Public Health Commons^™

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. …

Revamp It: Utilization Of Socioecological Approach To Combat Adolescent Obesity In Knott County, Kentucky, Jonathan Wang

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

The Kentucky River District Health Department proposes the implementation of REVAMP IT in four selected elementary schools in Knott County, Kentucky to improve subjective attitudes towards various aspects of health knowledge, physical activity, social support, and screen-time, as well as reduce biometrically measured television time and increased step count. REVAMP IT is an evidence-based program that utilizes the socioecological model of Public Health to target aspects of the individual, relational, and community level to facilitate changes from multiple aspects. Screen-time and physical activity goals will be individually set by students, and Knott County Elementary School teachers will be responsible for …

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 …

Bridging Public Health And Clinical Practice: A Pilot Of The Cdc’S Stopping Elderly Accidents, Deaths, And Injuries (Steadi) Fall Risk Screening And Prevention Program In An Academic Medical Center Family And Community Medicine Clinic, Carolyn C. Shammas

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

Background: Fall-related morbidity and mortality in the older adult population is a pressing public health problem both nationally and in Kentucky, which has a fall rate above the national average. Implementation of the CDC’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) fall prevention program, offers an opportunity to effectively reduce falls, fall-related injuries and associated costs. The implementation process also serves to foster cooperative interdisciplinary and interdepartmental relationships within health care systems, and bridge public health and clinical practice.

Purpose:The capstone describes and evaluates a pilot of STEADI at the University of Kentucky’s Family and Community Medicine (UKFCM) …

A Population-Based Survival Analysis Of Mesothelioma And Smoking In Appalachian And Non-Appalachian Kentucky, Peter Van Wie

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

Mesothelioma is one of the most aggressive cancers in the United States and around the world, with a grim 5-year survival rate of only 8%. After diagnosis there is little that can be done to stop the progression of the disease. Smoking has been negatively associated with mesothelioma survival. This may be due to several factors including increased oxidative stress or sequestration of tobacco-related carcinogenic compounds by asbestos fibers trapped in the lung. This study investigated the association between smoking and mesothelioma survival in the Kentucky population. It examines the risk of living in the low socioeconomic region of Appalachian …

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, …

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 …

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 …

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 …

Dusty Occupations And Pulmonary Obstruction In Kentucky: A Proportionate Mortality Analysis, Neil Bradford Horsley

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

Background

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States. Occupational exposure to vapors, gases, dusts, or fumes (VGDFs), in combination with smoking, significantly increases the risk of developing COPD. Amongst agricultural workers, exposure to pesticides has been found to cause significantly elevated rates of annual decline in lung function, ultimately leading to a clinical diagnosis of pulmonary obstruction if the period of exposure is sufficient.

Purpose

It is hypothesized that, when compared to the standard population, workers in “dusty” occupations (where VGDF workplace exposure is significant) die at significantly elevated rates from …

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 …

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 …

An Assessment Of The Effectiveness Of Unannounced Safety Inspections Versus Announced Inspections In Academic Research Laboratories That Utilize Biological Hazards, Holley M. Trucks

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

Inspections are integral to comprehensive biosafety programs at academic research institutions that use a wide variety of infectious agents. However, there is no standardization of biosafety inspection procedures from institution to institution. This study analyzed results of 2,098 documented inspections conducted from January 2012 through December of 2016 performed by biosafety staff at a large Research I land grant institution in order to evaluate the effectiveness of an unannounced versus the more traditional announced approach to inspection procedure. Results demonstrated that: a) more findings were noted during unannounced inspections, therefore more accurately informing biosafety staff of the true day to …

Use Of Clonidine In Sedation Dentistry, Asma Kumar

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

Background:

Clonidine is an alpha-2 adrenergic agonist which has been used to treat hypertension for over 40 years. In October 2008, clonidine was approved by the FDA for use as a premedication agent prior to sedation. The overall goal of this study is to determine if clonidine can be used as a pre- operative sedative agent in moderate sedation dentistry and if so, what should be considered a safe level.

