Digital Commons Network^™

The Opioid Crisis: Analyzing Access To Resources, Mental Health And The Influence On Overdose Deaths In Urban And Rural Communities, Katharina Johnson, Maggie Obourn

Scholarship in Medicine - All Papers

Background: Opioid use contributes significantly to deaths throughout the United States. Opioid overdose deaths have increased in recent years and the opioid crisis has far reaching effects on many communities. There are several factors that contribute to opioid overuse and death, including access to resources and social factors.
Objective: In this study we aimed to assess how social factors affect overdoses by examining the differences between rural and urban communities over time.
Methods: We utilized data from County Health Rankings and conducted a retrospective review of data from 2016 and 2023 to compare several factors that we hypothesized affected opioid …

Access To Exercise Opportunities And Food Security: Mediators In The Prevalence Of Chronic Diseases In Ohio, Anidya Soni, Lisa Victor

Scholarship in Medicine - All Papers

Background: Obesity remains a leading public health issue in the United States, with 40.3% of adults classified as overweight, underscoring the need to understanding the environmental and social determinants of health1. The neighborhood food environment, including access to healthy food and recreational spaces in one's community, plays a critical role in shaping dietary behaviors and physical activity levels.

Objective: This study examines the relationship between neighborhood food environments including access to healthy food and exercise opportunities, socioeconomic factors, and health outcomes like obesity, and diabetes in Ohio from two-time points: 2016 to 2023 using data from the County Health Rankings …

A Program Evaluation Case Study, Madelyne G. Culbertson

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

This case study presents a program evaluation of a physical activity intervention implemented in Bourbon County, Kentucky, guided by the Centers for Disease Control and Prevention’s Framework for Program Evaluation in Public Health.

A Case Study In Program Evaluation, Alexis Strottman

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

This paper presents a comprehensive evaluation plan for the Bourbon County Physical Activity Improvement Program, as prompted in the University of Kentucky's 2025 MPH-Health Management and Policy Capstone Case Study. The case study outlines a program developed in response to high obesity and inactivity rates in Bourbon County, Kentucky. Utilizing the CDC's 6-step program evaluation framework, the plan outlines engagement of a diverse group of stakeholders to assess the program's effectiveness in increasing physical activity among residents. The evaluation focuses on both process and outcome measures, examining the implementation of exercise facilities, community events, and an app designed to track …

A Case Study In Program Evaluation: Evaluation Of A Program Designed To Increase Activity Levels In Bourbon County Residents, Brooke M. Woodburn

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

This paper provides recommendations to eliminate possible barriers in a program developed to reduce inactive levels across Bourbon County.

Increasing Hpv Vaccination Adherence In Floyd County, Ky: Give Teens Vaccines, Taylor M. Stumbo

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

Cervical cancer remains a pressing public health issue, particularly in underserved and rural areas where access to preventive care is limited. This capstone addresses the urgent need to increase human papillomavirus (HPV) vaccination adherence in Floyd County, Kentucky—part of the central Appalachian region that experiences disproportionately high cervical cancer incidence and mortality. Despite the proven effectiveness of HPV vaccines in preventing the virus strains most responsible for cervical cancer, uptake in this region remains below national targets due to socioeconomic barriers, limited healthcare access, and lack of awareness. Give Teens Vaccines is a two component intervention leveraging existing healthcare systems …

A Case Study In Program Evaluation Evaluation Of A Physical Inactivity Program In Bourbon County, Kentucky, Carine N. Malekera

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

This paper evaluates a physical activity program by the Bourbon County Health Department aimed at increasing physical activity among local residents. Using the CDC’s Framework for Program Evaluation, the study includes both process and outcome evaluations to assess program implementation and impact on health outcomes. Key findings indicate success in urban areas but challenges in rural regions due to limited access to resources. Recommendations include improving access to exercise opportunities in rural areas and offering virtual classes. This evaluation emphasizes the importance of continuous assessment for effective public health interventions.

