Public Health Commons^™

The Effect Of The Patient Protection And Affordable Care Act On The Medicare Part D Coverage Gap As Reflected In Diabetes Medication Adherence., Jennifer A. Forristal

Electronic Theses and Dissertations

This dissertation involves an evaluation of the effect of the Patient Protection and Affordable Care Act (ACA) on diabetic medication adherence for mail order utilizers over 6 years as the Medicare Part D coverage gap begins to close. The study had 3 objectives: 1) to evaluate diabetes medication adherence of health plan members before they reach the coverage gap and then while they are in the coverage gap, 2) to compare diabetes medication adherence between two similar groups with differing benefit structures, one group with a gap in coverage as opposed to a group with no benefit changes within the …

Evaluation Of Liver Transplant Prioritization Methods For Hepatocellular Carcinoma Patients Using Multistate Models., Sarah Katharine Alver

Electronic Theses and Dissertations

The Model for End Stage Liver Disease (MELD), used for prioritizing liver transplantation, predicts mortality from liver disease. Patients with hepatocellular carcinoma (HCC) risk disease progression not reflected in their MELD score. Exception scores prioritize HCC patients higher than their MELD scores, but advantage them over non-HCC patients. To address this, a delay of six months for using exception scores has been implemented, and alternative HCC-specific scores have been developed. Using multistate models, this study projects waitlist dropout and transplant probabilities under the delay and under two alternative scores. The delay improves equity between HCC and non-HCC patients for the …

Physical Activity Levels And Health Of Passamaquoddy Tribe At Indian Township, Michael R. Best

Electronic Theses and Dissertations

This study focuses on reporting the occupational, household, transportation and leisure time physical activity of the Passamaquoddy Tribe at Indian Township. This study also focuses on health measures and the presence of chronic disease and how they are affected by physical activity, risk factors, and other health related measures.

An interview-administered questionnaire, developed by the CDC, was given to participants age 25-44 years old, with one small change. The original Intertribal Heart Project (ITHP) questionnaire used a shortened version of the WHO’s Monica Optional Study of Physical Activity (MOSPA), in order to reduce the time it takes to administer the …

Rural Opioid And Other Drug Use Disorder Diagnosis: Assessing Measurement Invariance And Latent Classification Of Dsm-Iv Abuse And Dependence Criteria, Billy Brooks

Electronic Theses and Dissertations

The rates of non-medical prescription drug use in the United States (U.S.) have increased dramatically in the last two decades, leading to a more than 300% increase in deaths from overdose, surpassing motor vehicle accidents as the leading cause of injury deaths. In rural areas, deaths from unintentional overdose have increased by more than 250% since 1999 while urban deaths have increased at a fraction of this rate. The objective of this research was to test the hypothesis that cultural, economic, and environmental factors prevalent in rural America affect the rate of substance use disorder (SUD) in that population, and …

Network Participation In Public Health : The Development Of Instruments And Adapted Theory To Predict Stakeholder Participation In A Public Health Network., David Johnson

Electronic Theses and Dissertations

Background: Participation in public health networks is important to achieve the goals of public health. This dissertation addresses a common problem in public health management—of how to measure support and predict participation by individuals and organizations in network level collaboratives—through testing an adapted theory producing a newly developed instrument. Purpose: Community health collaboratives have grown in popularity and in funding opportunities in the past couple decades, but they notoriously fail to achieve measureable results. By adapting theory and relevant instruments to a specific public health network context, factors that enable and inhibit participation are identified. Method: A prospective, theory-driven, sequential …

The Influence Of Race And Gender On Hiv Risk Behaviors In High School Students In The Southern States Of The United States, Malendie T. Gaines

Electronic Theses and Dissertations

The incidence of the Human Immunodeficiency Virus (HIV) is highest in the southern states of the United States (US), with adolescents in this region being one of the most affected populations in the country. A limited amount of information is available on adolescent HIV risk behaviors in the southern states, specifically focusing on race and gender. The purpose of this study was to use the Centers for Disease Control and Prevention’s National Youth Risk Behaviors Survey (YRBS) for high school students in the southern states for 2011 and 2013 to examine the influence of race and gender on 1) early …

Implementation Of Break Time For Employee Nursing Mothers At The University Of Louisville : A Case Study., Robin Elise Weiss, 1971-

Electronic Theses and Dissertations

This dissertation is a mixed methods look at the barriers to successful implementation of the Break Time for Nursing Mothers provisions of the Affordable Care Act (ACA) at an upper southern-midwestern university. As public health and medical officials push the desire for an increase in breastfeeding initiation and duration, many mothers must overcome barriers within the employment arena. Previous work has failed to look at how the university setting presents unique challenges with a diverse workforce, varied jobs, and differing space availability. In other settings, barriers have been identified; the goal of this dissertation was to identify what the specific …

