Medicine and Health Sciences Commons^™

Treatment At An Academic Medical Center Eliminates Survival Disparities For Appalachian Kentuckians With Pancreatic Ductal Adenocarcinoma, Emily Cassim, Hannah Mcdonald, Megan Harper, Quan Chen, Miranda Lin, Reema Patel, Michael Cavnar, Prakash Pandalai, Bin Huang, Pamela C. Hull, Joseph Kim, Erin Burke

Journal of Appalachian Health

Introduction: Rates of cancer mortality in Appalachian Kentucky is among the highest in the nation. It is unknown whether geographic location of treatment for pancreatic ductal adenocarcinoma (PDAC), one of the deadliest cancers worldwide, influences survival in Appalachian Kentuckians.

Purpose: This study compares outcomes among Appalachian Kentuckians with PDAC who received treatment at an academic medical center (AMC) or community facility (CF).

Methods: Using the Kentucky Cancer Registry, patients diagnosed with PDAC between 2003 and 2018 were identified. Patients were categorized according to treatment location (AMC v. CF) and county of residence (Appalachian v. non-Appalachian). Kaplan-Meier curves were constructed to …

Evaluation Of Public Radon Messaging In Kentucky As Compared To Three Other States, Abigail Knapp

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

Radon poses a large health risk to those exposed to it, as it is an invisible, odorless, carcinogenic gas. Kentucky has high ambient levels of radon, but public awareness remains low as tobacco has been publicized as the main cause of lung cancer. As Kentucky has the highest incidence of lung and bronchial cancers in the United States, we aimed to examine the state’s health department radon page to see if it has sufficient information to warn residents about radon and provide resources. We reviewed the current Kentucky public messaging, radon rates, testing rates, and legislation compared to Ohio, Washington, …

Disparities In Mortality Between Appalachian And Non-Appalachian Regions Of Kentucky, Sonali S. Salunkhe, Sahal Alzahrani, Beatrice Ugiliweneza

Journal of Appalachian Health

Introduction: In the opioid epidemic, the U.S. faces a significant public health crisis, with some areas of the country, such as rural and Appalachian regions, suffering more than others. The differential regional impact of the crisis in Kentucky—a state with both non-metropolitan/metropolitan and Appalachian/Non-Appalachian statuses—has not yet been documented despite such knowledge being essential to the success of overdose prevention efforts.

Purpose: This study compares all-cause, drug- and opioid-related mortality between counties in different regions of Kentucky: Appalachian non-metropolitan, Appalachian metropolitan, non-Appalachian non-metropolitan, and non-Appalachian metropolitan.

Methods: Age-adjusted mortality data from the Centers for Disease Control and Prevention’s Wide-ranging Online …

Carbapenem-Resistant Enterobacterales—Kentucky, 2013–2020: Challenges And Successes, Mary Issac, Andrea Flinchum, Kevin Spicer

Journal of Appalachian Health

Introduction: Carbapenem-resistant Enterobacterales (CRE) are considered urgent, antibiotic-resistant threats in the U.S. and are of global concern. Active collaboration between public health authorities and healthcare facilities and providers will be necessary to prevent and contain these organisms.

Purpose: To describe the epidemiology of CRE in Kentucky and to discuss challenges and successes with building and sustaining an effective prevention and containment program.

Methods: Retrospective descriptive summary of CRE isolates reported by healthcare providers, facilities, and laboratories in Kentucky from 2013 through 2020. Data available from case reporting forms and laboratory testing are summarized.

Results: From 2013 through 2020, 1805 CRE …

Self-Reported Consumption Of Bottled Water V. Tap Water In Appalachian And Non-Appalachian Kentucky, Jason W. Marion

Journal of Appalachian Health

Introduction: Quantitative studies on drinking water perceptions in Appalachia are limited. High-profile water infrastructure failures in the U.S. and Eastern Kentucky, coupled with human-made and natural disasters in the Appalachian Region, have likely impacted opinions regarding tap water.

