Briding The Gap: Treatment Engagement Profiles And Outcomes Utilizing Novel Models, Allison Koetter

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

Background. The opioid epidemic is a public health emergency that requires collaboration between both private and public sectors to increase access to and capacity for efforts directed at treatment, prevention, and recovery. The Commonwealth of Kentucky via funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) created their State Targeted Response to the Opioid Crisis (Opioid STR) in order to help address these needs. The University of Kentucky, as an awardee of these funds, decided on an approach to highlight the Emergency Department (ED) bridge model, which links patients discharged from EDs and the hospital (inpatient addiction consult …

Prevalence Of Restricted Spirometry Within Two Eastern Kentucky Counties A Cross Sectional Study, Quincy Bascombe

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

Objective: This study examines the prevalence of restrictive spirometry in Eastern Kentucky and its association among men and women with various demographic and exposure (occupational and environmental) factors.

Methods: A cross sectional, cluster sample (N = 685) of participants from Letcher and Harlan Counties, aged 21 and over, answered a questionnaire focused on risk factors for respiratory health outcomes including questions on demographic, health, occupational, and environmental exposures variables. Pulmonary function tests were administered to all participants with no significant cardiovascular or cerebrovascular events within the past 30 days. Log-binomial regression was used to calculate prevalence ratios (PRs) …

Analysis Of High Potency Anticholinergic Prescribing In Scottish Nursing Home Patients, Alexandra Nugent

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

Purpose: The aim of this study was to compare the use of two or more high-potency anticholinergic (HPA) medications between patients 65 years and older in nursing homes and in the greater community using prescribing data. Methods: This secondary data analysis of the NHS Scotland PIS databased used prescription data from a nationally representative patient-level database. Patients were included were ≥65 years old, received ≥2HPA prescriptions from 2011Q2-2012Q1(11/12), 2016Q1-2017Q2(16/17), 2018Q2-2017Q1(18/19). The principle endpoint of this study was to assess for a change in patient’s relative risk of receiving ≥2HPA prescriptions. Results: 29,301 patients were identified. From 11/12 to 16/17 all …

Policy Analysis Of California Senate Bill 1138: Mandating Plant-Based Meal Options In Hospitals And Prisons, David Morton

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

Obesity, chronic disease, and poor nutrition are prevalent in the United States while healthcare costs rise. Nutritional research advancements have suggested the healthfulness of plant-based diets. In 2018, the California state senate passed Senate Bill 1138, requiring plant-based meal options in hospitals and prisons. This paper sought to examine the context surrounding the bill, determine the appropriateness of the bill, and recommend next steps for nutritional policies in the United States. In a review of the literature, malnutrition in hospitals and prisons is highly prevalent, and state governments have already made efforts to improve their citizens’ nutrition. In this analysis, …

Utilization Of A Community Pharmacy-Based Service For The Treatment Of Uncomplicated Urinary Tract Infections In Scotland, Robert Borchardt

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

Introduction: In November 2013, Scotland piloted a program in Grampian for the treatment of Urinary Tract Infections (UTIs) in community pharmacies, increasing health access for patients and reducing general practitioner workload. This program became known as ‘Pharmacy First’ and was later implemented nationwide in November 2017. This paper seeks to understand utilization of the Pharmacy First program across Scotland by patients and potential barriers to access.

Methods: Using data from the Prescribing Information System collected by the National Health Service of Scotland from July 2013 to April 2019, orders for uncomplicated UTIs were gathered by examining all nitrofurantoin and trimethoprim …

Assessing The Impact Of Raising The National Minimum Purchase Age Of Tobacco To 21 On Tobacco Use In Youth, Nicholas D. Guerra

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

Introduction: Tobacco use is the number one cause of preventable death in the United States with roughly 500,000 premature deaths a year and 3,200 youth smoking their first cigarette daily. On December 20, 2019, President Trump signed legislation to raise the federal minimum age of sale of tobacco products from 18 to 21 years, effective immediately. Prior to this recent regulation, over half of the US population was enforcing this age restriction. The objective of this research is to investigate the impact of tobacco 21 laws on tobacco use and project the national tobacco impact by using the state experiences …

