Implementing The Be Proud! Be Responsible! Program In Wolfe County Public Schools, Casey Gill

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

Kentucky’s teen pregnancy rate is higher than the national average, and Wolfe County has one of the highest rates of teen pregnancy in the state. Teen pregnancy causes adverse health effects for both mother and baby. Teen mothers have a higher likelihood of dropping out of high school, increased health problems related to pregnancy such as preterm labor and preeclampsia, increased risk of being a single parent, and lower income and SES status. The baby is also affected, with an increased risk of living in a single parent household, and living in poverty. The Kentucky River District Health Department plans …

Utilizing A Formative Program Evaluation Approach And An Application Of Grounded Theory To Assess A Novel Harm Reduction Program, Dia Obonyo

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

Formative program evaluation is conducted during development and early implementation to ensure a program is feasible, appropriate, and acceptable. The Harm Reduction Initiative (HRI), a program of KIRP, the Kentucky AIDS Drug Assistance (KADAP) Income Reinvestment Program, seeks to address some of the underlying causes of infectious disease vulnerability resulting from drug use by focusing on infectious disease testing and linkage to care among high risk individuals. The primary objective of the evaluation was to achieve the following aims: 1) characterize the need for the program, 2) clarify the theory and logic of the program, 3) inform implementation, and 4) …

The Association Between The Medicare Bundled Payments Initiative And Cardiac Rehabilitation Enrollment, Jing Li

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

Cardiac rehabilitation (CR) represents a proven-effective intervention in secondary prevention that can stabilize, slow or reverse cardiovascular disease (CVD) progression, facilitate the ability of the patient to preserve or resume an active and functional contribution to the community, and reduce the risk of future cardiovascular events. Despite multiple guideline recommendations for CR and coverage by Medicare and most health plans, participation in CR remains low. Bundled payments are one of the suggested reforms designed to move health care providers toward to value-based care and is very applicable to the CR utilization in patients diagnosed with acute myocardial infarction (AMI) or …

Community Collaborations For Health Improvement In Laurel County, Kentucky: A Case Study, Kendall Ferrell

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

Kentucky is currently ranked fifth in the United States for opioid-involved overdose deaths. This study assesses how the results of a community health needs assessment have developed collaborative community effort to create and expand services and programs to address opioid and substance use disorder in Laurel County, Kentucky. This particular community continues to rank opioid and substance abuse as a major health concern causing efforts to be put in place to create an opioid response program. A consortium was formed that developed the community health needs assessment survey. The results from the survey were then incorporated in to a strategic …

Implementing Centeringpregnancy, A Group Prenatal Care Model, In Hamilton County, Ohio, Morgan Avery

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

Target Population and Need

Hamilton County, Ohio exhibits high rates of poverty, unemployment, and negative health outcomes. Specifically, Hamilton County continues to perform poorly in maternal and child health outcomes such as infant mortality, low birth weight, gestational diabetes, and preterm birth rates. Many people in the community exbibit poor health behaviors such as inadequate prenatal care, drug use during pregnancy, and smoking during pregnancy.

Program Approach

The Hamilton County Health Department intends to implement an evidence based group prenatal care program, CenteringPregnancy, in three health centers around Hamilton County in an effort to reduce poor maternal and child health …

Monitoring Opioid Use In Cancer Survivors: Implementation Of Screening, Brief Intervention, And Referral To Treatment (Sbirt) In A Clinical Setting, Jennifer M. Dolly Prothro

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

Kentucky is a disparate state, ranking as one of the top states in incidence, prevalence, and mortality for both opioid use disorders (OUD) and cancer. Due to the high volume of both diseases in the state, there is a rising concern about the overlap of these two populations. Cancer and its’ treatment are known to cause chronic pain, defined as daily pain lasting 3 months or longer. Generally, chronic pain patients of any type are known to experience higher rates of opioid misuse (21-28%) and opioid dependence (8-12%) than the general population (4.1%, 0.9% respectively). The risk of OUD must …

Prevalence Of Restricted Spirometry Within Two Eastern Kentucky Counties A Cross Sectional Study, Quincy Bascombe

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

Objective: This study examines the prevalence of restrictive spirometry in Eastern Kentucky and its association among men and women with various demographic and exposure (occupational and environmental) factors.

