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When Climate Change Forces Flight: Legal Duties In The Age Of Retreat, Mark P. Nevitt

Faculty Articles

In the face of climate-driven disasters, government officials and individuals alike must decide whether to invest in climate-exposed areas or retreat. This Article analyzes emerging legal and policy issues associated with both climate retreat (when the government relocates people and infrastructure away from climate-exposed areas) and abandonment (when individuals leave climate-exposed areas, following natural disasters or otherwise). I argue that government-driven climate retreat must consider four overlapping legal duties, raising novel questions in an era of climate destabilization. First, does the government have an affirmative duty to rescue its citizens, and is this duty transformed by the government’s role in …

Hardin Health Link: A Community-Integrated Paramedicine (Cip) Program In Hardin County, Kentucky, Samantha Jones

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

Rural and mixed rural–urban communities face persistent disparities in access to timely emergency medical services (EMS), contributing to preventable morbidity and mortality from time-sensitive conditions such as cardiovascular disease, stroke, and injury. Hardin County, Kentucky, reflects these challenges due to its geographically dispersed population, high burden of chronic disease, and variability in EMS response times. This capstone proposes Hardin Health Link, a Community-Integrated Paramedicine (CIP) program designed to expand the traditional role of EMS providers through in-home health assessments, chronic disease monitoring, post-discharge follow-up, medication reconciliation, and connection to clinical and social services.

Guided by an evidence-informed framework, the program …

Stronger Starts: Advancing Maternal And Infant Health In Breathitt County, Kentucky, Madisyn Smith

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

Maternal and infant health outcomes remain significantly poorer in rural Appalachian communities, where structural and socioeconomic barriers limit access to timely and comprehensive care. Kentucky reports elevated rates of preterm birth and infant mortality, with counties such as Breathitt County facing challenges including limited obstetric services, transportation barriers, and high poverty rates. These factors contribute to delayed prenatal care, fragmented services, and increased risk of adverse outcomes.

The Stronger Starts Initiative is an evidence-informed public health program designed to improve maternal and infant health outcomes through a coordinated, multi-level approach. The program integrates nurse-led home visiting, telehealth obstetric consultations, community-based …

Rapid Response To Recovery: Expand Integrated, Technology-Enabled Crisis Care, Madison Chandler

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

Behavioral health challenges in rural communities continue to place significant strain on healthcare systems, particularly through repeated reliance on emergency departments for crisis care. Nelson County, Kentucky, reflects this pattern, with higher reported rates of poor mental health and limited access to behavioral health providers. This paper proposes the Beacon Behavioral Health Response Program, a community-based, multidisciplinary crisis intervention model designed to improve access to timely care and strengthen continuity of support. The program combines mobile crisis response—delivered by a licensed clinical social worker and a peer support specialist—with a technology-enabled component using the Luma AI-supported mental health platform. Together, …

Promoting Maternal And Infant Health In Franklin County, Ky: A Community-Based Physical Activity And Education Intervention, Subin Kim

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

Maternal and infant health outcomes are key indicators of population health, yet persistent disparities exist in rural communities across the United States. In Kentucky, Franklin County reflects this pattern, with concerning maternal and infant health indicators despite relatively favorable socioeconomic conditions. Identified challenges include elevated rates of poor physical and mental health days, high drug overdose mortality, provider shortages, and ongoing reproductive health concerns such as tobacco use during pregnancy and increased infant mortality associated with elevated maternal body mass index.

To address these gaps, a three-pronged, community-based prenatal and postpartum physical activity and education program is proposed. The program …

A Program To Increase Prenatal And Postnatal Care Access In A Rural Kentucky County, Alyssa Thomas

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

Prenatal and postpartum health care access is necessary for positive pregnancy and postpartum outcomes. Many rural areas in the United States are facing maternity care deserts, where there are no obstetric services available in their county. Maternity care deserts typically have higher rates in maternal mortality, low-birth weight, and pre-term births. Fleming County, Kentucky is a small rural community with a population of about 15,000 that is a maternity care desert. To improve prenatal and postpartum care access in this county, this program will use a mobile health clinic and community health workers (CHWs). The mobile health clinic will operate …

Momentum For Healthy Births-Hardin County, Ky, Brittany R. Jackson

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

Maternal and infant health disparities in Hardin County, Kentucky, reflect persistent gaps in timely access to care, particularly among rural and underserved populations. Structural barriers, including transportation limitations and unmet social needs, contribute to delayed prenatal care initiation and low postpartum follow-up, increasing the risk of adverse outcomes. This capstone project proposes the MOMentum (Maternal Outreach and Monitoring for Mothers) Program, an integrated care model designed to strengthen access, improve care coordination, and enhance continuity across the prenatal and postpartum period.

