Public Health Commons^™

Evaluating A Public Health Program Using The Cdc Framework: A Case Study Approach, Brooke A. Poe

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

In Bourbon County, Kentucky, where rural health challenges and chronic disease burdens persist, a coalition of public health partners set out to improve population-level physical activity through an innovative, community-centered initiative. The Bourbon County Physical Activity Program emerged through collaboration between the Bourbon County Health Department, the University of Kentucky College of Public Health, and UK HealthCare. Together, these partners designed a six-month intervention that combined discounted YMCA memberships, partnerships with employers, a physical activity tracking app with behavioral incentives, and community-wide events to promote accessible and sustained engagement.

Guided by the CDC’s framework for program evaluation in public health, …

Influence Of Perceived Health Provider Communication, Diabetes Duration And Age At Diagnosis With Confidence In Diabetes Self-Care, Courtney L. Ortz, Meredith S. Duncan, Oluwatosin Leshi, William B. Burrows, Brittany L. Smalls

Family and Community Medicine Faculty Publications

Introduction: Several factors influence individuals’ confidence to perform diabetes-related self-care activities, including perceived patient-provider communication, diabetes duration and age at diagnosis. It has been well-documented that patient-provider communication is essential when managing chronic diseases such as diabetes; however, the impact of this communication with diabetes duration and age at diabetes diagnosis on confidence in performing self-care behaviors is obscure.

Research design and methods: We utilized data from the 2021 Household Component of the Medical Expenditure Survey among participants 18 years or older who had completed the Diabetes Care Survey. Ordinal logistic regression models were utilized to assess the association between …

Exploratory Analysis Of Gait Mechanics In Farmers, Mariana V. Jacobs, Kate N. Jochimsen, Jody L. Clasey, Michael A. Samaan

Kinesiology and Health Promotion Faculty Publications

Farmers may be at a higher risk of developing hip osteoarthritis (OA) due to the high demands of their occupation. To the authors’ knowledge, the gait patterns of farmers that may be associated with hip joint degeneration have yet to be analyzed. Therefore, this study compares gait mechanics between farmers and non-farmers (controls). It is hypothesized that farmers would exhibit altered lower extremity joint mechanics during walking when compared to matched controls. This exploratory study included five farmers and five sex-, age-, and body mass index (BMI)-matched controls. A 3D gait analysis was performed while study participants walked at a …

Assessment Of Hip Joint Mechanics During Walking In People With Marfan Syndrome, Mariana V. Jacobs, Justin Melan Pol, Aaron D. Fain, Jody L. Clasey, Brecca M. M. Gaffney, Christopher J. Mclouth, Mary B. Sheppard, Michael A. Samaan

Kinesiology and Health Promotion Faculty Publications

Background: Marfan syndrome (MFS) is an autosomal dominant connective tissue disorder and is associated with muscle dysfunction. Individuals with MFS exhibit quadriceps weakness, hip joint pain, and an increased incidence of hip osteoarthritis (OA) compared to the general population, yet the underlying biomechanical factors associated with these poor hip-related outcomes are not well understood.

Research Question: The purpose of this study was to assess the effects of MFS on gait mechanics and to determine the relationship of gait mechanics with hip-related outcomes within the MFS group. Methods: Eighteen people with MFS and 18 healthy, asymptomatic controls underwent 3D gait analysis. …

A Comprehensive Evaluation Of Thigh Mineral-Free Lean Mass Measures Using Dual Energy X-Ray Absorptiometry (Dxa) In Young Children, Trey R. Naylor, Mariana V. Jacobs, Michael A. Samaan, Laura C. Murphy, Douglas J. Schneider, Margaret O. Murphy, Hong Huang, John A. Bauer, Jody L. Clasey

Kinesiology and Health Promotion Faculty Publications

This study aimed to (1) demonstrate the intra- and interrater reliability of quadriceps (QUADS) and hamstring (HAMS) mineral-free lean (MFL) mass measures using DXA scanning, (2) determine the association of total thigh MFL mass measures with MFL mass measures of the hamstrings and quadriceps combined and (3) analyze the association between total thigh MFL mass and total body MFL mass measures. A total of 80 young children (aged 5 to 11 yrs) participated and unique regions of interest were created using custom analysis software with manual tracing of the QUADS, HAMS, and total thigh MFL mass measures. Repeated-measure analysis of …

A Qualitative Study Of End-Stage Liver Disease And Liver Transplant Referral Practices Among Primary Care Providers In Nonurban America, Vashisht Madabhushi, Matthew Wright, Gabriel Orozco, Allison Murphy, Antonio R. Garcia, Natalie D. Pope, Xiaonan Mei, Alexandra Cocca, Roberto Gedaly, Meera Gupta

Surgery Faculty Publications

Purpose: In rural America, the road to obtaining a liver transplant (LTX) often starts at the primary care provider’s (PCP’s) office. Patients with end-stage liver disease (ESLD) in rural communities experience lower rates of wait-listing and higher mortality. This study identifies issues related to the knowledge and perceptions of ESLD and LTX referral among PCPs in rural Kentucky (KY).