A Case Study In Program Evaluation, Kaitlyn E. Lee

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

This capstone project evaluates a fictious online MRSA education program developed by the Lexington-Fayette County Health Department and Fayette County Public Schools after a suspected outbreak among student athletes. Using the CDC’s 6-Step Framework for Program Evaluation, the project focuses on how stakeholders were engaged, how the program was described and mapped, how the evaluation questions were developed, what evidence was collected, and how conclusions were formed. The goal of the evaluation is to understand whether the program’s structure, delivery, and implementation support clear infection-control education for the different school personnel who use it. This project emphasizes the overall evaluation …

Customary Corruption, Ani B. Satz, Liza Vertinsky

Faculty Articles

For over a hundred years, it has been well-accepted among tort scholars that physicians—as one of the legally recognized professions— determine their own customary practices. Within tort law, and medical malpractice more specifically, customary practice establishes whether physicians breach or uphold the required standard of care toward their patients. The results of our hand-coded examination of decided cases and statutes show a more complex picture. While some states have endeavored to shift the standard away from professional custom, it continues to play a critical, and in many cases a determinative, role in establishing physician liability in most states.

Using illustrative …

Tort Liability For Failure To Age Gate: A Promising Regulatory Response To Digital Public Health Hazards, Matthew B. Lawrence, Brett Frischmann, Avi Sholkoff

Faculty Articles

Tort liability for failure to “age gate” is a promising legal response to the public health hazards of AI, social media, sports gambling, and other digital spaces. Tort liability for failure to “age gate” hinges liability for harms to minors on an app’s failure to take reasonable steps to prevent minors from gaining access or otherwise to apply appropriate governance rules, such as privacy-protective default settings or ensuring genuine parental consent. While no one legal response is a panacea, tort liability for failure to age gate carries several distinctive advantages that make it a particularly promising option at this stage …

Constitutionalizing Climate Rights, Mark P. Nevitt

Faculty Articles

This Essay proceeds in three Parts. In Part I, I describe and analyze which states have climate and environmental amendments within their state constitutions. Here, I focus on three states (Hawaii, Montana, and Pennsylvania) that have comparably strong Green Amendments and have experienced litigation in recent years enforcing these constitutional provisions. I describe and analyze three cases: Navahine F. v. Hawaii Department of Transportation (Hawaii), Held v. Montana (Montana), and Robinson Township (Pennsylvania). I argue that these three decisions—all of which enjoyed varying degrees of success—will spur greater efforts to constitutionalize state environmental rights. Indeed, there are grassroot efforts within …

Impacts Of Physical Inactivity Models On Endothelial Function: A Systematic Review, Joel E. Harden, J. David Branch, Leryn J. Reynolds

Exercise Science Faculty Publications

Background

Endothelial dysfunction is associated with cardiovascular disease and cardiac events. Numerous studies demonstrate that a reduction in physical activity/exercise levels are associated with poor endothelial function. Yet, these studies use a plethora of models to mimic reduced activity levels which may have widely different results on endothelial function. It is pertinent to collectively review these articles to provide a comprehensive understanding of the impact of reduced activity on vascular health, as endothelial function is one of many factors that influences vascular tone.

Objective

The purpose of this systematic review is to examine and synthesize the current literature regarding the …

The Association Between Food Benefit Online Ordering And Redemptions: Evidence From The Special Supplemental Nutrition Program For Women, Infants, And Children, Junzhou Zhang, Chuanyi Tang, Kayoung Park, Qi Zhang

Marketing Faculty Publications

Objective:

To examine how the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) online food benefit ordering could influence WIC benefit redemptions.

Design:

A cross-sectional study. We compare the average redemption rates between online ordering early adopters and non-adopters among WIC customers before and after implementing WIC online ordering. A propensity score-weighted difference-in-difference model was used to estimate the coefficients.

Setting:

The Oklahoma WIC programme and a grocery store chain in Oklahoma.

