Public Health Commons^™

Behavioral Modification Program To Control Obesity Among School Children In Knott County, Kentucky, Samjhana Shakya

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

Childhood obesity is one of the major public health concerns in the United States (US). Obese children have a greater likelihood of developing cardiovascular disease risk factors such as high blood pressure and cholesterol, and impaired blood glucose[7].The prevalence of obesity among children 2 to 5 years of age in Kentucky was 15.7% (US average 8.4%) and 17.6% (US average 17%) among adolescents in Kentucky being higher than the national averages [8,3].

A major goal of the Behavioral Modification Program is to promote healthy behaviors among elementary school children to control obesity by modifying eating, physical activity and screen time …

The Impact Of An Ambulatory Clinical Intervention On Viral Load Suppression And Retention In Care For Newly Diagnosed Hiv Persons, Latasha R. Jones

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

Ambulatory clinical healthcare settings that serve patients infected with the human immunodeficiency virus (HIV) are critical in improving access to quality HIV care and treatment, in part due to their ability to streamline patient care along the HIV care continuum. Barriers to HIV care are significant among newly diagnosed HIV patients and in order to engage and retain these individuals in care and treatment, specific interventions must be in place to link these individuals to care. In this study, the difference in differences method was used for data analysis to measure the impact of an ambulatory clinics intervention on their …

Access For Adolescents: Multisystemic Therapy In The Juvenile Justice System, Meagan Pilar

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

In this application for funding, DC YouthLink, a non-profit organization that connects adolescents in the juvenile justice system to community resources, proposes to implement an evidence-based mental health intervention into the juvenile justice system in Washington D.C. The Director of DC YouthLink will serve as the Principal Investigator for this pilot program; she, along with five trained staff members, will be responsible for implementing multisystemic therapy (MST), an intensive form of therapy designed specifically for at-risk youth and their families. We propose to intervene at three main stages of the juvenile justice system— intake, correctional placement/probation supervision, and reentry. The …

Enough Smoke: Implementation Of An Evidence-Based Smoking Cessation Program In Owsley County, Kentucky, Meghan Fay Johnson

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

In 1964, the first United States (U.S.) Surgeon General’s Report explicitly stating the dangers of smoking, including an increased risk of lung cancer, was released. Fifty years later, the U.S. continues to carry the significant health and economic burdens for failing to heed this public health warning. Owsley County, Kentucky, located in the heart of the Appalachian is one of the most impoverished and medically underserved counties in the U.S., ranking last in almost every category of overall health outcomes in the state. The county is also entirely rural, with no major cities within an 80-mile radius. In every health …

Focas Appalachia: A Cervical Cancer Prevention Program For The Women Of The Kentucky River Area Development District, Chrisanthi M. Masero

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

In response to the National Institute of Health’s (NIH) funding announcement, the Kentucky River District Health Department (KRDHD) proposes to implement an evidence-based cervical cancer prevention program in the Kentucky River Area Development District (KRADD) in southeastern Appalachian Kentucky. The proposed evidence-based program was part of the National Cancer Institute’s (NCI) “Public Health Approaches to Breast and Cervical Cancer” research initiative and is one of nine cervical cancer Research Tested Intervention Programs (RTIPs) on the NCI’s RTIP database. The Forsyth County Cancer Screening Project (FoCaS) was designed to improve the beliefs, attitudes, and behaviors regarding breast and cervical cancer screening …

Risk Factors Associated With Severe Injuries In Inland Aquaculture Farms, Amah Martin

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

Objective: The main objective of this study was to analyze risk factors associated with severe occupational injuries among inland aquaculture farms.

Methods: Survey results were compiled in a data set that consisted of qualitative data from 51 farmers who were interviewed between 2008 and 2011 in 10 states and the Canadian province of British Columbia. Chi-square and Fisher’s exact test were used to assess the differences in the dichotomous level of severity among several farm and injury variables. Logistic regression was used to predict the outcome of a severe injury event.