Methods: The study protocol involved relying upon a semistructured outline to explore the knowledge, attitude, and perceptions of PCPs toward ESLD and LTX referral among PCPs in rural KY. Inductive thematic analysis was utilized to identify, analyze, and report themes.

Findings: …

Blood Biomarkers In Down Syndrome: Facilitating Alzheimer’S Disease Detection And Monitoring, Melissa E. Petersen, Lisi Flores-Aguilar, Elizabeth Head, Laia Montoliu-Gaya, Andre Strydom, Sarah E. Pape, Juan Fortea, Nicholas J. Ashton, Chinedu Udeh-Momoh, Sid E. O’Bryant, Dwight German, Florin Despa, Mark Mapstone, Henrik Zetterberg

Neurology Faculty Publications

Blood-based biomarkers continue to be explored for disease detection, monitoring of progression, and therapeutic outcomes as the diagnostic determination of Alzheimer’s Disease in Down Syndrome (DS-AD) remains challenging in clinical settings. This perspective highlights the current status of this effort. Overall, amyloid (A), tau (T), and neurodegeneration (AT[N]) blood-based biomarkers have been shown to increase with disease pathology for individuals with DS. Phosphorylated tau biomarkers (p-tau217, p-tau181) have been consistently shown to track disease progression for DS-AD and are likely good candidates for use in clinical settings. Biomarkers of inflammation (glial fibrillary acidic protein) also show promise; however, additional work …

A Case Study In Program Evaluation, Soma Dutta

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

Program evaluation is a systematic process of assessing a program’s design, implementation, and outcomes to determine its effectiveness, efficiency, and impact, guiding data-driven improvements and decision-making. The Centers for Disease Control and Prevention (CDC) Evaluation Framework provides a structured approach to assessing public health programs, ensuring they are effective, accountable, and continuously improving. By systematically applying this framework, evaluations can provide actionable insights that inform program improvements, guide resource allocation, and ensure that evaluations are practical and meaningful to all stakeholders involved (Centers for Disease Control and Prevention, 2024).

The Bourbon County Health Department (BCHD) has implemented a Physical Activity …

A Case Study In Program Evaluation: Evaluation Of The Bourbon County Physical Activity Initiative, Michaela D. Amburgey

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

This evaluation examines the Bourbon County Physical Activity Initiative, which aims to increase physical activity levels in Bourbon County, Kentucky. The initiative includes increased access to exercise opportunities, community events, and an incentive-based activity tracking system. This evaluation assesses the program’s implementation, effectiveness, and provides recommendations for improvement. By utilizing evaluation findings, public health practitioners can enhance decision-making, optimize resource allocation, and improve population health outcomes.

Bones And Brains: The Association Between Osteoporosis And Depression, Mason Taylor

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

Introduction: Osteoporosis and depression are two public health problems that are increasing in prevalence. Previous studies have found a positive association between the two variables in women and men and women together, but there is a gap when looking at men. Therefore, it was important to investigate the odds of depression in men, women, and men and women together to make comparisons by sex.

Methods: 1,602 participants aged 65 and older were included in the study from the National Health and Nutrition Examination Survey (NHANES) 2017 – March 2020 Pre-Pandemic dataset. One unadjusted and seven adjusted models were created for …

Evaluation Of The Bourbon County Health Department Physical Activity Program, Walker S. Hancock

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

Bourbon County has a low physical activity rate. A program has been implemented to increase rates of physical activity. An evaluation has been performed using the CDC’s 6-step program evaluation process framework.

According the the framework, two recommendations were made. The first one is to increase access to parks or exercise facilities for those outside of Paris city limits. The second one is to increase the number of indoor facilities for people to use during the cold, winter months.

