Public Health Commons^™

Quality Improvement In The Department Of Family And Community Medicine At The University Of Kentucky, Manisha Vasishta

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

The purpose of this capstone project is to analyze the quality improvement data that was collected in order to increase the pediatric population at the University of Kentucky Department of Family and Community Medicine clinic at Turfland. There were three different patient populations that were surveyed: reproductive aged women between 18 and 40, parents of the pediatric population that the clinic saw between July 2014 and June 2015, and pregnant women between July 2014 and June 2015. The results show that continuity of care and not being able to see the provider of choice were some of the weaknesses that …

Behavioral Modification Program To Control Obesity Among School Children In Knott County, Kentucky, Samjhana Shakya

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

Childhood obesity is one of the major public health concerns in the United States (US). Obese children have a greater likelihood of developing cardiovascular disease risk factors such as high blood pressure and cholesterol, and impaired blood glucose[7].The prevalence of obesity among children 2 to 5 years of age in Kentucky was 15.7% (US average 8.4%) and 17.6% (US average 17%) among adolescents in Kentucky being higher than the national averages [8,3].

A major goal of the Behavioral Modification Program is to promote healthy behaviors among elementary school children to control obesity by modifying eating, physical activity and screen time …

The Impact Of An Ambulatory Clinical Intervention On Viral Load Suppression And Retention In Care For Newly Diagnosed Hiv Persons, Latasha R. Jones

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

Ambulatory clinical healthcare settings that serve patients infected with the human immunodeficiency virus (HIV) are critical in improving access to quality HIV care and treatment, in part due to their ability to streamline patient care along the HIV care continuum. Barriers to HIV care are significant among newly diagnosed HIV patients and in order to engage and retain these individuals in care and treatment, specific interventions must be in place to link these individuals to care. In this study, the difference in differences method was used for data analysis to measure the impact of an ambulatory clinics intervention on their …

Access For Adolescents: Multisystemic Therapy In The Juvenile Justice System, Meagan Pilar

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

In this application for funding, DC YouthLink, a non-profit organization that connects adolescents in the juvenile justice system to community resources, proposes to implement an evidence-based mental health intervention into the juvenile justice system in Washington D.C. The Director of DC YouthLink will serve as the Principal Investigator for this pilot program; she, along with five trained staff members, will be responsible for implementing multisystemic therapy (MST), an intensive form of therapy designed specifically for at-risk youth and their families. We propose to intervene at three main stages of the juvenile justice system— intake, correctional placement/probation supervision, and reentry. The …

Enough Smoke: Implementation Of An Evidence-Based Smoking Cessation Program In Owsley County, Kentucky, Meghan Fay Johnson

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

In 1964, the first United States (U.S.) Surgeon General’s Report explicitly stating the dangers of smoking, including an increased risk of lung cancer, was released. Fifty years later, the U.S. continues to carry the significant health and economic burdens for failing to heed this public health warning. Owsley County, Kentucky, located in the heart of the Appalachian is one of the most impoverished and medically underserved counties in the U.S., ranking last in almost every category of overall health outcomes in the state. The county is also entirely rural, with no major cities within an 80-mile radius. In every health …

Focas Appalachia: A Cervical Cancer Prevention Program For The Women Of The Kentucky River Area Development District, Chrisanthi M. Masero

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

In response to the National Institute of Health’s (NIH) funding announcement, the Kentucky River District Health Department (KRDHD) proposes to implement an evidence-based cervical cancer prevention program in the Kentucky River Area Development District (KRADD) in southeastern Appalachian Kentucky. The proposed evidence-based program was part of the National Cancer Institute’s (NCI) “Public Health Approaches to Breast and Cervical Cancer” research initiative and is one of nine cervical cancer Research Tested Intervention Programs (RTIPs) on the NCI’s RTIP database. The Forsyth County Cancer Screening Project (FoCaS) was designed to improve the beliefs, attitudes, and behaviors regarding breast and cervical cancer screening …

Subacute Effects Of Prallethrin On Behavior Of Mosquitoes (Diptera: Culicidae) And Other Human Disease Vectors, Kyndall C. Dye

