Public Health Commons^™

The Impacts Of Recreational Marijuana Legalization On Colorado Policy Analysis On Amendment 64, Santhi Chilukuri

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

This report is a policy analysis on the impacts of Colorado’s Amendment 64. Marijuana is the most commonly used illicit drug in the U.S, and a Schedule 1 Drug under the federal government. Despite this, twenty-nine states and territories in the U.S. have legalized it for medicinal purposes; (Hanson NCSL, 2017) four of which legalized it for recreational purposes. (Hall & Lynskey, 2016) Medical Marijuana has been legal in Colorado since 2009; however, Amendment 64 was passed in 2012 which legalized the possession, retail sale, and purchase of marijuana to Colorado state residents 21 and over. Commercialization in retail stores …

Respiratory Function And Associated Risk Factors In The Kentucky Women’S Health Registry, Negash Amsalu

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

From the University of Kentucky Women’s Health Registry Database (KWHRD) a total of 1838 women were voluntarily asked to undergo Spirometric respiratory function tests. These women came to the clinic for various reasons. Various independent variables (risk factors) were also recorded for these women. Among these risk factors were: age, BMI, smoking status, asthmatic status, educational status and ethnicity.

The purpose of the study was to investigate whether any of the risk factors had significant impacts on women’s respiratory health. Appropriate categorizations were tabulated for each risk factor so that comparisons would be possible and easier. The motivation of the …

The Effects Of Improved Water And Sanitation Access On Under Five Child Diarrhea In Peru, April Ballard

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

Significance: Diseases related to poor or lack of access to clean water, sanitation, and hygiene negatively impact health, education, and development worldwide and cause millions of deaths in children each year. Health outcomes associated with lack of access to clean water and sanitation are under-evaluated.

Aim: To assess the effect of improved water and sanitation infrastructure development on child morbidity in Peru by investigating diarrhea in children under five years of age.

Methods: The child, family, and household data from the Peruvian Demographic and Health Surveys (DHS) were used to evaluate the association between access to water …

Association Between Cerebrovascular Pathology And Anti-Hypertensive Treatment In Diabetics, Gary Owen

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

Background

Dementia is a growing public health concern as the population ages. Vascular dementia is the second most common type of dementia behind Alzheimer’s, and is caused by cerebrovascular damage, such as infarcts and hemorrhages. As in systemic cardiovascular disease, diabetes and hypertension are leading risk factors for cerebrovascular pathology. Anti-hypertensive treatment (AHT), therefore, may have a role in preventing cerebrovascular damage.

Methods

A case-control study design was utilized to evaluate any association between AHT during life and cerebrovascular pathology in autopsy in diabetic participants from the National Alzheimer’s Coordinating Centers (NACC). Pathology outcomes included infarcts of various sizes and …

Compliance And Treatment Failure Of Hepatitis C With Direct-Acting Antivirals: A 2-Year Retrospective, Observational Study In Kentucky Medicaid Patients, Juequan Nie

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

Background: New generation Direct-acting antivirals (DAAs) for the treatment of chronic hepatitis C infection have been on the market for more than 3 years since late 2013. Whether these medications cure patients at the rates claimed in clinical trials is not clear. Furthermore, as compliance is known to affect treatment outcomes, DAAs compliance rate is worth studying.

Methods: We analyzed the association of social-demographic, DAA use, enrollment with Kentucky Medicaid Managed Care Organizations (MCOs) and comorbidities, and DAA compliance in 1128 Kentucky Medicaid members treated with DAAs between August 07, 2014 and August 06, 2016.

Results: Age, MCOs, liver fibrosis …

Do Numbers Matter? Comparing Single Homicide Followed By Suicide And Multiple Homicide Followed By Suicide Using The National Violent Death Reporting System, 2003-2012, Courtney Blondino

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

Introduction

Homicide-followed-by-suicide or homicide-suicides were examined to understand the dynamics of acting outwardly and inwardly violent in a single incident. The purpose of this study was to identify if specific circumstances had an association with the number of victims per homicidesuicide incident. This study addresses an important public health issue by encouraging an accurate viewpoint of homicide-suicide in order to properly program prevention efforts.