A Case Study In Program Evaluation: Evaluation Of A Program To Increase Physical Activity, Megan M. Harper

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

Public health revolves around 3 core functions: assessment, policy development, and assurance.¹ For public health initiatives to have long-term success, we must determine if the intended effects of those programs are met in the beginning stages of program development and implementation; thus, program evaluation relates to the core function of assessment. The Centers for Disease Control and Prevention (CDC) developed a framework to facilitate this process and enable subsequent informed decisions on how to improve public health programs, which relates to policy development.² The CDC framework is comprised of 6 interconnected steps and 4 groups of standards; together, …

Understanding The Impact Of Pharmacist Prescriptive Authority On Hiv Pre-Exposure Prophylaxis At The State Level, Cameron G. King

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

HIV transmission, with relative risk reductions of up to 99%. However, real world data have revealed that even with large increases in PrEP use, new HIV diagnoses may only slightly decline. This disparity suggests that access to PrEP may be suboptimal, especially among high-risk subgroups, who are often hard to maintain on the continuum of HIV care. Pharmacists, because of their accessibility, trusted role in their communities, and growing scope of practice, could serve as an intervention point to improve access to PrEP.

A previously validated algorithm using National Drug Codes (NDCs) and the International Classification of Disease, 10^{th …}

How Sleep Disorders And Sleep Duration Impact Memory, Alexandria J. Sims

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

INTRODUCTION: Sleep duration and sleep disorders can cause changes in memory function as populations age. Previous studies have shown that disordered sleep is associated with increased risk of cognitive dysfunction and long and short sleep durations can cause memory impairment. This study studies aims to find if there is an association between sleep disorders and sleep duration and the impacts on memory.

METHODS: In this study, 3,478 participants aged 60 year and older from the National Health and Nutrition Examination Survey (NHANES) 2013-2014 dataset were included in adjusted and unadjusted models, comparing the sleep disorders and sleep duration exposures to …

Environmental And Behavioral Determinants Of Congenital Defects: An Ecologic Study In Kentucky, Amelia G. Floyd

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

Congenital defects are a significant contributor to infant morbidity and mortality. The multifactorial etiology of such defects presents complex challenges for public health. This ecologic study investigates the association between environmental and behavioral exposures and congenital defects rates at the county level in Kentucky from 2010 to 2019. The Kentucky Department for Public Health, Office of Vital Statistics, provided all relevant defect data. County-level exposure data was collected from multiple sources.

Descriptive and geospatial analyses revealed substantial geographic variability, with notable high defect rates in northeastern Kentucky. Negative binomial regression models identified behavioral and socioeconomic factors to be the strongest …

Assessing The Impact Of A Physical Activity Program In Bourbon County Using The Cdc Evaluation Framework, Abigail Lay

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

Physical inactivity is a significant public health concern, contributing to increased risks of chronic diseases such as obesity, cardiovascular disease, and diabetes (Centers for Disease Control and Prevention [CDC], 2022). To address this issue, communities across the United States have implemented physical activity programs to promote healthier lifestyles, including Bourbon County. This project evaluates the impact of a physical activity program in Bourbon County, KY, using the CDC Framework for Program Evaluation to assess its effectiveness, sustainability, and areas for improvement (CDC, 1999).

The primary objective of this evaluation is to determine whether the program has successfully increased participants' physical …

Changes In Local Public Health System Characteristics Before And After The Implementation Of Ohio’S Public Health Accreditation Board Policy For Local Public Health Departments., Christine Lynn Vazquez

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

The Public Health Accreditation Board is a nationally recognized nonprofit organization that manages a series of programs including the national public health accreditation program. Public health accreditation is awarded to health departments that achieve a set of nationally recognized goals and standards for departments to adopt. The state of Ohio initiated policy requiring that Local Health Departments to achieve accreditation by 2018. In result, Ohio has the largest number of accredited local health departments. This study looked at the local health departments in Ohio responses to the National Longitudinal Survey of Public Health Systems to understand if services provided improved …

Evaluating Hiv Testing Strategies And Screening In The University Of Kentucky’S Target 4 Project, Emily E. Wagoner

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

The University of Kentucky’s Target 4 project aims to expand HIV testing and provide accessible, confidential services throughout Kentucky, focusing on individuals at highest risk for HIV and Hepatitis C. In December 2023, the Target 4 project implemented a new, expanded HIV screening form, increasing the number of questions from seven to eighteen. This study analyzes the impact of the new screening form on risk factor identification and HIV positivity rates in Region 9, a 16-county area in central Kentucky, from September 2021 to November 2023. Data from 11,187 encounters before the implementation of the new screening form and 2,585 …

Elucidating The Adverse Effects Of Chronic Pfos Exposure On Gastrointestinal Pathology And Colorectal Cancer, Jerika Durham

