Medicine and Health Sciences Commons^™

Community Leadership Institute Of Kentucky, Beth Bowling, Frances J. Feltner, Nancy E. Schoenberg, Ernie Scott, Gia Mudd-Martin

Center of Excellence in Rural Health Presentations

The Community Leadership Institute of Kentucky(CLIK) aims to improve community research capacity to address health disparities in communities, particularly Appalachia.

Established in 2014, through a partnership of the UK Center of Excellence in Rural Health, the UK Center for Clinical and Translational Science Community Engagement Program, and the Kentucky Office of Rural Health, the intensive four-week training provides:

• Training in research and leadership
• Funding for community research projects
• Technical support for up to one year as participants implement community research projects

Up to 12 slots are available annually, with priority given to leaders from Appalachian Kentucky and to projects related …

Modeling The Influence Of Early Skin-To-Skin Contact On Exclusive Breastfeeding In A Sample Of Hispanic Immigrant Women, Ana Maria Linares, Karen Wambach, Mary Kay Rayens, Amanda Wiggins, Elizabeth Coleman, Mark B. Dignan

Nursing Faculty Publications

Using data from a longitudinal study of breastfeeding in Hispanics, this study evaluated the influence of early skin-to-skin contact (SSC) on initiation and sustained exclusive breastfeeding (EBF) at 1 month postpartum. Two-thirds of the women in the sample participated in early SSC. At discharge, over half of the women were EBF; this proportion decreased to one-third at 1 month postpartum. Controlling for demographic and clinical variables in the model, participation in early SSC was associated with a greater than sevenfold increase in the odds of EBF at discharge (p = .005) but was not predictive of EBF at 1 …

Healthcare Contact And Treatment Uptake Following Hepatitis C Virus Screening And Counseling Among Rural Appalachian People Who Use Drugs, Dustin B. Stephens, April M. Young, Jennifer R. Havens

Behavioral Science Faculty Publications

Background—Hepatitis C virus (HCV) remains a major contributor to morbidity and mortality worldwide. Since 2009, Kentucky has led the United States in cases of acute HCV, driven largely by injection drug use in rural areas. Improved treatment regimens hold promise of mitigating the impact and transmission of HCV, but numerous barriers obstruct people who inject drugs (PWID) from receiving care, particularly in medically underserved settings.

Methods—503 rural people who use drugs were recruited using respondent-driven sampling and received HCV screening and post-test counseling. Presence of HCV antibodies was assessed using enzyme immunoassay of dried blood samples. Sociodemographic and …

Advertising Exposure And Use Of E-Cigarettes Among Female Current And Former Tobacco Users Of Childbearing Age, Kristin Ashford, Emily Rayens, Amanda T. Wiggins, Mary Kay Rayens, Amanda Fallin-Bennett, Molly Malany Sayre

Nursing Faculty Publications

Objective: The study examined the relationship between exposure to e‐cigarette advertising and e‐cigarette use by pregnancy status, including use of flavored e‐cigarette products, among women of childbearing age.

Design: A cross‐sectional, correlational design was used.

Subjects: Female current or former tobacco users in Central and Eastern Kentucky, 18–45 years old (N = 194, 52% pregnant).

Measures: Demographics, pregnancy status, cigarette and e‐cigarette use, and exposure to e‐cigarette advertising.

Results: Younger age, white non‐Hispanic race, and greater exposure to e‐cigarette advertising were associated with a higher likelihood of ever using e‐cigarettes (p < .05 for each variable). Pregnancy was not associated with ever use (p = .11). Younger age was associated …

A Community-Based Marketing Campaign At Farmers Markets To Encourage Fruit And Vegetable Purchases In Rural Counties With High Rates Of Obesity, Kentucky, 2015-2016, Emily M. Dewitt, Margaret Louise Mcgladrey, Emily Liu, Nicole Rachael Peritore, Kelly H. Webber, Brooke F. Butterworth, Ann Vail, Alison A. Gustafson

Dietetics and Human Nutrition Faculty Publications

Availability of farmers markets may increase fruit and vegetable consumption among rural residents of the United States. We conducted a community-based marketing campaign, Plate it Up Kentucky Proud (PIUKP), in 6 rural communities over 2 years to determine the association between exposure to the campaign and fruit and vegetable purchases, adjusted for Supplemental Nutrition Assistance Program recipient status. Logistic regression was used to examine the odds of the PIUKP campaign influencing purchases. Awareness of the PIUKP marketing campaign was significantly associated with a willingness to prepare fruits and vegetables at home. Using marketing strategies at farmers markets may be an …

Care Coordination For Community Transitions For Individuals Post-Stroke Returning To Low-Resource Rural Communities, Patrick H. Kitzman, Keisha Hudson, Violet Sylvia, Frances Feltner, Johnnie Lovins

