Public Health Commons^™

Public Health Spending, Preventable Outcomes, And Medical Cost Offsets: Questions For Health Reform, Glen P. Mays

Health Management and Policy Presentations

Uncertainty continues to surround the health and economic effects that can be expected from increased federal spending on public health and prevention strategies. Recent research provides some insight into the question of whether spending on public health strategies can offset the need for future spending on medical care.

Does Place Of Residence Affect Risk Of Suicide? A Spatial Epidemiologic Investigation In Kentucky From 1999 To 2008, Daniel M. Saman, Sabrina Walsh, Anna Borówko, Agricola Odoi

Epidemiology and Environmental Health Faculty Publications

BACKGROUND: Approximately 32,000 people take their own lives every year in the United States. In Kentucky, suicide mortality rates have been steadily increasing since 1999. Few studies in the United States have assessed spatial clustering of suicides. The purpose of this study was to identify high-risk clusters of suicide at the county level in Kentucky and assess the characteristics of those suicide cases within the clusters.

METHODS: A spatial epidemiological study was undertaken using suicide data for the period January 1, 1999 to December 31, 2008, obtained from the Kentucky Office of Vital Statistics. Descriptive analyses using Pearson's chi-square test …

A Spatial Cluster Analysis Of Tractor Overturns In Kentucky From 1960 To 2002, Daniel M. Saman, Henry P. Cole, Agricola Odoi, Melvin L. Myers, Daniel I. Carey, Susan C. Westneat

Epidemiology and Environmental Health Faculty Publications

BACKGROUND: Agricultural tractor overturns without rollover protective structures are the leading cause of farm fatalities in the United States. To our knowledge, no studies have incorporated the spatial scan statistic in identifying high-risk areas for tractor overturns. The aim of this study was to determine whether tractor overturns cluster in certain parts of Kentucky and identify factors associated with tractor overturns.

METHODS: A spatial statistical analysis using Kulldorff's spatial scan statistic was performed to identify county clusters at greatest risk for tractor overturns. A regression analysis was then performed to identify factors associated with tractor overturns.

RESULTS: The spatial analysis …

National Longitudinal Survey Of Public Health Systems: 2011-2012 Wave, Public Health Practice-Based Research Networks

Health Management and Policy Reports

Since 1998, researchers have followed a nationally representative cohort of U.S. communities to examine the types of public health activities performed within the community, the range of organizations contributing to each activity, and the perceived effectiveness of each activity in addressing community needs. This information, obtained through a validated survey of local public health officials, provides an in-depth view of the structure and function of local public health delivery systems and how these systems evolve over time. Originally conducted with support from the U.S. Centers for Disease Control and Prevention, the National Longitudinal Survey of Public Health Systems (NLSPHS) was …

Atrazine Exposure In Public Drinking Water And Preterm Birth, Jessica L. Rinsky, Claudia Hopenhayn, Vijay Golla, Steven R. Browning, Heather M. Bush

Epidemiology and Environmental Health Faculty Publications

Objectives

Approximately 13% of all births occur prior to 37 weeks gestation in the U.S. Some established risk factors exist for preterm birth, but the etiology remains largely unknown. Recent studies have suggested an association with environmental exposures. We examined the relationship between preterm birth and exposure to a commonly used herbicide, atrazine, in drinking water.

Methods

We reviewed Kentucky birth certificate data for 2004–2006 to collect duration of pregnancy and other individual-level covariates. We assessed existing data sources for atrazine levels in public drinking water for the years 2000–2008, classifying maternal county of residence into three atrazine exposure groups. …

From Service Provision To Function Based Performance - Perspectives On Public Health Systems From The Usa And Israel, F. Douglas Scutchfield, Ehud Miron, Richard Ingram

Preventive Medicine and Environmental Health Faculty Publications

If public health agencies are to fulfill their overall mission, they need to have defined measurable targets and should structure services to reach these targets, rather than offer a combination of ill-targeted programs. In order to do this, it is essential that there be a clear definition of what public health should do- a definition that does not ebb and flow based upon the prevailing political winds, but rather is based upon professional standards and measurements.

