Public Health Commons^™

The Journal Of Appalachian Health: A Year Of Growth And Impact, Noah Wren, Bradley Firchow, Emily Wilson, Randy Wykoff

Journal of Appalachian Health

The Journal of Appalachian Health continues to grow in strength and reach, serving as a critical platform for research and discussion on the unique health challenges and opportunities in Appalachia, as well as how the challenges and opportunities Appalachia faces are local manifestations of broader regional and global phenomena. Over the past year, we have witnessed a remarkable expansion in our readership, reflecting the increasing demand for evidence-based insights into the health of our region.

Suicide Exposure In The Army National Guard: A Three Manuscript Dissertation, Rebecca Willis-Nichols

Theses and Dissertations--Social Work

Between 2000-2022, the U.S. suicide rate increased 36% with one death now occurring every 11 minutes (CDC, 2024). Despite the Department of Defense making a concerted effort to curb the suicide increases in their ranks, the rates have continued to rise. Active-duty component rates have slowly increased since 2011 while reserve and guard components have held steady (U.S. Department of Defense, 2023). After adjusting for age, the suicide rate in the veteran population was 57% greater than the civilian population in 2020 (CDC, 2024). There is a need for a better understanding of the impact of these deaths and the …

Environmental Health Priorities In Rural Public Health Departments: Perspectives From Health Agency Directors, Michelle Rastegar

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

Rural communities are staffed by environmental health practitioners with less formal public health training and fewer years of public health experience. The literature on environmental health program implementation in rural communities is incomplete and specifically misses the perspectives of those charged with developing and fielding such programs. The purpose of this paper is to gather and report the insights of three rural local public health department leaders regarding the challenges, opportunities and stakeholders for implementing environmental health programs. Using purposive sampling of faculty community partners, three rural Kentucky local health department directors were recruited to participate in the study. After …

Promoting Physical Activity (Pa) Among Latinas In Fayette County, Ky, Vanessa Diaz Mph

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

In the United States, the prevalence of overweight and obesity continues to rise at a disproportionate rate that is greatly affecting Latinas. This paper outlines the implementation of an adapted version of Fe en Acción, a faith-based evidence-based physical activity (PA) intervention that was initially implemented in San Diego, CA. The program targets Latinas in Fayette County, KY through culturally tailored, faith-based PA classes held at local Catholic churches. By using promotoras– health promoters– the program works to increase self-efficacy and social support while promoting sustainable behavior change. Key adaptations include a reduction in class frequency (four times a week), …

Pathways To Green River District Health Department, Gracelyn P. Bush

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

In an effort to decrease Neonatal Abstinence Syndrome (NAS) in the Green River District of Western Kentucky, this grant proposes the expansion of the evidence-based University of Kentucky PATHways program to the Green River District Health Department (GRDHD). To protect the health of both women and children, this program will specifically target pregnant women with substance use disorder (SUD). This program will deliver a group-based prenatal and postpartum curriculum with the integration of Peer Recovery Support Specialists, specifically modeled on Social Cognitive Theory and the adoption of whole-person care. The proposed program spans a three-year time frame, beginning with program …

A Case Study In Program Evaluation: Evaluation Of A Community Program To Increase Rates Of Physical Activity, Emma Hughes

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

Bourbon County faces rates of obesity and levels of physical inactivity that are at, or worse, than the Kentucky state average. The Bourbon County Health Department (BCHD) has prioritized addressing these issues and received funding from a private foundation to do so. Collaboration with the University of Kentucky and additional funding from UK Healthcare (UKHC) will support these efforts to improve the rates of regular physical activity, raise awareness of the negative health impacts of inactivity, and increase access to safe places to exercise. The BCHD developed a 6-month program that involves several interventions aimed at increasing the percent of …

Association Of State Cannabis Legalization With Cannabis Use Disorder And Cannabis Poisoning, Jayani Jayawardhana, Jialin Hou, Patricia Freeman, Jeffery C. Talbert

Health Management and Policy Faculty Publications

IMPORTANCE Whether state implementation of medical and recreational cannabis laws is associated with increased cannabis use disorder (CUD) and/or cannabis poisoning among adults is not evident.

