Public Health Commons^™

A Case Study In Program Evaluation, Alyssa Osborne

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

As a result of a Methicillin-Resistant Staphylococcus Aureus (MRSA) outbreak at a local high school, the Lexington Fayette County Health Department (LFCHD) has been tasked with developing a program to ensure timely reporting of actions taken in the event of a MRSA outbreak or disease outbreak of similar nature (1). This program evaluation is guided by the CDC’s 6-step program evaluation framework (2), which was used to inform this assessment.

Evaluation Of Public Radon Messaging In Kentucky As Compared To Three Other States, Abigail Knapp

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

Radon poses a large health risk to those exposed to it, as it is an invisible, odorless, carcinogenic gas. Kentucky has high ambient levels of radon, but public awareness remains low as tobacco has been publicized as the main cause of lung cancer. As Kentucky has the highest incidence of lung and bronchial cancers in the United States, we aimed to examine the state’s health department radon page to see if it has sufficient information to warn residents about radon and provide resources. We reviewed the current Kentucky public messaging, radon rates, testing rates, and legislation compared to Ohio, Washington, …

Acceptability And Feasibility Of Screening With A Pediatric Care Provider-Led Social Determinants Of Health Identification Tool, Alison Eyre, Janice Cohen, Sarah Funnell, Lynsey James, Sheena Guglani, Hounaida Abi Haidar, Lindy Samson, Michelle Ward, Radha Jetty, Megan Harrison, John Lyons Dr., Leigh Fraser-Roberts, Susan Bennet, Douglas Archibald, Soha Khorsand, Tobey Audcent

Health Management and Policy Faculty Publications

Background Complex social determinants of health may not be easily recognized by health care providers and pose a unique challenge in the vulnerable pediatric population where patients may not be able to advocate for themselves. The goal of this study was to examine the acceptability and feasibility of health care providers using an integrated brief pediatric screening tool in primary care and hospital settings.

Methods The framework of the Child and Adolescent Needs and Strengths (CANS) and Pediatric Intermed tools was used to inform the selection of items for the 9-item Child and Adolescent Needs and Strengths-Pediatric Complexity Indicator (CANS-PCI). …

Leveraging Local Knowledge To Contextualize The Opioid Epidemic Within Healing Communities Study Communities: A Photovoice Protocol, Peter Balvanz, Ramona G. Olvera, Margaret Louise Mcgladrey, Marisa Booty, Dacia Beard, Sylvia Ellison, Craig Mcclay, Monica Nouvong, Carrie B. Oser, Owusua Yamoah, Linda Sprague Martinez

Health Management and Policy Faculty Publications

Since its inception 30 years ago, Photovoice has gained increasing popularity as a research method and more recently has been incorporated within randomized controlled trial (RCT) designs. Photovoice is a participatory action research method that pairs photography with focus group discussions to record community strengths and concerns, build critical consciousness, and reach policymakers. Adherence of Photovoice implementation to these original tenets of Photovoice varies. This article provides the Photovoice protocol developed by the authors to improve the methodological rigor of Photovoice integration into RCTs and help contextualize the landscape for the HEALing Communities Study (HCS: NCT04111939), a greater than $350 …

Population Burden Of Rare Infectious And Inflammatory Diseases Of The Heart, Meera Marji

Theses and Dissertations--Epidemiology and Biostatistics

Rare diseases of the heart, such as infective endocarditis (IE), myocarditis, and pericarditis, have earned limited attention in cardiovascular research despite their potential for severe morbidity and mortality. Amidst the opioid crisis in the United States, there has been a notable increase in endocarditis hospitalizations among people who inject drugs. Kentucky, at the epicenter of the opioid epidemic, lacks available data on IE hospitalizations. Moreover, the COVID-19 pandemic has introduced unprecedented challenges to healthcare systems, influencing hospitalizations and healthcare utilization patterns. While trends before, during, and after the pandemic have been extensively studied for common cardiovascular diseases, such as heart …

A Sampling Strategy For Longitudinal And Cross-Sectional Analyses Using A Large National Claims Database, Timothy L. Mcmurry, Jennifer M. Lobo, Soyoun Kim, Hyojung Kang, Min-Woong Sohn

Health Management and Policy Faculty Publications

Importance: The United States (US) Medicare claims files are valuable sources of national healthcare utilization data with over 45 million beneficiaries each year. Due to their massive sizes and costs involved in obtaining the data, a method of randomly drawing a representative sample for retrospective cohort studies with multi-year follow-up is not well-documented.