Participants:

12743 Oklahoma WIC households that had redeemed their food benefits at the grocery store chain in 2020.

Results:

WIC online ordering significantly positively affected redemption …

Educational Interventions To Improve Pediatric Emergency Care: A Qualitative Assessment Of The Perspectives Of African Healthcare Workers, Emily A. Hartford, Chris A. Rees, Isaac Kihurani, Raana Hussain, Elena Seifert, Alexis Schmid, Tigist Bacha, Carol C. Chen, Megan L. Schultz

Paediatrics and Child Health, East Africa

Pediatric emergency care (PEC) training for health care workers (HCWs) is commonly offered in the form of short courses. This study gathers the perspectives of HCWs from eight African countries on how to best deliver and implement short training courses in PEC. This is a qualitative study using semi-structured key informant (KI) interviews. Utilizing the African Federation for Emergency Medicine (AFEM) member list serve, we identified African HCWs who had previous experience participating in and/or delivering short training courses in PEC. From this cohort, four interviewers were selected. These interviewers all received training in qualitative interviewing and then each recruited …

The European Health Data Space As A Compass For Academic/Industry Collaborations, Gabriela Lenarczyk, Hannah Louise Smith, W. Nicholson Price Ii

Articles

Against the backdrop of a deepening funding crisis for academic research in the US, how and when can closer relationships between academia and industry better support the research enterprise? Spector-Bagdady (2025) explores this potential response, bringing insight from genetic data sharing between academia and industry—and the benefits and challenges that arise from that sharing. She calls for a response that aligns academic institutional policy to support the realization of any public good, recognizing the pitfalls and problematic incentives that shape individual responses. It’s a timely call, and an attractive one in a time of urgent uncertainty about funding and support. …

A Qualitative Study Of End-Stage Liver Disease And Liver Transplant Referral Practices Among Primary Care Providers In Nonurban America, Vashisht Madabhushi, Matthew Wright, Gabriel Orozco, Allison Murphy, Antonio R. Garcia, Natalie D. Pope, Xiaonan Mei, Alexandra Cocca, Roberto Gedaly, Meera Gupta

Surgery Faculty Publications

Purpose: In rural America, the road to obtaining a liver transplant (LTX) often starts at the primary care provider’s (PCP’s) office. Patients with end-stage liver disease (ESLD) in rural communities experience lower rates of wait-listing and higher mortality. This study identifies issues related to the knowledge and perceptions of ESLD and LTX referral among PCPs in rural Kentucky (KY).

Methods: The study protocol involved relying upon a semistructured outline to explore the knowledge, attitude, and perceptions of PCPs toward ESLD and LTX referral among PCPs in rural KY. Inductive thematic analysis was utilized to identify, analyze, and report themes.

Findings: …

Man With An Itchy Back, Katherine Schaffer, Nevin Adamski, Brittany Ambrose, Kathleen Anderson

Department of Emergency Medicine Faculty Publications

[First paragraph] A 61-year old man with no significant past medical history presented with painful bug bites on his lower back 1 day after a 1.5-week-long visit to Africa. He noticed bug bites on his lower back 3 days ago; since then, they have increased in size and become more painful. He was prescribed doxycycline at urgent care earlier that morning and had taken 1 dose. He is taking prophylactic medications for malaria and has had no fever at home. Vital signs, exquisitely tender papular lesions with a central punctum and surrounding erythema in the bilateral paralumbar regions.

Blood Biomarkers In Down Syndrome: Facilitating Alzheimer’S Disease Detection And Monitoring, Melissa E. Petersen, Lisi Flores-Aguilar, Elizabeth Head, Laia Montoliu-Gaya, Andre Strydom, Sarah E. Pape, Juan Fortea, Nicholas J. Ashton, Chinedu Udeh-Momoh, Sid E. O’Bryant, Dwight German, Florin Despa, Mark Mapstone, Henrik Zetterberg

Neurology Faculty Publications

Blood-based biomarkers continue to be explored for disease detection, monitoring of progression, and therapeutic outcomes as the diagnostic determination of Alzheimer’s Disease in Down Syndrome (DS-AD) remains challenging in clinical settings. This perspective highlights the current status of this effort. Overall, amyloid (A), tau (T), and neurodegeneration (AT[N]) blood-based biomarkers have been shown to increase with disease pathology for individuals with DS. Phosphorylated tau biomarkers (p-tau217, p-tau181) have been consistently shown to track disease progression for DS-AD and are likely good candidates for use in clinical settings. Biomarkers of inflammation (glial fibrillary acidic protein) also show promise; however, additional work …