Results: Injury observations that indicated the use of raceway …

Local Health Department Choice In The Provision Of Cancer And Cardiovascular Disease Screening, Georgianne Tiu

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

Clinical preventive services, such as cancer and cardiovascular (CVD) disease screenings are critical components essential for reaching optimal population health outcomes. Although clinical preventive services are recognized to save lives, roughly three-fourths of adults between the ages of 50 and 64 and over 50% of adults aged 65 years and older forego clinical preventive services. Private medical practitioners can provide such services. However, public sector entities, such as local health departments (LHDs), can also deliver them in addition to population based activities. Because of a possible substitution effect among health systems, we hypothesized that a LHD’s choice to be involved …

Hiv Testing Health Care Related Discrimination Among Black And White Men From The 2006-2008 Sexual Acquisition And Transmission Of Hiv Cooperative Agreement Program (Sathcap), Kenisha Cantrell

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

Background: The study investigated whether experiencing difficulty obtaining heath care due to different forms of discrimination impacts Black and White men being tested for HIV. It is important to discover if discrimination as a structural factor inhibits progression through the HIV Care Continuum among Black men. Structural factors may better explain the origin of HIV prevalence disparities and how the social factors affect Black men being tested for HIV.

Methods: Data utilized was collected through the 2006-2008 Sexual Acquisition and Transmission of HIV Cooperative Agreement Program implemented in 6 U.S. cities and one Russian city: Los Angeles, CA; Chicago, IL; …

Injuries Among Security And Law Enforcement Personnel In The Private Versus Public Sectors, William S. Witt

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

Background and Objectives: Data collected through workers’ compensation may be useful for occupational injury surveillance. This study examined whether differences existed between the public and private sectors of the security and law enforcement industry in Kentucky.

Methods: Using a cross-­‐sectional design, workers’ compensation data from the Kentucky Department of Workers’ Claims was analyzed to evaluate differences in demographic and injury characteristics, as well as award outcomes, stratified by industry sector. The dataset included all workers’ compensation first reports of injury and claims filed by security and law enforcement personnel in Kentucky from 2005 to 2015. Statistical analyzes included chi-­‐square and …

Comparison Of The Difference In Nephrotoxicity Between Nafcillin And Piperacillin-Tazobactam, Sonali Kishor Patel

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

Objective

To evaluate whether nephrotoxicity differs between nafcillin and piperacillin-tazobactam in adult hospitalized patients.

Introduction

Acute kidney injury (AKI) is a significant cause of morbidity and mortality in the inpatient setting, with antibiotics being a significant contributor. There is evidence of an increased risk of nephrotoxicity with the combination of vancomycin and piperacillin-tazobactam compared to vancomycin and cefepime or vancomycin alone. It is unknown whether this effect is exclusive for piperacillin-tazobactam. Therefore, in order to promote optimal medication therapy for inpatient bacterial infections, there is a need to assess the persistence of this difference in other beta-lactam antibiotics.

Methods

A …

Comparing The Non-Cystic Fibrosis Bronchiectasis Patients With Non-Tuberculous Mycobacteria (Ntm) And Non-Ntm Infections, Maninder Bir Singh

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

Objective

The objective of the study is to compare the Non-Cystic Fibrosis Bronchiectasis patients with Non Tubercular Mycobacteria (NTM) and Non-NTM infection and determine if the NTM and Non-NTM groups are different.

Methods

Data from the COPD Foundation’s Bronchiectasis Research Registry (BRR) was used in the study (n=1660).Logistic regression, Cox proportional hazards regression, and Kaplan Meier survival analysis were used to analyze the data.

Results

The study found odds ratio for having NTM infection for age to be 1.02 and for gender to be 2.34, after adjusting for all other variables in the multivariate logistic regression, with the p-value of …

Eat Well, Keep Moving: Decreasing Childhood Obesity In Fulton County, Kentucky, Sandra Onekhena

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

With the high rates of childhood obesity in Fulton County, the Purchase District Health Department proposes the implementation of the Eat Well and Keep Moving Program in all the county’s elementary schools among fourth and fifth graders. It is an interdisciplinary, evidence-based program that will be aimed at our short-term goal of increasing knowledge about nutrition and physical activity and inspiring positive behavioral change. It works by integrating lessons and activities about proper nutrition and activity into various aspects of the children’s lives — in the classroom, cafeteria, at home and in the community. We hope to see children move …

