Medicine and Health Sciences Commons^™

Improving Black Maternal Outcomes In Christian County, Ky: A Social Marketing Approach To Perinatal Provider Change, Ariel A. Arthur

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

Compared to other states in the country, Kentucky has historically poor population health outcomes. While the statewide maternal mortality rate is 16.1 per 100,000 live births, this statistic belies the stark racial disparities that exist. In 2018, the pregnancy-related death rate for Black women was 40.2 per 100,000 live births compared to 13.1 for White women. This pattern is persistent even after controlling for socioeconomic status, prenatal care, and other protective factors. Research shows that institutional and interpersonal racism when receiving obstetric care contributes to poor childbirth and postpartum outcomes for Black women. Additionally, geography and rural status may compound …

Implementation Of A School-Based Adolescent Pregnancy Prevention Program In Harlan County, Kentucky, Jaycea Frederick

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

Kentucky has the 6^th highest rate of adolescent pregnancy in the United States and Harlan County ranks among the highest rates in the state. Adolescent pregnancy is a public health problem and costs taxpayers in the United States around $9.4 billion each year. Overall, there have been declines in adolescent pregnancy but the national average soars above those in other Western industrialized nations such as the United Kingdom. Implementing a comprehensive sexual health education program in a public school setting is an efficient strategy to reach numerous adolescents and influence sexual health knowledge and help to delay the initiation …

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 …

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 …

The Impact Of Kentucky's Medicaid Expansion Under The Affordable Care Act On Dental Care Visits, Mutlaq Alotaibi

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

Background. Lack of health insurance, cost of dental care services, and shortage of dental workforce are leading barriers to dental care access. Low-income adults and those who reside in areas with low dentist supply are less likely to visits a dental office than their counterparts. Studies have reported that dental visits increased among low-income adults in states that expanded Medicaid under the Affordable Care Act (ACA) and have an adequate number of dentists. However, the impact of Medicaid expansion on income-based disparities and urban-rural disparities in dental care visits is unclear.

Objectives. The aim of this study is to examine …

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: …

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 …

Barriers And Facilitors Of Healthcare Use Among People Who Inject Drugs, C. Brooke Kuns-Adkins

Theses and Dissertations--Nursing

Hepatitis C Virus (HCV) is an infection that can have grave consequences when left untreated. Hepatitis C can be easily eradicated with direct acting antiviral therapy. People who inject drugs (PWID) and inmates are among those with the highest incidence of HCV. However, cure rates among this population remains low. This is, in part, related to an interruption in the HCV care cascade such that only 30% of PWID are linked to care and only 8% of those receive treatment. Inadequate screening and failure to be linked to HCV care remain the largest impediments to treatment success. There is limited …

The Effect Of A School-Based Health Center On Access To Care In A Rural Community, Macey Cornwell

DNP Projects

BACKGROUND: Lack of access to healthcare is a nationwide issue that affects underserved, minority, and rural populations. School-Based Health Centers (SBHCs) is one way to help increase access to care for students, staff, and family members.

PURPOSE: The purpose of this project was to provide preliminary data on the impact of a SBHC in a rural Kentucky community on access to care and school attendance.

METHODS: A univariate descriptive analysis was conducted to evaluate the perceived impact of the SBHC on access to care and demographic factors. Data was analyzed using Pearson’s Product Moment Correlation, two-sample t-tests, and The Wilcoxon …

The School Food Environment And Its Association With Dietary Intake Among Rural Adolescents, Hannah F. Hickey

Theses and Dissertations--Nutrition and Food Systems

The school food environment has the ability to increase the consumption of fruit and vegetables in rural adolescents. This study used a survey to allow adolescents in seven rural counties to self-report their fruit and vegetable intake as well as utilizing the USDA Mathematica tool and the School Nutrition and Meal Cost Study audits to evaluate what food and beverage products were actually available to adolescents. By using these two measures, associations between fruit and vegetable intake and availability of healthy and unhealthy foods were determined. The availability of healthy snacks and beverages was found to be associated with sugar-sweetened …

Barriers To Colorectal Cancer Screening Within A Rural Community In Ohio, Kristina Knoll

DNP Projects

Purpose: The purpose of this study was to perform a needs assessment within the primary care practice of ProMedica Family Medicine in Fostoria, OH. The needs assessment will specifically identify intentions and behaviors, attitudes and beliefs, subjective norms about behavioral control, and healthcare provider or healthcare system barriers related to colorectal cancer screening.

