Public Health Commons^™

Continuing To Confront Copd International Surveys: Comparison Of Patient And Physician Perceptions About Copd Risk And Management, Ana M. Menezes, Sarah H. Landis, Meilan K. Han, Hana Muellerova, Zaurbek Aisanov, Thys Van Der Molen, Yeon-Mok Oh, Masakazu Ichinose, David M. Mannino, Kourtney J. Davis

Preventive Medicine and Environmental Health Faculty Publications

PURPOSE: Using data from the Continuing to Confront COPD International Physician and Patient Surveys, this paper describes physicians' attitudes and beliefs regarding chronic obstructive pulmonary disease (COPD) prognosis, and compares physician and patient perceptions with respect to COPD.

METHODS: In 12 countries worldwide, 4,343 patients with COPD were identified through systematic screening of population samples, and 1,307 physicians who regularly saw patients with COPD were sampled from in-country professional databases. Both patients and physicians completed surveys about their COPD knowledge, beliefs, and perceptions; physicians answered further questions about diagnostic methods and treatment choices for COPD.

RESULTS: Most physicians (79%) responded …

Aca Implementation In The South: The Political Economy Of Full Participation In Kentucky, Glen P. Mays

Health Management and Policy Presentations

This analysis, conducted as part of the ACA Implementation Research Network, examines economic and political forces shaping Kentucky's early experience with implementation of the Patient Protection and Affordable Care Act.

Linking The Home And Neighborhood Food Environments Regarding Dietary Intake Among Rural Adolescents, Matthew James Saulnier

Theses and Dissertations--Nutrition and Food Systems

Home availability of both healthful and unhealthful foods may influence consumption among rural adolescent populations. In conjunction, the availability of food in an individual’s local food environment has the potential to significantly impact what is procured for the home and eaten away from the home. The purpose of this study was to determine how in-store food availability and parental purchases influences home availability and, ultimately, dietary intake among adolescents. This study measured perceived home availability, using the University of Minnesota Project EAT Survey, and dietary intake, using the NHANES Dietary Screener Questionnaire, of (n=28) adolescent participants in two Kentucky counties …

Adolescent Oral Health In Kentucky, 2007 National Survey Of Childhood Health Analysis, Kory Brinker

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

Research indicates that children raised by their grandparents can have poorer health outcomes than their peers living in mother or father based households. There is, however, little research that indicates how childhood oral health is affected by grandparents raising grandchildren. This study investigated grandparent based family structures, and how this family structure affects oral health of Kentucky children. Using data from the 2007 National Survey of Children’s Health, 113 Kentucky children were identified as living with a grandparent as a primary caregiver. Chi-Square analyses were utilized to assess the oral health status of these children, as well as what role …

Needle Stick Injuries And Blood Born Pathogen Exposures Among Health Care Workers In University Of Kentucky Health Care Facilities, Haider Sahmsulddin

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

Objectives:

The number of cases of needle stick and sharps-related injuries among healthcare workers are difficult to estimate due to underreporting. Multiple research studies have been done in this area but the scale of the problem is substantial and requires further attention. This study focuses on the cases of needle stick injuries and blood born pathogen exposure among health care workers at the University of Kentucky. The purpose of this study is to examine the rates of needle stick vs splash related injuries among the University of Kentucky health care workers from 2009 to 2014, and stratify the frequencies of …

Nutritional Assessment Of Preschool Children In An Urban Ecuadorian Community, Elizabeth A. Bronner

Theses and Dissertations--Nutrition and Food Systems

Objectives: The goal of this project was to determine the nutritional needs of preschool age children to help guide intervention development. The research aims were 1) to examine and describe young child (ages one to five) nutritional status as it relates to key nutrients associated with stunting and wasting; 2) to determine what key macro- and micro-nutrient deficiencies (primarily iron and zinc) are associated with wasting and stunting.

Methodology:

Study sample: Sixty-seven families with children ages one to five who participating in routine health care clinic visits during the UK Shoulder to Shoulder Global health brigade visits.

