Public Health Commons^™

Breastfeeding Promotion In The Workplace, Katie C. Nettesheim

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

Breastfeeding is one of the best things a mother can do for her baby. It has many protective qualities including a reduced risk of sudden infant death syndrome (SIDS), asthma, obesity, type 1 diabetes, respiratory infections, ear infections, and stomach bugs for the baby (CDC, 2022). There are also protective qualities for the mother as well, including a reduced risk of high blood pressure, breast and ovarian cancer, and type II diabetes. Breastfeeding exclusively, the infant only receives breastmilk and no other supplementation for 6 months, which maximizes the many benefits that breastfeeding has.

Rural areas of the United States …

Concussion Perceptions And Reporting Behaviors By Individual And Team Sport Participation Among Female Diii Student-Athletes, Bethany L. Stewart

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

Abstract

Purpose. This study aimed to analyze differences between individual and team sport participation and academic year on perception of concussion and reporting behaviors.

Methods. A cross-sectional study was conducted using original data from the Perceptions and Likeliness to Report Concussions in Collegiate Athletes survey distributed to student-athletes from April 2021 to December 2022. The study population was restricted to current residents of the United States, current enrollment in college or university, female-identifying, and between the ages of 18 and 24, yielding a final population of 135 for analysis. Statistical frequency analyses were obtained, then stratified by team and individual …

Psychosocial Outcomes Post-Concussion Of Female Collegiate Athletes, Victoria Farley

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

Concussions are traumatic brain injuries impacting upwards of 3 million athletes per year. Female collegiate athletes are an essential group of athletes to investigate as they account for 47% of all collegiate athletes and often suffer more severe concussions with worse concussion symptoms than their male counterparts. Many symptoms are associated with concussion such as dizziness nausea, headaches, and instability, however, some injury symptoms extend beyond physical symptoms. The symptoms that extend beyond physical often mimic different psychosocial factors like depression and anxiety. This study investigated the associations of injury, the duration of symptoms, and the psychosocial impacts of injury …

Community Pharmacy Provision Of Extended-Release Injectable Naltrexone In Kentucky: Perspective Of People Who Use Opioids, Anye Wamucho

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

Aim: To identify demographic, socio-economic, and other factors associated with likelihood of obtaining extended-release injectable naltrexone (EIN) if provided in a private space at a local pharmacy among people who use opioids (PWUO) in rural Appalachian Kentucky.

Methods: People who used opioids in the past 6 months in rural Appalachian Kentucky (n=170) completed interviewer-administered questionnaires eliciting demographic, socio-economic, and other characteristics. Participants were also asked about whether they will be more likely to obtain EIN if provided in a private space at a local pharmacy. Factors associated with increased likelihood to obtain pharmacy-provided EIN were assessed using unadjusted univariate and …

Covid-19 Vaccine Acceptance, Hesitancy, And Refusal Among Educators In Spring Of 2021, Jenifer O'Brien

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

The COVID-19 pandemic provided unprecedented vaccine development and deployment. Educators were among the first non-healthcare occupations to become eligible for the vaccine, and were an early predictor of vaccine hesitancy especially among educated females. By the spring of 2021, 87% of teachers had received at least one dose of the COVID-19 vaccine. Among those who expressed hesitancy, no defining demographic factors were found. Those who expressed hesitancy commonly cited a rushed vaccine development process and fear of long term side effects as reasons against vaccination.

The Meals On Wheels-Breathitt: A Health Campaign For Reducing Food Insecurity Among The Older Adults In Breathitt County, Kentucky., Sarah Haroon

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

The population of the United States of America is aging at a faster rate than ever before. More than 1 in 6 Americans are now 65 or older (The Washington Post, 2023). Since 2010, compared to people under 65, there has been close to a two-hundred percent increase in people 65 and above (The Washington Post, 2023). The rise in the aging U.S. population is due to increased life span and people living longer (U.S. Census Bureau, 2020). Furthermore, life expectancy for the total U.S. population is projected to increase by six years, from 79.7 in 2017 to 85.6 by …

Increasing Hpv Vaccination In Elliott And Lawrence Counties, Keeghan Francis

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Methods: The study population …

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

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

Abstract

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

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

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

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

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

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

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

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

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

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

ABSTRACT:

Background and Objectives:

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

Methods:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Increasing Physical Activity Rates Among High School Girls In Jefferson County, Kentucky, Haley Copeland

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

Obesity rates across the U.S. are increasing, especially among adolescent females. Physical activity rates have been associated with obesity and many related health outcomes. Regular physical activity can help adolescents improve their cardiorespiratory fitness, build strong bones, control their weight, and reduce depression ¹. It can also help reduce the risk of developing health conditions like heart disease, cancer, high blood pressure, osteoporosis, type II diabetes, and obesity ¹. Thus, physical activity among youth provides a risk factor to target, with the intention of eventually decreasing obesity rates.

