Public Health Commons^™

The Effect Of Rescheduling Of Hydrocodone On Prescription Writing Among University Of Kentucky Dentists, Robert Taylor

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

Opioid abuse has become a public health crisis over the last two decades. Hydrocodone is the most frequently prescribed opioid to patients whose deaths are related to prescription drug abuse. On October 6, 2014, Federal law changed hydrocodone, an opioid-based analgesic, from Schedule III to Schedule II. This limits the number of ways it can be prescribed, including eliminating refills. This study examined hydrocodone and oxycodone prescriptions written across all dental clinics associated with the University of Kentucky College of Dentistry and analyzed three different dental disciplines that perform procedures that require pain management. Prescription data was obtained through axiUm, …

Impact Of The School Health Innovations Grant Act On Healthcare Access, Outcomes, And Cost In The District Of Columbia, Robert West

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

This paper provided a prospective policy analysis of the Washington, D.C. School Health Innovations Grant Act. This act establishes a grant program to facilitate the formation of school-based telehealth centers to provide mental health services to District school children. The purpose of this act is to improve access to mental health services for children, especially children in disadvantaged populations, such as those low-income, predominantly African American neighborhoods in eastern Washington, D.C., where a high burden of need is compounded by a shortage of health professionals.

This analysis was guided by the Bardach framework of policy analysis. The various factors affecting …

Influence Of Depression On Treatment And Survival: A Population-Based Study In Patients With Breast Cancer In Kentucky, Feitong Lei

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

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

Estimating The Effects Of Z-Drugs On The Risk Of Cognitive Impairment, Xuan Zhang

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

Background: Dementia and sleep disorders are two significant health problems in older adults. Studies suggest that sleep disorders and their treatment might associate with the risk of dementia. Z-drugs are one of the most widely used prescription hypnosedatives in the United States (US) for insomnia in addition to benzodiazepines (BZDs). Studies have shown that BZDs are associated with dementia among senior users. Study Aim: The purpose of this study is to evaluate the association between Z-drug initiation and cognitive impairment among the elderly in the US. Study Design and Data Source: We conducted a retrospective cohort study with a new …

Bronchiolitis In The Bluegrass: Epidemiology, Disease Burden And Resource Utilization At Kentucky Children’S Hospital, Ashwin Krishna

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

Background: Every year Kentucky Children’s Hospital (KCH) admits infants and toddlers with respiratory disease due to viral bronchiolitis. This disease is characterized by viral-induced inflammation and edema of the lower airways. The resulting disease is characterized by increasing mucus production, acute bronchospasm, necrosis of the respiratory epithelium and functional obstructive lung disease. Patients usually present with symptoms consistent with an upper respiratory tract infection, but can progress to marked respiratory distress and ultimately respiratory failure, as well as poor oral intake and dehydration. While Respiratory Syncytial Virus (RSV) is the pathogen classically described cause of viral bronchiolitis, other viruses have …

Modeling The Impact Of 13rs-Hb358: Hpv Vaccination For School Entry In A High-Prevalence State, Stacy Lee Ware

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

Prophylactic cancer vaccination presents novel opportunities to improve the health and well-being of populations. Since the approval of a cervical cancer vaccine against human papillomavirus (HPV) in 2006, only three states have passed legislation adding it to their school-entry schedules of required vaccinations. Despite ample evidence of its safety and efficacy, the vaccine remains controversial, and national vaccination rates among both girls and boys remain low. Risk for HPV-related cancers varies by population, and Appalachian Kentucky has among the highest HPV-related morbidity and mortality in the nation. Annual attempts to pass HPV vaccine legislation in Kentucky have so far failed …

Commercial Driver License Examinees’ Misreport On Their Federal Motor Carrier Safety Administration Certification Evaluation, Adam Pascoe

