Medicine and Health Sciences Commons^™

Changes In Primary Care Availability In Appalachia, Whitney Beckett

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

The Affordable Care Act (ACA) was a groundbreaking moment in the United States healthcare system. It affected many different aspects of the system, including access to primary care professionals. Primary care professionals provide a key role in American’s health, especially when it comes to preventative care. With one-third of Americans experiencing barriers to such access, a solution is desperately needed to increase said access. These barriers are especially profound in low-income, underserved areas such as the Appalachian regions of Georgia, Kentucky, Tennessee, and West Virginia. The ACA attempted to increase access via Medicaid expansion; however, not all States expanded their …

The Distribution Of Cp-Cre Cases From 2013-2020 In The Commonwealth Of Kentucky, Hannah Hiscox

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

Multidrug-resistant organisms (MDROs), particularly Carbapenem-Resistant Enterobacterales (CRE), pose a significant threat to public health due to their resistance to multiple antibiotics, including carbapenems. CRE infections, especially those producing carbapenemases (CP-CRE), are associated with high morbidity and mortality rates, making them a growing concern in healthcare settings. Despite the prevalence of CRE infections in the United States, limited data exist on the incidence and distribution of CP-CRE infections in specific regions, such as the Appalachian counties of Kentucky.

This study aimed to investigate the cumulative incidence and distribution of CP-CRE cases in Appalachian and non-Appalachian counties of Kentucky, as well as …

A Pilot Randomized Controlled Trial Of Smoking Cessation Induction Treatment For Rural, Underserved Cancer Survivors Across The Continuum Of Motivation To Quit, William Bowling

Theses and Dissertations--Psychology

The United States’ smoking prevalence has decreased substantially, but this public health improvement is unevenly distributed across the population. A promising individual-level approach to cancer control equity is to develop more acceptable and efficacious interventions that are widely disseminated to rural and other disadvantaged cancer survivors. Smoking cessation induction focuses not on long-term abstinence, but on engaging people in the process of making quit attempts and may be ideal for hard-to-reach populations. The aim of this pilot randomized controlled trial was to evaluate the feasibility and acceptability of a smoking cessation induction intervention designed for rural cancer survivors. The treatment …

Social And Biological Determinants Of Pregnancy-Related Mortality And Morbidity In A Rural, Underserved Population, Anna Hansen

Theses and Dissertations--Sociology

Cases of severe maternal morbidity (SMM) and pregnancy-related mortality (PRM) are increasing in the US. Research concerning SMM and PRM has neglected women in Central Appalachia; a largely rural, health-disparate population. The aims of this study are two-fold: (1) Examine patient-level and place-based predictors of SMM/PRM via hierarchical logistic regression modeling, and (2) Elucidate Appalachian healthcare patients’ and providers’ experiences with SMM/PRM, perceptions of contributing factors, and insights on points of intervention.

This study uses a mixed methods approach guided by the WHO’s conceptual framework for action on social determinants of health to identify determinants of SMM and PRM among …

Increasing Hpv Vaccination In Elliott And Lawrence Counties, Keeghan Francis

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

Appalachian counties within Kentucky have higher rates of HPV-related cancers, including cervical cancer. HPV vaccines are effective at reducing the risk of cervical cancer, but vaccination coverage in Appalachia remains low. The proposed program relies on recommended strategies to improve vaccine uptake by increasing access and demand for HPV vaccines. This will be done through school vaccine clinics and parent education on HPV, cervical cancer, and HPV vaccines.

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, …

Identifying Factors Associated With Syringe Reuse Among People Who Inject Drugs (Pwid) In Appalachia Kentucky, Grayson Keith Fuller

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

Aim: Syringe reuse contributes to the spread of infectious diseases. The purpose of this study is to identify factors associated with syringe reuse among people who inject drugs (PWID) in Kentucky.

