Digital Commons Network^™

Improving Black Maternal Outcomes In Christian County, Ky: A Social Marketing Approach To Perinatal Provider Change, Ariel A. Arthur

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

Compared to other states in the country, Kentucky has historically poor population health outcomes. While the statewide maternal mortality rate is 16.1 per 100,000 live births, this statistic belies the stark racial disparities that exist. In 2018, the pregnancy-related death rate for Black women was 40.2 per 100,000 live births compared to 13.1 for White women. This pattern is persistent even after controlling for socioeconomic status, prenatal care, and other protective factors. Research shows that institutional and interpersonal racism when receiving obstetric care contributes to poor childbirth and postpartum outcomes for Black women. Additionally, geography and rural status may compound …

Implementation Of A Postpartum Depression Program In A Rural Kentucky County, Abby Cecil

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

This paper aims to describe the process of implementing a Postpartum Depression (PPD) prevention program in low-income women residing in rural communities. The paper describes the process of recruiting women in this population, where and how the program will be integrated into an existing clinic, and how the program will be sustained. PPD is a significant global public health problem that can be prevented and treated. The ROSE program (Reach Out, Stay Strong, Essentials for new mothers) is a series of classes that provide informational and social support to prevent PPD. This evidence-based program has been previously successful in reducing …

Increasing Hpv Vaccination In Two Appalachian Counties, Autumn Rice

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

In response to the Funding Opportunity Announcement (FOA), the evidence-based Making Effective HPV Vaccine Recommendations training program will be implemented in the Southeast Kentucky AHEC region over the course of three years. The implementation of the Making Effective HPV Vaccine Recommendations program has three specific aims:

Aim 1: Effectively implement and deliver the Making Effective HPV Vaccine Recommendations program to immunization providers in the Southeast Kentucky AHEC region

Aim 2: Increase provider self-efficacy for making strong recommendations for HPV routinely

Aim 3: Increase the number of recommendations for the HPV vaccine among adolescents of Bell and Harlan Counties in Kentucky …

Patient Access To Glp-1 Ra’S: A Medicare Part D Policy Analysis, Celine Hummer

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

This policy analysis examines the evolving landscape of GLP-1 receptor agonists (GLP-1 RAs) and their implications for Medicare Part D coverage. Initially developed for managing type 2 diabetes, GLP-1 RAs have rapidly gained popularity due to their efficacy in treating obesity and reducing cardiovascular events, leading to broader therapeutic applications. However, access to these medications under Medicare Part D is limited by high costs and coverage restrictions, particularly when used for obesity without diabetes. This analysis evaluates current Medicare Part D policies, including specialty drug tier placement, formulary restrictions, and the potential impact of recent legislative initiatives such as the …

Breastfeeding Perceptions And Decisions Among Hispanic Participants In The Special Supplemental Nutrition Program For Women, Infants, And Children: A Qualitative Study, Emily Fisher, Priyanka Patel, Kathryn G. Wouk, Bidusha Neupane, Futun Alkhalifah, Marilyn M. Bartholmae, Chuanyi Tang, Qi Zhang

Community & Environmental Health Faculty Publications

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a nutrition assistance program in the U.S. WIC served 2.5 million eligible Hispanic women, infants, and children under the age of five in 2021, which is WIC's largest racial/ethnic group. However, limited research has been conducted to understand Hispanic WIC participants' perceptions of WIC breastfeeding recommendations and their breastfeeding decisions. For this qualitative study, we interviewed 18 of these pregnant and postpartum WIC participants on their experiences and decision-making processes related to breastfeeding. Hispanic cultures and home country norms were identified as prominent influences on breastfeeding decisions, along …

Navigating New Normals: Student Perceptions, Experiences, And Mental Health Service Utilization In Post-Pandemic Academia, Hadiza Galadima, Anne Dumadag, Cara Tonn

Community & Environmental Health Faculty Publications

This study explores the profound impacts of the COVID-19 pandemic on higher education, focusing on shifts in learning experiences and students’ intentions to utilize mental health services post-pandemic. Utilizing Andersen’s Behavioral Model of Health Services Use, this study assesses perceptions from a stratified random sample of college students on post-pandemic learning experiences and mental health service utilization intentions. Findings reveal a positive reception to university initiatives and a preference for ongoing virtual classes. There is an evident increase in, and varying intentions for, using mental health services, shaped by demographics, employment, and prior service utilization. Younger and female students showed …

