Public Health Commons^™

Owner Of Towing Company Dies When Struck By Box Truck, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Motor Vehicle

In the early morning hours of a summer day, a 49-year-old male owner-operator of a towing company died when he was struck by a driver operating a box truck. The towing company had been called to retrieve a sport utility vehicle (SUV) that had broken down in another state and was returning the vehicle to its owner in Kentucky. It was approximately 4:00 a.m. when the towing company owner and his two sons were on an interstate returning with the SUV, when the operator thought the load felt strange. He parked his tow truck on the right hand shoulder and …

The Impact Of The Internet On The Sexual Health Of Adolescents: A Brief Review, Julia Springate, Hatim A. Omar

Pediatrics Faculty Publications

The object of this review is to summarize the impact of the Internet on the sexual health of adolescents. This article examines the use of websites, blogs and chat rooms as sources for sexual health information for adolescents. The influence of Internet pornography on sexual behaviors and attitudes is addressed. The use of the Internet as a place to find sexual partners is also assessed. During a time of great physical, emotional and sexual change, the Internet is playing a huge role in the decisions adolescents are making, both positive and negative.

The Psychological Impacts Of False Positive Ovarian Cancer Screening: Assessment Via Mixed And Trajectory Modeling, Amanda T. Wiggins

Theses and Dissertations--Epidemiology and Biostatistics

Ovarian cancer (OC) is the fifth most common cancer among women and has the highest mortality of any cancer of the female reproductive system. The majority (61%) of OC cases are diagnosed at a distant stage. Because diagnoses occur most commonly at a late-stage and prognosis for advanced disease is poor, research focusing on the development of effective OC screening methods to facilitate early detection in high-risk, asymptomatic women is fundamental in reducing OC-specific mortality. Presently, there is no screening modality proven efficacious in reducing OC-mortality. However, transvaginal ultrasonography (TVS) has shown value in early detection of OC. TVS presents …

Task-Based Noise Exposures For Farmers Involved In Grain Production, Michael J. Humann, Wayne T. Sanderson, Kelley J. Donham, Kevin M. Kelly

Epidemiology and Environmental Health Faculty Publications

Few studies have been done examining noise exposures associated with agricultural tasks. This study was conducted to address that research gap by calculating the noise exposures for tasks and equipment associated with grain production and assessing the variability in those exposures. An additional aim of this study was to identify tasks and equipment that could be targeted for intervention strategies as a means toward reducing the total noise exposures of farmers and farm workers. Through the use of personal noise dosimetry and direct observation, over 30,000 one-minute noise exposure measurements and corresponding task and equipment data were collected on 18 …

An Investigation Of Perinatal Polychlorinated Biphenyl Exposure On Body Composition And Glucose Homeostasis, Cetewayo S. Rashid

Theses and Dissertations--Nutritional Sciences

Recent advancements have uncovered environmental contributions to obesity and diabetes etiology. In fact, perinatal malnutrition resulting in low birth weight (LBW) has been shown to correlate with later life obesity and impaired glucose tolerance in aged offspring. LBW can result from a myriad of developmental perturbations including macronutrient restriction, hypoxia, maternal stress and toxin exposure.

Polychlorinated biphenyls (PCBs) are ubiquitous environmental pollutants that bioaccumulate in the food chain resulting in dietary exposure in humans. Maternal and cord blood PCB levels are inversely associated with birth weight, and recent studies indicate that perinatal exposures to PCBs contribute to gender-specific obesity development …

Organizational Response To Perceptual Risk: Managing Substantial Response To Unsubstantiated Events, Elizabeth L. Petrun

Theses and Dissertations--Communication

Analysis and perceived severity of risk influences organizational decisions to anticipated threats. As economic development and technology improve our standards of living, they also create new challenges to conceptualizing concrete and abstract threats. Organizations that face new threats, along with agencies that oversee these organizations, produce tightly coupled systems that increase risks for direct, indirect, and future stakeholders (Perrow, 1999). Natural disasters, political misbehavior, organizational corruption, financial collapse, food and water contaminations, chemical or nuclear accidents, international tension, to name a few, all present risks and challenges. Unfortunately, many of these situations endanger the lives and well-being of persons. The …

The Nature And Perceived Influence Of Lifestyle Discussions With Older Adults In Primary Care, Shoshana H. Bardach

