Public Health Commons^™

The Association Between Personal Particulate Matter Exposures And Cognitive Function Among Stroke Patients, Kentucky, Usa, Nana Afua Ankomah Dei

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

Stroke, a major cause of long-term disability and cognitive problems in the U.S., significantly affects people’s quality of life. Exposure to particulate matter (PM_2.5) may result in systemic inflammation and oxidative stress, which can worsen the cognitive function of post-thrombectomy stroke patients. This project thus assessed the relationship between PM_2.5 exposure and its effect on the cognitive function of post-thrombectomy stroke patients. Fifteen stroke patients (9 non-Appalachian and 6 Appalachian) undergone thrombectomy were recruited. Personal PM_2.5 exposure was measured using wearable sensors for a week during the study period. Montreal Cognitive Assessment (MoCA) scores and covariates …

Addressing Obesity And Diabetes In Appalachian Kentucky, Hannah E. Orens

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

Type 2 diabetes and obesity are major public health concerns in Appalachian Kentucky. Populations in this region experience much higher rates of chronic disease than the rest of the state, have limited access to preventive care, and ongoing economic challenges that affect health. Many rural counties face increased poverty, transportation challenges, and shortages of healthcare professionals, all of which contributed to poor health outcomes and reduced access to evidence-based prevention programs. As a result, there is a strong need for focused, feasible, community-based interventions that improve access to evidence-based prevention while addressing the social and economic factors influencing health in …

Purchasing A Healthier Future: A Nutrition-Focused, Community-Centered Approach To Reduce Obesity And Diabetes In Graves County, Kentucky, Marissa Stephens

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

Obesity and type 2 diabetes are among the most significant public health challenges in the United States, with Kentucky consistently ranking among the states with the highest prevalence of both conditions. Together, these conditions contribute to reduced quality of life, rising healthcare costs, and increased morbidity and mortality, underscoring the need for targeted, community-centered interventions. The disease burden of obesity and diabetes is particularly pronounced in rural areas, including the state’s westernmost region, the Jackson Purchase. Among rural populations, chronic disease risk is driven by a combination of factors, including low socioeconomic status, limited access to healthcare/supermarket options, and food …

Characteristics Of Pulmonary Vs. Extrapulmonary Tuberculosis Cases In Kentucky From 2020 To 2024, Mariam M. Alkhairat

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

Objective: Tuberculosis (TB) remains an important public health concern in the United States, especially among people experiencing social and clinical vulnerabilities. Extrapulmonary TB, which occurs outside of the lungs, can be harder to detect and diagnose than pulmonary TB. This study aimed to describe the demographic and clinical characteristics of people with active TB in Kentucky and to identify factors associated with extrapulmonary TB.

Methods: Secondary surveillance data were obtained from the Kentucky Department for Public Health (KDPH) using the National Tuberculosis Surveillance System (NTSS). The study sample included 301 confirmed active TB cases reported in Kentucky. Descriptive statistics were …

Preventing Teen Pregnancy Through Expanded Contraceptive Access In Mccreary County, Kentucky, Dacey B. Chitwood

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

This capstone project proposes a school-based Condom Availability Program to reduce teen pregnancy risk by expanding discreet contraceptive access for adolescents in McCreary County, Kentucky. Teen pregnancy remains a persistent public health concern in rural communities where stigma, privacy concerns, transportation barriers, and limited healthcare access can prevent adolescents from obtaining reproductive health resources. McCreary County faces elevated teen birth rates, socioeconomic disadvantage, and limited maternal healthcare infrastructure, making teen pregnancy prevention an important local priority. The proposed program would place free latex and non-latex condoms in student restrooms at McCreary Central High School, with QR-code-linked information connecting students to …

The Impact Of Food Insecurity And Associated Variables On Colon Cancer In Kentucky: An Ecologic Study, Claire E. Lynch

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

Objective: Given colorectal cancer incidence rates are increasing, especially in socioeconomic disadvantaged areas, this study aims to determine if there is an association between specific socioeconomic variables, such as food insecurity, and colon cancer at the county-level in Kentucky.