Study …

Reassessment Of Risk Genotypes (Grn, Tmem106b, And Abcc9 Variants) Associated With Hippocampal Sclerosis Of Aging Pathology, Peter T. Nelson, Wang-Xia Wang, Amanda B. Partch, Sarah E. Monsell, Otto Valladares, Sally R. Ellingson, Bernard R. Wilfred, Adam C. Naj, Li-San Wang, Walter A. Kukull, David W. Fardo

Pathology and Laboratory Medicine Faculty Publications

Hippocampal sclerosis of aging (HS-Aging) is a common high-morbidity neurodegenerative condition in elderly persons. To understand the risk factors for HS-Aging, we analyzed data from the Alzheimer’s Disease Genetics Consortium and correlated the data with clinical and pathologic information from the National Alzheimer’s Coordinating Center database. Overall, 268 research volunteers with HS-Aging and 2,957 controls were included; detailed neuropathologic data were available for all. The study focused on single-nucleotide polymorphisms previously associated with HS-Aging risk: rs5848 ( GRN ), rs1990622 ( TMEM106B ), and rs704180 ( ABCC9 ). Analyses of a subsample that was not previously evaluated (51 HS-Aging cases …

College Students’ Use Of Social Media To Communicate About Alcohol And Drinking Behaviors, Jenna E. Reno

Theses and Dissertations--Communication

Social networking sites (SNSs) are an increasingly popular channel for communication among college students. Often students disclose more freely via social networking sites than they would in other situations. These disclosures commonly include information about engaging in risky health behaviors (e.g., binge drinking). Study 1 examined students’ impression management goals and self-presentation tactics specifically related to self-disclosures of drinking behavior on SNSs. Findings suggest that students use differing self-presentation tactics across various SNSs in order to achieve their impression management goals and to avoid consequences associated with disclosing about risky health behaviors to certain audiences. Study 2 sought to develop …

The Relationship Of Hispanic Ethnicity, Drug Use, And Bullying With Suicidal Ideation Among Adolescent Females In The 2013 Youth Risk Behavior Surveillance Survey, Erin Camp

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

BACKGROUND: There is little research on the relationship of Hispanic ethnicity, drug use, and bully victimization with suicidal ideation among adolescent females. This study investigates all components and their association with suicidal ideation using the 2013 Youth Risk Behavior Surveillance Survey (YRBSS).

METHODS: Participants were 6,621 adolescent females who completed a self-administered questionnaire (YRBSS). Students answered a series of questions regarding unintentional injuries and violence and alcohol and other drug use.

RESULTS: Results indicated that there was an association between drug use, bully victimization, and suicidal ideation. Bivariate analyses using chi-square tests showed the relationships between these risk factors and …

Financial Strain, High Stress And Smoking Among United Way Missouri 2-1-1 Callers, Brandon Cofield

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

Objectives.

We evaluated the influence of financial strain and perceived stress on smoking status among United Way Missouri 2-1-1 callers of predominantly low socioeconomic status.

Methods.

Data for this study were collected as part of a randomized, controlled intervention trial integrating cancer control referrals into regular United Way 2-1-1 Missouri services. Those who consented, completed the assessment and had at least one cancer control need were invited to participate in a longitudinal study that included completing the baseline assessment used in this study. We conducted chi-square analyses to assess the bivariate relationships between each financial strain variable and smoking status, …

Proton Pump Inhibitors And Atrial Fibrillation, Dustin Hughes

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

Background

Proton pump inhibitors (PPIs) are widely used drugs in the United States. Atrial fibrillation (AF) affects 2.7 million people in this country and often leads to other serious medical conditions. There is a growing body of evidence suggesting that PPIs may be proarrhythmic. This study seeks to better appreciate the relationship between these popular drugs and the most common arrhythmia.

Methods

This is a nested case-control study using a large, nationally representative insurance database. Members with an incident AF diagnosis between 2007 and 2009 were identified. Each case was matched with one control member, using incidence density sampling, and …

Menthol Cigarette Smoking And Obesity In Young Adult Daily Smokers In Hawaii, Alyssa Marie M. Antonio, Pebbles Fagan, Faith D. Hamamura, Ian Joseph N. Lagua, Jenny Liu, Devin J. Park, Pallav Pokhrel, Thaddeus A. Herzog, Ian Pagano, Kevin Cassel, Angela Sy, Dorothy Jorgensen, Tania Lynch, Crissy Kawamoto, Carol J. Boushey, Adrian Franke, Mark S. Clanton, Eric T. Moolchan, Linda A. Alexander

