Public Health Commons^™

Effects Of A Smoke-Free Law In Parks And Beaches On Smoking Behaviour: Methods To Determine Effectiveness, Chizimuzo T.C. Okoli, Andrew Johnson, Amanda Fallin, Ann Pederson, Anna Liwander

Nursing Presentations

As part of a comprehensive approach to tobacco control,smoke free laws have resulted in reductions of indoor air pollution, improvements in respiratory and cardiovascular health, reduction of smoking uptake by youth, and increasing tobacco use cessation in various jurisdictions. Although many studies have demonstrated the beneficial effects of smoke-free policies in indoor spaces (e.g., restaurants, bars, workplaces, hospital settings, etc.), little is known about the effectiveness of such policies in outdoor public spaces. On September 1st, 2010, Vancouver’s smoke-free by-law for the city’s parks, beaches, and facilities came into effect. The aims of this study are two-fold: a) to examine …

An Evidence-Based Approach To Address Tobacco Dependence Treatment In Mental Health And Addictions Settings, Chizimuzo T.C. Okoli

Nursing Presentations

Purpose: To examine the program completion and smoking cessation outcomes of a tobacco dependence treatment program for individuals with a history of substance use (SUD) and/or psychiatric disorders (PD). Despite the steady decline in the overall smoking prevalence in North America during the last decade some subsets of the population continue to smoke at high rates, particularly individuals with a SUD and/or PD. Among clinical samples, an estimated 75% of individuals with SUD and up to 90% of individuals with PD concurrently smoke. Such findings have prompted the need for tailored tobacco dependence treatment approaches in this population.

Methods: The …

Outcomes Of An Intensive Smoking Cessation Program For Individuals With Substance Use Disorders, Milan Khara, Lindsay Killam, Chizimuzo T.C. Okoli

Nursing Presentations

BACKGROUND: Individuals with substance use disorders (SUD) are disproportionately affected by tobacco use morbidity and mortality. Yet, with adequate intervention, such individuals can be successful in their smoking cessation efforts. The Tobacco Dependence Clinic (TDC) provides tobacco dependence treatment using combined behavioural counseling and pharmacotherapy for clients through the Mental Health and Addiction Services of the Vancouver Coastal Health Authority, British Columbia, Canada.

OBJECTIVES: To a) provide smoking cessation outcomes of participants accessing the TDC b) examine predictors of program completion and smoking cessation of participants of the TDC.

METHODS: Participants of the TDC receive a structured 8 week group …

Two Tree Trimmers Die When Struck By Errant Semi Tractor-Trailer, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Motor Vehicle

One spring morning in 2010, three male tree trimmers set up a work site in a highway intersection at the base of a mountain. As one tree trimmer removed equipment from the truck, two other tree trimmers, 21- and 32-years old, posted signage in the intersection. The two tree trimmers were located on the shoulder of the highway. A semi tractor-trailer was driving down the mountain toward the intersection, when its brakes failed. To avoid hitting vehicles in front of the semi, the driver steered to the left, crossed the intersection, striking both tree trimmers with the semi tractor-trailer. Both …

Pre- And Post-Bronchodilator Lung Function As Predictors Of Mortality In The Lung Health Study, David M. Mannino, Enrique Diaz-Guzman, Sonia Buist

Preventive Medicine and Environmental Health Faculty Publications

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is supposed to be classified on the basis of post-bronchodilator lung function. Most longitudinal studies of COPD, though, do not have post-bronchodilator lung function available. We used pre-and post bronchodilator lung function data from the Lung Health Study to determine whether these measures differ in their ability to predict mortality.