Neurotoxic Effects Of Occupational Exposures In Agricultural Workers, Miriam Siegel

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

Background: Pesticides and organic solvents are two classes of neurotoxic substances regularly used in agriculture. Pesticides have been studied in relation to a range of nervous system effects, and have been repeatedly shown to relate to depression in agricultural workers. Likewise, occupational solvent exposure is recognized as a risk factor for central nervous system effects, including mood disturbances and cognitive impairment, across various industries. Many gaps in knowledge regarding the effects of chronic exposure to these substances on mental/neurological health in agricultural workers still exist. The specific aims of the current analysis were to 1.) Estimate associations between metrics of …

Examining Associations Between Prevalence Of Chronic Obstructive Pulmonary Disease And Self-Perceived Health-Related Quality Of Life Among Adults In Kentucky, Seth Siameh

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

Introduction

The objective of this study is to examine associations between Chronic Obstructive Pulmonary Disease (COPD) prevalence in Kentucky and measures of health-related quality of life (HRQOL) using a large population-based sample.

Methods

Data from the 2013 Kentucky Behavioral Risk Factor Surveillance System (BRFSS) was used to calculate age-adjusted prevalence of COPD among various population subgroups (N=10,958). Multivariable logistic regression models were used to estimate adjusted odds ratios for COPD and HRQOL measures.

Results

In 2013, the age-adjusted prevalence of self-reported COPD among Kentucky adults aged ≥18 years was 10.3% (standard error [SE], ±0.4; 95% CI, 9.5 – 11.2). Kentucky …

Reduction Of Fecal Coliform Bacteria Through The Elimination Of Sewage Discharges In West Virginia Streams, Kady Rogers

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

Background and Objectives

Early environmental regulations such as the Federal Water Pollution Control Act of 1948, and the 1972 amendments—which would later become known as the Clean Water Act—have improved the quality of the drinking and recreational waters here in the United States. This has been achieved as a result of strict regulations on discharges, proper management strategies, as well as thorough sampling and testing for contaminants. One such contaminant is fecal waste; these materials are a public health concern because of the potential risk of gastrointestinal diseases. Scientists have used fecal coliforms as an indicator of the presence of …

A Comparative Study Of Ever And Never Smokers With Bronchiectasis, Laura Higdon

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

Objective: The objective of the study is to predict the odds of death in participants with bronchiectasis and to determine if ever smokers have increased odds of death when compared to never smokers.

Methods: Data for the study was used from the Bronchiectasis Research. Pearson chi square test is used to compare never smokers to ever smokers for age, gender, and participants enrolled status. Logistic regression is used to predict the odds of death for smoking status, age, gender, or CT scan findings. CT scan findings for this study are dilated airways, airways that are thickening, tree-in-bud infiltrates or mucoid …

Overdose Education And Naloxone Distribution By Board-Certified Pharmacists In Five Eastern Kentucky Counties, Laura Elizabeth Broughton

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

The Coalition of Kentucky Health Professionals Against Substance Abuse (CKHPASA) is a professional organization uniting members of the various health professions against a rising tide of substance abuse in the state of Kentucky. In 2013, Kentucky ranked 3rd in the United States for highest number of drug overdose fatalities. Previously under the scourge of the prescription opioid epidemic, the state of Kentucky is now seeing rising numbers of overdose deaths related to heroin use, which is an opioid that works similarly to morphine and prescription pain medications.

Naloxone is a life-saving antidote for opioid related overdoses and evidence has shown …

Improving Indoor Air Quality For Children In Rural Kentucky, Denerica L. Curry

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

Community interventions directed towards improving indoor air quality for children are often implemented after exposure has occurred and focuses on parental smoking cessation. Our proposed project will intervene during the prenatal stage prior to exposure and continue to support families 6 months postpartum. Infants are at an increased risk of secondhand smoke exposure due to the amount of time they spend in the home and proximity to the smoker. We hypothesize that by enhancing care of the current home visitation model to include an early intervention we will increase the amount of smoking bans in the home and decrease maternal …