Physical Therapy Faculty Publications

High rates of hospital readmissions have been shown within 12 months post-discharge from inpatient rehabilitation following stroke. Multiple studies coupled with our previous work indicate a need for care support for stroke survivors’ transitions to the community. The Kentucky Care Coordination for Community Transitions (KC³T) program was developed to provide access to medical, social, and environmental services to support community transitions for individuals with neurological conditions and their caregivers living in Kentucky. This program assessment was conducted to determine the effectiveness of using a specially trained community health worker to support community transitions. Thirty acute stroke survivors were …

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 …

Mccrearamycins A-D, Geldanamycin-Derived Cyclopentenone Macrolactams From An Eastern Kentucky Abandoned Coal Mine Microbe, Xiachang Wang, Yinan Zhang, Larissa V. Ponomareva, Qingchao Qiu, Ryan M. Woodcock, Sherif I. Elshahawi, Xiabin Chen, Ziyuan Zhou, Bruce E. Hatcher, James C. Hower, Chang-Guo Zhan, Sean Parkin, Madan K. Kharel, S. Randal Voss, Khaled A. Shaaban, Jon S. Thorson

Center for Pharmaceutical Research and Innovation Faculty Publications

Four cyclopentenone‐containing ansamycin polyketides (mccrearamycins A–D), and six new geldanamycins (Gdms B–G, including new linear and mycothiol conjugates), were characterized as metabolites of Streptomyces sp. AD‐23‐14 isolated from the Rock Creek underground coal mine acid drainage site. Biomimetic chemical conversion studies using both simple synthetic models and Gdm D confirmed that the mccrearamycin cyclopentenone derives from benzilic acid rearrangement of 19‐hydroxy Gdm, and thereby provides a new synthetic derivatization strategy and implicates a potential unique biocatalyst in mccrearamycin cyclopentenone formation. In addition to standard Hsp90α binding and cell line cytotoxicity assays, this study also highlights the first assessment of Hsp90α …

Mcreynolds, Benjamin, 1769-1845 (Mss 603), Manuscripts & Folklife Archives

MSS Finding Aids

Finding aid and full-text scans of selected items (Click on "Additional Files" below) for Manuscripts Collection 603. Manuscript books of sermons, religious, medical and other writings created by Benjamin McReynolds, a Butler County, Kentucky Methodist minister. Includes family history and records of schools operated by McReynolds.

Boyd, Douglas A., B. 1970 (Fa 1002), Manuscripts & Folklife Archives

FA Finding Aids

Finding aid only for Folklife Archives Project 1002. Group interview with several Tyler family members who were physicians in Owensboro and Daviess County, Kentucky, as well as friends and family of the doctors. People share folkways related to medical practice and stories by and about the Tyler family. The copyright for this interview is retained by the interviewer; this copy is for research purposes only.

The Healthy Flea Market, Robin L. Cooper, Kimberly J. Zeidler-Watters, Diane Johnson, Jennifer Wilson

Biology Faculty Publications

Learn how rural students in Kentucky shared their classroom knowledge by presenting on health topics and new technologies at flea markets, swap meets, and specialty events such as car shows.

Disparities In Stage-Appropriate Therapy For Resectable Non-Small Cell Lung Cancer In Kentucky, Jeremiah T. Martin

Theses and Dissertations--Clinical Research Design

Lung cancer (NSCLC) is the leading cause of cancer related mortality. Lung cancer screening aims to detect treatable cancers, however survival advantage will only be seen with early and appropriate stage-directed therapy. This study aims to understand recent rates of therapy for early-stage lung cancer in Kentucky, and to explore potential sources of disparities in treatment and outcomes. A Kentucky Cancer Registry query was performed of all NSCLC cases treated in the state from 2005-2014. Of 39,763 lung cancer patients, 10,622 were clinically operable. Of these, overall 40% did not receive surgery, while 16% did not receive any stage-appropriate local …

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

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

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

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

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

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

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

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

Hepatitis C Screening And Treatment Of Prisoners: Analysis Of Policy And Practice In Kentucky, Charity Faith Kranz

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

INTRODUCTION

The United States and the Commonwealth of Kentucky are currently overwhelmed by a triad of complex epidemics—incarceration, opioid overdose deaths secondary to substance use disorders, and hepatitis C. Research has suggested hepatitis C screening and treatment of prisoners may be a cost-effective strategy to address the hepatitis C epidemic. Since Kentucky has been particularly impacted by these interrelated health threats, further exploration of hepatitis C in Kentucky prison populations and their potential role in addressing these epidemics is warranted.