METHODS: We limited our analysis to subjects who were of black or white race, on whom we had complete data, and who participated at either the 1 year or the 5 year follow-up visit. We classified subjects based on their baseline lung function, according …

Using Public Health Pbrn Research To Inform Policy & Practice, Public Health Practice-Based Research Networks

Health Management and Policy Reports

The Public Health Practice-Based Research Networks Program is a national program of the Robert Wood Johnson Foundation that supports research networks dedicated to producing new scientific knowledge on how best to organize, finance, and deliver public health strategies in realworld practice settings. This body of scientific inquiry, known as Public Health Services and Systems Research (PHSSR), is a rapidly developing area of scholarship within the larger fields of public health research and health services research. A public health practice-based research network (PBRN) brings multiple public health organizations into collaboration with an academic research center for the purposes of designing and …

Outcomes Of A Tailored Tobacco Treatment Approach For Individuals With Substance Use Disorders And/Or Psychiatric Disorders, Chizimuzo T.C. Okoli, Milan Khara

Nursing Presentations

Summary of Key Findings

• Smoking abstinence at end of program:
• Intent to treat analysis: 31% (167/540)
• Among program completers: 41% (167/406)

• Significant predictors of abstinence:
• Having a history of an anxiety disorder is predictive of being less likely to quit smoking when compared to having no history of a psychiatric disorder.
• Having a lower CO level at program enrolment was a significant predictor of being more likely to quit.
• Attending the TDC program for a longer duration was a significant predictor of being more likely to quit.

Building A Sustainable Public Health Pbrn: Tips For Securing Ongoing Research Funding, Public Health Practice-Based Research Networks

Health Management and Policy Reports

Diversify your network’s research funding base. The Public Health PBRN Program funding made available by the Robert Wood Johnson Foundation provides start-up resources and initial research support for networks, but networks will require larger and more sustainable sources of funding for public health research as they progress. The most ample sources can be found in federal funding agencies that operate competitive extramural research programs, include CDC, NIH, AHRQ, HRSA, USDA, and NSF. Public health research funding is also available from state and foundation sources, and even corporate sources (e.g. Pfizer’s Public Health Research Fellowship Program). For sustainability, networks should look …

Public Health Pbrns: Generating Evidence For Policy & Practice, Public Health Practice-Based Research Networks Program

Health Management and Policy Reports

The Public Health Practice-Based Research Networks Program is a national program of the Robert Wood Johnson Foundation that supports the development of research networks for studying the comparative effectiveness, efficiency and equity of public health strategies deployed in real-world practice settings. A practice-based research network (PBRN) brings multiple public health agencies together with research partners to design and implement studies of population-based strategies that prevent disease and injury and promote health. Participating practitioners and researchers collaborate to identify pressing research questions of interest, design rigorous and relevant studies, execute research effectively, and translate findings rapidly into practice. As such, PBRNs …

Workers Die From Heat Stroke, Kentucky Injury Prevention And Research Center

Kentucky Haz Alerts--Other

To prevent heatstroke, employers should:

• Train supervisors and employees to recognize symptoms of heat stroke
• Give frequent breaks and provide drinking water
• Adjust work hours to accommodate work conditions such as high heat index and/or high humidity
• Monitor workers who are at risk of heat stroke

Employees should:

• Report unusual behavior
• Know how to treat co-workers for heat stroke
• Monitor your physical condition and that of your coworkers

Workers Killed After Being Electrocuted, Kentucky Injury Prevention And Research Center

Kentucky Haz Alerts--Other

To prevent electrocutions, employers should:

• Provide non-conductive ladders
• Conduct a jobsite survey to identify potential hazards
• Provide electricity awareness training
• Provide onsite automated external defibrillators (AEDs)

• Use non-conductive ladders
• De-energize lines before beginning work
• Make sure all equipment is properly grounded
• Know how to use automated external defibrillators (AEDs)

Farmwork-Related Injury Among Farmers 50 Years Of Age And Older In Kentucky And South Carolina: A Cohort Study, 2002-2005, Jennifer L. Marcum, Steven R. Browning, Deborah B. Reed, Richard Charnigo

Epidemiology and Environmental Health Faculty Publications

Farmers in the U.S. are becoming more diverse; the average age of the farmer is increasing, as is the number of women and minority farm operators. There is limited research on injury risk factors in these special populations of farmers. It is especially important to study the risk factors for injury in these growing and at-risk groups. A longitudinal survey was conducted of farmers (n = 1,394) age 50 and older who resided in Kentucky and South Carolina. The questionnaire was administered by telephone and mail surveys four times between 2002 and 2005 to the fixed cohort of farmers, obtained …