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

Commercial Driver’s License (CDL) examinees report their medical history during their Federal Motors Carriers Safety Administration (FMCSA) medical certification exams ≤2 years. When the examinees report diagnoses which may impact the control and operation of commercial motor vehicles (CMV), they face scrutiny with decreased medical certification or may be Adam PascoePascoe Page 2 7/18/2018 considered unfit to control and operate a CMV. Medical examiners may have access to the examinees’ electric medical records (EMRs) to generate a deeper appreciation, independent from the examinees’ self-report, of their risk for sudden and/or gradual incapacitation. We do not know how often diagnoses are …

Latino Worker Reported Respiratory Symptoms And Stall Bedding On Thoroughbred Horse Farms, Lacy Jinks

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

Objective: The purpose of this study is to assess the association between self-reported respiratory symptoms in Latino workers and bedding type used in stalls on thoroughbred horse farms.

Methods: Self-reported community-based questionnaire data from 225 Latino horse farm workers in the southeastern US collected from October 2013-April 2014 were used to investigate associations between upper and lower respiratory symptom prevalence and the type of bedding used in stalls (straw, sawdust, or straw plus wood shavings or sawdust). Analysis was performed by chi-square to compare frequencies of symptoms and demographic and exposure risk factors. Logistic regression was used to adjust …

An Evaluation Of The Mpowerment Evidence-Based Program In Congruence With Chicago-Specific Mobile App On Reducing Hiv Transmission And Acquisition, Katelyn Elizabeth Mason

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

Black Men who have sex with Men are at higher risk of contracting HIV than other populations, and thus require programs that focus of their need. Chicago, Illinois has incidence and prevalence rates 3 times higher than the national average, with a large burden of the disease falling on BMSM. Mpowerment is an evidence-based intervention that utilizes formal and informal meetings at a home base and local venues, and has found promising effects in reducing unprotected anal intercourse. Mobile applications have also shown promise in increasing adherence, and will be adapted into the Mpowerment program to create a High Impact …

Sociodemographic And Clinical Predictors Of Triple Negative Breast Cancer, Madison Ries

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

Background and Objectives

Breast cancer has the highest incidence rates among women and is the second leading cause of death due to cancer in women. Of all breast cancers, triple negative breast cancer (TNBC) accounts for about one-fifth of breast cancer and tends to result in an aggressive form with larger tumors and rates of metastasis and is more frequently found in younger women. This results in an important need in information regarding the risk of diagnosis with triple negative breast cancer over other forms and covariates associated with death and TNBC. This paper studies the relationship between race, tobacco …

The Role Of Stress In The Relationship Between Shift Worked And Hypertension, Madison Liford

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

Purpose: Individuals working non-daytime shifts have been reported to have an increased risk for many negative health outcomes, including poor cardiovascular health. This study aims to examine the relationship between shift worked and hypertension—a major risk factor for cardiovascular disease. Of particular interest in this study was the role of stress and type of shift worked (day, evening, night, or rotating) in this relationship.

Methods: The study utilized National Health and Nutrition Examination Survey data collected between 2005 and 2010. The study population was limited to adult workers 20 years of age and older (n=9356). Initial descriptive statistics of …

Malignant Melanoma In Kentucky: An Analysis Of The Individual And Social Factors On Disease Stage And Treatment, Virginia Valentin

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

Introduction: In 2016 there will be an estimated 76,380 new cases of malignant melanoma and 10,130 deaths in the United States (US). ¹ Malignant melanoma incidence is increasing faster than any other preventable cancer in the US with an expected 112,000 new cases a year by 2030. ^2,3 This capstone attempts to quantify the association of individual and social factors on melanoma late-stage diagnosis and non-adherence to surgical treatment guidelines for early-stage lesions in Kentucky.

