Digital Commons Network^™

Contractual Democracy From Statehouse To School Board: Shifts In Legislation And School Board Authority In Kentucky, Hannah M. Edelen

University of Kentucky Doctoral Dissertations

School boards have long been regarded as a cornerstone of American democracy, providing local governance over public education. While considerable scholarship highlights the increasing involvement of state and federal governments in education, relatively few studies examine with specificity how legislatures shape the local authority of these governance structures. This study investigates how the Kentucky State Legislature has influenced the authority of local school boards over three legislative sessions (2020–2022) and how board members perceive their evolving role. Using a multi-method approach and conceptualized in principal-agent theory, this research contributes to understanding how legislatures shape the governing responsibilities of school boards …

Bringing Pandemic Science To The Classroom: Building Public Health Capacity At A Rural Kentucky High School, Sahar Alameh, Anna G. Hoover, James W. Keck, Scott M. Berry, Sagan Goodpaster, Savannah Tucker, Ashley Goodin

Science, Technology, Engineering, and Mathematics (STEM) Education Faculty Publications

In response to the COVID-19 pandemic, a multidisciplinary team at the University of Kentucky developed an interdisciplinary science, technology, engineering, and mathematics and environmental health unit—the Wastewater Assessment for Coronavirus in Kentucky: Implementing Enhanced Surveillance Technology (WACKIEST) Unit—for high school students in summer 2022. This case study outlines the WACKIEST Unit, which focused on wastewater surveillance and COVID-19, the obstacles faced during development and recruitment, and implementation of the WACKIEST Unit in conjunction with a rural wastewater surveillance initiative. The unit was implemented in spring 2023 at a rural high school in Kentucky, spanning 12 days and engaging 190 students. …

Chinese Athletes’ And Parents’ Motivations For U.S. Collegiate Sports Participation, Wenting Sun, Russell D. Ravert, Simran Kaur Sethi

Kinesiology and Health Promotion Faculty Publications

To gain an understanding of international student recruitment and retention in collegiate athletics, this study examines the motivations and decision-making processes of Chinese high school athletes and their parents in pursuing U.S. collegiate sport opportunities. Using the push–pull framework and an ecological perspective, it explores how individual aspirations, family priorities, institutional resources, and national policies shape transnational mobility. Semistructured focus group discussions with 10 athletes and eight parents revealed six key motivational themes and highlighted the influence of recent collegiate sport-related policy changes in China. The findings suggest that while both groups value U.S. sport pathways, athletes and parents may …

Comparing Strength Testing Measures And The Association Of Strength And Body Composition In Young Children, Abigayle R. Spong

Theses and Dissertations--Kinesiology and Health Promotion

Muscle strength is an important component of physical fitness; however, measuring it with isokinetic dynamometry (IKD) is expensive and requires dedicated space. Handheld dynamometry (HHD) provides a practical alternative for field and clinical settings. Thus, the purpose of this study was to compare peak knee flexion and extension torque measured by IKD and HHD in 37 children (ages 5-11 years) and examine relationships with body composition. Participants completed a RAMPing protocol at 90^o knee flexion consisting of two warm-up contractions at 50% and 75% effort followed by three maximal voluntary isometric contractions. Body composition was assessed via DXA scans. …

Hurricane Helene, One Year Later: Lived Experience, Geraldine A. Miller

Journal of Appalachian Health

Ashe County is located in the northwestern corner of North Carolina (NC), bordered by Virginia and Tennessee. The county is isolated, mountainous, and historically has lacked good highway access. Hurricane Helene, a category 4 hurricane at landfall, struck Western NC on September 27, 2024, resulting in flooding and wind damage that destroyed local communities in terms of land, homes, bridges, water, electricity, etc. with a damage of $59.6 billion.⁶ One year later, the recovery from the hurricane continues draining individuals and communities of their time, energy, and money. Geri Miller reflects on her hurricane impact experiences a year later. …

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 …

Impact Of A Workshop On Rural Healthcare Delivery On Medical Student Attitudes, Robert L. Snedegar, Ryan Hayes, Jun Xiang, Treah Haggerty, Kendra Unger, Jason Oreskovich, Amie M. Ashcraft

Journal of Appalachian Health

Introduction: Rural residents in the United States (U.S.) experience significant health disparities due to social determinants such as poverty, geographic isolation, and limited healthcare access. Physician shortages in rural areas further exacerbate these challenges.

