Medicine and Health Sciences Commons^™

Salmonellosis In Kentucky Cattle - 2003-2014, Azia Elizabeth Ramirez

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

The group of bacteria known collectively as Salmonella has historically been a major cause of both health and economic hardships. In particular, Salmonella in bovine has been estimated to cause the economy to lose billions of dollars annually, both due to the increased morbidity and mortality rates of the cattle themselves and the indirect loss of potential profits, and also results in the spread of the bacteria to humans to ill effect. Salmonella thus can be quite taxing to agricultural communities, the animals upon which they rely, and the consumers that buy said communities’ commodities. Thus, the importance of an …

Breast Cancer Screening For African American Women, Jennifer Ross

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

INTRO Breast cancer is the most common type of malignancy among women in the United States (U.S.) and the second leading killer. Despite the availability of effective breast screening tools, a disparity has formed. Specifically, white women over the age of 40 experienced a higher incidence rate of breast cancer, while African American women experience higher related mortality rate. The purpose of this study was to examine SES and ethnicity/race factors that may influence breast cancer screening rates, and specifically explore how those factors may differ between African American and white women.

METHODS Women between the ages of 50-74 who …

Factors Predicting Beta-Blocker Treatment After Myocardial Infarction In Patients With Type 2 Diabetes, Ryan P. Hickson

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

OBJECTIVE – Beta-blockers remain important for secondary prevention after myocardial infarction (MI). Despite clinical guideline recommendations, the potential for poor glycemic control and masking warning signs of hypoglycemia limit their utilization in type 2 diabetes. This study evaluated factors predicting post-MI beta-blocker initiation among type 2 diabetic patients.

RESEARCH DESIGN AND METHODS – A retrospective cohort of employed, commercially insured individuals was developed using de-identified enrollment files, medical claims, and pharmacy claims from 2007-2009 in the U.S. Inclusion criteria: (1) type 2 diabetes, (2) ≥18 years old, (3) continuous eligibility, (4) MI. Exclusion criteria: (1) females prescribed metformin exclusively without …

Trends In Drug Use During Suicide, 2005-2012, Kentucky, Jacqueline Seals

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

Objective

With high rates of suicides worldwide more research on suicide is necessary for improved prevention strategies. This study examines the trends of positive drug tests at the time of suicide in Kentucky with respect to region, time, and intrapersonal violence.

Methods

Data from the Kentucky Violent Death Reporting System was used to look at all suicides in Kentucky from 2005 to 2012 amongst individuals 10 or older (n= 4691). Trends of opiates, amphetamines, cocaine, marijuana, benzodiazepine, and barbiturates were examined. The relationship of a positive drug test and time and intrapersonal violence were evaluated with an ANOVA test and …

Outbreak Severity Index: The International Response To The Global Outbreaks, Mohamed A. Abofaye

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

Outbreaks are emergency situations that carry hazards of death, disability, loss of home and property, and variety of other calamities. With technological advancement, not only people and commodities are easy to transfer but also disease outbreaks. However, outbreaks are dealt with by different countries based on the differences in their healthcare systems and their ability to achieve effective control of the outbreak. SARS, MERS, and Ebola are example of such outbreaks that traveled around the globe and successful control was different according to the virulence of outbreak agent and to the effectiveness of local health system control measures. This capstone …

Injury Prevention In An Industrial Environment Via Strategic Job Placement, Michelle Cooper

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

Objectives. This study investigated the effects of an injury prevention program, specific to work related musculoskeletal disorders (WMSDs), which placed employees into jobs based on their physical abilities compared to the physical demands of their prospective jobs.

Methods. Employee injury data (N=3550) from a large auto manufacturer in the U.S. was analyzed to examine changes in injury rates for employees that were hired pre versus post-strategic placement. Bivariate and multivariate analyses were used to determine dependence between placement, injury within 120 days of hire and gender.