A Case Study In Program Evaluation, Soma Dutta

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

Program evaluation is a systematic process of assessing a program’s design, implementation, and outcomes to determine its effectiveness, efficiency, and impact, guiding data-driven improvements and decision-making. The Centers for Disease Control and Prevention (CDC) Evaluation Framework provides a structured approach to assessing public health programs, ensuring they are effective, accountable, and continuously improving. By systematically applying this framework, evaluations can provide actionable insights that inform program improvements, guide resource allocation, and ensure that evaluations are practical and meaningful to all stakeholders involved (Centers for Disease Control and Prevention, 2024).

The Bourbon County Health Department (BCHD) has implemented a Physical Activity …

A Case Study In Program Evaluation: Evaluation Of The Bourbon County Physical Activity Initiative, Michaela D. Amburgey

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

This evaluation examines the Bourbon County Physical Activity Initiative, which aims to increase physical activity levels in Bourbon County, Kentucky. The initiative includes increased access to exercise opportunities, community events, and an incentive-based activity tracking system. This evaluation assesses the program’s implementation, effectiveness, and provides recommendations for improvement. By utilizing evaluation findings, public health practitioners can enhance decision-making, optimize resource allocation, and improve population health outcomes.

Bones And Brains: The Association Between Osteoporosis And Depression, Mason Taylor

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

Introduction: Osteoporosis and depression are two public health problems that are increasing in prevalence. Previous studies have found a positive association between the two variables in women and men and women together, but there is a gap when looking at men. Therefore, it was important to investigate the odds of depression in men, women, and men and women together to make comparisons by sex.

Methods: 1,602 participants aged 65 and older were included in the study from the National Health and Nutrition Examination Survey (NHANES) 2017 – March 2020 Pre-Pandemic dataset. One unadjusted and seven adjusted models were created for …

Evaluation Of The Bourbon County Health Department Physical Activity Program, Walker S. Hancock

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

Bourbon County has a low physical activity rate. A program has been implemented to increase rates of physical activity. An evaluation has been performed using the CDC’s 6-step program evaluation process framework.

According the the framework, two recommendations were made. The first one is to increase access to parks or exercise facilities for those outside of Paris city limits. The second one is to increase the number of indoor facilities for people to use during the cold, winter months.

A Case Study In Program Evaluation: Evaluation Of A Program To Increase Physical Activity, Megan M. Harper

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

Public health revolves around 3 core functions: assessment, policy development, and assurance.¹ For public health initiatives to have long-term success, we must determine if the intended effects of those programs are met in the beginning stages of program development and implementation; thus, program evaluation relates to the core function of assessment. The Centers for Disease Control and Prevention (CDC) developed a framework to facilitate this process and enable subsequent informed decisions on how to improve public health programs, which relates to policy development.² The CDC framework is comprised of 6 interconnected steps and 4 groups of standards; together, …

Understanding The Impact Of Pharmacist Prescriptive Authority On Hiv Pre-Exposure Prophylaxis At The State Level, Cameron G. King

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

HIV transmission, with relative risk reductions of up to 99%. However, real world data have revealed that even with large increases in PrEP use, new HIV diagnoses may only slightly decline. This disparity suggests that access to PrEP may be suboptimal, especially among high-risk subgroups, who are often hard to maintain on the continuum of HIV care. Pharmacists, because of their accessibility, trusted role in their communities, and growing scope of practice, could serve as an intervention point to improve access to PrEP.

A previously validated algorithm using National Drug Codes (NDCs) and the International Classification of Disease, 10^{th …}

How Sleep Disorders And Sleep Duration Impact Memory, Alexandria J. Sims

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

INTRODUCTION: Sleep duration and sleep disorders can cause changes in memory function as populations age. Previous studies have shown that disordered sleep is associated with increased risk of cognitive dysfunction and long and short sleep durations can cause memory impairment. This study studies aims to find if there is an association between sleep disorders and sleep duration and the impacts on memory.