Methods: A cross sectional, cluster sample (N = 685) of participants from Letcher and Harlan Counties, aged 21 and over, answered a questionnaire focused on risk factors for respiratory health outcomes including questions on demographic, health, occupational, and environmental exposures variables. Pulmonary function tests were administered to all participants with no significant cardiovascular or cerebrovascular events within the past 30 days. Log-binomial regression was used to calculate prevalence ratios (PRs) …

Policy Analysis Of California Senate Bill 1138: Mandating Plant-Based Meal Options In Hospitals And Prisons, David Morton

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

Obesity, chronic disease, and poor nutrition are prevalent in the United States while healthcare costs rise. Nutritional research advancements have suggested the healthfulness of plant-based diets. In 2018, the California state senate passed Senate Bill 1138, requiring plant-based meal options in hospitals and prisons. This paper sought to examine the context surrounding the bill, determine the appropriateness of the bill, and recommend next steps for nutritional policies in the United States. In a review of the literature, malnutrition in hospitals and prisons is highly prevalent, and state governments have already made efforts to improve their citizens’ nutrition. In this analysis, …

Asthma In Scotland: Prescribing Trends Since The National Review Of Asthma Deaths (Nrad), Quentin Kenner

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

Asthma in Scotland: prescribing trends since the National Review of Asthma Deaths (NRAD)

Purpose: Asthma remains prevalent worldwide with implications for morbidity and mortality. In Scotland, 1 in 14 people are currently being treated for asthma. Asthma burden prompted the creation of the National Review of Asthma Deaths (NRAD), which identified contributing factors. Since the NRAD, guidelines have changed and therapeutic indicators have been developed with an increased emphasis on controller medications. Few publications describe how the NRAD study affected prescribing and if inequalities among the asthmatic population exist. This study aimed to determine whether patients were receiving appropriate treatment …

An Empirical Pilot Study Examining The Relationship Between Intention To Participate In Food Security Efforts And Childhood Socioeconomic Status Among Conference Attendees, Liana Dixon

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

Hunger is a global public health issue and finding a solution is a priority for the United Nations. The United Nations Sustainable Development Goal 2.2 calls for ending hunger, achieving food security, improving nutrition, and promoting sustainable agriculture for all people by 2030. The Universities Fighting World Hunger (UFWH) Summit, originating with the United Nation’s originated World Food Programme (WFP) and Auburn University, convenes attendees annually to share their own knowledge and ideas about how to “fight hunger,” as well as benefit from others knowledge and ideas. An important factor in tackling hunger and achieving health is addressing poverty and …

Occupational Opioid Surveillance And Intervention Evaluation: A Mixed Methods Collaborative Project Among Southeast First Responders, Robin Thompson

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

Introduction: This capstone assessed and addressed the issue of occupational opioid exposure among first responders working in the southeastern United States from 2017-2019. The first study aimed to assess the emerging issue of occupational opioid exposure as well as current knowledge and training practices among first responders of the following southeastern states: Kentucky, Georgia, Mississippi, and Virginia. The second study aimed to address this emerging issue through formative research followed by evaluation of the impact of an educational video and associated knowledge gained with a group of Kentucky-based first responders.

Methods: The analysis drew from three primary datasets: (1) self-reported …

Utilizing Cdc Framework For Program Evaluation To Inform Assessment Of An Interprofessional Leadership And Teamwork Curriculum, Madeline Aulisio

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

Background
The ability to collaborate effectively and lead a team when the need arises has become an expectation of health professionals. Graduates of health professions programs are expected to possess skillsets that will allow them to both collaborate and lead effectively in addition to their profession-specific knowledge. Leadership Legacy, an interprofessional elective created at the University of Kentucky in 2009, was designed to address this need.