Purpose: To use existing unexplored data to describe baseline tap water v. bottled water consumption in Kentucky.

Methods: Telephone-based cross-sectional data were obtained from the 2013 Kentucky Health Issues Poll (KHIP) directed by the Foundation for a Healthy Kentucky. Among many items in KHIP, self-reported consumption of bottled water over tap water, reasons for bottled water use, and demographic data were obtained. …

The Impact Of Flooding Events In Kentucky Counties On Preventable Asthma Hospitalizations, Mckaylee Copher

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

Objective: Given the frequency and intensity of flooding, along with the disparities in respiratory illnesses in Kentucky, this study aims to determine if there is an association between flooding and asthma is crucial to the health of the state population.

Methods: Preventable asthma hospitalizations in adults aged 18-39 were obtained from the Kentucky Cabinet of Health and Family Services, Health and Facility Services Data and included the count of admissions of an ICD-9 diagnosis of asthma, as determined by hospital discharge data. FEMA disaster declarations were used to identify 69 counties that had floods during the period of 2008-2015. A …

Cardinal's Blues: Implementation Of A School-Based Cognitive Behavioral Therapy Program For Jefferson County Public Schools In Louisville, Kentucky, Loui Chang

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

With the increasing rate of adolescent depression and anxiety1 2, developing mental health interventions is necessary. Many adolescents’ times spent in schools increased compared to 20 years ago5, which makes school-based intervention programs suitable for reaching adolescent population effectively. Though there are numerous treatment providers available in Jefferson County, Kentucky, the school-based prevention programs addressing adolescent’s negative mental health outcomes have never been implemented. The Blueprints for Healthy Youth Development developed a program called the Blues Program24. The Blues Program provides an adapted version of group Cognitive Behavioral Therapy sessions to train and educate adolescents coping skills and cognitive restructuring24. …

Impact Of Insurance Payer On Stage At Diagnosis Of Prostate Cancer, Hunter M. Stiff

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

Objectives: Prostate cancer (CaP) is the most common site of cancer in men in the United States and is very treatable when diagnosed in localized and regional stages. While there are widely available forms of screening that can detect CaP in its early stages, factors that can affect healthcare access such as health insurance, race, and Appalachian residency have been linked with differences in rates of distant-stage CaP diagnosis. This study aimed to explore the relationships between health insurance, race, Appalachian residency, and late-stage CaP diagnosis in the state of Kentucky.

Methods: A sample of 26,622 men from the state …

Implementing A Mobile Saliva Rinse Screening For P16 Markers For Hpv (Human Papillomavirus) Positive Head And Neck Cancers In Central Kentucky, Madeline Brown

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

Rates of HPV-related head and neck cancers are increasing across the nation and more specifically, there has been a significant increase in the state of Kentucky. This study focuses on the implementation of a mobile clinic saliva-rinse screening program. This program will be set up at UK Athletics Men's basketball and football games in hopes of recruiting middle aged men ages 45-60, who are the target audience of the study. This is the population with highest prevalence for HPV positive head and neck cancers and also the population least likely to visit their health providers regularly. A quick saliva rinse …

Roadway Density And Lung Cancer Histology In Kentucky, Mahala Pettus

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

The purpose of this article was to examine the relationship between a proxy measure of exposure to automotive exhaust – roadway density – and risk for adenocarcinoma lung cancer. Using data from the Kentucky Cancer Registry and the Kentucky Geoportal Data Clearinghouse, we conducted a cross-sectional study of the distribution of adult lung cancer cases by histological type across the state of Kentucky. The north-central region of Kentucky has a higher prevalence of adenocarcinomas and greater roadway density. Among adenocarcinoma cases in Kentucky, there are more non-smokers than other types of tobacco use. As smoking rates decrease in Kentucky, and …

Sociodemographic Factors Related To Late-Stage Lung Cancer Diagnosis In Kentucky, Kaylee Stickler