Theses and Dissertations--Entomology

The synthetic pyrethroid, prallethrin, is an active ingredient in a widely marketed ultralow volume (ULV) mosquito adulticide. Volatilized prallethrin is intended to stimulate mosquito flight, increasing overall effectiveness of the adulticide. However, field tests using volatilized prallethrin did not produce significant differences in various vector trap catches, suggesting prallethrin’s behavioral effects are not viable. Laboratory tests were conducted to evaluate prallethrin’s effect on flight behavior of adult female Asian tiger mosquitoes (Aedes albopictus). Mosquitoes were divided into three groups; a control, those exposed to volatilized prallethrin, and those exposed to a simulated ULV application at label rates. After …

Breastfeeding Practices Among Native Hawaiians And Pacific Islanders, Ingrid K. Adams, Chizimuzo T.C. Okoli, Akilah Dulin Keita, Ana Maria Linares, Keiko Tanaka, Joshua R. Polanin, Annie Koempel

Dietetics and Human Nutrition Faculty Publications

Background. Breastfeeding is associated with a decreased risk of obesity in the early and adult years. Native Hawaiians and Pacific Islanders (NHPI) experience high rates of obesity which is often obfuscated with aggregated data. Using disaggregated data, we examined breastfeeding practices among NHPI. Methods. Seven databases and reference lists were searched. Two independent researchers extracted relevant studies based on predetermined criteria. Nine studies met our inclusion criteria and a meta-analysis was conducted using random-effects, inverse-various weighted models. Results. Few studies disaggregated NHPI populations when examining breastfeeding practices. Most studies were cross-sectional and our search yielded no randomized or quasirandomized control …

Risk Factors Associated With Severe Injuries In Inland Aquaculture Farms, Amah Martin

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

Objective: The main objective of this study was to analyze risk factors associated with severe occupational injuries among inland aquaculture farms.

Methods: Survey results were compiled in a data set that consisted of qualitative data from 51 farmers who were interviewed between 2008 and 2011 in 10 states and the Canadian province of British Columbia. Chi-square and Fisher’s exact test were used to assess the differences in the dichotomous level of severity among several farm and injury variables. Logistic regression was used to predict the outcome of a severe injury event.

Results: Injury observations that indicated the use of raceway …

Local Health Department Choice In The Provision Of Cancer And Cardiovascular Disease Screening, Georgianne Tiu

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

Clinical preventive services, such as cancer and cardiovascular (CVD) disease screenings are critical components essential for reaching optimal population health outcomes. Although clinical preventive services are recognized to save lives, roughly three-fourths of adults between the ages of 50 and 64 and over 50% of adults aged 65 years and older forego clinical preventive services. Private medical practitioners can provide such services. However, public sector entities, such as local health departments (LHDs), can also deliver them in addition to population based activities. Because of a possible substitution effect among health systems, we hypothesized that a LHD’s choice to be involved …

Hiv Testing Health Care Related Discrimination Among Black And White Men From The 2006-2008 Sexual Acquisition And Transmission Of Hiv Cooperative Agreement Program (Sathcap), Kenisha Cantrell

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

Background: The study investigated whether experiencing difficulty obtaining heath care due to different forms of discrimination impacts Black and White men being tested for HIV. It is important to discover if discrimination as a structural factor inhibits progression through the HIV Care Continuum among Black men. Structural factors may better explain the origin of HIV prevalence disparities and how the social factors affect Black men being tested for HIV.

Methods: Data utilized was collected through the 2006-2008 Sexual Acquisition and Transmission of HIV Cooperative Agreement Program implemented in 6 U.S. cities and one Russian city: Los Angeles, CA; Chicago, IL; …

Injuries Among Security And Law Enforcement Personnel In The Private Versus Public Sectors, William S. Witt

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

Background and Objectives: Data collected through workers’ compensation may be useful for occupational injury surveillance. This study examined whether differences existed between the public and private sectors of the security and law enforcement industry in Kentucky.

