Medicine and Health Sciences Commons^™

Reproducing Childbirth: Negotiated Maternal Health Practices In Rural Yucatan, Veronica Miranda

Theses and Dissertations--Anthropology

This ethnographically informed dissertation focuses on the ways rural Yucatec Maya women, midwives and state health care workers participate in the production of childbirth and maternal health care practices. It further addresses how state health programs influence the relationships and interactions between these groups. Although childbirth practices in Yucatan have always been characterized by contestation, negotiation and change, their intensity and speed have significantly increased over the last decade. Drastic changes in the maternal health of rural indigenous communities in Mexico and throughout the world are directly connected to intensified state interventions that favor biomedicine over traditional health systems. In …

The Effects Of A Worksite Wellness Program On Prescription Claims, Carrie Deann Davidson

Theses and Dissertations--Kinesiology and Health Promotion

The purpose of this study was to determine the effectiveness of the worksite wellness weight loss program called Weight Loss Matters (WLM) for employees at the University of Kentucky. The three main objectives were to measure the effect of Weight Loss Matters for employees from June 2006 to December 2011 in the following areas (1) prescription claims for hypertension, diabetes, and dyslipidemia, (2) weight loss, and (3) food diary compliance. Participants included 591 employees who participated in WLM for at least one session from 2006 to 2011 for whom there were data. This study employed a Quasi-experiment, longitudinal design. Data …

Understanding The Links Of Mindfulness, Relationship Satisfaction, And Sexual Satisfaction, Elizabeth N. Greer

Theses and Dissertations--Kinesiology and Health Promotion

The purpose of the present study was to examine the relationship between mindfulness and its link to sexual satisfaction and relationship satisfaction. Data were collected from 809 individuals (18.8% bisexual, 60.7% straight, 19.2% gay/lesbian) in romantic relationships. Participants completed an online survey to measure mindfulness (five facets: observing of experience, describing with words, acting with awareness, non judging of inner experience, non reactivity to inner experience), sexual satisfaction, and relationship satisfaction. Results from two multivariate analyses (predicting sexual satisfaction and relationship satisfaction) revealed that relationship satisfaction is significantly predicted by three of the five facets of mindfulness – acting with …

Statistical Analyses To Detect And Refine Genetic Associations With Neurodegenerative Diseases, Yuriko Katsumata

Theses and Dissertations--Epidemiology and Biostatistics

Dementia is a clinical state caused by neurodegeneration and characterized by a loss of function in cognitive domains and behavior. Alzheimer’s disease (AD) is the most common form of dementia. Although the amyloid β (Aβ) protein and hyperphosphorylated tau aggregates in the brain are considered to be the key pathological hallmarks of AD, the exact cause of AD is yet to be identified. In addition, clinical diagnoses of AD can be error prone. Many previous studies have compared the clinical diagnosis of AD against the gold standard of autopsy confirmation and shown substantial AD misdiagnosis Hippocampal sclerosis of aging (HS-Aging) …

Gastrointestinal Bleeding Events And Statin Use: A Large Propensity Score-Matched Retrospective Cohort Study, Ashley I. Martinez

Theses and Dissertations--Pharmacy

Literature is conflicting regarding the association between statin use and gastrointestinal (GI) bleeding. This study sought to determine whether there is an association between statin use and GI bleeding by comparing incidence of gastrointestinal events between statin users and an active comparator group.

Data was obtained from a large administrative claims database composed of subjects enrolled in a selection of insurance plans throughout the United States from 2009-2014. New statin users (exposed) and thyroid medication users (active comparator, unexposed) were followed from the baseline period (one year prior to medication initiation) until first event, discontinuation, or disenrollment. Subjects were matched …

All 4 Hardin County Freshman!, Cortney Lynn Gandy

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

Within this application for funding the Lincoln Trail Health Department proposes an evidenced based intervention for implementation into two high schools in the Hardin County with the long term goals of decreasing the rate of sexually transmitted infections in the county. The LTHD based in Elizabethtown, Kentucky services six counties in central Kentucky. The community health needs assessment and community health improvement plans for the county highlighted the problem of sexually transmitted infections in the community. The Centers for Disease Control also produces data about the higher rate of STIs in Hardin county in respect to Kentucky and the US …

