Public Health Commons^™

A Program Evaluation Of A Colon Cancer Screening Program Using At-Home Fecal Immunochemical Tests With Certified Patient Navigators, Candace E. H. Brunk

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

Colorectal cancer is the second leading cause of cancer-related death in this country, but 33% of these deaths could be prevented by screening. While colonoscopy is an effective screening tool, it is expensive, invasive, and prone to encounter considerable patient resistance. An alternative is to first screen those at-risk using at-home fecal immunochemical test (FIT) kits. This study determined factors associated with the return of these kits distributed by Kentucky CancerLink, a non-profit organization, and its affiliates to participants in a colon cancer prevention program.

Objectives: To identify factors associated with: completing a FIT kit, completing the kit with minimal …

Epidemiology Of Young Adult Renal Cell Carcinoma In Kentucky: Incidence, Clinicopathologic Features, And Cancer-Specific Survival, Jason R. Bylund

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

Introduction:

Renal cell carcinoma (RCC) is an important cause of morbidity and mortality in our country. Previously reported data suggest that the overall incidence of RCC continues to rise and may be accelerating even faster among younger adult patients.

Methods:

Data for analysis included the combined NPCR-SEER USCS public use database and the Kentucky Cancer Registry dataset. Incidence rates and trends by age group and location were calculated and tested. Clinicopathologic features of disease among Kentucky cases were analyzed by age group. Cancer-specific survival (CSS) analysis was performed, along with Cox proportional hazards regression to test for association of younger …

Understanding The Silent Crisis: An Analysis Of Suicide Methods Among Kentucky Females, Charles Hamilton Rhea

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

Background: Suicide has been called the ‘silent crisis’. As rates have increased in recent years, it is now the 10th leading cause of death in the United States. Within the state of Kentucky, females die by suicide most often through the use of firearms, differing from the national trend where poisoning is most common. With a drastic increase in firearm suicides has been observed beginning in 2010. The aim of this study is to investigate why Kentucky females who have died by suicide are using firearms most often, as opposed to other methods, and compare those results to other states …

Association Between Reproductive Factors And Breast Cancer Subtypes: A Meta-Analysis, Xihua Mao

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

Introduction: Hormone-related reproductive factors have been reported to be associated with breast cancer subtypes. However, the direction and magnitude of these associations were inconsistent. Additionally, for breast cancer defined by estrogen receptor (ER) and progesterone receptor (PR): ER+PR+, ER+PR-, ER-PR+, and ER-PR- subtypes, no meta-analysis was available for ER+PR-and ER-PR+ subtypes. For ER+PR+ and ER-PR- subtypes, only a few reproductive risk factors have been examined in meta-analyses.

Methods: Primary studies published from 2011 to 2017 were retrieved from PubMed, Embase, and Scopus. Following PRISMA guidelines, a total of 98 eligible studies investigated the association between reproductive factors and breast cancer …

An Assessment Of Agreement In Detection Methods For Histophilus Somni In Bovine Lungs, Laura Michelle Arnold

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

Objectives: To examine the inter-laboratory agreement between multiplex realtime quantitative polymerase chain reaction (qPCR) assay results and aerobic culture results on bovine lung samples for detection of Histophilus somni (HS), and to assess associations of laboratory-derived factors on test agreement.

Methods: A survey of records from the University of Kentucky Veterinary Diagnostic Laboratory (UKVDL) was conducted to evaluate test results from grossly pneumonic bovine lung samples submitted during the period April 1, 2015 through August 31, 2018. Cohen’s kappa coefficient with 95% confidence interval (CI) was calculated to describe the extent of agreement. Animal, environmental and laboratory factors were examined …

“You’Re Not Alone In This”: Navigating Patients To Colorectal Cancer Screening In Appalachian Kentucky Communities, Audrey Bachman