Objective: To present a method to construct longitudinal patient samples from Medicare claims files that are representative of Medicare populations each year.

Design: Retrospective cohort and cross-sectional designs.

Participants: US Medicare beneficiaries with diabetes over a 10-year period.

Methods: Medicare Master Beneficiary Summary Files were used to …

Veterans Direct Admission Reassessment Tool Validation For The Reduction Of Rapid Response Code Blue, And Code Stroke Team Activations In Newly Arrived Direct Admission Veterans, Joshua Monroe Wells

DNP Projects

Abstract

Purpose: Rapid clinical assessment of newly arriving direct admission veteran patients to the Department of Veterans Affairs Health Care System (VAHCS) Lexington is of the utmost importance to determine current patient condition, alteration from previously known condition at time of provider acceptance or time of report, and appropriate level of care for these veterans. The facility has seen an increase in the number of unexpected patient declines by direct admission patients presenting to medical surgical units at the VA Health Care System Lexington KY. This recurrent decline resulted in the facility performing a Root Cause Analysis (RCA), which identified …

Associations Between Physical Activity Levels And Physical And Mental Health In Military Veterans., Troy Hubert

Theses and Dissertations--Psychology

Research suggests that higher rates of health conditions are associated with lower levels of physical activity, but this association is not well characterized in U.S. Military Veterans. The current study utilized a sample of U.S. military veterans (n = 3,989) from the 2019-2020 National Health and Resiliency in Veterans Study (NHRVS). Physical activity levels (insufficient, moderate, and active), physical and mental health were evaluated with a variety of self-report questionnaires. After controlling for covariates, veterans with any disability, asthma, chronic pain, diabetes, high cholesterol, and stroke were significantly less likely to report sufficient physical activity compared to insufficient physical …

Characterizing The Relationship Between The Presence Of Depression Risk, Post-Traumatic Stress Disorder, And Benzodiazepine Use To Get High, Julia Kollitz

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

Aim: To determine if there is a relationship between depression risk, post-traumatic stress disorder (PTSD), and engaging in benzodiazepine misuse.

Methods: A secondary cross-sectional analysis was conducted on data from a sample of people who use drugs (n=743). Depression risk was assessed via the Center for Epidemiological Studies-Depression scale. Meeting DSM-IV criteria for PTSD was identified using the Mini International Neuropsychiatric Interview (MINI). We used simple and multivariable logistic regression models to estimate the association between mental health factors of interest and benzodiazepine misuse, defined as self-reported benzodiazepine use “to get high” in the past six months.

Results: Of the …

A Case Study In Program Evaluation: A Prospective Program Evaluation Of Timely Reporting And Action Of An Infectious Disease Outbreak, Destiny Cozart

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

Methicillin-resistant Staphylococcus aureus also known as MRSA is an infection of a staph bacteria. High school athletes are at risk of contracting MRSA through skin to skin contact and/or MRSA contaminated equipment. This case study uses the CDC's six-step framework for program evaluation to measure the effectiveness of the online training modules designed to increase the knowledge of staff and stakeholders about MRSA and infectious disease outbreaks. The findings from this evaluation will advise the potential change(s) implemented in training modules, ultimately to enhance competency for decision makers and prevent MRSA and infectious disease outbreak amongst high school athletic programs.

Prevalence Of Hpv16 E6 Antibodies And Oral Hpv Among Men Living In Kentucky, Christopher O. Otieno

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

ABSTRACT

Objective: The incidence of human papillomavirus-driven oropharyngeal cancer (HPV-OPC) is surging in the United States, particularly in the southeast and Appalachia. The reason for this increase is unknown. We evaluated the prevalence of two markers of increased risk, HPV16 E6 antibodies and oral HPV infection, among men in Appalachian and non-Appalachian Kentucky.