Methods: PWID (n=238) completed interviewer-administered questionnaires to collect data on syringe reuse and demographic, behavioral, and clinical characteristics. Negative log binomial regression was used to model the associations.

Results: On average, people reused each syringe 9.3 times (median: 3; IQR: 2-10, range 1-95). Syringe reuse was higher among men [aOR=1.386; 95% CI: 1.041-1.845] and those who injected methamphetamine [aOR=2.122; 95% CI: 1.445-3.116]. Reuse was also higher among those who …

Environmental Respiratory Exposures And Pulmonary Function Among Residents Of Rural Appalachia, Kentucky, John C. Flunker

Theses and Dissertations--Epidemiology and Biostatistics

Introduction

Resource extraction exposures are hypothesized to promote adverse respiratory health outcomes among residents of rural Appalachia, yet no studies to date have simultaneously quantified small-scale geographic variation in residential exposure, individual level health factors, and respiratory health outcomes.

Methods

The Mountain Air Project (MAP) is a community engaged cross-sectional study based in Harlan and Letcher counties of Southeastern Kentucky. MAP utilized a novel small-scale method to define residential exposure boundaries: hydrologic unit code (HUC), which represents distinct drainages (AKA “hollows”) where residents cluster. We assigned the HUC level density of active and abandoned surface and underground mining, oil/gas wells, …

Identification Of Infant Feeding Practices In Eastern Kentucky And Southern West Virginia That Correlate With High Weight-For-Length, Havilah R. Adkins

DNP Projects

Background: Approximately 20% of children in the United States are obese. West Virginia and Kentucky rank in the top 10 for obesity rates in children as young as 2-4 years old. Obesity increases the risk for numerous short-term health problems and impacts long-term health, development, quality of life, and life expectancy. Research indicates that obesogenic behaviors can be addressed prior to the development of obesity or significant health problems to prevent, rather than treat. Interventions targeting caregivers of infants younger than 2-years can promote early development of healthy feeding habits that persist through the developmental stages of nutrition. Before a …

Maternal Proximity To Mountaintop Removal Mining And Birth Defects In Appalachian Kentucky, 1997-2003, Daniel B. Cooper

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

Background: Extraction of coal through mountaintop removal mining (MTR) alters many dimensions of the landscape, and explosive blasts, exposed rock, and coal washing have the potential to pollute air and water with substances known to increase risk of developmental and birth anomalies. Previous research suggests that infants born to mothers living in MTR coal mining counties have higher prevalence of most types of birth defects.

Objectives: This study seeks to examine further the relationship between MTR activity and birth defects by employing individual level exposure estimation through precise satellite data of MTR activity in the Appalachian region and maternal residence …

Patient Engagement In Patient Portals In Appalachia Versus Surrounding Us Census Regions: An Analysis Of Hints (Health Information National Trends Survey) Data, 2017 - 2020, Heather Lea Tudor

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

OBJECTIVE: Those living in the Appalachian regions face more significant healthcare disparities than those in the US. Patient portals can decrease disparities and increase health outcomes and health literacy. The purpose of this study was to determine if those living in the Appalachian region were offered access to and used their patient portals differently than the surrounding US Census region. Additionally, we aimed to determine if there was a difference in reported reasons for non-use of patient portals.

METHODS: This was a descriptive study using data from the National Cancer Institute’s Health Information National Trends Survey (HINTS) data (2017-2020) to …

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 …

Maternal Residential Proximity To Surface Mining Associated With Preterm Birth And Low Birth Weight In Appalachian Kentucky, Whitney Smith

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

Objective: This study aims to examine the relationship between maternal residency in a county with surface coal production and preterm birth or low birth weight.

Methods: A cross-sectional study was conducted using birth records (n=62,766) for 54 Appalachian counties and coal production in tons. Logistic regression and chi-squared analysis was done to analyze the relationship between surface coal mining and preterm birth and low birth weight in two different birth groups.

