Health Management And Policy Capstone: A Case Study In Program Evaluation, Kelsey R. Gatton

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

Program evaluation of a hypothetical comprehensive hypertension self-management program as directed by the CDC Framework for Program Evaluation in Public Health.

Evaluation Of Facebook Social Media Messages Following The 2022 Eastern Kentucky Floods, Delaney Bonds

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

Purpose: The goal of this study is to examine the availability of disaster-related information online from local health departments in flood-impacted counties in the month following 2022 Eastern Kentucky Floods. This study aims to evaluate Facebook messages by (1) when messages were posted (2) types of posts (3) message content.

Methods: This mix-methods environmental scan of Facebook messages posted by 8 flood-impacted Eastern Kentucky local health departments from July 26^th, 2022, to August 26^th, 2022. Messages were coded for absence or presence of a message feature. These message features were examined to identify features relevant to …

The Prepare Mobile Program For Hiv Prevention In Washington D.C., Gabrielle Cochran

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

Incidence rates of HIV have decreased in the United States in the past decade, but the southern United States has higher rates of HIV than other regions, and cities in the south, like Washington D.C., have some of the highest rates of HIV incidence in the nation. Risky sexual behavior, needle sharing, and substance use increase the risk of transmitting or acquiring HIV, and these behaviors are more common among unhoused people (CDC, 2021; CPPH, 2022).

Expansion of community resources in cities with high levels of HIV have allowed for many people at high risk for HIV to comply with …

Retrospective Analysis Of Non-Ketotic Hyperglycinemia Patients In Central And Eastern Kentucky, Shane Reeves

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

Aim: To obtain a better understanding of the non-ketotic hyperglycinemia (NKH) patient population in regards to clinical features, mortality, geographic clustering, genetics, and incidence rate within the University of Kentucky (UK) catchment area of Central and Eastern Kentucky.

Methods: Patients with ICD codes corresponding to NKH who were treated at UK between January 1, 2008, and July 1, 2022, and who had clinical documentation available for review were identified through UK’s medical records (N=15). Demographic and clinical data were obtained through review of these patient’s charts in the electronic medical record. Differences in features among patients was assessed utilizing Fisher …

Trends In Respirable Coal Mine Dust Concentration (Mg/M3) Based On Coal Miners’ Occupational Designation: An Analysis Of The Msha Coal Dust Samples Data Set (2000-2022), Aaron Blake Charles

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

Rates of Coal Workers' Pneumoconiosis (CWP) have recently increased in prevalence over the past 20 years. Recent regulation (Phase III) by the Mining Safety and Health Administration to lower the coal dust standard to 1.5 mg/m3 has been mandated to assist in reducing the burden of CWP. Occupations in the coal mining industry have different exposures to coal dust depending on their occupational responsibilities. This study examined the respirable coal dust trends for underground and surface mining occupations from 2000 to 2022. The ultimate goal is to see how respirable coal dust exposures have changed in multiple occupations over this …

Health Management And Policy Capstone: A Case Study In Program Evaluation, Bradford Brewer

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

Hypertension has risen steadily among adults in United States over the past 30 years. This increase has also been marked by a significant increase in reported prevalence rates of cardiovascular diseases. In response, the Centers for Disease Control and Prevention (CDC) funded the Lexington-Fayette County Health Department to deliver a hypertension self-management program for adults aged 35 and older. This manuscript follows the six steps of CDC program evaluation to aid Lexington citizens with uncontrolled high blood pressure (≥140/90 mmHg) in successful hypertension self-management. This evidence-based community intervention helps patients take responsibility for managing their hypertension with assistance from health …

Rapid Scoping Review Of The Epidemiological Evidence For Mercury Exposure And Prevalence Of Alzheimer’S Disease, Rebecca Mattingly

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

This rapid scoping review examines the current body of epidemiologic research evaluating the potential linkage between environmental exposure to mercury and Alzheimer's disease (AD). Alzheimer’s disease accounts for 60-80% of all neurodegenerative disease in the United States and was the seventh leading cause of death in Kentucky in 2020. The exact etiology of AD needs further investigation; however, environmental factors such as pesticides, arsenic, cadmium, lead, and mercury have been correlated with development of AD lesions, cognitive decline, and AD. Mercury is a toxic metal that can be found in air, water, and soil, both from natural and human-made sources. …