Methods: Colorectal cancer age-adjusted incidence rates at the county-level were collected from the Kentucky Cancer Registry. Conty-level data was collected from County Health Ranking, The U.S Census Bureau, National Institute on Minority Health and Health Disparities and the Behavioral Risk Factor Surveillance System from 2019 to 2023. R was used to run statical analyses such as a linear regression and a …

Rural Oral Health Access Coordination Program Proposal, Anna Luu

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

Oral health disparities remain a major public health issue in the United States, particularly in rural Kentucky, with barriers such as limited access to preventive dental services, transportation, and insurance coverage contributing to delayed treatment and worsening oral health outcomes. In response, the proposed Rural Oral Health Access Coordination Program aims to improve care access by strengthening referral systems, integrating oral health screenings into public health settings, and enhancing care coordination for high-risk populations. The program intends to focus on the Kentucky River District Health Department Region, connecting individuals to existing services rather than providing direct clinical care. Expected outcomes …

Perry County Perinatal Access Navigator Program (Pc-Pamp) A Public Health Program Proposal To Improve Timely Prenatal Care Access In Perry County, Kentucky, Amber E. Mcguire-Chun

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

Delayed initiation of prenatal care remains a significant public health concern in rural Appalachian communities, including Perry County, Kentucky, where structural barriers such as limited provider availability, transportation challenges, and fragmented referral systems contribute to inadequate access to timely care. This capstone project proposes the Perry County Prenatal Access Navigator Program (PC-PANP), a community-based patient navigation model designed to improve initiation of prenatal care in the first trimester. The program is led by the local health department and leverages partnerships with healthcare providers, the University of Kentucky College of Public Health, WIC, Extension services, and community organizations to support early …

Hardin Health Link: A Community-Integrated Paramedicine (Cip) Program In Hardin County, Kentucky, Samantha Jones

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

Rural and mixed rural–urban communities face persistent disparities in access to timely emergency medical services (EMS), contributing to preventable morbidity and mortality from time-sensitive conditions such as cardiovascular disease, stroke, and injury. Hardin County, Kentucky, reflects these challenges due to its geographically dispersed population, high burden of chronic disease, and variability in EMS response times. This capstone proposes Hardin Health Link, a Community-Integrated Paramedicine (CIP) program designed to expand the traditional role of EMS providers through in-home health assessments, chronic disease monitoring, post-discharge follow-up, medication reconciliation, and connection to clinical and social services.

Guided by an evidence-informed framework, the program …

Stronger Starts: Advancing Maternal And Infant Health In Breathitt County, Kentucky, Madisyn Smith

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

Maternal and infant health outcomes remain significantly poorer in rural Appalachian communities, where structural and socioeconomic barriers limit access to timely and comprehensive care. Kentucky reports elevated rates of preterm birth and infant mortality, with counties such as Breathitt County facing challenges including limited obstetric services, transportation barriers, and high poverty rates. These factors contribute to delayed prenatal care, fragmented services, and increased risk of adverse outcomes.

The Stronger Starts Initiative is an evidence-informed public health program designed to improve maternal and infant health outcomes through a coordinated, multi-level approach. The program integrates nurse-led home visiting, telehealth obstetric consultations, community-based …

Rapid Response To Recovery: Expand Integrated, Technology-Enabled Crisis Care, Madison Chandler

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

Behavioral health challenges in rural communities continue to place significant strain on healthcare systems, particularly through repeated reliance on emergency departments for crisis care. Nelson County, Kentucky, reflects this pattern, with higher reported rates of poor mental health and limited access to behavioral health providers. This paper proposes the Beacon Behavioral Health Response Program, a community-based, multidisciplinary crisis intervention model designed to improve access to timely care and strengthen continuity of support. The program combines mobile crisis response—delivered by a licensed clinical social worker and a peer support specialist—with a technology-enabled component using the Luma AI-supported mental health platform. Together, …

Promoting Maternal And Infant Health In Franklin County, Ky: A Community-Based Physical Activity And Education Intervention, Subin Kim

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

Maternal and infant health outcomes are key indicators of population health, yet persistent disparities exist in rural communities across the United States. In Kentucky, Franklin County reflects this pattern, with concerning maternal and infant health indicators despite relatively favorable socioeconomic conditions. Identified challenges include elevated rates of poor physical and mental health days, high drug overdose mortality, provider shortages, and ongoing reproductive health concerns such as tobacco use during pregnancy and increased infant mortality associated with elevated maternal body mass index.

