Public Health Commons^™

Improving Dental Students' Knowledge And Confidence In Treating Tobacco Use, Victoria Pierce

DNP Projects

Background: Tobacco use can lead to numerous chronic health conditions. Healthcare professionals in the dental field are in a unique position to broach this issue with patients. Research shows that dental students do not feel equipped to provide tobacco cessation care, citing lack of education on the subject among their top reasons for this.

Purpose: The purpose of this project was to evaluate changes in dental students’ knowledge and confidence related to treating tobacco use after participation in an educational intervention about the 5A’s, behavioral counseling, and first-line prescription medications.

Methods: This quality improvement initiative utilized a quasi-experimental survey design …

Evaluating A High School Mrsa Prevention Program: A Case Study, Jamie Henning

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

MRSA poses a significant health risk to athletes nationwide. This case study examines the application of an online training module to address knowledge gaps regarding Methicillin-resistant Staphylococcus aureus (MRSA) among key decision-makers for high school athletes. It reviews the development and initial evaluation of a web-based training program designed to empower decision-makers with the knowledge to prevent MRSA infection and respond to suspected cases. Program evaluation recommended expanding the training module to wrestling staff with improved evaluation methods while continuing implementation and effectiveness assessment for the football staff. Despite initial data quality limitations, the online training module evaluation offered valuable …

A Case Study In Program Evaluation, Kayla Shepherd

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

A program evaluation of a case study presented by the College of Public Health. This case study included a fictitious MRSA outbreak at a Kentucky high school football camp and the response of the Fayette County Public School System (FCPS) and the Lexington-Fayette County Health Department (LFCHD). Using the Centers for Disease Control and Prevention's Framework for Program Evaluation, I evaluated the Educational Infectious Disease Program designed by the FCPS and LFCHD. I provided recommendations to help improve the success of the program.

A Case Study In Program Evaluation: Evaluation Of A Mrsa Education Program, Kangai Miriti

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

Program evaluations provide a deeper understanding of program components to promote effective program implementation. This evaluation follows the CDC’s 6-step Framework for Program Evaluation in Public Health to evaluate a MRSA education program. This evaluation has been prepared to be presented to the Lexington- Fayette County Health Department.

A Case Study In Evaluation, Laura Nagle

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

The Lexington – Fayette County Health Department is proposing a comprehensive evaluation of programming focused on preventing MRSA infections among high school athletes within Fayette County Public Schools. This document describes the recommended evaluation process.

Program Evaluation Case Study: Infectious Disease Reporting Training Program Evaluation, Emily Sekkath Veedu

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

The Lexington-Fayette County Health Department (LFCHD) has developed an educational program aimed at Fayette County Public Schools (FCPS) health and athletics staff members to ensure timely reporting and action in the event of an infectious disease outbreak (4). The program was implemented after a methicillin-resistant staphylococcus aureus (MRSA) outbreak occurred in a Kentucky community, with a high school football team presenting several of the cases (4). It was noted by a school nurse that many people attending an informational session lacked knowledge regarding infection control, suggesting a need for intervention in this community. I have evaluated this program in the …

A Case Study In Program Evaluation, Alyssa Osborne

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

As a result of a Methicillin-Resistant Staphylococcus Aureus (MRSA) outbreak at a local high school, the Lexington Fayette County Health Department (LFCHD) has been tasked with developing a program to ensure timely reporting of actions taken in the event of a MRSA outbreak or disease outbreak of similar nature (1). This program evaluation is guided by the CDC’s 6-step program evaluation framework (2), which was used to inform this assessment.

Adverse Outcomes Of Co-Occurring Methamphetamine And Opioid Use Among Pregnant And Postpartum Women, Hope Tevis

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

Background

Overdose mortality rates increased significantly between 2018 and 2021 in the United States (NIH, 2023). Moreover, pregnant and postpartum women (PPW), who were aged 35 to 44 were observed to have the highest overdose mortality rates (NIH, 2023). Although there is existing research that examines the increase of co-occurring opioid and methamphetamine use, it still remains understudied when specifically focusing on PPW. This analysis intends to explore this gap in research by 1) exploring the history of co-occurring methamphetamine and opioid use among PPW who were seeking residential treatment, 2) highlighting the adverse health outcomes that follow co-use among …

A Case Study In Program Evaluation, Sierra L. Williams

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

The Lexington-Fayette County Health Department (LFCHD) developed an education program targeted toward infectious disease outbreaks. The program ensures timely reporting and action during an infectious disease outbreak within the Fayette County Public Schools (FCPS) system. I have been tasked with evaluating the program and its implementation of training modules through pre and post-surveys to determine if the program is significantly increasing the overall knowledge of program participants and make recommendations for how program aspects can be improved.

