A Cross Sectional Study Of Drinking Water Quality And Health Effects In The El Bua Tsáchila Community, Santo Domingo De Los Tsáchilas, Ecuador, Dannette Cook

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

Background: Access to clean water and sanitation is known to decrease childhood mortality, improve health outcomes, and decrease risk of water-borne diseases. However, access to clean water is often restricted in impoverished or indigenous communities. This cross-sectional study evaluated the primary source of drinking water for forty homes, the Est. Cheche river, a local spring, and a local school in the TsáChila indigenous community of El Bua, Santo Domingo, Ecuador. This analysis focused on the presence of coliforms and E. coli in the water source (well or city/piped), the physical parameters of the water and the type of sanitation …

Retrospective Policy Analysis Of Kentucky House Bill 1, Sarah E. B. Covey

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

Background: In 2011, the Centers for Disease Control (CDC) coined the phrase, “opioid epidemic” in response to the staggering increase in opioid use and opioid- related deaths. Kentucky House Bill 1 (HB1) passed in 2012, attempted to stifle the impact of the opioid epidemic on the citizens of the Commonwealth by imposing supply-side restrictions on the prescription and dispensing of opioid pills. Objective: The primary objective of this analysis is to evaluate the effectiveness of HB1 on the reduction of opioid-related deaths, opioid prescription rates, and intravenous opioid drug use rates. Methods: This analysis employed Eugene Bardach’s framework for policy …

Examining The Effects Of Indiana’S Syringe Exchange Program On New Hepatitis C And Hiv Diagnoses From 2015-2017, Katherine Youngen

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

In 2015, a rural Indiana county experienced an outbreak of HIV related to intravenous drug use. 181 people were diagnosed with HIV between Oct. 1, 2014 and Nov. 1, 2015. This outbreak prompted the state legislature to implement a policy that legalized syringe exchange programs for the first time ever in Indiana. This capstone attempts to summarize the situation that led to the creation of this policy and the effects of this policy, Indiana Senate Enrolled Act 461 (IN SEA 461). Finally, this capstone makes recommendations for modifying the existing policy or implementing a similar policy in an area experiencing …

The Relationship Bewteen Noise Exposure And The Risk Of Occupational Injury Among Workers In Kentucky, Kenneth M. Alea

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

Objective: To examine for an association between the occurrence of work­ related trauma injuries in the state of Kentucky and occupational noise exposure.

Methods: Using the Kentucky Trauma Registry, work-related trauma injuries were identified between the years of 2013 and 2017. Subjects were assigned noise scores based on O*NET noise exposure data by occupational industry. Associations between the occurrence of occupationally-related injuries and noise scores were assessed using linear regression analysis.

Results: A total of 1,808 work-related traumatic injuries were identified from the trauma registry over the five years of data reviewed in the study. The majority of occupational injuries …

Positive Action: Implementing A Social-Emotional And Character Development Program In Marshall County, Kentucky Schools, Mallory Antel

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

Approximately 8% to 10% of children less than 5 years old experience clinically significant mental health problems, and 10–20% of all children and adolescents have a mental health problem of some type. While the prevalence of mental illness is similar between rural and urban residents, the services available differ significantly. Less than half of rural counties have a mental health facility that provides outpatient treatment for children and adolescents, resulting in children and adolescents in these areas being largely underserved. Following family homes, schools are the primary locations responsible for youth development. Research shows that well- designed, well-implemented school-based prevention …

Preventing Interpersonal Violence At The University Of Kentucky: A Community-Level Expansion Of The Green Dot Program, Chelsey Reid

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

College students in the United States are at risk for being impacted by interpersonal violence (IPV), a spectrum of violence that includes sexual assault, dating violence, domestic violence, and stalking, with 1 in 5 women and 1 in 16 men being impacted by victimization during their collegiate careers. Through enhanced approaches to primary prevention, including through active bystander training, research has identified evidence-based strategies for reducing IPV prevalence. In Kentucky, 10.1% of all women impacted by IPV are first victimized prior to 18-years-old and 12.4% of all completed rapes are either alcohol or drug-facilitated. In light of these cumulative data, …

