Public Health Commons^™

Reducing Cancer Disparities Through Community Engagement In Policy Development: The Role Of Cancer Councils, Michael A. Preston, Glen P. Mays, Rise' D. Jones, Sharla A. Smith, Chara N. Stewart, Ronda Henry-Tillman

Health Management and Policy Faculty Publications

Cancer is the second leading cause of death in the U.S and a source of large racial and ethnic disparities in population health. Policy development is a powerful but sometimes overlooked public health tool for reducing cancer burden and disparities. Along with other partners in the public health system, community-based organizations such as local cancer councils can play valuable roles in developing policies that are responsive to community needs and in mobilizing resources to support policy adoption and implementation. This paper examines the current and potential roles played by local cancer councils to reduce cancer burden and disparities. Responsive public …

Key Nutrient Selection And Consumption By Elementary Students In The National School Lunch Program, Jocelyn Hayward Cowen

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

While the recent decline in the rate of obesity amongst preschool children in 19 states is encouraging,(1) the overall rate of obese children in the United States remains at 17%.(2) Obese children suffer physical, emotional, and psychological health consequences such as high blood pressure, high cholesterol, impaired glucose tolerance, breathing problems, fatty liver disease, poor selfZesteem, and depression.(3) Furthermore, obese children are more likely to become obese adults with their health problems worsening with age.(3)

The National School Lunch Program (NSLP), which provided meals to over 30 million students in 2013,(4) was recently revised to improve school food environments to …

The Effectiveness Of Sexual Education Programs On Teen Births Among Females With And Without A Family History Of Teen Births, Holly Poynter

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

Adolescents (ages 10 to 19) and young adults (ages 20 to 24) make up 21% of the population of the United States. Therefore, the topic of adolescent health is an important focus in Healthy People 2020.5 The HP 2020 initiative describes adolescent health as a fairly broad topical area that encompasses smaller subjects such as teen smoking, pregnancy, and suicide. Due to its recent decline, teen pregnancy is often overlooked as an epidemic problem in the United States. According to the CDC, “…the sexual and reproductive health of America’s young persons remains an important public health concern: a substantial number …

Flavored Milk And The National School Lunch Program, Ellen Hutchins

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

According to the National Health and Nutrition Examination Survey (NHANES) nearly 17% of children nineteen years of age and younger are obese.1 Obese children face many health ailments similar to those of obese adults including sleep apnea, asthma, hypertension, and early onset of type 2-diabetes.2 These problems continue into adulthood when additional risks such as cancer and cardiomyopathy begin to develop.2 Furthermore, obese children are at increased risk of adult obesity.3 Addressing the childhood obesity challenge has become a national priority, with significant initiatives from the White House, USDA, CDC, and other national health organizations as well as numerous intervention …

Health Care Avoidance Among Rural Populations: Results From A Nationally Representative Survey, Angela M. Spleen, Eugene J. Lengerich, Fabian T. Camacho, Robin C. Vanderpool

Health, Behavior & Society Faculty Publications

BACKGROUND: Previous research suggests that certain populations, including rural residents, exhibit health care avoidant behaviors more frequently than other groups. Additionally, health care avoidance is related to sociodemographics, attitudes, social expectations, ability to pay for care, and prior experiences with providers. However, previous studies have been limited to specific geographic areas, particular health conditions, or by analytic methods.

METHODS: The 2008 Health Information Trends Survey (HINTS) was used to estimate the magnitude of health care avoidance nationally and, while controlling for confounding factors, identify groups of people in the United States who are more likely to avoid health care. Chi-square …

A Life Span Approach To The Relationship Between Cholesterol, Late Onset Alzheimer’S Disease, And Cognitive Functioning Among Older Adults, Brian Downer

Theses and Dissertations--Gerontology

There is evidence that cholesterol presents an important risk factor for Alzheimer’s disease (AD), but the direction of this relationship is modified by age. High cholesterol during midlife and low cholesterol during late life are both associated with an increased risk for AD. This dissertation research engaged a life span approach to study the relationship between cholesterol, AD and cognitive functioning among older adults. The purpose of this research was to determine if trajectories of cholesterol from midlife through late life differ according to AD status and if these trajectories are associated with cognitive functioning during old age.