OBJECTIVE To examine state-level medical and recreational cannabis laws’ associations with CUD and cannabis poisoning, overall and by sex and age subgroups.

DESIGN, SETTING, AND PARTICIPANTS In this longitudinal cohort study, state-level CUD and cannabis poisoning diagnoses from January 2011 to December 2021 were examined across all 50 US states and the District of Columbia before and after the implementation of medical and recreational cannabis laws (MCLs and RCLs, respectively) using a staggered adoption …

Demographic Variation In Continuous Glucose Monitoring Utilisation Among Patients With Type 1 Diabetes From A Us Regional Academic Medical Centre: A Retrospective Cohort Study, 2018–2021, Omer Atac, Kory R. Heier, Daniela Moga, John L. Fowlkes, Min-Woong Sohn, Aaron J. Kruse-Diehr, Teresa M. Waters, Mary E. Lacy

Health Management and Policy Faculty Publications

Objective: While continuous glucose monitoring (CGM) utilisation has been increasing among patients with type 1 diabetes (T1D), few studies have examined patterns of use across age, race/ethnicity and insurance status together. In this study, we examine CGM utilisation among patients with T1D from a regional academic medical centre across all insurance types.

Design and Setting: This is a retrospective cohort study including both paediatric and adult patients with T1D who visited a regional academic medical centre between 1 January 2018 and 31 December 2021.

Methods: Patients were followed from the date of their first T1D encounter during the study period …

Third Party Negotiated Hospital Pricing In Rural And Urban Hospitals Within 12 U.S. States, Lindsey R. Hammerslag, Aaron P. Smith, Jeffrey C. Talbert

Rural & Underserved Health Research Center Publications

No abstract provided.

Association Between Lifetime Interpersonal Violence And Post– Covid-19 Condition Among Women In Kentucky, 2020-2022, Ayşe Güler, Heather M. Bush, Katie Schill, Nurlan Kussainov, Ann L. Coker

Biostatistics Faculty Publications

Objective: The COVID-19 pandemic increased the risk of interpersonal violence. We investigated the association between lifetime interpersonal violence experience and risk of post–COVID-19 condition (the persistence of symptoms of COVID-19 and severity of health problems associated with COVID-19 that last a few weeks, months, or years) among women with lifetime interpersonal violence experience.   Methods: Women participants aged ≥18 years in Kentucky’s Wellness, Health & You—COVID-19 study completed online quantitative surveys about the impacts of the pandemic, developing COVID-19, and symptoms of post–COVID-19 condition. We conducted cross-sectional analyses estimating rate ratios of developing COVID-19 and symptoms of post–COVID-19 condition during the …

High-Resolution Geospatial Database: National Criteria-Air-Pollutant Concentrations In The Contiguous U.S., 2016–2020, Tianjun Lu, Sun-Young Kim, Julian D. Marshall

Epidemiology and Environmental Health Faculty Publications

Concentration estimates for ambient air pollution are used widely in fields such as environmental epidemiology, health impact assessment, urban planning, environmental equity and sustainability. This study builds on previous efforts by developing an updated high-resolution geospatial database of population-weighted annual-average concentrations for six criteria air pollutants (PM_2.5, PM₁₀, CO, NO₂, SO₂, O₃) across the contiguous U.S. during a five-year period (2016–2020). We developed Land Use Regression (LUR) models within a partial-least-squares–universal kriging framework by incorporating several land use, geospatial and satellite–based predictor variables. The LUR models were validated using conventional …

A Program Evaluation Case Study, Madelyne G. Culbertson

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

This case study presents a program evaluation of a physical activity intervention implemented in Bourbon County, Kentucky, guided by the Centers for Disease Control and Prevention’s Framework for Program Evaluation in Public Health.