Women Identifying New Goals Of Safety (Wings) In Conflict Affected Regions Of Ukraine, Maryna Hrudii

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

According to Radio’s Liberty (Radiosvoboda) analyses of data provided by United Nations Population Fund (UNFPA), the National Violence Hotline and the Geneva Center of Democratic Control of Armed Forces (DCAF), there were 1.85 million survivors of intimate partner violence (IPV) in Ukraine in 2014-2017, and of these, only 83,000 contacted the police. IPV and gender based violence (GBV) in Ukraine remain underreported due to the lack of law enforcement investigations, as well as due to stigma and shame. Women in conflict-ridden regions of Ukraine are at heightened risk for GBV/IPV. The project will IPV/GBV in Luhansk and Donetsk regions, where …

Reducing Infant Mortality Through The Nurse Family Partnership Home Visitation Program In Montgomery County, Alabama, Kristyn Hill

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

The mitigation of infant mortality (IM) has long been a public health effort within the United States. And although the rates have dramatically decreased with medical advancements, certain populations remain disproportionately affected. There are various factors that are thought to contribute to our IM rates and the disparities between women of varying demographics. Alabama has the highest rates of infant mortality in our county, and women of color within the state have even higher rates.

Many programs with goals of decreasing the IM rate within the United States have been implemented over time. In particular, home visitation programs have been …

School-Based Hpv9 Vaccination Clinic In The Cumberland Valley Area Development District Of Kentucky, Eryne Wirthorn

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

Human Papillomavirus (HPV) is a group of more than 150 virus that can cause genital warts and cancers of the oropharynx, cervix, vagina, vulva, penis, and anus. A preventive vaccine currently exists that protects against seven oncogenic HPV strands and two strands that cause genital warts. Current guidelines for HPV9 vaccination consist of a 2-dose series delivered at 0 and 6 months for males and females ages 9-14, and a 3-dose series delivered at 0, 2, and 6 months for those ages 15-26.

While up-to-date (UTD) vaccination rates have increased across the Unites States, in 2017, only about 52.4% of …

Assessing The Tuberculosis (Tb) Screening Compliance Rates And Treatment Completion Among International Students At The University Of Kentucky, Bongiwe P. Malinga

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

Background: Tuberculosis early screening and diagnosis are cost-effective strategies for infection control. Tuberculosis elimination which is aimed for 2030 requires that both latent tuberculosis and active disease be fully treated. This study measures the tuberculosis screening rates and treatment completion rates among the international students at the University of Kentucky between 2016 and 2018.

Methods: This retrospective cohort study included all J1 and F1 student visa holders enrolling from 2016 fall to 2017 fall. To accommodate the nine months treatment completion, the cohort period overlapped to 2018. Data were provided by the University Health Services and the sample size …

Assessing The Implementation Of Syringe Exchange Programs In Kentucky: A Case Study, Alexandra Miller

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

Problem: There are currently 52 operating syringe exchange programs in Kentucky; a state that has 25% of the highly vulnerable counties for an HIV outbreak. The implementation process of syringe exchange programs can limit the potential for growth. The aims of this study were to identify key barriers and successes to the implementation process of syringe exchange programs in Kentucky. This was assessed by comparing various social and political factors that come into play in local communities.

Methods: The study was conducted using an exploratory case study approach. The researcher conducted interviews with three key informants at the Louisville Metro …

Methods For Multiple Imputation By Chained Equations Accounting For Missingness: A Simulation Study, Nathaniel Wilson

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

Improper treatment of missing data can lead to biased or invalid results. If the data are missing at random (MAR), multiple imputation by chained equations (MICE) is one method utilized to reduce bias. When implementing MICE, the imputation model must be compatible with the final analysis model. We aim to show how to include interaction terms in the imputation model to ensure valid results are obtained. Data were simulated for one continuous outcome originating from two binary predictor variables and their interaction. Missingness was imposed via a MAR mechanism. To handle the missing data, four methods were performed: complete records …