Results. Chi-square tests of independence revealed that injury rates and job placement may be …

Association Between Stressful Life Events And Change Of Maternal Smoking During Pregnancy Using Prams 2011-2012, Shidie Tang

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

Objective: To examine the association between stressful life events during pregnancy and change of maternal smoking behaviors.

Methods: We used data from the CDC’s Pregnancy Risk Assessment Monitoring System (PRAMS) to conduct the research. Our data included 24 states from 2011-2012. We considered 13 stressful life events and grouped them into four categories: emotional, partner-related, financial and traumatic stressors. Change of Maternal Smoking during pregnancy was defined by smoking at the last trimester of pregnancy versus smoking at 3 months prior to smoking. Confounders included maternal age, race/ethnicity, education, marital status, Medicaid coverage upon delivery and income prior …

The Relationship Of Hispanic Ethnicity, Drug Use, And Bullying With Suicidal Ideation Among Adolescent Females In The 2013 Youth Risk Behavior Surveillance Survey, Erin Camp

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

BACKGROUND: There is little research on the relationship of Hispanic ethnicity, drug use, and bully victimization with suicidal ideation among adolescent females. This study investigates all components and their association with suicidal ideation using the 2013 Youth Risk Behavior Surveillance Survey (YRBSS).

METHODS: Participants were 6,621 adolescent females who completed a self-administered questionnaire (YRBSS). Students answered a series of questions regarding unintentional injuries and violence and alcohol and other drug use.

RESULTS: Results indicated that there was an association between drug use, bully victimization, and suicidal ideation. Bivariate analyses using chi-square tests showed the relationships between these risk factors and …

Correlates Of Depression And Poor Respiratory Health: A Cohort Study In A Rural County, Stephanie Courtney

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

Objective

High rates of depression are widespread globally and are among the leading causes of disability. To better understand the effects of depression on health outcomes, more research is necessary. This study examines the associations between depression and adverse respiratory outcomes among a cohort of Iowa residents living in a rural county. This study also investigates differences in the reporting of chronic and incident respiratory outcomes.

Methods

Data were obtained from the Keokuk County Rural Health Study (1994-2004) for individuals 18 years of age or older (N=1012). The primary outcome, poor respiratory health (PRH), was based on self-reported diagnoses for …

Healthcare Industry Injuries By Patient Contact Status In Kentucky, 2012-2014, Kristen Ranzenberger

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

Objectives

The healthcare industry continues to have a high number of reported injuries. The purpose of this study was to 1) characterize healthcare industry injuries by patient contact status; 2) identify the occupations associated with healthcare injuries by patient contact status; and 3) determine healthcare injury rates by occupation, to gain a better understanding of healthcare industry compensated injuries , and better target healthcare industry safety practices and programs.

Methods

Workers’ Compensation first reports of injuries (FROI) from the healthcare industry in Kentucky were categorized into injuries involving in direct patient contact vs. injuries without direct patient contact using narrative …

The Role Predictors Of Socioeconomic Status Play In Receipt Of The Shingles Vaccination In Adults Aged 50 Years Of Age And Above In The United States, Lesley Williams

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

Introduction: Vaccinations help to prevent deleterious diseases or lessen their side effects, saving millions in healthcare expenditures. While we associate most vaccinations with children, there are specific vaccinations that are indicated in the elderly. The shingles, or herpes zoster, vaccination is indicated in all adults over the age of 50 years of age to prevent the development of or lessen the severity of shingles – the re­‐emergence of chickenpox in the form of painful blisters on the body, however, statistics indicate that only around 20% of the indicated population has ever received that vaccination. Why have so few been …

Concealed Weapon Proliferation And The Impact On Firearm-Related Fatalities And Injuries Due To Assault In Kentucky, 2005-2013, Travis Young

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

Objectives: The objective of our research was to look broadly at firearms and health in the state of Kentucky, where annual gun purchases are rising and laws eliminating restrictions on concealed carry have empowered more than 300,000 citizens to carry firearms in virtually any public setting. As guns become more prevalent, and more readily accessible, will violent crime decrease as some have predicted, or will the potential for conflict escalation cause the opposite effect?