The establishment of the Essential Public Health Services framework in the U.S.A. was a major move in that direction, and the model, or revisions …

Governance In Large Nonprofit Health Systems: Current Profile And Emerging Patterns, Lawrence Prybil, Samuel Levey, Rex Killian, David Fardo, Richard Chait, David R. Bardach, William Roach

Health Management and Policy Faculty Book Gallery

From the foreword:

Nonprofit healthcare organizations are not exempt from good governance. In fact, more today than ever, the hospitals and health care systems of this country must have the discipline and commitment to organize their governance structures and practices to provide forward-thinking leadership and stand up to scrutiny from any type of evaluation and review. As we move from “sick care” organizations to “health care” organizations with accountability for the health of the population of our communities from birth to end-of-life, the role of governance becomes even more critical.

Fourteen of the largest and most notable health care systems …

Workers Die From Carbon Monoxide Poisoning, Kentucky Injury Prevention And Research Center

Kentucky Haz Alerts--Other

To prevent carbon monoxide poisoning,employers should:

• Train supervisors and employees to recognize symptoms of carbon monoxide poisoning
• Provide first aid training, including what to do if exposed to carbon monoxide
• Review carbon monoxide prevention tips with their employees

Employees should:

• Report unusual behavior
• Know how to treat co-workers for carbon monoxide poisoning
• Carry a carbon monoxide detector to mobile sites Recognize signs of carbon monoxide poisoning

Physical Activity, Sleep Patterns, And Health Outcomes In University Law Enforcement Officers, Nicole C. Koebke

Theses and Dissertations--Kinesiology and Health Promotion

Research indicates that law enforcement officers (LEOs) have a higher prevalence of developing coronary artery disease (CAD) compared to the general population. Sleep deprivation and physical inactivity have been found to be related to many risk factors for CAD. This cross-sectional study examined the health status and the relationship between sleep and physical activity outcomes versus CAD risk factors among 27 University LEOs. The subjects’ health behaviors, and CAD and metabolic syndrome risk factors were described using basic statistics. Accelerometer derived sleep and physical activity outcomes were correlated to measures of health to identify potential relationships. 33% of LEOs were …

Factors Relating To Hpv Behaviors Of Female College Students, Nicole Rachael Peritore

Theses and Dissertations--Kinesiology and Health Promotion

This study examined the knowledge, sources of information, reasons for and against Gardasil® uptake, and possible relationships between unhealthy behaviors and vaccination for undergraduate college females at a public university. Utilizing an online survey, 2400 random students were emailed as well as recruited through online classes. The final sample size was 516 females. The study determined how many participants had been vaccinated and their rationale for or against vaccination. The majority of study participants were knowledgeable about HPV and Gardasil®. The primary sources of information about HPV and Gardasil® were doctors and television; however parents and friends were also common …

The Impact Of Maternal Smoking In Kentucky And Effect Of The Giving Infants And Families Tobacco-Free Starts Pilot Project On Smoking Cessation And Birth Outcomes, Joyce Madeline Robl

Theses and Dissertations--Kinesiology and Health Promotion

Smoking during pregnancy remains a significant public health issue despite knowledge about the adverse maternal and fetal health effects. This research had six purposes: identifying effective smoking cessation strategies for low income pregnant women; identifying characteristics of Kentucky women who smoke during pregnancy; estimating the role of smoking on birth outcomes in Kentucky; exploring the impact of tobacco reduction on birth outcomes; identifying the characteristics of women participating in the Giving Infants and Families Tobacco-free Starts (GIFTS) pilot program; and evaluating the impact of GIFTS on smoking status and birth outcomes.

