Medicine and Health Sciences Commons^™

Improving Indoor Air Quality For Children In Rural Kentucky, Denerica L. Curry

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

Community interventions directed towards improving indoor air quality for children are often implemented after exposure has occurred and focuses on parental smoking cessation. Our proposed project will intervene during the prenatal stage prior to exposure and continue to support families 6 months postpartum. Infants are at an increased risk of secondhand smoke exposure due to the amount of time they spend in the home and proximity to the smoker. We hypothesize that by enhancing care of the current home visitation model to include an early intervention we will increase the amount of smoking bans in the home and decrease maternal …

Risk Factors Associated With Severe Injuries In Inland Aquaculture Farms, Amah Martin

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

Objective: The main objective of this study was to analyze risk factors associated with severe occupational injuries among inland aquaculture farms.

Methods: Survey results were compiled in a data set that consisted of qualitative data from 51 farmers who were interviewed between 2008 and 2011 in 10 states and the Canadian province of British Columbia. Chi-square and Fisher’s exact test were used to assess the differences in the dichotomous level of severity among several farm and injury variables. Logistic regression was used to predict the outcome of a severe injury event.

Results: Injury observations that indicated the use of raceway …

Identifying Predictors Of Functional Limitations Associated With Depression, Anxiety, And Emotional Problems In Us Adults, Jillian Richardson

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

Depressive disorders are characterized as sharing affected mood, and somatic (e.g. sleep pattern, appetite, and unintentional changes in weight) and cognitive alterations from previous normal daily functioning that are clinically significant. Anxiety disorders are characterized by excessive fear, general or specific anxiety, and related behavioral disturbances that are also clinically significant. This project attempts to identify risk factors that may predict what groups are most likely to be affected by depression and/or anxiety.

Sponsored by the CDC, the National Health Interview Survey collects general health information for non-institutionalized individuals living in the US. Variables for use in logistic regression model …

The Link Between Smoking, Lung Cancer And Socioeconomic Factors In Kentucky, Shreya Berlia

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

Background and Purpose

Lung cancer is the leading cause of cancer death and the second most diagnosed cancer in both men and women in the United States. An estimated 158,080 deaths from lung cancer are expected to occur in 2016, which will account for approximately 1 in 4 of all cancer deaths. The 1- and 5-year relative survival rates for lung cancer are 44% and 17%, respectively. The incidence rate for lung cancer has been declining since the mid-1980s in men, but only since the mid-2000s in women. Tobacco smoke is the leading cause of preventable disease and death in …

Policy And Political Motives For Medicaid Expansion Under The Patient Protection And Affordable Care Act, Ross C. Stanton

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

Objective

This study aims to analyze policy-related and political rationales for Medicaid expansion under the Patient Protection and Affordable Care Act (PPACA). More specifically, this study seeks to discover whether states’ decisions regarding Medicaid expansion were likely based on policy implications regarding the uninsured or political motives.

Methodology

The approach is a cross-sectional/observational study of American states and the District of Columbia after the Sebelius decision in 2012. This study compares three variables: (1) whether each state decided to opt into the expansion (“Opted In”), (2) whether each state’s governor and legislature were affiliated with either the Democratic or Republican …

Evaluations Of Patients’ Appointment Duration By Type In An Ophthalmology Practice, Brittany U'Wren

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

Objective: The Affordable Care Act expanded health care coverage and provided more access to physicians, resulting in potentially longer wait times. Large portions of ophthalmology patients are on Medicare. Two thirds of the expansion populations were Hispanic or African Americans, which have higher rates of eye disease. Another contributoring factor leading to the increase for eye care is the surge of baby boomers. More specifically, these are individuals reaching sixty-five and are beginning to utilize Medicare. Access to care has increased but the capacity of the practice has not. An important goal, therefore, is to maximize efficiency of current …

Occupational Risks For Recent Asthma Episodes Among Adults, Molly Reese

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

Objective

Asthma affects more than 37 million Americans at some point in their lives, making it one of the most common, but costly chronic conditions. There are many known risk factors for asthma, but additional research on environmental and occupational factors is needed to better understand the association between these variables and asthma. This study investigates the associations between occupational exposures and asthma episodes among adults.

Methods

Data was obtained from the 2011-2013 Behavioral Risk Factor Surveillance System (BRFSS) Asthma Call-back Survey for adults. There was a final study population of 11,408 participants after the exclusion criteria were applied. The …

Forced Sexual Intercourse And Its Link To Suicide Ideation/Suicide Attempts Among Adolescent Girls: Findings From 2013 Youth Risk Behavioral Survey, Adebukola Helen Adegbite

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

Objectives. We sought to assess the association between forced sexual intercourse and suicidal ideation/attempts among adolescent girls ages 14-17.

