Digital Commons Network^™

Formative Research To Identify Contributors To Risky Drinking And Adapt An Alcohol Reduction Intervention Among Young Adults Vulnerable To Hiv: Qualitative Focus Group Study, Fidelis Y. Sesenu, Sally Kirklewski, Bryce Takenaka, Jaime Brown, Erin Nicholson, Kimberly Haney, Kaylia Carroll, Arjee Restar, Donte Travon Boyd, Keisa Fallin-Bennett, Trace Kershaw, Carolyn Lauckner

Communication Faculty Publications

Background: Across populations, risky drinking has been demonstrated to increase HIV risk behaviors. This is of special concern for sexually minoritized cisgender men and gender-diverse young adults (aged 18‐34 years), who report greater incidence of hazardous drinking (as defined by the Alcohol Use Disorders Identification Test - Consumption criteria) and HIV compared to their heterosexual and/or cisgender peers.

Objective: This study aimed to examine alcohol perceptions, patterns of use, and the role that anti-LGBTQ+ (lesbian, gay, bisexual, transgender, queer) policies and discrimination played in alcohol risk behaviors for sexually minoritized cisgender men and gender-diverse individuals. Results were used to inform …

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 …

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 …

The Impact Of Food Insecurity And Associated Variables On Colon Cancer In Kentucky: An Ecologic Study, Claire E. Lynch

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

Objective: Given colorectal cancer incidence rates are increasing, especially in socioeconomic disadvantaged areas, this study aims to determine if there is an association between specific socioeconomic variables, such as food insecurity, and colon cancer at the county-level in Kentucky.

Methods: Colorectal cancer age-adjusted incidence rates at the county-level were collected from the Kentucky Cancer Registry. Conty-level data was collected from County Health Ranking, The U.S Census Bureau, National Institute on Minority Health and Health Disparities and the Behavioral Risk Factor Surveillance System from 2019 to 2023. R was used to run statical analyses such as a linear regression and a …

We Need To Care About Care: (Un)Caring Relations In Victorian Fiction, Roslyn Fleming

Theses and Dissertations--English

The professionalization and institutionalization of care in the Victorian era ushered in a growing societal concern about the pitfalls of care being “systematized and depersonalized” and treating people as burdens, problems to be solved. Given the increasing attention paid to people’s welfare and well-being during this period, the cultural shift from intimate community care to professional and institutional care, and the growing stigmatization of disabled bodyminds, the fiction produced amidst these cultural changes makes a compelling site for a study of care. Critical scholarship attending to Victorian novels’ representations of care, however, has largely concentrated on specific categorizations of care …

Inside The Box: Containerization And The Limits Of Trade Unionism In The International Longshoremen's Association, 1945-1977, Calvin Horning

Theses and Dissertations--Geography

The International Longshoremen’s Association (ILA), the union of dock workers on the East Coast of the United States, saw a dramatic change in form and fortune in the middle of the 20^th century as the shipping industry and global labor underwent an immense reorganization. In the context of this reorganization, I argue that due to internal conservatism and racism alongside external state pressure, the ILA moved from an unruly, mafia-ruled union to a highly organized, professionalized, well-paid core of workers that served to support the United States’ capitalist-imperialist project.

Through archival material spanning over three decades, I analyze the …

(En)Counter Cartographies: Data Collection, Interpretation, And Visualization In Lexington’S Urban Forest, Claire Hilbrecht

Theses and Dissertations--Geography

This thesis examines how urban forestry data practices shape relationships between people, trees, and knowledge in Lexington, Kentucky. Drawing on political ecology, science and technology studies, and critical making, it argues that conventional methods of data collection, interpretation, and visualization privilege Western scientific and market-based frameworks that often exclude affective, embodied, and more-than-human ways of knowing. Using autoethnography and six semi-structured interviews with urban forestry professionals, the study explores how practitioners experience tensions between treating trees as measurable commodities and engaging them as relational beings. It finds that while urban foresters rely on dominant discourses such as ecosystem services to …

Spatial Marginalization Of Emotional Support: Understanding Animal-Human Dynamics Of Care On College Campuses, Aleksandra Craine

Theses and Dissertations--Geography

In 2015 Kearny-Nebraska court case determined that student campus housing is considered a dwelling and is therefore covered by housing antidiscrimination laws. Since then, increasing numbers of students across U.S. campuses applied to bring an emotional support animal to live with them. Emotional Support Animals (ESAs) are defined by the U.S. Department of Housing and Urban Development as “trained or untrained animals that do work, perform tasks, provide assistance, and/or provide therapeutic emotional support for individuals with disabilities.” Persons requesting ESA accommodations usually must provide documentation from a medical provider or therapist. ESAs remain a legally and socially contested category …

Visual Genealogies Of Disability In Mexican Visual Culture, Daniela Calvache Garcia