Blue Oval Sk Battery Park Environmental Impact And Community Guide, Warren Rummage

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

This Capstone Project Paper will discuss the potential effects of the BlueOval SK Battery Park being constructed in Glendale, Kentucky based on knowledge attained from open records requests and available publicly online. Based on the process of attaining said information, a Community Guide has been generated and is available to distribute to concerned community members. It is the hope that this work will enable those in Hardin County, and possibly beyond, to ensure their environment and community health are prioritized during the construction phase and eventual operation of the EV-battery manufacturing faciliities on this massive 1,500 acre plot of land.

Pfas Clinical Guidance, John Bingham

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

Introduction

A broad category of synthetic organic compounds, per- and polyfluorinated alkyl substances (PFAS), forms the impetus for this project. Known compounds in this category are numerous and diverse, with over 4700 identified molecular entities (Panieri, Baralic, Djukic-Cosic, Buha Djordjevic, & Saso, 2022). Their only commonality is the presence of at least one carbon atom that is saturated with fluoride groups. These chemical bonds are exceptionally difficult to break (Tansel, 2022), which incepts both the utility of PFAS compounds and the concerns they raise for human health (Cousins et al., 2020). While PFAS are …

The Relationship Between Maternal Depressive Symptoms And Unsafe Infant Sleep Practices In A Low-Resource Community, Rebecca D. Day, Ketrell L. Mcwhorter, Hartley C. Feld, Steven R. Bronwing

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

Objectives: To determine the relationship between maternal depressive symptoms and unsafe infant sleep intention and practices during and after pregnancy.

Methods: This study recruited 100 women from a small clinic in a low-resource community of Santo Domingo, Ecuador from 2018 to 2020. Information on intention to practice safe sleep was collected during the third trimester of pregnancy and safe sleep practices were assessed at 1 month and 6 months postpartum via survey. Depressive symptoms were measured using the Patient Health Questionnaire 2 (PHQ-2). Using log-binomial regression, we estimated prevalence ratios (PR) and 95% confidence intervals (CI) cross-sectionally at …

Fork It, Kylee Pipgrass

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

Obesity prevalence is at an alarmingly high rate within the United States, but especially in rural areas of Kentucky. Obesity can lead to a variety of negative physical health outcomes including heart disease, diabetes, stroke, and some cancers. There are also mental disorders associated with obesity through mechanisms such as weight stigma and self-perception. Similar to obesity rates, prevalence and mortality associated of these health outcomes are also seen at disproportionately higher rates in rural, Appalachian Kentucky. Causes for increased obesity and obesity related consequences include some genetic factors as well as behavioral factors like physical inactivity, poor diet, stress, …

Epidemiology Of Angiosarcomas In Kentucky, 2000-2019, Emma Gough

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

Background/Objective: Angiosarcomas are rare, highly aggressive malignant soft-tissue sarcomas of vascular or lymphatic origin. The purpose of this study is to describe geographical distribution of angiosarcoma in Kentucky and to examine the epidemiology of angiosarcoma in Kentucky from 2000 to 2019, including the most common sites where angiosarcomas occurred and risk factors affecting survival. Methods: A sample of 246 angiosarcoma patients was received from the Kentucky Cancer Registry (KCR). Kaplan-Meier curves were produced to examine overall survival, as well as survival by age, insurance type, tumor size, and SEER site. A Cox proportional hazards regression analysis was conducted to estimate …

Roadway Density And Lung Cancer Histology In Kentucky, Mahala Pettus

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

The purpose of this article was to examine the relationship between a proxy measure of exposure to automotive exhaust – roadway density – and risk for adenocarcinoma lung cancer. Using data from the Kentucky Cancer Registry and the Kentucky Geoportal Data Clearinghouse, we conducted a cross-sectional study of the distribution of adult lung cancer cases by histological type across the state of Kentucky. The north-central region of Kentucky has a higher prevalence of adenocarcinomas and greater roadway density. Among adenocarcinoma cases in Kentucky, there are more non-smokers than other types of tobacco use. As smoking rates decrease in Kentucky, and …

Breastfeeding Promotion In The Workplace, Katie C. Nettesheim

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

Breastfeeding is one of the best things a mother can do for her baby. It has many protective qualities including a reduced risk of sudden infant death syndrome (SIDS), asthma, obesity, type 1 diabetes, respiratory infections, ear infections, and stomach bugs for the baby (CDC, 2022). There are also protective qualities for the mother as well, including a reduced risk of high blood pressure, breast and ovarian cancer, and type II diabetes. Breastfeeding exclusively, the infant only receives breastmilk and no other supplementation for 6 months, which maximizes the many benefits that breastfeeding has.

