Medicine and Health Sciences Commons^™

Respiratory Function And Associated Risk Factors In The Kentucky Women’S Health Registry, Negash Amsalu

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

From the University of Kentucky Women’s Health Registry Database (KWHRD) a total of 1838 women were voluntarily asked to undergo Spirometric respiratory function tests. These women came to the clinic for various reasons. Various independent variables (risk factors) were also recorded for these women. Among these risk factors were: age, BMI, smoking status, asthmatic status, educational status and ethnicity.

The purpose of the study was to investigate whether any of the risk factors had significant impacts on women’s respiratory health. Appropriate categorizations were tabulated for each risk factor so that comparisons would be possible and easier. The motivation of the …

Construction Fatalities In Kentucky, Tennessee And West Virgina Between 2005 And 2014, Jacob Petrey

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

Background: The construction industry involves many hazards and accounts for the greatest number of work related fatalities in the United States. The objective of this study was to characterize the demographics of people involved in construction fatalities and the causes of these fatalities in Kentucky, Tennessee and West Virginia between 2005 and 2014.

Methods: The Bureau of Labor Statistics Census of Fatal Occupation Injuries (CFOI) was the source of data about the number of fatalities, rates and characteristics about fatalities for each state. The U.S. Census Bureau was also used to find the average annual construction population for each state …

Hepatitis C Screening And Treatment Of Prisoners: Analysis Of Policy And Practice In Kentucky, Charity Faith Kranz

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

INTRODUCTION

The United States and the Commonwealth of Kentucky are currently overwhelmed by a triad of complex epidemics—incarceration, opioid overdose deaths secondary to substance use disorders, and hepatitis C. Research has suggested hepatitis C screening and treatment of prisoners may be a cost-effective strategy to address the hepatitis C epidemic. Since Kentucky has been particularly impacted by these interrelated health threats, further exploration of hepatitis C in Kentucky prison populations and their potential role in addressing these epidemics is warranted.

Primary Objective

The main goal of this research was to examine hepatitis C screening and treatment policy and practice within …

Evaluating The Relationship Between Diabetes And Menstrual Cycle Irregularities, Kailyn Leanne Conner

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

Purpose. To evaluate the relationship between menstrual cycle irregularity and several key variables, and to determine whether the odds of diabetic women self-reporting menstrual cycle irregularities is greater than non-diabetic women self-reporting menstrual cycle irregularities.

Methods. A cross-sectional study was conducted using data from the Kentucky Women’s Health Registry from 2006 to 2014. The data was restricted based on age (used as a proxy for menopause status) and self-reported pregnancy and breastfeeding status, as well as eligibility to menstruate, yielding a final population of 4,256 participants for analysis. Basic statistical frequency analyses were conducted, stratified by menstrual cycle …

Implementing The Family Check-Up Program To Prevent Initiation Of Opioid Misuse Among Sixth Graders In Pike County, Kentucky, Emily Edmiston

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

The availability of prescriptions for opioids has been increasing since 1996. This type of drug is commonly misused by adolescents ages 12 to 17, making the trends in availability particularly alarming. Adolescence is a crucial point initiation of several risk behaviors, including substance use. During this time, parental monitoring, or awareness of the child’s activities and communication about those activities, is incredibly important for prevention of those risk behaviors. Despite this importance, parental monitoring behaviors often slip during this time. To help strengthen family management and communication leading into adolescence, the Pike County Health Department (PCHD)is proposing the implementation of …

Do Numbers Matter? Comparing Single Homicide Followed By Suicide And Multiple Homicide Followed By Suicide Using The National Violent Death Reporting System, 2003-2012, Courtney Blondino

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

Introduction

Homicide-followed-by-suicide or homicide-suicides were examined to understand the dynamics of acting outwardly and inwardly violent in a single incident. The purpose of this study was to identify if specific circumstances had an association with the number of victims per homicidesuicide incident. This study addresses an important public health issue by encouraging an accurate viewpoint of homicide-suicide in order to properly program prevention efforts.

