Public Health Commons^™

Unpacking The Behavioural Components And Delivery Features Of Early Childhood Obesity Prevention Interventions In The Topchild Collaboration: A Systematic Review And Intervention Coding Protocol, Brittany J. Johnson, Kylie E. Hunter, Rebecca K. Golley, Paul Chadwick, Angie Barba, Mason Aberoumand, Sol Libesman, Lisa Askie, Rachael W. Taylor, Kristy P. Robledo, Seema Mihrshahi, Denise A. O'Connor, Alison J. Hayes, Luke Wolfenden, Charles T. Wood, Louise A. Baur, Chris Rissel, Lukas P. Staub, Sarah Taki, Wendy Smith, Ana Maria Linares

Nursing Faculty Publications

INTRODUCTION: Little is known about how early (eg, commencing antenatally or in the first 12 months after birth) obesity prevention interventions seek to change behaviour and which components are or are not effective. This study aims to (1) characterise early obesity prevention interventions in terms of target behaviours, delivery features and behaviour change techniques (BCTs), (2) explore similarities and differences in BCTs used to target behaviours and (3) explore effectiveness of intervention components in preventing childhood obesity.

METHODS AND ANALYSIS: Annual comprehensive systematic searches will be performed in Epub Ahead of Print/MEDLINE, Embase, Cochrane (CENTRAL), CINAHL, PsycINFO, as well as …

Transforming Obesity Prevention For Children (Topchild) Collaboration: Protocol For A Systematic Review With Individual Participant Data Meta-Analysis Of Behavioural Interventions For The Prevention Of Early Childhood Obesity, Kylie E. Hunter, Brittany J. Johnson, Lisa Askie, Rebecca K. Golley, Louise A. Baur, Ian C. Marschner, Rachael W. Taylor, Luke Wolfenden, Charles T. Wood, Seema Mihrshahi, Alison J. Hayes, Chris Rissel, Kristy P. Robledo, Denise A. O'Connor, David Espinoza, Lukas P. Staub, Paul Chadwick, Sarah Taki, Angie Barba, Sol Libesman, Ana Maria Linares

Nursing Faculty Publications

INTRODUCTION: Behavioural interventions in early life appear to show some effect in reducing childhood overweight and obesity. However, uncertainty remains regarding their overall effectiveness, and whether effectiveness differs among key subgroups. These evidence gaps have prompted an increase in very early childhood obesity prevention trials worldwide. Combining the individual participant data (IPD) from these trials will enhance statistical power to determine overall effectiveness and enable examination of individual and trial-level subgroups. We present a protocol for a systematic review with IPD meta-analysis to evaluate the effectiveness of obesity prevention interventions commencing antenatally or in the first year after birth, and …

Choice Bundling Increases Valuation Of Delayed Losses More Than Gains In Cigarette Smokers, Jeffrey S. Stein, Jeremiah M. Brown, Allison N. Tegge, Roberta Freitas-Lemos, Mikhail N. Koffarnus, Warren K. Bickel, Gregory J. Madden

Family and Community Medicine Faculty Publications

Choice bundling, in which a single choice produces a series of repeating consequences over time, increases valuation of delayed monetary and non-monetary gains. Interventions derived from this manipulation may be an effective method for mitigating the elevated delay discounting rates observed in cigarette smokers. No prior work, however, has investigated whether the effects of choice bundling generalize to reward losses. In the present study, an online panel of cigarette smokers (N = 302), recruited using survey firms Ipsos and InnovateMR, completed assessments for either monetary gains or losses (randomly assigned). In Step 1, participants completed a delay-discounting task to …

Combined Driving: Task-Specific Position Impacts Grip Strength Of Equestrian Athletes, Michaela M. Keener, Kimberly I. Tumlin, Nicholas R. Heebner

Athletic Training and Clinical Nutrition Faculty Publications

BACKGROUND: Loss of hand strength is a predictor of mortality in aging populations. Despite reliance on the hands to participate in equestrian driving activity, no existing studies focus on associations of hand strength to athletic performance. Therefore, this study 1) established baseline handgrip of equestrian combined drivers in standing and task-specific positions, 2) determined endurance of task-specific handgrip, 3) compared handgrip strength to normative data, and 4) evaluated associations of handgrip and equestrian-specific variables.