The following specific aims were established for this study:

1. To determine whether patients receiving clonidine required less intravenous medications.
2. To determine if clonidine can lower blood pressure and pulse to …

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 …

Utilizing The Social Ecological Model To Address Drinking Behaviors Among College Students Participating In Ncaa Division I Non-Revenue Generating Sports, Andrew M. Smith

Theses and Dissertations--Educational Policy Studies and Evaluation

College students between the ages of 18 and 24 are considered high-risk for alcohol-related negative consequences due to drinking at high-risk levels (Barry, Howell & Salaga, 2015). Within that population, varsity student athletes are considered at even greater risk for those issues (Druckman, 2015; Wechsler, 2002).

With football and men’s basketball being considered the only revenue-generating NCAA Division I sports, non-revenue-generating sports consist of the majority of student athletes (NCAA, 2016). This study is designed to examine high-risk drinking as well as alcohol-related consequences among non-revenue-generating student athletes attending a National Collegiate Athletic Association (NCAA) Division I school.

The sample …

Screening For Alcohol Use/Abuse In The Primary Care Setting Using The Audit-C And Sbirt (Screening, Brief Intervention, Referral To Treatment), Whitney D. Spear

DNP Projects

PURPOSE: The purpose of this study was to examine the feasibility of alcohol screening in the primary care setting to detect alcohol abuse or misuse using the AUDIT-C standardized screening tool and SBIRT.

METHODS: This study design was a Quasi-Experimental intervention, one group post-test. Data was collected via retrospective chart review from the electronic medical records by the type of office visit; either new patient initial visit or annual well visit. The patient sample consisted of 25 participants for the study period of September 19^th through October 10^th, 2017.

RESULTS: There were 37 patients eligible to participate …

Use Of The Afix Model To Improve Adolescent Hpv Vaccination: A Pilot Research Study, Emily Messerli

DNP Projects

Problem: The CDC estimates one person every 20 minutes every day acquires an HPV-related cancer. Kentucky’s HPV associated cancer burden is among the highest in the nation. Adolescent HPV vaccination rates in Kentucky are far below HealthyPeople 2020 goals. Barriers are multifaceted and include provider, patient and system barriers. The AFIX model is an evidenced based quality improvement program that addresses key provider barriers. The USPSTF findings identify a gap in the literature related to AFIX methods to improve rates of adolescent vaccines.

Objectives: The purpose of this study was to evaluate the effects of an intervention using the AFIX …

A Secondary Analysis Of Survey Data Evaluating The Lifelines Suicide Prevention Program Among Middle School Students, Nicki Sullivan

DNP Projects

PURPOSE: The purpose of this study was to evaluate student feedback of the 2015 Lifelines Suicide Prevention Program at Jessie Clark Middle School. Student feedback was examined by assessing students’ knowledge of suicide, attitudes toward suicide, knowledge of when and from whom to seek help if feeling suicidal or told by a friend that they are suicidal, and impressions of the educational presentation following participation in the Lifelines Suicide Prevention Program.

METHODS: In this secondary analysis, anonymous student responses (N=269) from a 2015 middle school survey were examined by using a mixed method design with the quantitative study measures being …

Reproducing Childbirth: Negotiated Maternal Health Practices In Rural Yucatan, Veronica Miranda

Theses and Dissertations--Anthropology

This ethnographically informed dissertation focuses on the ways rural Yucatec Maya women, midwives and state health care workers participate in the production of childbirth and maternal health care practices. It further addresses how state health programs influence the relationships and interactions between these groups. Although childbirth practices in Yucatan have always been characterized by contestation, negotiation and change, their intensity and speed have significantly increased over the last decade. Drastic changes in the maternal health of rural indigenous communities in Mexico and throughout the world are directly connected to intensified state interventions that favor biomedicine over traditional health systems. In …

Alcohol Use And Strenuous Physical Activity In College Students: A Longitudinal Test Of 2 Explanatory Models Of Health Behavior, Heather A. Davis, Elizabeth N. Riley, Gregory T. Smith, Richard S. Milich, Jessica L. Burris