Team Up Against Overdose Deaths, Mary Elizabeth Pendergrass

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

This grant proposal describes a community collaboration strategy for reducing overdose deaths. Utilizing a Community Advisory Board, the goal of the project is to increase awareness, knowledge, and usage of the Good Samaritan Law to obtain emergency medical care.

Changes In Perceptions Of First Responders After Witnessing A Drug Overdose: Individual And Contextual Variations Among People Who Use Opioids In West Virginia, Kathleen L. Egan, Kelly Gurka, Alexandria Macmadu, Herb Linn

Journal of Appalachian Health

Introduction: Success of opioid overdose interventions involving first responders is dependent on the comfort level that bystanders have with first responders and their willingness to call for assistance. Positive or negative experiences with first responders following witnessing an overdose may influence a person’s willingness to call a first responder for assistance in the future.

Purpose: The objective of this study was to examine changes in bystanders’ perceptions of first responders following witnessing an overdose attended by emergency medical services or a law enforcement official. It specifically explored perception changes among a sample of individuals residing in Appalachia who use prescription …

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

Journal of Appalachian Health

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

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

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

Assessing And Addressing The Determinants Of Appalachian Population Health: A Scoping Review, David L. Driscoll, Hannah O'Donnell, Maitri Patel, David C. Cattell-Gordon

Journal of Appalachian Health

Introduction: Residents of Appalachia experience elevated rates of morbidity and mortality compared to national averages, and these disparities are associated with inequitable exposures to various determinants of population health. Social and environmental determinants of health are a useful lens through which to develop and evaluate programs to mitigate regional health disparities.

Methods: This 2023 scoping review was conducted of studies linking determinants of Appalachian health with leading causes of regional mortality and morbidity. The search strategy employed a keyword search that included geographic terms for the Appalachian Region and the primary adverse health outcomes in that region. Studies meeting the …

High-Risk Individuals And Naloxone Use: Implications For Thn Programs In Rural Appalachian Communities, Victor Garcia, Lisa Mccann, Erick Lauber, Christian Vaccaro, Melissa Swauger, Alex Daniel Heckert

Journal of Appalachian Health

Introduction: Take-home naloxone (THN) is being made available across rural Appalachia to curb opioid overdose fatalities. Despite this initiative, some opioid users do not possess naloxone, and if they do, do not administer it to others.

Purpose: Research findings on risk factors that contribute to opioid overdose are presented. These factors, identified in a sample of 16 overdose cases, are (1) early onset age of opioid use; (2) progressive opioid use; (3) a transition from pain medication to heroin and fentanyl; (4) fears of being arrested at a naloxone intervention if first responders are contacted, and (5) limited knowledge of …

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

Journal of Appalachian Health

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

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

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

Results: From 2013 through 2020, 1805 CRE …

Factors Associated With Covid-19 Vaccine Hesitancy In South Central Appalachia, Florence M. Weierbach, Rebecca Adkins Fletcher, Ingrid E. Luffman, Cynthia Meyer, Janet M. Keener, Manik Ahuja, Hadii M. Mamudu

Journal of Appalachian Health

Introduction: The newly emergent COVID-19 virus reached pandemic levels in March 2020. By the middle of August 2020, there were over 1 million deaths attributed to COVID-19 in the U.S., with those in rural areas outpacing urban counterparts. Prior to emergency approval of the Pfizer, Moderna and Johnson & Johnson vaccine formulations, mitigation efforts addressing individual behavior were challenging. However, even with the entrance of these three new vaccines, herd immunity was not achieved in rural areas, as vaccine uptake remained low there. Although there has since been an abundance of COVID-19-related research addressing health literacy, vaccine hesitancy and overall …

Review Of: Coal, Cages, Crisis: The Rise Of The Prison Economy In Central Appalachia, Ted Olson Phd

Journal of Appalachian Health

Ted Olson, PhD, is a professor of both Appalachian Studies and Bluegrass, Old-Time and Roots Music Studies at East Tennessee State University. In this piece, he reviews Professor Judah Schept's Coal, Cages, Crisis: The Rise of the Prison Economy in Central Appalachia and discusses the impacts of incarceration on the health of Appalachia and on its residents more broadly.