METHODS: There were 51 combined drivers (9 males, 42 females) ages 21-78 who completed a survey, standing handgrip, and grip strength and endurance in a task-specific …

A Qualitative Study On Pharmacy Policies Toward Over-The-Counter Syringe Sales In A Rural Epicenter Of Us Drug-Related Epidemics, Monica Fadanelli, Hannah L. F. Cooper, Patricia R. Freeman, April M. Ballard, Umed Ibragimov, April M. Young

Pharmacy Practice and Science Faculty Publications

BACKGROUND: Expanding access to sterile syringes in rural areas is vital, as injection-related epidemics expand beyond metropolitan areas globally. While pharmacies have potential to be an easily accessible source of sterile syringes, research in cities has identified moral, legal and ethical barriers that preclude over-the-counter (OTC) sales to people who inject drugs (PWID). The current study builds on prior urban-based research by elucidating (1) pharmacy OTC policies and (2) pharmacists' rationale for, and barriers and facilitators to, OTC syringe sales in a US rural area hard hit by drug-related epidemics.

METHODS: We conducted 14 semi-structured interviews with pharmacists recruited from …

Esfuerzos Realizados En Puerto Rico Hacia La Consolidación De Políticas Públicas Para La Prevención De Cánceres Asociados Al Vph, Diana T. Medina-Laabes, Vivian Colón-López, Vilnery Rivera-Figueroa, Coralia Vázquez-Otero, Glizette O. Arroyo-Morales, Lara Arce-Cintrón, Paola Fernández-Rivera, Idamaris Vega, Roxana Soto-Abreu, Olga L. Díaz-Miranda, Ángel Rivera, Iris Cardona, Ana P. Ortiz, Lilliam Rodríguez Capó, Pamela C. Hull

Behavioral Science Faculty Publications

El propósito de este informe especial es describir cronológicamente los eventos que contribuyeron al desarrollo y aprobación de la legislación e implementación del requisito escolar de vacunación en Puerto Rico (PR), con el fin de prevenir el VPH y los cánceres asociados a este. A partir del 2010, PR inició las aprobaciones de políticas públicas con el objetivo de mejorar el registro de casos de los cánceres y la cobertura de la vacuna contra el VPH a través de los planes médicos en adolescentes de 11 a 18 años. En el 2014, los esfuerzos científicos y comunitarios lograron documentar la …

Lack Of Knowledge Is The Leading Key For The Growing Cervical Cancer Incidents In Bangladesh: A Population Based, Cross-Sectional Study, Nur E. Alam, Md. Shariful Islam, Fabia Rayyan, Humaira Nur Ifa, Md. Imam Ul Khabir, Kamal Chowdhury, A. K. M. Mohiuddin

Biology Graduate Research

Introduction

Cervical cancer is the second most common gynecological cancer in Bangladesh. Lack of awareness of screening methods, risk factors, and symptoms may lead to presenting most cervical cancers at an advanced stage. We investigated knowledge and awareness of cervical cancer (CCa) among females at the Sheikh Hasina Medical College (SHMC) of Tangail district in Bangladesh.

Methods

A cross sectional survey was conducted to collect data via a structured questionnaire from SHMC during the period of February 2019 to January 2020. Data on socio-demographic characteristics and knowledge of cervical cancer were collected. Multivariable logistic regression models were used to identify …

Increasing Hpv Vaccination In Elliott And Lawrence Counties, Keeghan Francis

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

Appalachian counties within Kentucky have higher rates of HPV-related cancers, including cervical cancer. HPV vaccines are effective at reducing the risk of cervical cancer, but vaccination coverage in Appalachia remains low. The proposed program relies on recommended strategies to improve vaccine uptake by increasing access and demand for HPV vaccines. This will be done through school vaccine clinics and parent education on HPV, cervical cancer, and HPV vaccines.