Characterizing Health Risks In Privately-Supplied Drinking Water Due To Agricultural Practices In Rural Western Kentucky, Karen Schroeder Card

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

At least 400,000 people in Kentucky rely on private water wells or springs for drinking water. 551 households that rely on private water wells for drinking water were surveyed in 2009 about adverse health outcomes, including selected cancer incidence, adverse birth outcomes, and yearly incidence of diarrheal illness. Survey recipients were drawn from a population of well owners in the Jackson Purchase Region of Kentucky whose wells were tested for nitrate-nitrogen (NO3-N), triazine pesticides, and E. coli or total coliforms, by Kentucky Geologic Survey within the previous 15 years. 214 questionnaires were returned and matched to water quality data for …

Evaluations Of Patients’ Appointment Duration By Type In An Ophthalmology Practice, Brittany U'Wren

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

Objective: The Affordable Care Act expanded health care coverage and provided more access to physicians, resulting in potentially longer wait times. Large portions of ophthalmology patients are on Medicare. Two thirds of the expansion populations were Hispanic or African Americans, which have higher rates of eye disease. Another contributoring factor leading to the increase for eye care is the surge of baby boomers. More specifically, these are individuals reaching sixty-five and are beginning to utilize Medicare. Access to care has increased but the capacity of the practice has not. An important goal, therefore, is to maximize efficiency of current …

Characterization Of Foreign-Born Vs. U.S. Native-Born Worker Fatalities In Kentucky, 2001-2014, Yailet Cruz Galardy

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

Background: Foreign-born workers may be more vulnerable to fatal and nonfatal work injuries. Available information on the differences that exist between foreign-born and U.S. native-born worker fatal injuries is scarce. This study aims to describe and characterize occupational fatal injuries in foreign-born and U.S. native-born workers in Kentucky.

Methods: A retrospective descriptive analysis of foreign-born vs. U.S. native-born worker fatalities was performed over a 14-year period from 2001-2014 using Kentucky Fatality Assessment and Control Evaluation (FACE) program worker fatality surveillance data.

Results: From 2001-2014, there were a total of 87 foreign-born and 1,361 native-born worker fatalities. The average age of …

A Controversial Bill (H.R. 897) To Mosquito Control Programs: A Policy Analysis, Charles Guissou

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

The primary purpose of this paper was to analyze the legal, financial, and administrative burdens of the Pesticides General Permit on mosquito control programs from a policy perspective. Mosquito control is often highly controversial, particularly when it involves the use of pesticides that have their own potentially serious health and environmental impacts. In 2009, the Environment Protection Agency issued the permit to be obtained by pesticide applicators before pesticides could be discharged into waterways in addition to existing Federal Insecticides, Fungicides, and Rodenticides Act (FIFRA) regulations. Some provisions of the permit could impact mosquito control activities. Therefore, in response to …

Social Network Analysis Of Cellphone Surveillance Data For Ebola In Sierra Leone, Jia B. Kangbai

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

Aim: To explore and visualize the connectivity of suspected Ebola cases and surveillance callers who used cellphone technology in Moyamba District in Sierra Leone for Ebola surveillance, and to examine the demographic differences and characteristics of callers who make more calls as well as more likely to make at least one positive Ebola call.

Methods: Surveillance data for 393 suspected Ebola cases (192 males, 201 females) were collected from October 23, 2014 to June 28, 2015 using cellphone technology. UCINET and NetDraw were used to explore and visualize the social connectivity between callers and suspected Ebola cases. Poisson and logistic …

Self Center: Addressing Teen Pregnancy In Wolfe County, Ky, Lindsey Smith

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

Teen pregnancies and births are at an all-time low across the United States. Despite this decline in rates within the last decade, the teen pregnancy rate in Kentucky remains significantly higher than that of the overall United States. Additionally, teen pregnancy still has significant economic and health impacts on both teen parents and their children. In rural communities, such as Wolfe County, KY, teen birth rates are approximately one-third higher than the rest of the country. Self Center is an evidence-based teen pregnancy prevention program that involves school-linked reproductive health services and provides participants with education, counseling, and healthcare services. …