Theses and Dissertations--Gerontology

The Nature and Perceived Influence of Lifestyle Discussions with Older Adults in Primary Care Rationale: A healthy diet and physical activity help with disease prevention and disease management and can promote quality of life regardless of the age at which an individual begins engaging in these behaviors. Despite the value of these health behaviors, many older adults do not follow lifestyle recommendations. Given that older adults frequently interact with the healthcare system, primary care providers are well situated to counsel older adults to improve their health behaviors. Unfortunately, we do not know how to most effectively engage in this counseling. …

Using Geospatial Technologies To Characterize Relationships Between Travel Behavior, Food Availability, And Health, Warren J. Christian

Theses and Dissertations--Geography

Epidemic obesity in the U.S. has prompted exploration of causal factors related to the built environment. Recent research has noted statistical associations between the spatial accessibility of retail food sources, such as supermarkets, convenience stores, and restaurants, and individual characteristics such as weight, socioeconomic status, and race/ethnicity. These studies typically use residential proximity or neighborhood density to food sources as the measure of accessibility. Assessing food environments in this manner, however, is very limiting. Since most people travel outside of their neighborhood on a daily basis, the retail food sources available to individuals residing in the same area could vary …

Data Mining And Pattern Discovery Using Exploratory And Visualization Methods For Large Multidimensional Datasets, Hsin-Fang Li

Theses and Dissertations--Epidemiology and Biostatistics

Oral health problems have been a major public health concern profoundly affecting people’s general health and quality of life. Given that oral health data is composed of several measurable dimensions including clinical measurements, socio-behavioral factors, genetic predispositions, self-reported assessments, and quality of life measures, strategies for analyzing multidimensional data are neither computationally straightforward nor efficient. Researchers face major challenges to identify tools that circumvent the processes of manually probing the data.

The purpose of this dissertation is to provide applications of the proposed methodology on oral health-related data that go beyond identifying risk factors from a single dimension, and to …

Anterior Cruciate Ligament Prevention: Effect Of Neuromuscular Training Compliance On Muscular Strength Development, Daisuke Sugimoto

Theses and Dissertations--Rehabilitation Sciences

The anterior cruciate ligament (ACL) originates from posterior part of the medial side of the lateral condyle of femur to anterior intercondylar notch between a transverse meniscal ligament and medial side of medial meniscus of tibia. Once ACL is disrupted, pain, effusion and atrophy are commonly observable and cause functional disability. Because of the functional limitations, athletic participation is severely restricted. ACL injury is more prevalent in physically active females compared to their male counterparts in the sports of basketball and soccer in high school and collegiate levels.

Several attributes of females are considered risk factors for the higher ACL …

Relationship Between Nonmedical Benzodiazepine Use And Psychiatric Disorders Among Rural Appalachian Drug Abusers, Derek Szesny

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

Abstract

Background: Inhabitants of Appalachian Kentucky are encumbered by tremendous health disparities, exhibit high rates of prescription drug abuse, and often co-present with psychiatric disorders. Compared to opioids, little research has focused on the nonmedical use of benzodiazepines.

Objective: To examine the association between nonmedical benzodiazepine use and major depressive disorder (MDD), generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), and anti-social personality disorder (ASPD) in a population of opioid drug abusers.

Methods: Data for this cross-sectional study was obtained from the Social Networks among Appalachian People (SNAP) study. Contingency tables analysis and the

X2statistic were used to …

The Effect Of State Expansion Of Medicaid Eligibility On Uninsurance Rates And Health Outcomes Of Nonelderly Adulst, Lazarus Ude Eze

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

Abstract

Background:

Arizona, New York, and Maine expanded Medicaid eligibility to include nonelderly non-disabled childless adults between 2001 and 2002. This study examines whether this policy affects the percentage of uninsured nonelderly adult population and years of potential life lost in the state.