Methods: The analysis combines three datasets: individual level data from the Kentucky Cancer Registry, census tract level data from the US Census and …

A Diabetes-Free Breathitt County: Implementation Of The National Diabetes Prevention Program In Pharmacies, Urvi Patel

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

The National Diabetes Prevention Program (NDPP) is a primary prevention program endorsed by the Centers for Disease Control and Prevention (CDC). The program’s purpose is to promote dietary modification and physical activity to reduce the incidence of diabetes. NDPP is currently offered by national organizations such as the Young Men’s Christian Association and Weight Watchers. However, NDPP is not commonly available in geographic areas that are in the most need of such preventive health programming such as rural communities. One such area where NDPP is not widely offered is the Diabetes Belt, an area within the Appalachian region of the …

Planet Health: A School-Based Health Promotion Program, Jane Katherine Landon

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

The Kentucky River District Health Department (KRDHD) proposes implementation of Planet Health, a school-based intervention aimed at increasing healthful nutrition and fitness behaviors in middle- and high-school aged students. Planet Health’s core messaging (increasing fruit and vegetable intake, increasing physical activity, decreasing screen time, decreasing sugar-sweetened beverage and trans-fat intake) contributes to our long-term goal of decreasing childhood obesity in our service area. Planet Health will be offered to 3 counties in our service area (Lee, Letcher and Wolfe) with planned expansion to all counties in the KRDHD service area within 5 years of the original pilot. This project will …

Spatio-Temporal Analysis Of Childhood Retinoblastoma And Cns Tumors In Kentucky, From 1995 Through 2014, Jennifer A. Khoury

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

Objectives

Childhood cancer poses a significant public health burden, both globally and in the United States (US). The most common childhood cancers affect the brain and central nervous system (CNS). Age-adjusted childhood brain tumor (CBT) incidence rates in Kentucky are larger than in the rest of the US; these rates are also higher in Appalachian Kentucky than in the rest of the state. This study determined if high-rate clusters of either CNS tumor or retinoblastoma existed in Kentucky.

Methods

Data for this study were retrieved from the Kentucky Cancer Registry for the years 1995 through 2014. Cases were individuals between …

All 4 Hardin County Freshman!, Cortney Lynn Gandy

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

Within this application for funding the Lincoln Trail Health Department proposes an evidenced based intervention for implementation into two high schools in the Hardin County with the long term goals of decreasing the rate of sexually transmitted infections in the county. The LTHD based in Elizabethtown, Kentucky services six counties in central Kentucky. The community health needs assessment and community health improvement plans for the county highlighted the problem of sexually transmitted infections in the community. The Centers for Disease Control also produces data about the higher rate of STIs in Hardin county in respect to Kentucky and the US …

Evaluating The Relationship Between Diabetes And Menstrual Cycle Irregularities, Kailyn Leanne Conner

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

Purpose. To evaluate the relationship between menstrual cycle irregularity and several key variables, and to determine whether the odds of diabetic women self-reporting menstrual cycle irregularities is greater than non-diabetic women self-reporting menstrual cycle irregularities.

Methods. A cross-sectional study was conducted using data from the Kentucky Women’s Health Registry from 2006 to 2014. The data was restricted based on age (used as a proxy for menopause status) and self-reported pregnancy and breastfeeding status, as well as eligibility to menstruate, yielding a final population of 4,256 participants for analysis. Basic statistical frequency analyses were conducted, stratified by menstrual cycle …

Cadmium Exposure And Residence-To-Road Proximity In Eastern Kentucky, Ellen Flora

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

Background and Objectives

Cadmium is a carcinogenic and toxic metal. The general population can be exposed to cadmium from multiple sources. The purpose of this study is to evaluate the association of urinary cadmium and residence distance-to-road by performing landscape analyses in eastern Kentucky, a region where smoking prevalence is high, coal production has been a primary industry, and the landscape is predominantly undeveloped. Composite dust samples were also collected and analyzed for Cadmium (Cd), Manganese (Mn), and Zinc (Zn). The primary objective of this study is to ascertain if there is an association between participants with elevated accumulated cadmium …

Filling The Gap In Obesity Prevention: Implementation Of The General’S Activity Program (Gap) In Carroll County, Kentucky, Brent Emerson