Methods: Using a cross-­‐sectional design, workers’ compensation data from the Kentucky Department of Workers’ Claims was analyzed to evaluate differences in demographic and injury characteristics, as well as award outcomes, stratified by industry sector. The dataset included all workers’ compensation first reports of injury and claims filed by security and law enforcement personnel in Kentucky from 2005 to 2015. Statistical analyzes included chi-­‐square and …

Comparison Of The Difference In Nephrotoxicity Between Nafcillin And Piperacillin-Tazobactam, Sonali Kishor Patel

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

Objective

To evaluate whether nephrotoxicity differs between nafcillin and piperacillin-tazobactam in adult hospitalized patients.

Introduction

Acute kidney injury (AKI) is a significant cause of morbidity and mortality in the inpatient setting, with antibiotics being a significant contributor. There is evidence of an increased risk of nephrotoxicity with the combination of vancomycin and piperacillin-tazobactam compared to vancomycin and cefepime or vancomycin alone. It is unknown whether this effect is exclusive for piperacillin-tazobactam. Therefore, in order to promote optimal medication therapy for inpatient bacterial infections, there is a need to assess the persistence of this difference in other beta-lactam antibiotics.

Methods

A …

Comparing The Non-Cystic Fibrosis Bronchiectasis Patients With Non-Tuberculous Mycobacteria (Ntm) And Non-Ntm Infections, Maninder Bir Singh

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

Objective

The objective of the study is to compare the Non-Cystic Fibrosis Bronchiectasis patients with Non Tubercular Mycobacteria (NTM) and Non-NTM infection and determine if the NTM and Non-NTM groups are different.

Methods

Data from the COPD Foundation’s Bronchiectasis Research Registry (BRR) was used in the study (n=1660).Logistic regression, Cox proportional hazards regression, and Kaplan Meier survival analysis were used to analyze the data.

Results

The study found odds ratio for having NTM infection for age to be 1.02 and for gender to be 2.34, after adjusting for all other variables in the multivariate logistic regression, with the p-value of …

Eat Well, Keep Moving: Decreasing Childhood Obesity In Fulton County, Kentucky, Sandra Onekhena

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

With the high rates of childhood obesity in Fulton County, the Purchase District Health Department proposes the implementation of the Eat Well and Keep Moving Program in all the county’s elementary schools among fourth and fifth graders. It is an interdisciplinary, evidence-based program that will be aimed at our short-term goal of increasing knowledge about nutrition and physical activity and inspiring positive behavioral change. It works by integrating lessons and activities about proper nutrition and activity into various aspects of the children’s lives — in the classroom, cafeteria, at home and in the community. We hope to see children move …

Neurotoxic Effects Of Occupational Exposures In Agricultural Workers, Miriam Siegel

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

Background: Pesticides and organic solvents are two classes of neurotoxic substances regularly used in agriculture. Pesticides have been studied in relation to a range of nervous system effects, and have been repeatedly shown to relate to depression in agricultural workers. Likewise, occupational solvent exposure is recognized as a risk factor for central nervous system effects, including mood disturbances and cognitive impairment, across various industries. Many gaps in knowledge regarding the effects of chronic exposure to these substances on mental/neurological health in agricultural workers still exist. The specific aims of the current analysis were to 1.) Estimate associations between metrics of …

Examining Associations Between Prevalence Of Chronic Obstructive Pulmonary Disease And Self-Perceived Health-Related Quality Of Life Among Adults In Kentucky, Seth Siameh

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

Introduction

The objective of this study is to examine associations between Chronic Obstructive Pulmonary Disease (COPD) prevalence in Kentucky and measures of health-related quality of life (HRQOL) using a large population-based sample.

Methods

Data from the 2013 Kentucky Behavioral Risk Factor Surveillance System (BRFSS) was used to calculate age-adjusted prevalence of COPD among various population subgroups (N=10,958). Multivariable logistic regression models were used to estimate adjusted odds ratios for COPD and HRQOL measures.