Methods

I compared the three states with Medicaid expansion with three other states with similar demographic characteristics but without expansions. The study population consists of uninsured adults between ages of 19 and 64 years of income equals or below 138% federal poverty level. I carried out a paired-samples t-test on the data and also plotted a line …

Conviction Celerity, Punishment Severity, And Treatment Compliance As Predictors Of Dui Recidivism: Mediation And Moderation Models Of Deterrence, Megan F. Dickson

Theses and Dissertations--Sociology

Driving under the influence (DUI) is one of the most frequently committed offenses in the United States and approximately one-third of DUI offenders are recidivists. Researchers have evaluated multiple DUI prevention approaches, most of which have been rooted in deterrence theory. Recently, the criminal justice system has moved away from deterrence-based approaches and begun employing various forms of rehabilitation to reduce DUI recidivism. This shift in the criminal justice system has lead researchers to begin exploring the effects of rehabilitation on DUI offenders, including an examination of offender compliance with rehabilitation programs. Although each of these areas has been investigated …

Multistate Markov Chains And Their Application To The Biologically Resilient Adults In Neurological Studies Cohort, Erin L. Abner

Theses and Dissertations--Epidemiology and Biostatistics

Dementia is increasingly recognized as a major and growing threat to public health worldwide, and there is a critical need for prevention and treatment strategies. However, it is necessary that appropriate methodologies are used in the identification of risk factors. The purpose of this dissertation research was to develop further the body of literature featuring Markov chains as an analytic tool for data derived from longitudinal studies of aging and dementia.

Data drawn from 649 participants in the University of Kentucky’s Alzheimer’s Disease Center’s (UK ADC) Biologically Resilient Adults in Neurological Studies (BRAiNS) cohort, which was established in 1989 and …

Adherence To Physical Activity Among Individuals With Or Without Cardiovascular Disease, Zyad T. Saleh

Theses and Dissertations--Nursing

Cardiovascular disease (CVD) is a major public health problem and a primary cause of morbidity and mortality in the United States. Regular physical activity is recommended for prevention and management of CVD. Despite the cardiovascular health benefits of physical activity most adults are physically inactive. Therefore, the aim of this dissertation was to examine the factors associated with adherence to physical activity among individuals with or without CVD.

The first paper is a report of a study conducted to examine which baseline demographic (age, gender, marital status, socioeconomic status, and place of residency), psychosocial (social support, depression, anxiety, and fatalism), …

Health Status And Care Access Of The Uninsured In Kentucky, Douglas Keith Branham

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

ABSTRACT/EXECUTIVE SUMMARY

With the individual mandate of the Patient Protection and Affordable Care Act (ACA) set to go into effect in 2014, as well as the Medicaid expansion in some states, the federal and state governments have a difficult road ahead planning how to respond to the anticipated increase in health services use. Kentucky is an undecided state regarding the Medicaid expansion and as one of the more impoverished states in the U.S. potentially has much to gain from the new law.

Many studies have focused on the U.S. as a whole in describing the health status of the uninsured. …

United States: Mental Health Issues In An Adolescent Medicine Clinic Patient Population, Abdel Salous, Linah Al-Alem, Hatim A. Omar

Pharmacology and Nutritional Sciences Faculty Publications

The correlation between exposure to forms of violence and development of mental disorders in victims is well established. The purpose of this chapter was to identify mental health problems in an adolescent medicine clinic population in Lexington, Kentucky and to investigate potential correlation of mental disorders with psychosocial factors. Data were gathered from the charts of 169 adolescent clinic patients (age 10-22) seen in the clinic for mental health care and analyzed using Excel. Of the patient population, 68% were urban, whereas 32% were rural. In terms of gender, 40% of the patients were male and 60% were female, 80% …

Cattle-Related Injuries And Farm Management Practices On Kentucky Beef Cattle Farms, Steven R. Browning, Susan C. Westneat, Wayne T. Sanderson, Deborah B. Reed

Epidemiology and Environmental Health Faculty Publications

While working on farms with livestock increases the risk of injury among farm workers in comparison to other commodity farms, few studies have examined the role offarm management practices in association with the risk of cattle-related injury. We examined the farm management practices of Kentucky beef cattle farms in association with self-reported rates of cattle-related injuries among workers. We conducted a mail survey of a random sample of 2,500 members of the Kentucky Cattlemen's Association. Results from 1,149 farm operators who were currently raising beef cattle and provided complete survey response are reported. During the busy season, the principal operator …

The Impact Of Discontinuing Coverage Of Second Generation Antihistamines In A Managed Care Organization, Matthew D. Harman