Rural areas of the United States …

Concussion Perceptions And Reporting Behaviors By Individual And Team Sport Participation Among Female Diii Student-Athletes, Bethany L. Stewart

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

Abstract

Purpose. This study aimed to analyze differences between individual and team sport participation and academic year on perception of concussion and reporting behaviors.

Methods. A cross-sectional study was conducted using original data from the Perceptions and Likeliness to Report Concussions in Collegiate Athletes survey distributed to student-athletes from April 2021 to December 2022. The study population was restricted to current residents of the United States, current enrollment in college or university, female-identifying, and between the ages of 18 and 24, yielding a final population of 135 for analysis. Statistical frequency analyses were obtained, then stratified by team and individual …

Psychosocial Outcomes Post-Concussion Of Female Collegiate Athletes, Victoria Farley

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

Concussions are traumatic brain injuries impacting upwards of 3 million athletes per year. Female collegiate athletes are an essential group of athletes to investigate as they account for 47% of all collegiate athletes and often suffer more severe concussions with worse concussion symptoms than their male counterparts. Many symptoms are associated with concussion such as dizziness nausea, headaches, and instability, however, some injury symptoms extend beyond physical symptoms. The symptoms that extend beyond physical often mimic different psychosocial factors like depression and anxiety. This study investigated the associations of injury, the duration of symptoms, and the psychosocial impacts of injury …

Community Pharmacy Provision Of Extended-Release Injectable Naltrexone In Kentucky: Perspective Of People Who Use Opioids, Anye Wamucho

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

Aim: To identify demographic, socio-economic, and other factors associated with likelihood of obtaining extended-release injectable naltrexone (EIN) if provided in a private space at a local pharmacy among people who use opioids (PWUO) in rural Appalachian Kentucky.

Methods: People who used opioids in the past 6 months in rural Appalachian Kentucky (n=170) completed interviewer-administered questionnaires eliciting demographic, socio-economic, and other characteristics. Participants were also asked about whether they will be more likely to obtain EIN if provided in a private space at a local pharmacy. Factors associated with increased likelihood to obtain pharmacy-provided EIN were assessed using unadjusted univariate and …

Covid-19 Vaccine Acceptance, Hesitancy, And Refusal Among Educators In Spring Of 2021, Jenifer O'Brien

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

The COVID-19 pandemic provided unprecedented vaccine development and deployment. Educators were among the first non-healthcare occupations to become eligible for the vaccine, and were an early predictor of vaccine hesitancy especially among educated females. By the spring of 2021, 87% of teachers had received at least one dose of the COVID-19 vaccine. Among those who expressed hesitancy, no defining demographic factors were found. Those who expressed hesitancy commonly cited a rushed vaccine development process and fear of long term side effects as reasons against vaccination.

The Meals On Wheels-Breathitt: A Health Campaign For Reducing Food Insecurity Among The Older Adults In Breathitt County, Kentucky., Sarah Haroon

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

The population of the United States of America is aging at a faster rate than ever before. More than 1 in 6 Americans are now 65 or older (The Washington Post, 2023). Since 2010, compared to people under 65, there has been close to a two-hundred percent increase in people 65 and above (The Washington Post, 2023). The rise in the aging U.S. population is due to increased life span and people living longer (U.S. Census Bureau, 2020). Furthermore, life expectancy for the total U.S. population is projected to increase by six years, from 79.7 in 2017 to 85.6 by …

The Effect Of An Educational Handout On Knowledge, Awareness And Attitudes Of Pre-Exposure Prophylaxis (Prep) Among Participants At A Needle And Syringe Exchange Site, Mckenzie Buckel

DNP Projects

Background: In 2018, the total number of HIV cases in the United States was 1.2 million. Almost 186,500 of these cases were attributed to intravenous drug use. With the adherence to pre-exposure prophylaxis (PrEP) there is approximately a 49% decrease in the rates of HIV among people who inject drugs and the most significant barrier to PrEP among this population is a lack of awareness and knowledge.