The Association Of Skin Cancer Prevention Knowledge, Sun-Protective Attitudes, And Sun-Protective Behaviors In A Navy Population, Rachel Newnam, Uyen Le-Jenkins, Carolyn Rutledge, Craig Cunningham

Ellmer School of Nursing Faculty Publications

Introduction: U.S. Navy service members are primarily between the ages of 18 and 30 years and often required to be outside for extended periods of time in geographical locations with increased and often unfamiliar ultraviolet indexes that collectively increase their risk for skin cancer. Skin cancer is the country's most common form of cancer, yet there is a paucity of skin cancer prevention literature, especially within the U.S. Navy. The purpose of this study was to describe skin cancer risk and skin cancer prevention "cues-to-action" and to determine if skin cancer prevention knowledge was associated with sun-protective attitudes (e.g., prevention …

Unraveling The Complex Interactions Among Lung Cancer, Copd, Cardiovascular Disease, And Pulmonary Fibrosis: Overlapping Risks, Converging Pathways, And Integrated Care Approaches, Daisy Umutoni, Mayowa Soloman Owolabi, Sakariyau Adio Waheed

Chemistry & Biochemistry Faculty Publications

Background: The coexistence of lung cancer, chronic obstructive pulmonary disease (COPD), cardiovascular disease (CVD), and pulmonary fibrosis poses significant challenges in clinical management due to shared risk factors, overlapping pathogenic mechanisms, and the complexity of co-managing multimorbid conditions. Smoking, environmental exposures, and genetic predispositions are critical shared risk factors, while common molecular mechanisms such as oxidative stress, chronic inflammation, and aberrant tissue remodeling contribute to the pathogenesis of these diseases. This review comprehensively examines the prevalence, shared mechanisms, and clinical implications of these comorbid conditions, emphasizing the importance of integrated management strategies to improve patient outcomes. We further highlight research …

Vegetarian Diet And Health Outcomes, Shabana Masood

CGU Theses & Dissertations

Introduction: Vegetarian diet is one of the most consistent diets which has shown long-term health benefits. According to a nationwide survey of adults 18+, 4% of Americans were vegetarians. The dissertation was divided into 3 separate studies and assessed the effect of vegetarian diet in the association between (Study1) childhood ADHD symptoms and young adult weight status; (Study 2) health behaviors and depression in young adults; (Study 3) comparison of weight perception and weight control strategies among vegetarians and non-vegetarians.

Methods: The National Longitudinal Study of Adolescent to Adult Health (Add Health) dataset is a national dataset spanning decades and …

Answering The “Now What?”: The Development Of A Transdisciplinary Breast Cancer Survivorship Nonprofit Organization, Vir-Iaesta Maniquiz Vergel De Dios

CGU Theses & Dissertations

Although patients are living longer or are surviving breast cancer, the side effects of treatment still leave patients struggling with quality-of-life issues. The lack of whole-person care leaves patients unequipped after treatment is complete, searching for answers and a way to survive on their own. The unintended consequence becomes a dramatic shift from the weekly/daily medical appointments during active treatment to a silence that can be daunting for many to navigate. Living Your Truth Empowered, shortened to LYTE Foundation, is an antiauthoritarian minded and anti-hierarchal nonprofit created to address the needs of the growing breast cancer survivor population. LYTE is …

The Impact Of Roe V. Wade Overturning On Women’S Access To Medical Abortions: Exploring Alternative Care Models, Gillie Mason

Nursing | Student Research Posters

The Impact of Roe v. Wade Overturning on Women’s Access to Medical Abortions: Exploring Alternative Care Models

Medical abortion access is heavily influenced by state laws, with restrictive policies posing significant barriers for women seeking care. These barriers include limited local resources, travel burdens, and legal restrictions, which disproportionately affect marginalized populations. The Health Belief Model (HBM) highlights how individuals' perceptions of risks, benefits, and barriers shape their health decisions, making it an ideal framework for studying this issue (Rosenstock, 1974).

This research focuses on educating California-based providers to increase access to medical abortion services for patients in restrictive states. …

Advancing School Nursing Practice: A Novel Approach To Screening For Gastrointestinal Disorders In Children, Ashley Bunting, Isabella Cavlan

Nursing | Student Research Posters

California schools currently only screen for vision and hearing, leaving many other health concerns unaddressed. Among these, gastrointestinal (GI) health is particularly significant, as digestive disorders can lead to severe consequences, like malnutrition and stunted growth. By incorporating routine GI screenings, school nurses can promote the early detection of disease, allowing for timely intervention and improved health outcomes in children.

