Public Health Commons^™

Healthy Living People: A Hiv Transmission Intervention In Four Chicago Communities, Angela Wuerger

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

The transmission of HIV within the city of Chicago has been established as a major health concern: however, the lack of adequate resources has created gaps within current programming available for people living with HIV. Healthy Living People (HLP) is an evidence-based program focused on reducing the transmission of HIV through strengthening adherence to antiretroviral therapy and decreasing number of higher risk sexual encounters. The Chicago Department of Public Health will provide the HLP program, which includes fifteen 90-minute sessions over the course of one year. The HLP program will be offered for people living with

HIV in four Chicago …

Can Treatment Of Social Isolation And Loneliness Reduce Healthcare Utility? An Analysis Of Social Prescribing, Matthew Mattingly

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

The paper focuses on the practice of social prescribing as it is currently implemented through the National Health Service (NHS) of the United Kingdom. Social Prescribing is an emerging healthcare intervention aimed at referring patients to community-based activities. NHS promotes social prescribing as a method of reducing healthcare utilization in chronically ill patients. Current evidence on social prescribing is subject to significant variation and has not supported NHS’s claims. The potential link between feeling of social isolation, loneliness and chronic illness was further investigated through data from the National Social Life, Health & Aging Project (NSHAP). Data was tested for …

Rabies In Kentucky From 1989-2020: A Case For Surveillance, Sarah Jane Robbins

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

The Kentucky rabies reporting system includes data from five laboratories and provides an account of suspected rabies reports since 1989. Over 35,000 suspected cases are used to estimate rabies incidence temporally and spatially. Recommendations to the current rabies reporting methodologies are presented through proposed innovations of a standard, electronic reporting form. Given the multiple sources of data, the reporting system lacks standardization and comprehensive information about suspected rabies events, resulting in limited epidemiological capabilities; and data issues that prevent its use as a surveillance system. These issues are a limiting factor in rabies elimination; but a driving factor in over-testing, …

Implementation Of A School-Based Sexual Health Curriculum For Fayette County, Kentucky Public Schools, Laura P.H. Bellnier

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

Adolescents in the United States are vulnerable to negative sexual health outcomes such as unplanned pregnancy and sexually transmitted infections (STIs) due to a high prevalence of risky sexual behaviors in this population. Research demonstrates that providing adolescents with comprehensive sexuality education that addresses sexual health knowledge, attitudes, and behaviors can increase protective behaviors, such as condom use and decrease negative health outcomes over the long term. Implementing a comprehensive sexuality education program in a public school setting is an effective strategy to reach a large number of adolescents and targeting early adolescents can influence student sexual health knowledge, attitudes, …

Volatile Organic Compound Exposure And Hearing Loss In Children, Brooke Spillman

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

Hearing loss is often associated with repeated exposure to noise levels above 85 decibels. While noise is noted as the largest contributor to hearing loss, some fail to consider the impacts of chemical exposure on the hearing health of children, specifically VOCs. Early detection and prevention of hearing loss in children is important due to the impacts that hearing has on the learning, behavior, speech, and language development of children. This study examined the relationship between VOC exposure and hearing loss in children using NHANES data collected from 2005-2006. This was analyzed with Chi-square analyses and a logistic regression taking …

Maternal Residential Proximity To Surface Mining Associated With Preterm Birth And Low Birth Weight In Appalachian Kentucky, Whitney Smith

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

Objective: This study aims to examine the relationship between maternal residency in a county with surface coal production and preterm birth or low birth weight.

Methods: A cross-sectional study was conducted using birth records (n=62,766) for 54 Appalachian counties and coal production in tons. Logistic regression and chi-squared analysis was done to analyze the relationship between surface coal mining and preterm birth and low birth weight in two different birth groups.