Methods: This study was nested within an ongoing HPV-OPC screening study of healthy men aged 45+ residing in urban (non-Appalachian) and rural (Appalachian) Kentucky and included the first 1,581 participants with either HPV serologic and/or oral HPV testing. Blood and oral rinse samples were collected at enrollment. …

Dental Outreach In Academic Dental Settings, Tisha Clayborn

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

Creating an effective outreach program in a dental academic setting involves a strategic approach combining educational objectives and community service. This Dental Outreach Program Guide aligns with organizational objectives, contributes to community well-being, and serves as a model for future outreach initiatives in academic dental settings. This program utilizes the PRECEDE-PROCEED planning model to design and evaluate an oral health strategy. This program aims to outline a strategic plan incorporating evidence-based decision-making, data-driven metrics, and a comprehensive roadmap for successful implementation.

Fall 2023 Covid-19, Influenza, And Respiratory Syncytial Virus Vaccine Uptake In Kentucky, Abigail Dial

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

Fall 2023 COVID-19, Influenza, and Respiratory Syncytial Virus Vaccine Uptake in Kentucky

Background: In the fall of 2023, vaccine recommendations included updated COVID-19 and influenza vaccines, as well as a new vaccine and immunization for respiratory syncytial virus (RSV). Vaccine co-administration, the administration of more than one vaccine in one vaccination session, is safe and effective for COVID-19, influenza, and RSV vaccines and can improve vaccine uptake for all recommended vaccines (Bonanni, et al., 2023; CDC, 2023). The COVID-19 pandemic altered the landscape for locations where people receive vaccinations, and it may be beneficial to public health to have …

Redefining Ed Utilization: A Rabies Post-Exposure Prophylaxis Perspective, David Bennington

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

Rabies, though rare in the United States, remains a lethal viral disease with significant public health implications. Post-exposure prophylaxis (PEP) through timely administration of rabies vaccines and rabies immune globulin (RIG) is critical for preventing the progression of the virus following potential exposure. However, the current system of healthcare delivery in the United States has witnessed an alarming trend: the unnecessary utilization of emergency department (ED) visits for rabies PEP, including follow-up vaccinations. This paper aims to examine and address this issue through a review of the factors contributing to the inappropriate use of ED services for rabies treatment.

Through …

A Case Study In Prospective Program Evaluation, Sarai Rosemary Combs

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

Evaluation is a helpful tool in public health to provide transparency about community interventions and programs. The following is a prospective evaluation of a case study, looking at a recently designed program by the Lexington-Fayette County Health Department, as a capstone project for the Health Management and Policy concentration of the Masters in Public Health program of the College of Public Health. The health department developed a series of online training modules to increase knowledge of Methicillin-resistant staphylococcus aureus (MRSA) and other similar organism outbreaks and how to respond to these outbreaks. The program targets were Fayette County Public School …

Characteristics Of Congenital Syphilis Cases In Kentucky 2019-2023, Ines Roy

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

Abstract:

Background: The incidence of congenital syphilis (CS) has increased both in the United States (US) and globally and remains a public health concern. In Kentucky alone, there has been a significant increase in CS cases, from 9 cases in 2019 to 27 cases in 2023. CS is a preventable disease, but testing and immediate treatment are critical to prevent its spread. We have limited knowledge regarding Kentucky’s characteristics and behavioral factors that may be associated with this rise. The goal of this study is to identify characteristics and potential risk factors that contribute to the rise of CS in …

The Distribution Of Cp-Cre Cases From 2013-2020 In The Commonwealth Of Kentucky, Hannah Hiscox

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

Multidrug-resistant organisms (MDROs), particularly Carbapenem-Resistant Enterobacterales (CRE), pose a significant threat to public health due to their resistance to multiple antibiotics, including carbapenems. CRE infections, especially those producing carbapenemases (CP-CRE), are associated with high morbidity and mortality rates, making them a growing concern in healthcare settings. Despite the prevalence of CRE infections in the United States, limited data exist on the incidence and distribution of CP-CRE infections in specific regions, such as the Appalachian counties of Kentucky.

This study aimed to investigate the cumulative incidence and distribution of CP-CRE cases in Appalachian and non-Appalachian counties of Kentucky, as well as …

A Case Study In Program Evaluation, Iantha Wright

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

The framework for program evaluation is a systematic way of improving and accounting for public health actions by providing practical, feasible, ethical, and accurate information. As a practical, non-prescriptive tool, it guides public health professionals through the essential steps in program evaluation. The framework uses the six steps to understand how to improve and conduct assessments effectively. Additionally, it emphasizes integrating stakeholders and using ongoing evaluation strategies to plan effective interventions, improve existing programs, and demonstrate the efficient use of resources.