This research …

Roofer Dies After Gust Of Wind Knocks Him And A Co-Worker Off Roof, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Falls

Around 11:00 a.m. on a windy fall day, a 73-year-old roofer and a roofing coworker arrived at the commercial construction site to roof a newly constructed building. The two roofers climbed an extension ladder to access the roof to determine where they were going to place their anchors to tie off. While reviewing the backside of the commercial structure, a gust of wind around 33 m.p.h. made the two roofers lose their balance and fall from the roof. The 73-year-old roofer landed first and the second roofer landed on top of him. Both men fell 15 feet and 6 inches …

Drug Overdose Deaths, Hospitalizations, And Emergency Department Visits In Kentucky, 2000‐2012, Svetla Slavova, Terry L. Bunn, Joshua W. Lambert

Kentucky Injury Prevention and Research Center Special Report

This report presents drug overdose morbidity and mortality data for Kentucky residents, using multiple data sources:

• Kentucky Death Certificate Files, Kentucky Office of Vital Statistics, 2000‐2012 (data captured as of October 21, 2013). The 2009‐2012 files are provisional and subject to change.
• Kentucky Inpatient Hospitalization (IH) Discharge Files, Cabinet for Health and Family Services, Office of Health Policy, 2000‐2012 (data for 2010‐2012 are provisional and subject to change).
• Kentucky Emergency Department (ED) Discharge Files, Cabinet for Health and Family Services, Office of Health Policy, 2008‐2012 (data for 2010‐2012 are provisional and subject to change).

Assessing Provider Adherence To An Emergency Contraception Guideline In Reproductive Age Women, Amber E. Davis

DNP Projects

Purpose: To determine current provider adherence to the 2010 ACOG Emergency Contraception (EC) guidelines, specifically by assessing provider EC counseling with patients at well-woman annual exam visits or during contraceptive counseling visits. A second aim of this study is to identify provider facilitators and barriers of EC discussion with patients.

Methods: Using a retrospective design, 90 medical records of patients presenting to a university clinic within the previous year were reviewed for the discussion of EC during annual exams or contraceptive counseling. Forty-five medical records were reviewed prior to implementation of the Ambulatory Electronic Health Record (AEHR) and forty-five medical …

Adolescent Violence Prevention, Hatim A. Omar

Pediatrics Faculty Publications

Violence in adolescence has seen an increase since the 1990s with dramatic statistics on violent death and risk behaviors. School violence has been focused upon by a huge media coverage of especially violent cases that could have had some endemic consequences worldwide. We present a case of a 14 year old white male with change in school behavior, strategies for the case investigation, its results and long term prevention. Other research has shown that preventive measures during pregnancy, infancy and childhood can prevent adolescent and adult delinquency.

Prevention: Sexual Violence Against Adolescent And Young Adult Women, Kimberly K. Mcclanahan, Marlene B. Huff, Hatim A. Omar, Joav Merrick

Pediatrics Faculty Publications

No abstract provided.

Associations Of Maternal Socio-Demographic And Psychosocial Characteristics With Alcohol Use During Pregnancy, Nneoma Adaobi Ilogu

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

Alcohol is reported to be one of the most used legal substances among women of reproductive age, and its use during pregnancy is one of the most preventable causes of birth defects and developmental disabilities.1 Due to its teratogenic nature, alcohol use during pregnancy has been associated with a condition referred to as Fetal Alcohol Spectrum Disorders (FASD).2 This comprises of a wide spectrum of disorders such as Fetal Alcohol Syndrome (FAS), alcohol-related birth defects, and alcohol-related neurodevelopmental disorders, which are estimated to affect 1% of all births in the United States and can be prevented through the modification of …

Are There Benefits Of Smoking Reduction During Pregnancy? Smoking Status Of Pregnant Women And The Effect On Pre-Term Delivery, Kelli Ann Mclane