Health, Behavior & Society Faculty Publications

This study investigates 1) the relationship between menthol cigarette smoking and obesity and 2) the association of body mass index with the nicotine metabolite ratio among menthol and non-menthol daily smokers aged 18–35 (n = 175). A brief survey on smoking and measures of height and weight, carbon monoxide, and saliva samples were collected from participants from May to December 2013 in Honolulu, Hawaii. Multiple regression was used to estimate differences in body mass index among menthol and non-menthol smokers and the association of menthol smoking with obesity. We calculated the log of the nicotine metabolite ratio to examine differences …

Healthcare Industry Injuries By Patient Contact Status In Kentucky, 2012-2014, Kristen Ranzenberger

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

Objectives

The healthcare industry continues to have a high number of reported injuries. The purpose of this study was to 1) characterize healthcare industry injuries by patient contact status; 2) identify the occupations associated with healthcare injuries by patient contact status; and 3) determine healthcare injury rates by occupation, to gain a better understanding of healthcare industry compensated injuries , and better target healthcare industry safety practices and programs.

Methods

Workers’ Compensation first reports of injuries (FROI) from the healthcare industry in Kentucky were categorized into injuries involving in direct patient contact vs. injuries without direct patient contact using narrative …

Are There Delays In Receipt Of Treatment Among Appalachian Kentucky Women With Breast Cancer, Huong Thi Thanh Luu

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

Background: Women living in rural and under-resourced Appalachian Kentucky may experience delays in receiving cancer treatment yet such delays have not been systematically evaluated. In this analysis, we hypothesize that women diagnosed with breast cancer who live in Appalachian Kentucky would be more likely to have a treatment delay compared to those living in other Kentucky regions and adjusting for individual measures of socioeconomic status.

Methods: In this cohort study, women included in the Kentucky Cancer Registry with a diagnosis of an incident, primary breast cancer in the prior 12 months were interviewed by phone (n=1,245; response rate 26.9%). Cox …

Examining Alcohol Consumption, Psychological Distress, And Current Smoking Status: Results From The Behavioral Risk Factor Surveillance System, 2013, Guangxing Zhan

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

Introduction: Approximately 443,000 people die from smoking or exposure to secondhand smoke, and another 8.6 million people have a serious smoking-related illness, which costs nearly $96 billion in health-care expenditures and $97 billion in productivity losses annually in the United States. This study examined the association between alcohol consumption and smoking status, and how psychological distress can affect this association. Methods: Data come from the 2013 Behavioral Risk Factor Surveillance System (BRFSS). We used binary logistic regression models to compute adjusted odds ratios between alcohol consumption and smoking status, controlling for age, gender, race, education, and income. We used chi-square …

Associations Among Sexual Violence, Risky Sexual Behaviors, And Substance Abuse: Risk And Protective Factors Among Women From The National Survey Of Family Growth, Michelle Kroger

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

Introduction: Millions of women experience sexual violence which results in a plethora of adverse health consequences. Given the scope of the problem, more attention is needed to examine the complexities in which sexual violence occurs, and possible associations among sexual violence and related health behaviors. The present study analyzes whether a significant association between sexual violence and condom use and/or sexually transmitted diseases (STDs) exists, and whether consuming alcohol and/or drugs increases women’s risk of having unprotected sex and/or an STD.

Methods: Data from the National Survey of Family Growth 2006-2010 and 2011-2013 were analyzed using bivariate and multivariate chi-square …

Rural Healthcare Worker's Willingness To Report To Work During Catastrophic Events, Aaron M. Macdonald

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

In the events leading up to, during, and following a catastrophic event, healthcare workers play a critical role in the outcome of these events. Therefore it is of the utmost importance that healthcare workers are able and willing to report to work. Prior to September, 2001 there had been three willingness to report studies published in the literature. Post September, 2001 and up until 2011 there was a renewed interest in the topic which led to the publishing of twenty plus papers on the topic. The current literature has examined willingness to report thoroughly and definitively; however, there is a …

Farm To School Programs And Children's Dietary Behaviors, Kathleen Evers

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

There is an increasing promotion of the importance of fruit and vegetable consumption through prevention efforts, specifically in school systems, to control and prevent childhood obesity. Farm to School (FTS) programs offer interactive hands on experiences involving fruits and vegetables. This study examines a specific FTS program including a farmer interaction, and a broccoli taste testing experience for kindergarten and fourth grade students in a rural Kentucky county. By using a digital still photography method of plate waste, the decisions of approximately 115 students to take/not take broccoli and percentage of students’ consumption of broccoli was analyzed. Using chi-square and …

Association Between Stressful Life Events And Change Of Maternal Smoking During Pregnancy Using Prams 2011-2012, Shidie Tang

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

Objective: To examine the association between stressful life events during pregnancy and change of maternal smoking behaviors.