Implementing The Alive! Behavioral Intervention Program In Phillips County, Arkansas, Raeschell Williams

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

The Arkansas Department of Health proposes implementing the Alive! behavioral intervention program in Phillips County, Arkansas to decrease the prevalence of obesity in this community. Alive!, A Lifestyle Intervention Via Email, is an evidence-bases, email-derived, worksite intervention focused on reducing saturated fats, increasing fruit and vegetable intake, and increasing physical activity. As an email-based program, participants will receive weekly emails tailored to their individual goals with reminder emails delivered during the week with small-step goals to help the participant achieve their larger goal. As the country with the highest prevalence of obesity and second highest prevalence of obesity in 2014, …

The Effects Of Improved Water And Sanitation Access On Under Five Child Diarrhea In Peru, April Ballard

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

Significance: Diseases related to poor or lack of access to clean water, sanitation, and hygiene negatively impact health, education, and development worldwide and cause millions of deaths in children each year. Health outcomes associated with lack of access to clean water and sanitation are under-evaluated.

Aim: To assess the effect of improved water and sanitation infrastructure development on child morbidity in Peru by investigating diarrhea in children under five years of age.

Methods: The child, family, and household data from the Peruvian Demographic and Health Surveys (DHS) were used to evaluate the association between access to water …

Diagnostic Prevalence Of Diabetes Among Older Adults In Rural Appalachia, Gabriella Hodges

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

Background

The rural, mountainous Appalachian region continuously has poorer health outcomes than the rest of the United States. This is true for many chronic diseases including diabetes: the 7th leading cause of death in the United States. This study assessed differences in the prevalence of diagnosed diabetes between older adults in rural, Appalachian counties and rural, non- Appalachian counties.

Methods

Data for the year 2013 was extracted from the Centers for Medicare and Medicaid Services (CMS) Public Use Files for Medicare beneficiaries (September 2015), which provides county level prevalence for diabetes as well as several other conditions among Medicare fee-for-service …

Compliance And Treatment Failure Of Hepatitis C With Direct-Acting Antivirals: A 2-Year Retrospective, Observational Study In Kentucky Medicaid Patients, Juequan Nie

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

Background: New generation Direct-acting antivirals (DAAs) for the treatment of chronic hepatitis C infection have been on the market for more than 3 years since late 2013. Whether these medications cure patients at the rates claimed in clinical trials is not clear. Furthermore, as compliance is known to affect treatment outcomes, DAAs compliance rate is worth studying.

Methods: We analyzed the association of social-demographic, DAA use, enrollment with Kentucky Medicaid Managed Care Organizations (MCOs) and comorbidities, and DAA compliance in 1128 Kentucky Medicaid members treated with DAAs between August 07, 2014 and August 06, 2016.

Results: Age, MCOs, liver fibrosis …

Spatial Distribution Of Partner-Seeking Men Who Have Sex With Men (Msm): An Epidemiologic Study Using Msm Geosocial Networking Applications, Angel Blake Algarin

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

Background: Geosocial networking (GSN) applications (apps) have made finding sexual partners easier for partner-seeking MSM, raising challenges for HIV/STI prevention but also providing opportunities for research. To date, little is known about app usage in smaller cities where there may be more stigma surrounding MSM.

Objective: This study uses GSN apps to identify areas with high density partner-seeking MSM, and to characterize these areas using Census block group demographic measures in a Southern mid-sized city.

Methods: Data collection points (n=62) were spaced in two-mile increments along nine routes (112 miles) covering the area. At each point, staff …

Filling The Gap In Obesity Prevention: Implementation Of The General’S Activity Program (Gap) In Carroll County, Kentucky, Brent Emerson

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

As obesity rates continue to rise, there is a significant need for public health programs that are able to effectively increase physical activity at the community level. Regular physical activity can help reduce the risk of negative health outcomes associated with obesity including cardiovascular disease, type 2 diabetes, and some forms of cancer while also strengthening muscles, improving mental health and mood, and increasing average life expectancy. Previous research has supported that one way to increase physical activity at the community level is through social marketing of state and local parks. Through the promotion of parks, community residents are able …