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

In eastern Kentucky, some communities experience colorectal cancer (CRC) mortality rates as high as 25.9 deaths per 100,000 people as compared to the national rate of 14.8 deaths per 100,000 people (NCI, 2018; Kentucky Cancer Registry, 2018). Innovative screening mechanisms, coupled with patient navigation services, may be the key to increasing screening rates and preventing unnecessary deaths in the region. The current study focuses on the accounts of patient navigators (n = 9) to identify the essential ingredients for addressing barriers to CRC screening cited by Appalachian Kentucky patients. Using the core tenants of effective patient navigation programs (Freeman & …

The Impact Of Adjuvant Chemotherapy On Survival For Patients With Stage Ii Colon Cancer Portfolio, Li Ding

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

This capstone project describes the results of a consultative experience in biostatistics.

Reducing Depression And Suicide Ideation Among College Students, Andrew Ritzel

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

Suicide rates have been on the rise for the past 30 years; 42,773 Americans dying every year by suicide. Suicide is the tenth leading cause of death among all ages, but the second leading cause of death among Americans ages 15-24. College students traditionally fall within this age group, and are especially at risk for suicide due to stressful life conditions. The University of Kentucky, located centrally within Kentucky in the city of Lexington, is an ideal location for a suicide prevention intervention. Students demonstrated an increased rate of depression compared to the national population (15.13% of students surveyed reported …

Environmental Exposure To Atrazine And Birth Defects: An Ecological Study In Kentucky, 2005-2014, Maria Dimitrios Politis

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

Atrazine is one of the most widely used pesticides in the United States. Studies have shown that pesticides, in particular herbicides such as atrazine, may be associated with birth defects. The purpose of this study is to evaluate the association between potential environmental exposures to atrazine in water systems and prevalence rates of birth defects for the state of Kentucky. An ecological study using the Kentucky Birth Defects Registry Surveillance and the Kentucky Geological Survey databases from 2005 to 2014 was conducted. Poisson regression was used to estimate crude and adjusted rate ratios of the association between agricultural exposure metrics …

Implementing Counseling African Americans To Control Hypertension Intervention In Louisville Metro, Raven Robbins

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

Hypertension disproportionately affects Africans Americans more than their White counterparts. Counseling African Americans to Control Hypertension (CAATCH) is an intervention program that is targeted at African American adults to decrease uncontrolled hypertension. The CAATCH intervention has three components, which includes 1) computerized hypertension education, 2) at home blood pressure monitoring, and 3) behavioral counseling. The CAATCH intervention will be implemented in three sites in the northwest portion of Jefferson County in Louisville, KY. The overall goals of the CAATCH intervention are to decrease the number of participants who suffer from uncontrolled hypertension, increase knowledge of hypertension among participants, increase the …

The Financial Impact Of A Healthy Eating Intervention In A Government Worksite Cafeteria, Andrew M. Wheeler

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

Unhealthy eating habits are associated with a greater risk of obesity and many chronic diseases. Historically, public health nutrition interventions have focused on education of the individual to induce dietary behavior change. However, given that many factors influence food choices, more comprehensive interventions that address these multiple factors are needed. Worksite cafeterias provide a unique opportunity to intervene at multiple levels of influence on employees eating habits. In this paper we used cafeteria sales data to evaluate the changes in purchases and the financial impact of implementing a healthy eating intervention using an environmental change and various promotional efforts to …

Evaluation Of Anemia In Communities Served By Shoulder To Shoulder Global: A Cross-Sectional Study In Santo Domingo, Ecuador, Kevin Mercer

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

BACKGROUND: Shoulder to Shoulder Global (STSG) recognizes anemia as a cause of morbidity among patients in Santo Domingo, Ecuador. Little research has been done to assess targetable anemia risk factors to serve as a foundation for future pharmacotherapeutic interventions. This study sought to identify risk factors for anemia in this population.