Community Collaborations For Health Improvement In Laurel County, Kentucky: A Case Study, Kendall Ferrell

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

Kentucky is currently ranked fifth in the United States for opioid-involved overdose deaths. This study assesses how the results of a community health needs assessment have developed collaborative community effort to create and expand services and programs to address opioid and substance use disorder in Laurel County, Kentucky. This particular community continues to rank opioid and substance abuse as a major health concern causing efforts to be put in place to create an opioid response program. A consortium was formed that developed the community health needs assessment survey. The results from the survey were then incorporated in to a strategic …

Asthma In Scotland: Prescribing Trends Since The National Review Of Asthma Deaths (Nrad), Quentin Kenner

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

Asthma in Scotland: prescribing trends since the National Review of Asthma Deaths (NRAD)

Purpose: Asthma remains prevalent worldwide with implications for morbidity and mortality. In Scotland, 1 in 14 people are currently being treated for asthma. Asthma burden prompted the creation of the National Review of Asthma Deaths (NRAD), which identified contributing factors. Since the NRAD, guidelines have changed and therapeutic indicators have been developed with an increased emphasis on controller medications. Few publications describe how the NRAD study affected prescribing and if inequalities among the asthmatic population exist. This study aimed to determine whether patients were receiving appropriate treatment …

Dalbavancin In The Community Emergency Department, Wesley Johnson

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

Introduction

Dalbavancin is an antibiotic within the class of medications known as lipoglycopeptides. This medication is given to patients presenting to the hospital with acute skin and skin-structure infections (ABSSSI). This is a unique medication because it is given as a one-time dose in the outpatient setting and it could prevent patients from requiring admission to the hospital.

Methods

The emergency department (ED) at Good Samaritan community hospital performed a trial period with dalbavancin and data was collected from November 2018 to March 2020. Retrospective chart review was performed to obtain patient data and outcomes. Patients would be contacted by …

Describing Interventional Approaches To The E-Cigarette/Juuling/Vaping Epidemic In Eastern Kentucky High Schools: A Case Study, Taylor Miller

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

Problem: Over the past few years there has been significant increase in vaping/juuling/e-cigarette use among the adolescent population. Since this is a new health issue, there are very few intervention programs for teens to receive education about these devices and support for quitting/treatment. The aim of this study was to provide insight on interventions that have already been implemented to provide direction for those seeking to design their own vape/juul/e-cigarette intervention. This was assessed by comparing approaches and lessons learned during the intervention implementation process.

Methods: The study was conducted using a case study approach. The researcher conducted interviews with …

Improving Colorectal Cancer Screening Rates In Perry County, Vashisht Madabhushi

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

Appalachian Kentucky has one of the highest incidence and mortality rates from colorectal cancer (CRC) in the country. CRC is curable if identified early through screening. However, Perry County has suboptimal screening levels. A multimodal program of patient reminders and mailed screenings will be used to increase CRC screening rates in Perry County. The primary outcome will be evaluated using a T-test for this prospective cohort study. Short term outcomes include increased CRC screening rates in delinquent patients. Long term outcomes include increased CRC detection rates and decreased CRC mortality in Perry County.

Implementing The Be Proud! Be Responsible! Program In Wolfe County Public Schools, Casey Gill

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

Kentucky’s teen pregnancy rate is higher than the national average, and Wolfe County has one of the highest rates of teen pregnancy in the state. Teen pregnancy causes adverse health effects for both mother and baby. Teen mothers have a higher likelihood of dropping out of high school, increased health problems related to pregnancy such as preterm labor and preeclampsia, increased risk of being a single parent, and lower income and SES status. The baby is also affected, with an increased risk of living in a single parent household, and living in poverty. The Kentucky River District Health Department plans …

An Analysis Of The Association Between Adverse Childhood Experiences And Food Insecurity Within The United States, Margaret Brooks

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

Adverse childhood experiences and food insecurity are significant public health issues within the United States. Previous studies have established the overall relationship between ACEs and food insecurity. This research investigates the statistical relationship between individual ACE indicators and food insecurity as well as the relationship between having two or more ACEs and food insecurity.

