Public Health Commons^™

Examining The State Of Substance Use Treatment Among Youth And Adults In The United States, Esther Adejoke Adeniran

Electronic Theses and Dissertations

In the United States (US), substance use, misuse, and substance use disorders are significant public health problems. Additionally, the difference between needing substance use treatment (SUT) and receiving treatment is becoming more pronounced. Therefore, the aims of this dissertation include, 1) to synthesize evidence of barriers and facilitators to integrating SUT into mainstream health care (MHC) after the Affordable Care Act was nationally implemented in 2014, 2) to examine the rate of treatment completion and dropout, along with its associated factors, among youth who received Medication-Assisted Opioid Therapy (MAT), 3) to determine the relationship between prior treatment episodes and length …

Perceptions, Knowledge, And Attitudes About Long-Acting Reversible Contraceptives (Larcs) Among Women In Appalachian Tennessee, Fenose Osedeme

Electronic Theses and Dissertations

In Tennessee (TN), the rate of unintended pregnancies remains higher than the national rate (32.4% vs. 30.3%). Although long-acting reversible contraceptives (LARCs) are 99% effective in preventing undesired pregnancies; uptake remains low in rural and underserved communities. Previous research has provided some insight into women’s perceptions of LARCs; however, those guided by conceptual frameworks to understand the multiple influences that impact perceptions towards LARCs, especially among rural regions, are scarce. This multimethod qualitative study explored multiple influences that impact northeast Tennessee women’s perceptions and attitudes toward LARCs using the Socio-ecological Model (SEM) as a guiding framework.

The study comprised six …

Assessing Best Practices, Perceptions, And Barriers To Breastfeeding In The Appalachian Region, Melissa White

Electronic Theses and Dissertations

Background: Breastfeeding protects against a variety of adverse health outcomes for mothers and babies. Global best practices, known as the Baby-Friendly Hospital Initiative (BFHI), have been developed to support the initiation and exclusivity of breastfeeding during the post-delivery hospital stay. The aims of this study were to explore the literature related to the impact of the BFHI on breastfeeding disparities in the U.S.; compare the impact of exposure to these best practices on exclusive breastfeeding rates in Appalachian and non-Appalachian hospitals; and to understand knowledge, perceptions, and barriers to breastfeeding of postpartum mothers receiving care in a Northeast Tennessee OB/GYN …

Self-Measured Blood Pressure Monitoring In Hypertension Control: The Role Of Social Determinants Of Health, Current State In The United States, And Future Directions, Adekunle Oke

Electronic Theses and Dissertations

Hypertension, a medical condition, predisposes to other cardiovascular diseases, and can be impacted by the social determinants of health (SDOH). Self-measured blood pressure monitoring (SMBP) is an evidence-based approach to hypertension control, but not much is known about the influence of SDOH on SMBP. This dissertation aims to: 1) highlight the SDOH factors whose relationship with SMBP have been explored in research studies; 2) examine the relationship between SDOH and SMBP among United States (U.S.) adults with high blood pressure; and 3) examine the current state of SMBP in the U.S., highlight policy implications from the empirical study and provide …

Early Detection Of Atypical Motor And Neurobehavior Of Infants At Risk Secondary To Opioid Exposure: A Prospective Study, Kara Boynewicz

Electronic Theses and Dissertations

Prenatal opioid exposure has been studied in relation to infants' medical outcomes. However, large gaps exist in the literature supporting early identification of atypical neurobehavior and motor development of infants with prenatal opioid exposure. The purpose of the study was to investigate whether prenatal opioid exposure has a negative influence on a newborn infant’s neurobehavior and motor development to aid in the early identification of potential delays. Using a prospective quasi experimental design, infants motor development using the Test of Infant Motor Performance (TIMP) and neurobehavior using the NICU Neonatal Network Scale (NNNS) was assessed on 58 infants in a …

Nurses Leading In Bridging The Culture Gap: Communicating With The Deaf Community, Veronica C. Leftridge

Electronic Theses and Dissertations

Nurses provide patient care in clinics, hospitals, homes, churches, schools, communities, and military, as well as on emergency medical helicopters. When a nurse is assigned to care for a patient, the patient expects the nurse to be culturally competent, communicate effectively, and provide safe quality care. However, cultural incompetence is observed when nurses provide care for Deaf patients, but they are unfamiliar with Deaf culture. In addition, communication is a fundamental skill nurses learn in nursing school, but course content in nursing programs rarely touches on how to communicate effectively with Deaf patients. Of the approximately 325 million people in …

Utilizing Prams And Healthy People 2020 To Examine Black Women’S Breastfeeding Behavior In Louisiana Prior To The Onset Of The Covid-19 Pandemic, Almetra Amayá Granger

Electronic Theses and Dissertations

No abstract provided.