Sociodemographic And Clinical Predictors Of Triple Negative Breast Cancer, Madison Ries

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

Background and Objectives

Breast cancer has the highest incidence rates among women and is the second leading cause of death due to cancer in women. Of all breast cancers, triple negative breast cancer (TNBC) accounts for about one-fifth of breast cancer and tends to result in an aggressive form with larger tumors and rates of metastasis and is more frequently found in younger women. This results in an important need in information regarding the risk of diagnosis with triple negative breast cancer over other forms and covariates associated with death and TNBC. This paper studies the relationship between race, tobacco …

Addressing Barriers To Hepatitis C Treatment Initiation In Kentucky Clinic, Moaz Abdelwadoud

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

Introduction. Hepatitis C virus (HCV) is the most prevalent blood borne infection in the United States and its chronic infection has a high burden on the American healthcare system. Since 2014, the all-oral Directly Acting Antiviral (DAA)-based therapy has been established as the standardized curative treatment for HCV with unprecedented high effectiveness and tolerability. Nevertheless, there is a significant gap between the promise from DAAs benefits and the treatment initiation rates in the United States and Kentucky.

Objectives. The goal of this study is to improve the access to the all-oral DAA-based treatment among HCV patients seeking outpatient …

Factors Associated With Large Vehicle Collision Fatalities From 2009-2015, An Assessment Of Factors Relevant To The 2014 Implementation Of The National Registry Of Certified Medical Examiners And Strategies For Driver Safety, Melinda L. Carol

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

OBJECTIVE: The Federal Motor Carrier Safety Administration (FMCSA) developed a National Registry of Certified Medical Examiners (NRCME) as a stride toward greater driver safety and public health. This retrospective, observational, cross-section study is intended to trend and analyze driver related factors that are pertinent to FMCSA certifying medical examination performed by NRCME providers in addition to driver behaviors and environmental factors from the years 2009 to 2015. The results of this study are intended to speculate the effectiveness of the NRCME and propose additional public health interventions aimed to reduce large vehicle fatalities.

METHODS: Data was extracted from …

Shaping Our Appalachian Region (Soar): Beginning To Now, Samantha Zarycki

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

Introduction

Appalachian Kentucky has been and is currently facing difficult times including low employment rates, low education rates and less-than-favorable healthcare and health status for the people of the region (Estep, 2014). There have been multiple government and non-government agencies who have implemented interventions with the purpose of lifting up the region. Shaping Our Appalachian Region, or SOAR, is a bipartisan organization which began in 2013, and was established for the purpose of caring for the region.

Methods

A qualitative data analysis using confidential interviews with six people involved with SOAR was used for this project. Using the deductive approach …

Planet Health: A School-Based Health Promotion Program, Jane Katherine Landon

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

The Kentucky River District Health Department (KRDHD) proposes implementation of Planet Health, a school-based intervention aimed at increasing healthful nutrition and fitness behaviors in middle- and high-school aged students. Planet Health’s core messaging (increasing fruit and vegetable intake, increasing physical activity, decreasing screen time, decreasing sugar-sweetened beverage and trans-fat intake) contributes to our long-term goal of decreasing childhood obesity in our service area. Planet Health will be offered to 3 counties in our service area (Lee, Letcher and Wolfe) with planned expansion to all counties in the KRDHD service area within 5 years of the original pilot. This project will …

Self-Reported Adherence To Physical Activity For Cancer Survivors: An Update From The 2015 Nhis Database, Andrew Jackson Shearer

Theses and Dissertations--Kinesiology and Health Promotion

Cancer is the second leading cause of death in America. It’s been suggested that regular physical activity (PA) can improve health outcomes in cancer survivors. An estimate from BRFSS data (2009) suggested that 47% of all cancer survivors met recommended guidelines and that this estimate was not different from the population at large (48%). Several factors were examined from these BRFSS data to determine whether subgroups of survivors existed who might benefit from interventions aimed at improving their PA status. The purpose of this investigation was to obtain more recent estimates of adherence to established PA guidelines for cancer survivors. …