Theses and Dissertations--Hispanic Studies

Disability in Mexico is a visually constructed category, shaped by a long genealogy of representation in which images of bodily difference actively participate in defining power and the management of all bodies. The discursive forces that define disability as unproductivity reduce body-minds to the service of the economic system, affecting our relationship with death, illness, reproduction, size, youth, and beauty. Across the Mesoamerican visual space, such representations have long unsettled dominant systems of truth about bodies. This dissertation examines how conceptions of disability are produced, negotiated, and reimagined through three historical moments and cultural expressions: Pre-Hispanic Mayan imagery, Mexican colonial …

Understanding Knowledge And Perceptions Of The Beef Industry On A Land-Grant University Campus, Allison E. Reaves

Theses and Dissertations--Community & Leadership Development

A well-researched phenomenon in the agricultural industry is the effects of constant innovation coupled with an increasing divide between producer and consumer. This issue has been presented as especially prevalent within animal agriculture and the beef industry, a predominant concern considering Kentucky’s agricultural commodities. This study (n = 31) utilized a mixed-methods approach to understand the knowledge, perceptions, and behavior of beef consumers on a land-grant university campus. Methodologies included Python’s DeepFace emotion recognition, semi-structured interviews, and the JMALI agricultural literacy assessment. Findings revealed participants to be below expected agricultural literacy levels of high school graduates (M=11), with no …

Unseen To Unstoppable: Critically Redefining Care For Rural Women With Alcohol Use Disorders, Nicole Gerace

DSW Capstone Projects

Research reveals that rural women with alcohol use disorders (AUDs) are up to 90% less likely to seek treatment than men or urban women. This Doctor of Social Work capstone project brings together a systematic literature review (SLR), a conceptual paper, and a practice application paper to examine the clinical social work practice problem of rural women with AUDs underutilizing treatment. Collectively, these products investigate factors contributing to these disparities, identify gaps in care, and propose more equitable and responsive approaches to treatment for these women. This project began with an SLR (2020–2025) that investigated clinical treatment interventions that demonstrated …

Unexpected Longevity In Myasthenia Gravis, Bhupendra O. Khatri, Scott Schutten, Sergey Tarima

Biostatistics Faculty Publications

Background: This study compares age at death in patients with myasthenia gravis (MG) and multiple sclerosis (MS) with the general U.S. population and examines age at death patterns during a period preceding modern high-efficacy therapies. Objective: To compare age at death among individuals with MG and MS with the general population and assess differences in age at death between MG and MS. Design: Retrospective population-based study using death certificate data from four U.S. states (Florida, Wisconsin, Texas, and New York) for 2000, 2005, 2010, and 2015. Methods: Individuals with MG or MS listed on death certificates were identified. Age at …

Integration Of Community-Engaged Research Technology And Methods To Guide Tobacco Regulatory Science In Rural Communities, Melissa H. Abadi, Stephen R. Shamblen, Mary Kay Rayens, Kirsten T. Thompson, Amy Wildman, Kathy Rademacher, William Wieczorek, Raphael Nishimura, Shyanika W. Rose, Mikhail N. Koffarnus, Seth Himelhoch, Ellen J. Hahn

Biostatistics Faculty Publications

Objective – This study aims to build a rural Appalachian cohort to examine how US Food and Drug Administration (FDA) Center for Tobacco Products (CTP) regulatory policies influence tobacco and nicotine product use across levels of rurality. Methods – The AppalTRUST (Appalachian Tobacco Regulatory Science Team) Cohort integrates four inter-connected Community-engaged Research + Technology (CEnRT) elements to support recruitment and retention: (1) building trust and cultural relevance; (2) addressing barriers to participation in research; (3) focusing on ethics and confidentiality; and (4) fostering ongoing and consistent collaboration between the scientific and field teams. The study uses a dual sampling design …

Adult Tobacco Product Use Patterns Across The Urban–Rural Continuum: The Longitudinal Population Assessment Of Tobacco And Health (Path) Study, 2016–2023, Jing Zhang, Shyanika W. Rose, Ellen J. Hahn, Megan E. Roberts, Bethany Shorey Fennell, Jenny E. Ozga, Seth Himelhoch, Saber Feizy, W. Jay Christian, Amanda Thaxton Wiggins, Melissa Abadi, Delvon T. Mattingly, Mary Kay Rayens

Nursing Faculty Publications

Purpose: To determine the association between adult tobacco/nicotine product use over time and residence location (urban, suburban, town, rural), controlling for demographics.

Methods: Data from Waves 4–7 (2016–2023) of the Population Assessment of Tobacco and Health (PATH) study (N = 18,590 adults) were analyzed using survey-weighted logistic regression to evaluate location and time differences in likelihoods of current, daily, and established use of combustible tobacco, electronic nicotine delivery systems (ENDS), smokeless products, and poly use (≥2 products).

