Public Health Commons^™

Correlates Of Hepatitis C Serostatus Disclosure In Rural Appalachian Kentucky, Megan G. Hofmeister

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

Aim: To identify demographic, behavioral, and interpersonal characteristics associated with hepatitis C (HCV) serostatus disclosure among adult, rural, high-risk people who use drugs (PWUD) in Appalachian Kentucky.

Methods: Laboratory confirmed HCV antibody-positive participants (n=243), drawn from the fifth follow-up assessment of a longitudinal study of rural PWUD, completed interviewer-administered questionnaires eliciting demographic and interpersonal characteristics, risk behaviors, and information on HCV disclosure. Correlates of HCV disclosure were assessed using logistic regression.

Results: Most (69.1%) reported disclosing their HCV-positive status to at least one of their social referents (current or past sex partners, current or past injection drug use (IDU) partners, …

Equine Leptospirosis Seroprevealence In The Central And Bluegrass Regions Of Kentucky From 1993 - 2015, Charlene Siza

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

BACKGROUND

Leptospirosis is a worldwide zoonotic bacterial disease of significant importance for both human and animal health. There are many sources of infection and shedding of the bacteria, including horses. There is a known occupational hazard for leptospirosis, especially in occupations that work directly with animals or animal products. This study examined the prevalence of equine leptospirosis in Kentucky in relation to trends over time and geographical distribution.

METHODS

Data was obtained from the University of Kentucky Veterinary Diagnostic Laboratory(UKVDL) on equine leptospirosis from 1993 through September 2015. Overall seropositive prevalence and prevalence stratified by serovar were calculated. Furthermore, distribution …

Impact Of Partner Support On Time To First Treatment For Women With Breast Cancer, Laura Anne Cannon

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

Background: Treatment delays have been linked to decreased survival in women with breast cancer. Many women rely on their spouse or partner to provide support following breast cancer diagnosis. To date, little research has explored the effects of partner supportive behaviors on timely receipt of recommended cancer treatment and ultimately cancer survival.

Objective: To determine whether women identified as having lower partner support experience delays in time to first breast cancer treatment relative to women with highly supportive partners.

Methods: Women aged 18-79 who were diagnosed with incident and primary breast cancer within the past 12 months and included in …

Birth Cohort Effects In Risk Factors For Alzheimer’S Disease, Kingsley Uzodinma

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

Background and Objectives: The purpose of this study was to assess the presence of birth cohort effects by exploring differences in established risk factors of Alzheimer’s disease (AD) and dementia using case-control designs and also estimate the AD risk among women with respect to their number of biological children.

Methods: This is a case control study design of participants born in 1896 – 1955 and were enrolled in one of the designated Alzheimer’s disease centers (ADCs). The uniform Data Set of the National Alzheimer’s Coordinating center (NACC) include those who had Alzheimer’s disease or mild cognitive impairment (cases) and were …

Increasing Colorectal Cancer Screening Rates In Shelby County, Tennessee Through The Implementation Of Flu-Fit In Community Clinics And Pharmacies, Samantha Wang

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

The Shelby County Health Department (SCHD) proposes implementing of Flu-FIT in community clinics and pharmacies to increase colorectal cancer screening (CRCS) rates in Shelby County, Tennessee. Flu-FIT is an evidenced-based program that involves health care providers offering patients between 50 and 75 years of age the fecal-immunochemical test at the time the patients receive their annual influenza vaccine along with counseling on colorectal cancer and reminder phone calls. Flu-FIT aligns with the mission of SCHD to “promote, protect, and improve the health and environment of all Shelby County residents.” The project’s short term outcomes include increasing CRCS rates in patients …

The Utilization Of Models Of Care Transition To Reduce Medicare Beneficiaries’ Hospital Readmission Rates In Kentucky: A Case Study, Audra Putt

