross-sectional analysis using data from the 2016 National Ambulatory Medical Care Survey to investigate whether an injurious fall impacts the odds of being prescribed a new FRID. We included patients age >/= 65 years and classified visits based on presence of an injurious fall. The outcome of …

Recovery Housing In The United States And The Importance Of Data Collection, Maanasa Manchikanti

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

Substance use disorder (SUD) has been a prevalent issue in both the clinical and public health sectors for some time. Substance use disorder can be defined as a disease that affects an individual’s brain and behavior, causing them to develop an inability to control the use of legal or illegal drugs and substances (Mayo Clinic, 2021). Substances include but are not limited to alcohol, marijuana, opioids, and other controlled substances (Mayo Clinic, 2021). Substance misuse is a large topic of focus in public health because it not only deteriorates the quality of health in individuals and society, but also comes …

Equine West Nile Virus In Kentucky: Characteristics Of Historical Testing And Analysis Of Causal Factors, Kaelyn Short

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

As the arbovirus with the highest incidence in both humans and horses in the United States, West Nile Virus (WNV) presents a significant risk to the equine population of Kentucky. Widespread infection has the potential to cause a significant economic impact to the state and long-term health complications for the horses. To better understand the burden of equine WNV, historical diagnostic testing archives the University of Kentucky Veterinary Diagnostic Lab were analyzed along with environmental and census data collected from additional sources. A total of 2146 test results were analyzed utilizing descriptive statistics, chi-square tests of independence, and binary logistic …

Rates Of Diabetes Screening In Kentucky Before And After Implementation Of The Affordable Care Act (Aca), Cory Reinert

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

Diabetes mellitus, commonly referred to as “diabetes”, is currently at epidemic proportions in the United States as its prevalence has drastically increased over the past several decades. The percentage of Americans with diagnosed diabetes has risen from 0.93 percent of the population in 1958 to 10.5 percent in 2018 (ADA, 2021). Diabetes also impacts record numbers of Kentucky residents.

Regular screening for those considered at-risk can encourage patients to implement lifestyle modifications, pharmacological therapy, or other interventions earlier in the course of disease. This can help prevent or delay onset of T2D and can reduce diabetes-related complications in those who …

The Impact Of The 2018 Kentucky Cigarettes Taxes On Tobacco Use Among Youth, Claire W. Mampunza

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

Introduction: In the Commonwealth of Kentucky, cigarette smoking results in 1.92 billion dollars spent every year on medical costs, the death of approximately 9,000 Kentuckians, and 34 percent of all cancer cases. In 2017, 14.3 percent of high school students in Kentucky declared being current cigarette smokers, compared to 8.8 percent nationally. Tobacco use among youth is a public health concern because 88 percent of adult smokers initiate smoking before age 18. Youth nicotine use can damage the growing brain, which continues to develop until 25 years of age. In July 2018, the excise tax on cigarettes increased from …

The Relationship Between Health Insurance Literacy, Health Insurance Coverage, And Health Insurance Utilization In The United States, Elizabeth Graves

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

The Affordable Care Act (ACA) made health insurance more accessible but that does not mean that individuals understand their health insurance or are more confident in using it. The knowledge and confidence that individuals have in health insurance impact their health insurance literacy. Health insurance literacy (HIL) is defined as the ability and capacity to seek, obtain, understand, and potentially use health insurance information and plans.

This capstone study assesses how having HIL, which includes having a knowledge of health insurance terms and confidence in utilizing health insurance services, is related to having health insurance and having a usual source …

Rabies In Kentucky From 1989-2020: A Case For Surveillance, Sarah Jane Robbins

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

The Kentucky rabies reporting system includes data from five laboratories and provides an account of suspected rabies reports since 1989. Over 35,000 suspected cases are used to estimate rabies incidence temporally and spatially. Recommendations to the current rabies reporting methodologies are presented through proposed innovations of a standard, electronic reporting form. Given the multiple sources of data, the reporting system lacks standardization and comprehensive information about suspected rabies events, resulting in limited epidemiological capabilities; and data issues that prevent its use as a surveillance system. These issues are a limiting factor in rabies elimination; but a driving factor in over-testing, …

Implementing The Textme Cardiovascular Mobile Health Intervention In Detroit, Michingan, Melissa Horton

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

Cardiovascular disease is currently the leading cause of death in the United States. One of the cities with the highest rates of cardiovascular disease is Detroit, Michigan. Those diagnosed with cardiovascular disease are encouraged to make lifestyle modifications to improve their health. However, if cardiovascular disease is not managed, it can lead to serious health outcomes such as stroke, heart disease, and death. The TEXTMe program is designed to send randomized text messages to participants to encourage lifestyle changes around diet, exercise, and smoking cessation. Participants in the program will be recruited from three health clinics located in the city …

Teeka Tehreek: Increasing Epi Vaccinations In Khyber Pakhtunkhwa, Pakistan, Narjis Fatima Hussain

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

Abstract

Globally, Pakistan ranks third among countries with the most unvaccinated and under-vaccinated children. Within the country, there are huge regional disparities, and the Khyber Pakhtunkhwa region (KPK FATA) has one of the lowest vaccination rates in the country. Low vaccination rates contribute to the high burden of childhood infectious diseases in Pakistan that cause 70% of childhood deaths. Addressing the issue requires an understanding of the barriers towards vaccinations; 30% of refusals are due to religious reasons and other misconceptions that are compounded by low literacy rates. Since religion has a critical authority in shaping the population’s beliefs, attitudes, …

Nurse Home Visitation Program In Hamilton County, Oh To Increase Maternal And Child Health Outcomes, Hannah Widner

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

Hamilton County Ohio currently has poor outcomes related to maternal and infant health, specifically among African Americans. Compared to the Healthy People 2020 goals, Hamilton County has higher rates of infant mortality, preterm birth, neonatal infant mortality, and conception within 18 months of previous pregnancies. These rates are disproportionate among African Americans. For instance, African American babies born in Ohio have higher infant mortality rate (14.3 per 1,000) prematurity as a cause of death (4 per 1,000) and neonatal mortality rate (9.2 per 1,000). These are compared to White babies in Ohio with infant mortality rate (5.1 per 1,000), prematurity …

Maternal Residential Proximity To Surface Mining Associated With Preterm Birth And Low Birth Weight In Appalachian Kentucky, Whitney Smith

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

Objective: This study aims to examine the relationship between maternal residency in a county with surface coal production and preterm birth or low birth weight.

Methods: A cross-sectional study was conducted using birth records (n=62,766) for 54 Appalachian counties and coal production in tons. Logistic regression and chi-squared analysis was done to analyze the relationship between surface coal mining and preterm birth and low birth weight in two different birth groups.

Results: After controlling for covariates, statistically significant increases were seen in Birth Group 1 and Birth group 2. Birth Group 1 had statistically significant results for preterm birth ((1.19 …

Colorectal Cancer Differences In Staging And Survival: Appalachian And Non-Appalchian Kentuckians, Ripley Lucas

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

Colorectal cancer is the third most commonly diagnosed cancer in the United States. Historically, the Appalachian region of Kentucky has experienced disparities in colorectal cancer screening and survival as compared to both the non-Appalachian region of the state and the United States. The aim of this paper is to investigate the differences in cancer staging and survival after diagnosis in Appalachian and non-Appalachian Kentuckians. The present time period of study is a retrospective, population-based cohort with data taken from the Kentucky Cancer Registry. Binomial logistic regression and Cox proportional hazards models were used to estimate unadjusted and adjusted odds ratios …