Purpose: This study evaluates the impact of an educational workshop on medical students’ attitudes toward rural healthcare barriers, aiming to determine whether targeted education can enhance their understanding and interest in rural practice.

Methods: Third-year medical students at the West Virginia University School of Medicine participated in a workshop that included a 20-minute pre-recorded lecture and a 90-minute interactive virtual session. Pre- and post-surveys assessed students’ …

Leveraging Community Health Worker’S Deep Community Knowledge To Address Food And Nutrition Security In Appalachia, Alexis Kimbro Scott, Melissa D. Olfert, Dawn Brewer, Makenzie Barr, Julie Plasencia

Journal of Appalachian Health

Introduction: Community health workers (CHWs) are trusted professionals in communities because of the deep understanding and cultural insights learned from their lived experiences. In Appalachia, CHWs are embedded in the community, giving them a unique understanding of how social determinants, like food and nutrition security, impact health outcomes.

Purpose: This study aimed to examine the professional characteristics and knowledge of CHWs while identifying culturally sensitive practices around food insecurity.

Methods: This cross-sectional, mixed-methods study used an online survey and in-depth phone interviews with CHWs in the Appalachian Region to examine their professional characteristics and knowledge on food security in their …

Stigmatization And Healthcare Inequity Perceived By Individuals Served By Homeless Shelters In An Appalachian City, Molly Powney, James M. Mears, Reagan Sharp, Lisa Calderwood

Journal of Appalachian Health

Introduction: People experiencing homelessness are medically vulnerable and suffer disproportionately from chronic physical and mental health conditions. Evidence-based standards to inform decisions surrounding care would be valuable for this population. Studies exploring how homeless individuals in Appalachia perceive their interactions with the healthcare system remain limited, however.

Purpose: The purpose of this study is to assess perceptions of the healthcare system among homeless individuals served by temporary housing shelters in an Appalachian city.

Methods: A voluntary anonymous survey was administered to residents at three shelters in Charleston, West Virginia (WV) from September 2023 – March 2024. Responses were collected utilizing …

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 …

Influence Of Family Health History And Parental Education On Body Mass Index, Blood Pressure, And Lipid Levels In 5th Grade Children: A Secondary Data Analysis Of The Cardiac Project, Madha Rani Das, Lee A. Plyes, Eloise Elliott, Christa L. Lilly

Journal of Appalachian Health

Introduction: Childhood obesity and related cardiovascular risks reflect the interplay of genetic predispositions and socioeconomic adversity. Appalachia’s poverty, limited health care, and educational gaps worsen family health risks, driving early cardio-metabolic problems in children, highlighting the need for effective interventions.

Purpose: The purpose of this study is to examine the association of family health history and parental education with BMI, BP, and lipid profiles among 5^th grade children in West Virginia (WV).

Methods: The study used WV CARDIAC data from 2006–2009. Outcomes were BMI, SBP/DBP, and fasting lipids (HDL, LDL, TG). Predictors were parental education and family health history …

Understanding Breastfeeding Practices In Tennessee: Goals, Duration, And Reasons For Discontinuation, Amir Alakaam, Chia-Lin Chang, Hannah Jeffery

Journal of Appalachian Health

Introduction: Breastfeeding is widely recognized as the optimal source of infant nutrition, offering many health benefits.

Purpose: The purpose of this study was to examine goals, exclusivity, and duration of breastfeeding and explore factors that influence breastfeeding practices among individuals in Tennessee (TN).

Methods: A cross-sectional study was conducted among individuals (N = 1,249). Participants were recruited and data were collected from June – September 2021. The data were entered and analyzed from September 2022 – March 2023. Descriptive statistics, chi-square test, and ANOVA were used to analyze the data and identify associations between variables.

Results: About 32% of the …

Pathways To Better Sleep, Mairead E. Moloney, Emily Slade, Joon Chung, Kory Heier, Daniela C. Moga

Sociology Faculty Publications

Background: Rural Appalachia has some the highest rates of sleep and health disparities in the United States. This study investigates the relationship between social support and insomnia severity in rural Appalachian adults, with specific attention to the potential mediating roles of depression, anxiety, and stress. Methods: Participants from 12 rural Eastern Kentucky counties completed validated measures of insomnia severity, social support, depression, anxiety, and perceived stress. Using R, we calculated descriptive statistics and fit mediation models for depressive symptoms, anxiety symptoms, and stress, with social support as the exposure and insomnia severity as the outcome. Results: Aligning with regional demographics, …

Becoming Steve Bright, Robert L. Tsai

Kentucky Law Journal

No abstract provided.