Results

In 2013, the age-adjusted prevalence of self-reported COPD among Kentucky adults aged ≥18 years was 10.3% (standard error [SE], ±0.4; 95% CI, 9.5 – 11.2). Kentucky …

Investigating The Efficacy Of Vocal Function Exercises In Improving Vocal Function In Adults Irradiated For Laryngeal Cancers: A Three Part Dissertation, Vrushali Angadi

Theses and Dissertations--Rehabilitation Sciences

Deterioration in voice quality following radiation therapy for the treatment of laryngeal cancers (LC) is well documented in literature. The majority of studies show that these voice problems are long term and in some cases permanent. Deterioration in voice quality, especially over a period of time could lead to significant communication difficulties in daily life or in some cases could even result in loss of profession. Despite the negative effects of radiation therapy on voice quality being well documented, few studies have focused on the efficacy of voice therapy in the irradiated LC population.

The purpose of this study was …

Reduction Of Fecal Coliform Bacteria Through The Elimination Of Sewage Discharges In West Virginia Streams, Kady Rogers

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

Background and Objectives

Early environmental regulations such as the Federal Water Pollution Control Act of 1948, and the 1972 amendments—which would later become known as the Clean Water Act—have improved the quality of the drinking and recreational waters here in the United States. This has been achieved as a result of strict regulations on discharges, proper management strategies, as well as thorough sampling and testing for contaminants. One such contaminant is fecal waste; these materials are a public health concern because of the potential risk of gastrointestinal diseases. Scientists have used fecal coliforms as an indicator of the presence of …

A Comparative Study Of Ever And Never Smokers With Bronchiectasis, Laura Higdon

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

Objective: The objective of the study is to predict the odds of death in participants with bronchiectasis and to determine if ever smokers have increased odds of death when compared to never smokers.

Methods: Data for the study was used from the Bronchiectasis Research. Pearson chi square test is used to compare never smokers to ever smokers for age, gender, and participants enrolled status. Logistic regression is used to predict the odds of death for smoking status, age, gender, or CT scan findings. CT scan findings for this study are dilated airways, airways that are thickening, tree-in-bud infiltrates or mucoid …

Overdose Education And Naloxone Distribution By Board-Certified Pharmacists In Five Eastern Kentucky Counties, Laura Elizabeth Broughton

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

The Coalition of Kentucky Health Professionals Against Substance Abuse (CKHPASA) is a professional organization uniting members of the various health professions against a rising tide of substance abuse in the state of Kentucky. In 2013, Kentucky ranked 3rd in the United States for highest number of drug overdose fatalities. Previously under the scourge of the prescription opioid epidemic, the state of Kentucky is now seeing rising numbers of overdose deaths related to heroin use, which is an opioid that works similarly to morphine and prescription pain medications.

Naloxone is a life-saving antidote for opioid related overdoses and evidence has shown …

Improving Indoor Air Quality For Children In Rural Kentucky, Denerica L. Curry

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

Community interventions directed towards improving indoor air quality for children are often implemented after exposure has occurred and focuses on parental smoking cessation. Our proposed project will intervene during the prenatal stage prior to exposure and continue to support families 6 months postpartum. Infants are at an increased risk of secondhand smoke exposure due to the amount of time they spend in the home and proximity to the smoker. We hypothesize that by enhancing care of the current home visitation model to include an early intervention we will increase the amount of smoking bans in the home and decrease maternal …

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 …

Evaluations Of Patients’ Appointment Duration By Type In An Ophthalmology Practice, Brittany U'Wren

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

Objective: The Affordable Care Act expanded health care coverage and provided more access to physicians, resulting in potentially longer wait times. Large portions of ophthalmology patients are on Medicare. Two thirds of the expansion populations were Hispanic or African Americans, which have higher rates of eye disease. Another contributoring factor leading to the increase for eye care is the surge of baby boomers. More specifically, these are individuals reaching sixty-five and are beginning to utilize Medicare. Access to care has increased but the capacity of the practice has not. An important goal, therefore, is to maximize efficiency of current …

Lifestyle Contributors To Cardiovascular Disease Risk, Adam J. Berrones

Theses and Dissertations--Kinesiology and Health Promotion

Aortic stiffness is an independent risk factor that has prognostic value regarding future cardiovascular disease (CVD) events such as myocardial infarction, strokes, and heart failure. Although death rates due to coronary heart disease have declined in recent years, the leading global killer remains CVD and prevalence is still high. Understanding lifestyle contributors associated with aortic stiffness would provide the public with insight into targeting key health-related behaviors.

