Public Health Commons^™

Healthcare Industry Injuries By Patient Contact Status In Kentucky, 2012-2014, Kristen Ranzenberger

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

Objectives

The healthcare industry continues to have a high number of reported injuries. The purpose of this study was to 1) characterize healthcare industry injuries by patient contact status; 2) identify the occupations associated with healthcare injuries by patient contact status; and 3) determine healthcare injury rates by occupation, to gain a better understanding of healthcare industry compensated injuries , and better target healthcare industry safety practices and programs.

Methods

Workers’ Compensation first reports of injuries (FROI) from the healthcare industry in Kentucky were categorized into injuries involving in direct patient contact vs. injuries without direct patient contact using narrative …

Are There Delays In Receipt Of Treatment Among Appalachian Kentucky Women With Breast Cancer, Huong Thi Thanh Luu

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

Background: Women living in rural and under-resourced Appalachian Kentucky may experience delays in receiving cancer treatment yet such delays have not been systematically evaluated. In this analysis, we hypothesize that women diagnosed with breast cancer who live in Appalachian Kentucky would be more likely to have a treatment delay compared to those living in other Kentucky regions and adjusting for individual measures of socioeconomic status.

Methods: In this cohort study, women included in the Kentucky Cancer Registry with a diagnosis of an incident, primary breast cancer in the prior 12 months were interviewed by phone (n=1,245; response rate 26.9%). Cox …

Examining Alcohol Consumption, Psychological Distress, And Current Smoking Status: Results From The Behavioral Risk Factor Surveillance System, 2013, Guangxing Zhan

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

Introduction: Approximately 443,000 people die from smoking or exposure to secondhand smoke, and another 8.6 million people have a serious smoking-related illness, which costs nearly $96 billion in health-care expenditures and $97 billion in productivity losses annually in the United States. This study examined the association between alcohol consumption and smoking status, and how psychological distress can affect this association. Methods: Data come from the 2013 Behavioral Risk Factor Surveillance System (BRFSS). We used binary logistic regression models to compute adjusted odds ratios between alcohol consumption and smoking status, controlling for age, gender, race, education, and income. We used chi-square …

Associations Among Sexual Violence, Risky Sexual Behaviors, And Substance Abuse: Risk And Protective Factors Among Women From The National Survey Of Family Growth, Michelle Kroger

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

Introduction: Millions of women experience sexual violence which results in a plethora of adverse health consequences. Given the scope of the problem, more attention is needed to examine the complexities in which sexual violence occurs, and possible associations among sexual violence and related health behaviors. The present study analyzes whether a significant association between sexual violence and condom use and/or sexually transmitted diseases (STDs) exists, and whether consuming alcohol and/or drugs increases women’s risk of having unprotected sex and/or an STD.

Methods: Data from the National Survey of Family Growth 2006-2010 and 2011-2013 were analyzed using bivariate and multivariate chi-square …

Rural Healthcare Worker's Willingness To Report To Work During Catastrophic Events, Aaron M. Macdonald

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

In the events leading up to, during, and following a catastrophic event, healthcare workers play a critical role in the outcome of these events. Therefore it is of the utmost importance that healthcare workers are able and willing to report to work. Prior to September, 2001 there had been three willingness to report studies published in the literature. Post September, 2001 and up until 2011 there was a renewed interest in the topic which led to the publishing of twenty plus papers on the topic. The current literature has examined willingness to report thoroughly and definitively; however, there is a …

Farm To School Programs And Children's Dietary Behaviors, Kathleen Evers

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

There is an increasing promotion of the importance of fruit and vegetable consumption through prevention efforts, specifically in school systems, to control and prevent childhood obesity. Farm to School (FTS) programs offer interactive hands on experiences involving fruits and vegetables. This study examines a specific FTS program including a farmer interaction, and a broccoli taste testing experience for kindergarten and fourth grade students in a rural Kentucky county. By using a digital still photography method of plate waste, the decisions of approximately 115 students to take/not take broccoli and percentage of students’ consumption of broccoli was analyzed. Using chi-square and …

Association Between Stressful Life Events And Change Of Maternal Smoking During Pregnancy Using Prams 2011-2012, Shidie Tang

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

Objective: To examine the association between stressful life events during pregnancy and change of maternal smoking behaviors.

