Public Health Commons^™

Use And Cost Analysis Of Comprehensive Respiratory Panels At A Children’S Hospital Within A Tertiary Medical Center, Megan Cummins

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

Introduction

A comprehensive respiratory panel (CRP) is a quick and non-invasive laboratory diagnostic test that can detect viral nucleic acids by utilizing polymerase chain reactions (PCR). A CRP can detect multiple causative agents associated with upper respiratory illness and CRPs are commonly used in the Kentucky Children’s Hospital as part of the initial evaluation for patients who present with signs and symptoms of a respiratory infection. While CRPs are quick to detect the presence of a viral illness and are shown to increase the prescribing of antivirals for viral illnesses, the cost of the CRP to the hospital is around …

A Population-Based Analysis Of Patient Age And Other Disparities In The Treatment Of Ovarian Cancer In Central Appalachia And Kentucky, Robert Ore

Theses and Dissertations--Clinical Research Design

Objectives: Adherence to National Comprehensive Cancer Network (NCCN) guidelines for ovarian cancer treatment improves patient outcomes. The aim of this study was to assess disparities associated with ovarian cancer treatment in the state of Kentucky and central Appalachia.

Methods: Data on patients diagnosed as having ovarian cancer from 2007 through 2011 were extracted from administrative claims-linked Kentucky Cancer Registry data. NCCN compliance was defined by stage, grade, surgical procedure, and chemotherapy. Selection criteria were reviewed carefully to ensure data quality and accuracy. Descriptive analysis, logistic regression, and Cox regression analyses were performed to examine factors associated with guidelines compliance and …

Social Networks, Identity, Health, And Quality Of Life Among Older Gay And Lesbian Individuals In Rural Environments, Marc Aaron Guest

Theses and Dissertations--Gerontology

The goal of this dissertation was to explore aging lesbian and gay individuals living in rural communities, in terms of their social networks and the relationships between these networks, identity, health, and quality of life. Guiding the study were three overarching questions. Using a multi-method design, the research was grounded within a socio-ecological context and focused on how structural systems create pathways for health and are affected by social position (intersectionality). Participants (n=25) were recruited from Kentucky (n=20), West Virginia (n=3), and Tennessee (n=2). Thirteen participants self-identified as gay and twelve as lesbian. Findings highlight the complexity of the aging …

Fraud Detection Protocol For Web-Based Research Among Men Who Have Sex With Men: Development And Descriptive Evaluation, April M. Ballard, Trey Cardwell, April M. Young

Epidemiology and Environmental Health Faculty Publications

Background: Internet is becoming an increasingly common tool for survey research, particularly among “hidden” or vulnerable populations, such as men who have sex with men (MSM). Web-based research has many advantages for participants and researchers, but fraud can present a significant threat to data integrity.

Objective: The purpose of this analysis was to evaluate fraud detection strategies in a Web-based survey of young MSM and describe new protocols to improve fraud detection in Web-based survey research.

Methods: This study involved a cross-sectional Web-based survey that examined individual- and network-level risk factors for HIV transmission and substance use among young MSM …

Preventing Interpersonal Violence At The University Of Kentucky: A Community-Level Expansion Of The Green Dot Program, Chelsey Reid

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

College students in the United States are at risk for being impacted by interpersonal violence (IPV), a spectrum of violence that includes sexual assault, dating violence, domestic violence, and stalking, with 1 in 5 women and 1 in 16 men being impacted by victimization during their collegiate careers. Through enhanced approaches to primary prevention, including through active bystander training, research has identified evidence-based strategies for reducing IPV prevalence. In Kentucky, 10.1% of all women impacted by IPV are first victimized prior to 18-years-old and 12.4% of all completed rapes are either alcohol or drug-facilitated. In light of these cumulative data, …

Brief Intervention And Buprenorphine Initiation For Opioid Use Disorder In Northern Kentucky Emergency Departments, Cady Cornell

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

The opioid epidemic has had sweeping, devastating effects on the United States. Kentucky has the fifth highest overdose mortality rate in the nation and the Northern Kentucky counties, specifically Kenton and Campbell, have been especially affected. Their opioid overdose mortality rates are the third and fourth highest in the state, respectively. In order to contribute to ongoing Northern Kentucky community efforts to combat the opioid epidemic, St. Elizabeth Healthcare is proposing to implement The Brief Negotiation Interview (BNI) in our emergency departments in order to provide more comprehensive care. The BNI is a motivational interviewing strategy that has been combined …