Psychology Faculty Publications

Objective: To help clarify the effect of gender on the bidirectional relationship between alcohol use and strenuous physical activity in college students. Participants: Five hundred twenty-four (52% female) college students recruited in August 2008 and 2009 and followed up in April 2009 and April 2011, respectively. Methods: Participants reported their alcohol use and strenuous physical activity on 2 occasions (baseline and follow-up) spaced approximately 1 or 2 years apart. Results: For females, alcohol use quantity at baseline was associated with increased strenuous physical activity at 1- and 2-year follow-ups, and alcohol use frequency at baseline was …

The Carrot And The Stick? Strategies To Improve Compliance With College Campus Tobacco Policies, Amanda Fallin-Bennett, Maria Roditis, Stanton A. Glantz

Nursing Faculty Publications

Objective: Tobacco-free policies are being rapidly adopted nationwide, yet compliance with these policies remains a challenge. This study explored college campus key informants' experiences with tobacco policies, and their perceived benefits, drawbacks, and outcomes. Participants: The sample for this study was 68 key informants representing 16 different California universities with varying tobacco policies (no smoking indoors and within 20 feet of entrances, designated smoking areas, 100% smoke-free, and 100% tobacco-free). Methods: Qualitative, descriptive study. Semistructured interviews were transcribed verbatim and analyzed using content analysis. Results: Strategies to improve compliance ranged from a social approach to a …

Dna Methylation Signatures Of Chronic Low-Grade Inflammation Are Associated With Complex Diseases, Symen Ligthart, Carola Marzi, Stella Aslibekyan, Michael M. Mendelson, Karen N. Conneely, Toshiko Tanaka, Elena Colicino, Lindsay L. Waite, Roby Joehanes, Weihua Guan, Jennifer A. Brody, Cathy Elks, Riccardo Marioni, Min A. Jhun, Golareh Agha, Jan Bressler, Cavin K. Ward-Caviness, Brian H. Chen, Tianxiao Huan, Kelly Bakulski, Elias L. Salfati, Whi-Empc Investigators, Giovanni Fiorito, Charge Epigenetics Of Coronary Heart Disease, Simone Wahl, Katharina Schramm, Jin Sha, Dena G. Hernandez, Allan C. Just, Jennifer A. Smith, Donna K. Arnett

Epidemiology and Environmental Health Faculty Publications

Background: Chronic low-grade inflammation reflects a subclinical immune response implicated in the pathogenesis of complex diseases. Identifying genetic loci where DNA methylation is associated with chronic low-grade inflammation may reveal novel pathways or therapeutic targets for inflammation.

Results: We performed a meta-analysis of epigenome-wide association studies (EWAS) of serum C-reactive protein (CRP), which is a sensitive marker of low-grade inflammation, in a large European population (n = 8863) and trans-ethnic replication in African Americans (n = 4111). We found differential methylation at 218 CpG sites to be associated with CRP (P < 1.15 × 10^–7) in the discovery panel …

Farm Work Injuries Among A Cohort Of Children In Kentucky, Usa, Steven R. Browning, Susan C. Westneat, Deborah B. Reed

Epidemiology and Environmental Health Faculty Publications

Children residing on farms with livestock may be at an increased risk for work-related injuries, compared to children who work on other commodity farms. This study characterizes children's work tasks on Kentucky farms and assesses whether children who work on beef cattle farms are at an increased risk for farm work injuries. The results of a cohort study of children aged 5-18 years (N=999 at baseline) working on family farms in Kentucky, followed for two consecutive years after an initial enumeration five years previously, found that 70% of the children were involved in animal-related chores. Across all age groups, children …

Self-Reported Sleep Apnea And Dementia Risk: Findings From The Prevention Of Alzheimer's Disease With Vitamin E And Selenium Trial, Xiuhua Ding, Richard J. Kryscio, Joshua Turner, Gregory A. Jicha, Gregory E. Cooper, Allison M. Caban-Holt, Frederick A. Schmitt, Erin L. Abner

Sanders-Brown Center on Aging Faculty Publications

OBJECTIVES: To investigate the association between baseline sleep apnea and risk of incident dementia in the Prevention of Alzheimer's Disease with Vitamin E and Selenium (PREADViSE) study and to explore whether the association depends on apolipoprotein E (APOE) ɛ4 allele status.