Exploring Methods To Increase Hiv Testing In Kentucky, Chukwudi Yagazie Mbagwu

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

This project was conducted to develop a policy proposal that would increase HIV testing after evaluating current Kentucky Law and Regulations, current health insurance laws, studies on acceptability of different HIV test, barriers to testing from both providers and patients/individuals, and factors associated with positive likelihood of HIV testing. Based on these findings a proposal was developed that would require changing Kentucky regulations on providers communicating test results to patients, change in what form HIV testing would be covered under certain insurances, develop incentives for patients to be tested and report their results to their provider (and hence increasing surveillance …

Cost-Effectiveness Of A Weight Loss Intervention: An Adaptation Of The Look Ahead Lifestyle Intervention In The Us Military, Karina Manz

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

Objective: To assess whether a counselor-initiated adaptation (CI) of the Look AHEAD Intensive Lifestyle Intervention (ILI) in a military setting was cost-effective relative to a self- paced adaptation (SP).

Methods: We performed cost-effectiveness analysis from a payer perspective alongside a 2014- 2017 randomized behavioral weight loss trial among 248 active-duty military personnel stationed at a US Air Force Base in Texas. We calculated incremental cost-effectiveness ratios (ICERs) for weight loss, reductions in waist circumference, and quality-adjusted life years (QALYs).

Results: After 12 months, the CI adaptation cost more per participant compared to the SP adaptation ($1,081 vs. $120), but achieved …

Implementing Components Of The Cafeteria Power Plus Project And The Five-A-Day Power Plus Project With The Catch’S Go, Slow & Whoa Program To Increase Fruit And Vegetable Consumption In Community Eligibility Provision Elementary Schools In Lexington, Ky, Kayla Payton Keller

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

Poor diet quality is a leading risk factor for many chronic diseases affecting Americans today. Increasing consumption of fresh fruits and vegetables during childhood helps to protect against chronic diseases in adulthood and overall prolonged healthier habits. Since 1988, trends in fruit consumption remain unchanged in the United States and vegetable consumption has slightly decreased. Communities living under the poverty level have a greater disparity for access to and consumption of fresh fruits and vegetables. This proposal is given by the Lexington Fayette County Health Department (LFCHD) and combines aspects of three evidence-based programs: the 5-a-day Power Plus Project, the …

Thyroid Function Screening & Dysfunction In Patients With Heart Failure: An Examination Of Practice At The University Of Kentucky Albert B. Chandler Hospital From 2007-2017, Alexandra Paige Hall

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

Introduction: Heart failure constitutes a global pandemic affecting at least 26 million globally (an estimated 5.7 million of which are Americans), and its burden on our healthcare system is projected to increase.[1] As a result, it is imperative that diagnostics and treatment among that population be evidence based in order to contain costs and optimize patient outcomes. Over the last 20 years, thyroid function screening has been recommended for patients upon initial diagnosis of heart failure by the American College of Cardiology and other professional organizations. However, it remains unclear whether this recommendation is followed by practitioners and how much …

Evaluating The Effects Of Safe Injection Facility Legalization On Fatal And Non-Fatal Overdose And Infectious Disease, Olivia M. Ramirez

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

In 2017, 70,000 lives were lost to fatal drug overdoses with approximately 46,000 of those involving the use of prescription and illicit opioids (CDC, 2018b). Unaddressed, the opioid epidemic is costing large amounts of money, lost productivity and valuable lives.

Injection drug use has also become increasingly common in the United States, as it is an efficient means of consuming opioids. Unfortunately, injecting drugs is also an efficient method of transmitting bloodborne diseases. Estimates show that in the United States, 8% of all new HIV infections in 2010 and 22% of all adults and adolescents with HIV resulted from injection …

The Impact Of Medication Donation Repositories: A Policy Analysis, Lacey Brinegar

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

Two major issues surround the U.S. healthcare system: waste and inaccessibility of prescription drug medication. This paper primarily examines the financial impact medication donation repositories have on individuals and the healthcare system overall. Healthcare facilities may act as repositories for donated medications to be dispensed to those otherwise unable to afford them. The specifics of each policy vary from state to state with some policies covering a wider array of acceptable donations than others. Although Kentucky enacted a policy in 2005, the state still lacks any operational programs. By analyzing the policies of multiple states, this paper elucidates the more …