Results: After controlling for covariates, statistically significant increases were seen in Birth Group 1 and Birth group 2. Birth Group 1 had statistically significant results for preterm birth ((1.19 …

The Effect Of The Affordable Care Act On The Ability Of Health Departments In The Appalachian Regions To Offer Primary Care Services, Ogechi Anyagaligbo

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

In the Appalachian region, the need for primary care services has increased due to an increase in morbidity rates from coal mining, obesity, drugs, and poor health care. The Affordable Care Act (ACA) was enacted in part to expand access to patient care. The ACA aimed to help solve these problems and help underdeveloped communities such as the ones in the Appalachian region that do not have access to affordable and quality health care. This project examines differences before and after the ACA was passed on the delivery of primary care services by local health departments within the Appalachian region. …

The Impact Of Kentucky's Medicaid Expansion Under The Affordable Care Act On Dental Care Visits, Mutlaq Alotaibi

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

Background. Lack of health insurance, cost of dental care services, and shortage of dental workforce are leading barriers to dental care access. Low-income adults and those who reside in areas with low dentist supply are less likely to visits a dental office than their counterparts. Studies have reported that dental visits increased among low-income adults in states that expanded Medicaid under the Affordable Care Act (ACA) and have an adequate number of dentists. However, the impact of Medicaid expansion on income-based disparities and urban-rural disparities in dental care visits is unclear.

Objectives. The aim of this study is to examine …

Healthy, Fit, & Strong: A Parent-Child Physical Activity Program For Families With Obese And Overweight Adolescents, Patrick Maloney

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

Over 20% of Kentucky children between the ages of 10-17 are obese, the third highest prevalence in the nation. The Healthy, Fit, & Strong Program works with children with a BMI above the 85th percentile and their parents to improve behaviors related to physical activity (PA) and nutrition. The intervention is a 12-week program which features tri-weekly physical activity sessions and nutrition classes. Both children and parents participate in activities in order to build knowledge and confidence related to healthy behaviors. The goal of this intervention is to improve upon baseline physical activity levels and diet as well as to …

Alcohol Excise Taxes And Their Effects On The Community, Christopher R. Watts

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

Objectives: This study examines the association of an additional excise tax on alcoholic beverages in Georgetown, Kentucky with alcohol-related motor vehicle accidents. Evaluate the additional benefits of the excise tax on the community of Georgetown, Kentucky.

Methods: Using an interrupted time series design, this study compares alcohol-related crash statistics from two similar cities based on 126 months of data from the Kentucky State Police. Analyses included linear regression and Poisson models to evaluate the data in each city to determine population-wide results.

Results: Alcohol-related motor vehicle crashes immediately declined (-12.5%) in Georgetown following the implementation of the excise tax and …

Mitigating Opioid Related Healthcare Use In Kentucky: An Assessment Of The Impact Of Kentucky Revised Statute (Krs) Changes To Opioid Prescribing On Opioid Related Prescribing And Healthcare Utilization, Drew Speer

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

The opioid epidemic has impacted few other places more than the state of Kentucky. In 2018, data from the Centers of Disease Control and Prevention (CDC) and the National Institute on Drug Abuse (NIDA) ranked Kentucky as being in the top ten for rate of drug overdose deaths and opioid-involved overdose deaths per 100,000 persons.^1,2 These rankings exist even though prescription opioid dispensing rates have fallen from 102.6 per 100 persons in 2015 to 72.3 per 100 persons in 2019.³ Aligning with this trend, while research shows this problem began with prescription opioids in the late 1990’s, it …

Risk Factors Of Carbapenem-Resistant Enterobacteriaceae Acquisition Among Adult Intensive Care Unit Patients At A Kentucky Academic Medical Center, Jason Eric Wilson, Jason Wilson

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

Background: This study aimed to identify risk factors of carbapenem-resistant Enterobacteriaceae (CRE) acquisition among adult intensive care unit (ICU) patients at a Kentucky academic medical center and to evaluate sink drains as a possible environmental reservoir of carbapenem-resistant organism (CRO) transmission.