Findings: Compared to those residing in urban locations, suburban residents were less likely to report current (adjusted odds ratio (aOR) …

A Conductor's Guide To All-State Orchestra: An Overview Of Repertoire And Best Practices, Nicoletta Moss

Theses and Dissertations--Music

For over one-hundred years, all-state orchestras have served as the premier gatherings of high school musicians across the United States. These short-term events offer intensive ensemble experiences that bring together students from diverse musical and social backgrounds. While conductors play a central role in shaping these experiences, research is limited examining the areas of repertoire programming, pedagogical practices, and other logistical considerations associated with all-state orchestra leadership. In this dissertation, I address these gaps and develop a comprehensive resource for current and future all-state conductors. The present study employs a two-study design: 1) a content analysis of repertoire performed between …

Kentucky Space Futures: Defining The Driving And Limiting Factors Of Growth In The State Aerospace Industry, Ashley M. Grospitch, Isabella A. Sibold

MPA/MPP/MPFM Capstone Projects

Kentucky’s aerospace industry has quietly become one of the state’s most significant economic drivers, generating almost $19 billion in exports in 2024 and ranking third nationally in aerospace exports in 2023 (Mattingly, 2025; Babbage & Hartsough, 2024). Despite this, Kentucky remains largely invisible as an aerospace state, both to Kentuckians and national audiences. This work was conducted on behalf of our client, Kentucky Space Futures, to identify the factors shaping the growth of Kentucky’s aerospace industry, including its driving and limiting factors, and provide actionable guidance for policymakers and industry leaders.

Using a qualitative research design, this study triangulated findings …

Protecting The Vulnerable: Elderly Population Change In Kentucky & Nursing Home Floodplain Proximity, David M. Stevens, Austin Matthew Mullen, Nicklaus P. Hammond

MPA/MPP/MPFM Capstone Projects

This study explores Kentucky’s changing vulnerability to flooding. Relying on America Community Survey (ACS) survey data estimates for 2019 and 2024, we illustrate how Kentucky’s elderly population has changed over this five-year period. Using nursing home data and floodplain spatial data, provided by the Centers for Medicare & Medicaid Services and FEMA respectively, we identify all 269 facilities and their proximity to floodplains across Kentucky. To narrow the scope of our study, we highlight counties that (a) have seen the largest percentage increase in elderly residents and (b) have a large total elderly population. Using a quartile ranking system, we …

Essays In Housing And Consumer Finance, Spencer Stone

Theses and Dissertations--Finance and Quantitative Methods

In my first chapter, I show how consumer left-digit bias affects borrowing costs in the US residential mortgage market. I find that the distribution of mortgage rates bunch at .99-ending rates just below left-digit changing thresholds, and that this bunching is greater in the distribution of rates selected by borrowers than those simply offered by lenders. Comparing observably similar borrowers within the same 1-bp interest rate band, selecting similar mortgage products, in the same census tract and origination month, I show that borrowers receiving .99-ending rates pay significantly more fees than borrowers receiving the nearest whole-number rate just above them, …

Reach Of Community-Selected Strategies To Reduce Opioid-Related Overdose Deaths In The Healing Communities Study, Megan E. Hall, La Shawn Glasgow, Ja Nae Holloway, Rouba A. Chahine, Jill Davis, Miriam T.H. Harris, Hannah K. Knudsen, Jessica L. Neufeld, Emmanuel Oga, David W. Lounsbury, Nasim Sabounchi, Alissa Davis, Marissa Smith, Rachel P. Chase, Sylvia A. Ellison, Judy Harness, Hilary L. Surratt, Sharon L. Walsh, Peace Julie Nakayima, Redonna Chandler

Psychiatry Faculty Publications

Introduction: Despite recent declines, the U.S. opioid overdose crisis persists. The HEALing Communities Study (HCS) aimed to reduce opioid overdose deaths through community-level adoption of evidence-based practices (EBPs), including overdose education and naloxone distribution (OEND) and medications for opioid use disorder (MOUD). This paper describes the reach of OEND and MOUD strategies implemented by the 33 HCS wait-list control communities. Methods: We conducted descriptive statistical analysis of reach data collected from July 2022 through December 2023 to (1) summarize overall EBP implementation and reach and (2) compare the demographic representation of individuals reached to community demographic population estimates. Results: Communities …

The Association Between Naloxone Distribution, Buprenorphine Treatment And Retention And Incident High-Risk Opioid Prescribing With Opioid Overdose Death In Kentucky, Massachusetts, New York And Ohio, United States, Alexander Y. Walley, Debbie M. Cheng, Nathan Vandergrift, Marc Larochelle, Ja Nae Holloway, Jennifer L. Brown, Redonna Chandler, Laura C. Fanucchi, Daniel J. Feaster, Patricia Freeman, Timothy Hunt, Michelle R. Lofwall, Hannah K. Knudsen, Edward V. Nunes, Emmanuel Oga, Douglas R. Oyler, Jeffrey H. Samet, Jennifer Villani, Sharon Walsh, T. John Winhusen