Methods: Utilizing death records for firearm-related homicides and hospitalization and emergency department visit data for injuries occurring due to firearm-related assault, we correlated the rate of …

Tier 1 Genomic Applications: A Kentucky State Needs Assessment, Andrea L. Durst

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

Paper 1: An Assessment of Kentucky Cancer Registry Data for Appropriate Referral to Genetic Services for Hereditary Breast and Ovarian Cancer Syndrome and Lynch Syndrome, 2009-2012

BACKGROUND: It is estimated that over 1 million people in the United States have Hereditary Breast and Ovarian Cancer syndrome (HBOC) or Lynch syndrome (LS). Evidence-based guidelines for identifying individuals with HBOC and LS are available, and the CDC has developed a toolkit to provide guidance for the implementation of programs to increase identification of patients appropriate for cancer genetic services. However, most individuals with HBOC and LS remain undiagnosed. While some state public …

Pulmonary Function Among Latino Thoroughbred Workers - A Pilot Study, John C. Flunker

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

Background/Objectives

Evidence suggests working in horse barns is associated with adverse respiratory effects among Latino thoroughbred workers, yet no studies to date have measured pulmonary function. We examined the prevalence of self-reported respiratory symptoms, abnormal pulmonary function, and associated occupational factors among Latino thoroughbred farmworkers.

Methods

Participants were recruited via a community-based, purposive sampling strategy and participated in an interview-administered survey and spirometer test. Surveys and spirometry tests were administered to 80 participants by two trained health promoters (Promotoras) in July-September 2014. Pulmonary function (abnormal/normal) was classified by a pulmonologist. Demographic and occupational factors were assessed for associations with respiratory …

Enhancing The Value Care Of Lung Cancer Treatment For Medically Underserved Population In Kentucky, Morita Sari

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

Background

For many years Kentucky has had the nation’s highest lung cancer incidence. Kentucky is one of the thirteen states in Appalachia in which the difference in wealth is a key determinant of health, since residents of Appalachia do not have access to the same financial resources as the rest of the US population. The disparities in lung cancer mortality within the Commonwealth of Kentucky are not completely clear, but some postulate that poor access to care or substandard care may contribute. In this study the value of lung cancer treatment for a medically underserved population (Appalachia) will be evaluated …

The Use Of Local Tax Dollars In Kentucky Local Health Departments To Sustain Programs From 2009-2013, Crystal A. Miller

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

This is a descriptive “case” study of public health finance in Kentucky, no data from other states were examined. The data used in this study were provided by the Kentucky Department for Public Health (KDPH). The data used in this study are longitudinal (2009-2013) and the core focus of this study is on: 1) changes in funding from the state to the 57-61 local health departments (single county and multi-county district departments) 2009-13, 2) changes in restricted and un-restricted fund reserves among local health departments, and 3) an examination of the local taxing districts and greater reliance on use of …

The Comorbidity And Temporal Relationship Between Anxiety Disorders, Eating Disorders, And Personality Disorders, Mitchell C. Duross

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

Background - Population-level data on the prevalence of comorbidity between anxiety-, eating-, and personality disorders remain relatively unexplored. Additionally, the potential existence of a temporal relationship among these three classes of mental disorder is also of interest.

Methods - Lifetime prevalence of, and temporal relationships among, anxiety-, eating-, and personality disorders were assessed using Part II WHO Composite International Diagnostic Interview data from the National Comorbidity Survey- Replication, a nationally representative household survey (n=5692).

Results - Lifetime prevalence estimates for any anxiety-, eating-, and personality disorder were 59.8%, 2.8%, and 13.5%, respectively, among those diagnosed with at least one core …

The Impact Of Physical And Psychosocial Factors On Workplace Injuries In Nursing Assistants, Colleen Roberts

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

Objective: The objectives of this study were to 1) Describe the nature and prevalence of workplace injuries in nursing assistants (NAs) and 2) Assess the impact of physical and psychosocial works factors on the occurrence of back injuries and muscle strains in these nursing assistants.