Methods: We used data from the CDC’s Pregnancy Risk Assessment Monitoring System (PRAMS) to conduct the research. Our data included 24 states from 2011-2012. We considered 13 stressful life events and grouped them into four categories: emotional, partner-related, financial and traumatic stressors. Change of Maternal Smoking during pregnancy was defined by smoking at the last trimester of pregnancy versus smoking at 3 months prior to smoking. Confounders included maternal age, race/ethnicity, education, marital status, Medicaid coverage upon delivery and income prior …

A Qualitative Analysis Of Four Appalachian Cervical Cancer Patient Navigators Interviews, Steven Hiestand

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

Despite widespread incorporation of patient navigation into cancer care programs, there remains little consensus on the definition or core competencies which distinguish the patient navigator role within health care. In order to determine the definition and core competencies, the experiences and insights of patient navigators must be understood. Four patient navigators participating in a 2010 Appalachian Cervical Cancer intervention were interviewed. I qualitatively analyzed these interviews for important themes relating to the definition of patient navigation as well as important skills and competencies. The patient navigators identified patient navigation as being patient-centric and focused on overcoming barriers to cancer care. …

Cardiovascular Disease Risk Factors In Structural Firefighters, Nicholas W. Trubee

Theses and Dissertations--Kinesiology and Health Promotion

This dissertation is composed of two manuscripts assessing cardiovascular disease (CVD) risk in structural firefighters. Study 1 compared traditional CVD risk factors and health-related behaviors between professional and volunteer firefighters. Online questionnaires were sent to approximately 4000 firefighters in the state of Kentucky. The results indicated that 90% of volunteer and 58% of professional firefighters were classified as moderate-to-high CVD risk. Volunteer firefighters were significantly (p < 0.001) older and more likely (p = 0.026) to be current cigarette smokers. The mean body mass index among all firefighters in the sample was 30.8 kg·m^-2. Nearly 60% of volunteer firefighters were obese. Obese firefighters were more likely (p < 0.05) to have been diagnosed as diabetic or pre-diabetes compared to overweight and normal weight firefighters. These results indicate that volunteer firefighters may be at a greater CVD risk compared to professional firefighters.

Study 2 investigated the association of cardiorespiratory fitness (CRF) and body fat with arterial stiffness in professional firefighters. Forty-six …

A Public Duty: Medicine And Commerce In Nineteenth-Century American Literature And Culture, Heather E. Chacon

Theses and Dissertations--English

Using recent criticism on speculation and disability in addition to archival materials, “A Public Duty: Medicine and Commerce in Nineteenth-Century American Literature and Culture” demonstrates that reform-minded nineteenth-century authors drew upon the representational power of public health to express excitement and anxiety about the United States’ emerging economic and political prominence. Breaking with a critical tradition holding that the professionalization of medicine and authorship served primarily to support and define an ascending middle class, I argue that the authors such as Robert Montgomery Bird, Fanny Fern, George Washington Cable, and Pauline Hopkins fuse the rhetoric of economic policy and public …

Medication Misadventures: The Case Of Benzodiazepines, Sarah E. Wixson

Theses and Dissertations--Pharmacy

For patients afflicted with symptoms of anxiety and insomnia, benzodiazepines are generally a safe and effective short-term pharmacological treatment option. Although considered safer than other sedative-hypnotic medications, substantial concern exists regarding the addictive nature and abuse potential of benzodiazepines along with potentially inappropriate prescribing and utilization in clinically vulnerable populations. These medication misadventures can have a significant impact on public health. Examples of medication misadventures as they pertain to benzodiazepines include the prescribing and use in clinically vulnerable populations for whom they are contraindicated or their efficacy has not been evaluated, the development of tolerance or addiction, abuse of the …