Facilitators To Becoming And Remaining Open Defecation Free In Uganda: Implications For Community-Led Total Sanitation Programming, Danette Lee Cagnet

Electronic Theses and Dissertations

Poor sanitation behaviors, including open defecation, present risks for diarrhea, which is credited with 600,000 deaths a year in children under age five. Although CLTS is a solution to ending open defecation, more than half of the investment in producing open defecation free (ODF) communities is lost during the maintenance phase. The purpose of this qualitative, case study was to understand stakeholder perceptions of the facilitators and hindrances to becoming ODF certified and maintaining ODF status and sanitary behaviors in a small village community located in Uganda, East Africa. The researcher held individual interviews and in-person focus group discussions to …

Exploring The Relationship Between Historical Redlining And Place-Based Reproductive Health Inequities: A Qualitative Gis Approach, Kristi L. Roybal

Electronic Theses and Dissertations

Individual-level risk factors and characteristics do not fully explain racial, ethnic, and socioeconomic inequities in preterm birth in the United States, and evidence suggests that medical advancements, increased access to prenatal care, and high per-capita spending on health care have done little to reduce these inequities. Health inequities research has shifted its attention from individual-level factors that influence health outcomes to the social determinants of health. Neighborhoods, considered an important upstream social determinant of health, can influence health outcomes through their social, service, and physical environments, and have been consistently linked to birth outcomes. Despite increased attention to neighborhood influences …

Factors Associated With Increased Breastfeeding At Initiation And Continuation At Two Months In American Indian Women, Addison Reimer

Electronic Theses and Dissertations

Introduction: The purpose of this report was to determine the prevalence of breastfeeding at initiation and two months continuation in American Indian South Dakota mothers who gave birth between 2017-2019 and determine the factors associated with breastfeeding and various health behaviors and beliefs. This study serves to fill the current gaps in research focusing on breastfeeding in American Indian women in South Dakota. Methods: Data from the South Dakota Pregnancy Risk Assessment Monitoring System (SD PRAMS), a state-based surveillance system, was used to investigate the relationship between breastfeeding and maternal behaviors, attitudes, and experiences. Logistic regression was used to determine …

A Public Health Ethics Approach To Substance Use Disorder, Adele Flaherty

Electronic Theses and Dissertations

The goal of the dissertation is to undertake an analysis of substance use disorders that focuses on a public health ethics perspective. The ethical argument focuses upon justifying the use of harm reduction and is primarily concerned with the current opioid crisis. While substance abuse/misuse over the course of history has been identified as a public health concern, this dissertation presents substance use disorders over the course of the lifespan, examining various contexts in which it can affect daily living and health outcomes. It achieves this by analyzing substance use disorders through the lens of the socioecological model of public …

The Impact Of Statin Use On Outcomes Of Diabetic Adult Patients Hospitalized For Community Acquired Pneumonia., Joel Lanceta

Electronic Theses and Dissertations

BACKGROUND: Statins, a class of drugs that treat hyperlipidemia, may have an immunosuppressive effect for patients with community acquired pneumonia (CAP). Retrospective and in vitro studies have suggested an immunomodulatory, antioxidative and anticoagulant effects from statin use in patients with Type 2 Diabetes Mellitus (T2DM) hospitalized for CAP. Prospective studies that have tested any effect of statin therapy on patients with T2DM and CAP have not been found literature. To date, prospective studies showing of the effects statin therapy may have on T2DM patients hospitalized for CAP are not available. METHODS: This dissertation is a secondary analysis using deidentified data …

Exploring The Contextual Factors And Decision-Making Process Of Risky Sexual Behavior Among Homeless Adults In Louisville, Kentucky., Sarah C. Van Heiden