METHODS: Data obtained from existing patient records from January 1, 2010 to August 31, 2016 included hemoglobin/hematocrit, age, sex, pregnancy status, and presenting community. Chi-square tests compared means to examine risk factors associated with anemia. Poisson regression and incidence rate ratios (IRR) were used to estimate risk factors associated …

Statistical Analysis Of Rabies Submissions In Kentucky And Weather As A Potential Predictor Of Positive Cases, Hannah Free

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

Background

The rabies virus is a zoonotic pathogen that is nearly 100 percent fatal once symptoms occur. Because it is still active in wildlife populations in Kentucky, the need for preventive measures and surveillance is critical. Temperature and precipitation have been shown to affect rabies. This study examined rabies submissions in Kentucky, weather and geographical distribution to both describe and predict cases.

Methods

Data from the University of Kentucky Veterinary Diagnostics laboratory were used to assess rabies submissions from 2005 through 2015. These submissions were anonymously submitted by the public and the Florescent Antibody Test was used to determine infection …

Evaluation Of Barriers For Small-Scale Fruit And Vegetable Growers In Kentucky, Amanda Schroeder Hege

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

The food system in the United States has witnessed significant challenges resulting in food security and safety concerns, environmental damage, economic distress, and a decline in our population’s health. While the last fifty years showed a drop in land and workforce dedicated to farming, industrialized farms are producing an overabundance of cheap corn that directly supplies inexpensive, unhealthy foods leading to American’s diets falling short of recommendations for good health, thus contributing to the obesity epidemic. This study utilizes an upstream approach to learn from farmers’ ability to grow good food that promotes healthy people, environments, and communities. Specifically, the …

The Relationship Between Access To Healthcare And Heart Disease Mortality In Kentucky, 2012-2014, Nima Farsi

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

Cardiovascular disease is the cause for a large portion of the mortalities in the United States. Furthermore, Kentucky has one of the highest heart disease mortality rates out of all 50 U.S. States. This study hypothesized that heart disease mortality in Kentucky counties has a positive relationship with lack of accessibility to healthcare. Furthermore, this ecological study hypothesized that because there is no available usual source of a healthcare providers and ultimately a lack of accessibility to receive diagnostic/preventative services for this population, the high rate of cardiovascular disease mortality in Kentucky is dependent on access to healthcare services.

This …

Consultation Experience In Public Health, Hannah Bellamy

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

The following portfolio is an overview of my consulting experience in public health. My experiences include making frequency tables, producing summary statistics, conducting Chi- Square and T-Test, and reproducing a demographics table. Working with investigators, I have conducted a power analysis for a pilot study, assisted with a study design consultation, used the Kappa coefficient to test for inter-rater reliability, presented survey results with answer distributions, and produced summary statistics for an investigator’s research poster.

Working in the Applied Statistics Laboratory and with investigators has taught me the process of consulting. It begins by meeting with an investigator and determining …

A Policy Analysis Of The Kupuna Caregivers Act: Addressing The Needs Of Working Caregivers In Hawaii, Emily S. Mccarthy

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

The primary purpose of this paper was to provide a policy analysis of the Kupuna Caregivers Act that was passed at the end of 2017 in Hawaii. This legislation provides a $70 daily voucher that working caregivers can use to hire long-term care services for their elderly loved ones. This type of assistance allows caregivers to stay in the workplace, alleviates the stress of caregiving, and assists them in securing their own financial futures. The number of people over the age of 65 will double in size over the next forty years, presenting a variety of long-term care challenges in …

Gabapentin Prescribing Practices Among Physicians: Clinical Indications And Reasoning, Lili Buzsaki

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

Gabapentin is an anticonvulsant and nerve pain medication with a variety of offlabel indications. There is at least some evidence that physicians have prescribed gabapentin to successfully treat several off-label conditions including alcohol dependence and withdrawal, brachioradial pruritus, chronic, refractory cough, diabetic neuropathy, fibromyalgia, hiccups (singultus), hot flashes, insomnia, neuropathic pain, adjunct therapy for postoperative pain, restless legs syndrome (RLS), anxiety disorders, and uremic pruritus.