¿Cómo Se Dice, "Liberty And Justice For All Cannot Exist Without Equal Access For All" En Español?, Turner Denise Reynolds

Kentucky Law Journal

No abstract provided.

Like Balance On Ice: Towards A New Approach To The Open And Obvious Doctrine Under Kentucky Law, Hayden T. Crosby

Kentucky Law Journal

No abstract provided.

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.

Prosecutorial Discretion And Digital Democracy, Erin Sheley

Kentucky Law Journal

No abstract provided.

Founder Worship, Effective Altruism, And Corporate Governance, Jennifer S. Fan, Xuan-Thao Nguyen

Kentucky Law Journal

No abstract provided.

Gene Expression Profile–Based Test To Predict Melanoma Sentinel Node Status, Tina J. Hieken, Michael E. Egger, Christina V. Angeles, John R. Hyngstrom, Erin E. Burke, Michael C. Lowe, Georgia M. Beasley, Edmund K. Bartlett, Scott C. Bresler, Kelly L. Harms, Jonathan S. Zager, Julia S. Lehman, Nabil Wasif, Sanjay P. Bagaria, Kelly M. Mcmasters, David A. Wada, Prakash Pandalai, Keith A. Delman, Jay Lee, Klaus J. Busam, Jane L. Messina, Vernon K. Sondak

Surgery Faculty Publications

Importance Contemporary guidelines recommend sentinel lymph node biopsy (SLNB) for patients with melanoma with predicted risk of SLN metastasis greater than 10% and consideration of SLNB when the risk is 5% to 10%. A gene expression profile (GEP)–based test that can accurately identify patients with a low risk of SLN metastasis would refine selection for SLNB. Objective To establish the predictive capability of the combined clinicopathological factors and GEP (CP-GEP) test to identify patients with primary cutaneous melanoma who can safely forgo SLNB and to investigate the prognostic value of CP-GEP regarding the outcome in patients with cutaneous melanoma after …

Trends In Cardiovascular Disease Prevalence Among Adults With Type 1 Diabetes In The Usa, Orighomisan Freda Agboghoroma, Kory R. Heier, Omer Atac, Meredith S. Duncan, Anna Kucharska-Newton, Mary E. Lacy

Epidemiology and Environmental Health Faculty Publications

Introduction Cardiovascular disease (CVD) is a common complication and major cause of mortality in people with type 1 diabetes (T1D). This study quantifies the prevalence of CVD among commercially insured adults with T1D in the USA from 2017 to 2021, overall and among age-defined and sex-defined subgroups. Research design and methods We used Merative MarketScan nationwide commercial insurance claims database (2017–2021) to identify adults ≥20 years with T1D (International Classification of Diseases, 10th Revision (ICD-10) codes). CVD ascertainment was based on ICD-10 codes for myocardial infarction, atrial fibrillation, ischemic heart disease, heart failure, peripheral artery disease, and stroke. Comorbidities included …

Genomic Surveillance Uncovers Regional Variation In Hcv Transmission Networks In Rural United States, Damien C. Tully, David J. Bean, Jacklyn Sarette, Thang Long Ngo, Karen A. Power, Daniel Brook, Hannah Cooper, Judith Feinberg, Peter D. Friedmann, Karli R. Hochstatter, Jennifer R. Havens, Shanna Babalonis, Christopher Hurt, Wiley Jenkins, P. Todd Korthuis, William Miller, Mai T. Pho, Gordon Smith, Thomas J. Stopka, Judith I. Tsui, L. Sarah Mixson, Ryan P. Westergaard, April M. Young, Todd M. Allen

Epidemiology and Environmental Health Faculty Publications

Hepatitis C virus (HCV) remains a public health concern in the United States, particularly in rural communities where the opioid epidemic accelerates transmission among people who use drugs (PWUD). Despite this growing burden, the genetic features and transmission dynamics of HCV in these settings are poorly understood. We analyze 692 HCV antibody-positive specimens collected from rural communities in ten U.S. states using amplicon-based deep sequencing and the Global Hepatitis Outbreak and Surveillance Technology (GHOST) platform to reconstruct transmission networks. Among sequenced individuals, 29.5% are linked within clusters. Cluster structure varies by region from sparse networks in Ohio to dense clusters …