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

Lung cancer is the leading cause of cancer mortality in the United States, and the state of Kentucky has a significant burden of lung cancer morbidity and mortality. The aim of this study is to examine the sociodemographic factors associated with late-stage lung cancer diagnosis in Kentucky. The present study is a retrospective, population-based cohort study that utilizes data from the Kentucky Cancer Registry to examine the associations between late-stage lung cancer diagnosis and sociodemographic factors. Descriptive, bivariate, and multivariable analyses were conducted to estimate the significance of these associations. Significant relationships between the variables of sex, age, Appalachian status, …

The Meals On Wheels-Breathitt: A Health Campaign For Reducing Food Insecurity Among The Older Adults In Breathitt County, Kentucky., Sarah Haroon

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

The population of the United States of America is aging at a faster rate than ever before. More than 1 in 6 Americans are now 65 or older (The Washington Post, 2023). Since 2010, compared to people under 65, there has been close to a two-hundred percent increase in people 65 and above (The Washington Post, 2023). The rise in the aging U.S. population is due to increased life span and people living longer (U.S. Census Bureau, 2020). Furthermore, life expectancy for the total U.S. population is projected to increase by six years, from 79.7 in 2017 to 85.6 by …

Disparities In Access To Chemotherapy Among Kentucky Stage Iv Non-Small Cell Lung Cancer Patients, Joshua Brown

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

OBJECTIVE: This population-based retrospective cohort study examines the association of sociodemographic disparities with the receipt of chemotherapy among patients with metastatic non-small cell lung cancer in the Commonwealth of Kentucky in the precision oncology and immunotherapy era.

METHODS: Kentucky Cancer Registry data from 2010 through 2017 was analyzed using univariate, bivariate, unadjusted, and adjusted multivariate regressions to assess disparities in our population (N = 9490).

RESULTS:We found no significant difference in receipt of chemotherapy between sexes (OR 0.99, P=0.90) nor races (OR 1.12, P=0.22). Patients diagnosed in an Appalachia county were significantly less likely to receive chemotherapy (OR 0.71, …

Key Factors Associated With Late-Stage Diagnosis Of Endometrial Cancer In Kentucky, Lexee Long

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

Objectives: Cancer of the endometrium is the most common female reproductive cancer in the United States, but is understudied in relation to stage at diagnosis, which is a potential predictor of survival. The primary objective of this study is to analyze potential associations of independent variables such as age at diagnosis, race, marital status, smoking status, Appalachian status, and insurance type with late-stage diagnosis of endometrial cancer.

Methods: This population-based study used Kentucky Cancer Registry data to study endometrial cancer cases diagnosed between January 1^st,2015 and December 31^st, 2019. Chi-square statistics were used to examine bivariate …

Through The Lens: Youth Experiences With Cancer In Rural Appalachian Kentucky Using Photovoice, Katie Gaines, Courtney Martin, Chris Prichard, Nathan L. Vanderford

Markey Cancer Center Faculty Publications

Rural Appalachian Kentucky experiences disproportionately high cancer incidence and mortality rates. This cancer burden is due to social determinants of health and cultural factors prominent in the region. The firsthand experiences of community members—especially young people—can highlight these factors and identify areas for improvement. The purpose of this study was to encourage Appalachian Kentucky youth to consider determinants of cancer and visualize the effects that cancer has on their families or communities by asking them to take photographs of cancer-related objects around them. Content analysis was performed on 238 photographs submitted by 25 students, and photographs were organized into themes, …

A Cross-Sectional Survey Of Potential Factors, Motivations, And Barriers Influencing Research Participation And Retention Among People Who Use Drugs In The Rural Usa, Angela T. Hetrick, April M. Young, Miriam R. Elman, Sarann Bielavitz, Rhonda L. Alexander, Morgan Brown, Elizabeth Needham Waddell, P. Todd Korthuis, Kathryn E. Lancaster

Epidemiology and Environmental Health Faculty Publications

BACKGROUND: Despite high morbidity and mortality among people who use drugs (PWUD) in rural America, most research is conducted within urban areas. Our objective was to describe influencing factors, motivations, and barriers to research participation and retention among rural PWUD.