Reimagining A Caregiver-Friendly Society, Jodi L. Southerland

Journal of Appalachian Health

Demographic aging is accelerating in the Appalachian Region, resulting in a growing proportion of caregivers living in areas that lack services to support their needs. Strategies are urgently needed in Appalachia to address deficiencies in the region’s long-term supports and services for older adults and their caregivers. Strengthening equitable access to care and community supports for family caregivers is a policy priority for state and community leaders in Appalachia.

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

Journal of Appalachian Health

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

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

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

Evaluation Of A Faculty Fellows Program In Science Communication, Stacy Stanifer, Beverly Delidow, Kathy Rademacher, Luz Huntington-Moskos, Kelly Kennoy, Amanda Thaxton-Wiggins, Craig Wilmhoff, Ellen J. Hahn

Journal of Appalachian Health

Introduction: Science communication plays a crucial role in tackling pressing regional, national, and global health issues. Effective communication with various audiences is integral to dissemination of science findings.

Purpose: This study evaluates changes in self-efficacy and attitudes toward science communication skills over time and also assesses program outcomes and satisfaction with a Faculty Fellows in Science Communication (FFSC) program among faculty (N = 30) with interest in environmental health science and/or education in Appalachia Kentucky.

Methods: A mixed methods program evaluation was employed using longitudinal data on behaviors, attitudes, and program outcomes from three cohorts of Faculty Fellows who participated …

Association Between Insurer Connectivity In Appalachian Population Health Networks And Preventable Hospitalizations: Evidence From Kentucky, Rachel Hogg-Graham, Kelsey R. Gatton, Rick Ingram, Glen P. Mays

Journal of Appalachian Health

Introduction: Addressing complex health and social needs requires cross-sector collaboration to deliver medical, social, and population health services at the community level. Capacity in community health and social services networks may be constrained in regions like Appalachia due to the combined effects of rurality and persistently poor health and social outcomes. One way that cross-sector networks serving low-resource communities can expand their capacity is by engaging partners, like health insurers, who can leverage resources from outside the local area.

Purpose: This study examines insurer connectivity in cross-sector networks across Kentucky’s geographic regions and the association between connectivity and the probability …

Impact Of Interprofessional Student Teams At A Remote Area Medical Event In Rural Appalachia, Emily K. Flores, Karilynn Dowling, Caroline Abercrombie Md, Rick L. Wallace

Journal of Appalachian Health

Introduction: Education in interprofessional collaboration is vital to expand healthcare access, especially in areas of higher disparity. To address this need, interprofessional faculty collaborators incorporated undergraduate and graduate health profession students into teams at an annual Remote Area Medical event in rural Appalachia between 2017 and 2020.

Purpose: This article evaluates the impact of an interprofessional student teams model on both patient care experience and students’ interprofessional collaboration attitudes and behaviors.

Methods: Student volunteers completed pre- and post-event surveys containing questions about demographics, open-ended questions, and questions from two instruments: the Student Perceptions of Interprofessional Clinical Education-Revised Instrument, Version 2 …

The Ninth Myth Of Appalachia, Randolph Wykoff

Journal of Appalachian Health

Many stereotypes afflict our much-maligned region, and the Jonesborough­­–Washington County History Museum displays eight of these "myths of Appalachia." Here, our Editor-in-Chief suggests a ninth—that the people of Appalachia "do not care" about their health—and argues that regional health disparities result not from apathy but from a confluence of socioeconomic factors.

The Appalachian Gap In Preventable Hospitalizations: Are We Seeing Any Progress?, Rachel Hogg-Graham, Juan Lang, Teresa M. Waters

Journal of Appalachian Health

Introduction: Previous studies have documented geographic variation in preventable hospitalizations between rural and urban areas, but much less is known about preventable hospitalization patterns between heterogeneous rural areas. Unique challenges related to access of care and poverty may put the rural Appalachian Region at risk for higher rates of preventable hospitalizations.