Mixture Modeling With Applications In Alzheimer's Disease, Frank Appiah

Theses and Dissertations--Epidemiology and Biostatistics

This dissertation involves an application of mixture of regression models to 114 individuals who are cognitively intact (from the Alzheimer's Disease and Neuroimaging Initiative-ADNI, data). The correct number of components in the model were estimated with the Singular BIC (SBIC), marking the first time it has been applied to such a problem. The smallest true model in conjunction with the approximation of SBIC was fixed at 1. The resulting posterior probabilities from the model were used to estimate the probability of a person transitioning and risk plots were obtained that could in principle be used by clinicians to identify patients …

Connecting Self-Efficacy Of Dietary Choices And The Association With Dietary Intake Among Rural Adolescents In North Carolina And Kentucky, Rachel Gillespie

Theses and Dissertations--Nutrition and Food Systems

Determining the level of belief one has in themselves, or their self-efficacy, can be a key factor to improve certain dietary patterns and choices in the rural youth population. Sugar sweetened food and beverage consumption continues to rise and fruit and vegetable intake remains a struggle in rural areas; addressing both the food environment and adolescents’ self-efficacy could have a lasting impact on changing the nature of a generation of rural student’s food and beverage choices. This study measured self-efficacy levels of (n=425) adolescents in rural Kentucky and North Carolina using the Youth Impact Questionnaire and dietary intake using the …

Promotion Of Early Pediatric Hearing Detection Through Patient Navigation, Matthew L. Bush

Theses and Dissertations--Clinical and Translational Science

Congenital hearing loss is the most common neonatal sensory disorder and it is crucial to diagnose hearing loss as soon as possible after birth in order to facilitate rapid treatment. Universal standards of infant hearing healthcare dictate that infant hearing screening should be completed by one month of age and abnormal screening tests should be followed with definitive audiological testing by three months of age. Obtaining diagnostic testing can be complicated by limited access to care in rural areas, breakdowns in communication, lack of parental support, and poor coordination of care. There is no established method to address appointment non-adherence …

Malignant Melanoma In Kentucky: An Analysis Of The Individual And Social Factors On Disease Stage And Treatment, Virginia Valentin

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

Introduction: In 2016 there will be an estimated 76,380 new cases of malignant melanoma and 10,130 deaths in the United States (US). ¹ Malignant melanoma incidence is increasing faster than any other preventable cancer in the US with an expected 112,000 new cases a year by 2030. ^2,3 This capstone attempts to quantify the association of individual and social factors on melanoma late-stage diagnosis and non-adherence to surgical treatment guidelines for early-stage lesions in Kentucky.

Methods: The analysis combines three datasets: individual level data from the Kentucky Cancer Registry, census tract level data from the US Census and …

Smart Moves Bright Bodies: A Rural Adaptation To Combat Obesity Among African-American Teenagers In Wilcox And Lowndes Counties, Alabama, Nicole D. Fields

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

Obesity is a significant problem in the United States; however, it is a burgeoning epidemic among youth in the United States. As of 2016, Alabama is the second-most obese state in the nation¹ and 16% of Alabama adolescents are obese². While obesity is a significant problem across all ethnic groups, minorities bear a disproportionate burden in Alabama: one in five African-American adolescents is obese². This disproportionate burden is demonstrated in two Alabama counties: Wilcox and Lowndes. Both counties are predominately African-American and rank in the bottom ten counties, statewide, for overall health outcomes^9,14. …

Vaccine-Preventable Disease Surveillance In Kentucky, Katherine Jay

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

Background: Vaccine-preventable disease (VPD) surveillance is important component to the success of vaccines. This report examines the levels of 13 of these VPDs in the state of Kentucky from 2005 to 2015.

Methods: All reported cases in the state of Kentucky for the years 2005 to 2015 of 13 vaccine-preventable diseases were obtained from the Disease Surveillance Module (DSM) and the National Electronic Disease Surveillance System (NEDSS). Where enough cases were reported, descriptive statistics were prepared. For acute hepatitis B and pertussis, more thorough analysis was performed.