A Tale Of Two Cities? The Heterogeneous Impact Of Medicaid Managed Care In Kentucky, James Marton, Aaron Yelowitz, Jeffery C. Talbert

University of Kentucky Center for Poverty Research Discussion Paper Series

Does managed care produce lower health care utilization and costs through better aligned financial incentives and alternative delivery methods (the “pure” HMO effect) or by attracting more healthy enrollees (enrollee selection)? The purpose of this paper is to shed new light on this fundamental question using a quasi-experimental approach that exploits the timing and county specific implementation of Medicaid managed care plans in two distinct sub-sets of Kentucky counties in the late 1990s. We find large differences in the relative success of each region in reducing utilization that are likely driven by important differences in plan design. Asthmatic children enrolled …

Workers Killed During Tree Trimming/Removal, Kentucky Injury Prevention And Research Center

Kentucky Haz Alerts--Other

To prevent tree trimming and removal fatalities, workers should:

• Perform a hazard assessment of the work area before starting work
• Appropriate personal equipment should be worn at all times while trimming or removing trees
• Determine the tree’s felling direction. Address forward lean, back lean, and/or side lean issues
• All trees and limbs should be inspected for structural weakness before work commences
• Have an escape route planned

Semi Truck Driver Falls Asleep While Driving, Crashes And Dies, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Motor Vehicle

A 56 year-old male long-haul semi-truck driver fell asleep while driving. It was approximately 4:15 AM and the driver was hauling a load of canned tomatoes. He was approximately 225 miles away from his destination driving in the right hand lane, on a four lane interstate traveling south, when he fell asleep. Upon falling asleep, the unit travelled to the right, across the rumble strip and the emergency lane, behind a guardrail, down an embankment and crashed into a grove of trees. A man driving a car behind the semi truck saw dust rise from the crash, stopped, called emergency …

Does Comorbidity Explain The Ethnic Inequalities In Cervical Cancer Survival In New Zealand? A Retrospective Cohort Study, Naomi Brewer, Barry Borman, Diana Sarfati, Mona Jeffreys, Steven T. Fleming, Soo Cheng, Neil Pearce

Epidemiology and Environmental Health Faculty Publications

BACKGROUND: There are large ethnic differences in cervical cancer survival in New Zealand that are only partly explained by stage at diagnosis. We investigated the association of comorbidity with cervical cancer survival, and whether comorbidity accounted for the previously observed ethnic differences in survival.

METHODS: The study involved 1,594 cervical cancer cases registered during 1994-2005. Comorbidity was measured using hospital events data and was classified using the Elixhauser instrument; effects on survival of individual comorbid conditions from the Elixhauser instrument were also assessed. Cox regression was used to estimate adjusted cervical cancer mortality hazard ratios (HRs).

RESULTS: Comorbidity during the …

Engineered Nanomaterials: Exposures, Hazards, And Risk Prevention, Robert A. Yokel, Robert C. Macphail

Pharmaceutical Sciences Faculty Publications

Nanotechnology presents the possibility of revolutionizing many aspects of our lives. People in many settings (academic, small and large industrial, and the general public in industrialized nations) are either developing or using engineered nanomaterials (ENMs) or ENM-containing products. However, our understanding of the occupational, health and safety aspects of ENMs is still in its formative stage. A survey of the literature indicates the available information is incomplete, many of the early findings have not been independently verified, and some may have been over-interpreted. This review describes ENMs briefly, their application, the ENM workforce, the major routes of human exposure, some …

Racial/Ethnic Disparities In Survival Among Men Diagnosed With Prostate Cancer In Texas, Arica L. White, Ann L. Coker, Xianglin L. Du, Katherine S. Eggleston, Melanie Williams

CRVAW Faculty Journal Articles

BACKGROUND:

To the authors' knowledge, few studies to date have examined racial differences in prostate cancer survival while controlling for socioeconomic status (SES). No such studies have examined this association in Texas, a large state with significant ethnic and racial diversity. The objective of this analysis was to determine whether racial disparities in survival for men diagnosed with prostate cancer in Texas from 1995 through 2002 remained after adjusting for SES, rural residence, and stage of disease.