Methods
After nearly ten years of cohorts, an opportunity arose for program evaluation with a reliable method such as the Centers for Disease Control and Prevention Framework for Program Evaluation. The novel use of …

Briding The Gap: Treatment Engagement Profiles And Outcomes Utilizing Novel Models, Allison Koetter

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

Background. The opioid epidemic is a public health emergency that requires collaboration between both private and public sectors to increase access to and capacity for efforts directed at treatment, prevention, and recovery. The Commonwealth of Kentucky via funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) created their State Targeted Response to the Opioid Crisis (Opioid STR) in order to help address these needs. The University of Kentucky, as an awardee of these funds, decided on an approach to highlight the Emergency Department (ED) bridge model, which links patients discharged from EDs and the hospital (inpatient addiction consult …

Syringe Exchange Programs And Emergency Department Use For Drug Overdoses In Kentucky, Timothy Williams

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

In 2015, syringe exchange programs (SEPs) were legalized in Kentucky as part of a response to the high and rising morbidity and mortality associated with injection drug use, particularly opioids. In addition to their primary function of preventing the spread of some infectious diseases by providing injection drug users (IDUs) with easy access to sterile injection equipment, SEPs may also offer ancillary services such as referrals to primary care providers and substance abuse and mental health treatment, as well as safe injection education and naloxone training. These ancillary services are intended to improve the overall health of IDUs and the …

Analysis Of High Potency Anticholinergic Prescribing In Scottish Nursing Home Patients, Alexandra Nugent

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

Purpose: The aim of this study was to compare the use of two or more high-potency anticholinergic (HPA) medications between patients 65 years and older in nursing homes and in the greater community using prescribing data. Methods: This secondary data analysis of the NHS Scotland PIS databased used prescription data from a nationally representative patient-level database. Patients were included were ≥65 years old, received ≥2HPA prescriptions from 2011Q2-2012Q1(11/12), 2016Q1-2017Q2(16/17), 2018Q2-2017Q1(18/19). The principle endpoint of this study was to assess for a change in patient’s relative risk of receiving ≥2HPA prescriptions. Results: 29,301 patients were identified. From 11/12 to 16/17 all …

Epidemiology Of Colorectal Cancer Comorbidities And Stage At Diagnosis, Survival, And Second Primary Malignancies In Kentucky, 2003-2016, Nikita Leigh Vundi

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

Background: Colorectal cancer (CRC) is the third most common type of cancer and the third most common cause of cancer death among men and women in the United States.^1-3 The American Cancer Society estimates that there will be 147,950 new cases of CRC and 53,200 CRC related deaths in the U.S. for the year 2020.3 Kentucky CRC incidence for 2012-2016 was the highest in the nation, and the mortality rate for years 2013-2017 was ranked 5th in the nation.^4-6 Risk factors for CRC include lifestyle factors, genetics, and disease status (comorbidities and treatment).2, 7 Diabetes has been …

Utilization Of A Community Pharmacy-Based Service For The Treatment Of Uncomplicated Urinary Tract Infections In Scotland, Robert Borchardt

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

Introduction: In November 2013, Scotland piloted a program in Grampian for the treatment of Urinary Tract Infections (UTIs) in community pharmacies, increasing health access for patients and reducing general practitioner workload. This program became known as ‘Pharmacy First’ and was later implemented nationwide in November 2017. This paper seeks to understand utilization of the Pharmacy First program across Scotland by patients and potential barriers to access.