An observational cross-sectional study was used to determine the various reallife off-label uses of gabapentin and physicians’ perspectives with regard to particular advantages over other drugs and interventions, via an online survey. In addition, a …

Identifying Veterans With Opioid Use Disorder That Could Benefit From Referral For Evidence-Based Medication-Assisted Treatment, Emily Hampton

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

Current treatment guideline recommendations published by the American Society of Addiction Medicine for Opioid Use Disorder (OUD) include both psychotherapy and Medication- Assisted Treatment for optimal management of this chronic medical illness. Military veterans are at an increased risk for fatal outcomes related to opioid overdoses due to a higher prevalence of depression/Post-Traumatic Stress Disorder (PTSD) and self-medicated substance use compared to their civilian counterparts. Additionally, many have been diagnosed with OUD but are not being treated in accordance with current treatment recommendations.

In an effort to increase access to treatment and combat the opioid epidemic, the Lexington VA Medical …

An Ecologic Study Of Access To Acute Stroke Care, Mortality And Its Correlates In The Stroke Belt, Jeffrey E. Levy

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

Importance: Stroke is leading cause of death in the United States, but quick access to treatment has been shown to result in better outcomes and improved mortality. Among the many barriers to access, geographic proximity to hospitals certified in stroke care may also play a role.

Objectives: To calculate county-level measures of accessibility to certified stroke hospitals using GIS, and to examine its relationship with county stroke mortality while controlling for other county-level potential confounders.

Methods: Ecologic study using county mortality rates and census data to recreate stroke death counts for use in traditional, and a geographically …

Impact Of Health Insurance And Sociodemographic Characteristics On Survival For Women Diagnosed With Breast Cancer In Kentucky, Pramila Rai

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

Introduction Objective of the study was to explore the impact of health insurance and socio-demographic factors on survival for breast cancer patients in Kentucky. Breast cancer is the most prevalent cancer among women in the US. Breast cancer survival is affected by various factors including health insurance, residence, age, race, geographical distance, income.

Methods The data were obtained from Kentucky Cancer Registry and included 47,128 women diagnosed with primary breast cancer between 2000 to 2014. The relationship of health insurance and other socio-demographic factors was analyzed using Cox regression.

ResultsThe overall five-year survival proportion was 0.97, 0.76 and 0.71 …

Characteristics Of Synchronous And Multiple Primary Ovarian Cancer Cases In Seer And Kentucky, Lauren Shelton

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

OBJECTIVES: The primary aim of this study was to investigate whether ovarian cancer patients in Kentucky are more likely to have multiple primary and synchronized primary cancers compared to Non-Kentucky SEER registry cancer patients. A secondary aim of the study was to determine if there are other factors that may be associated with an increased risk of having multiple primary and synchronized cancer as well as determining if having multiple primary and synchronous cancer diagnoses changes survival rates in ovarian cancer patients. Additionally, another objective was to identify the most frequently observed subsequent and synchronous cancers sites that are diagnosed …

Implementing The National Diabetes Prevention Program In Mason County, Kentucky, Cassandra Yelton

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

The National Diabetes Prevention Program (DPP) is sponsored by the Centers for Disease Control and Prevention (CDC). The program’s goal is to reduce the incidence of diabetes through dietary modification and physical activity. On one hand, the DPP is currently offered by various organizations through the country. On the other hand, the DPP is mostly unavailable in rural areas, especially the Diabetes Belt. The Diabetes Belt is in the eastern Appalachian region of the United States. People who live in this area of the country are more likely to develop diabetes than those who do not. Mason County, Kentucky has …

Wayne County Board Of Education Adaptation Of Love Notes Curriculum For Adolescent Pregnancy Prevention, Allison Shea Merritt

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

West Virginia has the 8^th highest rate of adolescent pregnancy in the United States and the rate in Wayne County is significantly higher. Adolescent pregnancies cause negative health outcomes for both the baby and the mother. Adolescent mothers are at an increased risk of anemia, preeclampsia, and preterm labor and babies born to adolescent mothers are more likely to have a low birth weight and to have cognitive impairment. To address this burden, the school board has decided to use the ADAPT-ITT framework on the evidence-based Love Notes adolescent pregnancy prevention curriculum to adapt it to be more culturally …