Improving Access To Antenatal Care In Ngara, Tanzania Through Implementation Of The Lady Health Worker Programme, Alison L. Bailey

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

Maternal mortality is one of the greatest health disparities facing the world today. A disproportionate number of women who die from pregnancy-related complications live in developing countries: the average maternal mortality in developed nations is 12/100,000, compared to 239/100,000 in developing nations; this rate is even higher in several sub-Saharan African nations. Reasons for this disparity include a lack of providers, inaccessibility to care, and poor quality of treatment in developing nations. Women living in the sub-Saharan country of Tanzania face many of these barriers, and as a result the country’s maternal mortality rate is 398/100,000. Antenatal care is an …

Case-Control Study Of Nutrition And Lung Cancer In Appalachian Kentucky, Afton N. Wright

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

Background and Objectives

Lung cancer is the most common cause of cancer-related deaths world-wide. Recent studies suggest a possible association between nutrition and risk for specific histological subtypes of cancer. We examined the relationship between nutrition and lung cancer histology in Kentucky, a largely rural U.S. state that ranks among the highest in the nation in lung cancer rates, as well as diseases related to diet, such as diabetes and obesity. The objective of this study was to examine the impact of nutrition on lung cancer risk and histology in Kentucky. More specifically, we wanted to investigate potential associations with …

Trends In Opioid Use Disorder Among Pregnant Women And Opioid Use During Vaginal Delivery Hospitalization, Ayooluwatomiwa Deborah Adekunle

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

Background: The prevalence of opioid use in pregnancy has increased sharply in recent years. Kentucky is one of the hardest hits states and has seen many babies born with withdrawal symptoms over the past decade. Recent years have seen an increase in efforts to decrease opioid use in both inpatient and outpatient settings. However, Kentucky continues to have high rates of opioid prescription. This study aims at looking at trends in Opioid Use Disorder (OUD) in pregnancy, Neonatal Opioid Withdrawal Syndrome(NOWS) and the use of opioids during delivery hospitalization at a Kentucky tertiary institution.

Methods- Data on all deliveries between …

Association Between Pm2.5 And The Coexistence Of Chronic Obstructive Pulmonary Disease And Coronary Heart Disease, Shan Gao

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

Aim: To identify PM2.5 as a risk factor for chronic obstructive pulmonary disease (COPD) and coronary heart disease (CHD) respectively, and to explore the magnitude of the association of PM2.5 with the coexistence of CHD and COPD, by using the combined dataset of 1999-2014 EPA Air Data and 2017 BRFSS SMART data (age 18 and older).

Methods: Cross-sectional study was designed to identify the association between PM2.5 exposure and COPD and CHD. The PM2.5 exposure values were adapted from the county-level EPAAir Data, the yearly mean values of PM2.5 were used to determine the association. Characteristics of sex, age, race, …

Influence Of Occupation And Geographic Location On Underground Coal Miner Exposure To Respirable Crystalline Silica, Quantez Ramaud Crowe

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

I. Specific Aims:

i. Review potential factors contributing to the resurgence of coal workers’ pneumoconiosis (CWP) in Appalachia and analyze the Mine Safety and Health Administration (MSHA) Complete Quartz dataset for potential contributors of underground (UG) coal miner exposure to silica and coal dust.

Objectives:

1. i. To provide evidence of an association between silica and coal dust exposure and various UG coal miner occupations and mine locations.
2. ii. Explore changes over time in UG coal miner silica exposure, dust exposure, and silica concentration in samples collected.
3. iii. Determine if UG coal miners have experienced an increase in exposure to silica …

Examining The Effect Of Socioeconomic Factors On Kindergarten Vaccination Rates In Kentucky Counties, Abigail Wiggins

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

The purpose of this project is to examine the relationship between county-level socioeconomic factors and immunization compliance rates among kindergarten age children. All 120 counties in Kentucky were included in this evaluation.