Key Factors Associated With Late-Stage Diagnosis Of Endometrial Cancer In Kentucky, Lexee Long

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

Objectives: Cancer of the endometrium is the most common female reproductive cancer in the United States, but is understudied in relation to stage at diagnosis, which is a potential predictor of survival. The primary objective of this study is to analyze potential associations of independent variables such as age at diagnosis, race, marital status, smoking status, Appalachian status, and insurance type with late-stage diagnosis of endometrial cancer.

Methods: This population-based study used Kentucky Cancer Registry data to study endometrial cancer cases diagnosed between January 1^st,2015 and December 31^st, 2019. Chi-square statistics were used to examine bivariate …

Patterns Of Continuous Glucose Monitoring Utilization Among Adults With Type 1 Diabetes, 2016-2018, Katherine Elizabeth Lee

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

BACKGROUND: Continuous glucose monitoring (CGM) improves diabetes control by reducing HbA1c and decreasing rates of hypoglycemia. Despite clinical benefits and clear guidelines from the American Diabetes Association, <20% of patients with type 1 diabetes mellitus (T1DM) use CGM. Studies report disparities in CGM among youth with T1DM by race/ethnicity, socioeconomic status, and region, but, insight into patterns of CGM utilization in adults with T1D is limited. METHODS: This project retrospectively analyzed CGM utilization among individuals with T1DM age 18-64 using the Truven MarketScan® Commercial Claims and Encounters (CCAE) database from 1/1/2016-12/31/2018. CGM utilization was determined using National Drug Code (NDC), Current Procedural Terminology (CPT), or Healthcare Common Procedure Coding system II (HCPCS II) claim identifiers. Individuals with >365 days of continuous medical and pharmacy insurance eligibility were followed from their first Type 1 diabetes-related diagnosis code until the end of the study period or >120 day gap in coverage. Using descriptive statistical analysis, CGM utilization was examined in the overall population and was stratified by patient demographics (age, sex, region), and clinical characteristics (insulin pump, diabetes complications). As a secondary analysis, CGM utilization was further stratified by both calendar year …

Maximal Strength Training Increases Metabolic Energy Expenditure In Sedentary Adults Classified As Obese, Robert E. Anderson Iii

Theses and Dissertations--Nutrition and Food Systems

Background: Metabolic adaptations reduce resting and non-resting energy expenditure to account for approximately 120 kcal/day. Weight loss promotes greater skeletal muscle efficiency, reducing the energy cost of physical activity and is correlated with declines in skeletal muscle glucose oxidation. Maximal Strength Training (MST) has the potential to upregulate glucose utilization and may offset these metabolic adaptations. Objective: To determine if MST offsets markers of metabolic adaptation by increasing resting and non-resting energy expenditure in sedentary individuals classified as obese. Methods: Five (5) participants (2 females, 3 males), ages 18-35 years, with obesity (BMI 30–45 kg/m2) were enrolled in an 8-week …

A Content Analysis Of Reddit Comments Discussing Fibroadenoma Appraisal And Decision Making, Hayley Marie Kay Stahl

Theses and Dissertations--Communication

Though fibroadenomas are clinically benign in most cases, clinical research suggests that these lesions can cause diagnosis-related physical health complications and psychological distress. However, this research is limited and should be investigated further. Thus, this study aimed to explore how patients appraise their fibroadenoma diagnosis uncertainty. Additionally, this study sought to determine if a correlation existed between appraisal and decision making as well as identify the factors that influence the most common treatment decision: removal. Data was retrieved from Reddit discussions for a content analysis. These discussions were then qualitatively analyzed using codebooks associated with this study’s research questions. Findings …

The Impact Of Covid-19 On Collaboration And Turnover Among State Health Leadership, Kaylee Gouge