Methods

Using the restricted access data (RAD) from 17 National Violent Death Reporting System (NVDRS) states, we characterized 1904 homicide-suicide incidents through qualitative and quantitative analysis based on victim and suspect demographic information, method of injury, …

Breathe Easy Mississippi, Christian Rashad Campbell

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

Asthma disproportionately affects rural minority children and is the leading reason for all school absences in our nation. Breathe Easy Mississippi is a multi-level intervention designed to improve long term control of asthma in youth. Breathe Easy Mississippi components include: 1) Home Visits by asthma counselors to identify asthma triggers and remediate the child’s environment, and 2) School Based Curriculum (Asthma Education) to promote ideal asthma management knowledge and foster more effective relationships between children, parents, healthcare professionals and paraprofessionals. Breathe Easy Mississippi will be implemented in a total of six schools that make up the entire elementary school district …

Validity Of The Public Health Accreditation Board’S Governance Measures, Badr Alnasser

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

Background. The dynamics through which governance operates and impacts performance has been the focus of scholars in recent years. This is also true in public health systems, where there is a growing tendency to understand governance mechanisms and dimensions, as illustrated in the Public Health Accreditation Board’s (PHAB’s) Domain 12, which tends to measure governance engagement in health departments. The development of Domain 12 standards and measures has undergone systematic revisions by subject matters and experts. However, there is still a need for a scientific approach to assess the validity of such measures, or examine whether they measure what …

The Effects Of Tobacco Policy On Tobacco Treatment In Psychiatric Institutions, Terrence A. Sharper Ii

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

Introduction: Tobacco use among those with mental illnesses is substantially higher than the general population. To avoid tobacco related comorbidities, tobacco policies are an important aspect for control of tobacco use, exposure, and to support tobacco treatment.

Aim: To conduct a systematic literature review of tobacco treatment policies in psychiatric institutions and examine the knowledge, availability of resources, and perceived barriers for treating tobacco use among managers.

Method: There were two main parts used to examine tobacco treatment policies in psychiatric facilities. First, a review of the literature summarized the effect of different tobacco-free policies on tobacco treatment delivery in …

The Role Of Stress In The Relationship Between Shift Worked And Hypertension, Madison Liford

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

Purpose: Individuals working non-daytime shifts have been reported to have an increased risk for many negative health outcomes, including poor cardiovascular health. This study aims to examine the relationship between shift worked and hypertension—a major risk factor for cardiovascular disease. Of particular interest in this study was the role of stress and type of shift worked (day, evening, night, or rotating) in this relationship.

Methods: The study utilized National Health and Nutrition Examination Survey data collected between 2005 and 2010. The study population was limited to adult workers 20 years of age and older (n=9356). Initial descriptive statistics of …

Hepatocellular Carcinoma Among Kentencky Residents From 1995 To 2011: Risk Factors For Late-Stage Diagnosis And Survivability, Zilahatou B. Tohon

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

Introduction: Hepatocellular carcinoma incidence and mortality rates are the rise in the United States and in Kentucky as well. According to the National Cancer Institute, there will be an estimated 40,710 new cases of liver and intrahepatic bile duct cancer and 28,920 deaths in 2017, with than 20% of 5-years survivors ¹. The numbers of new cases expected by year 2030 is 37,574 ². The aim of this capstone is to assess the risk factors of late-stage diagnosis and survivability in Kentucky.

Methods: A combined dataset from the Kentucky Cancer Registry and the Behavioral Risk Factor Surveillance System …

All 4 Hardin County Freshman!, Cortney Lynn Gandy

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

Within this application for funding the Lincoln Trail Health Department proposes an evidenced based intervention for implementation into two high schools in the Hardin County with the long term goals of decreasing the rate of sexually transmitted infections in the county. The LTHD based in Elizabethtown, Kentucky services six counties in central Kentucky. The community health needs assessment and community health improvement plans for the county highlighted the problem of sexually transmitted infections in the community. The Centers for Disease Control also produces data about the higher rate of STIs in Hardin county in respect to Kentucky and the US …