Diabetes Locus Of Control And Depression In Older Adults With Type 1 And Type 2 Diabetes: The Study Of Longevity In Diabetes, Jahvona Pretty

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

Abstract:

Objective: To determine if diabetes locus of control (dLOC) is associated with depression in older adults with type 1 and type 2 diabetes and whether this association differs by diabetes type.

Methods: Data for the current study were obtained from The Study of Longevity in Diabetes (SOLID), a prospective cohort study of aging, and diabetes. SOLID participants aged 60 and older with type 1 diabetes (T1D), type 2 diabetes (T2D), and without diabetes were recruited from members of Kaiser Permanente Northern California (KPNC). For the current study, we excluded all of the participants without diabetes since the primary exposure, …

Maternal Demographic And Psychosocial Factors Associated With Low Attendance Of A Centeringpregnancy Prenatal Care Program Among A Group Of High-Risk Women From Kentucky., Javeria Zafar

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

Abstract

Aim: To identify maternal demographic and psychosocial risk factors associated with poor attendance of CenteringPregnancy group prenatal care, and whether past or current experience of intimate partner violence is related to poor attendance.

Methods: Data from the EMPOWR (Efforts to Maximize Perinatal Outcomes in Women at risk) were used in a cross-sectional study design. Self-reported data from 607 high-risk pregnant women from Kentucky was used. Poor-attendance or non-compliance was defined as attending less than 6 out of the 10 group prenatal care session. Multivariable logistic regression was performed to assess the association between risk factors and compliance with the …

Analysis Of Health Survey Data To Address Topics In Environmental And Public Health, Nimish Valvi

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

Introduction: Manganese is an essential trace element that can cause adverse health effects with deficiency and in excess amounts. The purpose of this study is to determine the asscociation of blood manganese levels and the prevalence of myocardial infarction, stroke, and renal dysfunction in a general US population.

Methods: Data were used from the National Health and Nutritional Examination Survey (NHANES) of non-institutionalized US adults 20 years and older using the 2011-2012, 2013-2014, and 2015-2016 survey cycles (n=16629). Weighted multivariable logistic regression models adjusted for age, race/ethnicity, sex, and poverty income ratio (PIR), were used to determine the association of …

Examining The Effect Of Socioeconomic Factors On Kindergarten Vaccination Rates In Kentucky Counties, Abigail Wiggins

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

The purpose of this project is to examine the relationship between county-level socioeconomic factors and immunization compliance rates among kindergarten age children. All 120 counties in Kentucky were included in this evaluation.

County-level percent of uninsured children, number of children in poverty, children receiving free lunch (percentage), unemployment rate (percentage), and high school graduation rate were assessed. Socioeconomic data for each county were compared to county-level kindergarten vaccination rates. All vaccination data were obtained from the 2015-2016 Kentucky Annual School Immunization Survey Report. All socioeconomic county data were obtained from the 2016 County Health Rankings data, published by the Robert …

Use And Cost Analysis Of Comprehensive Respiratory Panels At A Children’S Hospital Within A Tertiary Medical Center, Megan Cummins

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

Introduction

A comprehensive respiratory panel (CRP) is a quick and non-invasive laboratory diagnostic test that can detect viral nucleic acids by utilizing polymerase chain reactions (PCR). A CRP can detect multiple causative agents associated with upper respiratory illness and CRPs are commonly used in the Kentucky Children’s Hospital as part of the initial evaluation for patients who present with signs and symptoms of a respiratory infection. While CRPs are quick to detect the presence of a viral illness and are shown to increase the prescribing of antivirals for viral illnesses, the cost of the CRP to the hospital is around …

Preventing Interpersonal Violence At The University Of Kentucky: A Community-Level Expansion Of The Green Dot Program, Chelsey Reid