Seven randomized controlled trials targeting low income women with …

Energy Drink Consumption (With And Without Alcohol) And Its Relationship To Risky Behavior, Risk Awareness, And Behavioral Intention In College Students, Julia K. Buchanan

Theses and Dissertations--Kinesiology and Health Promotion

The purpose of this study was to assess the relationships between energy drink consumption (with and without alcohol) and other risky behaviors; students’ overall awareness level of the risks for consuming energy drinks; and overall behavioral intention to consume energy drinks among college students at the University of Kentucky. A total of 277 students enrolled during the Spring 2012 semester responded to the online survey, 46.5% (n=129) of which were considered energy drink users. Students classified as energy drink users participated in other risky behaviors more often than non-users (p=0.001). In addition, energy drink users exhibited a higher …

Relationships Of Access And Affordability To Household Food Security Status Among Rural, Low Income Caregivers, Jodi Elaine Marani

Theses and Dissertations--Kinesiology and Health Promotion

Household food security status in rural areas is a significant issue facing caregivers as positive health outcomes depend on appropriate access to healthy foods necessary to lead an active life. Access and affordability of healthy foods are two mediating factors of household food security that may be improved to ultimately increase rates of food security and overall health status among rural, low income populations.

The purpose of the study was to examine the factors of access and affordability of nutritionally adequate food sources in one rural community in relation to food security status through the perspective of its caregivers. In …

Evaluating Retention In Medical Care And Its Impact On The Health Outcomes Of Individuals Living With Human Inmmunodeficiency Virus, Timothy N. Crawford

Theses and Dissertations--Epidemiology and Biostatistics

In the last few years, engagement in medical care among individuals living with HIV has become a major priority among HIV medical providers and public health researchers. Engagement in medical care is an important concept as it involves the process of linking newly diagnosed individuals into medical care and retaining those individuals in care throughout the course of their infection. Although there have been major advances in the management of HIV, like the advent of Highly Active Antiretroviral Therapy, morbidity and mortality due to HIV cannot be fully reduced if the individual does not optimally retain in care. Retention in …

Effects Of Methoprene On The Survivorship Of Adult Aedes Mosquitoes: A Strategy Or Inactivating Released Mosquitoes, Peter J. Brabant Iii

Theses and Dissertations--Entomology

Methoprene is a Juvenile Hormone (JH) analogue commonly used for the control of mosquito larvae. When applied to a mosquito breeding site, methoprene enters the haemolymph, where it mimics the function of JH and interferes with normal metamorphosis, resulting in larval mortality. Methoprene is commonly used for the control of larvae and has not been used as an adulticide, due to an absence of acute effects. This study evaluated possible chronic effects caused by the exposure of adult Aedes mosquitoes to methoprene. Methoprene was applied, in both technical grade and the commercially available Altosid®, topically to adults through droplet application …

Equitable Consequences? Issues Of Evidence, Equity And Ethics Arising From Outdoor Smoke-Free Policies, Ann Pederson, Wendy Rice, Phoebe M. Long, Natasha Jategaonkar, Lorraine Greaves, Steven Chasey, Natalie Hemsing, Chizimuzo T.C. Okoli, Joan L. Bottorff

Nursing Faculty Publications

From Introduction:

Kass argues that an ethical approach in public health is one that places the fewest burdens on individuals’ health without significantly reducing the potential benefits of intervening. Yet many population health regulations are highly intrusive, compromising individual liberty and imposing penalties for non-compliance. Moreover, the benefits of these regulations and the burdens they impose may not be shared equally. When developing interventions, the state has, therefore, an obligation to consider the benefits and burdens, particularly on those vulnerable to health inequities and other disparities.

A Systematic Review Of Physical Activity Interventions In Hispanic Adults, Melinda J. Ickes, Manoj Sharma

Kinesiology and Health Promotion Faculty Publications

Healthy People 2020 aims to achieve health equity, eliminate disparities, and improve the health of all groups. Regular physical activity (PA) improves overall health and fitness and has the capability to reduce risk for chronic diseases. Identifying barriers which relate to the Hispanic population is important when designing PA interventions. Therefore, the purpose was to review existing PA interventions targeting Hispanic adults published between 1988 and 2011. This paper was limited to interventions which included more than 35% Hispanic adults (n = 20). Most of the interventions were community based (n = 16), although clinical, family-based, and faith-based …

Predictors Of Clinician Tobacco Intervention Counseling In Six North Carolina Free Clinics, Joe G. Spangler, Eun-Young Song, Jessica Richardson Pockey, Erin L. Sutfin, Donald W. Helme, Cindy Jones, Kristie L. Foley