Methods

Using the restricted access data (RAD) from 17 National Violent Death Reporting System (NVDRS) states, we characterized 1904 homicide-suicide incidents through qualitative and quantitative analysis based on victim and suspect demographic information, method of injury, …

Smart Moves Bright Bodies: A Rural Adaptation To Combat Obesity Among African-American Teenagers In Wilcox And Lowndes Counties, Alabama, Nicole D. Fields

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

Obesity is a significant problem in the United States; however, it is a burgeoning epidemic among youth in the United States. As of 2016, Alabama is the second-most obese state in the nation¹ and 16% of Alabama adolescents are obese². While obesity is a significant problem across all ethnic groups, minorities bear a disproportionate burden in Alabama: one in five African-American adolescents is obese². This disproportionate burden is demonstrated in two Alabama counties: Wilcox and Lowndes. Both counties are predominately African-American and rank in the bottom ten counties, statewide, for overall health outcomes^9,14. …

Revamp It: Utilization Of Socioecological Approach To Combat Adolescent Obesity In Knott County, Kentucky, Jonathan Wang

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

The Kentucky River District Health Department proposes the implementation of REVAMP IT in four selected elementary schools in Knott County, Kentucky to improve subjective attitudes towards various aspects of health knowledge, physical activity, social support, and screen-time, as well as reduce biometrically measured television time and increased step count. REVAMP IT is an evidence-based program that utilizes the socioecological model of Public Health to target aspects of the individual, relational, and community level to facilitate changes from multiple aspects. Screen-time and physical activity goals will be individually set by students, and Knott County Elementary School teachers will be responsible for …

Construction Fatalities In Kentucky, Tennessee And West Virgina Between 2005 And 2014, Jacob Petrey

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

Background: The construction industry involves many hazards and accounts for the greatest number of work related fatalities in the United States. The objective of this study was to characterize the demographics of people involved in construction fatalities and the causes of these fatalities in Kentucky, Tennessee and West Virginia between 2005 and 2014.

Methods: The Bureau of Labor Statistics Census of Fatal Occupation Injuries (CFOI) was the source of data about the number of fatalities, rates and characteristics about fatalities for each state. The U.S. Census Bureau was also used to find the average annual construction population for each state …

Bridging Public Health And Clinical Practice: A Pilot Of The Cdc’S Stopping Elderly Accidents, Deaths, And Injuries (Steadi) Fall Risk Screening And Prevention Program In An Academic Medical Center Family And Community Medicine Clinic, Carolyn C. Shammas

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

Background: Fall-related morbidity and mortality in the older adult population is a pressing public health problem both nationally and in Kentucky, which has a fall rate above the national average. Implementation of the CDC’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) fall prevention program, offers an opportunity to effectively reduce falls, fall-related injuries and associated costs. The implementation process also serves to foster cooperative interdisciplinary and interdepartmental relationships within health care systems, and bridge public health and clinical practice.

Purpose:The capstone describes and evaluates a pilot of STEADI at the University of Kentucky’s Family and Community Medicine (UKFCM) …

A Population-Based Survival Analysis Of Mesothelioma And Smoking In Appalachian And Non-Appalachian Kentucky, Peter Van Wie

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

Mesothelioma is one of the most aggressive cancers in the United States and around the world, with a grim 5-year survival rate of only 8%. After diagnosis there is little that can be done to stop the progression of the disease. Smoking has been negatively associated with mesothelioma survival. This may be due to several factors including increased oxidative stress or sequestration of tobacco-related carcinogenic compounds by asbestos fibers trapped in the lung. This study investigated the association between smoking and mesothelioma survival in the Kentucky population. It examines the risk of living in the low socioeconomic region of Appalachian …

Implementing The Alive! Behavioral Intervention Program In Phillips County, Arkansas, Raeschell Williams

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

The Arkansas Department of Health proposes implementing the Alive! behavioral intervention program in Phillips County, Arkansas to decrease the prevalence of obesity in this community. Alive!, A Lifestyle Intervention Via Email, is an evidence-bases, email-derived, worksite intervention focused on reducing saturated fats, increasing fruit and vegetable intake, and increasing physical activity. As an email-based program, participants will receive weekly emails tailored to their individual goals with reminder emails delivered during the week with small-step goals to help the participant achieve their larger goal. As the country with the highest prevalence of obesity and second highest prevalence of obesity in 2014, …