The program combines a Community Health Worker (CHW)-led navigation model with enhanced postpartum care supported by telehealth services and …

Improving Prenatal And Postpartum Care Gaps In Breathitt County, Megan Deaton

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

Maternal and infant health remain a major public health issue across the United States, particularly in rural communities. Barriers such as shortages of obstetric providers, transportation challenges, and limited access to prenatal and postpartum care contribute to delayed care, low follow-up rates, and an increased risk of poor outcomes, including preterm birth and low birth weight. In response, the proposed Maternal and Infant Health Program aims to address gaps in care access through a home visiting model that provides in-home support, maternal health education, care coordination, and referrals to healthcare services, with a direct focus on Breathitt County. Expected outcomes …

Implementation Of A Reminder/Recall Messaging Program In Kentucky, Laura Schwarz

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

Childhood vaccination remains a critical public health priority, yet measles, mumps, and rubella (MMR) vaccination rates in several rural Kentucky counties fall below the 95% threshold required for herd immunity. Recent declines in coverage, compounded by socioeconomic disparities and barriers to healthcare access, place children at increased risk for vaccine-preventable diseases and outbreaks. This capstone project proposes the implementation of an evidence-based reminder/recall (R/R) text messaging intervention utilizing the Kentucky Immunization Registry (KYIR) to improve timely MMR vaccination among children aged 4–6 years before kindergarten entry.

The proposed program targets thirteen Kentucky counties with vaccination rates below 70% and documented …

Strengthening Rural Mental Health Crisis Response: Integrating Broadband Telehealth Care Across Counties Served By Kentucky River District Health Department, Mary K. Mcnabb

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

Rural communities in Eastern Kentucky face persistent barriers to timely and effective mental health crisis care, including provider shortages, transportation challenges, and limited broadband infrastructure. Counties served by the Kentucky River Health Department Wolfe, Lee, Owsley, Perry, Knott, Leslie, and Letcher experience disproportionately high behavioral health needs while relying on shared regional resources. The Broadband-Enabled Rural Crisis Stabilization Initiative (BERCSI) is a proposed public health program designed to strengthen rural mental health crisis response through integrated, technology-enabled care. Grounded in evidence-based practices, including tele-mental health and crisis stabilization models, BERCSI leverages broadband expansion to facilitate rapid assessment, coordinated care, and …

Protein Intake Patterns, Health Profiles, Body Composition Among Us Adults By Physical Activity Levels: Nhanes 2017–2020, Jacqueline Vernarelli, Jessica R. Kiel, Christopher D. Coleman, Satya S. Jonnalagadda

Public Health Faculty Publications

Regular physical activity is known to provide numerous health benefits, including improvements in cardiovascular function, metabolic health, and mental well-being. This study aimed to assess the metabolic, behavioral, and physiological benefits of physical activity in US adults and compare the dietary intake of active versus inactive individuals, with a specific focus on protein consumption. This study used data from 7,910 adults (>18 y) who participated in the 2017–2020 NHANES Pre-Pandemic Survey. As part of the NHANES, height and weight were measured by trained examiners, dietary intake data was collected using 24-hour recall. Data analysis was conducted using SAS 9.4 …

Fusion, 2026, George Washington University, William H. Beaumont Medical Research Honor Society

Fusion

No abstract provided.

Characteristics Of Pulmonary Vs. Extrapulmonary Tuberculosis Cases In Kentucky From 2020 To 2024, Mariam M. Alkhairat

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

Objective: Tuberculosis (TB) remains an important public health concern in the United States, especially among people experiencing social and clinical vulnerabilities. Extrapulmonary TB, which occurs outside of the lungs, can be harder to detect and diagnose than pulmonary TB. This study aimed to describe the demographic and clinical characteristics of people with active TB in Kentucky and to identify factors associated with extrapulmonary TB.