Methods For Multiple Imputation By Chained Equations Accounting For Missingness: A Simulation Study, Nathaniel Wilson

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

Improper treatment of missing data can lead to biased or invalid results. If the data are missing at random (MAR), multiple imputation by chained equations (MICE) is one method utilized to reduce bias. When implementing MICE, the imputation model must be compatible with the final analysis model. We aim to show how to include interaction terms in the imputation model to ensure valid results are obtained. Data were simulated for one continuous outcome originating from two binary predictor variables and their interaction. Missingness was imposed via a MAR mechanism. To handle the missing data, four methods were performed: complete records …

Thyroid Function Screening & Dysfunction In Patients With Heart Failure: An Examination Of Practice At The University Of Kentucky Albert B. Chandler Hospital From 2007-2017, Alexandra Paige Hall

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

Introduction: Heart failure constitutes a global pandemic affecting at least 26 million globally (an estimated 5.7 million of which are Americans), and its burden on our healthcare system is projected to increase.[1] As a result, it is imperative that diagnostics and treatment among that population be evidence based in order to contain costs and optimize patient outcomes. Over the last 20 years, thyroid function screening has been recommended for patients upon initial diagnosis of heart failure by the American College of Cardiology and other professional organizations. However, it remains unclear whether this recommendation is followed by practitioners and how much …

A Comparison Of Pediatric Prevention Policies To Pediatric Health Supervision Codes, Rania Burke

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

The number of policy statements from the AAP presents pediatricians with an increasing amount of advice related to prevention, yet the definition of prevention and well-child visits has not changed for outpatient office visits. Outpatient office visits are the primary means by which preventive care is administered. The objective of this study is to quantify and characterize the prevention policy recommendations that pediatricians are expected to provide patients/guardians beyond the well-child visit. Secondarily, an analysis was completed to demonstrate which prevention policies make recommendations that can be coded for reimbursement as part of a well-child prevention visit.

METHODS The author …

Differential Abundance And Clustering Analysis With Empirical Bayes Shrinkage Estimation Of Variance (Dasev) For Proteomics And Metabolomics Data, Zhengyan Huang

Theses and Dissertations--Epidemiology and Biostatistics

Mass spectrometry (MS) is widely used for proteomic and metabolomic profiling of biological samples. Data obtained by MS are often zero-inflated. Those zero values are called point mass values (PMVs). Zero values can be further grouped into biological PMVs and technical PMVs. The former type is caused by the absence of components and the latter type is caused by detection limit. There is no simple solution to separate those two types of PMVs. Mixture models were developed to separate the two types of zeros apart and to perform the differential abundance analysis. However, we notice that the mixture model can …

Evaluating The Impacts Of Antidepressant Use On The Risk Of Dementia, Ran Duan

Theses and Dissertations--Epidemiology and Biostatistics

Dementia is a clinical syndrome caused by neurodegeneration or cerebrovascular injury. Patients with dementia suffer from deterioration in memory, thinking, behavior and the ability to perform everyday activities. Since there are no cures or disease-modifying therapies for dementia, there is much interest in identifying modifiable risk factors that may help prevent or slow the progression of cognitive decline. Medications are a common focus of this type of research.

Importantly, according to a report from the Centers for Disease Control and Prevention (CDC), 19.1% of the population aged 60 and over report taking antidepressants during 2011-2014, and this number tends to …

Cost-Effectiveness Of A Weight Loss Intervention: An Adaptation Of The Look Ahead Lifestyle Intervention In The Us Military, Karina Manz

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

Objective: To assess whether a counselor-initiated adaptation (CI) of the Look AHEAD Intensive Lifestyle Intervention (ILI) in a military setting was cost-effective relative to a self- paced adaptation (SP).

Methods: We performed cost-effectiveness analysis from a payer perspective alongside a 2014- 2017 randomized behavioral weight loss trial among 248 active-duty military personnel stationed at a US Air Force Base in Texas. We calculated incremental cost-effectiveness ratios (ICERs) for weight loss, reductions in waist circumference, and quality-adjusted life years (QALYs).