Evidence-Based Hospitals, David R. Bardach

Theses and Dissertations--Epidemiology and Biostatistics

In 2011 the University of Kentucky opened the first two inpatient floors of its new hospital. With an estimated cost of over $872 million, the new facility represents a major investment in the future of healthcare in Kentucky. This facility is outfitted with many features that were not present in the old hospital, with the expectation that they would improve the quality and efficiency of patient care. After one year of occupancy, hospital administration questioned the effectiveness of some features. Through focus groups of key stakeholders, surveys of frontline staff, and direct observational data, this dissertation evaluates the effectiveness of …

Developments In Nonparametric Regression Methods With Application To Raman Spectroscopy Analysis, Jing Guo

Theses and Dissertations--Epidemiology and Biostatistics

Raman spectroscopy has been successfully employed in the classification of breast pathologies involving basis spectra for chemical constituents of breast tissue and resulted in high sensitivity (94%) and specificity (96%) (Haka et al, 2005). Motivated by recent developments in nonparametric regression, in this work, we adapt stacking, boosting, and dynamic ensemble learning into a nonparametric regression framework with application to Raman spectroscopy analysis for breast cancer diagnosis. In Chapter 2, we apply compound estimation (Charnigo and Srinivasan, 2011) in Raman spectra analysis to classify normal, benign, and malignant breast tissue. We explore both the spectra profiles and their derivatives to …

Nonlinear Hierarchical Models For Longitudinal Experimental Infection Studies, Michael David Singleton

Theses and Dissertations--Epidemiology and Biostatistics

Experimental infection (EI) studies, involving the intentional inoculation of animal or human subjects with an infectious agent under controlled conditions, have a long history in infectious disease research. Longitudinal infection response data often arise in EI studies designed to demonstrate vaccine efficacy, explore disease etiology, pathogenesis and transmission, or understand the host immune response to infection. Viral loads, antibody titers, symptom scores and body temperature are a few of the outcome variables commonly studied. Longitudinal EI data are inherently nonlinear, often with single-peaked response trajectories with a common pre- and post-infection baseline. Such data are frequently analyzed with statistical methods …

The Non-Steroidal Anti-Inflammatory Drugs-Myocardial Infarction Association: An Investigation Of Kentucky Medicaid Prescription Claims, Leonard A. Gordon

Theses and Dissertations--Epidemiology and Biostatistics

Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most widely used medications globally. There are generally two types: selective (COX-2) and traditional NSAIDs (COX-1). They are primarily used for the treatment of pain. They gained attention after a study about their basic mechanisms highlighted their toxicity.

Several studies have reported an association between NSAIDs and risk of myocardial infarction (MI). However, the direction of the relationship is not conclusive. Further studies are needed to ascertain the direction of this relationship and evaluate the present situation with available drugs. Due to the seriousness of cardiovascular diseases as one of the leading cause …

The Synergistic Impact Of Income And Rurality On Timely Mammograms In A National Sample Of Women In The United States, Asri Mumpuni

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

Introduction. Breast cancer is the cancer of highest incidence among women in the U.S., making it a significant public health problem. Currently, the U.S. Preventive Services recommends biennial screening mammography for women ages 50-74. This study examined the associations between socioeconomic status and rurality on breast cancer screening behavior. Methods. Data for this study come from the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System Survey (BRFSS). Breast cancer screening behavior was dichotomized into those who did not meet screening mammogram recommendations (2 years or more) and those who met screening mammogram recommendations (within the …

Palliative Care: Evaluating And Designing Process Improvements For An Inpatient Consultative Program, Shawn M. Crouch

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

The purpose of this capstone project paper and study was to evaluate an inpatient palliative care consultation service and then make recommendations for improving the program. This paper includes a literature review related to palliative care models and best practices in structuring a successful inpatient palliative care service. The project included an analysis of how the program at one university based hospital measured success of the program and SWOT analysis based on interviews with members of the program’s team and leadership. Data sources used for the analysis included palliative care consultation utilization data from the identified hospital; other metrics used …

Alcohol Sale Status And Violent Deaths In Kentucky, Usa: 2005-2012, Hanan Abdulghafoor Khaleel

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

Alcohol is one of the major public health problems worldwide because of its association with many health and psychological problems. This study adds to the extant literature by examining the association between being a resident in a wet county and having an alcohol related violent death, an alcohol related suicide, or an alcohol related homicide victimization.

The first aim of this study is to determine whether residents of wet counties have a higher odds of alcohol related violent deaths than residents of dry/moist counties after adjusting for other confounding factors. The second aim is to determine whether residents of wet …