Methods: Secondary surveillance data were obtained from the Kentucky Department for Public Health (KDPH) using the National Tuberculosis Surveillance System (NTSS). The study sample included 301 confirmed active TB cases reported in Kentucky. Descriptive statistics were …

Bringing Awareness And Education To Rural Areas About The Role Occupational Therapy (Ot) Has In Infant Care, Makenzi Richwald

Occupational Therapy Doctorate Capstone Posters

This capstone project focused on education and advocacy. The aim of my capstone project was to provide education to parents of eastern Kentucky (KY) about what Occupational Therapy (OT) can address with infants aged 0-18 months. I saw a gap in knowledge in the eastern KY community about what OT could do for infants and wanted to address this. Through my research, consultation with my mentors, and collaboration with the occupational therapists at my site (BPT) I discerned 14 areas of development and/or common reasons of needed referral for OT services by this age group. These educational materials aimed to …

J Am Coll Dent 2026 92 2b

Journal of the American College of Dentists

This special issue of the Journal of the American College of Dentists responds to a growing but long-underrecognized demand for humanities and ethics in dental education, practice, and scholarship. It emerges from the work of the National Collaborative on Humanities and Ethics in Dentistry (NCHED), a multi-institutional partnership formed in 2023 to address the persistent exclusion of dentistry from broader health humanities conversations. Through national webinars and scholarly collaboration, NCHED has demonstrated substantial interest in ethical reflection, historical analysis, narrative inquiry, and the arts as essential to understanding oral health and dental care.

The unexpectedly strong response to the call …

Between Tradition And Transition: Cultural Negotiations And Contraceptive Perceptions Among Ghanaian Students In The United States, Beatrice Amissah

Theses and Dissertations

As global mobility continues to rise, international students often encounter new cultural norms and health practices that differ from those in their home countries. While some studies have focused on contraception within the context of gender and types, less focus has been placed on diasporic populations, especially how students navigate tensions surrounding contraception within new cultural environments. This study explores how Ghanaian students in the United States interpret, negotiate, and respond to contraceptive messaging while navigating the cultural transition between their heritage and host societies. Drawing on Berry’s (1980)  Acculturation Theory, the study examines the tensions students experience, the strategies …

Preventing Teen Pregnancy Through Expanded Contraceptive Access In Mccreary County, Kentucky, Dacey B. Chitwood

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

This capstone project proposes a school-based Condom Availability Program to reduce teen pregnancy risk by expanding discreet contraceptive access for adolescents in McCreary County, Kentucky. Teen pregnancy remains a persistent public health concern in rural communities where stigma, privacy concerns, transportation barriers, and limited healthcare access can prevent adolescents from obtaining reproductive health resources. McCreary County faces elevated teen birth rates, socioeconomic disadvantage, and limited maternal healthcare infrastructure, making teen pregnancy prevention an important local priority. The proposed program would place free latex and non-latex condoms in student restrooms at McCreary Central High School, with QR-code-linked information connecting students to …

Measles Vaccine Hesitancy Improvement Bundle To Improve Vaccination Rates In A Rural Outpatient Clinic, Ramie Malone

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Introduction

Despite the Centers for Disease Control and Prevention's recommendations to vaccinate children against measles, a decline in measles vaccination rates has been observed at a rural family medicine clinic. While numerous factors contribute to the decline in vaccination rates—including parental doubts about the necessity of vaccination, concerns about vaccine side effects, and insufficient education—the latter remains a fundamental underlying cause of suboptimal vaccination coverage.

Objectives

This project focused on surveying, educating, and boosting parents' confidence in measles vaccines for children under five to raise the measles vaccination rate.

Methods

This project used a pre- and post-intervention bundle over an …

Environmental Predictors Of Human Lyme Disease Incidence Across Appalachian Counties In Kentucky, Virginia, And West Virginia, 2000-2019, Karlie D. Rennison

Theses and Dissertations--Epidemiology and Biostatistics

This ecological study examined county-level environmental, landscape, and host-related predictors of Lyme disease incidence across Kentucky, Virginia, and West Virginia from 2000-2019. Lyme disease is an emerging public health concern in the Appalachian region, where geographic expansion and shifting ecological conditions may influence disease risk.