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

College students in the United States are at risk for being impacted by interpersonal violence (IPV), a spectrum of violence that includes sexual assault, dating violence, domestic violence, and stalking, with 1 in 5 women and 1 in 16 men being impacted by victimization during their collegiate careers. Through enhanced approaches to primary prevention, including through active bystander training, research has identified evidence-based strategies for reducing IPV prevalence. In Kentucky, 10.1% of all women impacted by IPV are first victimized prior to 18-years-old and 12.4% of all completed rapes are either alcohol or drug-facilitated. In light of these cumulative data, …

Brief Intervention And Buprenorphine Initiation For Opioid Use Disorder In Northern Kentucky Emergency Departments, Cady Cornell

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

The opioid epidemic has had sweeping, devastating effects on the United States. Kentucky has the fifth highest overdose mortality rate in the nation and the Northern Kentucky counties, specifically Kenton and Campbell, have been especially affected. Their opioid overdose mortality rates are the third and fourth highest in the state, respectively. In order to contribute to ongoing Northern Kentucky community efforts to combat the opioid epidemic, St. Elizabeth Healthcare is proposing to implement The Brief Negotiation Interview (BNI) in our emergency departments in order to provide more comprehensive care. The BNI is a motivational interviewing strategy that has been combined …

Methods For Multiple Imputation By Chained Equations Accounting For Missingness: A Simulation Study, Nathaniel Wilson

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

Improper treatment of missing data can lead to biased or invalid results. If the data are missing at random (MAR), multiple imputation by chained equations (MICE) is one method utilized to reduce bias. When implementing MICE, the imputation model must be compatible with the final analysis model. We aim to show how to include interaction terms in the imputation model to ensure valid results are obtained. Data were simulated for one continuous outcome originating from two binary predictor variables and their interaction. Missingness was imposed via a MAR mechanism. To handle the missing data, four methods were performed: complete records …

Thyroid Function Screening & Dysfunction In Patients With Heart Failure: An Examination Of Practice At The University Of Kentucky Albert B. Chandler Hospital From 2007-2017, Alexandra Paige Hall

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

Introduction: Heart failure constitutes a global pandemic affecting at least 26 million globally (an estimated 5.7 million of which are Americans), and its burden on our healthcare system is projected to increase.[1] As a result, it is imperative that diagnostics and treatment among that population be evidence based in order to contain costs and optimize patient outcomes. Over the last 20 years, thyroid function screening has been recommended for patients upon initial diagnosis of heart failure by the American College of Cardiology and other professional organizations. However, it remains unclear whether this recommendation is followed by practitioners and how much …

A Comparison Of Pediatric Prevention Policies To Pediatric Health Supervision Codes, Rania Burke

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

The number of policy statements from the AAP presents pediatricians with an increasing amount of advice related to prevention, yet the definition of prevention and well-child visits has not changed for outpatient office visits. Outpatient office visits are the primary means by which preventive care is administered. The objective of this study is to quantify and characterize the prevention policy recommendations that pediatricians are expected to provide patients/guardians beyond the well-child visit. Secondarily, an analysis was completed to demonstrate which prevention policies make recommendations that can be coded for reimbursement as part of a well-child prevention visit.

METHODS The author …

Cost-Effectiveness Of A Weight Loss Intervention: An Adaptation Of The Look Ahead Lifestyle Intervention In The Us Military, Karina Manz

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

Objective: To assess whether a counselor-initiated adaptation (CI) of the Look AHEAD Intensive Lifestyle Intervention (ILI) in a military setting was cost-effective relative to a self- paced adaptation (SP).

Methods: We performed cost-effectiveness analysis from a payer perspective alongside a 2014- 2017 randomized behavioral weight loss trial among 248 active-duty military personnel stationed at a US Air Force Base in Texas. We calculated incremental cost-effectiveness ratios (ICERs) for weight loss, reductions in waist circumference, and quality-adjusted life years (QALYs).