Primary Objective

The main goal of this research was to examine hepatitis C screening and treatment policy and practice within …

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

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

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

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

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

Introduction

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

Methods

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

Hepatocellular Carcinoma Among Kentencky Residents From 1995 To 2011: Risk Factors For Late-Stage Diagnosis And Survivability, Zilahatou B. Tohon

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

Introduction: Hepatocellular carcinoma incidence and mortality rates are the rise in the United States and in Kentucky as well. According to the National Cancer Institute, there will be an estimated 40,710 new cases of liver and intrahepatic bile duct cancer and 28,920 deaths in 2017, with than 20% of 5-years survivors ¹. The numbers of new cases expected by year 2030 is 37,574 ². The aim of this capstone is to assess the risk factors of late-stage diagnosis and survivability in Kentucky.

Methods: A combined dataset from the Kentucky Cancer Registry and the Behavioral Risk Factor Surveillance System …

All 4 Hardin County Freshman!, Cortney Lynn Gandy

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

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

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

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

Background

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

Methods

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

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

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

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

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

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

Filling The Gap In Obesity Prevention: Implementation Of The General’S Activity Program (Gap) In Carroll County, Kentucky, Brent Emerson

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

As obesity rates continue to rise, there is a significant need for public health programs that are able to effectively increase physical activity at the community level. Regular physical activity can help reduce the risk of negative health outcomes associated with obesity including cardiovascular disease, type 2 diabetes, and some forms of cancer while also strengthening muscles, improving mental health and mood, and increasing average life expectancy. Previous research has supported that one way to increase physical activity at the community level is through social marketing of state and local parks. Through the promotion of parks, community residents are able …

Addressing Barriers To Hepatitis C Treatment Initiation In Kentucky Clinic, Moaz Abdelwadoud

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

Introduction. Hepatitis C virus (HCV) is the most prevalent blood borne infection in the United States and its chronic infection has a high burden on the American healthcare system. Since 2014, the all-oral Directly Acting Antiviral (DAA)-based therapy has been established as the standardized curative treatment for HCV with unprecedented high effectiveness and tolerability. Nevertheless, there is a significant gap between the promise from DAAs benefits and the treatment initiation rates in the United States and Kentucky.

Objectives. The goal of this study is to improve the access to the all-oral DAA-based treatment among HCV patients seeking outpatient …

Shaping Our Appalachian Region (Soar): Beginning To Now, Samantha Zarycki

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

Introduction

Appalachian Kentucky has been and is currently facing difficult times including low employment rates, low education rates and less-than-favorable healthcare and health status for the people of the region (Estep, 2014). There have been multiple government and non-government agencies who have implemented interventions with the purpose of lifting up the region. Shaping Our Appalachian Region, or SOAR, is a bipartisan organization which began in 2013, and was established for the purpose of caring for the region.

Methods

A qualitative data analysis using confidential interviews with six people involved with SOAR was used for this project. Using the deductive approach …

Planet Health: A School-Based Health Promotion Program, Jane Katherine Landon

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

The Kentucky River District Health Department (KRDHD) proposes implementation of Planet Health, a school-based intervention aimed at increasing healthful nutrition and fitness behaviors in middle- and high-school aged students. Planet Health’s core messaging (increasing fruit and vegetable intake, increasing physical activity, decreasing screen time, decreasing sugar-sweetened beverage and trans-fat intake) contributes to our long-term goal of decreasing childhood obesity in our service area. Planet Health will be offered to 3 counties in our service area (Lee, Letcher and Wolfe) with planned expansion to all counties in the KRDHD service area within 5 years of the original pilot. This project will …

Retention In Continuous Care And Sustained Viral Suppression: Examining The Association Among Individuals Living With Hiv, Timothy N. Crawford, Alice C. Thornton

Internal Medicine Faculty Publications

Objectives: To examine the relationship between retention in continuous care and sustained viral suppression.

Methods: The authors retrospectively followed 653 persons who were virally suppressed and seeking care at an infectious disease clinic in Kentucky for an average of 6 years to determine the rates of retention in medical care (≥2 visits separated by ≥3 months within a 12-month period) and sustained viral suppression (<400 copies/mL). A generalized linear mixed model was used to determine an association between retention and suppression over time.

Results: Approximately 61% of the study population were retained in continuous care and 75% had sustained viral suppression for all patient-years. Persons retained in care were 3 times the odds of sustaining viral suppression over …

Vaccine-Preventable Disease Surveillance In Kentucky, Katherine Jay

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

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

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

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

Identifying Family Resource And Youth Services Employees Preparedness For Job Responsibilities And Service Offerings In Kentucky, Melissa Slone, Frances J. Feltner, Sydney P. Thompson

Center of Excellence in Rural Health Workforce Reports

Family Resource and Youth Services Center (FRYSC) coordinators help at-risk students and their families obtain access to the necessary resources to overcome obstacles that affect their ability to learn. Although mandated to provide certain services, each FRYSC coordinator is also able to identify the unique needs of their student population and tailor some services specifically to the children and families in their school community. The current study looks at the educational levels, experience on the job and feelings of preparedness for their positions. Additionally, FRYSC coordinators were asked to provide insight as to which factors influence their job success.

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

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

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

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

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

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