Factors Associated With Large Vehicle Collision Fatalities From 2009-2015, An Assessment Of Factors Relevant To The 2014 Implementation Of The National Registry Of Certified Medical Examiners And Strategies For Driver Safety, Melinda L. Carol

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

OBJECTIVE: The Federal Motor Carrier Safety Administration (FMCSA) developed a National Registry of Certified Medical Examiners (NRCME) as a stride toward greater driver safety and public health. This retrospective, observational, cross-section study is intended to trend and analyze driver related factors that are pertinent to FMCSA certifying medical examination performed by NRCME providers in addition to driver behaviors and environmental factors from the years 2009 to 2015. The results of this study are intended to speculate the effectiveness of the NRCME and propose additional public health interventions aimed to reduce large vehicle fatalities.

METHODS: Data was extracted from …

Vaccine-Preventable Disease Surveillance In Kentucky, Katherine Jay

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

Background: Vaccine-preventable disease (VPD) surveillance is important component to the success of vaccines. This report examines the levels of 13 of these VPDs in the state of Kentucky from 2005 to 2015.

Methods: All reported cases in the state of Kentucky for the years 2005 to 2015 of 13 vaccine-preventable diseases were obtained from the Disease Surveillance Module (DSM) and the National Electronic Disease Surveillance System (NEDSS). Where enough cases were reported, descriptive statistics were prepared. For acute hepatitis B and pertussis, more thorough analysis was performed.

Results: Rates of acute hepatitis B in Kentucky from 2005 …

Shaping Our Appalachian Region (Soar): Beginning To Now, Samantha Zarycki

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

Introduction

Appalachian Kentucky has been and is currently facing difficult times including low employment rates, low education rates and less-than-favorable healthcare and health status for the people of the region (Estep, 2014). There have been multiple government and non-government agencies who have implemented interventions with the purpose of lifting up the region. Shaping Our Appalachian Region, or SOAR, is a bipartisan organization which began in 2013, and was established for the purpose of caring for the region.

Methods

A qualitative data analysis using confidential interviews with six people involved with SOAR was used for this project. Using the deductive approach …

Dusty Occupations And Pulmonary Obstruction In Kentucky: A Proportionate Mortality Analysis, Neil Bradford Horsley

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

Background

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States. Occupational exposure to vapors, gases, dusts, or fumes (VGDFs), in combination with smoking, significantly increases the risk of developing COPD. Amongst agricultural workers, exposure to pesticides has been found to cause significantly elevated rates of annual decline in lung function, ultimately leading to a clinical diagnosis of pulmonary obstruction if the period of exposure is sufficient.

Purpose

It is hypothesized that, when compared to the standard population, workers in “dusty” occupations (where VGDF workplace exposure is significant) die at significantly elevated rates from …

Hepatitis C Screening And Treatment Of Prisoners: Analysis Of Policy And Practice In Kentucky, Charity Faith Kranz

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

INTRODUCTION

The United States and the Commonwealth of Kentucky are currently overwhelmed by a triad of complex epidemics—incarceration, opioid overdose deaths secondary to substance use disorders, and hepatitis C. Research has suggested hepatitis C screening and treatment of prisoners may be a cost-effective strategy to address the hepatitis C epidemic. Since Kentucky has been particularly impacted by these interrelated health threats, further exploration of hepatitis C in Kentucky prison populations and their potential role in addressing these epidemics is warranted.

Primary Objective

The main goal of this research was to examine hepatitis C screening and treatment policy and practice within …

Validity Of The Public Health Accreditation Board’S Governance Measures, Badr Alnasser

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

Background. The dynamics through which governance operates and impacts performance has been the focus of scholars in recent years. This is also true in public health systems, where there is a growing tendency to understand governance mechanisms and dimensions, as illustrated in the Public Health Accreditation Board’s (PHAB’s) Domain 12, which tends to measure governance engagement in health departments. The development of Domain 12 standards and measures has undergone systematic revisions by subject matters and experts. However, there is still a need for a scientific approach to assess the validity of such measures, or examine whether they measure what …

The Effects Of Tobacco Policy On Tobacco Treatment In Psychiatric Institutions, Terrence A. Sharper Ii

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

Introduction: Tobacco use among those with mental illnesses is substantially higher than the general population. To avoid tobacco related comorbidities, tobacco policies are an important aspect for control of tobacco use, exposure, and to support tobacco treatment.