Recommended physical education class CDC guidelines are not being met …

An Analysis Of The Differences In Health Outcomes And Socioeconomic Factors Between Veteran Smokers And Non-Smokers In Tobacco-Growing States, Jacob Hauser

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

Tobacco usage still remains the single most preventable cause of disease, disability, and death in the United States. Service members and veterans, especially those residing in tobacco-growing states, face higher levels of societal pressure to take up the habit compared to their civilian counterparts. This research investigates why this is the case, the differences in health outcomes, and the differences in socioeconomic factors between the veteran smoking and non-smoking populations before making policy recommendations to policymakers and stakeholders to address this problem.

Covid-19 Mitigation Strategies School Staff In Indiana, Kentucky, And Ohio, Luu Le

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

Abstract

Background: This cross-sectional study aims to identify the difference in COVID-19 mitigation strategies implementation and adherence among elementary, middle, and high schools in Indiana, Ohio, and Kentucky, based on data from the School Staff Health and Wellness Study research at the University of Kentucky in 2020.

Methods: The sample size of the study was 6,794 participants who work at elementary, middle, or high schools in Indiana, Ohio, and Kentucky. Complete case analyses were performed, which included observation with no missingness in variables (N = 5,971). Descriptive statistics were generated, including a table indicating the implementation of COVID-19 mitigation strategies …

Frequency And Type Of Diabetes Screening Tests In A Sample Of Women With Polycystic Ovarian Syndrome: A Descriptive Study, Jacklyn Vollmer

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

Introduction: Polycystic ovarian syndrome (PCOS) is a hormonal disorder that affects 6-12% of United States women of reproductive age. Women with PCOS are at an increased risk of developing type 2 diabetes and fall into high-risk groups for screening guidelines put out by the American College of Obstetricians and Gynecologists (ACOG). Guidelines further suggest that an oral glucose tolerance test (OGTT) be used for diabetes screening in women with PCOS as opposed to an A1C or fasting plasma glucose test. The purpose of this study is to examine rates and type of diabetes screening used among a sample of women …

An Analysis Of The Association Between Cognitive Decline And Geographic Residence Among Women Over 65 In The Southeastern United States, Christine Invergo

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

Abstract

Introduction: The United States is an increasingly aging nation, and aging increases the risk of cognitive decline. Information on the relationship between cognitive decline and geographic residence in the U.S. is limited. Available evidence suggests that rural residents tend to suffer persistent disadvantages in cognitive functioning when compared to sociodemographically similar urban peers. This analysis focused on women over 65 years of age living in the southeastern U.S. The primary objective of this analysis was to determine if there was a significant association between geographic residence and cognitive decline. A secondary objective was to explore variables of interest that …

An Analysis Of Rural-Urban Differences In Health Care Access Among Women In The United States, Ellery Denny

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

The purpose of this project was to examine the relationship between women’s health care access and rural and urban America. Extensive review of existing literature was completed and showed that the United States ranked last out of 11 high-income countries in regard to access to care, administrative efficiency, equity, and health care outcomes (Schneider, 2021). Additionally, women in the United States faced heightened financial barriers to health care that men do not, and also faced unique disadvantages that resulted in reduced utilization of care (Cameron, 2010, p. 1649).

Results showed that rural women were significantly more likely to have one …

Comparing Governmental Communication About Covid-19 Layered Protection Strategies In Taiwan, Kenya, And The United States: A Mixed-Method Analysis Of National Health Agency Websites, Cynthia Mofunanya

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

COVID-19 is a novel coronavirus caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It can result in severe respiratory damage. Different countries have recommended different combinations of protections during the COVID-19 pandemic. Various combinations of mitigation strategies or “layered protections” against coronavirus have also been communicated differently across nations. This mixed-methods content analysis seeks to compare COVID-19 mitigation information on three national health agency websites for Taiwan, Kenya, and the United States. Availability and navigability of information was examined for each mitigation strategy. The Web Resource Rating tool was used to assess the quality of the information about …

An Analysis Of The Association Between Cognitive Decline And Geographic Residence Among Women Over 65 In The Southeastern United States, Christine Invergo

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

Abstract

Introduction: The United States is an increasingly aging nation, and aging increases the risk of cognitive decline. Information on the relationship between cognitive decline and geographic residence in the U.S. is limited. Available evidence suggests that rural residents tend to suffer persistent disadvantages in cognitive functioning when compared to sociodemographically similar urban peers. This analysis focused on women over 65 years of age living in the southeastern U.S. The primary objective of this analysis was to determine if there was a significant association between geographic residence and cognitive decline. A secondary objective was to explore variables of interest that …