A Hierarchical Graph For Nucleotide Binding Domain 2, Samuel Kakraba

Electronic Theses and Dissertations

One of the most prevalent inherited diseases is cystic fibrosis. This disease is caused by a mutation in a membrane protein, the cystic fibrosis transmembrane conductance regulator (CFTR). CFTR is known to function as a chloride channel that regulates the viscosity of mucus that lines the ducts of a number of organs. Generally, most of the prevalent mutations of CFTR are located in one of two nucleotide binding domains, namely, the nucleotide binding domain 1 (NBD1). However, some mutations in nucleotide binding domain 2 (NBD2) can equally cause cystic fibrosis. In this work, a hierarchical graph is built for NBD2. …

The Association Of Medical Student Debt On Choice Of Primary Care Specialty And Rural Practice Location., Craig Ziegler

Electronic Theses and Dissertations

A shortage of primary care physicians (PCP) is present nationally and within Kentucky. The shortage is expected to worsen, unless a dramatic increase occurs in the generation of additional primary care clinicians. Geographical maldistributions of PCP also exist. Whereas 20% of the US population resides in rural areas, only 10% of physicians practice in these areas. This study explores factors that influence medical students’ decisions to select primary care residency training programs, and to practice in rural areas. Specifically, the levels of debt among 1391 graduates from University of Louisville School of Medicine (ULSOM) during 2001-2010 were examined in association …

Impact Of Numeracy On Parental Self-Efficacy And Treatment Outcome Of Children On Complex Diets., Diana Cardina Pantalos

Electronic Theses and Dissertations

Health numeracy, a counterpart to health literacy, can be a mediator of health disparities. This study analyzed the impact of both cognitive and affective numeracy on the pathway linking health behavior to health outcomes, and the role of self-efficacy in this relationship, based on the Health Belief Model. The context was parental management of children's complex diets that require numerical calculations. Parents of children ages 12 months to 12 years with type 1 diabetes (T1D) or phenylketonuria (PKU) were recruited at clinics or community events in east-central states. Ninety-eight participants completed a standardized test of math skills, an instrument to …

The Influence Of Child Physical Activity Programs On Parent Physical Activity In A Rural Community., Katie F. Leslie

Electronic Theses and Dissertations

Introduction: In 2008, a coalition of community leaders and parents sought to increase access to physical activity opportunities for residents of Meade County, a rural Kentucky community. To date, the Meade Activity Center has implemented a variety of year-round programs conducted at borrowed spaces from local schools that have targeted children, utilizing the strategy to first engage children as a way to extend behavior change to other members of the community. This study assessed the influence of child participation in physical activity programs on parent physical activity, and determined potential methods of intervention to increase adult physical activity in a …

The Relationship Between Financial Empowerment And Health Related Quality Of Life In Family Scholar House Participants., Chelsey Erbaugh Franz

Electronic Theses and Dissertations

The Family Scholar House program was a unique intervention designed to stop the cycle of poverty by providing college education and support to single parents. The different aspects of the Family Scholar House program addressed each of the five social determinants of health (economic stability, education, social and community context, health care, and neighborhood and built environment). Results of the studies showed that participant’s mental health and general health rating, as measured by a health-related quality of life survey, improved during the time in the Family Scholar House program. Upon graduation from the program, the mental health and the health …

Unicondylar Knee Arthroplasty In The Inpatient Vs Outpatient Setting: Impact On Process Time, Quality Outcomes, And Patient Satisfaction, Ibrahim Zeini

Electronic Theses and Dissertations

The implications of rising healthcare expenditures are of great concern nationally and internationally. Performing procedures in the outpatient setting can be one solution to this crisis. However, there is a lack of research on systematic approaches for transitioning procedures to the outpatient setting. Unicondylar knee arthroplasty (UKA) presents an opportunity, as it is already in the early stages of transitioning to the outpatient setting. The key step in facilitating an effective transition to the outpatient setting is comparing outpatient UKAs with inpatient UKAs with a focus on process time, quality outcomes, and patient satisfaction. This study retrospectively compares 400 UKA …

Provider Recommendations For Human Papillomavirus Vaccine (Hpv) Among Adolescent Males In Southwest Georgia Counties And The Associated Hpv Prevalence In This Population, Benjamin K. Poku

Electronic Theses and Dissertations

Objective: The purpose of this research study was to examine the variation in healthcare providers’ behavior in recommending the Human Papillomavirus (HPV) vaccine to young male adolescents (aged 11-12), middle male adolescents (aged 13-17) and late male adolescents (aged 18-26) in rural Southwest Georgia counties. This research also aimed to identify factors associated with providers’ behaviors concerning HPV vaccination recommendation to youth in various age groups.