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

ABSTRACT Background: Second generation antihistamines (SGAs) are approved to treat seasonal and/or perennial allergic rhinitis (AR) and chronic idiopathic urticaria (CIU). It is estimated that 82% of Americans with AR use antihistamines, with the majority using SGAs due to their low side effect profile. As policy, over-the-counter (OTC) SGAs were not covered in this health plan population (cetirizine and loratadine products were available OTC prior to the study period, while fexofenadine products became available OTC during the study period). On January 1, 2012, the policy was extended to remove coverage of prescription-only SGAs (included desloratadine and levocetirizine products). Objectives: To …

The Influence Of Race And Socioeconomic Status On Routine Screening Practices Of Physician Assistants, Deshana Ann Collett

Theses and Dissertations--Educational Policy Studies and Evaluation

Health disparities in minorities and those of low socioeconomic status persist despite efforts to eliminate potential causes. Differences in the delivery of services can result in different healthcare outcomes and therefore, a health disparity. Some of this difference in care may attribute to discrimination resulting from clinical biases and stereotyping which may provide a possible source for the persistence of health disparities. Health disparities may occur because the delivery of services at some level is inadequate. Disparities resulting from the quality and quantity of care delivered by a practitioner result in differentiated delivery of healthcare, thus unequal health outcomes. The …

Untangling Neoliberalism’S Gordian Knot: Cancer Prevention And Control Services For Rural Appalachian Populations, George F. Bills

Theses and Dissertations--Sociology

In eastern Kentucky, as in much of central Appalachia, current local storylines narrate the frictions and contradictions involved in the structural transition from a post-WWII Fordist industrial economy and a Keynesian welfare state to a Post-Fordist service economy and Neoliberal hollow state, starving for energy to sustain consumer indulgence (Jessop, 1993; Harvey, 2003; 2005). Neoliberalism is the ideological force redefining the “societal infrastructure of language” that legitimates this transition, in part by redefining the key terms of democracy and citizenship, as well as valorizing the market, the individual, and technocratic innovation (Chouliaraki & Fairclough, 1999; Harvey, 2005). This project develops …

Military Tobacco Dependence Treatment: Implications Of Treatment Type On Abstinence And Weight Management Ability, Bradley A. Briscoe

DNP Projects

Military readiness, employer productivity and individual health are all significantly impacted by high rates of tobacco use. Current research, to date, suggests that use of brief, individually tailored behavioral modification strategies through group therapy may be most effective in smoking cessation. The objective of this Practice Inquiry Project was to explore aspects of tobacco use the U.S. military population and examine potential relationships between type of treatment, smoking abstinence, and maintenance of body weight (e.g. avoid weight gain) among those seeking tobacco use cessation. The findings of this project can provide guidance on enhancing current tobacco cessation efforts to enable …

Use Of The County Health Rankings By Local Health Departments In Florida, 2010 - 2011, Nancy L. Winterbauer, Bonita Sorensen, James B. Tidwell

Frontiers in Public Health Services and Systems Research

This paper describes how local health departments (LHDs) in Florida used the County Health Rankings over the first two years of their release (2010 – 2011). We surveyed LHD leadership to describe if, how and to what extent the Rankings were used by Florida’s 67 LHDs to improve the health of their communities and describe changes in use from the 2010 to the 2011 release. Our results indicate substantial use of the Rankings by Florida’s LHDs, particularly as applied to community health assessments, staff education, as a starting point for examining other indicators and databases, and in grant applications. From …

Effectiveness And Challenges For Implementing Quality Improvement Activities In Nebraska’S Local Health Departments, Li-Wu Chen, Anh Nguyen, Janelle J. Jacobson, Diptee Ojha, David Palm

Frontiers in Public Health Services and Systems Research

What is already known on this topic? Although the implementation strategies and effectiveness of quality improvement (QI) activities have been examined extensively for many industries, including the health care sector, very few studies have focused on QI activities in the public health context.

What is added by this report? The study results indicated that Nebraska’s LHDs still face significant barriers for QI implementation, including low capacity, knowledge gaps, inadequate resources, and low institutional QI maturity.