Lyme disease case rates (per 10,000 population) were analyzed in relation to climate variables, land cover metrics, host density measures, and rurality using publicly available data sources. Descriptive and regression analyses were conducted to evaluate associations between candidate predictors and disease incidence.

Substantial geographic variation in Lyme disease incidence was observed, with higher case rates …

Socio-Spatial Patterns Of Suicide Mortality In The United States, Kushagra Tiwari, M. Amin Rahimian, Marie-Laure Charpignon, Philippe J. Giabbanelli, Praveen Kumar

VMASC Publications

Suicides cause more than 49,000 deaths per year in the United States, including 55% associated with the use of a firearm. Across states and counties in the US, suicide mortality exhibits substantial geographical and sociodemographic heterogeneity. However, the role of large-scale social networks in shaping this variation remains underexplored. To assess how both the risk of suicide mortality and the effect of firearm restriction policies propagate through inter-county social ties, we integrate data on county-level suicide mortality (2010–2022) and the Facebook Social Connectedness Index (SCI), a continuous measure of the strength of social ties between counties used to derive weighted …

Politics Of A Silent Pandemic: Antimicrobial Resistance And State Capacity In India And Nigeria, Mia Kelly

CMC Senior Theses

Antimicrobial Resistance (AMR) has emerged as one of the most pressing yet widely underestimated health threats of the 21st century; this thesis explores the potentially devastating global impact of this “silent pandemic”, exposing how deeply health outcomes depend on political choices, regulatory capacity, and economic constraints. Although the danger of spreading drug-resistant pathogens is now widely acknowledged in both the scientific and political communities, states differ in their abilities to contain the issue, with low- and middle-income countries facing the greatest obstacles to national action plan implementation. This thesis investigates these disparities through a comparison of India and Nigeria, two …

Reframing Sexual Assault And Intimate Partner Violence Through A Maternal And Child Health Lens: Implications For Integrated Prevention, Policy, And Practice, Daija C. Gibson

Theses and Dissertations

Sexual assault and intimate partner violence remain persistent public health concerns in the United States, with significant consequences for individual health, family stability, and population well-being. Although these forms of violence are frequently addressed through criminal justice and behavioral health frameworks, less attention has been given to their implications within maternal and child health, where relational dynamics, life course development, and intergenerational outcomes are central. This study reframed SA and IPV as core MCH issues to examine how integrated, systems-based approaches can strengthen prevention efforts. A structured literature review and systematic synthesis of peer-reviewed studies published between 2015 and 2026 …

The Importance Of Multi-Component Strategies And Healthcare Worker Compliance In Preventing Healthcare-Associated Infections: A Systematic Review, Michelle Northcut

Theses and Dissertations

Healthcare-associated infections (HAIs) remain a preventable threat to patient safety and are linked to morbidity, mortality, antimicrobial resistance, and increased healthcare costs (CDC, 2024; AHRQ, 2024). Evidence suggests that 30–70% of HAIs may be prevented through consistent application of infection prevention practices; however, implementation and adherence gaps persist (CDC, 2024). This systematic review examined the relationship between healthcare worker compliance with infection prevention practices and infection outcomes and explored how institutional and organizational factors influenced both compliance and infection outcomes.

Following PRISMA 2020 guidelines, searches were conducted in PubMed, CINAHL, ProQuest, and Google Scholar for studies published between 2015 and …

Understanding Maternal Morbidity And Mortality Rates In Georgia, Ebony Hall

Theses and Dissertations

The United States continues to have a significant concern for public health regarding the maternal morbidity and mortality rates. In contrast, women of African American descent and other marginalized populations maintain a disproportionately higher rate of pregnancy-related disparities. More specifically, in Georgia, a persistent number of disparities can correlate to a lack of access to adequate prenatal care, insurance status, and many other social determinants of health that are linked to the contribution of adverse maternal health care outcomes. The purpose of this research study is to evaluate various maternal health experiences during pregnancy, while focusing on the occurrence of …

Child Maltreatment Risk Identification In Complex Caregiving Environments: A Public Health Review Of Split-Custody And Multi-Household Family Contexts, Makenzie Lee

Theses and Dissertations

Child maltreatment remains a significant public health concern with lifelong consequences for children's health, development, and well-being. As children's caregiving environments become increasingly diverse through split-custody arrangements, blended families, kinship care, and other multi-household contexts, recognizing and assessing child safety concerns may become more complex. Although these family structures are not inherently associated with maltreatment, the distribution of caregiving responsibilities and information across multiple households may complicate child maltreatment risk identification.