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

Premature delivery is defined as a baby born before thirty-­‐seven completed weeks of pregnancy. Premature delivery can result in a longer hospital stay after delivery compared to babies born at full-­‐term.1 Babies born before 37 gestational weeks also have a greater potential for health problems such as acute respiratory, gastrointestinal, immunologic, central nervous system, hearing, and vision problems, as well as longer-­‐term motor, cognitive, visual, hearing, behavioral, social-­‐emotional, health, and growth problems.2 Premature births can impact at the individual level and at a societal level. “The birth of a preterm infant can bring considerable emotional and economic costs to families …

Factors Affecting School Health Scores: Wellsat Scores, School Policy, And The School Environment, Alicia Baker

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

A recent trend in school health intervention has been through policy creation and development. Studies have shown that changes in school health policy can improve student health behaviors, particularly in physical activity and nutrition. This study looked at how potential factors could affect the scores of a school policy assessment tool called the Wellness School Assessment Tool (WellSAT). Using a combination of t-tests, chi-square tests, and logistic regression, schools’ strength and comprehensiveness nutrition scores from the WellSAT were analyzed when compared to Free and Reduced Lunch Rates, type of school, and whether schools had separate policies from their school district. …

Effects Of Locality And Risk Of Late Stage Breast Cancer Diagnosis In Kentucky Females, 2001-2011, Michael Jacob Sither

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

Breast cancer survival is heavily dependent on stage at diagnosis. Recent evidence supports rural women are more likely than urban women to be diagnosed with advanced stage disease but historically these findings have been mixed when investigated at the state level. Cancer surveillance in the Appalachian region suggests Kentucky females are at significantly greater risk of premature breast cancer mortality due to consistently lower prevalence of screening mammography utilization. In the literature, disparities in breast cancer outcomes have been largely explained by population demographics, areabased measures of socioeconomic deprivation, shortages of referring providers as well as differences in spatial access …

Evaluating Oral Health Trends In Kentucky, 2006-2012, Briana Michelle Forsythe

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

According to the former US Surgeon General, C. Everett Koop, “You’re not healthy without good oral health.” Poor oral health, comprising of the presence of caries and/or periodontal disease, can lead to edentulism, which in turn can yield poor physical health, inability to communicate properly, poor mental health, and a lesser quality of life. In Kentucky, over one quarter of the adult population has lost six or more teeth due to decay or gum disease, a figure 10% higher than the national average. Objectives: The purpose of this study was to examine: a) Kentucky’s Statewide Oral Health Strategic Plan, implemented …

Factors Influencing Differential Oral Health Care Use Between Hispanics And Non-Hispanic Whites In The U.S., Nathalie Astudillo

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

Oral health is often considered merely the absence of disease. However, oral health involves much more. Good oral health facilitates very basic functions like eating and speaking; a healthy smile is also associated with good self-esteem and productivity.1 Most oral health diseases are largely preventable. Despite this, a large portion of the population in the United States still suffer from untreated dental decay.2 Poor oral health has a direct effect on systemic health, quality of nutrition, digestion, phonetics, selfimage and self-esteem.5 Whether considered individually or combined, each of these factors has a direct impact on the quality of life of …

Injuries Among Miners In Kentucky During 2010-2012 From Workers Compensation Data, Evelyn Thomas

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

Introduction: Coal miners in Kentucky have higher rates of injury morbidity and mortality than national rates. In order to understand better what is happening in this area, we not only analyzed the injuries and deaths, but also identified common characteristics between these nonfatal and fatal injuries. The objectives of this study were to 1) Identify injuries among coal miners in Kentucky; 2) Determine if there are any other risk factors for injuries other than working in a mine; and 3) Determine the different health effects on coal mine workers. Methods: Data from Kentucky Workers’ Compensation First Reports of Injuries and …

Influence Of Marianismo On Colorectal Cancer Screening Behavior Among Hispanic Women In The United States, Robin Thompson

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

Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the second leading cause of cancer death in the United States (U.S).1 Although early detection and treatment can reduce CRC-related morbidity and mortality, almost twothirds of patients are diagnosed with advanced stage disease indicating non-adherence to recommended screening guidelines.1 Indeed, less than half of individuals over 50 years of age get screened at recommended intervals.2 More specifically, lower rates of CRC screening exist among these groups: those identifying as being of Hispanic origin, the uninsured, disabled individuals, and women.3 In a 2011 report from the National Center on Health …