Communication Faculty Publications

While the poor and the uninsured are at increased risk for tobacco use, up to two thirds of these patients express interest in near-term quitting. Nonetheless, tobacco counseling rates remain low in clinics serving these patients. As part of a larger tobacco intervention project in North Carolina free clinics, we gathered baseline data on patient characteristics in six randomly selected facilities affiliated with the North Carolina Association of Free Clinics. An exit interview was completed by 231 patients; 126 (54%) were tobacco users. Among all patients, 71% had been asked by a clinician about tobacco use in the past 3 …

Recreational Music-Making In Music Pedagogy: A Manifesto For Change, Brandon Keith Wood

Theses and Dissertations--Music

The arts are an essential part of any student’s well rounded education. The future of music in education will depend on its ability to deliver relevant, effective, and measurable outcomes. However, the expectations and performance nature of traditional curricula often foster a sense of musical elitism and ostracizes students that are solely interested in music as a recreational outlet. Incorporating recreational music-making into education can provide opportunities for students to experience self-expression, creativity, social connection, and enjoyment. These values will not only enhance their education, but also lead to acquired skills for use in all areas of their lives. Activities …

Factors Influencing Acceptance Of A Worksite Wellness Program In A Major Urban Healthcare System - A Cross-Sectional Analysis, Deborah A. Ballard

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

Abstract

Adults spend a significant portion of their lives at their workplace. Thus the workplace provides an important venue for public health interventions aimed at prevention and wellness. Best practices for workplace wellness programs are continually being refined. Ironically, health care workers are often less healthy than other professionals and face significant barriers to participating in workplace wellness programs. This paper analyzes the experience of a large urban health care system as it instituted a workplace wellness program and offers recommendations to increase participation in healthcare workplace wellness program and create an overall healthier work environment for healthcare workers.

Factors …

An Analysis Of Laboratory Inspections At The University Of Kentucky, Rachel Eldridge

MPA/MPP/MPFM Capstone Projects

Recent news stories about laboratory accidents in which students were severely injured and killed have brought much-needed attention to lab safety. Creating a positive safety climate on college and university campuses is very important in reducing accidents. At the University of Kentucky, all laboratories are inspected once every year, and the results are recorded in a lab inspection database. These data include the department, building, lab classification, type of violation, room number, and the name of the PI (Principal Investigator). I want to analyze inspections to find out whether department and the lab classification are significant in looking at violations. …

Explaining Benefit Utilization Variability In Fmnp In Kentucky: An Application Of Pierre Bourdieu’S Theory, Stephanie M. Holcomb-Kreiner

Theses and Dissertations--Sociology

Research has demonstrated the crucial role fresh fruit and vegetable consumption plays in maintaining good health. However, most Americans do not consume adequate amounts, and low-income Americans consume the lowest quantities of fresh fruits and vegetables. The Farmers’ Market Nutrition Program (FMNP) and Senior Farmers’ Market Nutrition Program (SFMNP) attempts to rectify this situation by providing vouchers to low-income women, children, and elders that can be used only at farmers’ markets for the purchase of locally grown, fresh fruits and vegetables. Unfortunately, FMNP and SFMNP exhibit variable and often low benefit utilization. This variable and often low benefit utilization is …

Driving Qi With Research: Findings From Public Health Pbrns, Glen P. Mays

Health Management and Policy Presentations

Public health agencies are increasingly experimenting with quality improvement (QI) strategies designed to enhance the effectiveness and efficiency of their efforts. Does QI work in public health, and if so for whom and under what circumstances? What QI strategies work best for which types of public health process failures, and at what cost? Research underway through the Public Health Practice-Based Research Networks (PBRN) Program is examining these types of questions to build an evidence base for public health QI.