Objective: The purpose of this study was to determine participants’ of a needle and syringe exchange site knowledge, awareness and attitudes of PrEP after reviewing an educational handout about PrEP.

Methods: A quasi …

Electronic Cigarettes And Young Adults: Use Of Screening Tools And Provider Knowledge, Kayla Erin Chelf

DNP Projects

Background: Electronic Cigarette (e-cigarette) use is now more common than traditional cigarette use in adolescents and young adults (Dinardo & Rome, 2019). There is concern that the lack of screening for use and knowledge about the health consequences of e-cigarette use is driving this growth.

Objective: The purposes of this project were to (1) assess baseline e-cigarette knowledge and screening practices from healthcare professionals, and (2) evaluate changes in knowledge after delivery of an educational intervention about e-cigarettes.

Methods: In this quasi-experimental study a seven-question survey on screening practice and knowledge concerning e-cigarettes in young adults was posted on the …

Modified Early Warning Scoring (Mews) Versus Epic Deterioration Index (Edi): Battle Royale For Which Has The Best Patient Outcomes In The Inpatient Setting, Dirk A. Church

DNP Projects

Abstract

Background: The increased workload bedside nurses face today requires new tools to assist with the identification of deteriorating patients during hospitalization. The Modified Early Warning Score (MEWS) tool has formed the background of early warning tools. Newer, more complex tools, like Epic’s Deterioration Index (EDI), have been developed to identify patient deterioration earlier. There is lack of evidence in the literature comparing different early warning tools, implementation, and patient outcomes.

Objective: The purpose of the study was to examine models for EWS notification for RRT and patient outcomes between the use of the MEWS and EDI in an adult, …

Deep Community Partnerships: The Future Of Community-Based Senior Care In A Value-Driven Era, Diana Wilcox

DSW Capstone Projects

This capstone reviews three scholarly products that examine how chronically ill older adults interact with healthcare systems and senior service delivery systems in the United States. The systematic literature review examines how community-based senior programs that are funded by the Older Americans Act (OAA) positively impact health outcomes and promote health and wellness among the older adult population. The conceptual paper examines how Accountable Care Organizations (ACOs), Managed Care Organizations (MCOs), Area Agencies on Aging (AAA) interact with the patient and with one another using the lens of Systems Theory. The practice application paper examines best practices regarding care coordination …

Disparities In Mental Health Technology Among African Americans: Breaking Cultural Inclusion Barriers, Nyoki Cosey-Brown

DSW Capstone Projects

Mental health technology is a healthcare delivery model of the future. The engagement in virtual healthcare was intensified when traditional healthcare methods were inaccessible during the federal restrictions implemented due to the COVID-19 pandemic. Utilizing digital apparatuses for healthcare improved the convenience, efficiency, and accessibility of various mental health services that were inoperable in past healthcare models. However, the historical constructs of stigma, discrimination, inequity, exclusion, and structural racism in mental healthcare were prevalent problems that remained present in virtual mental health platforms concerning the experiences of African-American patients and professionals who utilized the spaces.

This research explored mental health …

Sexual Reproductive Healthcare: Reproductive Autonomy, Access Inequity And The Call For Service Expansion, Elizabeth Johnson

DSW Capstone Projects

Sexual Reproductive Healthcare (SRH) is a key component of not only women’s healthcare but healthcare for every one of every age. SRH impacts not only physical health and social emotional well-being but foundations of families, communities and society including the economic impacts and the challenges of inequity. By examining the history of sexual reproductive health care, including advances in access and subsequent barriers, funding and lack thereof, the impact bias in obtaining care and the ever-changing law, policies and regulations impacting care this Capstone highlights the current yet ever changing status of sexual reproductive health care in the United States. …

An Evaluation Of Injurious Falls And Fall-Risk-Increasing-Drug (Frid) Prescribing In Ambulatory Care In Older Adults, Taylor R. Elliott, Susan Westneat, Shama D. Karanth, Erin L. Abner, Anna M. Kucharska‑Newton, Daniela C. Moga

Epidemiology and Environmental Health Faculty Publications

Background: Falls are a major public health problem afecting millions of older adults each year. Little is known about FRID prescribing behaviors after injurious falls occur. The primary objective of this study was to investigate whether an injurious fall is associated with being prescribed a new FRID.