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

Background/Objectives: State Health Officials (SHOs), the physician-leaders of state public health departments in the US, have long been indicated as potential peacemakers between the fields of medicine and public health. However, the average term length of SHOs has declined in recent years. Meanwhile, the COVID-19 pandemic has increased public visibility of state public health departments and their leadership. Some have hypothesized that the political strain of the pandemic has further accelerated SHO turnover, compromising their leadership efficacy. Contrarily, others have suggested that the pandemic would force public health and organized medicine into closer collaborative alignment through a common enemy. …

Maternal Occupational Exposure To Organic Solvents And Noise: Maternal Effects And Infant Outcomes, Kristen Van Buren

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

Introduction: Several maternal occupational exposures have not yet been studied for potential reproductive harm or have inconsistent findings in the literature. Despite the challenges, identification of potential risk factors, specifically reproductive toxicants, is necessary to mitigate and prevent adverse health outcomes for working mothers and their infants. The purpose of this study was to examine maternal occupational exposure to organic solvents and noise to small-for-gestational age (SGA) and preterm birth (PTB) among infants. Additionally, the study sought to examine maternal occupational exposure to noise and presence of gestational diabetes (GDM) and pregnancy-related hypertension among participant mothers.

Methods: The study population …

Potential Impact Of Socioeconomic Status On Complications Associated With Obesity In Adult Women In The United States., Cassidy Taylor

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

Abstract

The purpose of this project is to determine whether there is an association between socioeconomic factors and complications of obesity in adult women in the United States based on the national 2020 Behavioral Risk Factor Surveillance System (BRFSS) data.

Dependent variables were categorized as complications associated with obesity in adult, obese women. BRFSS items that referenced objective measures regarding chronic obesity-related complications included items such as diabetes, heart disease, arthritis, and breast cancer diagnosis. Two measures relating to participants’ socioeconomic status were also used as independent variables. BRFSS items that referenced objective measures regarding socioeconomic status are educational attainment, …

Attitudes Towards Fentanyl Test Strips Among A Cohort Of People Who Use Drugs In Rural Kentucky, Alaina Murphy

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

Background and aims Fentanyl-related overdoses have largely contributed to the nearly 500,000 opioid overdose deaths in the United States since 1999. Fentanyl test strips (FTS) are a new technology that is designed to help prevent these overdoses. People who use drugs (PWUD) can test their drug supply for fentanyl by placing the strip in a sample of the drug. However, access to FTS varies across the country. This variance is largely due to rural PWUD not having the same access to harm reduction programs, compared to urban settings. This study uses data on PWUD in rural Kentucky to evaluate attitudes …

Local Public Health System Comprehensiveness And Opioid Overdose Mortality, 2012-2018, Stephanie Courtney

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

Background: Deaths due to opioid overdose are a significant public health burden in the United States. Studies suggest that local public health systems that perform a high number of essential activities where local health departments contribute to the delivery of the activities and promote increased partnership may positively influence population health outcomes such as overdose mortality. Studies have shown that comprehensive public health systems are associated with improved health outcomes, but this association has not been addressed in the context of opioid overdose deaths. Study Aim: The purpose of this study is to evaluate the associations between local public health …

The Utilization Of Physical Literacy To Understand Physical Activity In Individuals With A History Of Anterior Cruciate Ligament Reconstruction, Rachel Renee Kleis

Theses and Dissertations--Rehabilitation Sciences

Injury to the anterior cruciate ligament (ACL) is common in physically active populations. Anterior cruciate ligament reconstruction (ACLR) is commonly performed after injury in order to restore joint stability and knee function and return patients to desired levels of physical activity. However, not everyone will return to their pre-injury levels of sport after surgery and recent evidence reveals that individuals with a history of ACLR are less likely to meet the recommended physical activity guidelines. Specifically, previous literature has reported that individuals with a history of ACLR take fewer daily steps and participate in less moderate-to-vigorous physical activity compared to …

Implementation Of Physical Activity In Kentucky Public Schools: From Theory To Policy, Nancy Kearns