Based on existing literature, we have developed a novel pediatric GI screening tool for school nurses to use in routine screenings, presented below.

How To Save A Life: The Impact Of Cpr And Bleeding Control Education On Adolescents, Emily Charlton

Nursing | Student Research Posters

Background: Out of hospital cardiac arrest (OHCA) and uncontrolled traumatic bleeding are two of the leading causes of death globally. Death due to OHCA and bleeding is largely preventable. With appropriate bystander intervention, positive outcomes in cases of OHCA and traumatic bleeding would greatly increase. Purpose: Bystander ability and intent to provide emergency cardiopulmonary resuscitation (CPR) and bleeding control is dependent on educational programs including death prevention first aid. Upon review of research, a gap was identified in adolescent death prevention training. The purpose of this proposed prospective study is to determine the effect of a high school education curriculum …

Nurses Current State Of Knowledge On Prion Disease, Chelsy Grande

Nursing | Student Research Posters

Human prion disease is a rare and fatal neurodegenerative disorder. Creutzfeldt- Jakob prion disease rapidly progresses, and is caused by prion, an infectious protein that damages the central nervous system (Bailey et al., 2000). The infectious pathogen is different from other infectious diseases as the normal prion protein misfolds, changing the structures and results in an accumulation of cellular prion proteins (Rentz, 2003). There is no cure for Creutzfeldt- Jakob disease, only palliative care to improve their symptoms and provide support as the disease progresses. How much do nurses know and understand about prion disease, and how can this influence …

Nursing Education On Sleep Health And Its Impact On Insulin Resistance In Adolescents, Salamasina Tufa

Nursing | Student Research Posters

Sleep is essential for human physical restoration, cognitive function, and emotional well-being. Recent studies have discovered that sleep is also important for proper endocrine system health, and problems with sleep may directly put a person at risk for Type II Diabetes Mellitus (T2DM) (Tsuneki et al., 2016). A precursor to T2DM is insulin resistance (IR), which is when insulin is not effective in bringing glucose into the cells for energy. (Centers for Disease Control and Prevention [CDC], 2024). Sleep disorders, poor sleep quality, and short sleep duration contribute to IR by harming the body’s cells, making them less responsive to …

Effect Of Perturbation-Based Balance Training On Fall Risk And Fear Of Falls In Community-Dwelling Older Adults – A Pilot Study, Lindsey Kelly, Casey Kostecki, Garrett Markham, Conner Morris, Trevor Strem, Lyndsay Stutzenberger, Gabe Haberly

Student-Faculty Research - College of Physical Therapy

Falls are a major health concern among adults ≥65 years as it is the leading cause of injury and injury related death in the United States. Perturbation-based training (PBT) has been shown to reduce rate of falls by 50% and 24 slips has been shown to be optimal. It is unknown whether falls reduction would be greater with one session or spread out over multiple sessions. The purpose of this study was to determine the effects of PBT dosage (12 slips over 2 sessions vs. 24 slips in one session) on falls incidence, fear of falling, and reactive stepping in …

Childhood Dairy Consumption Is Associated With Lower Age Of Menarche In A National Representative Sample Of Us Women, Jacqueline Vernarelli, Sara Szollosy

Public Health Faculty Publications

Background and aims: Breast cancer is the most prevalent cancer and leader in cancer-related deaths among women with a variety of established risk factors.

Methods Data from a nationally representative sample of 5,574 women who participated in the 2015–2018 NHANES was used to evaluate the correlation of childhood and adolescent dairy milk consumption and age of menarche. Reproductive history was asked of women > 12y. Data regarding dairy consumption between the ages of 5–12 was available for women > 20y. Survey regression models were used to calculate adjusted age of menarche for categories of dairy consumption after adjusting for relevant confounders.

Results …

Evidence Synthesis Methodology: Promoting Reproducible Methodology Through Modified Assignments, Laura Lipke, Neyda Gilman

Library Created Resources

Initially, systematic reviews in healthcare served to synthesize findings from clinical studies, aiding comprehensive access to the most effective treatments within evidence-based practice. Over time, their scope has broadened beyond treatment effectiveness, leading to a surge in publication. Consequently, many health science faculty now assign systematic reviews in classrooms without a full grasp of the standardized process, leaving students ill-equipped due to insufficient guidance and resources.