Results: After controlling for covariates, statistically significant increases were seen in Birth Group 1 and Birth group 2. Birth Group 1 had statistically significant results for preterm birth ((1.19 …

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 …

“You’Re Not Alone In This”: Navigating Patients To Colorectal Cancer Screening In Appalachian Kentucky Communities, Audrey Bachman

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

In eastern Kentucky, some communities experience colorectal cancer (CRC) mortality rates as high as 25.9 deaths per 100,000 people as compared to the national rate of 14.8 deaths per 100,000 people (NCI, 2018; Kentucky Cancer Registry, 2018). Innovative screening mechanisms, coupled with patient navigation services, may be the key to increasing screening rates and preventing unnecessary deaths in the region. The current study focuses on the accounts of patient navigators (n = 9) to identify the essential ingredients for addressing barriers to CRC screening cited by Appalachian Kentucky patients. Using the core tenants of effective patient navigation programs (Freeman & …

Uterine Corpus Malignancies In Appalachia Kentucky: Incidence, Survival And Related Health Disparities, Marian Symmes Johnson

Theses and Dissertations--Clinical Research Design

Uterine cancer is the nation’s most common gynecologic malignancy but is understudied in the geographically and socioeconomically diverse state of Kentucky (KY). This study assessed the frequency, distribution, and survival of uterine corpus malignancies in KY, and specifically the differences between Appalachia (AP) and non-Appalachia (NAP).

This study utilizes SEER and Kentucky Cancer Registries to study uterine corpus malignancy between January 1, 2000 and December 31, 2014. The analysis looks at incidence between diagnoses in AP and NAP. Evaluation criteria includes: tumor histology (Type I, Type II, sarcoma, and mixed uterine malignancy), age, race, smoking status, stage at diagnosis, insurance …

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 …

Cardiovascular Disease Risk Factors Among Emerging Adults In College, Demetrius A. Abshire

Theses and Dissertations--Nursing

The purpose of this dissertation was to examine factors associated with cardiovascular disease (CVD) risk among emerging adults in college aged 18-25 years. CVD risks that develop during this period often persist into adulthood making it an ideal time to target CVD prevention. The specific aims of this dissertation were to 1) explore perceptions of cardiovascular risk among emerging adult men in college; 2) compare differences in unhealthy behaviors and obesity between emerging adults in college living in rural, Appalachian Kentucky and urban Fayette County, Kentucky; and 3) compare measures of general and abdominal obesity in predicting blood pressure among …

Distribution Of Wildlife Rabies In Central Appalachia And Analysis Of Factors Influencing Human Exposure, Sara J. Reilly

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

Abstract Background: The rabies virus is a Lyssavirus of the family Rhabdoviridae which affects all mammals and causes progressive encephalomyelitis that is fatal in nearly one hundred percent of untreated cases. In the United States, wildlife act as the primary reservoir for rabies and prevention, surveillance, and control costs remain high. The purpose of this study is to understand the current distribution of wildlife rabies in Central Appalachia, as well as identify any demographic or geographic factors which may affect the risk of human exposure at the county level. Methods: A spatial statistical analysis using StatScan was performed to identify …

Untangling Neoliberalism’S Gordian Knot: Cancer Prevention And Control Services For Rural Appalachian Populations, George F. Bills

Theses and Dissertations--Sociology

In eastern Kentucky, as in much of central Appalachia, current local storylines narrate the frictions and contradictions involved in the structural transition from a post-WWII Fordist industrial economy and a Keynesian welfare state to a Post-Fordist service economy and Neoliberal hollow state, starving for energy to sustain consumer indulgence (Jessop, 1993; Harvey, 2003; 2005). Neoliberalism is the ideological force redefining the “societal infrastructure of language” that legitimates this transition, in part by redefining the key terms of democracy and citizenship, as well as valorizing the market, the individual, and technocratic innovation (Chouliaraki & Fairclough, 1999; Harvey, 2005). This project develops …