Theses and Dissertations--Rehabilitation Sciences

Physical activity in schools improves academic performance and fitness measures in children. However, state policy supporting implementation of physical activity remains poor. Identifying specific barriers to implementing physical activity minutes in Kentucky public schools is pivotal in preserving the cognitive and physical health of our children. This is of particular interest as physical activity minutes remain low despite the positive effects of exercise on cognition. The purpose of this dissertation is to provide policymakers and school administrators a method of identifying current policies, attitudes and infrastructure that inhibit the implementation of physical activity minutes in public schools. Thus, the findings, …

Cannabis Use Rates And Modes Of Use In Kentucky, Gunnar Kennedy

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

ABSTRACT:

Background and Objectives:

The purpose of this study was to assess cannabis use rates and modes among people who use cannabis (PWUC) in the state of Kentucky in relation to socioeconomic, demographic, and geographic factors. Furthermore, this study compared Kentucky’s rates of use to other states and built a multivariable regression model to identify characteristics of individuals who use cannabis in Kentucky.

Methods:

For this cross-sectional descriptive analysis, we used 2020 data from the Kentucky Behavioral Risk Factor Surveillance System (BRFSS). We tabulated weighted responses to questions asking about frequency of cannabis use over the past 30 days, primary …

Addressing Ascertainment Bias In The Study Of Cardiovascular Disease Burden In Opioid Use Disorders - Application Of Natural Language Processing Of Electronic Health Records, Jade Huang Singleton

Theses and Dissertations--Epidemiology and Biostatistics

In the United States, the prevalence of long-term exposure to opioid drugs, for both medically and nonmedically indicated purposes, has increased considerably since the mid-1990’s. Concerns have emerged about the potential health effects of opioid use. There is also growing interest in other possible connections with opioid use including cardiovascular disease. Electronic health records (EHR) contain information about patient care in the form of structured codes and unstructured notes. Natural language processing (NLP) provides a tool for processing unstructured textual data in EHR clinical notes and extracts useful information for research with structured formats. The purpose of this dissertation was …

Opioid Use Disorder Treatment With Buprenorphine: Analysis Of Treatment Utilization And Associated Outcomes In Kentucky, Feitong Lei

Theses and Dissertations--Epidemiology and Biostatistics

Opioid use disorder (OUD) is chronic opioid use that results in clinically significant suffering, impairment, or even death. The opioid epidemic in the United States has become a public health and economic crisis, affecting patients' well-being and the nation's overall health and welfare. Eastern Kentucky was among the first regions affected by the opioid crisis, and Kentucky has historically ranked among the top five states for age-adjusted drug overdose mortality rate.

There are three medications (buprenorphine, methadone, naltrexone) approved by the U.S. Food and Drug Administration to treat OUD. As a partial opioid agonist, buprenorphine is a safe medication for …

Investigating The Uncertainties In Ct Non-Small Cell Lung Cancer Radiomics, Gary Ge

Theses and Dissertations--Radiation Medicine

Radiomics is a technique that extracts quantitative features, termed radiomic features, from medical images using data-characterization algorithms. These radiomic features can be used to identify tissue characteristics and radiologic phenotyping that are not observable by clinicians in a non-invasive, low-cost manner, potentially generating image biomarkers for clinical decision. To date, there are still many uncertainties involved in radiomics which limit its clinical implementation. Herein, we propose to explore the impact of each component in the radiomics pipeline on predicting clinical outcomes. In Chapter II, we conduct a thorough review of CT lung cancer radiomics studies to examine the typical feature …

An Ecological Study Of Glyphosate Use And Non-Hodgkin’S Lymphoma, Dexter Corlett, Steven R. Browning

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

Glyphosate is currently the most widely used herbicide in the world. Initially thought to be non-carcinogenic in humans, in 2015 glyphosate was classified as a “probable carcinogen” by the International Agency for Research on Cancer due to several small epidemiological studies indicating a link between the pesticide and hematologic cancers, especially non-Hodgkin’s lymphoma (NHL). The current work is an ecological study using counties in Kentucky, Arkansas, and Iowa to compare glyphosate usage to NHL incidence using a multivariate Poisson regression. We found no significant correlation between glyphosate use and NHL incidence, though caution should be taken to draw significance from …