Purpose: This study examines whether within-rural differences in Kentucky’s preventable hospitalization rates exist and how these differences may be changing over time.

Methods: Longitudinal and geographic trends in county-level preventable hospitalization rates were examined using Kentucky hospital discharge data from 2016 to 2019. Regression models were run to determine …

Patient Engagement In Patient Portals In Appalachia V. Surrounding U.S. Census Regions: An Analysis Of Hints (Health Information National Trends Survey) Data, 2017–2020, Heather Lea Tudor, Rick Ingram, Sarah Wackerbarth

Journal of Appalachian Health

Introduction: Those living in the Appalachian Region face a greater number of significant health disparities than residents of other areas of the U.S. Patient portals can decrease disparities, increase health literacy, and improve health outcomes.

Purpose: This study explores if those living in the Appalachian Region are offered access to and use their patient portals differently than those in the surrounding U.S. Census regions. Additionally, the study aims to determine if there was a difference in reported reasons for the non-use of patient portals.

Methods: A secondary analysis was completed using data from the National Cancer Institute's Health Information National …

A Mini-Review Of What Matters In The Management Of Nas, Is Esc The Best Care?, Enrique Gomez Pomar

Pediatrics Faculty Publications

As the use of opioids and polysubstance by pregnant women has increased over the years, there has also been a sharp increase in cases of neonatal abstinence syndrome (NAS). Classically, infants affected by NAS have been cared for in neonatal intensive care units resulting in an increase of healthcare expenditure and resource utilization as well as separation from the families. Consequently, the Eat, Sleep, and Console (ESC) tool was developed and promoted as a novel method that focuses on maternal/infant dyad during hospital stay while decreasing the use of pharmacological interventions and therefore decreasing the length of stay and healthcare …

Diabetes Prevalence And Monitoring In Nonmetropolitan And Metropolitan Areas Within A Commercially Insured U.S. Population, Lindsey R. Hammerslag, Jeffery Talbert

Rural & Underserved Health Research Center Publications

Overview of Key Findings

• Enrollees living in nonmetropolitan areas had 22% higher likelihood of having diabetes, even after controlling for factors like age and region.
• The prevalence of diabetes in 2019-2020 was 7.9% in nonmetropolitan areas and 6.2% in metropolitan areas.
• Annual hemoglobin A1c (HbA1c) testing occurred for 85.1% of nonmetropolitan and 85.7% of metropolitan enrollees with diabetes. After controlling for other factors, we found significantly lower testing for those in nonmetropolitan areas.
• For diabetic enrollees, having an HbA1c test in 2019 was associated with an 8% decrease in the likelihood of non-cardiovascular complications related to diabetes and a 6% …

Reviewer Acknowledgments, Randy Wykoff Md, Mph & Tm, Rachel E. Dixon Mphil

Journal of Appalachian Health

As we reach our fifth year, we are particularly thankful for the contributions of our peer reviewers. The knowledge, expertise, and guidance offered by the people listed below have ensured that we can continue to share timely research to effect health and well-being across Appalachia.

Review Of: Appalachian Health: Culture, Challenges, And Capacity, Danielle M. Davidov

Journal of Appalachian Health

The Journal of Appalachian Health is committed to reviewing published media that relates to contemporary concepts affecting the health of Appalachia. This is a review of the text Appalachian Health: Culture, Challenges, and Capacity. This book is an ideal starting point for anyone interested in Appalachian history, public health, and health disparities research.

Piloting An Oral History Approach To Investigate Cancer Perspectives Among Residents Of Appalachian Kentucky, Courtney Martin, Lauren Hudson, Nathan L. Vanderford

Journal of Appalachian Health

Introduction: Kentucky ranks first in the U.S. in overall cancer incidence and mortality rates. Areas of the state that fall within the Appalachian Region, along Kentucky’s eastern border, experience disproportionately high rates of cancer compared to non-Appalachian counties.

Purpose: This pilot study investigates whether oral history interviews can be used to understand perspectives on cancer among residents of Appalachian Kentucky.

Methods: In 2020, participants (n = 5) who identified as being from and/or having strong connections to Appalachian Kentucky were recruited to participate in this pilot study. Participants included individuals working in cancer-related fields, oncology professionals, and those with personal …