Demographic And Behavioral Characteristics Of People Who Help Others Inject Drugs: A Study Of People Who Inject Drugs In Appalachia Kentucky, Ryli Hockensmith

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

Aim: This study aims to understand the demographic and behavioral characteristics of people who inject drugs (PWID) who assist others with injection, hereafter “injection assistors,” and assess the characteristics of injection assistors compared to PWID who do not assist others with injection in Appalachian Kentucky.

Methods: A cross sectional secondary data analysis of data collected from 433 PWID enrolled in the ongoing Kentucky Outreach Service (KyOSK) was performed. Logistic regression analyses were performed to compare injection assistors to those who do not assist others on demographic, behavioral, service usage, and harm reduction characteristics.

Results: In total, 128 (29%) PWID reported …

Mail-Based Or Home Delivery Services: Preferences Among People Who Inject Drugs In Appalachian Kentucky, Su Su Zin

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

Aim: To explore acceptability of delivery-based syringe services program (SSP) among people who inject drug (PWID) in Eastern Kentucky and compare those who wanted to participate in delivery-based SSP to those who did not.

Methods: This was a cross-sectional analysis of data from PWID who injected drugs to get high in the past 30 days (n=246) collected during the baseline assessment administered to the Gateway2Health cohort. Chi-square tests, t-tests, univariate and multivariable logistic regressions were calculated between independent variables and the outcome variable (likelihood of participating in a delivery-based SSP).

Results: 52.9% of PWID reported being likely to participate in …

Human Papilloma Virus Type 16 Seroprevalence Among Men Living With Hiv, Ashley Duff

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

Objectives: Individuals living with HIV are at a higher risk for developing human papillomavirus-driven oropharyngeal cancer (HPV-OPC). There are no methods for early detection; however, HPV16 E6 antibodies have been identified as a promising early marker. The objective of this study was to evaluate seroprevalence and predictors of HPV16 E6 seropositivity among men living with HIV.

Methods:2,334 men aged 40+ living with HIV with blood specimens banked within the Tennessee Center for AIDS Research (TN-CFAR) biorepository were evaluated using HPV multiplex serology. Seroprevalence of HPV16 antibodies was calculated for all HPV16 proteins analyzed (L1, E1, E2, E4, E6, E7). …

A Case Study In Program Evaluation, Sierra L. Williams

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

The Lexington-Fayette County Health Department (LFCHD) developed an education program targeted toward infectious disease outbreaks. The program ensures timely reporting and action during an infectious disease outbreak within the Fayette County Public Schools (FCPS) system. I have been tasked with evaluating the program and its implementation of training modules through pre and post-surveys to determine if the program is significantly increasing the overall knowledge of program participants and make recommendations for how program aspects can be improved.

Program Evaluation Case Study, Grace Mullikin

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

Program evaluation case study utilizing Center for Disease Control and Prevention's Case Evaluation Framework.

Physical And Psychosocial Factors Related To Firefighter Musculoskeletal Disorders, Jennifer Ellen Tinsley Kubala

Theses and Dissertations--Rehabilitation Sciences

Career firefighters must perform physically and psychologically challenging duties in unpredictable and dangerous conditions. Previous investigations have found that firefighters suffer nearly 4 times the recorded musculoskeletal disorders (MSD) and workplace injuries compared to private and public sector workers, and take approximately 1.5 days longer to return to normal work. Thus, the burden of firefighter MSD experiences has been a growing area of exploration. The few investigations that have concurrently examined physical and psychosocial consequences experienced by firefighters have found a positive relationship between increased occupational stress reports and MSD experiences. However, these investigations, as well as those that individually …

Correlates Of Transactional Sex Among Black Men And Women Who Misuse Opioids, Shemeka Thorpe, Paige Orphé, Gabriella Pitcher, Kendall Mccleod, Natalie Malone, Danelle Stevens-Watkins