County-level percent of uninsured children, number of children in poverty, children receiving free lunch (percentage), unemployment rate (percentage), and high school graduation rate were assessed. Socioeconomic data for each county were compared to county-level kindergarten vaccination rates. All vaccination data were obtained from the 2015-2016 Kentucky Annual School Immunization Survey Report. All socioeconomic county data were obtained from the 2016 County Health Rankings data, published by the Robert …

Drugs, Alcohol, And Their Impact On The Severity Of A Traumatic Work-Related Injury, Keisha Mcfarlane

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

Objectives

Traumatic work-related injuries result in thousands of deaths per year in the United States. It is important to determine factors that may contribute to these deaths in order to find ways to decrease the risk of injury. The study objectives were to determine if alcohol and drug (prescription and illicit) use could increase the risk of severe injuries or cause a specific mechanism of injury (being struck by or against an object, a fall, or injured as an occupant in a motor vehicle) when consumed prior to an injury.

Methods

A retrospective, facility-based, case review study of traumatic work-related …

Consultation Experience In Public Health, Zimu Li

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

Nowadays, students safe in violence area is becoming to a huge problems, from the survey- National Youth Risk Behavior Survey we find that the sexual and dating violence rate is increasing during the past few years.For the willing that we try to reduce the risk of dating and sexual violence, we are going to build some programs and publish them to the society especially the schools to protect our teenagers. As we know that the period for students from high school to the university is a very important time to build their right social norms, we start a program called …

Brief Intervention And Buprenorphine Initiation For Opioid Use Disorder In Northern Kentucky Emergency Departments, Cady Cornell

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

The opioid epidemic has had sweeping, devastating effects on the United States. Kentucky has the fifth highest overdose mortality rate in the nation and the Northern Kentucky counties, specifically Kenton and Campbell, have been especially affected. Their opioid overdose mortality rates are the third and fourth highest in the state, respectively. In order to contribute to ongoing Northern Kentucky community efforts to combat the opioid epidemic, St. Elizabeth Healthcare is proposing to implement The Brief Negotiation Interview (BNI) in our emergency departments in order to provide more comprehensive care. The BNI is a motivational interviewing strategy that has been combined …

Seasonality, Atmospheric Conditions, And Variation In Household Radon, 1990-2015, Nicholas Conley

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

_Background:

Radon is a colorless, odorless, and tasteless radioactive gas. Indoor radon exposure is responsible for at least 21,000 lung cancer deaths per year in the U.S. Radon concentrations vary greatly, with atmospheric conditions as one of the major factors contributing to this variation. There is also a link between season of the year and indoor radon values, with higher readings in winter compared with summer months. Seasonality studies are necessary in order to determine the best time for radon exposure screening. The purpose was to determine if atmospheric conditions (i.e., temperature, precipitation and wind) were predictive of observed home …

Culminating Experience In The Application Of Biostatistics In Public Health: A Report On My Consultation Experiences, Samantha Kennedy

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

Executive Summary

This portfolio is a compilation of three different consulting experiences that I have had to opportunity to work with as a part of University of Kentucky’s Master of Public Health program with a concentration in biostatistics. My portfolio consists of project descriptions, notes, reports, relevant SAS code and output, and other supporting materials for the three projects I worked with. Each of the projects that I worked with were vastly different, as was my role in them. As such the supporting documents for each are very different as well, but each does have a brief description of the …

Disparities In The Risk Of Subsequent Primary Cancer Diagnosis And Recurrence Among Women With Breast Cancer (First Primary) In Kentucky, Pierre Fwelo

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

Background and objectives

Breast cancer is one of the most common malignancies among women in the United States. Women residing in the state of Kentucky have breast cancer incidence and mortality rates greater than the national average. Recent studies suggest an association between breast cancer subtypes/hormone receptor (HR) status and the risk of recurrence and the onset of subsequent primary cancer, however, limited research has focused on Kentucky or its Appalachian region.

Investigating these associations may potentially save lives by providing information that can be used in breast cancer education in Kentucky, assessing the population at greater risk of recurrence …