What are the implications for public health practice/policy/research? Policy makers and LHDs should provide QI training and external QI expertise to LHD staff and better …

Building Capacity To Support And Study Qi In Local Georgia Public Health Systems, William C. Livingood, Nandi Marshall, Angela Peden, Ketty Gonzales, Gulzar H. Shah, Russ Toal, Kellie Penix, Dayna Alexander, Kay Davis, Sylvester Nixon, Purity Cummings, William Riley, Lynn Woodhouse

Frontiers in Public Health Services and Systems Research

The study of quality improvement within Georgia’s local public health systems provides important insight into the use of regional bodies as quality improvement (QI) collaboratives and multijurisdictional entities. This report describes QI initiatives following a RWJF funded quick strike research grant to assess health district capacity to conduct QI in Georgia’s local public health systems. These QI initiatives use QI to improve public health outcomes including: Adolescent pregnancy and Sexually Transmitted Infection prevention, HIV prevention and control, and HIV Management.

Tax Levy Financing For Local Public Health: Relationships Between Fiscal Allocation, Fiscal Effort And Fiscal Capacity, William Riley, Kim J. Gearin, Carmen D. Parrotta, Jill Briggs, M. Elizabeth Gyllstrom

Frontiers in Public Health Services and Systems Research

This study examines property tax levy (local tax levy) as a source of local health department (LHD) funding during a five year period (2006-2010) in all Minnesota counties by assessing fiscal effort, fiscal allocation and fiscal capacity. Local health departments rely on pluralistic funding from local, state, federal and private sources. However, local tax levy funding is unexplored and little is known regarding the extent of fiscal allocation (tax levy used for LHD), fiscal effort (potential amount of tax levy available for LHD), and fiscal capacity (wealth of community). More important it is not known to what extent variation between …

Mandated Activities And Limited Decision-Making Authority Among Local Public Health Officials, Betty Bekemeier, Anthony L-T Chen, Nami Kawakyu

Frontiers in Public Health Services and Systems Research

Local public health department leaders face difficult decisions regarding the allocation of increasingly scarce resources, yet existing evidence for public health decision making, while still limited, is underutilized by public health officials. Participants in this study described processes regarding resource allocation in response to local budget cuts as based largely on legally mandated activities and categorical funding and perceived these factors as limiting much of their agency-level decision making to a relatively small portion of flexible funding. In the limited areas in which they perceived themselves to have flexibility, they generally considered their agencies to have very little capacity for …

Evidence-Based Decision Making In Local Health Departments, Linda Weiss, Collette Sosnowy, Christopher M. Maylahn, Nancy J. Katagiri, Sylvia Pirani

Frontiers in Public Health Services and Systems Research

Evidence-based decision making (EBDM) represents an important strategy to increase efficacy and efficiency of public health programs and practice. There is insufficient information on the application of EBDM among local health departments (LHDs). This qualitative study examined use of EBDM in New York State (NYS) LHDs and factors facilitating and impeding its adoption through interviews and focus groups with 47 LHD commissioners, health directors, and other upper-level staff. Findings suggest variability in application of EBDM in NYS LHDs. A number of internal factors (e.g., staff capacity, organizational culture) and external factors (e.g., policy environment, appropriate and …

From The Frontier: Translating Research To Practice, Paul C. Erwin

Frontiers in Public Health Services and Systems Research

The purpose of this invited article is to describe the process of translating research into public health practice. An example is provided, showing how questions arose in the practice setting, a researcher was identified to help answer the questions, and findings from the research were applied in the practice setting. In this example, Dr. Lea LaFave (Community Health Institute/JSI in New Hampshire) worked with Dr. Danielle Varda (Assistant Professor at the University of Colorado/ Denver, School of Public Affairs) to use social network analysis to better understand a network of coalitions focused on underage substance abuse. The social network analysis …

Stimulating Public Health Improvement In Complex And Constrained Delivery Systems: Findings From The Public Health Pbrns, Glen P. Mays

Frontiers in Public Health Services and Systems Research

The Robert Wood Johnson Foundation’s Public Health Practice-Based Research Networks Program sponsored a series of studies to examine how public health decision-makers are responding to accreditation, quality improvement, and public reporting initiatives amid the ongoing fiscal pressures. Overall, the evidence to date indicates that these initiatives represent promising strategies for strengthening evidence-based decision-making and expanding the delivery of evidence-tested programs and policies in local public health settings. Continued, comparative research and evaluation activities are needed to provide more definitive evidence about which combination of strategies work best, for which population groups, in which community and organizational settings, and why.