Aim: To conduct a systematic literature review of tobacco treatment policies in psychiatric institutions and examine the knowledge, availability of resources, and perceived barriers for treating tobacco use among managers.

Method: There were two main parts used to examine tobacco treatment policies in psychiatric facilities. First, a review of the literature summarized the effect of different tobacco-free policies on tobacco treatment delivery in …

An Assessment Of The Effectiveness Of Unannounced Safety Inspections Versus Announced Inspections In Academic Research Laboratories That Utilize Biological Hazards, Holley M. Trucks

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

Inspections are integral to comprehensive biosafety programs at academic research institutions that use a wide variety of infectious agents. However, there is no standardization of biosafety inspection procedures from institution to institution. This study analyzed results of 2,098 documented inspections conducted from January 2012 through December of 2016 performed by biosafety staff at a large Research I land grant institution in order to evaluate the effectiveness of an unannounced versus the more traditional announced approach to inspection procedure. Results demonstrated that: a) more findings were noted during unannounced inspections, therefore more accurately informing biosafety staff of the true day to …

Use Of Clonidine In Sedation Dentistry, Asma Kumar

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

Background:

Clonidine is an alpha-2 adrenergic agonist which has been used to treat hypertension for over 40 years. In October 2008, clonidine was approved by the FDA for use as a premedication agent prior to sedation. The overall goal of this study is to determine if clonidine can be used as a pre- operative sedative agent in moderate sedation dentistry and if so, what should be considered a safe level.

The following specific aims were established for this study:

1. To determine whether patients receiving clonidine required less intravenous medications.
2. To determine if clonidine can lower blood pressure and pulse to …

Hepatocellular Carcinoma Among Kentencky Residents From 1995 To 2011: Risk Factors For Late-Stage Diagnosis And Survivability, Zilahatou B. Tohon

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

Introduction: Hepatocellular carcinoma incidence and mortality rates are the rise in the United States and in Kentucky as well. According to the National Cancer Institute, there will be an estimated 40,710 new cases of liver and intrahepatic bile duct cancer and 28,920 deaths in 2017, with than 20% of 5-years survivors ¹. The numbers of new cases expected by year 2030 is 37,574 ². The aim of this capstone is to assess the risk factors of late-stage diagnosis and survivability in Kentucky.

Methods: A combined dataset from the Kentucky Cancer Registry and the Behavioral Risk Factor Surveillance System …

Evaluation Of Guideline-Recommended Combined Antiretroviral Treatment Regimens In Commercially-Insured Patients Living In The United States Between 2007 And 2009, Joye Brigitte Allen

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

Background: Randomized clinical trials of combination antiretroviral therapy (cART) inform the use of specific antiretrovirals (ARV) and their combination for optimizing therapeutic efficacy. It is critical that patients have access to and receive the most appropriate first-line treatment.

Objective: To examine factors that impact receiving initial guideline-recommended cART within a cohort of commercially insured patients in the United States (US)

Research Design: A population based cohort study.

Data Sources: A secondary administrative insurance claims database.

Subjects: Employed, commercially insured individuals with HIV who were continuously eligible for insurance coverage from January 2007 through December 2009 and received a new ARV …

Undiagnosed Pulmonary Obstruction And Restriction And Dust Exposure: Pilot Investigations Examining The Relationship Among Agricultural Workers, Caroline E. Holsinger

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

Chronic obstructive pulmonary disease (COPD) is a progressive disease that is characterized by limited airflow.1 In the United States (U.S.) alone, COPD is the third leading cause of death.2,3 While smoking remains the strongest risk factor for COPD, 20 percent of patients who die from COPD have never smoked.5–7 The American Thoracic 3 Society showed that about 15% of COPD cases might be attributable to workplace exposure.8 Agricultural dust exposure has long been recognized as a cause of decreased respiratory function, and exposures to both forms of dust may exacerbate other important risk factors of COPD and lead to the …

An Assessment Of Workplace Injury In Kentucky’S Commercial Logging Industry, Logan Ray

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

Objective: To identify demographic, operational, and task-related characteristics associated with increased frequency and severity of injury in Kentucky’s commercial loggers.