Methods: Data for this study are from the 2004 National Nursing Assistant Survey (NNAS), which was conducted as a supplement to the National Nursing Home Survey (NNHS). The original dataset contained 3,017 records. The data were analyzed as a case-control for this study’s purpose. Cases were defined as participants who had experienced a …

Rural Healthcare Worker's Willingness To Report To Work During Catastrophic Events, Aaron M. Macdonald

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

In the events leading up to, during, and following a catastrophic event, healthcare workers play a critical role in the outcome of these events. Therefore it is of the utmost importance that healthcare workers are able and willing to report to work. Prior to September, 2001 there had been three willingness to report studies published in the literature. Post September, 2001 and up until 2011 there was a renewed interest in the topic which led to the publishing of twenty plus papers on the topic. The current literature has examined willingness to report thoroughly and definitively; however, there is a …

Regional Differences Of Hepatitis C Virus Infection In Kentucky, Yvette N. Achuo-Egbe

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

Objective: Few studies have been conducted in Kentucky to investigate the statewide prevalence of HCV infection and its associated risk factors. The purpose of this study was to examine the factors related to HCV infection in the state, and specifically to investigate geographical differences of HCV infection between those residing in Appalachian vs. Non-Appalachian counties in Kentucky.

Methods: The study sample (n =5205) was selected from a pool of 8300 high-risk individuals participating in a pilot cross-sectional study on HCV conducted by the Kentucky Department for Public Health. The pilot study involved serologically testing participants for antibodies against HCV infection …

Are There Delays In Receipt Of Treatment Among Appalachian Kentucky Women With Breast Cancer, Huong Thi Thanh Luu

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

Background: Women living in rural and under-resourced Appalachian Kentucky may experience delays in receiving cancer treatment yet such delays have not been systematically evaluated. In this analysis, we hypothesize that women diagnosed with breast cancer who live in Appalachian Kentucky would be more likely to have a treatment delay compared to those living in other Kentucky regions and adjusting for individual measures of socioeconomic status.

Methods: In this cohort study, women included in the Kentucky Cancer Registry with a diagnosis of an incident, primary breast cancer in the prior 12 months were interviewed by phone (n=1,245; response rate 26.9%). Cox …

Alcohol Sale Status And Violent Deaths In Kentucky, Usa: 2005-2012, Hanan Abdulghafoor Khaleel

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

Alcohol is one of the major public health problems worldwide because of its association with many health and psychological problems. This study adds to the extant literature by examining the association between being a resident in a wet county and having an alcohol related violent death, an alcohol related suicide, or an alcohol related homicide victimization.

The first aim of this study is to determine whether residents of wet counties have a higher odds of alcohol related violent deaths than residents of dry/moist counties after adjusting for other confounding factors. The second aim is to determine whether residents of wet …

Demographic Disparities In Children With Behavioral Or Conduct Disorders, Caitlin Dunworth

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

This study examines the demographic disparities in children with externalizing behavior disorders, such as oppositional defiant disorder and conduct disorder, utilizing secondary data from the 2011/2012 National Survey of Children’s Health (NSCH). Current literature suggests that children with externalizing behavior disorders are more likely to be male, live in a low-­‐income family, receive lower grades in school, and to develop later conditions such as depression. Chi square tests and logistic regression were used to examine the associations of presence of a current behavioral or conduct problems with age group, race/ethnicity, sex, household income level, and insurance type. Additionally, associations were …

Impact Of Kentucky Vaccination Exemption Laws On Pertussis Incidence, Katherine Blain

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

Purpose: According to CDC statistics, prior to pertussis vaccine development in the 1940’s, about 200,000 children contracted pertussis annually. Today, although this number has decreased drastically, pertussis cases began trending upward again in the 1980’s. There are several proposed contributory factors, including vaccination exemption. In Kentucky, there are both medical and religious exemptions to mandatory school vaccines. The purpose of this study was to examine possible correlations between reported school vaccination exemptions and pertussis incidence in Kentucky counties between the years 2004-2012.