Results: After 12 months, the CI adaptation cost more per participant compared to the SP adaptation ($1,081 vs. $120), but achieved …

School-Based Hpv9 Vaccination Clinic In The Cumberland Valley Area Development District Of Kentucky, Eryne Wirthorn

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

Human Papillomavirus (HPV) is a group of more than 150 virus that can cause genital warts and cancers of the oropharynx, cervix, vagina, vulva, penis, and anus. A preventive vaccine currently exists that protects against seven oncogenic HPV strands and two strands that cause genital warts. Current guidelines for HPV9 vaccination consist of a 2-dose series delivered at 0 and 6 months for males and females ages 9-14, and a 3-dose series delivered at 0, 2, and 6 months for those ages 15-26.

While up-to-date (UTD) vaccination rates have increased across the Unites States, in 2017, only about 52.4% of …

Prevalence Of Sports-Related Stress Urinary Incontinence In The Female Collegiate Athlete, Stacey Pagorek

Theses and Dissertations--Rehabilitation Sciences

Urinary incontinence is a health condition that is associated with involuntary leakage of urine. Stress urinary incontinence (SUI) describes involuntary leakage of urine on effort or exertion and can impact one’s ability to participate in activities and affect quality of life. Furthermore, clinical management of this health condition is challenging as individuals who experience urinary incontinence often do not report this concern to a health care provider.

Stress urinary incontinence is not typically a health concern associated with young, healthy athletes. However, researchers have begun to examine the presence of this health condition amongst both a younger population and in …

The Relationship Bewteen Noise Exposure And The Risk Of Occupational Injury Among Workers In Kentucky, Kenneth M. Alea

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

Objective: To examine for an association between the occurrence of work­ related trauma injuries in the state of Kentucky and occupational noise exposure.

Methods: Using the Kentucky Trauma Registry, work-related trauma injuries were identified between the years of 2013 and 2017. Subjects were assigned noise scores based on O*NET noise exposure data by occupational industry. Associations between the occurrence of occupationally-related injuries and noise scores were assessed using linear regression analysis.

Results: A total of 1,808 work-related traumatic injuries were identified from the trauma registry over the five years of data reviewed in the study. The majority of occupational injuries …

Association Between Pm2.5 And The Coexistence Of Chronic Obstructive Pulmonary Disease And Coronary Heart Disease, Shan Gao

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

Aim: To identify PM2.5 as a risk factor for chronic obstructive pulmonary disease (COPD) and coronary heart disease (CHD) respectively, and to explore the magnitude of the association of PM2.5 with the coexistence of CHD and COPD, by using the combined dataset of 1999-2014 EPA Air Data and 2017 BRFSS SMART data (age 18 and older).

Methods: Cross-sectional study was designed to identify the association between PM2.5 exposure and COPD and CHD. The PM2.5 exposure values were adapted from the county-level EPAAir Data, the yearly mean values of PM2.5 were used to determine the association. Characteristics of sex, age, race, …

Retrospective Policy Analysis Of Kentucky House Bill 1, Sarah E. B. Covey

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

Background: In 2011, the Centers for Disease Control (CDC) coined the phrase, “opioid epidemic” in response to the staggering increase in opioid use and opioid- related deaths. Kentucky House Bill 1 (HB1) passed in 2012, attempted to stifle the impact of the opioid epidemic on the citizens of the Commonwealth by imposing supply-side restrictions on the prescription and dispensing of opioid pills. Objective: The primary objective of this analysis is to evaluate the effectiveness of HB1 on the reduction of opioid-related deaths, opioid prescription rates, and intravenous opioid drug use rates. Methods: This analysis employed Eugene Bardach’s framework for policy …

A Cross Sectional Study Of Drinking Water Quality And Health Effects In The El Bua Tsáchila Community, Santo Domingo De Los Tsáchilas, Ecuador, Dannette Cook

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

Background: Access to clean water and sanitation is known to decrease childhood mortality, improve health outcomes, and decrease risk of water-borne diseases. However, access to clean water is often restricted in impoverished or indigenous communities. This cross-sectional study evaluated the primary source of drinking water for forty homes, the Est. Cheche river, a local spring, and a local school in the TsáChila indigenous community of El Bua, Santo Domingo, Ecuador. This analysis focused on the presence of coliforms and E. coli in the water source (well or city/piped), the physical parameters of the water and the type of sanitation …

Disparities In The Risk Of Subsequent Primary Cancer Diagnosis And Recurrence Among Women With Breast Cancer (First Primary) In Kentucky, Pierre Fwelo

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

Background and objectives

Breast cancer is one of the most common malignancies among women in the United States. Women residing in the state of Kentucky have breast cancer incidence and mortality rates greater than the national average. Recent studies suggest an association between breast cancer subtypes/hormone receptor (HR) status and the risk of recurrence and the onset of subsequent primary cancer, however, limited research has focused on Kentucky or its Appalachian region.