Methods: Kentucky Master Loggers attending mandatory continued education courses completed a survey tool eliciting demographic and operational characteristics of their companies, and details of any on-site injury in the years 2012 through 2015 that led to medical costs, lost days or time, and/or decreased production. Associations to injury frequency and injury severity were assessed using logistic regression analysis.

Results: 86 Kentucky Master Loggers representing 66 of Kentucky’s 120 counties reported 33 accounts of non-fatal logging injury. Master Loggers were full-time …

Cross Sectional Analysis Of Patients With Alpha-1 Antitrypsin Deficiency Enrolled In A Disease Management And Prevention Program, Jordan T. Perkins

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

Background: Alpha-1 antitrypsin deficiency is a heritable genetic condition that is largely underdiagnosed and has been estimated to affect 1 out of every 5,000-7,000 people in North America. The condition is characterized by a decrease in the production or activity of the alpha-1 antitrypsin protein, increasing risk for chronic lung or liver inflammation, that may lead to disease. Currently, there is no cure for the condition and augmentation therapy, which replaces the lost protein, has shown mixed results, meaning preventive measures taken by the patient are a large component of the prescribed treatment. Thus, patients with the condition are strongly …

The Association Between Latent Tuberculosis Infection And Diabetes Mellitus Control In The United States, Whitney L. Remy

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

Rationale: Diabetes mellitus (DM) is recognized as a common comorbid condition for tuberculosis (TB). Those with comorbid conditions are more likely to develop active TB, to have trouble with treatment, and to have more severe symptoms.

Objective: To measure the prevalence and distribution of latent tuberculosis infection (LTBI) and DM control in the United State and test their association when measured by tuberculin skin test (TST) or QuantiFERON®-TB Gold In-Tube blood test (QFT-GIT) and by HbA1c, respectively. Literature Review: One-third of the world population is infected with TB. Ten percent of TB cases worldwide are linked to diabetes mellitus. Studies …

Occupational Risks For Recent Asthma Episodes Among Adults, Molly Reese

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

Objective

Asthma affects more than 37 million Americans at some point in their lives, making it one of the most common, but costly chronic conditions. There are many known risk factors for asthma, but additional research on environmental and occupational factors is needed to better understand the association between these variables and asthma. This study investigates the associations between occupational exposures and asthma episodes among adults.

Methods

Data was obtained from the 2011-2013 Behavioral Risk Factor Surveillance System (BRFSS) Asthma Call-back Survey for adults. There was a final study population of 11,408 participants after the exclusion criteria were applied. The …

The Link Between Smoking, Lung Cancer And Socioeconomic Factors In Kentucky, Shreya Berlia

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

Background and Purpose

Lung cancer is the leading cause of cancer death and the second most diagnosed cancer in both men and women in the United States. An estimated 158,080 deaths from lung cancer are expected to occur in 2016, which will account for approximately 1 in 4 of all cancer deaths. The 1- and 5-year relative survival rates for lung cancer are 44% and 17%, respectively. The incidence rate for lung cancer has been declining since the mid-1980s in men, but only since the mid-2000s in women. Tobacco smoke is the leading cause of preventable disease and death in …

Quality Improvement In The Department Of Family And Community Medicine At The University Of Kentucky, Manisha Vasishta

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

The purpose of this capstone project is to analyze the quality improvement data that was collected in order to increase the pediatric population at the University of Kentucky Department of Family and Community Medicine clinic at Turfland. There were three different patient populations that were surveyed: reproductive aged women between 18 and 40, parents of the pediatric population that the clinic saw between July 2014 and June 2015, and pregnant women between July 2014 and June 2015. The results show that continuity of care and not being able to see the provider of choice were some of the weaknesses that …