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

As obesity rates continue to rise, there is a significant need for public health programs that are able to effectively increase physical activity at the community level. Regular physical activity can help reduce the risk of negative health outcomes associated with obesity including cardiovascular disease, type 2 diabetes, and some forms of cancer while also strengthening muscles, improving mental health and mood, and increasing average life expectancy. Previous research has supported that one way to increase physical activity at the community level is through social marketing of state and local parks. Through the promotion of parks, community residents are able …

A Comprehensive Multi-Level Approach To Increasing Hpv Vaccination Rates In Rural Kentucky, Jim Weygandt

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

The Graves County Health Department (GCHD) proposes implementation of a multi-level approach to increase Human Papillomavirus (HPV) vaccination rates in Graves County, KY. The approach utilizes multiple evidence-based strategies, including Assessment, Feedback, Incentive, Exchange (AFIX), Vaccines for Children (VFC), Kentucky Immunization Registry (KIR), Comprehensive Clinic Assessment Application (CoCASA), and vaccines per protocol. This proposed project utilizes family medicine and pediatric clinics, pharmacies, and school nurses to deliver the intervention to the target population, which includes 11-12-year-old adolescents residing in Graves County. The objectives of this HPV vaccination-focused intervention align with Healthy People 2020 goals and objectives, the 2012-2013 President’s Cancer …

A Retrospective Analysis Of Open Burning Activity In Kentucky, Jeffrey Scott Blakeman

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

Objectives: To 1) summarize open burning activity observed by the Kentucky Division for Air Quality for a 12-month period and to 2) Identify distinguishing factors of areas having “high” levels of observed open burning compared to areas with “low” levels of open burning.

Methods: Data was collected by performing a records review of open burning investigation documents for the 554 investigation site visits performed by KY DAQ for the time period of January 1, 2015 through December 31, 2015.

Results: The average number of site visits per county was 4.66 visits. The source material with the highest …

Risk Factors For Self Reported Health Status In The National Health Interview Survey, Kayla Rhea Talbott

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

Purpose: The aim of this study was to gain a better understanding of how individuals view and analyze their health by evaluating the relationship between self-reported health (SRH) status and several variables representing health and lifestyle characteristics. Assessing the ability of self-reported health status to measure overall health was an additional objective of the study.

Methods: A secondary, cross-sectional study was conducted using information from the 2014 National Health Interview Survey for adults 18 and older. Data were stratified and compared based on a self-rated health status of either excellent or very good, good, or fair and poor, …

Spatial Distribution Of Partner-Seeking Men Who Have Sex With Men (Msm): An Epidemiologic Study Using Msm Geosocial Networking Applications, Angel Blake Algarin

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

Background: Geosocial networking (GSN) applications (apps) have made finding sexual partners easier for partner-seeking MSM, raising challenges for HIV/STI prevention but also providing opportunities for research. To date, little is known about app usage in smaller cities where there may be more stigma surrounding MSM.

Objective: This study uses GSN apps to identify areas with high density partner-seeking MSM, and to characterize these areas using Census block group demographic measures in a Southern mid-sized city.

Methods: Data collection points (n=62) were spaced in two-mile increments along nine routes (112 miles) covering the area. At each point, staff …

Implementing The Family Check-Up Program To Prevent Initiation Of Opioid Misuse Among Sixth Graders In Pike County, Kentucky, Emily Edmiston

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

The availability of prescriptions for opioids has been increasing since 1996. This type of drug is commonly misused by adolescents ages 12 to 17, making the trends in availability particularly alarming. Adolescence is a crucial point initiation of several risk behaviors, including substance use. During this time, parental monitoring, or awareness of the child’s activities and communication about those activities, is incredibly important for prevention of those risk behaviors. Despite this importance, parental monitoring behaviors often slip during this time. To help strengthen family management and communication leading into adolescence, the Pike County Health Department (PCHD)is proposing the implementation of …