Exploration And Comparison Of Methods For Combining Population- And Family-Based Genetic Association Using The Genetic Analysis Workshop 17 Mini-Exome, David W. Fardo, Anthony R. Druen, Jinze Liu, Lucia Mirea, Claire Infante-Rivard, Patrick Breheny

Biostatistics Faculty Publications

We examine the performance of various methods for combining family- and population-based genetic association data. Several approaches have been proposed for situations in which information is collected from both a subset of unrelated subjects and a subset of family members. Analyzing these samples separately is known to be inefficient, and it is important to determine the scenarios for which differing methods perform well. Others have investigated this question; however, no extensive simulations have been conducted, nor have these methods been applied to mini-exome-style data such as that provided by Genetic Analysis Workshop 17. We quantify the empirical power and false-positive …

The Science Of Public Health Delivery: Evidence, Uncertainties & Research Needs, Glen P. Mays

Health Management and Policy Presentations

Policy initiatives to reform the nation's health system increasingly recognize the need to incorporate public health and prevention strategies. The nation's delivery system for public health, however, varies widely across states and communities in its structure, authority, and capabilities. This session examines research from the growing field of public health services and systems research to identify directions for improving public health delivery.

Estimating The Value Of Public Health Services & Systems: Evidence, Uncertainties, And Research Needs, Glen P. Mays

Health Management and Policy Presentations

The Affordable Care Act authorized the largest expansion in federal funding for public health services and delivery systems in decades. These provisions, designed to support programs and services that promote health and prevent disease and injury on a population-wide basis, remain controversial because of uncertainties regarding their effectiveness in improving health and constraining medical cost growth. This session examines a series of recent studies to shed light on the health and economic value of spending on public health.

Disparities Research In Public Health Pbrns, Glen P. Mays

Health Management and Policy Presentations

Public health agencies are well positioned within the health system to play key roles in addressing oral health issues on a population-wide basis, However, current evidence reveals wide geographic variation in the delivery of public health interventions for oral health promotion. This session explores the factors contributing to this variation, and it highlights studies underway through the Public Health Practice-Based Research Networks (PBRNs) to produce more and better evidence about public health delivery and impact.

Tobacco Use Dependence And Approaches To Treatment, Audrey Darville, Chizimuzo T.C. Okoli

Nursing Presentations

Counseling Demonstrates a Dose-Response Effect/Comes in Many Forms

• Brief advice during a “window of opportunity” can increase quit attempts by 40%

• Medication combined with counseling doubles the success rate

• Quitlines: proactive fax to quitline most effective

• Online (becomeanex.org, smokefree.gov, mylastdip.com)

• Cooper Clayton Classes at many local health departments; schedules and provision of medication varies

• I-Phone apps/text to quit

Tailoring NRT to the tobacco user

• Studies show efficacy in smokers and smokeless tobacco users (Ebbert, et al, 2010)

• Combining patch with shorter acting form of NRT has been shown to be safe and effective (Stead, et al, Cochrane Review, 2008; Kozlowski, …

Smoking And Breast Cancer: Girls’ And Boys’ Reactions To Tailored, Internet Delivered Messages, Joan L. Bottorff, Chris G. Richardson, Rebecca Haines-Saah, John Oliff, Peter Hutchinson, Pamela A. Ratner, Chizimuzo T.C. Okoli, Carolyn Gotay, Kenneth Johnson

Nursing Presentations

Background

• Active smoking and exposure to secondhand smoke (SHS) are causally linked to premenopausal breast cancer (BC).

• To date, there have been few efforts to raise awareness of active smoking and SHS as risk factors for BC.

Purpose

• To develop and evaluate messages for Aboriginal and non-Aboriginal adolescent girls and boys to raise awareness about tobacco exposure as a risk factor for BC.

Smoking On The Margins? Assessing The Health Equity Effects Of A Smoke-Free Law In Parks And Beaches, Chizimuzo T.C. Okoli, Ann Pederson, Steve Chasey, Wendy Rice, Phoebe M. Long, Lorraine Greaves, Joan L. Bottorff, Nancy Poole, Natalie Hemsing

Nursing Presentations

Policies which aim to limit secondhand smoke (SHS) exposure by restricting spaces where people can smoke have been shown to improve population health and garner a high level of support from the public, health professionals and policy makers. Following local, national and international examples, Vancouver’s Board of Parks and Recreation approved a smoke-free by-law for the city’s parks, beaches, and facilities effective September 1, 2010. Research suggests that such smoke-free by-laws, when enacted indoors, may affect men and women in different ways, but little research has examined the effects of such outdoor smoking bans on women and men and other …