An Exploration Of Empowerment, Sexual Violence, And Hiv Among Indian Women, Brigid Kyung-Hwa Cecil

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

Empowerment plays a major role in sexual violence and HIV among women worldwide. Findings on empowerment in relation to domestic violence or HIV are scarce and are conflicting. The purpose of this study was to examine the relationship between empowerment and HIV status by means of sexual violence, and to compare this relationship between previously married women (N = 2,658) and currently married women (N = 37,539) living in India. The Baron and Kenny mediated regression model was used, involving simple logistic and multiple logistic regression, drawing from the National Family Health Survey 2005-2006 (NFHS-3). Sexual violence was not found …

Association Of Hiv Testing, Educational Attainment, And Age Among Black And Non-Black Men, Ashley N. Martell

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

Human Immunodeficiency Virus (HIV) infection can lead to a chronic condition, Acquired Immunodeficiency Syndrome (AIDS), but can be well managed with a combination of medications, treatments, and remedies.1 The emergence of HIV in the United States in 1981 created an atmosphere unlike any other at that time. Overtime, the science community has worked diligently to combat this disease through research, practice, and intervention. Although many efforts have been put forth over the past thirty years, millions of Americans still remain infected with HIV.2 Among those who are infected with HIV/AIDS we see disproportionate rates among specific races and gender. Research …

Patterns Of Pneumoconiosis Mortality In Kentucky: Analysis Of Death Certificate Data, Jake Beggs

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

ABSTRACT

Background: Despite ongoing surveillance efforts, mortality rates associated with total pneumoconiosis, and particularly coal worker’s pneumoconiosis, have remained elevated. Methods: Kentucky death certificate data from 2003-2011 was statistically compared to other coal mining states and descriptively analyzed from 2011-2013 to determine the mortality burden and public health implications of pneumoconiosis and coal worker pneumoconiosis (CWP) on Kentucky residents from 2003-2013. Results: Kentucky’s total pneumoconiosis and coal workers’ pneumoconiosis mortality rates decreased from 2003-2009, then increased in following years, showing a significant quadratic trend from 2003-2013 (p<.05) compared to West Virginia, Pennsylvania, and the overall United States rates that had significant negative linear trends from 2003-2011(p<.05). Deaths from pneumoconiosis primarily occurred in white males from CWP in the Appalachian region. Individuals diagnosed with pneumoconiosis died from respiratory illness 50% of the time, heart-related problems (23%) and cancer (12%). Autopsies were only performed on 12% of decedents over the three year study period and the primary locations of death were in hospital (47%) and at home (36%). Conclusions: Increased coal mining industry worker environmental exposure protection should be enhanced in Kentucky. Additionally, healthcare efforts should focus on increasing patient education to ensure early detection and treatment for individuals suffering from pneumoconiosis as well as for comorbid conditions such as Chronic Obstructive Pulmonary Disease. To further target healthcare and treatment of pneumoconiosis patients, increased autopsies of individuals with pneumoconiosis should be performed to identify involvement of other conditions such as silicosis and optimize pneumoconiosis fatality surveillance.

Dating Violence On Small Rural College Campuses: Are Administrator And Student Perceptions Similar?, Jean Allen Oldham

Theses and Dissertations--Kinesiology and Health Promotion

In recent years dating violence has become more and more prevalent on college campuses. Reports of the range of dating violence vary widely, with studies reporting from 20% to 85% of college women experiencing dating violence. However, almost all research has been conducted among urban and/or large colleges and universities, with virtually no attention to what is happening on small and/or rural college and university campuses.