This capstone presents a scoping review of peer-reviewed literature examining child maltreatment risk identification within complex caregiving environments. The review synthesized evidence related to caregiving environments, caregiver relationships, child …

Determinants Of Routine Childhood And Adolescent Vaccine Hesitancy And Uptake Among Parents In The United States: A Scoping Review, Precious Johnson

Theses and Dissertations

Routine childhood and adolescent vaccination is an essential public health strategy for preventing disease and protecting communities. However, parental vaccine hesitancy and barriers to vaccine uptake continue to affect vaccination decisions in the United States. This scoping review examined factors associated with routine childhood and adolescent vaccine hesitancy and uptake among U.S. parents. A comprehensive literature search of PubMed and EBSCO identified peer-reviewed studies published in English between 2016 and 2026. Studies focusing on parents, guardians, or caregivers of children and adolescents in the United States were screened according to predefined eligibility criteria. Of 69 records identified, 52 remained after …

Rural Oral Health Access Coordination Program Proposal, Anna Luu

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

Oral health disparities remain a major public health issue in the United States, particularly in rural Kentucky, with barriers such as limited access to preventive dental services, transportation, and insurance coverage contributing to delayed treatment and worsening oral health outcomes. In response, the proposed Rural Oral Health Access Coordination Program aims to improve care access by strengthening referral systems, integrating oral health screenings into public health settings, and enhancing care coordination for high-risk populations. The program intends to focus on the Kentucky River District Health Department Region, connecting individuals to existing services rather than providing direct clinical care. Expected outcomes …

Perry County Perinatal Access Navigator Program (Pc-Pamp) A Public Health Program Proposal To Improve Timely Prenatal Care Access In Perry County, Kentucky, Amber E. Mcguire-Chun

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

Delayed initiation of prenatal care remains a significant public health concern in rural Appalachian communities, including Perry County, Kentucky, where structural barriers such as limited provider availability, transportation challenges, and fragmented referral systems contribute to inadequate access to timely care. This capstone project proposes the Perry County Prenatal Access Navigator Program (PC-PANP), a community-based patient navigation model designed to improve initiation of prenatal care in the first trimester. The program is led by the local health department and leverages partnerships with healthcare providers, the University of Kentucky College of Public Health, WIC, Extension services, and community organizations to support early …

Decreasing Hospital Acquired Pressure Injuries Through A Multi-Intervention Approach: A Quality Improvement Project, Kendra D. Crawford

DNP Scholarly Projects

BACKGROUND: Hospital acquired pressure injuries (HAPIs) continue to plague hospitals across the country. HAPIs are an indication of the quality of care delivered by the hospital’s nursing workforce. These injuries are costly to organizations and can lead to increased length of stay (LOS). The development of a HAPI, depending on severity, is a reportable injury and is classified as patient harm. Patients who suffer from HAPIs can experience significant pain and at times, permanent disfigurement. This project’s focus is a community hospital that has seen a steady increase in HAPIs over the last 2 years. During 2025, 28% of the …

Reducing School Absenteeism In Children With Avoidance Behaviors, Kimberly Carey

DNP Scholarly Projects

Background: Chronic absenteeism and school avoidance are a problem facing schools across the nation following the COVID-19 pandemic. Chronic absenteeism is financially, emotionally, and academically expensive for society. Purpose: This quality improvement project aimed to decrease absences by 50% over a 6-week timeframe when compared to the same timeframe from the previous year. Methods: Utilizing a Plan-Do-Study-Act framework, an intervention based on tracking multi-day consecutive absences and reaching out to families to provide education and support was implemented. At three days of absence, the school nurse would either call the family for absence with unknown etiology or email with an …