Results: Rates of acute hepatitis B in Kentucky from 2005 …

The Impacts Of Recreational Marijuana Legalization On Colorado Policy Analysis On Amendment 64, Santhi Chilukuri

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

This report is a policy analysis on the impacts of Colorado’s Amendment 64. Marijuana is the most commonly used illicit drug in the U.S, and a Schedule 1 Drug under the federal government. Despite this, twenty-nine states and territories in the U.S. have legalized it for medicinal purposes; (Hanson NCSL, 2017) four of which legalized it for recreational purposes. (Hall & Lynskey, 2016) Medical Marijuana has been legal in Colorado since 2009; however, Amendment 64 was passed in 2012 which legalized the possession, retail sale, and purchase of marijuana to Colorado state residents 21 and over. Commercialization in retail stores …

A Comprehensive Multi-Level Approach To Increasing Hpv Vaccination Rates In Rural Kentucky, Jim Weygandt

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

The Graves County Health Department (GCHD) proposes implementation of a multi-level approach to increase Human Papillomavirus (HPV) vaccination rates in Graves County, KY. The approach utilizes multiple evidence-based strategies, including Assessment, Feedback, Incentive, Exchange (AFIX), Vaccines for Children (VFC), Kentucky Immunization Registry (KIR), Comprehensive Clinic Assessment Application (CoCASA), and vaccines per protocol. This proposed project utilizes family medicine and pediatric clinics, pharmacies, and school nurses to deliver the intervention to the target population, which includes 11-12-year-old adolescents residing in Graves County. The objectives of this HPV vaccination-focused intervention align with Healthy People 2020 goals and objectives, the 2012-2013 President’s Cancer …

Use Of The Afix Model To Improve Adolescent Hpv Vaccination: A Pilot Research Study, Emily Messerli

DNP Projects

Problem: The CDC estimates one person every 20 minutes every day acquires an HPV-related cancer. Kentucky’s HPV associated cancer burden is among the highest in the nation. Adolescent HPV vaccination rates in Kentucky are far below HealthyPeople 2020 goals. Barriers are multifaceted and include provider, patient and system barriers. The AFIX model is an evidenced based quality improvement program that addresses key provider barriers. The USPSTF findings identify a gap in the literature related to AFIX methods to improve rates of adolescent vaccines.

Objectives: The purpose of this study was to evaluate the effects of an intervention using the AFIX …

A Secondary Analysis Of Survey Data Evaluating The Lifelines Suicide Prevention Program Among Middle School Students, Nicki Sullivan

DNP Projects

PURPOSE: The purpose of this study was to evaluate student feedback of the 2015 Lifelines Suicide Prevention Program at Jessie Clark Middle School. Student feedback was examined by assessing students’ knowledge of suicide, attitudes toward suicide, knowledge of when and from whom to seek help if feeling suicidal or told by a friend that they are suicidal, and impressions of the educational presentation following participation in the Lifelines Suicide Prevention Program.

METHODS: In this secondary analysis, anonymous student responses (N=269) from a 2015 middle school survey were examined by using a mixed method design with the quantitative study measures being …

Screening For Alcohol Use/Abuse In The Primary Care Setting Using The Audit-C And Sbirt (Screening, Brief Intervention, Referral To Treatment), Whitney D. Spear

DNP Projects

PURPOSE: The purpose of this study was to examine the feasibility of alcohol screening in the primary care setting to detect alcohol abuse or misuse using the AUDIT-C standardized screening tool and SBIRT.

METHODS: This study design was a Quasi-Experimental intervention, one group post-test. Data was collected via retrospective chart review from the electronic medical records by the type of office visit; either new patient initial visit or annual well visit. The patient sample consisted of 25 participants for the study period of September 19^th through October 10^th, 2017.

RESULTS: There were 37 patients eligible to participate …

Respiratory Function And Associated Risk Factors In The Kentucky Women’S Health Registry, Negash Amsalu

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

From the University of Kentucky Women’s Health Registry Database (KWHRD) a total of 1838 women were voluntarily asked to undergo Spirometric respiratory function tests. These women came to the clinic for various reasons. Various independent variables (risk factors) were also recorded for these women. Among these risk factors were: age, BMI, smoking status, asthmatic status, educational status and ethnicity.

The purpose of the study was to investigate whether any of the risk factors had significant impacts on women’s respiratory health. Appropriate categorizations were tabulated for each risk factor so that comparisons would be possible and easier. The motivation of the …