Implementing The Alive! Behavioral Intervention Program In Phillips County, Arkansas, Raeschell Williams

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

The Arkansas Department of Health proposes implementing the Alive! behavioral intervention program in Phillips County, Arkansas to decrease the prevalence of obesity in this community. Alive!, A Lifestyle Intervention Via Email, is an evidence-bases, email-derived, worksite intervention focused on reducing saturated fats, increasing fruit and vegetable intake, and increasing physical activity. As an email-based program, participants will receive weekly emails tailored to their individual goals with reminder emails delivered during the week with small-step goals to help the participant achieve their larger goal. As the country with the highest prevalence of obesity and second highest prevalence of obesity in 2014, …

The Effects Of Improved Water And Sanitation Access On Under Five Child Diarrhea In Peru, April Ballard

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

Significance: Diseases related to poor or lack of access to clean water, sanitation, and hygiene negatively impact health, education, and development worldwide and cause millions of deaths in children each year. Health outcomes associated with lack of access to clean water and sanitation are under-evaluated.

Aim: To assess the effect of improved water and sanitation infrastructure development on child morbidity in Peru by investigating diarrhea in children under five years of age.

Methods: The child, family, and household data from the Peruvian Demographic and Health Surveys (DHS) were used to evaluate the association between access to water …

Diagnostic Prevalence Of Diabetes Among Older Adults In Rural Appalachia, Gabriella Hodges

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

Background

The rural, mountainous Appalachian region continuously has poorer health outcomes than the rest of the United States. This is true for many chronic diseases including diabetes: the 7th leading cause of death in the United States. This study assessed differences in the prevalence of diagnosed diabetes between older adults in rural, Appalachian counties and rural, non- Appalachian counties.

Methods

Data for the year 2013 was extracted from the Centers for Medicare and Medicaid Services (CMS) Public Use Files for Medicare beneficiaries (September 2015), which provides county level prevalence for diabetes as well as several other conditions among Medicare fee-for-service …

Compliance And Treatment Failure Of Hepatitis C With Direct-Acting Antivirals: A 2-Year Retrospective, Observational Study In Kentucky Medicaid Patients, Juequan Nie

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

Background: New generation Direct-acting antivirals (DAAs) for the treatment of chronic hepatitis C infection have been on the market for more than 3 years since late 2013. Whether these medications cure patients at the rates claimed in clinical trials is not clear. Furthermore, as compliance is known to affect treatment outcomes, DAAs compliance rate is worth studying.

Methods: We analyzed the association of social-demographic, DAA use, enrollment with Kentucky Medicaid Managed Care Organizations (MCOs) and comorbidities, and DAA compliance in 1128 Kentucky Medicaid members treated with DAAs between August 07, 2014 and August 06, 2016.

Results: Age, MCOs, liver fibrosis …

Spatial Distribution Of Partner-Seeking Men Who Have Sex With Men (Msm): An Epidemiologic Study Using Msm Geosocial Networking Applications, Angel Blake Algarin

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

Background: Geosocial networking (GSN) applications (apps) have made finding sexual partners easier for partner-seeking MSM, raising challenges for HIV/STI prevention but also providing opportunities for research. To date, little is known about app usage in smaller cities where there may be more stigma surrounding MSM.

Objective: This study uses GSN apps to identify areas with high density partner-seeking MSM, and to characterize these areas using Census block group demographic measures in a Southern mid-sized city.