Methods: This study retrospectively analyzed data from 120 Kentucky counties between 2004-2012. The Commonwealth of Kentucky School Annual …

Proton Pump Inhibitors And Atrial Fibrillation, Dustin Hughes

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

Background

Proton pump inhibitors (PPIs) are widely used drugs in the United States. Atrial fibrillation (AF) affects 2.7 million people in this country and often leads to other serious medical conditions. There is a growing body of evidence suggesting that PPIs may be proarrhythmic. This study seeks to better appreciate the relationship between these popular drugs and the most common arrhythmia.

Methods

This is a nested case-control study using a large, nationally representative insurance database. Members with an incident AF diagnosis between 2007 and 2009 were identified. Each case was matched with one control member, using incidence density sampling, and …

Adolescent Oral Health In Kentucky, 2007 National Survey Of Childhood Health Analysis, Kory Brinker

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

Research indicates that children raised by their grandparents can have poorer health outcomes than their peers living in mother or father based households. There is, however, little research that indicates how childhood oral health is affected by grandparents raising grandchildren. This study investigated grandparent based family structures, and how this family structure affects oral health of Kentucky children. Using data from the 2007 National Survey of Children’s Health, 113 Kentucky children were identified as living with a grandparent as a primary caregiver. Chi-Square analyses were utilized to assess the oral health status of these children, as well as what role …

Examining Alcohol Consumption, Psychological Distress, And Current Smoking Status: Results From The Behavioral Risk Factor Surveillance System, 2013, Guangxing Zhan

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

Introduction: Approximately 443,000 people die from smoking or exposure to secondhand smoke, and another 8.6 million people have a serious smoking-related illness, which costs nearly $96 billion in health-care expenditures and $97 billion in productivity losses annually in the United States. This study examined the association between alcohol consumption and smoking status, and how psychological distress can affect this association. Methods: Data come from the 2013 Behavioral Risk Factor Surveillance System (BRFSS). We used binary logistic regression models to compute adjusted odds ratios between alcohol consumption and smoking status, controlling for age, gender, race, education, and income. We used chi-square …

The Synergistic Impact Of Income And Rurality On Timely Mammograms In A National Sample Of Women In The United States, Asri Mumpuni

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

Introduction. Breast cancer is the cancer of highest incidence among women in the U.S., making it a significant public health problem. Currently, the U.S. Preventive Services recommends biennial screening mammography for women ages 50-74. This study examined the associations between socioeconomic status and rurality on breast cancer screening behavior. Methods. Data for this study come from the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System Survey (BRFSS). Breast cancer screening behavior was dichotomized into those who did not meet screening mammogram recommendations (2 years or more) and those who met screening mammogram recommendations (within the …

Farm To School Programs And Children's Dietary Behaviors, Kathleen Evers

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

There is an increasing promotion of the importance of fruit and vegetable consumption through prevention efforts, specifically in school systems, to control and prevent childhood obesity. Farm to School (FTS) programs offer interactive hands on experiences involving fruits and vegetables. This study examines a specific FTS program including a farmer interaction, and a broccoli taste testing experience for kindergarten and fourth grade students in a rural Kentucky county. By using a digital still photography method of plate waste, the decisions of approximately 115 students to take/not take broccoli and percentage of students’ consumption of broccoli was analyzed. Using chi-square and …

Fatal Injuries Among Young Workers In Kentucky, 2005-2014, Allison Christian

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

Background: Young workers have been more vulnerable to fatal and nonfatal work injuries. To gain a comprehensive understanding of the injuries that led to fatalities in younger workers, the goal of this study was to compare characteristics of young worker fatal injuries in those aged 16-24 to all workers aged 25 and older in Kentucky using a descriptive analysis.

Methods: A retrospective analysis of fatalities among workers under the age of 25 compared to workers aged 25 and older was performed over a ten-year period from 2005-2014 using Kentucky Fatality Assessment and Control Evaluation (FACE) program data.

Results …