While mastering systematic review techniques is crucial for evidence-based practice, faculty can opt for modified assignments to foster a deeper understanding of the review process. These modified tasks, can be completed within a semester, …

Association Of Immune Checkpoint Inhibitor Approval On Suicide Rates Among Patients With Cancer: A Pre-Post Analysis With Seer, Rachel Wang

Public Health Theses

Objective: Patients with cancer are at elevated suicide risks compared to the general population, and patients diagnosed with advanced cancers have higher suicide risks compared to those diagnosed with early-staged cancers. Immune Checkpoint Inhibitors (ICIs) were initially approved to treat metastatic melanoma, non-small cell lung cancer (NSCLC), and renal cell carcinoma (RCC), and an unpublished study observed a decreased suicide risk in patients with these cancers at all stages. This study evaluates suicide risks in patients with breast, colorectal, liver, pancreatic, and prostate cancer, of which ICIs have limited effects on, to assess if the lower suicide rates observed previously …

Health Consequences Of Racial Disparity In Access To Abortion: A Systematic Review, Lacy M. Frye, Calvin Odhiambo

University of South Carolina Upstate Student Research Journal

Prior to the 2022 Dobbs decision, Black women already experienced negative maternal health outcomes at an alarmingly disparate rate in comparison to White women. Given that the Dobbs decision emboldens state power to enforce abortion restrictions or protections, there has been significant strides made in both directions. Nonetheless, within states where reproductive rights have been significantly eroded, the heightened abortion restrictions may compound the limited access that Black women previously had before Dobbs. This, in turn will exacerbate the already disparate negative maternal outcomes that Black women experience. However, research on the relationship between the lack of access to abortion …

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 …

Recent Trends In Stimulant Prescribing In Kentucky, 2021-2023, Jordan Shannon

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

Abstract

Introduction

Prescription stimulants have a long history of clinical use dating as far back as the 1930s. In the United States stimulant prescribing rates have steadily climbed over the last 3 decades. The primary objective is to describe recent (2021-2023) prescribing trends of stimulant medications in the Commonwealth of Kentucky

Methods

Prescription data collected from Kentucky’s prescription drug monitoring (PDMP) database known as the Kentucky All Schedule Prescription Electronic Reporting System (KASPER). Annual and quarterly trends in stimulant prescribing between 2021-2023 were calculated, examined by age, sex, and geographic location.

Results

Stimulant prescribing increased by ~15% where the majority …

Evaluating Healthcare Workers’ Knowledge, Attitudes, And Practices Regarding Language Access Services In The Clinical Setting, Rachel Archibald

DNP Projects

Background: Barriers to accessing and understanding healthcare can place patients with low English proficiency at an increased risk of poor health outcomes. Language-based inequities in healthcare exist due to lack of interpretation and translation services available, lack of healthcare workers’ knowledge of resources, and/or perceptions that these services require too much time or effort. Failing to address barriers affecting this population leaves them vulnerable in the healthcare setting.

Purpose: The purpose of this DNP project was to educate nurses, providers, and staff on an inpatient unit at a rural hospital of the language interpretation resources available, best practices for implementation, …

Rural And Urban Clinician Views On Covid- 19’S Impact On Substance Use Treatment For Individuals On Community Supervision In Kentucky, Carrie B. Oser, Maria Rockett, Sebastian Otero, Evan Batty, Marisa Booty, Rachel Gressick, Michele Staton, Hannah K. Knudsen

Center on Drug and Alcohol Research Faculty Publications

Background The COVID-19 pandemic produced system-level changes within the criminal legal system and community-based substance use disorder (SUD) treatment system with impacts on recovery efforts. This study examines rural and urban clinicians’ perspectives of COVID-19 on SUD treatment delivery for people on community supervision.

Methods Virtual qualitative interviews were conducted between April and October 2020 with 25 community supervision clinicians employed by Kentucky’s Department of Corrections (DOC), who conduct assessments and facilitate community-based treatment linkages for individuals on probation or parole. Transcripts were analyzed in NVivo using directed content analysis methods.