Methods: Data collection points (n=62) were spaced in two-mile increments along nine routes (112 miles) covering the area. At each point, staff …

Filling The Gap In Obesity Prevention: Implementation Of The General’S Activity Program (Gap) In Carroll County, Kentucky, Brent Emerson

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

As obesity rates continue to rise, there is a significant need for public health programs that are able to effectively increase physical activity at the community level. Regular physical activity can help reduce the risk of negative health outcomes associated with obesity including cardiovascular disease, type 2 diabetes, and some forms of cancer while also strengthening muscles, improving mental health and mood, and increasing average life expectancy. Previous research has supported that one way to increase physical activity at the community level is through social marketing of state and local parks. Through the promotion of parks, community residents are able …

Sociodemographic And Clinical Predictors Of Triple Negative Breast Cancer, Madison Ries

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

Background and Objectives

Breast cancer has the highest incidence rates among women and is the second leading cause of death due to cancer in women. Of all breast cancers, triple negative breast cancer (TNBC) accounts for about one-fifth of breast cancer and tends to result in an aggressive form with larger tumors and rates of metastasis and is more frequently found in younger women. This results in an important need in information regarding the risk of diagnosis with triple negative breast cancer over other forms and covariates associated with death and TNBC. This paper studies the relationship between race, tobacco …

Addressing Barriers To Hepatitis C Treatment Initiation In Kentucky Clinic, Moaz Abdelwadoud

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

Introduction. Hepatitis C virus (HCV) is the most prevalent blood borne infection in the United States and its chronic infection has a high burden on the American healthcare system. Since 2014, the all-oral Directly Acting Antiviral (DAA)-based therapy has been established as the standardized curative treatment for HCV with unprecedented high effectiveness and tolerability. Nevertheless, there is a significant gap between the promise from DAAs benefits and the treatment initiation rates in the United States and Kentucky.

Objectives. The goal of this study is to improve the access to the all-oral DAA-based treatment among HCV patients seeking outpatient …

Factors Associated With Large Vehicle Collision Fatalities From 2009-2015, An Assessment Of Factors Relevant To The 2014 Implementation Of The National Registry Of Certified Medical Examiners And Strategies For Driver Safety, Melinda L. Carol

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

OBJECTIVE: The Federal Motor Carrier Safety Administration (FMCSA) developed a National Registry of Certified Medical Examiners (NRCME) as a stride toward greater driver safety and public health. This retrospective, observational, cross-section study is intended to trend and analyze driver related factors that are pertinent to FMCSA certifying medical examination performed by NRCME providers in addition to driver behaviors and environmental factors from the years 2009 to 2015. The results of this study are intended to speculate the effectiveness of the NRCME and propose additional public health interventions aimed to reduce large vehicle fatalities.

METHODS: Data was extracted from …

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 …

Planet Health: A School-Based Health Promotion Program, Jane Katherine Landon

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

The Kentucky River District Health Department (KRDHD) proposes implementation of Planet Health, a school-based intervention aimed at increasing healthful nutrition and fitness behaviors in middle- and high-school aged students. Planet Health’s core messaging (increasing fruit and vegetable intake, increasing physical activity, decreasing screen time, decreasing sugar-sweetened beverage and trans-fat intake) contributes to our long-term goal of decreasing childhood obesity in our service area. Planet Health will be offered to 3 counties in our service area (Lee, Letcher and Wolfe) with planned expansion to all counties in the KRDHD service area within 5 years of the original pilot. This project will …

Malignant Melanoma In Kentucky: An Analysis Of The Individual And Social Factors On Disease Stage And Treatment, Virginia Valentin

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

Introduction: In 2016 there will be an estimated 76,380 new cases of malignant melanoma and 10,130 deaths in the United States (US). ¹ Malignant melanoma incidence is increasing faster than any other preventable cancer in the US with an expected 112,000 new cases a year by 2030. ^2,3 This capstone attempts to quantify the association of individual and social factors on melanoma late-stage diagnosis and non-adherence to surgical treatment guidelines for early-stage lesions in Kentucky.