Investigating these associations may potentially save lives by providing information that can be used in breast cancer education in Kentucky, assessing the population at greater risk of recurrence …

Factors That Influence Maternal Feeding Decisions For Toddlers: Extending The Theory Of Planned Behavior, Elizabeth Lucas Combs

Theses and Dissertations--Kinesiology and Health Promotion

Establishing healthy eating behaviors is vital in the early years to help combat the development of obesity and other chronic diseases. Mothers play an invaluable role in shaping their children's eating habits through controlling what and when children eat as well as the overall food environment, which is why a better understanding of what influences mothers’ decisions about these behaviors is important.

The purpose of the dissertation was to gain a better understanding of what impacts maternal feeding decisions regarding toddler nutrition behaviors. This was a two-phased mixed methods study. The aim of the initial study was to explore, using …

The Influence Of Patient-Provider Interaction, Self-Concept, And The Socio-Physical Environment On Pelvic Exam Seeking Behavior, Anxiety, And The Health Care Experience, Julie Lasslo

Theses and Dissertations--Education Sciences

Regular gynecological screenings are critical for women in promotion of health and preventing diseases like cervical cancer. Despite the importance of such examinations, many women fail to adhere to recommended screening protocols. As a result, women experience an increased disease risk. The current study examined the relationship between patient-provider communication quality, skill, and empathy on pelvic exam seeking behavior and exam-related anxiety and satisfaction. Additionally, negative self-concept, perceived poor genital self-image, and various elements of the socio-physical clinic environment were explored to better understand their impact on a women’s care seeking behavior.

A total of 350 women 19 through 80 …

Improving Safety Performance Of Highway Maintenance Crews Through Pre-Task Safety Toolbox Talks, Zamaan Al-Shabbani

Theses and Dissertations--Civil Engineering

The dangerous work environment in the construction industry and the inherent high risks associated with construction work make it the focus of safety training and regulations. Highway construction and maintenance has unique hazards but seemingly less directly applicable safety standards, regulations, and programs. Department of Transportation (DOT) employees working in highway maintenance are exposed to a variety of unique hazards specifically associated with their work and not relating to the adjacent traffic. Yet, highway construction and maintenance work has not received sufficient attention in terms of safety research and programs. The lack of safety training and education in highway construction …

A Lifestyle Intervention To Decrease Risk Of Developing Type 2 Diabetes Mellitus In A Rural Population, Amanda Culp-Roche

Theses and Dissertations--Nursing

Individuals with type 2 diabetes mellitus (T2DM) are at risk for developing life-threatening comorbidities such as cardiovascular disease (CVD). As a consequence, T2DM is associated with increased morbidity and mortality and decreased quality of life, thus highlighting the importance of prevention of T2DM. Further, the prevalence of T2DM is substantially greater in rural populations compared to urban populations, making rural individuals particularly appropriate targets for T2DM prevention.

T2DM is a largely preventable disease that is associated with modifiable risk factors such as poor diet, sedentary lifestyle, and obesity. Lifestyle interventions to improve these modifiable risk factors have been used to …

The Impact Of Maternal Nutrition During Pregnancy On Inflammation And Birth Outcomes, Lori Ogden

Theses and Dissertations--Nursing

More than 85% of American adults do not consume recommended amounts of fruits or vegetables. Preterm birth and hypertensive disorders of pregnancy are common adverse conditions affecting pregnancy and are leading causes of maternal and fetal morbidity and mortality. Preterm birth affects nearly 10% of all births in the United States and is on the rise, as are hypertensive disorders, which have increased by 25% over the last two decades. Pregnancy is a state of controlled inflammation, and dysregulation has been linked to preterm birth and other adverse gestational outcomes. A healthy diet is recommended in pregnancy, but little is …

Developing A Workflow To Evaluate Medications For Repurposing Using Health Claims Data: Application To Substance Use Disorders, Emily Ruth Hankosky