Methods: We used data from the CDC’s Pregnancy Risk Assessment Monitoring System (PRAMS) to conduct the research. Our data included 24 states from 2011-2012. We considered 13 stressful life events and grouped them into four categories: emotional, partner-related, financial and traumatic stressors. Change of Maternal Smoking during pregnancy was defined by smoking at the last trimester of pregnancy versus smoking at 3 months prior to smoking. Confounders included maternal age, race/ethnicity, education, marital status, Medicaid coverage upon delivery and income prior …

A Qualitative Analysis Of Four Appalachian Cervical Cancer Patient Navigators Interviews, Steven Hiestand

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

Despite widespread incorporation of patient navigation into cancer care programs, there remains little consensus on the definition or core competencies which distinguish the patient navigator role within health care. In order to determine the definition and core competencies, the experiences and insights of patient navigators must be understood. Four patient navigators participating in a 2010 Appalachian Cervical Cancer intervention were interviewed. I qualitatively analyzed these interviews for important themes relating to the definition of patient navigation as well as important skills and competencies. The patient navigators identified patient navigation as being patient-centric and focused on overcoming barriers to cancer care. …

The Synergistic Impact Of Income And Rurality On Timely Mammograms In A National Sample Of Women In The United States, Asri Mumpuni

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

Introduction. Breast cancer is the cancer of highest incidence among women in the U.S., making it a significant public health problem. Currently, the U.S. Preventive Services recommends biennial screening mammography for women ages 50-74. This study examined the associations between socioeconomic status and rurality on breast cancer screening behavior. Methods. Data for this study come from the Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor Surveillance System Survey (BRFSS). Breast cancer screening behavior was dichotomized into those who did not meet screening mammogram recommendations (2 years or more) and those who met screening mammogram recommendations (within the …

Palliative Care: Evaluating And Designing Process Improvements For An Inpatient Consultative Program, Shawn M. Crouch

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

The purpose of this capstone project paper and study was to evaluate an inpatient palliative care consultation service and then make recommendations for improving the program. This paper includes a literature review related to palliative care models and best practices in structuring a successful inpatient palliative care service. The project included an analysis of how the program at one university based hospital measured success of the program and SWOT analysis based on interviews with members of the program’s team and leadership. Data sources used for the analysis included palliative care consultation utilization data from the identified hospital; other metrics used …

Alcohol Sale Status And Violent Deaths In Kentucky, Usa: 2005-2012, Hanan Abdulghafoor Khaleel

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

Alcohol is one of the major public health problems worldwide because of its association with many health and psychological problems. This study adds to the extant literature by examining the association between being a resident in a wet county and having an alcohol related violent death, an alcohol related suicide, or an alcohol related homicide victimization.

The first aim of this study is to determine whether residents of wet counties have a higher odds of alcohol related violent deaths than residents of dry/moist counties after adjusting for other confounding factors. The second aim is to determine whether residents of wet …

Breast Cancer Screening For African American Women, Jennifer Ross

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

INTRO Breast cancer is the most common type of malignancy among women in the United States (U.S.) and the second leading killer. Despite the availability of effective breast screening tools, a disparity has formed. Specifically, white women over the age of 40 experienced a higher incidence rate of breast cancer, while African American women experience higher related mortality rate. The purpose of this study was to examine SES and ethnicity/race factors that may influence breast cancer screening rates, and specifically explore how those factors may differ between African American and white women.

METHODS Women between the ages of 50-74 who …

Impact Of Kentucky Vaccination Exemption Laws On Pertussis Incidence, Katherine Blain

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

Purpose: According to CDC statistics, prior to pertussis vaccine development in the 1940’s, about 200,000 children contracted pertussis annually. Today, although this number has decreased drastically, pertussis cases began trending upward again in the 1980’s. There are several proposed contributory factors, including vaccination exemption. In Kentucky, there are both medical and religious exemptions to mandatory school vaccines. The purpose of this study was to examine possible correlations between reported school vaccination exemptions and pertussis incidence in Kentucky counties between the years 2004-2012.

Methods: This study retrospectively analyzed data from 120 Kentucky counties between 2004-2012. The Commonwealth of Kentucky School Annual …

The Comorbidity And Temporal Relationship Between Anxiety Disorders, Eating Disorders, And Personality Disorders, Mitchell C. Duross

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

Background - Population-level data on the prevalence of comorbidity between anxiety-, eating-, and personality disorders remain relatively unexplored. Additionally, the potential existence of a temporal relationship among these three classes of mental disorder is also of interest.

Methods - Lifetime prevalence of, and temporal relationships among, anxiety-, eating-, and personality disorders were assessed using Part II WHO Composite International Diagnostic Interview data from the National Comorbidity Survey- Replication, a nationally representative household survey (n=5692).

Results - Lifetime prevalence estimates for any anxiety-, eating-, and personality disorder were 59.8%, 2.8%, and 13.5%, respectively, among those diagnosed with at least one core …

Factors Predicting Beta-Blocker Treatment After Myocardial Infarction In Patients With Type 2 Diabetes, Ryan P. Hickson

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

OBJECTIVE – Beta-blockers remain important for secondary prevention after myocardial infarction (MI). Despite clinical guideline recommendations, the potential for poor glycemic control and masking warning signs of hypoglycemia limit their utilization in type 2 diabetes. This study evaluated factors predicting post-MI beta-blocker initiation among type 2 diabetic patients.