METHODS:

A cohort of 87,449 men who were diagnosed with prostate cancer was identified from the Texas Cancer Registry. The SES measure was …

Semi Drivers Killed After Vehicle Rollovers, Kentucky Injury Prevention And Research Center

Kentucky Haz Alerts--Motor Vehicle

To prevent semi truck rollovers, employers should:

• Implement and enforce a seat belt safety program
• Establish and strengthen a company policy to reduce fatigue on the job

Employees should:

• Always wear a seat belt while in the vehicle
• Use correct lights during a fog
• Use proper precautions to reduce sloshing
• Reduce inadequate evasive actions

Subjects With Discordant Airways Obstruction: Lost Between Spirometric Definitions Of Copd, Bernd Lamprecht, Lea Schirnhofer, Bernhard Kaiser, Sonia A. Buist, David Mannino, Michael Studnicka

Preventive Medicine and Environmental Health Faculty Publications

Background. Since the FEV1/FVC ratio declines with age, using the fixed ratio of 0.70 leads to overdiagnosis of COPD in older populations and underdiagnosis among young adults. Objective. To evaluate whether discordant obstructive cases (FEV1/FVC < 0.70 but ≥LLN) are a healthy population or have clinical features that would place them at increased risk. Methods. We used post-bronchodilator spirometry data from the population-based Austrian Burden of Obstructive Lung Disease (BOLD) study. Those with post-bronchodilator FEV1/FVC ratio

Land Surveyor Struck And Killed By Passenger Vehicle, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Motor Vehicle

One late fall day in 2009, at approximately 3:30 PM, two land surveyors had completed surveying tasks for the day and were walking north, on opposites sides of a two-lane rural state highway. They were returning surveying equipment to the company truck. Surveyor 1, company owner, was walking with traffic on the east side of the road, in the grass, a few feet to the right of the pavement. Surveyor 2 was walking on the edge of the pavement on the west side of the road. Both men were on the road on the blind side of a hill and …

Municipal Solid Waste Collector Dies After Falling From Solid Waste Vehicle Hopper Area, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Motor Vehicle

On a spring day in 2010, a 41 year-old male, solid waste collector, was riding in the hopper area of a solid waste truck when he fell out and struck his head on the pavement. He was riding in the hopper area because the step he usually rode, located at the rear driver side, was broken. Another worker rode the rear step on the passenger side of the vehicle, and a third worker, the driver, drove. After approaching a stop, the driver looked into the rearview mirror and saw the decedent on the pavement. The driver stopped the truck, and …

Kriged And Modeled Ambient Air Levels Of Benzene In An Urban Environment: An Exposure Assessment Study, Kristina W. Whitworth, Elaine Symanski, Dejian Lai, Ann L. Coker

CRVAW Faculty Journal Articles

Background. There is increasing concern regarding the potential adverse health effects of air pollution, particularly hazardous air pollutants (HAPs). However, quantifying exposure to these pollutants is problematic. Objective. Our goal was to explore the utility of kriging, a spatial interpolation method, for exposure assessment in epidemiologic studies of HAPs. We used benzene as an example and compared census tract-level kriged predictions to estimates obtained from the 1999 U.S. EPA National Air Toxics Assessment (NATA), Assessment System for Population Exposure Nationwide (ASPEN) model. Methods. Kriged predictions were generated for 649 census tracts in Harris County, Texas using estimates of annual benzene …

Determinants Of Multimethod Contraceptive Use In A Sample Of Adolescent Women Diagnosed With Psychological Disorders, Delia L. Lang, Jessica M. Sales, Laura F. Salazar, Ralph J. Diclemente, Richard A. Crosby, Larry K. Brown, Geri R. Donenberg

Health, Behavior & Society Faculty Publications

OBJECTIVE: Despite recommendations for concurrent use of contraceptives and condoms to prevent unintended pregnancy and STIs, multimethod contraceptive use among women is poor. This study examined individual-, interpersonal-, and environmental-level factors that predict multimethod use among sexually active adolescent women diagnosed with psychological disorders.

METHODS: This multisite study analyzed data from 288 sexually active adolescent women who provided sociodemographic, psychosocial, and behavioral data related to birth control and condom use.