Storage-Dependent Variability In Alzheimer Disease-Related Plasma Biomarker Results Using The Fujirebio Lumipulse G1200 Platform, Ibrahim Choucair, Tiffany L. Lee, Linda J. Van Eldik, Jeffrey L. Dage, Brian T. Gold, Erin L. Abner, Gregory A. Jicha, Peter T. Nelson

Epidemiology and Environmental Health Faculty Publications

Alzheimer disease plasma biomarkers have emerged as minimally invasive, cost-effective tools for early diagnosis and disease monitoring yet their stability under common “real world” pre-analytical conditions remains incompletely characterized. We evaluated the stability of six plasma biomarkers, Aβ40, Aβ42, pTau181, pTau217, NfL, and glial fibrillary acidic protein (GFAP) using the Fujirebio Lumipulse G1200 platform. Plasma samples were initially collected from four healthy and cognitively unimpaired volunteers. Samples were stored under four conditions: room temperature (0-4h), +4°C (1-10days), −20°C (1-3weeks), and −80°C (4-8weeks). In this pilot study, Aβ40 and Aβ42 remained generally stable. In contrast, pTau181 readings exhibited marked elevations in …

Using Low-Cost Sensors And Gps To Assess Spatiotemporal Variations In Personal Exposure To Pm2.5 In The Washington State Twin Registry, Ningrui Liu, Ally Avery, Elena Austin, John S. Meschke, Nicola K. Beck, Graeme Carvlin, Yisi Liu, Anne V. Moudon, Igor Novosselov, Jeffry H. Shirai, Glen E. Duncan, Edmund Seto

Epidemiology and Environmental Health Faculty Publications

Epidemiological studies typically rely on exposure assessments based on ambient PM_2.5 concentrations at participants' home addresses. However, these approaches neglect personal exposures indoors and across different non-residential microenvironments. To address this problem, our study combined low-cost sensors and GPS to conduct two-week personal PM_2.5 monitoring in 168 adults recruited from the Washington State Twin Registry between 2018 and 2021. PM_2.5 mass concentration, size-resolved particle number concentration, temperature, humidity, and GPS coordinates were recorded at 1-min intervals, providing 5,161,737 data points. We used GPS coordinates and a processing algorithm for automatic classification of microenvironments, including seven land use …

Knowledge-Informed Deep Learning To Mitigate Bias In Joint Air Pollutant Prediction, Lianfa Li, Roxana Khalili, Frederick Lurmann, Nathan Pavlovic, Jun Wu, Yan Xu, Yisi Liu, Karl O’Sharkey, Beate Ritz, Luke Oman, Meredith Franklin, Theresa Bastain, Shohreh F. Farzan, Carrie Breton, Rima Habre

Epidemiology and Environmental Health Faculty Publications

Accurate prediction of atmospheric air pollutants is critical for public health protection and environmental management. Traditional machine learning (ML) methods achieve high spatial resolution but lack physicochemical constraints, leading to systematic biases that compromise exposure estimates for epidemiological studies. Chemical transport models incorporate atmospheric physics but require expensive parameterization and often fail to capture local-scale variability crucial for health impact assessment. This gap between data-driven accuracy and physical realism presents a major obstacle to advancing air quality science. We address this challenge through a novel physics-informed deep learning framework that integrates advection–diffusion equations and fluid dynamics constraints directly into neural …

Multi-Ancestry Genome-Wide Meta-Analysis Of 56,241 Individuals Identifies Known And Novel Cross-Population And Ancestry-Specific Associations As Novel Risk Loci For Alzheimer’S Disease, Farid Rajabli, Penelope Benchek, Giuseppe Tosto, Nicholas Kushch, Jin Sha, Katrina Bazemore, Congcong Zhu, Wan Ping Lee, Jacob Haut, Kara L. Hamilton-Nelson, Nicholas R. Wheeler, Yi Zhao, John J. Farrell, Michelle A. Grunin, Yuk Yee Leung, Pavel P. Kuksa, Donghe Li, Eder Lucio Da Fonseca, Jesse B. Mez, Ellen L. Palmer, Jagan Pillai, Richard M. Sherva, Yeunjoo E. Song, Xiaoling Zhang, Takeshi Ikeuchi, Taha Iqbal, Omkar Pathak