Methods. We performed secondary data analysis of the 2013 Youth Risk Behavioral Survey, using chi-square tests to examine the association of forced sex and race/ethnicity, with suicide ideation.

Results. We found that there was an association between those who had considered suicide and those who had experienced forced sexual intercourse. Moreover, race/ethnicity was associated with those who had ever considered suicide in the past 12 months before taking the survey. Lastly, we found that there was an association of suicide ideation …

"Life Skills Training" Prescription Drug Abuse Prevention Among Youth In Bell County, Kentucky, Arveen Kaur

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

Prescription Drug Abuse (PDA) has become a serious public health concern and a major epidemic in the United States (U.S.). According to the 2014 National Survey on Drug Use and Health (NSUDH), approximately 15 million people (aged 12 or older) used prescription drugs in the past year and 6.5 million in past month. Out of these, 2 million Americans (aged 12 or older) either abused prescription drugs or were dependant on them. Almost 5% of adolescents (1.1 million) between the age group 12-17 abused prescription painkillers in 2014. Nationally, Kentucky is among the top five states with highest age-adjusted overdose …

Access For Adolescents: Multisystemic Therapy In The Juvenile Justice System, Meagan Pilar

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

In this application for funding, DC YouthLink, a non-profit organization that connects adolescents in the juvenile justice system to community resources, proposes to implement an evidence-based mental health intervention into the juvenile justice system in Washington D.C. The Director of DC YouthLink will serve as the Principal Investigator for this pilot program; she, along with five trained staff members, will be responsible for implementing multisystemic therapy (MST), an intensive form of therapy designed specifically for at-risk youth and their families. We propose to intervene at three main stages of the juvenile justice system— intake, correctional placement/probation supervision, and reentry. The …

Enough Smoke: Implementation Of An Evidence-Based Smoking Cessation Program In Owsley County, Kentucky, Meghan Fay Johnson

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

In 1964, the first United States (U.S.) Surgeon General’s Report explicitly stating the dangers of smoking, including an increased risk of lung cancer, was released. Fifty years later, the U.S. continues to carry the significant health and economic burdens for failing to heed this public health warning. Owsley County, Kentucky, located in the heart of the Appalachian is one of the most impoverished and medically underserved counties in the U.S., ranking last in almost every category of overall health outcomes in the state. The county is also entirely rural, with no major cities within an 80-mile radius. In every health …

Quality Improvement In The Department Of Family And Community Medicine At The University Of Kentucky, Manisha Vasishta

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

The purpose of this capstone project is to analyze the quality improvement data that was collected in order to increase the pediatric population at the University of Kentucky Department of Family and Community Medicine clinic at Turfland. There were three different patient populations that were surveyed: reproductive aged women between 18 and 40, parents of the pediatric population that the clinic saw between July 2014 and June 2015, and pregnant women between July 2014 and June 2015. The results show that continuity of care and not being able to see the provider of choice were some of the weaknesses that …

The Association Between Latent Tuberculosis Infection And Diabetes Mellitus Control In The United States, Whitney L. Remy

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

Rationale: Diabetes mellitus (DM) is recognized as a common comorbid condition for tuberculosis (TB). Those with comorbid conditions are more likely to develop active TB, to have trouble with treatment, and to have more severe symptoms.

Objective: To measure the prevalence and distribution of latent tuberculosis infection (LTBI) and DM control in the United State and test their association when measured by tuberculin skin test (TST) or QuantiFERON®-TB Gold In-Tube blood test (QFT-GIT) and by HbA1c, respectively. Literature Review: One-third of the world population is infected with TB. Ten percent of TB cases worldwide are linked to diabetes mellitus. Studies …

Risking Connection: A Multi-Level Trauma-Informed Care Approach To Refugee Services In Lexington, Ky, Marie Paige Higginson-Rollins

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

This project proposes to implement a multi-level, trauma-informed care approach to refugee services in Lexington, KY. The intervention will be carried out at three sites, the Bluegrass Community Health Center, the Kentucky Refugee Ministries, and the Lexington Global Engagement Center. These sites were chosen because of their extensive work with the refugee community. The intervention proposed is Risking Connection, a SAMHSA recommended trauma-informed care program, with a cultural-sensitivity training module and marketing campaign, and a group therapy pilot intervention for Congolese women based on the Bashal program at the Center for Torture and Trauma Survivors. The short-term goals of this …

Colorectal Cancer Prevention In The North Slope Borough Of Alaska Utilizing The Flu-Fit Intervention, Jennifer Jenkins

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

The intention of the Flu-FIT intervention is to increase colorectal cancer screening rates by combing two annual activities into one visit that doesn’t necessitate a doctors visit. The original study increased colorectal cancer screening rates by 14 percentage points and this program should be able to show similar results in the North Slope Borough of Alaska. The North Slope Borough has the highest incidence rate of colorectal cancer in the United States, and this proposed intervention could lead to a reduction in that rate by increasing screening and knowledge about colorectal cancer in the community.