A Case Study In Program Evaluation, Alexis Strottman

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

This paper presents a comprehensive evaluation plan for the Bourbon County Physical Activity Improvement Program, as prompted in the University of Kentucky's 2025 MPH-Health Management and Policy Capstone Case Study. The case study outlines a program developed in response to high obesity and inactivity rates in Bourbon County, Kentucky. Utilizing the CDC's 6-step program evaluation framework, the plan outlines engagement of a diverse group of stakeholders to assess the program's effectiveness in increasing physical activity among residents. The evaluation focuses on both process and outcome measures, examining the implementation of exercise facilities, community events, and an app designed to track …

A Case Study In Program Evaluation: Evaluation Of A Program Designed To Increase Activity Levels In Bourbon County Residents, Brooke M. Woodburn

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

This paper provides recommendations to eliminate possible barriers in a program developed to reduce inactive levels across Bourbon County.

Increasing Hpv Vaccination Adherence In Floyd County, Ky: Give Teens Vaccines, Taylor M. Stumbo

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

Cervical cancer remains a pressing public health issue, particularly in underserved and rural areas where access to preventive care is limited. This capstone addresses the urgent need to increase human papillomavirus (HPV) vaccination adherence in Floyd County, Kentucky—part of the central Appalachian region that experiences disproportionately high cervical cancer incidence and mortality. Despite the proven effectiveness of HPV vaccines in preventing the virus strains most responsible for cervical cancer, uptake in this region remains below national targets due to socioeconomic barriers, limited healthcare access, and lack of awareness. Give Teens Vaccines is a two component intervention leveraging existing healthcare systems …

A Case Study In Program Evaluation Evaluation Of A Physical Inactivity Program In Bourbon County, Kentucky, Carine N. Malekera

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

This paper evaluates a physical activity program by the Bourbon County Health Department aimed at increasing physical activity among local residents. Using the CDC’s Framework for Program Evaluation, the study includes both process and outcome evaluations to assess program implementation and impact on health outcomes. Key findings indicate success in urban areas but challenges in rural regions due to limited access to resources. Recommendations include improving access to exercise opportunities in rural areas and offering virtual classes. This evaluation emphasizes the importance of continuous assessment for effective public health interventions.

A Case Study In Program Evaluation, Kaitlyn E. Lee

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

This capstone project evaluates a fictious online MRSA education program developed by the Lexington-Fayette County Health Department and Fayette County Public Schools after a suspected outbreak among student athletes. Using the CDC’s 6-Step Framework for Program Evaluation, the project focuses on how stakeholders were engaged, how the program was described and mapped, how the evaluation questions were developed, what evidence was collected, and how conclusions were formed. The goal of the evaluation is to understand whether the program’s structure, delivery, and implementation support clear infection-control education for the different school personnel who use it. This project emphasizes the overall evaluation …

Knee Health Is A Major Determinant Of Mobility Across The Healthspan, Brandon M. Peoples, Kenneth Harrison, Michael A. Samaan, Christopher B. Mobley, David T. Redden, Jaimie A. Roper

Kinesiology and Health Promotion Faculty Publications

Knee health constitutes a pivotal determinant of locomotor function and overall mobility throughout the healthspan. Impairments in knee function lead to a series of biomechanical and physiological alterations that pose substantial public health challenges and economic burdens worldwide. This review synthesizes evidence that delineates the complex and multifaceted relationship between knee health and mobility, emphasizing the interplay across various domains in adult populations. Knee health is conceptualized as a dynamic, interconnected system whereby structural integrity, neuromuscular mechanisms, biomechanical adaptations, and functional mobility are intricately interrelated through cascades of mechanistic processes operating across different temporal stages. A comprehensive understanding of these …

Adapting A Mobile Health Intervention To Improve Prep Adherence Among Young Black Msm In Fulton County, Georgia, Kassidy Maust