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

Problem: Unsuccessful care transitions for Medicare beneficiaries have resulted in high health expenditures and a diminished quality of care as the 30-day hospital readmission rate has increased. This has prompted the Centers for Medicare and Medicaid Services to require hospitals with high readmission rates to pay penalties. As a result, the Community-based Care Transitions Program was established under Section 3026 of the Affordable Care Act to provide health organizations funding to utilize models of care transition to improve the care transition process. The purpose of this capstone project was to identify whether two community-based organization programs, the Kentucky Appalachian Transition …

Drink Switch Program In South La Schools, Lauren Barker

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

Sugary drinks, including sports and energy drinks, are the number one source of added sugar in the American diet.1 Excess sugar consumption can lead to health complications such as overweight and obesity, and obesity-related chronic diseases such as diabetes, high blood pressure, and cardiovascular disease.2 Sugary drink consumption among youth in Los Angeles is particularly high, and teenagers in Service Planning Area (SPA) 6 of Los Angeles have some of the highest consumption rates in the county, with one out of two reporting consuming at least one sugary drink per day.3 Based on the correlation between sugar consumption and health, …

An Analysis Of The Role Of Medicaid Expansion On Mobile Mammography Units And Breast Cancer Screening In The Commonwealth Of Kentucky, Joseph Chiweshe

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

Introduction

Breast cancer and adequate screening remains a significant scientific, clinical and societal challenge both in Kentucky and in the U.S. To date, the lack of medical insurance has been implicated as a barrier to the provision of breast cancer screening not only to those within the Commonwealth of Kentucky but amongst the general population of the United States.

Methods

The Kentucky Department of Health provided study data utilized in our analysis. The data requested consisted of Medicaid claims for mammography screens for all counties in the Commonwealth of Kentucky. In addition, data gathering occurred via interviews with four Mobile …

Wnc Healthy Teens: A Multi-Level Teen Pregnancy Prevention Initiative, Katharine Macmillan

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

WNC Healthy Teens is a multi-component, community-based teen pregnancy prevention initiative. The program will be targeted in rural areas of Buncombe and Henderson Counties that have aggregate rates showing that over half the population of women aged 15-19 years are giving birth. Sexual education is necessary, but not sufficient to preventing risky sexual behaviors1. Tying multiple levels of evidence-based school interventions together with standardization of adolescent sexual health care will provide a well-rounded approach to address teenage pregnancy. Starting the initiative at age 14, it is anticipated the majority of teens will have yet to initiate sexual activity. Reducing the …

Risking Connection: A Multi-Level Trauma-Informed Care Approach To Refugee Services In Lexington, Ky, Marie Paige Higginson-Rollins

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

This project proposes to implement a multi-level, trauma-informed care approach to refugee services in Lexington, KY. The intervention will be carried out at three sites, the Bluegrass Community Health Center, the Kentucky Refugee Ministries, and the Lexington Global Engagement Center. These sites were chosen because of their extensive work with the refugee community. The intervention proposed is Risking Connection, a SAMHSA recommended trauma-informed care program, with a cultural-sensitivity training module and marketing campaign, and a group therapy pilot intervention for Congolese women based on the Bashal program at the Center for Torture and Trauma Survivors. The short-term goals of this …

Colorectal Cancer Prevention In The North Slope Borough Of Alaska Utilizing The Flu-Fit Intervention, Jennifer Jenkins

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

The intention of the Flu-FIT intervention is to increase colorectal cancer screening rates by combing two annual activities into one visit that doesn’t necessitate a doctors visit. The original study increased colorectal cancer screening rates by 14 percentage points and this program should be able to show similar results in the North Slope Borough of Alaska. The North Slope Borough has the highest incidence rate of colorectal cancer in the United States, and this proposed intervention could lead to a reduction in that rate by increasing screening and knowledge about colorectal cancer in the community.

Forced Sexual Intercourse And Its Link To Suicide Ideation/Suicide Attempts Among Adolescent Girls: Findings From 2013 Youth Risk Behavioral Survey, Adebukola Helen Adegbite

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

Objectives. We sought to assess the association between forced sexual intercourse and suicidal ideation/attempts among adolescent girls ages 14-17.

Methods. We performed secondary data analysis of the 2013 Youth Risk Behavioral Survey, using chi-square tests to examine the association of forced sex and race/ethnicity, with suicide ideation.