Methods: Using data from the Prescribing Information System collected by the National Health Service of Scotland from July 2013 to April 2019, orders for uncomplicated UTIs were gathered by examining all nitrofurantoin and trimethoprim …

Assessing The Impact Of Raising The National Minimum Purchase Age Of Tobacco To 21 On Tobacco Use In Youth, Nicholas D. Guerra

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

Introduction: Tobacco use is the number one cause of preventable death in the United States with roughly 500,000 premature deaths a year and 3,200 youth smoking their first cigarette daily. On December 20, 2019, President Trump signed legislation to raise the federal minimum age of sale of tobacco products from 18 to 21 years, effective immediately. Prior to this recent regulation, over half of the US population was enforcing this age restriction. The objective of this research is to investigate the impact of tobacco 21 laws on tobacco use and project the national tobacco impact by using the state experiences …

A Rapid Review Of Physician Burden Secondary To Electronic Health Records Use In The United States From 2015 To 2020, Lori Wong

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

Background: After the passing of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, there has been a tremendous increase in the number of hospitals and providers adopting and using Electronic Health Records (EHRs). While EHRs were a way of improving efficiency, quality, and safety of healthcare, there is emerging evidence that they are contributing to physician burden, which can take the form of increased workload, decreased satisfaction, negative attitudes, and burnout. For instance, Arndt et al. found that physicians spent half of their workday on the EHR during and after work, and Robertson et al. …

Dalbavancin In The Community Emergency Department, Wesley Johnson

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

Introduction

Dalbavancin is an antibiotic within the class of medications known as lipoglycopeptides. This medication is given to patients presenting to the hospital with acute skin and skin-structure infections (ABSSSI). This is a unique medication because it is given as a one-time dose in the outpatient setting and it could prevent patients from requiring admission to the hospital.

Methods

The emergency department (ED) at Good Samaritan community hospital performed a trial period with dalbavancin and data was collected from November 2018 to March 2020. Retrospective chart review was performed to obtain patient data and outcomes. Patients would be contacted by …

Describing Interventional Approaches To The E-Cigarette/Juuling/Vaping Epidemic In Eastern Kentucky High Schools: A Case Study, Taylor Miller

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

Problem: Over the past few years there has been significant increase in vaping/juuling/e-cigarette use among the adolescent population. Since this is a new health issue, there are very few intervention programs for teens to receive education about these devices and support for quitting/treatment. The aim of this study was to provide insight on interventions that have already been implemented to provide direction for those seeking to design their own vape/juul/e-cigarette intervention. This was assessed by comparing approaches and lessons learned during the intervention implementation process.

Methods: The study was conducted using a case study approach. The researcher conducted interviews with …

Hospital-Based Safe To Sleep Intervention To Decrease Sleep-Related Infant Deaths In St. Louis, Missouri, Olivia M. Pokoski

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

The city of St. Louis in Missouri has an elevated infant mortality rate compared to St. Louis County, Missouri, and the United States. When controlling for race, black or African American infants are over twice as likely to die before their first birthday compared to their white counterparts. Two of the leading causes of infant death are sleep-related causes and sudden infant death syndrome (SIDS) which occur if the infant is placed in an unsafe sleeping environment. To address this burden Affinia Healthcare, Barnes Jewish Hospital, and St. Mary’s Hospital have decided to implement a hospital-based Safe to Sleep campaign. …

Improving Colorectal Cancer Screening Rates In Perry County, Vashisht Madabhushi

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

Appalachian Kentucky has one of the highest incidence and mortality rates from colorectal cancer (CRC) in the country. CRC is curable if identified early through screening. However, Perry County has suboptimal screening levels. A multimodal program of patient reminders and mailed screenings will be used to increase CRC screening rates in Perry County. The primary outcome will be evaluated using a T-test for this prospective cohort study. Short term outcomes include increased CRC screening rates in delinquent patients. Long term outcomes include increased CRC detection rates and decreased CRC mortality in Perry County.

Utilizing A Community-Based Doula Care Intervention To Reduce Race-Based Perinatal Health Inequities In Jefferson County, Kentucky, Brendan Mathews

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

Target Population and Need

The United States is currently the only industrialized nation in the world experiencing increasing rates of

pregnancy-related mortality.

1,2

Black women die at 3-4 times the rate of their white counterparts.

1-5

This disparity

is likely caused by the experience of systemic racism, which increases allostatic load and produces epigenetic

modifications linked to higher likelihood for poor birth outcomes. Biases perpetuated by health care providers

result in black women being less likely to receive quality healthcare and more likely to experience poor perinatal

1-7 to all pregnant women.

health outcomes.