DESIGN: Secondary analysis based on data collected during PREADViSE.

SETTING: Participants were assessed at 128 local clinical study sites during the clinical trial phase and later were followed by telephone from a centralized location.

PARTICIPANTS: Men enrolled in PREADViSE (without dementia or other active neurological conditions that affect cognition such as major psychiatric disorders, including depression; N = …

The Role Of Stress In Assessing Life Satisfaction And Self-Efficacy Among Prison Officers, Kamilla Bargiel-Matusiewicz, Paulina Stelmachowska, Hatim A. Omar

Pediatrics Faculty Publications

Stress is a major public health concern. It can be observed in all aspects of life, in everyday family life and work life. The focus of this article is work-related stress. Work stress can be observed in any work environment and in all professions. As a complex condition it affects different people in different ways. The study presented in this article was done on a sample of 59 prison officers who volunteered to participate. Among those 59 participants 34 were males and 25 were females aged between 25 to 52. Each participant received a survey to collect general information about …

Correlates Of Sexual-Risk Behaviors Among Young Black Msm: Implications For Clinic-Based Counseling Programs, Richard A. Crosby, Leandro Mena, Janelle M. Ricks

Health, Behavior & Society Faculty Publications

This study applied an 8-item index of recent sexual-risk behaviors to young Black men who have sex with men (YBMSM) and evaluated the distribution for normality. The distribution was tested for associations with possible antecedents of sexual risk. YBMSM (N = 600), aged 16–29 years, were recruited from a sexually transmitted infection clinic, located in the southern US. Men completed an extensive audio computer-assisted self-interview. Thirteen possible antecedents of sexual risk, as assessed by the index, were selected for analyses. The 8-item index formed a normal distribution with a mean of 4.77 (SD = 1.77). In adjusted analyses, not …

Availability Of Buprenorphine Treatment In Kentucky, Elijah T. Myers, Tyrone F. Borders

Institute for Rural Health Policy Reports

Drug overdose and substance use treatment admissions data indicate that opioid use is problematic in Kentucky, but little information exists about the geographic availability of buprenorphine treatment across the state. Furthermore, there is even less information about the characteristics of the physicians prescribing buprenorphine. This report describes the availability of buprenorphine treatment in Kentucky.

A Dna Methylation Biomarker Of Alcohol Consumption, C. Liu, R. E. Marioni, Å. K. Hedman, L. Pfeiffer, P. -C. Tsai, L. M. Reynolds, A. C. Just, Q. Duan, C. G. Boer, T. Tanaka, C. E. Elks, S. Aslibekyan, J. A. Brody, B. Kühnel, C. Herder, L. M. Almli, D. Zhi, Y. Wang, T. Huan, C. Yao, M. M. Mendelson, R. Joehanes, L. Liang, S. -A. Love, W. Guan, S. Shah, A. F. Mcrae, A. Kretschmer, H. Prokisch, K. Strauch, Donna K. Arnett

Epidemiology and Environmental Health Faculty Publications

The lack of reliable measures of alcohol intake is a major obstacle to the diagnosis and treatment of alcohol-related diseases. Epigenetic modifications such as DNA methylation may provide novel biomarkers of alcohol use. To examine this possibility, we performed an epigenome-wide association study of methylation of cytosine-phosphate-guanine dinucleotide (CpG) sites in relation to alcohol intake in 13 population-based cohorts (n_total=13 317; 54% women; mean age across cohorts 42–76 years) using whole blood (9643 European and 2423 African ancestries) or monocyte-derived DNA (588 European, 263 African and 400 Hispanic ancestry) samples. We performed meta-analysis and variable selection in …