Psychiatry Faculty Publications

Aim: We evaluated whether community-level naloxone distribution, medication for opioid use disorder treatment and retention and incident high-risk opioid prescribing rates were associated with opioid overdose death rates. Design: Observational cohort conducted using 2019 to 2023 community-level data as an exploratory analysis of the HEALing (Helping to End Addiction Long-term®) Communities Study (HCS). Exposures included: (1) community-level naloxone distribution, past 12-months, categorized as ≤1000 units per 100 000 population vs. 1001–3000 units per 100 000 population vs. >3000 units per 100 000 population; (2) individuals treated with buprenorphine per 100 000 adult population in the current quarter; (3) individuals retained …

Stacked Risks, Unequal Returns: Stratified Risk Allocation In Housing And Higher Education, Regina M. Lewis

University of Kentucky Doctoral Dissertations

In the United States, public policy does more than distribute resources. It distributes risk. The same policy can create profoundly different consequences for different people because policies operate on landscapes shaped by generations of unequal investment and opportunity.

To explore this process, I introduce the Stratified Risk Allocation (SRA) Framework to demonstrate how facially neutral policies reproduce inequality by allocating risk across populations with unequal capacity to absorb it. Drawing on risk society theory, historical institutionalism, critical race theory, intersectionality, and stratification economics, the SRA framework distinguishes between Exposure, the likelihood of encountering policy-generated risk, and Capacity, the resources available …

Associations Between Social Media Usage, Physical Activity And Flourishing In Rural University Students, Anna Dysart, Minu Sara Thomas

Journal of Appalachian Health

Introduction: Most adolescents and young adults report significant use of social media.^1-3 However, there is limited research on the effect of social media use, specifically on physical activity and flourishing.

Purpose: This pilot research study examines the correlation between social media usage and the physical activity and flourishing levels of college students at a rural university in Appalachia.

Methods: The authors conducted a survey including the validated Secure Flourishing Index and Stanford Leisure-Time Activity Categorical Item, containing questions on social media use and demographics. Spearman’s rho was used for nonparametric correlations. Pearson’s correlation was used to determine the correlation …

Impact Of West Virginia Abortion Ban On West Virginia Physician Trainee Practice Intentions, Rebecca Wald, Kristy Ward, Sarah Dotson

Journal of Appalachian Health

In June 2022, the Dobbs v Jackson Women’s Health Organization overturned the constitutional right to abortion established by Roe vs. Wade. Shortly after, West Virginia (WV) began enforcing a near total ban on abortion. Statewide restrictions on access to reproductive health care have important implications for the recruitment and retention of physicians. This project aimed to determine overall awareness of the 2022 changes in abortion laws among physician trainees, and whether the law influenced the intention of resident/fellow physicians to practice medicine in the state following completion of their medical training. A total of 178 resident and fellow physicians at …

Geospatial Analysis Of Breast Cancer Incidence, Mortality, And Access To Screening In Rural And Appalachian Virginia, Jennifer Osher, Caleb Brown, Phillip Nichols, Tariq Ayubi, Jeremy Powers

Journal of Appalachian Health

Introduction: Breast cancer is the most common malignancy among women in the United States (U.S.), despite recent survival rates improving nationally. However, rural and Appalachian regions have experienced slower mortality declines. These communities face unique health care-related challenges that may contribute to observed disparities.

Purpose: The purpose of this study is to assess differences in breast cancer incidence, mortality, and mortality-to-incidence ratio (MIR) between Appalachian and non-Appalachian counties, as well as rural and non-rural counties in Virginia (VA). Furthermore, we aim to evaluate whether availability of mammography is associated with these differences.

Methods: County-level breast cancer incidence and mortality data …

Just A Place Or A Just Place?: Domestic Violence, Urban-Rural Differences, And Access To Justice, Cassie Chambers Armstrong

Kentucky Law Journal

No abstract provided.

Redistricting, Gerrymandering, And Graham V. Adams: It's Time For An Independent Redistricting Commission In Kentucky, Kathleen Dudgeon

Kentucky Law Journal

No abstract provided.

The Next Generation, Jeremiah Chin

Kentucky Law Journal

No abstract provided.

Fighting Death: A Critique Of Kentucky's Death Penalty System, Pamela R. Goodwine

Kentucky Law Journal

No abstract provided.

Ductile Rights, W. C. Bunting

Kentucky Law Journal

No abstract provided.

Punitive Legal Immigration, Pedro Gerson

Kentucky Law Journal

No abstract provided.