Electronic Theses and Dissertations

Homelessness is a complex public health issue; individuals who experience homelessness are said to engage in risky sexual behaviors at an increased rate and experience a higher prevalence of sexually transmitted infection (STI). While the sexual behaviors of homeless adolescents are commonly studied, little is known about the sexual behaviors of the growing population of older adults, or how they make decisions to engage in sex. Three aims guided this research: 1) to describe the sexual behaviors and sexual decision-making process of homeless older adults, 2) to examine how homeless older adults evaluate the outcomes associated with engaging in risky …

The Association Between Depression And Anxiety With Covid-19 Outcomes., Erica Miller

Electronic Theses and Dissertations

Previous studies have shown that mental disorders affect COVID-19 mortality. This study investigated the effect of depression and/or anxiety on COVID-19 outcomes. Depression/anxiety was defined by actively taking medication and/or diagnosis. The outcomes were ICU admission; ventilation; mortality; and time to mortality. Of 698 hospitalized patients, there were 204 (29%) defined to have either depression or anxiety. There were 109 deaths, and of those, 52 (48%) were diagnosed with depression/anxiety. Multivariable logistic regression and Cox proportional hazards models were used to examine associations. ICU admission and ventilation were not significantly associated with depression/anxiety. Depression/anxiety was associated with mortality (OR: 1.84, …

Peer Recovery Support Specialists: Role Clarification And Fit Within The Recovery Ecosystems Of Central Appalachia, Angela Hagaman

Electronic Theses and Dissertations

The Peer Recovery Support Specialist (PRSS), a certified professional who self-identifies as being in recovery from a substance use disorder (SUD), mental illness, or co-occurring disorders, plays a key role in the ongoing transformation of SUD treatment from one of acute clinical service provision with documented short-term outcomes including symptom reduction, to a more holistic and comprehensive approach to long-term recovery. Empirical evidence specific to outcomes of PRSS working in the addiction treatment realm is sparse and equivocal, indicating the need for additional research and improved methods designed to explore the nature of the PRSS role and fit within the …

Hospital-Based Professional Spiritual Care: Evaluating The Utilization, Availability, And Impact Of Chaplains., Kelsey B. White

Electronic Theses and Dissertations

BACKGROUND: The Affordable Care Act, enacted in 2010, transformed healthcare policy and forced hospitals to reevaluate traditional methods for care delivery. Researcher advocated for patient-centered models of care to reduce costs, address inequitable access to services, and improve service quality. These models prioritize patient values, preferences, and beliefs inclusive of patients’ religious and spiritual needs. Professional chaplains provide religious and spiritual care within many hospital settings. This dissertation explored the characteristics of hospitalized persons using chaplains, the factors associated with a hospital reporting a chaplaincy department, and how those services impacted patient satisfaction. METHODS: The first analysis used a two-part …

Opioid Use Disorder: A Crisis Of Concern, Evangella Harville

Electronic Theses and Dissertations

According to a statement from the U.S. Centers for Disease Control and Prevention, between 2000 and 2017, approximately 700,000 people died from drug overdoses in the United States. Approximately 128 persons lose their life each day from an opioid overdose. The data for this study were collected by the vice president of operations at the study site from a preexisting database for 2019 and 2020. The participants were inpatient patients, 18 and older, both male and female, and were from all ethnicities. The study facility was located in Western New York and offered a 30-bed inpatient treatment center with 24-hour …

Trends In Hysterectomy In Hospital And Ambulatory Settings In Kentucky 2017-2020., Felicia A. Pugh

Electronic Theses and Dissertations

Hysterectomy is the most common treatment for benign uterine conditions in the United States. Data suggest that one in nine women will have the procedure in their lifetime (1). Previous studies indicate that abdominal hysterectomy rates for non-malignancies are declining as alternative methods are increasing for decades; however, those trends do not apply for all women in the country (2-5). In this cross-sectional study, hysterectomy procedures completed between 2017-2020 are described in Kentucky Cabinet for Health and Family Services data. Multivariable logistic regression is used to assess the odds of abdominal hysterectomy for benign indications in Kentucky. Conclusion: Rates of …