Theses and Dissertations--Toxicology and Cancer Biology

Commonly referred to as "forever chemicals," per- and polyfluoroalkyl substances (PFAS) have been linked to a number of detrimental health effects, including an elevated risk of cancer. One "long-chain" subtype of PFAS, perfluorooctanesulfonic acid (PFOS), has a long elimination half-life and a significant propensity for bioaccumulation. Because PFOS is commonly found in drinking water, the gastrointestinal system absorbs it at a high rate. Recent studies demonstrate that PFAS exposures promote intestinal inflammation and gut barrier dysfunction. However, how a long-term PFOS exposure affects colorectal cancer (CRC) progression is not known. Therefore, the purpose of this research is to understand how …

Weighted Family History Density Of Substance Use: Influence On Participant Substance Use Onset, Escalation, And Duration, Carleigh A. Litteral

Theses and Dissertations--Psychology

Substance use disorders impose a staggering toll on the United States (U.S.), straining healthcare systems, destabilizing communities, and profoundly impacting both individuals and families. Approximately one in six Americans aged 12 and older had a past-year substance use disorder in 2022 (Key Substance Use, 2022), and nearly one-third of adults experience a substance use disorder in their lifetime (Wu, 2010), contributing to an economic burden exceeding $400 billion annually (National Drug Threat Assessment, 2011). Family history of substance use disorders is a key predictor of vulnerability, with individuals who have affected relatives being 2–8 times more …

Championing Reproductive And Perinatal Health With The Recovery Community: Improving Access To Healthcare And Health Promotion Resources To Support Recovery, Hartley C. Feld, Alex Elswick, Jeremy Byard, Whitney Beckett, Amanda Fallin-Bennett

Nursing Faculty Publications

Peer recovery support services are instrumental in the promotion of long-term recovery primarily by focusing on building the recovery capital of people with substance use disorders. Women may have specific health-related needs that are not generally part of recovery support staff training. Our team co-created a model by training people with lived experience as coaches to promote the health of women with SUD during the critical period of their reproductive years when mortality from overdose risk is high and can be compounded by issues surrounding pregnancy. We explored the outcomes of a small pilot test of this model to promote …

Challenges And Lessons Learned While Conducting A Diabetes Prevention Program Among Black Churches During The Covid-19 Pandemic, Erika R. Karle, Destiny Cozart, Bassema Abu Farsakh, Victor Afolayan, Treasure Ebikwo, Maranda Brooks, Lovoria B. Williams

Nursing Faculty Publications

We share our experiences conducting a 5-year randomized controlled diabetes prevention project among 20 Black churches in central Kentucky during the COVID-19 pandemic and offer strategies to inform future church-based interventions. Researchers have long recognized the potential to reach Black adults in church settings for health promotion interventions and have implemented trials within this socially rich setting. However, there is a dearth of literature that describes the challenges and lessons learned while conducting these trials. We describe the challenges we experienced and the strategies we used to overcome them to successfully conduct the trial. During the study, we maintained detailed …

Adverse Childhood Experiences And Psychological Correlates Of Substance Use Disorders Among Black Sexual Minority Women, Shemeka Thorpe, Kaylee A Palomino, Natalie Malone, Danelle Stevens-Watkins

Kinesiology and Health Promotion Faculty Publications

This study examined the influence of adverse childhood experiences (ACEs) on Black sexual minority women's mental health and substance use disorders in adulthood. Secondary data analysis was conducted using N = 149 Black sexual minority women's reports from the Generations Study. Study variables included psychological distress, chronic strains, stressful life events, ACEs, and substance use disorders, including alcohol use disorder and drug use disorder. Quantitative data analysis consisted of descriptives and bivariate correlations. Participants' total ACE scores were positively significantly correlated with increased alcohol misuse, chronic life strains, and stressful life events. Exposure to household interpersonal violence and household mental …

Open Access In The Age Of Ai: The Journal Of Appalachian Health And Hurricane Helene Recovery, Noah Wren, Bradley Firchow

Journal of Appalachian Health

The recent destruction brought upon the Appalachian region by Hurricane Helene has emphasized the importance of the Journal of Appalachian Health. As an open-access peer-reviewed source of information, the Journal plays a critical role in not only facilitating public health research about Hurricane Helene, but also combating misinformation regarding the event. In the days following Hurricane Helene, misinformation about the federal government’s response, along AI generated images, have left many in the region confused and misled about what had happened. Going forward, the Journal will play an necessary part in making sure accurate information is shared to understand how …

Reviewer Acknowledgements, Randy Wykoff, Emily Wilson

Journal of Appalachian Health

We at the Journal of Appalachian Health would like to thank the multitude of reviewers who have volunteered their time, talents, and attention to the journal. Reviewers help us consider the rigor and quality of the submissions we receive, and their willingness to read material ahead of publication ensures we can bring timely research to our readers in Appalachia and further afield.