Methods: We conducted a cross-sectional analysis using data from the National Ambulatory Medical Care Survey (2016). We included visits from patients age≥65 years and classifed visits based on presence of an injurious fall. The outcome of interest was prescription of new FRID between those with and without an injurious fall. Multivari‑ …

Estimating The Distribution Of Ratio Of Paired Event Times In Phase Ii Oncology Trials, Li Chen, Mark Burkard, Jianrong Wu, Jill M. Kolesar, Chi Wang

Markey Cancer Center Faculty Publications

With the rapid development of new anti-cancer agents which are cytostatic, new endpoints are needed to better measure treatment efficacy in phase II trials. For this purpose, Von Hoff (1998) proposed the growth modulation index (GMI), that is, the ratio between times to progression or progression-free survival times in two successive treatment lines. An essential task in studies using GMI as an endpoint is to estimate the distribution of GMI. Traditional methods for survival data have been used for estimating the GMI distribution because censoring is common for GMI data. However, we point out that the independent censoring assumption required …

Barriers And Facilitators To Stool-Based Screening For Colorectal Cancer Among Black Louisville Residents, Aaron J. Kruse-Diehr, Derek Cegelka, Elizabeth Holtsclaw, Jerod L. Stapleton, Camille Burnett, Rose Wood, Carlee Combs, Lovoria B. Williams

UK CARES Faculty Publications

Knowledge of colorectal cancer (CRC) screening options remains suboptimal in Black populations, contributing to screening disparities. Guided by community-based participatory research (CBPR) principles, we partnered with five Black churches in Louisville, a region of Kentucky with high Black-white CRC screening disparities, to explore screening barriers and facilitators for CRC education and outreach. Project champions (n = 5) served as primary points of contact, developed project support within their churches, and were trained to recruit church and community members (n = 39) to participate in five semi-structured focus groups. Interview questions probed actual and perceived barriers to CRC screening, focusing on …

Nationwide Analysis On Intentional Indoor And Outdoor Tanning: Prevalence And Correlates, Katharina Diehl, Eckhard E. Breitbart, Rüdiger Greinert, Joel Hillhouse, Jerod L. Stapleton, Tatiana Görig

Health, Behavior & Society Faculty Publications

Outdoor and indoor tanning are considered as risk factors for the development of skin cancer. The aims of this nationwide representative study were to quantify both behaviors in a sample with a wide age range, to identify those showing both behaviors and to explore and compare determinants of both behaviors. We used data from the fifth wave (2019) of the National Cancer Aid Monitoring (NCAM). We surveyed the representative sample including 4000 individuals, aged 16–65 years, living in Germany. Data were collected through telephone interviews. In addition to descriptive statistics, we used logistic regression analyses to identify determinants. The one-year-prevalence …

A Cross-Sectional Examination Of The Early-Onset Hypertensive Disorders Of Pregnancy And Industrial Emissions Of Toxic Metals Using Kentucky Birth Records, 2008–2017, Courtney J. Walker, W. Jay Christian, Anna M. Kucharska-Newton, Steven R. Browning

Epidemiology and Environmental Health Faculty Publications

This cross-sectional study assessed geospatial patterns of early-onset hypertensive disorders of pregnancy (eHDP) in primiparous mothers and exposure to industrial emissions using geocoded residential information from Kentucky live (N = 210,804) and still (N = 1,247) birth records (2008–2017) and census block group estimates of aerosol concentrations of arsenic (As), cadmium (Cd), chromium (Cr), lead (Pb), mercury (Hg), selenium (Se), and zinc (Zi) from the Risk Screening Environmental Indicators (RSEI) model. A latent class analysis allowed for the identification of four district exposure classes—As, Cd, and Pb (12.6%); Se and Zi (21.4%); Pb and Cr (8%); and low or no …