Development And Validation Of Biosafety Climate Scale And Survey-Based Analyses Of Safety Perceptions In Biological Research And Teaching Laboratories At Public Universities In The Usa., Sivarchana Mareedu

Electronic Theses and Dissertations

Biosafety plays a key role in ensuring safety of researchers’ as well as the public from unintentional exposures to infectious agents. However, the occurrence of lab acquired infections, exposures, and safety lapses in biological laboratories underscores challenges in biosafety program management. The raise in emerging and reemerging infectious diseases and the ongoing COVID-19 pandemic reiterates the need for biosafety and research community to work together. Literature recommends the application of safety climate in measuring safety culture. The goal of this dissertation is to quantify biosafety climate and examine associated factors to understand the gaps between research and biosafety professionals in …

“And The Next Day, You Are In Charge”: Policy Recommendations Stemming From A Qualitative Investigation Into The Professional Development Of Early Career Peer Support Specialists In Kentucky., Diane Zero

Electronic Theses and Dissertations

Over the last twenty years, the peer support segment of the behavioral health workforce has grown rapidly. However, few researchers have studied the effects on individuals from transitioning into the role. Likewise, there is limited research examining the professional development process of early career peer support specialists. To begin to fill these gaps in the literature, I conducted a qualitative research study examining workforce development experiences of peer support specialists in Kentucky. This dissertation reports on its findings and includes a policy paper with recommendations for improving policy and practice. Chapter one offers an introduction to the peer support workforce …

Exploring Opportunities For Prevention Of Child Sexual Abuse In A Diverse American Muslim Community., Rishtya Meena Kakar

Electronic Theses and Dissertations

Recognizing the significant mental, emotional, developmental and health consequences for victims of child sexual abuse (CSA) and sociopolitical consequences for families and communities in every cultural, ethnic, and religious group around the world, this study sought to determine key opportunities for prevention of CSA in a diverse American Muslim community using a public health socioecological lens, rooted in aspects of critical theory. While there is considerable research on situational and individual-level risk factors related to CSA cases, there is less research on the societal and community-level processes related to the primary prevention of CSA, especially among minoritized communities. Responding to …

Tobacco Cessation Counseling Practices Amongst Dental Hygienists In Central Texas, Lacy Murray

Electronic Theses and Dissertations

Although tobacco cessation is an uphill battle for almost everyone who attempts to quit, it is important that dental hygienists do not assume that patients are not interested. Dental hygienists are in an ideal position to offer cessation help to their tobacco using patients. The purpose of this study was to gain a better understanding of the tobacco cessation practices among central Texas dental hygienists. Specifically, dental hygienists were asked about beliefs, motivation, and confidence with regard to their tobacco cessation practice. A positive significant, moderate, relationship was found between beliefs and confidence (r=0.647), beliefs and practices ( …

Adverse Childhood Experiences (Aces): Assessing Their Impact On Mental Health Outcomes Among Us Children And The Mitigating Role Of Resilience, Glory Okwori

Electronic Theses and Dissertations

ACEs are traumatic life events occurring during childhood that can have negative effects. Common mental disorders that are diagnosed in childhood are attention-deficit/hyperactivity disorder (ADHD), behavior disorders, anxiety and depression. The associations between ACEs and such problems in children have not been significantly examined. There are protective factors that can help reduce the effects of exposure to ACEs that have not been fully explored.

The purpose of this research study was to examine: 1) the prevalence of mental health outcomes in children; 2) the associations between ACEs, resilience and mental health outcomes; and 3) the role of resiliency as a …

Economic Insecurity, Poverty, And Parental Alcohol Misuse, Joey Tucciarone

Electronic Theses and Dissertations

Because parental alcohol misuse is associated with numerous negative outcomes for drinkers and other family members, it is important to examine factors predictive of alcohol misuse patterns among parents living with at least one child under the age of 18. Two possible factors include economic insecurity and poverty. This study sought to address whether measures of economic insecurity (i.e., housing and/or food insecurity in the past 12 months) and a dichotomous measure of poverty predict parental binge drinking and parental heavy alcohol consumption in a large population-based sample. It was hypothesized that economic insecurity and poverty, analyzed separately, would predict …