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

Young Black men who have sex with men (YBMSM) in the southern United States, particularly in Fulton County, Georgia, face disproportionately high rates of HIV and unique structural barriers to pre-exposure prophylaxis (PrEP) uptake and adherence. Sustained adherence among YBMSM remains low due to intersecting structural, social, and behavioral barriers. To address these disparities, this paper presents an adapted implementation of the evidence-based M-Cubed (Mobile Messaging for Men) mHealth intervention. Prior studies of M-Cubed and similar mHealth interventions have shown promising outcomes in increasing PrEP adherence among Black MSM populations. The adapted intervention integrates culturally tailored messaging specific to behaviors …

Air Pollution Exposures And Cognitive Function Among Older Americans, Clarisse Nyondo Okoma

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

Background: New findings indicate that environmental factors, such as air pollution, could contribute to cognitive decline among older adults. Nonetheless, extensive longitudinal studies in the U.S. investigating this connection are few and far between.

Objective: This study assessed the relationship between long-term exposure to ambient air pollutants and cognitive function in older adults in the United States.

Methods: We examined data from the Health and Retirement Study (2010-2018), which included 234,250 observations from adults aged 50 and older. Cognitive performance was evaluated based on immediate and delayed word recall, a 27-point cognitive summary score, backward from 20, and …

Implementing An Opioid Overdose Education And Naloxone Distribution (Oend) Program Among Law Enforcement Officers In Lee County, Ky, Keelie Jolly

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

This grant proposal describes an implementation strategy for introducing an OEND training program among law enforcement officers (LEOs) to reduce opioid overdose deaths. The goal of the project is to increase LEOs' awareness and knowledge of opioid overdose and Naloxone administration and usage of Naloxone.

Rct Pre-Post Training Analysis Of The Vipcorps Maternal Mortality Prevention Course With A Focus On Intimate Partner Violence (Ipv), Rose A. Wood

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

Maternal mortality rates rob families across the U.S. of a mother figure, and each death is preventable. The U.S. has the highest maternal mortality rate of high-earning countries. This study assesses the effects of the VIPCorps program, a course on the top 3 risk factors of maternal mortality, on improving knowledge and attitudes towards victims of IPV. Students in helping professions at the University of Kentucky (n = 223) were recruited via on campus advertising and remotely allocated to either the VIPCorps program or a mock maternal mortality training control. Generalized linear modeling was used to estimate the difference in …

Psychological Impacts In Exercise Riders And Professional Jockeys Following Injury, Kelley M. Renner

Theses and Dissertations--Kinesiology and Health Promotion

One of the most well-known equestrian sports, horse racing, is not only a cornerstone of Kentucky’s economy, but also a vital part of its culture, with professional jockeys playing an essential role in the local communities and traditions that define the state. Despite its popularity and financial impact, mental health challenges within the sport have continually been shrouded in silence and ignored in research (Ball et al., 2007). Equally concerning is the high injury prevalence, and psychological impact of these injuries (e.g., psychological distress, depression, anxiety, loss of identity, and self-esteem (King et al., 2022; Losty et al., 2019; McConn-Palfreyman …

Proximity And Density Of Tobacco Retail Locations To Kentucky Schools And The Relationship To Youth Perceptions Of Harm And Susceptibility To E-Cigarette Use, Hannah Cardona

Theses and Dissertations--Kinesiology and Health Promotion

Purpose: To explore the potential relationship between tobacco retailer proximity/density around Kentucky elementary, middle, and high schools, and students’ perceptions, perceived norms, susceptibility to, and use of e-cigarettes. Design: A mixed-methods analysis of youth’s self-reported survey results and geographical data. Setting: 106 Kentucky elementary, middle, and high schools which participated in #iCANendthetrend’s tobacco education program between September 2023 and May 2024. Subjects: Convenience sample of students from Ky schools (N = 7,823) Measures: Items assessing e-cigarette use, susceptibility, perceptions, and perceived norms. Analysis: ANOVA tests used to compare responses of elementary, middle, and high school students. Chi-squared tests were used …

Pathogen Surveillance Of Viruses And Antimicrobial Resistance Through Wastewater Based Epidemiology, William Strike