When a possible 20% of college women have experienced dating violence on college campuses, there becomes a crucial need for administration at a college to have an accurate assessment of the college’s liability, and …

Behind The Mirrors: Examining The Role Of African American Cosmetologists And Salons In Domestic Violence Advocacy And Education, Pangela H. Dawson

Theses and Dissertations--Educational Policy Studies and Evaluation

African American beauty salons across the country have historically served as settings for social interaction, political activism, and community organizing in the African American community. These settings often offer opportunities for intimacy between cosmetologists and their clients. Research findings suggest that the unique bonds between women in salons can be a viable option when providing health intervention and education to large numbers of women. Data indicates that salon campaigns and promotions which focused on health issues such as stroke and diabetes education, breast and cervical cancer awareness, healthy living, and smoking cessation, have been efficacious in changing unhealthy habits or …

Primary And Secondary Prevention Of Hepatitis C Virus Among Rural Appalachian People Who Use Drugs, Dustin B. Stephens

Theses and Dissertations--Clinical and Translational Science

Hepatitis C virus (HCV) remains a major cause of morbidity and mortality worldwide, with 3% of the global population chronically infected. Clinical impacts in the United States are projected to increase for two decades, and mortality attributed to HCV now exceeds HIV. Injection drug use (IDU) is the most common route of transmission in the developed world. Advances in treatment offer hope of mitigating HCV impacts, but substantial barriers obstruct people who inject drugs (PWID) from receiving care, particularly in medically underserved regions including Central Appalachia. This study assessed IDU paraphernalia sharing longitudinally over 24 months in a sample of …

Farmers’ Market Shopping Behaviors And The Association Of Fruit And Vegetable Intake, Sarah G. Perkins

Theses and Dissertations--Nutrition and Food Systems

Fruit and vegetable (FV) intake continues to decline among sub-population in the United States. Current policies and interventions have aimed to improve intake by improving access to fruits and vegetables. One Centers for Disease Control and Prevention suggested strategy is to improve access to farmers’ markets in rural areas. The aims of this study were to determine if the frequency of shopping at Farmers’ Markets is associated with fruit and vegetable intake, adjusted for age, income and education and to compare rural and non-rural areas frequency of Farmers’ Market attendance based on Kentucky farmers’ market interview participants (n = 102). …

Factors In Breastfeeding Initiation Among Central Kentucky Wic And Non-Wic Participants, Lila Nicole Farnsworth

Theses and Dissertations--Nutrition and Food Systems

Vital statistics data were statistically analyzed to determine who is breastfeeding in central Kentucky and if factors differ between those in a WIC and non-WIC population. The sample consisted of 479 postpartum women aged 18-44 in central Kentucky. Participants in the study were analyzed as a whole, then divided by their participation in the WIC program (n=304) or non-participation in the WIC program (n=175). Variables recorded in the vital statistics form were analyzed. These variables included age, education level, marital status, and ethnicity of the mother, household income status, and gender, gestational age, and birth weight of the infant. In …

Disability And Women's Health, Stephanie Stockburger, Hatim A. Omar

Pediatrics Faculty Publications

Children, adolescents, and women with disabilities experience the same sexual development, pubertal changes, concerns, and desire to reproduce as their typically developing counterparts. However, society has tended to stigmatize women with disabilities as "asexual" and ignore this aspect of their health care. These women are less likely to receive gynecological exams, contraception, and evaluation of sexual dysfunction. Unfortunately, having a disability places women at risk for sexual exploitation and abuse as well as sexually transmitted infections. Therefore, reproductive health care for these women is imperative. A number of barriers to receiving reproductive care exist. However, with proper education and knowledge …

Academic Predictors And Characteristics Of Self-Reported Juvenile Firesetting, Carrie Howell Bowling, Hatim A. Omar

Pediatrics Faculty Publications

The main purpose of this study was to address gaps in existing research by examining the relationship between academic performance and attention problems with juvenile firesetting. Two datasets from the Achenbach System for Empirically Based Assessment (ASEBA) were used. The Factor Analysis Dataset (N = 975) was utilized and results indicated that adolescents who report lower academic performance are more likely to set fires. Additionally, adolescents who report a poor attitude toward school are even more likely to set fires. Logistic regressions were run to determine if attention problems predicted firesetting and the findings indicated that attention problems are predictive …

Adolescence And Sexuality, Joav Merrick, Ariel Tenenbaum, Hatim A. Omar

Pediatrics Faculty Publications

No abstract provided.