Impacts Of The Covid-19 Pandemic On Intimate Partner Violence And Child Maltreatment Services In Rural Northwest North Carolina, Elisabeth G. Galphin, Adam Hege, Amy Dellinger Page

Journal of Appalachian Health

The current study examined the impact of the COVID-19 pandemic on IPV and child maltreatment services in rural northwestern North Carolina. Qualitative interviews were conducted with eight professionals representing six service organizations across four counties. The findings highlighted challenges these agencies faced throughout the pandemic, new risks for the clients served, and positive outcomes. In addition, it has been a useful learning experience as public health and social service agencies learn to serve their communities more effectively moving forward. This is especially relevant for rural communities, as it has put public health preparedness at the forefront.

The Impact Of Primary Care Physician Capacity On Preventable Hospitalizations: Identifying Bright Spots In The Appalachian & Mississippi Delta Regions, Michael Topmiller, Peter J. Mallow, Hoon Byun, Mark Carrozza, Yalda Jabbarpour

Journal of Appalachian Health

Introduction: Several studies have documented that higher rates of primary care physicians are associated with lower rates of preventable hospitalizations. Counties with higher rates of preventable hospitalizations are found in the Appalachian and Mississippi (MS) Delta Regions.

Purpose: (1) To determine if the association of primary care capacity with preventable hospitalizations is different in the Appalachian and MS Delta regions compared to the rest of the U.S., and (2) to explore primary care capacity in counties with lower-than-expected preventable hospitalization rates.

Methods: This study modeled preventable hospitalizations with primary care physicians (PCP) per 100,000 (PCP capacity) while controlling for several …

Psychosocial Factors, Stress And Sleep Among Rural Appalachian Kentucky Residents With Type 2 Diabetes Mellitus, Blake Dipaola, Zoe Taylor, Eric Hennemann, Brittany L. Smalls, Philip M. Westgate, Nancy Schoenberg

Journal of Appalachian Health

Introduction: Rural Appalachian residents experience higher rates of most chronic diseases, including type 2 diabetes mellitus (T2DM). Stress and sleep deficiency also are common in the region.

Purpose: To better understand these associated health burdens, the relationship among these conditions and psychosocial factors—such as depressive symptoms, distress, empowerment, and social support—was examined among Appalachian residents with T2DM.

Methods: Using data collected from a community-based sample of Appalachian adults with T2DM, the study examined whether psychosocial factors were associated with perceived stress (Cohen Perceived Stress Scale) and self-reported sleep deficiency (Epworth Sleepiness Scale). Multilevel linear mixed effects regression modeling was used …

Nutrition Education Needs And Barriers Of Uninsured Clients Who Utilize Free Clinics In Western North Carolina, Manan Roy, Alisha Farris, Erin Loy, Lauren Sastre, Danielle L. Nunnery

Journal of Appalachian Health

Introduction: Many uninsured adults rely on free health clinics for prevention and treatment of chronic disease. Little is known about the nutrition education needs of adults served by free health clinics, especially those living in counties within the Western North Carolina Appalachian Mountain Region.

Methods: An in-person survey was distributed to 202 clients of two free health clinics in western North Carolina. Descriptive analyses were conducted to determine frequency distributions for food and physical activity practices, acceptable topics and strategies for nutrition education, and the acceptance and barriers for various modalities.

Results: Depending on the clinic, 49-58% of participants were …

Using Public Funeral And Obituary Listings To Identify Spikes In Excess Mortality In One Appalachian County, Allen Archer, Melissa White, Megan Quinn, Randy Wykoff

Journal of Appalachian Health

Introduction: Delays (10-22 months) in availability of official state and county-level mortality data could have significant public health consequences. The COVID-19 pandemic illuminated the need for health officials to access timely death data to identify unexpected increases in mortality in their communities.

Purpose: The purpose of this study is to determine if funeral home listings and/or newspaper obituaries could help identify excess mortality on the local level, prior to the availability of official death records.

Methods: To calculate excess mortality, four years (2017–2020) of data were collected from three sources: the state health department, online funeral home listings, and newspaper …