Results. We found that there was an association between those who had considered suicide and those who had experienced forced sexual intercourse. Moreover, race/ethnicity was associated with those who had ever considered suicide in the past 12 months before taking the survey. Lastly, we found that there was an association of suicide ideation …

Development Of Multiple Primary Cancers In Lung Cancer Patients: Appalachian Vs. Non-Appalachian Populations Of Kentucky, Vira Pravosud

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

OBJECTIVE: This study examined whether there were differences in the development of multiple primary cancers in lung cancer patients residing in the Appalachian versus Non-Appalachian regions of Kentucky. The study also identified other factors associated with the development of another primary cancer in lung cancer patients.

HYPOTHESIS: Lung cancer patients residing in Appalachian Kentucky are more likely to develop multiple primary cancers compared to patients residing in Non-Appalachian Kentucky.

METHODS: This was a retrospective, population-based cohort study of Kentucky patients (N=26456) aged 20 years and older, diagnosed with primary lung cancer between January 1, 2000 and December 31, 2013. The …

An Examination Of Traumatic Brain Injury As A Risk Factor For Psychiatric Symptoms In Alzheimer’S Disease Patients, Jennifer F. Walch

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

Introduction:

Dementia is a major public health issue both in the United States and worldwide. Alzheimer’s disease (AD) is widely considered to be the most prevalent type of dementia. While the hallmark AD symptom is profound memory loss, patients also commonly experience changes in personality and behavior. These changes often include depression, anxiety, social withdrawal, mood swings, irritability and aggression, changes in sleeping habits, and delusions.

Background:

Several studies have established a mechanistic link between traumatic brain injury (TBI) and the development of AD. However, it is unknown whether TBI contributes to the personality/behavior changes observed in many AD patients. …

Identifying Predictors Of Functional Limitations Associated With Depression, Anxiety, And Emotional Problems In Us Adults, Jillian Richardson

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

Depressive disorders are characterized as sharing affected mood, and somatic (e.g. sleep pattern, appetite, and unintentional changes in weight) and cognitive alterations from previous normal daily functioning that are clinically significant. Anxiety disorders are characterized by excessive fear, general or specific anxiety, and related behavioral disturbances that are also clinically significant. This project attempts to identify risk factors that may predict what groups are most likely to be affected by depression and/or anxiety.

Sponsored by the CDC, the National Health Interview Survey collects general health information for non-institutionalized individuals living in the US. Variables for use in logistic regression model …

"Life Skills Training" Prescription Drug Abuse Prevention Among Youth In Bell County, Kentucky, Arveen Kaur

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

Prescription Drug Abuse (PDA) has become a serious public health concern and a major epidemic in the United States (U.S.). According to the 2014 National Survey on Drug Use and Health (NSUDH), approximately 15 million people (aged 12 or older) used prescription drugs in the past year and 6.5 million in past month. Out of these, 2 million Americans (aged 12 or older) either abused prescription drugs or were dependant on them. Almost 5% of adolescents (1.1 million) between the age group 12-17 abused prescription painkillers in 2014. Nationally, Kentucky is among the top five states with highest age-adjusted overdose …

Hispanic Agricultural Workers: The Nexus Of Demographics, Employment Characteristics, And Health, Ashley Michelle Bush

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

Agriculture, which is home to elevated occupational injury and illness rates, has a substantial demographic makeup of Hispanic workers. Hispanic farmworkers are at increased risk of poor occupational health outcomes due to the precarious nature of work and other socio-ecological influences. These adverse occupational health outcome counts are inadequate and undercounted, failing to capture the true scope of agricultural work. To gain more knowledge about agriculture, this capstone will focus on the personal and work characteristics of agricultural workers to help further understand disparities within the agricultural sector by: providing a literature review of agricultural worker health; examining missed work …

Hiv Risks, Intimate Partner Violence (Ipv), And Depression Among A Sample Of Women Who Have Sex With Men And Women (Wsmw), Krystal S. Frieson

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

Objective: The purpose of this study is to examine the associations between interpersonal partner violence (IPV), HIV risks, and depression among a sample of adolescent females who have sex with men and women.