Methods: The analysis combines three datasets: individual level data from the Kentucky Cancer Registry, census tract level data from the US Census and …

Smart Moves Bright Bodies: A Rural Adaptation To Combat Obesity Among African-American Teenagers In Wilcox And Lowndes Counties, Alabama, Nicole D. Fields

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

Obesity is a significant problem in the United States; however, it is a burgeoning epidemic among youth in the United States. As of 2016, Alabama is the second-most obese state in the nation¹ and 16% of Alabama adolescents are obese². While obesity is a significant problem across all ethnic groups, minorities bear a disproportionate burden in Alabama: one in five African-American adolescents is obese². This disproportionate burden is demonstrated in two Alabama counties: Wilcox and Lowndes. Both counties are predominately African-American and rank in the bottom ten counties, statewide, for overall health outcomes^9,14. …

Vaccine-Preventable Disease Surveillance In Kentucky, Katherine Jay

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

Background: Vaccine-preventable disease (VPD) surveillance is important component to the success of vaccines. This report examines the levels of 13 of these VPDs in the state of Kentucky from 2005 to 2015.

Methods: All reported cases in the state of Kentucky for the years 2005 to 2015 of 13 vaccine-preventable diseases were obtained from the Disease Surveillance Module (DSM) and the National Electronic Disease Surveillance System (NEDSS). Where enough cases were reported, descriptive statistics were prepared. For acute hepatitis B and pertussis, more thorough analysis was performed.

Results: Rates of acute hepatitis B in Kentucky from 2005 …

The Impacts Of Recreational Marijuana Legalization On Colorado Policy Analysis On Amendment 64, Santhi Chilukuri

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

This report is a policy analysis on the impacts of Colorado’s Amendment 64. Marijuana is the most commonly used illicit drug in the U.S, and a Schedule 1 Drug under the federal government. Despite this, twenty-nine states and territories in the U.S. have legalized it for medicinal purposes; (Hanson NCSL, 2017) four of which legalized it for recreational purposes. (Hall & Lynskey, 2016) Medical Marijuana has been legal in Colorado since 2009; however, Amendment 64 was passed in 2012 which legalized the possession, retail sale, and purchase of marijuana to Colorado state residents 21 and over. Commercialization in retail stores …

A Comprehensive Multi-Level Approach To Increasing Hpv Vaccination Rates In Rural Kentucky, Jim Weygandt

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

The Graves County Health Department (GCHD) proposes implementation of a multi-level approach to increase Human Papillomavirus (HPV) vaccination rates in Graves County, KY. The approach utilizes multiple evidence-based strategies, including Assessment, Feedback, Incentive, Exchange (AFIX), Vaccines for Children (VFC), Kentucky Immunization Registry (KIR), Comprehensive Clinic Assessment Application (CoCASA), and vaccines per protocol. This proposed project utilizes family medicine and pediatric clinics, pharmacies, and school nurses to deliver the intervention to the target population, which includes 11-12-year-old adolescents residing in Graves County. The objectives of this HPV vaccination-focused intervention align with Healthy People 2020 goals and objectives, the 2012-2013 President’s Cancer …

Association Between Cerebrovascular Pathology And Anti-Hypertensive Treatment In Diabetics, Gary Owen

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

Background

Dementia is a growing public health concern as the population ages. Vascular dementia is the second most common type of dementia behind Alzheimer’s, and is caused by cerebrovascular damage, such as infarcts and hemorrhages. As in systemic cardiovascular disease, diabetes and hypertension are leading risk factors for cerebrovascular pathology. Anti-hypertensive treatment (AHT), therefore, may have a role in preventing cerebrovascular damage.

Methods

A case-control study design was utilized to evaluate any association between AHT during life and cerebrovascular pathology in autopsy in diabetic participants from the National Alzheimer’s Coordinating Centers (NACC). Pathology outcomes included infarcts of various sizes and …

Cadmium Exposure And Residence-To-Road Proximity In Eastern Kentucky, Ellen Flora

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

Background and Objectives

Cadmium is a carcinogenic and toxic metal. The general population can be exposed to cadmium from multiple sources. The purpose of this study is to evaluate the association of urinary cadmium and residence distance-to-road by performing landscape analyses in eastern Kentucky, a region where smoking prevalence is high, coal production has been a primary industry, and the landscape is predominantly undeveloped. Composite dust samples were also collected and analyzed for Cadmium (Cd), Manganese (Mn), and Zinc (Zn). The primary objective of this study is to ascertain if there is an association between participants with elevated accumulated cadmium …