Theses and Dissertations--Pharmacy

Healthcare big data are a growing source of real-world data with which to identify and validate medications with repurposing potential. Previously, we developed a claims-based workflow to evaluate medications with potential to treat stimulant use disorders. In order to test the workflow, the framework was applied in the context of opioid use disorders (OUDs), for which there are medications with known efficacy. Using the Truven Marketscan Commercial Claims Database, a nested case-control analysis was conducted to determine the association between OUD medications (buprenorphine, naltrexone) and remission. Cases were defined as enrollees with a remission diagnosis and matched (1:4) to controls …

Estimating Disease Severity, Symptom Burden And Health-Related Behaviors In Patients With Chronic Pulmonary Diseases, Radmila Choate

Theses and Dissertations--Epidemiology and Biostatistics

Chronic pulmonary diseases include a wide range of illnesses that differ in etiology, prevalence, symptomatology and available therapy. A common link among these illnesses is their impact on patients’ vital function of breathing, high symptom burden and significantly impaired quality of life.

This dissertation research evaluates disease severity, symptom burden and health behaviors of patients with three different chronic pulmonary conditions. First, alpha-1 antitrypsin deficiency (AATD) is an inherited condition that typically is associated with an increased risk of early onset pulmonary emphysema. This study examines differences in demographic, health, and behavioral characteristics and compares clinical outcomes and health related …

A Pilot Study Of A Multiple Health Behavior Change Intervention For Smokers, Srihari Seshadri

Theses and Dissertations--Clinical and Translational Science

Background: Being both obese and a smoker increases the probability of developing type 2 diabetes, cardiovascular disease, and cancer, diseases that impact Kentucky residents disproportionately. Kentucky (KY) has a high incidence of obesity (34.2%) and smoking (24.5 %). Weight gain associated with smoking cessation also can undermine health benefits of quitting, and may lead to smoking relapse.

Aim: The aim of the pilot study was to implement and evaluate a Multiple Health Behavioral Change (MHBC) program that combines Cooper Clayton Method to Stop Smoking (CCMSS) and the Diabetes Prevention Program (DPP) for weight control.

Method: A 15-week intervention was administered …

The Impact Of A Fruit And Vegetable Farmers' Market Voucher Prescription Program On A Low-Income Rural Population, Kevin Anthony Richie

Theses and Dissertations--Nutrition and Food Systems

Objective: Measures the impact of the Farmers’ Market Voucher program on weight, body mass index, waist circumference, during the 2016 summer on a rural, low-income population residing in Appalachian Kentucky.

Background: Rural communities often have limited access to fresh fruits and vegetables (FV) which contributes to low levels of consumption. FV are calorie poor, nutrient dense and are inversely associated with inflammation markers, obesity, hypertension, and high blood glucose levels. Appalachian rural communities have a higher prevalence of obesity, diabetes, strokes, and death by heart attack when compared to the U.S. Farmers’ markets

Methods: Pre-experimental intervention design examining FV consumption …

Dive Into The Hunger Pool: Exploring Students’ Experiences, Coping Strategies, And Suggestions Related To Elements Of Food Security At The University Of Kentucky, The Nu Sandar Oo

Theses and Dissertations--Nutrition and Food Systems

Background: College food insecurity (CFI) is a prevalent social justice and public health issue in the U.S. with the prevalence ranging between 15-59%. Though numerous quantitative studies were first conducted in the past decade, little qualitative research was conducted to assess CFI.

Objective: To explore and deeply understand the contexts of CFI at a land-grant university in Kentucky.

Methods: This qualitative study used a validated food insecurity survey tool and hour-long focus groups that were audio recorded and transcribed. Three theoretical models were combined into an adapted model and utilized for the thematic analysis.

Results: Thirty-three students participated in one …

Promotion Of Fruit And Vegetable Intake Through Recipe Card Distribution And Sampling At Farmers’ Markets Throughout Kentucky, Umaima Sidra Afsheen Syeda

Theses and Dissertations--Nutrition and Food Systems

The Center for Disease Control and Prevention (CDC) reports indicate that 8% and 6.3% of Kentuckians consume enough fruits and vegetables, respectively. The Plate It Up! Kentucky Proud (PIUKP) project is a recipe-development project that aims to boost produce consumption by incorporating local fruits and vegetables. The purpose of this study was to implement promotional strategies using PIUKP recipes at farmers’ markets and determine their effects on consumers’ intent of purchasing and preparing the produce. The study was conducted at nine farmers’ markets across Kentucky (n=300) in collaboration with Cooperative Extension agents/assistants.

The consumers’ impression of the sample was positively …