Breathe Easy Mississippi, Christian Rashad Campbell

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

Asthma disproportionately affects rural minority children and is the leading reason for all school absences in our nation. Breathe Easy Mississippi is a multi-level intervention designed to improve long term control of asthma in youth. Breathe Easy Mississippi components include: 1) Home Visits by asthma counselors to identify asthma triggers and remediate the child’s environment, and 2) School Based Curriculum (Asthma Education) to promote ideal asthma management knowledge and foster more effective relationships between children, parents, healthcare professionals and paraprofessionals. Breathe Easy Mississippi will be implemented in a total of six schools that make up the entire elementary school district …

Using Structural Equation Modeling To Predict Orofacial Pain-Related Outcomes, Marcia Vanessa Rojas-Ramirez

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

Objectives: To test if the structure of a proposed theoretical model comprised of specific observed variables clustered to measure three latent variables of anxiety, depression, and fatigue exhibited good global fit with the observed data and had adequate reliability using confirmatory factor analysis (CFA). A secondary objective was to use structural equation modeling (SEM) to test the direct effect of the latent variables of depression, anxiety, and fatigue on orofacial pain outcomes.

Methods: Subjects were evaluated and treated at an orofacial pain clinic between 2009 and 2014. Those who completed a battery of psychosocial and pain-related questionnaires were …

Resources And Well-Being In Amyotrophic Lateral Sclerosis Patients And Caregivers: A Longitudinal, Dyadic Analysis, Suzanne C. Segerstrom

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

Socioemotional selectivity theory predicts that as the end of life approaches, resources that provide immediate, hedonic reward become more important and resources that provide delayed rewards become less important. The present study tested the theory in the context of marital dyads in which one partner had been diagnosed with amyotrophic lateral sclerosis (ALS), a terminal disease. ALS patients (N = 102) and their spouses (N = 100) reported their loneliness, financial worry, and psychological health every 3 months for up to 18 months. In multilevel dyadic models, patients and spouses had similar levels of financial worry and loneliness, but spouses’ …

Diagnostic Prevalence Of Diabetes Among Older Adults In Rural Appalachia, Gabriella Hodges

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

Background

The rural, mountainous Appalachian region continuously has poorer health outcomes than the rest of the United States. This is true for many chronic diseases including diabetes: the 7th leading cause of death in the United States. This study assessed differences in the prevalence of diagnosed diabetes between older adults in rural, Appalachian counties and rural, non- Appalachian counties.

Methods

Data for the year 2013 was extracted from the Centers for Medicare and Medicaid Services (CMS) Public Use Files for Medicare beneficiaries (September 2015), which provides county level prevalence for diabetes as well as several other conditions among Medicare fee-for-service …

Community Based Sexual Education In Hamilton County Ohio, Jennifer Winbigler

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

This project proposes the implementation of a community-based sexual education program in Hamilton County Ohio. The proposed program is Focus on Youth + ImPACT. FOY + ImPACT is an evidenced based intervention focused on providing knowledge and skill based education to both youth (during FOY sessions) and parents (during the ImPACT session). The educational program will be implemented at three sites: the Boys and Girls Club of Greater Cincinnati, Lighthouse Youth Services, and Caracole. Each site was selected for its current infrastructure conducive to youth programming. This included ease of access to youth as well as experience in the provision …

Addressing Barriers To Hepatitis C Treatment Initiation In Kentucky Clinic, Moaz Abdelwadoud

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

Introduction. Hepatitis C virus (HCV) is the most prevalent blood borne infection in the United States and its chronic infection has a high burden on the American healthcare system. Since 2014, the all-oral Directly Acting Antiviral (DAA)-based therapy has been established as the standardized curative treatment for HCV with unprecedented high effectiveness and tolerability. Nevertheless, there is a significant gap between the promise from DAAs benefits and the treatment initiation rates in the United States and Kentucky.

Objectives. The goal of this study is to improve the access to the all-oral DAA-based treatment among HCV patients seeking outpatient …