To address these gaps, a three-pronged, community-based prenatal and postpartum physical activity and education program is proposed. The program …

A Program To Increase Prenatal And Postnatal Care Access In A Rural Kentucky County, Alyssa Thomas

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

Prenatal and postpartum health care access is necessary for positive pregnancy and postpartum outcomes. Many rural areas in the United States are facing maternity care deserts, where there are no obstetric services available in their county. Maternity care deserts typically have higher rates in maternal mortality, low-birth weight, and pre-term births. Fleming County, Kentucky is a small rural community with a population of about 15,000 that is a maternity care desert. To improve prenatal and postpartum care access in this county, this program will use a mobile health clinic and community health workers (CHWs). The mobile health clinic will operate …

Momentum For Healthy Births-Hardin County, Ky, Brittany R. Jackson

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

Maternal and infant health disparities in Hardin County, Kentucky, reflect persistent gaps in timely access to care, particularly among rural and underserved populations. Structural barriers, including transportation limitations and unmet social needs, contribute to delayed prenatal care initiation and low postpartum follow-up, increasing the risk of adverse outcomes. This capstone project proposes the MOMentum (Maternal Outreach and Monitoring for Mothers) Program, an integrated care model designed to strengthen access, improve care coordination, and enhance continuity across the prenatal and postpartum period.

The program combines a Community Health Worker (CHW)-led navigation model with enhanced postpartum care supported by telehealth services and …

Improving Prenatal And Postpartum Care Gaps In Breathitt County, Megan Deaton

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

Maternal and infant health remain a major public health issue across the United States, particularly in rural communities. Barriers such as shortages of obstetric providers, transportation challenges, and limited access to prenatal and postpartum care contribute to delayed care, low follow-up rates, and an increased risk of poor outcomes, including preterm birth and low birth weight. In response, the proposed Maternal and Infant Health Program aims to address gaps in care access through a home visiting model that provides in-home support, maternal health education, care coordination, and referrals to healthcare services, with a direct focus on Breathitt County. Expected outcomes …

Implementation Of A Reminder/Recall Messaging Program In Kentucky, Laura Schwarz

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

Childhood vaccination remains a critical public health priority, yet measles, mumps, and rubella (MMR) vaccination rates in several rural Kentucky counties fall below the 95% threshold required for herd immunity. Recent declines in coverage, compounded by socioeconomic disparities and barriers to healthcare access, place children at increased risk for vaccine-preventable diseases and outbreaks. This capstone project proposes the implementation of an evidence-based reminder/recall (R/R) text messaging intervention utilizing the Kentucky Immunization Registry (KYIR) to improve timely MMR vaccination among children aged 4–6 years before kindergarten entry.

The proposed program targets thirteen Kentucky counties with vaccination rates below 70% and documented …

Strengthening Rural Mental Health Crisis Response: Integrating Broadband Telehealth Care Across Counties Served By Kentucky River District Health Department, Mary K. Mcnabb

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

Rural communities in Eastern Kentucky face persistent barriers to timely and effective mental health crisis care, including provider shortages, transportation challenges, and limited broadband infrastructure. Counties served by the Kentucky River Health Department Wolfe, Lee, Owsley, Perry, Knott, Leslie, and Letcher experience disproportionately high behavioral health needs while relying on shared regional resources. The Broadband-Enabled Rural Crisis Stabilization Initiative (BERCSI) is a proposed public health program designed to strengthen rural mental health crisis response through integrated, technology-enabled care. Grounded in evidence-based practices, including tele-mental health and crisis stabilization models, BERCSI leverages broadband expansion to facilitate rapid assessment, coordinated care, and …

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 …

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 …

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.