The provision of doula-based care can …

Implementing The Fit And Strong! Program To Reduce Osteoarthritis In The Older Adult Population Of Carmel, Indiana, Lauren Alexis Bergstrom Roach

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

Osteoarthritis is a health outcome most commonly experienced by older adults. As the “baby boomer” population continues to age, the demand for services for older adults also increases. Fit and Strong! is an evidence-based program that works to reduce symptoms of osteoarthritis in this population through an 8-week course of physical activity classes, taught by Fit and Strong! certified instructors. Carmel, Indiana, a city in Hamilton County, has a high percentage of older adults within its population, and community health needs assessments have indicated that Hamilton County citizens have repeatedly expressed a need for resources for older members of the …

An Analysis Of The Association Between Adverse Childhood Experiences And Food Insecurity Within The United States, Margaret Brooks

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

Adverse childhood experiences and food insecurity are significant public health issues within the United States. Previous studies have established the overall relationship between ACEs and food insecurity. This research investigates the statistical relationship between individual ACE indicators and food insecurity as well as the relationship between having two or more ACEs and food insecurity.

Growing Green Minds: Implementation Of A School Garden & Nutrition Program For The Freedom Area School District In Rural Wisconsin, Marissa Schuh

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

Most children in the U.S. consume too few fruits and vegetables which is putting them at risk to develop obesity and other lifestyle diseases. The 2015-2020 Dietary Guidelines for Americans recommends that individuals should increase the amount and variety of fruits and vegetables consumed in order to prevent weight gain and other chronic diseases. Research shows that garden-based educational programs can increase children’s fruit and vegetable intake as well as change their preferences and attitudes towards eating and trying new fruits and vegetables. Incorporating a garden and nutrition curriculum into a school setting is an ideal opportunity to improve children’s …

Maternal Demographic And Psychosocial Factors Associated With Low Attendance Of A Centeringpregnancy Prenatal Care Program Among A Group Of High-Risk Women From Kentucky., Javeria Zafar

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

Abstract

Aim: To identify maternal demographic and psychosocial risk factors associated with poor attendance of CenteringPregnancy group prenatal care, and whether past or current experience of intimate partner violence is related to poor attendance.

Methods: Data from the EMPOWR (Efforts to Maximize Perinatal Outcomes in Women at risk) were used in a cross-sectional study design. Self-reported data from 607 high-risk pregnant women from Kentucky was used. Poor-attendance or non-compliance was defined as attending less than 6 out of the 10 group prenatal care session. Multivariable logistic regression was performed to assess the association between risk factors and compliance with the …

Diabetes Locus Of Control And Depression In Older Adults With Type 1 And Type 2 Diabetes: The Study Of Longevity In Diabetes, Jahvona Pretty

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

Abstract:

Objective: To determine if diabetes locus of control (dLOC) is associated with depression in older adults with type 1 and type 2 diabetes and whether this association differs by diabetes type.

Methods: Data for the current study were obtained from The Study of Longevity in Diabetes (SOLID), a prospective cohort study of aging, and diabetes. SOLID participants aged 60 and older with type 1 diabetes (T1D), type 2 diabetes (T2D), and without diabetes were recruited from members of Kaiser Permanente Northern California (KPNC). For the current study, we excluded all of the participants without diabetes since the primary exposure, …

Analysis Of Health Survey Data To Address Topics In Environmental And Public Health, Nimish Valvi

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

Introduction: Manganese is an essential trace element that can cause adverse health effects with deficiency and in excess amounts. The purpose of this study is to determine the asscociation of blood manganese levels and the prevalence of myocardial infarction, stroke, and renal dysfunction in a general US population.

Methods: Data were used from the National Health and Nutritional Examination Survey (NHANES) of non-institutionalized US adults 20 years and older using the 2011-2012, 2013-2014, and 2015-2016 survey cycles (n=16629). Weighted multivariable logistic regression models adjusted for age, race/ethnicity, sex, and poverty income ratio (PIR), were used to determine the association of …