METHODS: In this study, 3,478 participants aged 60 year and older from the National Health and Nutrition Examination Survey (NHANES) 2013-2014 dataset were included in adjusted and unadjusted models, comparing the sleep disorders and sleep duration exposures to …

Environmental And Behavioral Determinants Of Congenital Defects: An Ecologic Study In Kentucky, Amelia G. Floyd

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

Congenital defects are a significant contributor to infant morbidity and mortality. The multifactorial etiology of such defects presents complex challenges for public health. This ecologic study investigates the association between environmental and behavioral exposures and congenital defects rates at the county level in Kentucky from 2010 to 2019. The Kentucky Department for Public Health, Office of Vital Statistics, provided all relevant defect data. County-level exposure data was collected from multiple sources.

Descriptive and geospatial analyses revealed substantial geographic variability, with notable high defect rates in northeastern Kentucky. Negative binomial regression models identified behavioral and socioeconomic factors to be the strongest …

Assessing The Impact Of A Physical Activity Program In Bourbon County Using The Cdc Evaluation Framework, Abigail Lay

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

Physical inactivity is a significant public health concern, contributing to increased risks of chronic diseases such as obesity, cardiovascular disease, and diabetes (Centers for Disease Control and Prevention [CDC], 2022). To address this issue, communities across the United States have implemented physical activity programs to promote healthier lifestyles, including Bourbon County. This project evaluates the impact of a physical activity program in Bourbon County, KY, using the CDC Framework for Program Evaluation to assess its effectiveness, sustainability, and areas for improvement (CDC, 1999).

The primary objective of this evaluation is to determine whether the program has successfully increased participants' physical …

Changes In Local Public Health System Characteristics Before And After The Implementation Of Ohio’S Public Health Accreditation Board Policy For Local Public Health Departments., Christine Lynn Vazquez

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

The Public Health Accreditation Board is a nationally recognized nonprofit organization that manages a series of programs including the national public health accreditation program. Public health accreditation is awarded to health departments that achieve a set of nationally recognized goals and standards for departments to adopt. The state of Ohio initiated policy requiring that Local Health Departments to achieve accreditation by 2018. In result, Ohio has the largest number of accredited local health departments. This study looked at the local health departments in Ohio responses to the National Longitudinal Survey of Public Health Systems to understand if services provided improved …

Evaluating Hiv Testing Strategies And Screening In The University Of Kentucky’S Target 4 Project, Emily E. Wagoner

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

The University of Kentucky’s Target 4 project aims to expand HIV testing and provide accessible, confidential services throughout Kentucky, focusing on individuals at highest risk for HIV and Hepatitis C. In December 2023, the Target 4 project implemented a new, expanded HIV screening form, increasing the number of questions from seven to eighteen. This study analyzes the impact of the new screening form on risk factor identification and HIV positivity rates in Region 9, a 16-county area in central Kentucky, from September 2021 to November 2023. Data from 11,187 encounters before the implementation of the new screening form and 2,585 …

Challenges Associated With Pfas Detection Method In Africa, Abdullahi Tunde Aborode, Ridwan Olamilekan Adesola, Ibrahim Idris, Waheed Sakariyau Adio, Segun Olapade, Gladys Oluwafisayo, Israel Ayobami Onifade, Sodiq Fakorede, Taiwo Bakare-Abidola, Jelil Olaoye, Adedeji Daniel Ogunyemi, Oluwaseun Adeolu Ogundijo, Olamilekan Gabriel Banwo, Adetolase Azizat Bakre, Peter Oladoye, Grace Adegoye, Noimat Abeni Jinadu

Chemistry & Biochemistry Faculty Publications

Per- and polyfluoroalkyl substances (PFAS) are a group of man-made chemicals that are widely present in many industries. Monitoring and analyzing PFAS in Africa is challenging due to the limited availability of mass spectrometry (MS), which is an essential technique for detecting PFAS. This review assesses the scope and impact of the shortage of mass spectrometry instruments in Africa, emphasizing the resulting limitations in monitoring environmental and public health threats. The review analyzes the existing PFAS monitoring, the accessibility of MS instruments, and the technical capabilities within the continent. This study suggests that fewer African countries have sufficient MS instruments, …