Theses and Dissertations--Biomedical Engineering

Pandemic surveillance is a cornerstone in public health safety, as it enables identification of pathogens circulating within a community before they become widespread outbreaks. Wastewater based epidemiology has blossomed in recent years due to its success in the SARS-CoV-2 pandemic, but this form of public health surveillance has a global equity problem. A large majority of the wastewater-based surveillance work has been done in large metropolitan cities with access to advanced testing infrastructure, which poses a challenge as we consider where pandemics have historically emerged. Therefore, there is a need to identify, adapt, and develop workflows to meet the needs …

Understanding The Impact Of The Medicaid Expansion On Hospital Length Of Stay And Emergency Department Use In Kentucky, Cameron Bushling

Theses and Dissertations--Epidemiology and Biostatistics

Three related analyses were performed to try to understand the immediate effects of Medicaid expansion on hospital systems in Kentucky. Medicaid expansion led to a large, sudden increase in the number of individuals eligible for various health care needs. This sudden increase in demand for health services lead to initial hypotheses regarding hospitals’ ability to handle this demand. The first analysis examined hospital average length of stay (LOS) using a linear mixed-effects model. Length of stay was modeled longitudinally between 2013 and 2015 to determine if significant changes in the slope of LOS could be detected after expansion (2014). Separate …

Changes In Cancer Diagnosis And Survival In The United States During The Covid-19 Pandemic, Justin T. Burus

Theses and Dissertations--Epidemiology and Biostatistics

The COVID-19 Pandemic led to global societal disruptions as political leaders and public health authorities attempted to control the spread of the newly discovered SARS- CoV-2 virus. While these measures were designed to lessen morbidity and mortality from a novel pathogen, their impact was also felt in many other, often unintended ways. The purpose of this dissertation is to use cancer surveillance research methods to examine the association between COVID-19 Pandemic-related disruptions and changes in the normal diagnosis and care of cancer in the United States.

The first two studies of this dissertation analyzed reductions in cancer diagnoses in the …

Enhancing Public Health Surveillance: Development And Validation Of Machine Learning Models For Suspected Opioid Overdose Detection In Emergency Medical Services Data, Peter J. Rock

Theses and Dissertations--Clinical and Translational Science

The ongoing opioid overdose crisis in the United States requires timely and accurate surveillance systems to inform public health responses. Traditional public health surveillance methods rely on hospital discharge data and death certificates, which suffer from significant reporting delays and miss cases where patients refuse hospital transportation. Emergency Medical Services (EMS) data presents a promising alternative with advantages in timeliness and case ascertainment but lacks validated definitions for suspected opioid overdose (SOO).

This dissertation addresses this critical gap through the development, validation, and fairness assessment of machine learning models with natural language processing (ML-NLP) for identifying SOOs in EMS data. …

Assessing The Effectiveness Of A Modified Cook Together Eat Together Program On Food Resource Management Behaviors In A Rural Setting, Johanna K. Poysti

Theses and Dissertations--Nutrition and Food Systems

This study evaluated the effectiveness of a modified, hybrid Cook Together, Eat Together (CTET) program on food resource management behaviors in a rural setting. A six-week intervention combining virtual and in-person sessions aimed to improve health behaviors, food resource management skills, and self-efficacy. Although most behavioral changes were not statistically significant, participants reported increased confidence in cooking healthy meals on a budget. Positive qualitative feedback from focus group discussions indicated program feasibility and engagement. Strengths and limitations of the study were discussed as well as recommendations for future research were given.

Researching Dementia Indicators Among Rural Populations, Justin S. Yount

Theses and Dissertations--Community & Leadership Development

The study explored potential dementia indicators and risk factors among older adults residing in rural areas who are actively engaged in farming operations. Data was collected in three components a questionnaire, an audiogram test, and a memory impairment screening. 104 people responded to the questionnaire, 133 participants took the audiogram test, and 94 participated in the memory impairment screening. The findings revealed that 80.9% of participants showed no sign of cognitive impairment while 19.1% showed signs of possible impairment. Participants reported moderate levels of physical and social activity, but common risk factors such as elevated BMI, diabetes, hearing loss, and …