Methods: A retrospective cohort study was conducted from October 1, 2013 through October 31, 2016. Intensive care unit patients were screened for CRE at admission and weekly until discharge. Cases were defined as patients who tested positive for CRE on ICU admission day 3 or greater. Sink drains were sampled for CROs in selected units from January 2018 through …

Assessment Of The University Of Kentucky's Nutrition Education Program's Smarter Lunchrooms Pilot Plate Waste Project In Three Kentucky Schools, Natalie Jones

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

School-based approaches utilizing policy, systems, and environmental strategies are needed to address the complex factors driving childhood obesity. The purpose of this pilot study is to implement Smarter Lunchroom strategies in three participating Kentucky middle schools in 2019 and then assess two outcomes: (1) determine the impact of the intervention on fruit and vegetable purchases and waste, and (2) determine how purchases or waste varied by interventions selected for each setting. After the 6-week intervention, combined we found no statistical significant increases in fruit and vegetable purchasing from pre to post-intervention. No statistical significant decreases in fruit and vegetable plate …

An Evaluation Of Injurious Falls And Fall-Risk-Increasing-Drug (Frid) Prescribing Behaviors In A Nationally Representative Sample & The Pharmacist’S Role In Fall Prevention, Taylor Elliott, Susan Westneat, Shama Karanth, Erin Abner, Anna Kucharska-Newton, Daniela C. Moga

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

Background: Falls are a major public health problem affecting millions of older adults each year. Little is known about FRID prescribing behaviors after injurious falls occur.

Objective(s): The primary objective of this study was to investigate whether an injurious fall impacts the odds of being prescribed a new FRID.

Methods: We conducted a cross-sectional analysis using data from the 2016 National Ambulatory Medical Care Survey to investigate whether an injurious fall impacts the odds of being prescribed a new FRID. We included patients age >/= 65 years and classified visits based on presence of an injurious fall. The outcome of …

Occupational Opioid Surveillance And Intervention Evaluation: A Mixed Methods Collaborative Project Among Southeast First Responders, Robin Thompson

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

Introduction: This capstone assessed and addressed the issue of occupational opioid exposure among first responders working in the southeastern United States from 2017-2019. The first study aimed to assess the emerging issue of occupational opioid exposure as well as current knowledge and training practices among first responders of the following southeastern states: Kentucky, Georgia, Mississippi, and Virginia. The second study aimed to address this emerging issue through formative research followed by evaluation of the impact of an educational video and associated knowledge gained with a group of Kentucky-based first responders.

Methods: The analysis drew from three primary datasets: (1) self-reported …

Syringe Exchange Programs And Emergency Department Use For Drug Overdoses In Kentucky, Timothy Williams

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

In 2015, syringe exchange programs (SEPs) were legalized in Kentucky as part of a response to the high and rising morbidity and mortality associated with injection drug use, particularly opioids. In addition to their primary function of preventing the spread of some infectious diseases by providing injection drug users (IDUs) with easy access to sterile injection equipment, SEPs may also offer ancillary services such as referrals to primary care providers and substance abuse and mental health treatment, as well as safe injection education and naloxone training. These ancillary services are intended to improve the overall health of IDUs and the …

A Rapid Review Of Physician Burden Secondary To Electronic Health Records Use In The United States From 2015 To 2020, Lori Wong

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

Background: After the passing of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, there has been a tremendous increase in the number of hospitals and providers adopting and using Electronic Health Records (EHRs). While EHRs were a way of improving efficiency, quality, and safety of healthcare, there is emerging evidence that they are contributing to physician burden, which can take the form of increased workload, decreased satisfaction, negative attitudes, and burnout. For instance, Arndt et al. found that physicians spent half of their workday on the EHR during and after work, and Robertson et al. …

Hospital-Based Safe To Sleep Intervention To Decrease Sleep-Related Infant Deaths In St. Louis, Missouri, Olivia M. Pokoski

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

The city of St. Louis in Missouri has an elevated infant mortality rate compared to St. Louis County, Missouri, and the United States. When controlling for race, black or African American infants are over twice as likely to die before their first birthday compared to their white counterparts. Two of the leading causes of infant death are sleep-related causes and sudden infant death syndrome (SIDS) which occur if the infant is placed in an unsafe sleeping environment. To address this burden Affinia Healthcare, Barnes Jewish Hospital, and St. Mary’s Hospital have decided to implement a hospital-based Safe to Sleep campaign. …

Growing Green Minds: Implementation Of A School Garden & Nutrition Program For The Freedom Area School District In Rural Wisconsin, Marissa Schuh