METHODS: We recruited 255 eligible participants from community outreach and community-based, epidemiologic research cohorts from April to July 2019 to participate in a cross-sectional survey. Eligible participants reported opioid or injection drug use to get high within 30 days and resided in high-needs rural counties in Oregon, Kentucky, and Ohio. We aggregated response rankings to identify salient influences, motivations, and …

Losses, Gains, And Changes To The Food Environment In A Rural Kentucky County During The Covid-19 Pandemic, Makenzie L. Barr, Courtney Martin, Courtney T. Luecking, Kathryn M. Cardarelli

Dietetics and Human Nutrition Faculty Publications

The COVID-19 pandemic has caused alterations to be made in the way many people access, prepare, and consume food. Rural communities are particularly impacted due to pre-existing structural vulnerabilities, i.e., poverty, lack of infrastructure, and limited fresh food options. This study aimed to characterize experiences of one rural Appalachian community’s changes to the food environment during the pandemic. In April 2021, six focus groups were conducted with residents of Laurel County, Kentucky. Using grounded theory, we identified losses, gains, and overall changes to the community food environment since the onset of COVID-19. Seventeen Laurel Countians (17 female; ages 30–74) participated …

Access To And Use Of Technology For Health: Comparisons Between Appalachian Kentuckians And The General U.S. Population, Robin C. Vanderpool, Lindsay R. Stradtman, Anna Gaysynsky, Quan Chen, Meghan Johnson, Bin Huang

Journal of Appalachian Health

Introduction: Technology may increase the availability of health information and enable health promoting behaviors. However, lack of access to and use of technology may also exacerbate disparities, particularly in rural communities with limited Internet access.

Purpose: The purpose of this study was to compare Internet access, device ownership, and use of technology for health between Appalachian Kentuckians and the general U.S. population.
Methods: Findings from the 2017 Assessing the Health Status of Kentucky (ASK) survey were compared to national estimates from the Health Information National Trends Survey (HINTS) 5, Cycle 1 (2017), with a particular focus on degree of rurality. …

Physical Activity Barriers And Assets In Rural Appalachian Kentucky: A Mixed-Methods Study, Natalie Jones, Deirdre Dlugonski, Rachel Gillespie, Emily M. Dewitt, Joann Lianekhammy, Stacey A. Slone, Kathryn M. Cardarelli

Sports Medicine Research Institute Faculty Publications

Obesity is an increasing public health concern in the U.S. and a contributor to chronic illness, with trends revealing a rise in adult obesity and chronic disease rates among the most vulnerable and disadvantaged populations, including those in rural communities. A mixed-methods approach was used to examine perspectives on perceived physical activity barriers, resources, and level of community support. Researchers utilized the socioecological model to examine the multiple domains that support physical activity in rural Appalachia. The present study focuses on baseline data, including a cohort survey to assess physical activity, health status, and barriers to physical activity, and five …

Exploring Covid-19 Case Fatality In Relation To The Prevalence Of Chronic Conditions And Health Behaviors In Appalachian Kentucky, W. Jay Christian

Journal of Appalachian Health

Background: Research has demonstrated that common chronic conditions, especially those related to cardiovascular health, are important risk factors for severe COVID-19 symptoms or hospitalization. Population prevalence rates of such conditions have not previously been examined in relation to COVID-19 case fatality rates in the Central Appalachian region.

Purpose: This study examined prevalence rates of selected chronic conditions and COVID-19 case fatality rates to determine whether the relationship between them is consistent across Appalachian and non-Appalachian regions of Kentucky.