Kinesiology and Health Promotion Faculty Publications

The rise in opioid misuse coincides with increased sexually transmitted infection (STI) and HIV incidence. Transactional sex is an under-researched phenomenon among Black Americans who misuse opioids, and may increase their risk of STI or HIV transmission. Given the disproportionate impact of the opioid epidemic on Black Americans and the risks associated with opioid misuse, the current study aims to investigate sociostructural factors, history of violence, and sexual risk factors associated with transactional sex among Black men and women. A sample of n = 375 Black adult Kentuckians reporting opioid misuse completed a survey including transactional sex, sociostructural, violence history, …

Program Evaluation Case Study: Infectious Disease Reporting Training Program Evaluation, Emily Sekkath Veedu

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

The Lexington-Fayette County Health Department (LFCHD) has developed an educational program aimed at Fayette County Public Schools (FCPS) health and athletics staff members to ensure timely reporting and action in the event of an infectious disease outbreak (4). The program was implemented after a methicillin-resistant staphylococcus aureus (MRSA) outbreak occurred in a Kentucky community, with a high school football team presenting several of the cases (4). It was noted by a school nurse that many people attending an informational session lacked knowledge regarding infection control, suggesting a need for intervention in this community. I have evaluated this program in the …

Recent Trends In Stimulant Prescribing In Kentucky, 2021-2023, Jordan Shannon

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

Abstract

Introduction

Prescription stimulants have a long history of clinical use dating as far back as the 1930s. In the United States stimulant prescribing rates have steadily climbed over the last 3 decades. The primary objective is to describe recent (2021-2023) prescribing trends of stimulant medications in the Commonwealth of Kentucky

Methods

Prescription data collected from Kentucky’s prescription drug monitoring (PDMP) database known as the Kentucky All Schedule Prescription Electronic Reporting System (KASPER). Annual and quarterly trends in stimulant prescribing between 2021-2023 were calculated, examined by age, sex, and geographic location.

Results

Stimulant prescribing increased by ~15% where the majority …

Evaluating Healthcare Workers’ Knowledge, Attitudes, And Practices Regarding Language Access Services In The Clinical Setting, Rachel Archibald

DNP Projects

Background: Barriers to accessing and understanding healthcare can place patients with low English proficiency at an increased risk of poor health outcomes. Language-based inequities in healthcare exist due to lack of interpretation and translation services available, lack of healthcare workers’ knowledge of resources, and/or perceptions that these services require too much time or effort. Failing to address barriers affecting this population leaves them vulnerable in the healthcare setting.

Purpose: The purpose of this DNP project was to educate nurses, providers, and staff on an inpatient unit at a rural hospital of the language interpretation resources available, best practices for implementation, …

Rural And Urban Clinician Views On Covid- 19’S Impact On Substance Use Treatment For Individuals On Community Supervision In Kentucky, Carrie B. Oser, Maria Rockett, Sebastian Otero, Evan Batty, Marisa Booty, Rachel Gressick, Michele Staton, Hannah K. Knudsen

Center on Drug and Alcohol Research Faculty Publications

Background The COVID-19 pandemic produced system-level changes within the criminal legal system and community-based substance use disorder (SUD) treatment system with impacts on recovery efforts. This study examines rural and urban clinicians’ perspectives of COVID-19 on SUD treatment delivery for people on community supervision.

Methods Virtual qualitative interviews were conducted between April and October 2020 with 25 community supervision clinicians employed by Kentucky’s Department of Corrections (DOC), who conduct assessments and facilitate community-based treatment linkages for individuals on probation or parole. Transcripts were analyzed in NVivo using directed content analysis methods.

Results Clinicians were predominantly white (92%) and female (88%) …

Understanding Intention And Behavior Of Practicing Yoga Through The Lens Of Theory Of Planned Behavior Specifically In Rural Communities; A Qualitative Study, Shelley Meyer

Theses and Dissertations--Kinesiology and Health Promotion

While there are known health benefits for participating in yoga, little has been studied on the intention and behavior for why individuals practice yoga especially through a theoretical lens and intense qualitative thematic analysis. Targeting the rural community considers other extenuating circumstances experienced by rural residents that can impact yoga participation in rural areas. Interviews were used to gain insight into a holistic viewpoint with the rich data bringing clarity to an individual’s thought process (of intention) to incorporate yoga (behavior) in their daily life. Utilizing the Theory of Planned Behavior as the theoretical framework for developing interview questions allowed …