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

Most children in the U.S. consume too few fruits and vegetables which is putting them at risk to develop obesity and other lifestyle diseases. The 2015-2020 Dietary Guidelines for Americans recommends that individuals should increase the amount and variety of fruits and vegetables consumed in order to prevent weight gain and other chronic diseases. Research shows that garden-based educational programs can increase children’s fruit and vegetable intake as well as change their preferences and attitudes towards eating and trying new fruits and vegetables. Incorporating a garden and nutrition curriculum into a school setting is an ideal opportunity to improve children’s …

Implementing The Fit And Strong! Program To Reduce Osteoarthritis In The Older Adult Population Of Carmel, Indiana, Lauren Alexis Bergstrom Roach

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

Osteoarthritis is a health outcome most commonly experienced by older adults. As the “baby boomer” population continues to age, the demand for services for older adults also increases. Fit and Strong! is an evidence-based program that works to reduce symptoms of osteoarthritis in this population through an 8-week course of physical activity classes, taught by Fit and Strong! certified instructors. Carmel, Indiana, a city in Hamilton County, has a high percentage of older adults within its population, and community health needs assessments have indicated that Hamilton County citizens have repeatedly expressed a need for resources for older members of the …

An Empirical Pilot Study Examining The Relationship Between Intention To Participate In Food Security Efforts And Childhood Socioeconomic Status Among Conference Attendees, Liana Dixon

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

Hunger is a global public health issue and finding a solution is a priority for the United Nations. The United Nations Sustainable Development Goal 2.2 calls for ending hunger, achieving food security, improving nutrition, and promoting sustainable agriculture for all people by 2030. The Universities Fighting World Hunger (UFWH) Summit, originating with the United Nation’s originated World Food Programme (WFP) and Auburn University, convenes attendees annually to share their own knowledge and ideas about how to “fight hunger,” as well as benefit from others knowledge and ideas. An important factor in tackling hunger and achieving health is addressing poverty and …

Monitoring Opioid Use In Cancer Survivors: Implementation Of Screening, Brief Intervention, And Referral To Treatment (Sbirt) In A Clinical Setting, Jennifer M. Dolly Prothro

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

Kentucky is a disparate state, ranking as one of the top states in incidence, prevalence, and mortality for both opioid use disorders (OUD) and cancer. Due to the high volume of both diseases in the state, there is a rising concern about the overlap of these two populations. Cancer and its’ treatment are known to cause chronic pain, defined as daily pain lasting 3 months or longer. Generally, chronic pain patients of any type are known to experience higher rates of opioid misuse (21-28%) and opioid dependence (8-12%) than the general population (4.1%, 0.9% respectively). The risk of OUD must …

Implementing Centeringpregnancy, A Group Prenatal Care Model, In Hamilton County, Ohio, Morgan Avery

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

Target Population and Need

Hamilton County, Ohio exhibits high rates of poverty, unemployment, and negative health outcomes. Specifically, Hamilton County continues to perform poorly in maternal and child health outcomes such as infant mortality, low birth weight, gestational diabetes, and preterm birth rates. Many people in the community exbibit poor health behaviors such as inadequate prenatal care, drug use during pregnancy, and smoking during pregnancy.

Program Approach

The Hamilton County Health Department intends to implement an evidence based group prenatal care program, CenteringPregnancy, in three health centers around Hamilton County in an effort to reduce poor maternal and child health …

An Ecological Approach To Understanding Lethal Violence In The Us Using Stream Analogy, Jacqueline Seals

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

ABSTRACT OF CAPSTONE

Background: Lethal violence, homicides and suicides, is a growing issue in the US. Historically homicides and suicides have been studied separately, but with stream analogy of lethal violence homicides and suicides are both currents of lethal violence, just branching in opposite directions. The purpose of this study is to understand which county-level factors increase risk of lethal violence.