Methods: A cross-sectional study was conducted using data from the Youth Risk Behavior Surveillance System (YRBSS). YRBSS data was obtained from representative samples of students in grades 9-12. The study sample was comprised of adolescent and young women who self-identified as having sex with men and women (WSMW)(N=526). The primary exposure was sexual behavior (having sexual intercourse with both male and female partners). The primary outcomes were …

Are There Rural-Urban Differences In Dentist Supply?, Mutlaq Alotaibi

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

The purpose of this project was to examine the supply of dentists in the Commonwealth of Kentucky at the county level. Counties with shortages in dentist supply were determined and associated factors were examined.

Several county-level variables were analyzed. These included total number of dentists, total county population, dentist to population ratio, dentist supply shortage, median household income, median age, percent of Medicaid enrollees, rurality, oral cancer crude incidence and mortality rates per 100,000 and percent of adults missing six or more teeth.

This project showed that 42 of the 120 counties in Kentucky had shortages in dentist supply. Also, …

Policy And Political Motives For Medicaid Expansion Under The Patient Protection And Affordable Care Act, Ross C. Stanton

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

Objective

This study aims to analyze policy-related and political rationales for Medicaid expansion under the Patient Protection and Affordable Care Act (PPACA). More specifically, this study seeks to discover whether states’ decisions regarding Medicaid expansion were likely based on policy implications regarding the uninsured or political motives.

Methodology

The approach is a cross-sectional/observational study of American states and the District of Columbia after the Sebelius decision in 2012. This study compares three variables: (1) whether each state decided to opt into the expansion (“Opted In”), (2) whether each state’s governor and legislature were affiliated with either the Democratic or Republican …

The Association Of Atrazine And Non-Hodgkin Lymphoma In Kentucky, Justine F. Maxwell

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

Atrazine, one of the most widely used agricultural pesticides, largely sprayed on corn. throughout the Midwest.34 The Environmental Protection Agency (EPA) has estimated 76.4 million pounds are applied annually where its usage on corn accounts for approximately 86% of total United States (US) domestic usage (in pounds).35 Approximately 75% of the field corn acreage grown in the U.S. is treated with atrazine.35 Once atrazine enters into waterways, it can persist having a half-life greater than 200 days in surface waters.34 In Kentucky, atrazine is the most heavily applied in heavy corn-producing locations, which are mostly in western regions of the …

Analysis Of Firearm Legislation And Law Enforcement Suicides In Nvdrs-Funded States, Meagan L. Hurst

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

BACKGROUND:

The purpose of this study was to evaluate firearm-related suicides among law enforcement members and identify potential differences between decedents and firearm legislation grades from National Violent Death Reporting System (NVDRS) funded states

METHODS:

Descriptive and regression analyses were conducted using suicide data from 820 decedents who worked within law enforcement at the time of death. Data were collected over a ten-year period (2003-2013) from the NVDRS. Multivariable logistic regression and Pearson’s chi-square were used to identify if differences existed among firearm-related suicides and other means using variables such as age, marital status, occupation, mental health, and firearm legislation …

Service Training And Recovery (Star) Program: An Interdisciplinary Community-Based Project To Mitigate Rr-Ptsd Among Kentucky Women, Margaret Melissa Brown

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

Background: Kentucky has greater prevalence of sexual assault compared to the US overall, 37.5% versus 35.6% of all assault crimes respectively, translating to roughly 638,000 victims within the Commonwealth [1].Research identified sexual violence as the number one factor in development of PTSD among women. There are four times the prevalence of PTSD in victims of sexual violence versus other forms of trauma. [2, 3] The STAR program utilizes skills-based training methods to empower participants through improving a sense of safety and security, self-confidence, and self-efficacy to mitigate RR-PTSD symptoms leading to negative health outcomes.

Literature Review: Existing research …

Circumstances Contributing To Suicides Among Pregnant, Postpartum And Non-Pregnant Women (15 - 54 Years) In Rural And Urban Counties In The U.S., Nvdrs 2003-2012, Akosua Korantema Adu

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

Abstract withheld upon request.