Utilizing A Video-Based Intervention To Improve Medicine Adherence And Retention Of Hiv Care In A Hiv Clinic., Robert Currie

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

Memphis, Tennessee has higher rates of black men who have sex with men living with human immunodeficiency (BMSMLWH) compared to state and national levels. ART has been shown to be effective in keeping people living with HIV virally suppressed and unable to transmit HIV through sex. However, BMSMLWH are disproportionately affected by HIV than other races in Memphis, Tennesee. The proposed program relies on evidence-based data that demonstrates the effectiveness of video-based intervention in improving medication adherence and HIV retention of care. Taking Care of Me is a video-based intervention that promotes HIV treatment initiation, ART adherence, and retention in …

Disparities In Uptake Of The Primary Sars-Cov-2 Vaccine Series In A Southern Indiana Vaccine Clinic, Cassidy Padgett

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

Objective: COVID-19 is a potentially severe respiratory disease caused by infection from the SARS-CoV-2 virus. COVID-19 was first discovered in 2019 and vaccines against the virus began development in early 2020. COVID-19 vaccines are effective at preventing severe illness, hospitalizations, and death from SARS-CoV-2 infection. Clark Memorial Health is a 236-bed community health system located in southern Indiana. As one of the first four hospitals in the state of Indiana to receive the Pfizer-BioNTech’s COVID-19 vaccine in December of 2020, this health system led the area in vaccine administration. Prior to the emergency use authorization (EUA) of the COVID-19 vaccines, …

Examining The Association Between Cervical Cancer Screenings, Health Care Access, And Socio-Demographics Among Women Of Urban/Rural Status In Kentucky, Madison Penix

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

Background: This study focuses on cervical cancer screening rates (e.g., Pap testing) among women of urban/rural status in Kentucky. Specifically, this study’s primary objective is to examine the association between cervical cancer screening rates and health care access among the women of interest. Secondarily, this study aims to identify which socio-demographic variables impact cervical cancer screening rates and health care access. The purpose of doing so is to better understand what disparities and barriers might be contributing to the suboptimal screening rates observed throughout Kentucky.

Methods: An empirical analysis utilizing secondary data from the 2020 Behavioral Risk Factor Surveillance Survey …

Implementation Of Farmers Markets In Bell County, Kentucky, Rachael Schmetzer

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

This proposal addresses the link between food insecurity and obesity through the implementation of farmers markets in Bell County, Kentucky as a way to increase access and consumption of fruits and vegetables in this rural, low-income community.

Identifying Factors Associated With Syringe Reuse Among People Who Inject Drugs (Pwid) In Appalachia Kentucky, Grayson Keith Fuller

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

Aim: Syringe reuse contributes to the spread of infectious diseases. The purpose of this study is to identify factors associated with syringe reuse among people who inject drugs (PWID) in Kentucky.

Methods: PWID (n=238) completed interviewer-administered questionnaires to collect data on syringe reuse and demographic, behavioral, and clinical characteristics. Negative log binomial regression was used to model the associations.

Results: On average, people reused each syringe 9.3 times (median: 3; IQR: 2-10, range 1-95). Syringe reuse was higher among men [aOR=1.386; 95% CI: 1.041-1.845] and those who injected methamphetamine [aOR=2.122; 95% CI: 1.445-3.116]. Reuse was also higher among those who …

Effects Of Covid Prevention And Control Policies In Kentucky Schools During The Fall 2020 Semester, Ciaran Allen-Guy

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

Schools are reopening or have already reopened while implementing precautions intended to reduce the transmission of COVID-19. However, evidence on the effects of these strategies or their benefits relative to each other in the school environment is indirect or lacking. This study investigated the effects of some of these strategies as employed by Kentucky schools in the fall 2020 semester using a linear mixed effects regression model using publicly available fall 2020 school incidence data, survey data from school staff, and Kentucky Department of Education data on school faculty and primary enrollment.