Results: After 12 months, the CI adaptation cost more per participant compared to the SP adaptation ($1,081 vs. $120), but achieved …

School-Based Hpv9 Vaccination Clinic In The Cumberland Valley Area Development District Of Kentucky, Eryne Wirthorn

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

Human Papillomavirus (HPV) is a group of more than 150 virus that can cause genital warts and cancers of the oropharynx, cervix, vagina, vulva, penis, and anus. A preventive vaccine currently exists that protects against seven oncogenic HPV strands and two strands that cause genital warts. Current guidelines for HPV9 vaccination consist of a 2-dose series delivered at 0 and 6 months for males and females ages 9-14, and a 3-dose series delivered at 0, 2, and 6 months for those ages 15-26.

While up-to-date (UTD) vaccination rates have increased across the Unites States, in 2017, only about 52.4% of …

The Relationship Bewteen Noise Exposure And The Risk Of Occupational Injury Among Workers In Kentucky, Kenneth M. Alea

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

Objective: To examine for an association between the occurrence of work­ related trauma injuries in the state of Kentucky and occupational noise exposure.

Methods: Using the Kentucky Trauma Registry, work-related trauma injuries were identified between the years of 2013 and 2017. Subjects were assigned noise scores based on O*NET noise exposure data by occupational industry. Associations between the occurrence of occupationally-related injuries and noise scores were assessed using linear regression analysis.

Results: A total of 1,808 work-related traumatic injuries were identified from the trauma registry over the five years of data reviewed in the study. The majority of occupational injuries …

Association Between Pm2.5 And The Coexistence Of Chronic Obstructive Pulmonary Disease And Coronary Heart Disease, Shan Gao

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

Aim: To identify PM2.5 as a risk factor for chronic obstructive pulmonary disease (COPD) and coronary heart disease (CHD) respectively, and to explore the magnitude of the association of PM2.5 with the coexistence of CHD and COPD, by using the combined dataset of 1999-2014 EPA Air Data and 2017 BRFSS SMART data (age 18 and older).

Methods: Cross-sectional study was designed to identify the association between PM2.5 exposure and COPD and CHD. The PM2.5 exposure values were adapted from the county-level EPAAir Data, the yearly mean values of PM2.5 were used to determine the association. Characteristics of sex, age, race, …

Retrospective Policy Analysis Of Kentucky House Bill 1, Sarah E. B. Covey

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

Background: In 2011, the Centers for Disease Control (CDC) coined the phrase, “opioid epidemic” in response to the staggering increase in opioid use and opioid- related deaths. Kentucky House Bill 1 (HB1) passed in 2012, attempted to stifle the impact of the opioid epidemic on the citizens of the Commonwealth by imposing supply-side restrictions on the prescription and dispensing of opioid pills. Objective: The primary objective of this analysis is to evaluate the effectiveness of HB1 on the reduction of opioid-related deaths, opioid prescription rates, and intravenous opioid drug use rates. Methods: This analysis employed Eugene Bardach’s framework for policy …

A Cross Sectional Study Of Drinking Water Quality And Health Effects In The El Bua Tsáchila Community, Santo Domingo De Los Tsáchilas, Ecuador, Dannette Cook

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

Background: Access to clean water and sanitation is known to decrease childhood mortality, improve health outcomes, and decrease risk of water-borne diseases. However, access to clean water is often restricted in impoverished or indigenous communities. This cross-sectional study evaluated the primary source of drinking water for forty homes, the Est. Cheche river, a local spring, and a local school in the TsáChila indigenous community of El Bua, Santo Domingo, Ecuador. This analysis focused on the presence of coliforms and E. coli in the water source (well or city/piped), the physical parameters of the water and the type of sanitation …

Disparities In The Risk Of Subsequent Primary Cancer Diagnosis And Recurrence Among Women With Breast Cancer (First Primary) In Kentucky, Pierre Fwelo

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

Background and objectives

Breast cancer is one of the most common malignancies among women in the United States. Women residing in the state of Kentucky have breast cancer incidence and mortality rates greater than the national average. Recent studies suggest an association between breast cancer subtypes/hormone receptor (HR) status and the risk of recurrence and the onset of subsequent primary cancer, however, limited research has focused on Kentucky or its Appalachian region.

Investigating these associations may potentially save lives by providing information that can be used in breast cancer education in Kentucky, assessing the population at greater risk of recurrence …