Community Of Hope: A Comprehensive Suicide Prevention Intervention At Mit, Kyra Patel

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

Suicide is the second leading cause of death for most age groups in the United States. The current rate of suicide among college students is 7.5 per 100,000 with the rate remaining fairly steady over the past 30 years. While the rate is lower on college campuses, compared to the general population ages 18-24, the issue is still much larger on a college campus due to suicide bereavement or the number of people affected and to what degree they were impacted. As of 2015, MIT (Massachusetts Institute of Technology) had the highest suicide of all reporting colleges. The primary objective …

Increasing Colorectal Cancer Screening In Kentucky’S Buffalo Trace Area Development District With A Mailed Fit Program, Carrie Anne Burt

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

This program involves a partnership among eight primary care clinics in the Buffalo Trace Area Development District (BTADD) of Kentucky and proposes implementing a mailed Fecal Immunochemical Test (FIT), or FIT Pack, program to increase colorectal cancer screening (CRCS) rates in this region. Mailing FIT tests to eligible patients is an evidence-­‐based program that has been shown to increase CRCS among patients included in studies. The program will occur at the clinic level. Clinics will mail FITs and information leaflets to patients based on patient eligibility criteria identified in clinic electronic health records. The program’s short-­‐term goals are to increase …

Microclinic International Social Network Behavioral Health Intervention In Mongolia, Kalli A. Beasley

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

Diabetes is a chronic communicable disease that is projected by 2030 to be the seventh leading cause of death worldwide. In Mongolia diabetes and cardiovascular disease are the number one reason for disability-adjusted life years and trends of diabetes is starting to be observed in the poorer populations. Diabetes in countries like Mongolia are extremely costly to treat using insulin, costing $200 USD per month while the average annual income sits only at $1,466.85 USD. Mongolia has a total population of 2,959,000 and half of its population resides in the capital city of Ulaanbaatar. 60% of residents in capital live …

The Use Of A Video-Based Intervention To Motivate Gay And Bisexual Men On Prep To Use Condoms, Ethan Cardwell

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

Based on need and available resources, gay and bisexual men who have sex with men (GBMSM) in the Castro neighborhood of San Francisco, California represent the target population for this intervention. Through funding by the Center for Disease Control the Strut Clinic in collaboration with the University of California Berkley is proposing a video-based intervention with the following SMART objectives.

Objective 1: Efficiently develop and integrate a video-based intervention in the Strut Clinic within the first six months of the funding cycle.

Objective 2: Sustain an increase of consistent condom use to 30% of participants and up to a 10% …

Reducing Stigma Associated With Mental Illness And Mental Health Treatment Services In Racial And Ethnic Minority College Students, Joseph Christodoulou

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

Depression and Suicide

Mental health is a determining factor in how individuals function throughout their daily lives, encompassing an individual’s physical, emotional, and social well-being (U.S. Department of Health and Human Services, 2013). Mental illnesses such as depression, hinder daily functioning and lead to a range of negative outcomes. These include increased risk of mortality from suicide, chronic diseases such as heart disease, other conditions/behaviors such as anxiety and substance use disorders, and high economic burden (Centers for Disease Control and Prevention, 2016b). Depression is a major contributor to disability and burden of disease in the U.S., contributing to 3.7% …

Prospective Policy Analysis Of The Kentucky Health Demonstration Waiver, Keahna Akins

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

In January 2018, the Centers for Medicare & Medicaid Services approved Kentucky’s Section 1115 Medicaid demonstration waiver, which gave the state approval to require work/community engagement as a condition of Medicaid eligibility, charge premiums of up to 4% household income, and add an incentive account for dental and vison services. The waiver projected nearly 100,000 fewer enrollees and $2.4 billion less in spending over the five-year demonstration period. Two days short of the waiver July 1st implementation date a federal judge ruled the waiver invalid. This finding held that the Health and Human Services Secretary’s judgement was arbitrary and capricious. …