Methods: Data from Kentucky’s Behavioral Risk Factor Survey (KyBRFS) were used to calculate prevalence rates of asthma, diabetes, influenza vaccination, hypertension, obesity, …

Spatial Analysis Of Health Care Utilization Among Medicare Beneficiaries With Coal Workers’ Pneumoconiosis And Other Related Pneumoconiosis, Ahmed A. Arif, Claudio Owusu, Rajib Paul, Christopher M. Blanchette, Ripsi P. Patel, Tyrone F. Borders

Rural & Underserved Health Research Center Publications

Overview of Key Findings

• The states with the highest number of Medicare beneficiaries with coal workers’ pneumoconiosis (CWP) were Kentucky, West Virginia, Virginia, and Pennsylvania.
• Significant clustering of health care utilization rates for Medicare beneficiaries with CWP was observed in the central Appalachian states of Kentucky, West Virginia, and Virginia.
• Significant clustering of health care utilization rates for Medicare beneficiaries with Other Related Pneumoconiosis was observed in Appalachia and the southeast parts of Texas and Louisiana. This clustering merits additional research to understand underlying disease etiology.

Estimating The Population Attributable Fraction Of Asthma Due To Electronic Cigarette Use And Other Risk Factors Using Kentucky Behavioral Risk Factor Survey Data, 2016-2017, W. Jay Christian, Courtney J. Walker

Epidemiology and Environmental Health Faculty Publications

Introduction: Electronic nicotine delivery systems ENDS have become popular in the United States among both new users of nicotine and those seeking less harmful alternatives to traditional cigarettes. Users often perceive ENDS as being less harmful than traditional cigarettes. This study investigated the relationship between use of ENDS and asthma in a representative sample of adults. Methods: For this cross-sectional study, we used data from the Kentucky Behavioral Risk Factor Surveillance System telephone survey data from 2016-2017. Using a weighted multivariable logistic regression analysis, we identified important covariates to adjust for to calculate the population attributable fraction (PAF) of asthma …

An Assessment Of Kentucky Birth Records, Focusing On Early-Onset Hypertensive Disorders Of Pregnancy, Environmental Metal Exposures, And Geocoding Precision, 2008-2017, Courtney J. Walker

Theses and Dissertations--Epidemiology and Biostatistics

Using live and stillbirth records from Kentucky (2008-2017), this dissertation assessed the county-level prevalence and geospatial patterns of early-onset hypertensive disorders of pregnancy (eHDP); examined the geocoding precision of addresses recorded on birth records, and evaluated the association between individual risk factors and environmental metal exposures on eHDP prevalence. After adjusting for maternal demographic factors and pre-existing health conditions, we observed that eHDP prevalence was 38% higher (aPR=1.38, 95%CI:1.16, 1.64) in counties with the highest prevalence of married women (> 53.8%) compared to lower prevalence areas (31.6%) had a 20% higher prevalence of eHDP(aPR=1.20, 95%CI:1.00, 1.44) compared to counties with …

Prevalence And Correlates Of Secondary Syringe Exchange (Sse) Among People Who Inject Drugs (Pwid) In Rural Kentucky, Jordan R. Wilson

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

Aim: To describe the prevalence of secondary syringe exchange (SSE) in a sample of syringe service program (SSP) clients in rural Appalachian Kentucky and to identify the correlates of SSE.

Methods: Participants (n=338) completed interviewer-administered questionnaires. Only those who reported having ever exchanged syringes at a SSP (n=140) were included in analysis. SSE was measured through self-report of obtaining syringes for someone else at a SSP in the past 6 months. Prevalence and correlates of SSE were examined using bivariate analysis and multiple logistic regression.