Methods: This ecological study combined open-source datasets to create one dataset of socioeconomic risk factors of lethal violence. Counties with 10 or more lethal violent deaths were included (n=2751). Negative Binomial models examined the relationship between risk factors and …

Epidemiology Of Colorectal Cancer Comorbidities And Stage At Diagnosis, Survival, And Second Primary Malignancies In Kentucky, 2003-2016, Nikita Leigh Vundi

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

Background: Colorectal cancer (CRC) is the third most common type of cancer and the third most common cause of cancer death among men and women in the United States.^1-3 The American Cancer Society estimates that there will be 147,950 new cases of CRC and 53,200 CRC related deaths in the U.S. for the year 2020.3 Kentucky CRC incidence for 2012-2016 was the highest in the nation, and the mortality rate for years 2013-2017 was ranked 5th in the nation.^4-6 Risk factors for CRC include lifestyle factors, genetics, and disease status (comorbidities and treatment).2, 7 Diabetes has been …

Utilizing A Community-Based Doula Care Intervention To Reduce Race-Based Perinatal Health Inequities In Jefferson County, Kentucky, Brendan Mathews

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

Target Population and Need

The United States is currently the only industrialized nation in the world experiencing increasing rates of

pregnancy-related mortality.

1,2

Black women die at 3-4 times the rate of their white counterparts.

1-5

This disparity

is likely caused by the experience of systemic racism, which increases allostatic load and produces epigenetic

modifications linked to higher likelihood for poor birth outcomes. Biases perpetuated by health care providers

result in black women being less likely to receive quality healthcare and more likely to experience poor perinatal

1-7 to all pregnant women.

health outcomes.

The provision of doula-based care can …

The Impact Of Covid-19 On Worksite Wellness Programs, Marilyn S. Campbell

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

Introduction: Worksite wellness programs are popular employer offerings as of the last few decades. The COVID-19 pandemic has caused major shifts in behavior since these programs have been implemented. The purpose of this study was to see how the pandemic has affected various offerings within a university worksite wellness program.

Methods: This study is a secondary analysis of a university worksite wellness program, and it compares participation in the various offerings in response to the COVID-19 pandemic by evaluating 2019 participation (pre-pandemic) to 2020 participation (including onset of the pandemic and after). This worksite wellness program, which is available to …

Utilizing A Formative Program Evaluation Approach And An Application Of Grounded Theory To Assess A Novel Harm Reduction Program, Dia Obonyo

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

Formative program evaluation is conducted during development and early implementation to ensure a program is feasible, appropriate, and acceptable. The Harm Reduction Initiative (HRI), a program of KIRP, the Kentucky AIDS Drug Assistance (KADAP) Income Reinvestment Program, seeks to address some of the underlying causes of infectious disease vulnerability resulting from drug use by focusing on infectious disease testing and linkage to care among high risk individuals. The primary objective of the evaluation was to achieve the following aims: 1) characterize the need for the program, 2) clarify the theory and logic of the program, 3) inform implementation, and 4) …

Utilizing Cdc Framework For Program Evaluation To Inform Assessment Of An Interprofessional Leadership And Teamwork Curriculum, Madeline Aulisio

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

Background
The ability to collaborate effectively and lead a team when the need arises has become an expectation of health professionals. Graduates of health professions programs are expected to possess skillsets that will allow them to both collaborate and lead effectively in addition to their profession-specific knowledge. Leadership Legacy, an interprofessional elective created at the University of Kentucky in 2009, was designed to address this need.

Methods
After nearly ten years of cohorts, an opportunity arose for program evaluation with a reliable method such as the Centers for Disease Control and Prevention Framework for Program Evaluation. The novel use of …

The Association Between The Medicare Bundled Payments Initiative And Cardiac Rehabilitation Enrollment, Jing Li

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

Cardiac rehabilitation (CR) represents a proven-effective intervention in secondary prevention that can stabilize, slow or reverse cardiovascular disease (CVD) progression, facilitate the ability of the patient to preserve or resume an active and functional contribution to the community, and reduce the risk of future cardiovascular events. Despite multiple guideline recommendations for CR and coverage by Medicare and most health plans, participation in CR remains low. Bundled payments are one of the suggested reforms designed to move health care providers toward to value-based care and is very applicable to the CR utilization in patients diagnosed with acute myocardial infarction (AMI) or …