Epidemiology and Environmental Health Faculty Publications

Background : Limited ancestral diversity has impaired our ability to detect risk variants more prevalent in ancestry groups of predominantly non-European ancestral background in genome-wide association studies (GWAS). We construct and analyze a multi-ancestry GWAS dataset in the Alzheimer’s Disease Genetics Consortium (ADGC) to test for novel shared and population-specific late-onset Alzheimer’s disease (LOAD) susceptibility loci and evaluate underlying genetic architecture in 37,382 non-Hispanic White (NHW), 6728 African American, 8899 Hispanic (HIS), and 3232 East Asian individuals, performing within ancestry fixed-effects meta-analysis followed by a cross-ancestry random-effects meta-analysis. Results: We identify 13 loci with cross-population associations including known loci at/near …

Nonfatal Injury Emergency Department Visits And Inpatient Hospitalizations Among Persons Under Age 65 With An Intellectual And Developmental Disability Or Deaf Or Hard Of Hearing Disability, Terry L. Bunn, Jacqueline Seals, Dana Quesinberry, Alaina Murphy, Julia F. Costich

Epidemiology and Environmental Health Faculty Publications

Background: Vulnerable populations at risk of injury include persons with intellectual and developmental disabilities (IDD), and persons who are deaf or hard of hearing (DHH). The purpose of this study was to describe and compare emergency department and inpatient hospitalization (ED + IP) injury rates and rate ratios by injury type among persons under age 65 with IDD or with DHH to those without IDD or DHH. Methods: This is a descriptive population-based retrospective cross-sectional study of injuries among patients under the age of 65 with an IDD disability or a DHH disability using Kentucky ED + IP discharge datasets …

Preferences For Harm Reduction Vending Machine Design Among Rural People Who Use Drugs, April M. Young, Tasfia Jahangir, Susan Westneat, Chelsi Cheatom, Amanda Fallin-Bennett, Laura C. Fanucchi, Patricia R. Freeman, Jennifer R. Havens, Hannah K. Knudsen, Kathryn E. Mccollister, Susannah Stitzer, Jack Stone, Peter Vickerman, Melvin D. Livingston

Epidemiology and Environmental Health Faculty Publications

Globally, harm reduction vending machines (HRVMs) have been used for decades to dispense safe injection equipment and other supplies to people who use drugs (PWUD). However, HRVMs have only recently scaled up in the U.S. and few operate in rural settings. This study describes preferences for HRVM design among rural PWUD in two Appalachian Kentucky communities. Peer-referral and outreach were used to recruit participants (n = 731). Eligibility criteria were ≥ 18 years, residing in the target counties, and having used any drug (excluding alcohol, cannabis, and tobacco) to get high within 6 months. Interviewer-administered questionnaires elicited data on behavioral/demographic …

Prospective Cohort Study Of Fentanyl Test Strip Use And Distribution In Three States, Janet E. Childerhose, Kitty Gelberg, Rachel Vickers-Smith, Megan E. Dzurec, Emmanuel Oga, Mallory Harris, Rachel Caspar, Denise C. Babineau, Megan E. Hall, Beth S. Linas, Katherine E. Marks, Amanda Fallin-Bennett, Laura C. Fanucchi, Louisa Gilbert, James L. David, Mary Russo, Kathryn E. Lancaster, Soledad Fernandez, Michael Konstan, Redonna K. Chandler, Carter Roeber, Jennifer Villani, Rebecca D. Jackson, Bridget Freisthler, Sharon L. Walsh, Nabila El-Bassel

Epidemiology and Environmental Health Faculty Publications

Background: The Stay Safe Study is the first observational prospective cohort study investigating fentanyl test strip (FTS) use by people who use drugs (PWUD) and distribution by community organizations that provide harm reduction services (e.g., naloxone distribution) in three states (Kentucky, New York, and Ohio). The purpose of this paper is to describe the study design, along with implementation successes and challenges. A related goal is to provide recommendations and encourage researchers to undertake multi-state and multilevel studies of FTS use and distribution. Methods: The Stay Safe Study has one primary, five secondary, and three exploratory objectives. From May-December 2023, …