Results Clinicians were predominantly white (92%) and female (88%) …

Home Blood Pressure Monitoring Bundle For Hypertension Outcomes In Adult Patients Receiving Care In Public Health Clinics, Christine Jennifer Victorian

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: Hypertension (HTN) that is not adequately controlled leads to cardiovascular disease, stroke, and heart disease. It affects 116 million adults (47%) in the United States (U.S.). The HTN compliance rate in a South Texas public health clinic was 64%, below the national benchmark of 76%. Home blood pressure monitoring (HBPM) was recommended in a joint statement by the American Heart Association (AHA) and the American Medical Association (AMA). Literature evidence revealed that the HBPM bundle increased BP control (< 140/90 mmHg) compliance.

Methods: A quality improvement (QI) bundle was initiated to address the low HTN compliance rate from a quality management perspective. …

Clinical Practice Guideline For The Management Of Depression In Primary Care, Estrella Catherine Villarreal

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Background: The prevalence of depression poses a significant challenge in primary care, emphasizing the urgent need to address this issue during patient visits. Primary care providers are at the forefront of managing depression, yet they encounter difficulties in screening, diagnosing, assessing, and treating this complex condition. Clinical guidelines serve as valuable tools for primary care providers and practices, offering support in identifying and addressing depression effectively. An evidence-based approach to treating depression in primary care, with a focus on collaborative interventions with behavioral health to enhance depression management for American Indian/Alaskan Native (AI/AN) communities.

Methods: The descriptive analysis was conducted …

Implementation Of Prognosticator Algorithm For Initiation Of Serious Illness Discussions And Improving The Rate Of Palliative And Hospice Referrals, Joy Isebor

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Context: Early serious illness conversations related to end-of-life and goals of care with seriously ill patients have been associated with improving patients' outcomes and quality of care (Bernacki et al., 2015). However, initiating these serious illness discussions has been challenging in the home-based primary care setting.

Objectives: To train and support home-based primary care clinicians in integrating best practices in serious illness discussions and decision-making engagement among patients sixty-five and older with serious illnesses, optimize the alignment between patient goals and the medical care they receive, improving their quality of life and the rate of palliative care and hospice referrals. …

Obesity Management Guideline For The Correctional Setting, Rumi Y. Sato

Doctor of Nursing Practice (DNP) Scholarly Projects - Archive

Obesity can cause multiple chronic conditions, including cancer and death. Los Angeles jail primary care clinics do not address obesity management despite health hazards, rising costs, and high obesity rates in correctional facilities. The Centers for Medicare and Medical Services (CMS) obesity-management guidelines are over ten years old and outdated. The aim of this Doctor of Nursing Practice (DNP) project was to update the CMS obesity-management guideline with the newest intense behavioral therapy (IBT) evidence to assist the correctional multidisciplinary healthcare team. This project took place in a Los Angeles correctional facility's primary care clinic. A detailed literature review gathered …

What’S Harm Reduction Got To Do With It? A Study Of The Implementation Of Substance Use Management Practices Among A Sample Of U.S. Domestic Violence Programs, Stephanie H. Ratliff

Theses and Dissertations--Social Work

Domestic violence programs are essential resources for survivors of intimate partner violence (IPV). Programs offer services that go beyond providing safety and shelter. To improve outcomes, program staff have expanded services to meet the needs of survivors. One population of survivors that has gained attention in the peer-reviewed literature is survivors who use substances (SWUS). These survivors have unique needs and are at increased risk of IPV due to substance misuse. Research about the support available to SWUS after they access shelter is scarce. Using cross-sectional data from a national sample of 97 U.S. domestic violence programs, this study describes …

The Performance Of Marginal Modeling Methods For Rare Events With Application To Opioid Overdose Mortality And Morbidity, Shawn Nigam

Theses and Dissertations--Epidemiology and Biostatistics

Opioid misuse is a nationwide epidemic, with Kentucky having one of the highest opioid overdose-related fatality rates across all US states. These rates have increased significantly over the past decade, with particularly large increases during the COVID-19 pandemic. This dissertation aims to study the behavior of these increases and the methods for the marginal modeling of count outcomes related to opioid overdose.

Opioid overdose-related fatality rates in Kentucky increased significantly during the COVID-19 pandemic. In this chapter, we characterize the changes in opioid overdose fatality rates in Kentucky and identify associations between potential factors and fatality rates. County-level opioid overdose …