Shared Decision-Making For Contraceptive Counseling Among Women Seeking Services At Safety Net Clinics In South Carolina And Alabama, Dumisa M. Nyarambi

Electronic Theses and Dissertations

Shared decision-making (SDM) for contraceptive counseling and method initiation is a hallmark of patient-centered care; SDM is associated with patient satisfaction, method continuation, and the prevention of pregnancy and short inter-pregnancy intervals. To achieve a high-quality experience for women Person-centered approach to counseling is the preferred approach to achieve SDM. Demographic factors and women’s perceptions of their providers have been linked to decision-making. Literature is lacking on SDM practices in safety net clinics, particularly in local health departments. Exploring these constructs is important to inform practices and policies for family planning. This research aimed to examine: 1) the influence of …

Active Travel For Children And Youth: Lessons From Active Routes To Schools North Carolina, Leah Ferguson

Electronic Theses and Dissertations

This Integrated Learning Experience (ILE) investigates literature regarding the impact of national Safe Routes to School (SRTS) programs and takes a deeper dive into the lessons that can be learned from North Carolina’s Active Routes to School (NC ARTS) programs through an analysis of data collected from 2007 to 2019. This report is focused on understanding the relationship between and among variables included in the Six Es of SRTS framework: Education, Engineering, Encouragement, Enforcement, Equity, and Evaluation. This investigation provides insight that extends understanding of parental comfort and engagement with these programs. A unique theoretical model was developed as were …

Identifying The Cardiovascular Effects Of Multiple Pollutants., Katlyn Elizabeth Mcgraw

Electronic Theses and Dissertations

Cardiovascular disease (CVD) is the leading cause of death from environmental exposures. Although exposure to PM_2.5 is an established risk factor for CVD, the contribution of other hazardous pollutant exposure to CVD is less clear. Overall, this work aimed to examine the effect of pollutants with lesser documented effects on cardiovascular disease using a multi-pronged approach to exposure assessment. The three aims were to examine the relationship between county-level toxic chemical releases and CVD mortality in the contiguous United States between 2002 and 2012, to assess the relationship between individual-level VOC metabolites and vascular function, and to build multipollutant …

Particulate Matter Exposure And Community-Acquired Pneumonia Mortality Among Hospitalized Adults With Pneumococcal Pneumonia: Incidence Study (Happi) Participants., Jack Anthony Pfeiffer

Electronic Theses and Dissertations

The role of air pollution as an agent of elevated morbidity and mortality has come under increasingly intense scrutiny in recent years. As the body of literature grows, so too does our understanding of how extensive the harm of such pollutants can be. Particulate matter (PM) particularly harmful due to its small size, ability to travel great distance while airborne, and capacity to infiltrate numerous bodily systems, often to the detriment of those exposed. Besides being associated with increased mortality risk in more heavily exposed populations, PM exposure has also been associated with complications in the respiratory, cardiovascular, and nervous …

Rurality As A Moderator Of Perception Of Need For Medical Care And Patient Satisfaction, Kyndal Grammer

Electronic Theses and Dissertations

Many individuals experience barriers to accessing medical care, especially in rural areas. Some barriers are attitudinal and represent perceptions of quality care. Patient satisfaction and perceived need for medical care are two such attitudinal barriers related to health care utilization, yet the relationship between these variables has not been explored. Using data from an online survey, the current study examined the association between these variables, and further, whether rurality status moderated this association. Results indicated a significant correlation between patient satisfaction and perception of need. Although the overall moderation model was significant, perception of need was not significantly associated with …

Sarcopenia Screening By Registered Dietitian Nutritionists (Rdns) In The United States (U.S.), Madison Marcom

Electronic Theses and Dissertations

Sarcopenia is a disease of muscle wasting primarily seen in older adults. Although this term was first coined over three decades ago, there is a lack of consensus on a definition, screening criteria, and treatment protocol for sarcopenia. The primary purpose of this study is to determine whether registered dietitian nutritionists (RDNs) in the United States (U.S.) screen for sarcopenia. Study participants were recruited through a randomized email list and included RDNs throughout the U.S. Respondents completed a survey questioning knowledge of sarcopenia, screening tools and company protocols in place, and the need and desire for sarcopenia education. Data revealed …