Eat Well, Keep Moving: Decreasing Childhood Obesity In Fulton County, Kentucky, Sandra Onekhena

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

With the high rates of childhood obesity in Fulton County, the Purchase District Health Department proposes the implementation of the Eat Well and Keep Moving Program in all the county’s elementary schools among fourth and fifth graders. It is an interdisciplinary, evidence-based program that will be aimed at our short-term goal of increasing knowledge about nutrition and physical activity and inspiring positive behavioral change. It works by integrating lessons and activities about proper nutrition and activity into various aspects of the children’s lives — in the classroom, cafeteria, at home and in the community. We hope to see children move …

Cross Sectional Analysis Of Patients With Alpha-1 Antitrypsin Deficiency Enrolled In A Disease Management And Prevention Program, Jordan T. Perkins

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

Background: Alpha-1 antitrypsin deficiency is a heritable genetic condition that is largely underdiagnosed and has been estimated to affect 1 out of every 5,000-7,000 people in North America. The condition is characterized by a decrease in the production or activity of the alpha-1 antitrypsin protein, increasing risk for chronic lung or liver inflammation, that may lead to disease. Currently, there is no cure for the condition and augmentation therapy, which replaces the lost protein, has shown mixed results, meaning preventive measures taken by the patient are a large component of the prescribed treatment. Thus, patients with the condition are strongly …

An Assessment Of Workplace Injury In Kentucky’S Commercial Logging Industry, Logan Ray

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

Objective: To identify demographic, operational, and task-related characteristics associated with increased frequency and severity of injury in Kentucky’s commercial loggers.

Methods: Kentucky Master Loggers attending mandatory continued education courses completed a survey tool eliciting demographic and operational characteristics of their companies, and details of any on-site injury in the years 2012 through 2015 that led to medical costs, lost days or time, and/or decreased production. Associations to injury frequency and injury severity were assessed using logistic regression analysis.

Results: 86 Kentucky Master Loggers representing 66 of Kentucky’s 120 counties reported 33 accounts of non-fatal logging injury. Master Loggers were full-time …

Overdose Education And Naloxone Distribution By Board-Certified Pharmacists In Five Eastern Kentucky Counties, Laura Elizabeth Broughton

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

The Coalition of Kentucky Health Professionals Against Substance Abuse (CKHPASA) is a professional organization uniting members of the various health professions against a rising tide of substance abuse in the state of Kentucky. In 2013, Kentucky ranked 3rd in the United States for highest number of drug overdose fatalities. Previously under the scourge of the prescription opioid epidemic, the state of Kentucky is now seeing rising numbers of overdose deaths related to heroin use, which is an opioid that works similarly to morphine and prescription pain medications.

Naloxone is a life-saving antidote for opioid related overdoses and evidence has shown …

Development Of Multiple Primary Cancers In Lung Cancer Patients: Appalachian Vs. Non-Appalachian Populations Of Kentucky, Vira Pravosud

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

OBJECTIVE: This study examined whether there were differences in the development of multiple primary cancers in lung cancer patients residing in the Appalachian versus Non-Appalachian regions of Kentucky. The study also identified other factors associated with the development of another primary cancer in lung cancer patients.

HYPOTHESIS: Lung cancer patients residing in Appalachian Kentucky are more likely to develop multiple primary cancers compared to patients residing in Non-Appalachian Kentucky.

METHODS: This was a retrospective, population-based cohort study of Kentucky patients (N=26456) aged 20 years and older, diagnosed with primary lung cancer between January 1, 2000 and December 31, 2013. The …

The Impact Of An Ambulatory Clinical Intervention On Viral Load Suppression And Retention In Care For Newly Diagnosed Hiv Persons, Latasha R. Jones

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

Ambulatory clinical healthcare settings that serve patients infected with the human immunodeficiency virus (HIV) are critical in improving access to quality HIV care and treatment, in part due to their ability to streamline patient care along the HIV care continuum. Barriers to HIV care are significant among newly diagnosed HIV patients and in order to engage and retain these individuals in care and treatment, specific interventions must be in place to link these individuals to care. In this study, the difference in differences method was used for data analysis to measure the impact of an ambulatory clinics intervention on their …

Analysis Of Firearm Legislation And Law Enforcement Suicides In Nvdrs-Funded States, Meagan L. Hurst

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

BACKGROUND:

The purpose of this study was to evaluate firearm-related suicides among law enforcement members and identify potential differences between decedents and firearm legislation grades from National Violent Death Reporting System (NVDRS) funded states

METHODS:

Descriptive and regression analyses were conducted using suicide data from 820 decedents who worked within law enforcement at the time of death. Data were collected over a ten-year period (2003-2013) from the NVDRS. Multivariable logistic regression and Pearson’s chi-square were used to identify if differences existed among firearm-related suicides and other means using variables such as age, marital status, occupation, mental health, and firearm legislation …

Neurotoxic Effects Of Occupational Exposures In Agricultural Workers, Miriam Siegel

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

Background: Pesticides and organic solvents are two classes of neurotoxic substances regularly used in agriculture. Pesticides have been studied in relation to a range of nervous system effects, and have been repeatedly shown to relate to depression in agricultural workers. Likewise, occupational solvent exposure is recognized as a risk factor for central nervous system effects, including mood disturbances and cognitive impairment, across various industries. Many gaps in knowledge regarding the effects of chronic exposure to these substances on mental/neurological health in agricultural workers still exist. The specific aims of the current analysis were to 1.) Estimate associations between metrics of …

An Examination Of Traumatic Brain Injury As A Risk Factor For Psychiatric Symptoms In Alzheimer’S Disease Patients, Jennifer F. Walch

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

Introduction:

Dementia is a major public health issue both in the United States and worldwide. Alzheimer’s disease (AD) is widely considered to be the most prevalent type of dementia. While the hallmark AD symptom is profound memory loss, patients also commonly experience changes in personality and behavior. These changes often include depression, anxiety, social withdrawal, mood swings, irritability and aggression, changes in sleeping habits, and delusions.

Background:

Several studies have established a mechanistic link between traumatic brain injury (TBI) and the development of AD. However, it is unknown whether TBI contributes to the personality/behavior changes observed in many AD patients. …

Injuries Among Security And Law Enforcement Personnel In The Private Versus Public Sectors, William S. Witt

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

Background and Objectives: Data collected through workers’ compensation may be useful for occupational injury surveillance. This study examined whether differences existed between the public and private sectors of the security and law enforcement industry in Kentucky.

Methods: Using a cross-­‐sectional design, workers’ compensation data from the Kentucky Department of Workers’ Claims was analyzed to evaluate differences in demographic and injury characteristics, as well as award outcomes, stratified by industry sector. The dataset included all workers’ compensation first reports of injury and claims filed by security and law enforcement personnel in Kentucky from 2005 to 2015. Statistical analyzes included chi-­‐square and …

Wnc Healthy Teens: A Multi-Level Teen Pregnancy Prevention Initiative, Katharine Macmillan

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

WNC Healthy Teens is a multi-component, community-based teen pregnancy prevention initiative. The program will be targeted in rural areas of Buncombe and Henderson Counties that have aggregate rates showing that over half the population of women aged 15-19 years are giving birth. Sexual education is necessary, but not sufficient to preventing risky sexual behaviors1. Tying multiple levels of evidence-based school interventions together with standardization of adolescent sexual health care will provide a well-rounded approach to address teenage pregnancy. Starting the initiative at age 14, it is anticipated the majority of teens will have yet to initiate sexual activity. Reducing the …

Comparing The Non-Cystic Fibrosis Bronchiectasis Patients With Non-Tuberculous Mycobacteria (Ntm) And Non-Ntm Infections, Maninder Bir Singh

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

Objective

The objective of the study is to compare the Non-Cystic Fibrosis Bronchiectasis patients with Non Tubercular Mycobacteria (NTM) and Non-NTM infection and determine if the NTM and Non-NTM groups are different.

Methods

Data from the COPD Foundation’s Bronchiectasis Research Registry (BRR) was used in the study (n=1660).Logistic regression, Cox proportional hazards regression, and Kaplan Meier survival analysis were used to analyze the data.

Results

The study found odds ratio for having NTM infection for age to be 1.02 and for gender to be 2.34, after adjusting for all other variables in the multivariate logistic regression, with the p-value of …

“Exchange Northern Ky”: An Evidence-Based Needle & Syringe Exchange Program Serving The Northern Kentucky Area Development District, Amanda Hunter

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

Intravenous drug users (IDUs) account for nearly 16% of new HIV infections in the United States and almost one half (48%) of newly reported acute hepatitis C virus (HCV) infections have been found to be IDU related.1 Within the Northern Kentucky Area Development District, hepatitis C infections have soared with an incidence of more than 1,000 newly reported cases during 2015 alone.⁴ Rigorous scientific evidence complied by the U.S. Department of Health & Human Services has indicated that one of the most unique and effective strategies for the curtailing HIV incidence among IDUs is by ensuring users’ access to …