Hiv/Sti And Teen Pregnancy Prevention Within Mclennan County Texas, Kayla M. Storrs

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

In response to the Center for Disease Control and Prevention (CDC) funding announcement, the McLennan County Health Department proposes to implement Be Proud! Be Responsible!, an evidence-based HIV/STI and teen pregnancy prevention program into the pre-existing health curriculum of the sixth grade classes within the county. With the highest rates of chlamydia and gonorrhea within the state of Texas, and $7 million per year of teen pregnancy related costs spent in Waco, Texas alone, this intervention aims to increase HIV/STI knowledge, increase positive perceptions of safe sexual behaviors, increase parent-student communication about safe sexual behaviors, prolong first sexual initiation, and …

Prescription Opioid Policy And Illicit Drug Use, Douglas Keith Branham

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

Opioids have become a major public health concern in recent years with non-medical use of both prescription opioids and heroin on the rise. There have been increases in opioid related overdoses, accidental deaths, treatment admissions, and sales associated with the increased illicit use of opioids. The following capstone project uses the three paper model to explore some of the issues associated with this rising epidemic including prescription opioid policies enacted in recent years, the populations these policies impact, and potential effects they may have on drug use behavior, as well as additional factors that potentially influence opioid user behavior. Paper …

“Exchange Northern Ky”: An Evidence-Based Needle & Syringe Exchange Program Serving The Northern Kentucky Area Development District, Amanda Hunter

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

Intravenous drug users (IDUs) account for nearly 16% of new HIV infections in the United States and almost one half (48%) of newly reported acute hepatitis C virus (HCV) infections have been found to be IDU related.1 Within the Northern Kentucky Area Development District, hepatitis C infections have soared with an incidence of more than 1,000 newly reported cases during 2015 alone.⁴ Rigorous scientific evidence complied by the U.S. Department of Health & Human Services has indicated that one of the most unique and effective strategies for the curtailing HIV incidence among IDUs is by ensuring users’ access to …

Incidence Of Non-Hodgkin's Lymphoma By Residential Proximity To Superfund Sites In Kentucky: A Multivariate Analysis, William Brent Webber

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

Non-Hodgkin’s Lymphoma (NHL) is a category of cancers that arise from the lymphocytes of the immune system. The rates of NHL in the United States and Kentucky began to rise in the mid-20th Century, shortly after the manufacture, use, and disposal of numerous chemical substances began to increase during and after the Second World War. While the etiology of NHL is not fully known, there are several chemical substances for which evidence exists of a possible link between exposures and development of NHL and other cancers. Several of these substances are also present in sites within Kentucky designated by the …

Correlates Of Antibiotic Diversion In The Philippines: Misconceptions And Community-Level Access To Nonmedical Sources Of Antibiotics, Daniel Alexander Barber

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

Aim: To identify sociodemographic, knowledge, and attitudinal correlates to antibiotic diversion among a community-based sample of adults (age 18 and older) in a low-income setting of the Philippines and to explore community-level data on informal antibiotic distribution in sari-sari stands.

Methods: Participants (n=307) completed self-administered surveys. Correlates to antibiotic diversion were assessed using logistic regression with Firth’s bias-adjusted estimates. Availability and characteristics of antibiotics in the sari-sari stands (n=106) were observed through site visits.

Results: A majority (78%) had shared antibiotics in their lifetime, most often with family members. In multivariable analysis, agreement with the belief that it is safe …

Self-Rated Diet Health: Socioeconomic And Health Related Correlates, Emily B. Bell

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

BACKGROUND: Two-thirds of Americans are overweight or obese, increasing their risk for multiple chronic diseases. Self-rated diet health may be useful in public health efforts to prevent the negative consequences of overweight/obesity. This study aims to identify sociodemographic and health-related correlates of the NHANES self-rated diet health question.

METHODS: The 2009-2010 NHANES data for adults 20 years and older were used. Sociodemographic and health-related variables were investigated with selfrated diet health as the outcome. First, bivariate analyses determined associations of each variable with self-rated diet health. Those associated with pvalues ≤.25 were included in two multiple ordinal logistic regression models. …