RESULTS: 34.7% of the participants reported multimethod use in the past three months. Controlling for empirically and theoretically relevant covariates, a multivariable logistic regression identified self-efficacy, multiple partners, pregnancy history, …

Chronic Health Conditions Of Individuals In Public Housing, Alicia A. Arnett

Theses and Dissertations--Nutrition and Food Systems

A majority of low-income individuals living in public housing today are working or receiving some kind of assistance, but still struggle to make ends meet. Previous studies show that cost and availability are barriers to healthy eating for low-income individuals. The purpose of this study was to determine relationships among nutrition habits, health status, sources of income, and food and living resources for low-income residents in public housing. The study utilizes data collected over five years on the impact of the revitalization of the families. The sample was randomly selected from residents of the housing property in a Kentucky city. …

Factors Associated With Tobacco Use Among Rural And Urban Pregnant Women, Whitney Jeanne Katirai

University of Kentucky Doctoral Dissertations

The purpose of this study was to investigate the influences of smoking on rural and urban pregnant women. More specifically, the variables of the knowledge of health effects, health provider recommendations, subscores from the Health Belief Model (HBM), and social support were explored in relation to the smoking behavior of pregnant women. A secondary purpose was to investigate the accuracy of self-reported smoking during pregnancy using biochemical validation. Pregnant women (N=71) completed an anonymous questionnaire, designed by the researcher, to identify variables that predicted smoking for urban and rural women. Participants also gave a saliva sample for cotinine testing.

Approximately …

Service Technician Working Alone Dies After Being Assaulted, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Other

One late fall evening in 2009, a 53 year-old male technician was working alone at a repair shop. At approximately 9:45 PM, the technician returned to the shop with his dinner from a nearby fast-food establishment. He spread his dinner on the work bench and began eating when apparently he was attacked from behind. His attacker used a knife and cut the technician’s carotid artery and jugular vein on the left side of his neck. The attacker fled, and the technician used a cell phone to call 911, emergency medical services (EMS). When EMS arrived, they found the technician dead …

Public Health Systems And Services Research: Bridging The Practice-Research Gap., F. Douglas Scutchfield, Cynthia D. Lamberth

Preventive Medicine and Environmental Health Faculty Publications

Public health practitioners understand the principles of evidence-based practice

and the science that should drive their efforts to improve the community’s

health through the implementation of science-driven public health programs.

However, the translation of research to practice still has numerous barriers.

This commentary provides suggestions to strengthen the link between research

and practice.

Foreign-Born Semi Driver Dies After Driving Over Embankment, Kentucky Injury Prevention And Research Center

Fatality Case Reports--Motor Vehicle

One summer morning in 2009, at approximately 11:30 AM, a 41 year-old male, long-haul, semi tractor-trailer driver drove off an interstate highway, over a guardrail, and continued into a wooded ravine. His trailer was empty and he was travelling to pick up a load of retail goods. The trailer disengaged from the tractor, the fuel tanks ruptured, the tractor overturned and caught fire. As the tractor overturned, the driver was ejected. A passing motorist called emergency medical (EMS) services; EMS arrived and found the driver dead at the scene.

To prevent future occurrences of similar incidents, the following recommendations have …

Recent Trends In Exposure To Secondhand Smoke In The United States Population, Chieh-I Chen, Tanya Burton, Christine L. Baker, Vera Mastey, David Mannino

Preventive Medicine and Environmental Health Faculty Publications

BACKGROUND: Previous research using the National Health and Nutrition Examination Surveys (NHANES) data documented a significant downward trend in secondhand smoke (SHS) exposure between 1988 and 2002. The objective of this study was to assess whether the downward trend in exposure continued from 2001 through 2006.

METHODS: We analyzed data from the 2001-2006 NHANES to estimate exposure of nonsmokers to SHS. Geometric means of serum cotinine levels for all nonsmokers were computed.

RESULTS: Overall serum cotinine levels (95% Confidence Intervals) in 2001-2002, 2003-2004, and 2005-2006 were 0.06 ng/mL (0.05-0.07), 0.07 ng/mL (0.06-0.09), and 0.05 ng/mL (0.05-0.06), respectively. Subgroup analysis by …