The purpose of this observational study was to examine the association of physical activity, physical function, and dietary quality as independent factors contributing to aortic stiffness in apparently healthy middle aged men. Fifty-two …

The Role And Impact Of School Nurses And Intentions To Delegate Diabetes-Related Tasks Amidst Budget Cuts And Legislative Changes, Michelle J. Lineberry

Theses and Dissertations--Kinesiology and Health Promotion

As the percentage of school children with chronic conditions such as diabetes continues to rise, funding for school nurses to keep those students healthy and safe is decreasing. This dissertation includes three studies: (1) a systematic review of the literature on the role and impact of American elementary school nurses, (2) a focus group study that further examined the role of Kentucky school nurses and described their reaction to a new regulation that necessitates delegation of diabetes-related nursing tasks to unlicensed assistive personnel (UAP), and (3) a quantitative study that examined Kentucky school nurses’ past behaviors and future intentions regarding …

Comprehensive Sexuality Education In Kentucky, Luciana D. Hockersmith

Theses and Dissertations--Community & Leadership Development

Discussions of sex education of any kind can be controversial in a given setting. Traditional approaches to sex education prompt debate regarding effectiveness. Key indicators central to the effectiveness of sex education continue to be rates of teen pregnancy and transmission of sexually transmitted diseases (STDs). With discontentment surrounding the effectiveness of “traditional approaches,” a more wide-ranging method is worthy of being explored. The curriculum approach of Comprehensive Sexuality Education (CSE) includes six key concepts, and subsequent sub-concepts, intended to provide a broad and even all-inclusive range of topics for a similarly broad and even all-inclusive range of ages of …

Evaluating A Bystander Intervention Program On Reproductive Coercion: Using Quasi-Experimental Design Strategies To Address Methodologic Issues In Randomized Community Prevention Trials, Catherine P. Starnes

Theses and Dissertations--Epidemiology and Biostatistics

Community (or cluster) randomized trials are trials in which communities or groups of individuals (clusters) are randomized to receive the intervention of interest. Community randomized trials frequently more closely resemble a natural experiment than a randomized controlled trial (RCT) following intervention allocation. In particular, the effects of non-compliance can pose methodologic challenges in estimating the intervention effect which may require a quasiexperimental approach in order to minimize bias.

The motivating example to illustrate these issues is the Green Dot High School (GDHS) study. The GDHS study was a longitudinal, cluster-randomized controlled trial designed to assess the effectiveness of a bystander …

Exploration Of The Misuse, Abuse, And Diversion Of Gabapentin, Rachel Vickers Smith

Theses and Dissertations--Epidemiology and Biostatistics

Gabapentin is currently approved by the Food and Drug Administration (FDA) as an adjunctive anti-convulsant and an analgesic for post-herpetic neuralgia. Though gabapentin was initially presumed to have limited or no abuse potential, which may have contributed to its widespread off-label prescribing, there have been increasing anecdotal and published reports of its misuse by substance abusers in the community and penal system. However, to date, there has been limited systematic evaluation of the scope and risk of gabapentin misuse and its associated effects. This dissertation assesses the etiology and prevalence of gabapentin misuse, abuse, and diversion in a multi-faceted approach, …

Competitive Food Policy Implementation In Kentucky Schools, Paula Gisler

Theses and Dissertations--Nursing

This study was designed to explore the literature on competitive food policy implementation (CFPI); examines demographic and school factors associated with CFPI; and explores the experiences of school leaders and staff in CFPI using a proposed theoretical framework to guide the research. Competitive foods are those sold in vending machines, a la carte settings, fundraisers, class parties and other venues which compete with foods offered through the national school lunch and breakfast programs. Competitive foods have traditionally been of low nutritional value and high energy density. CFPI may be effective in reducing student calorie intake and BMI. However, evaluation of …