Results: Overall, 30% of participants reported SSE. Participants in the second [aOR= 3.83; 95% CI: …

Equine West Nile Virus In Kentucky: Characteristics Of Historical Testing And Analysis Of Causal Factors, Kaelyn Short

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

As the arbovirus with the highest incidence in both humans and horses in the United States, West Nile Virus (WNV) presents a significant risk to the equine population of Kentucky. Widespread infection has the potential to cause a significant economic impact to the state and long-term health complications for the horses. To better understand the burden of equine WNV, historical diagnostic testing archives the University of Kentucky Veterinary Diagnostic Lab were analyzed along with environmental and census data collected from additional sources. A total of 2146 test results were analyzed utilizing descriptive statistics, chi-square tests of independence, and binary logistic …

Rates Of Diabetes Screening In Kentucky Before And After Implementation Of The Affordable Care Act (Aca), Cory Reinert

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

Diabetes mellitus, commonly referred to as “diabetes”, is currently at epidemic proportions in the United States as its prevalence has drastically increased over the past several decades. The percentage of Americans with diagnosed diabetes has risen from 0.93 percent of the population in 1958 to 10.5 percent in 2018 (ADA, 2021). Diabetes also impacts record numbers of Kentucky residents.

Regular screening for those considered at-risk can encourage patients to implement lifestyle modifications, pharmacological therapy, or other interventions earlier in the course of disease. This can help prevent or delay onset of T2D and can reduce diabetes-related complications in those who …

Rabies In Kentucky From 1989-2020: A Case For Surveillance, Sarah Jane Robbins

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

The Kentucky rabies reporting system includes data from five laboratories and provides an account of suspected rabies reports since 1989. Over 35,000 suspected cases are used to estimate rabies incidence temporally and spatially. Recommendations to the current rabies reporting methodologies are presented through proposed innovations of a standard, electronic reporting form. Given the multiple sources of data, the reporting system lacks standardization and comprehensive information about suspected rabies events, resulting in limited epidemiological capabilities; and data issues that prevent its use as a surveillance system. These issues are a limiting factor in rabies elimination; but a driving factor in over-testing, …

Colorectal Cancer Differences In Staging And Survival: Appalachian And Non-Appalchian Kentuckians, Ripley Lucas

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

Colorectal cancer is the third most commonly diagnosed cancer in the United States. Historically, the Appalachian region of Kentucky has experienced disparities in colorectal cancer screening and survival as compared to both the non-Appalachian region of the state and the United States. The aim of this paper is to investigate the differences in cancer staging and survival after diagnosis in Appalachian and non-Appalachian Kentuckians. The present time period of study is a retrospective, population-based cohort with data taken from the Kentucky Cancer Registry. Binomial logistic regression and Cox proportional hazards models were used to estimate unadjusted and adjusted odds ratios …

Mitigating Opioid Related Healthcare Use In Kentucky: An Assessment Of The Impact Of Kentucky Revised Statute (Krs) Changes To Opioid Prescribing On Opioid Related Prescribing And Healthcare Utilization, Drew Speer

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

The opioid epidemic has impacted few other places more than the state of Kentucky. In 2018, data from the Centers of Disease Control and Prevention (CDC) and the National Institute on Drug Abuse (NIDA) ranked Kentucky as being in the top ten for rate of drug overdose deaths and opioid-involved overdose deaths per 100,000 persons.^1,2 These rankings exist even though prescription opioid dispensing rates have fallen from 102.6 per 100 persons in 2015 to 72.3 per 100 persons in 2019.³ Aligning with this trend, while research shows this problem began with prescription opioids in the late 1990’s, it …

Injuries Among Distillery Workers: Workers' Compensation First Reports Of Injury, 2010-2019, Mira Hali Mirzaian

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

AIMS: To identify the most frequent type, nature, and cause of work-related injury amongst distillery workers as well as contributing factors to the injurious event in an effort to inform potential intervention.

METHODS: Workers’ Compensation First Reports of Injury (FROI) from the years 2010-2019 (N=974) were obtained. Variables were created for ‘occupational category’ and ‘accident description’ to assist in the elucidation of the injurious event. The Ratchet Circular Scan Test was used to assess seasonal variation in injury. Kernal Density Analysis was conducted to assess rates of injury by calendar year.

RESULTS: Amongst injured distillery workers, 908 of the injuries …