Methods: This was a cross-sectional study using a survey among a convenience sample of patients who were 50 - 75 years of age and were not currently up-to-date with their colorectal cancer screening. In total, 222 patients were screened, 133 patients were determined to not be up-to-date, …

Promoting Healthy Eating And Physical Activity: A Qualitative Examination Of Community-Based Obesity Interventions In Rural Kentucky, Brooke F. Butterworth

Theses and Dissertations--Nutrition and Food Systems

Rural Americans are medically underserved groups and are at greater risk of becoming obese than urban Americans. The purpose of this qualitative study was to determine the perceived causes of obesity in six counties of rural Kentucky and to determine how to customize strategies to reduce obesity in these areas. University of Kentucky Cooperative Extension Service Agents formed coalitions in each of the six counties to assess their communities’ needs and assets to inform plans for implementing evidence-based obesity interventions. Between February and August of 2015, the coalitions were convened for a total of 11 meetings. Each of the coalition …

Community Level Assessment For Breastfeeding In The Gateway District, Vanessa Flannery

DNP Projects

Purpose: To assess community level support for breastfeeding in the Gateway District of eastern Kentucky.

Methods: A descriptive study was conducted to identify institutional support of breastfeeding women. Data collected during interviews included community level support based on the framework of the Ten Step program from the Baby-Friendly Hospital Initiative (BFHI) (WHO & UNICEF, 2009) and the Mother-Friendly Worksite Initiative (Texas Department of State Health Services, 2012). Respondents answered questions to determine breastfeeding support from the healthcare, education and business communities.

Results: Of the ten organizations whose representatives were interviewed, 100% perceived health benefits for mothers and infants from breastfeeding. …

Are There Rural-Urban Differences In Dentist Supply?, Mutlaq Alotaibi

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

The purpose of this project was to examine the supply of dentists in the Commonwealth of Kentucky at the county level. Counties with shortages in dentist supply were determined and associated factors were examined.

Several county-level variables were analyzed. These included total number of dentists, total county population, dentist to population ratio, dentist supply shortage, median household income, median age, percent of Medicaid enrollees, rurality, oral cancer crude incidence and mortality rates per 100,000 and percent of adults missing six or more teeth.

This project showed that 42 of the 120 counties in Kentucky had shortages in dentist supply. Also, …

Characterizing Health Risks In Privately-Supplied Drinking Water Due To Agricultural Practices In Rural Western Kentucky, Karen Schroeder Card

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

At least 400,000 people in Kentucky rely on private water wells or springs for drinking water. 551 households that rely on private water wells for drinking water were surveyed in 2009 about adverse health outcomes, including selected cancer incidence, adverse birth outcomes, and yearly incidence of diarrheal illness. Survey recipients were drawn from a population of well owners in the Jackson Purchase Region of Kentucky whose wells were tested for nitrate-nitrogen (NO3-N), triazine pesticides, and E. coli or total coliforms, by Kentucky Geologic Survey within the previous 15 years. 214 questionnaires were returned and matched to water quality data for …

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 …

Relationships Of Access And Affordability To Household Food Security Status Among Rural, Low Income Caregivers, Jodi Elaine Marani

Theses and Dissertations--Kinesiology and Health Promotion

Household food security status in rural areas is a significant issue facing caregivers as positive health outcomes depend on appropriate access to healthy foods necessary to lead an active life. Access and affordability of healthy foods are two mediating factors of household food security that may be improved to ultimately increase rates of food security and overall health status among rural, low income populations.

The purpose of the study was to examine the factors of access and affordability of nutritionally adequate food sources in one rural community in relation to food security status through the perspective of its caregivers. In …

Factors Associated With Tobacco Use Among Rural And Urban Pregnant Women, Whitney Jeanne Katirai

University of Kentucky Doctoral Dissertations

The purpose of this study was to investigate the influences of smoking on rural and urban pregnant women. More specifically, the variables of the knowledge of health effects, health provider recommendations, subscores from the Health Belief Model (HBM), and social support were explored in relation to the smoking behavior of pregnant women. A secondary purpose was to investigate the accuracy of self-reported smoking during pregnancy using biochemical validation. Pregnant women (N=71) completed an anonymous questionnaire, designed by the researcher, to identify variables that predicted smoking for urban and rural women. Participants also gave a saliva sample for cotinine testing.

Approximately …