Methods: Upon IRB approval, secondary data were obtained from Albany Area Primary Care for a paper-based survey that was conducted in 2014 using a representative random sample of family physicians (n=12), pediatricians (n=6), and …

The Role Of Self-Regulation, Self-Efficacy, And Outcome Expectancy Value On Physical Activity Of Former Division I Student Athletes, Takilya T. Davis

Electronic Theses and Dissertations

In an effort to acknowledge the needs of student athletes after college, the NCAA designed the Challenging Athletes Minds for Personal Success (CHAMPS) Life Skills program to assist student athletes with this transition. In this program personal development outside of occupational skills is often ignored. Though physical activity appears to be of little focus of the CHAMPS Life Skill program, recent research revealed that student athletes' physical activity patterns surpass those of their peers while in college but this difference is not maintained among alumni student athletes and their peers (Sorenson, 2012). Self-regulation interventions have successfully mediated and predicted physical …

Is Conflict A Factor In A Population's Quality Of Life? A Comparative Study Of University Students In The Palestinian Territories And Jordan, Yara Asi

Electronic Theses and Dissertations

As nearly one third of the world's population lives in an area that is in some way touched by war, researchers have long been interested in the varied impacts of conflict on civilians. Many indicators, measuring both physical and mental constructs, have been assessed in war-torn populations from around the world, one of which is health-related quality of life (HRQoL). The occupied Palestinian Territories (oPt) are one region in which copious research on health indicators has been undertaken in an effort to understand how long-term conflict manifests itself in noncombatant populations. However, existing studies focus primarily on indicators within the …

Public Health Implications Associated With The Practice Of Utilizing Tires To Singe Meat In Three Major Cities Of Ghana: A Concurrent Mixed Methods Study, Tempest D. Hill

Electronic Theses and Dissertations

Utilization of automobile tires to singe meat (e.g., cows) intended for human consumption presents public health risks due to hazardous chemicals released into the environment and meat. This has become a common practice in some African countries such as Ghana. The objective of this study was to investigate the awareness and perception of the residents in three major cities of Ghana (Cape Coast, Kumasi and Accra) using the Health Belief Model and Social Ecological Model. Survey participants (n=196) and focus group discussion members (n=37) completed the study. Data collected from study participants included meat consumption, awareness of the use of …

Examination Of Racial/Ethnic Disparities In Ovarian Cancer Stage Of Diagnosis, Surgery Treatment And Survival: Multilevel Analysis Of 2001-2012 Seer Data, Chen Chen

Electronic Theses and Dissertations

Context. Racial/ethnic disparities in cancer outcomes are major public health concerns. Ovarian cancer is the tenth most common cancer and the fifth leading cause of cancer-related deaths among women. Identifying individual- and contextual-level factors contributing to racial/ethnic disparities in ovarian cancer stage of diagnosis, surgery treatment and survival is necessary for reducing and eliminating these disparities.

Objective. The study aims to examine racial/ethnic disparities in ovarian cancer diagnosis, surgery treatment and survival outcomes; to explore individual- and contextual-level factors contributing to these disparities, and to examine the trend of ovarian cancer racial/ethnic disparities from 2001 to 2012.

Methods. The …

Association Of Kidney Stones With Chronic Disease Among Adults In The United States: Considerations By Race-Ethnicity, Lashaunta Marie Glover

Electronic Theses and Dissertations

Background: little research has been conducted to describe the relationship between kidney stones and risk of cardiovascular disease and stroke in individuals of different race ethnicities. Purpose: the purpose of this study was to compare the prevalence of co-morbidities and to investigate whether there was a statistically significant association between kidney stone formers and increased odds of cardiovascular disease and stroke in race-ethnicity groups. Methods: data from the 2007-2012 cycles of the national health and nutrition examination survey (Nhanes) were used. Survey and biological data used included kidney stone cases, hypertension, obesity, diabetes, chronic kidney disease, cardiovascular disease and stroke. …

Kidquest Childhood Obesity Prevention Program: Analysis Of Its Influence On Health Of Rural South Dakota 5th And 6th Grade Children, Nayef Bumaryoum

Electronic Theses and Dissertations

Obesity is a growing problem throughout the developed world. This project will focus on obesity in rural children by studying those living in an area of South Dakota. Research shows high levels of overweight and obese children in this demographic. The two major objectives of this study are to evaluate the efficacy of the KidQuest (KQ) nutrition and physical activity curriculum in reducing the proportion of children and adolescents who are overweight and obese within participating South Dakota 5th and 6th grade children using baseline/post-intervention data and to determine which KQ teacher type is most effective as evaluated by anthropometric, …

Photovoice: Engaging School Communities In Wellness Efforts, Hilary J. Overby

Electronic Theses and Dissertations

Introduction: Currently there are no interactive tools that allow school communities to assess their school wellness needs and foster interest in wellness efforts. PhotoVoice is a participatory action research methodology commonly used in public health that utilizes photography to document and showcase community strengths and weaknesses in order to promote change. Purpose: The purpose of this study was to gather perceptions of a school community after using PhotoVoice to document school wellness efforts 1. Participants: High school students (n=103) and school community members (i.e., residents of community, school faculty) (n=188) were recruited across three school districts. Methods: High school students …