Undiagnosed Hepatitis C Infection In An Urban Emergency Department, Naseem Ansari

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

Aim: To evaluate the prevalence of previously undiagnosed hepatitis C virus and associated patient risk factors in an urban ED through a universal, integrated screening program, to contextualize results found in terms of gaps in existing HCV screening models and to inform future sustainable and effective screening models.

Methods: ED patients, ages 18-71, that were medically stable, hadn’t had a prior HCV test, and were having blood drawn as part of routine clinical care, were offered (n=2,726) an anti-HCV test, of whom 1,945 accepted. An assessment of correlates to anti-HCV positivity was completed using a binomial logistic regression …

Adolescent Oral Health In Kentucky, 2007 National Survey Of Childhood Health Analysis, Kory Brinker

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

Research indicates that children raised by their grandparents can have poorer health outcomes than their peers living in mother or father based households. There is, however, little research that indicates how childhood oral health is affected by grandparents raising grandchildren. This study investigated grandparent based family structures, and how this family structure affects oral health of Kentucky children. Using data from the 2007 National Survey of Children’s Health, 113 Kentucky children were identified as living with a grandparent as a primary caregiver. Chi-Square analyses were utilized to assess the oral health status of these children, as well as what role …

Needle Stick Injuries And Blood Born Pathogen Exposures Among Health Care Workers In University Of Kentucky Health Care Facilities, Haider Sahmsulddin

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

Objectives:

The number of cases of needle stick and sharps-related injuries among healthcare workers are difficult to estimate due to underreporting. Multiple research studies have been done in this area but the scale of the problem is substantial and requires further attention. This study focuses on the cases of needle stick injuries and blood born pathogen exposure among health care workers at the University of Kentucky. The purpose of this study is to examine the rates of needle stick vs splash related injuries among the University of Kentucky health care workers from 2009 to 2014, and stratify the frequencies of …

The Relationship Of Hispanic Ethnicity, Drug Use, And Bullying With Suicidal Ideation Among Adolescent Females In The 2013 Youth Risk Behavior Surveillance Survey, Erin Camp

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

BACKGROUND: There is little research on the relationship of Hispanic ethnicity, drug use, and bully victimization with suicidal ideation among adolescent females. This study investigates all components and their association with suicidal ideation using the 2013 Youth Risk Behavior Surveillance Survey (YRBSS).

METHODS: Participants were 6,621 adolescent females who completed a self-administered questionnaire (YRBSS). Students answered a series of questions regarding unintentional injuries and violence and alcohol and other drug use.

RESULTS: Results indicated that there was an association between drug use, bully victimization, and suicidal ideation. Bivariate analyses using chi-square tests showed the relationships between these risk factors and …

Financial Strain, High Stress And Smoking Among United Way Missouri 2-1-1 Callers, Brandon Cofield

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

Objectives.

We evaluated the influence of financial strain and perceived stress on smoking status among United Way Missouri 2-1-1 callers of predominantly low socioeconomic status.

Methods.

Data for this study were collected as part of a randomized, controlled intervention trial integrating cancer control referrals into regular United Way 2-1-1 Missouri services. Those who consented, completed the assessment and had at least one cancer control need were invited to participate in a longitudinal study that included completing the baseline assessment used in this study. We conducted chi-square analyses to assess the bivariate relationships between each financial strain variable and smoking status, …

Proton Pump Inhibitors And Atrial Fibrillation, Dustin Hughes

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

Background

Proton pump inhibitors (PPIs) are widely used drugs in the United States. Atrial fibrillation (AF) affects 2.7 million people in this country and often leads to other serious medical conditions. There is a growing body of evidence suggesting that PPIs may be proarrhythmic. This study seeks to better appreciate the relationship between these popular drugs and the most common arrhythmia.

Methods

This is a nested case-control study using a large, nationally representative insurance database. Members with an incident AF diagnosis between 2007 and 2009 were identified. Each case was matched with one control member, using incidence density sampling, and …