RESEARCH DESIGN AND METHODS – A retrospective cohort of employed, commercially insured individuals was developed using de-identified enrollment files, medical claims, and pharmacy claims from 2007-2009 in the U.S. Inclusion criteria: (1) type 2 diabetes, (2) ≥18 years old, (3) continuous eligibility, (4) MI. Exclusion criteria: (1) females prescribed metformin exclusively without …

Demographic Disparities In Children With Behavioral Or Conduct Disorders, Caitlin Dunworth

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

This study examines the demographic disparities in children with externalizing behavior disorders, such as oppositional defiant disorder and conduct disorder, utilizing secondary data from the 2011/2012 National Survey of Children’s Health (NSCH). Current literature suggests that children with externalizing behavior disorders are more likely to be male, live in a low-­‐income family, receive lower grades in school, and to develop later conditions such as depression. Chi square tests and logistic regression were used to examine the associations of presence of a current behavioral or conduct problems with age group, race/ethnicity, sex, household income level, and insurance type. Additionally, associations were …

Fatal Injuries Among Young Workers In Kentucky, 2005-2014, Allison Christian

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

Background: Young workers have been more vulnerable to fatal and nonfatal work injuries. To gain a comprehensive understanding of the injuries that led to fatalities in younger workers, the goal of this study was to compare characteristics of young worker fatal injuries in those aged 16-24 to all workers aged 25 and older in Kentucky using a descriptive analysis.

Methods: A retrospective analysis of fatalities among workers under the age of 25 compared to workers aged 25 and older was performed over a ten-year period from 2005-2014 using Kentucky Fatality Assessment and Control Evaluation (FACE) program data.

Results …

The Impact Of Physical And Psychosocial Factors On Workplace Injuries In Nursing Assistants, Colleen Roberts

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

Objective: The objectives of this study were to 1) Describe the nature and prevalence of workplace injuries in nursing assistants (NAs) and 2) Assess the impact of physical and psychosocial works factors on the occurrence of back injuries and muscle strains in these nursing assistants.

Methods: Data for this study are from the 2004 National Nursing Assistant Survey (NNAS), which was conducted as a supplement to the National Nursing Home Survey (NNHS). The original dataset contained 3,017 records. The data were analyzed as a case-control for this study’s purpose. Cases were defined as participants who had experienced a …

The Role Predictors Of Socioeconomic Status Play In Receipt Of The Shingles Vaccination In Adults Aged 50 Years Of Age And Above In The United States, Lesley Williams

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

Introduction: Vaccinations help to prevent deleterious diseases or lessen their side effects, saving millions in healthcare expenditures. While we associate most vaccinations with children, there are specific vaccinations that are indicated in the elderly. The shingles, or herpes zoster, vaccination is indicated in all adults over the age of 50 years of age to prevent the development of or lessen the severity of shingles – the re­‐emergence of chickenpox in the form of painful blisters on the body, however, statistics indicate that only around 20% of the indicated population has ever received that vaccination. Why have so few been …

Pulmonary Function Among Latino Thoroughbred Workers - A Pilot Study, John C. Flunker

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

Background/Objectives

Evidence suggests working in horse barns is associated with adverse respiratory effects among Latino thoroughbred workers, yet no studies to date have measured pulmonary function. We examined the prevalence of self-reported respiratory symptoms, abnormal pulmonary function, and associated occupational factors among Latino thoroughbred farmworkers.

Methods

Participants were recruited via a community-based, purposive sampling strategy and participated in an interview-administered survey and spirometer test. Surveys and spirometry tests were administered to 80 participants by two trained health promoters (Promotoras) in July-September 2014. Pulmonary function (abnormal/normal) was classified by a pulmonologist. Demographic and occupational factors were assessed for associations with respiratory …

Relationship Of Bmi And Weight Perception To Weight Controlling Behaviors In 9th-12th Graders In The United States, Natalie Jones

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

Research indicates that high school students constitute the largest portion of those participating in unhealthy weight control behaviors. There is, however, little research that indicates what this behavior is influenced from. This study investigated the relationship of Body Mass Index (BMI) and (discordant or concordant) weight perception to weight control behaviors among 9th-12th graders in the United States. Using data from the 2013 Youth Risk Behavior Surveillance System (YRBSS), over 40 states and 13,000 surveys completed. Multiple Chi-square tests were performed, examining the association between BMI and weight perception in relation to weight control behaviors. We then examined whether perception …

Trends In Drug Use During Suicide, 2005-2012, Kentucky, Jacqueline Seals

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

Objective

With high rates of suicides worldwide more research on suicide is necessary for improved prevention strategies. This study examines the trends of positive drug tests at the time of suicide in Kentucky with respect to region, time, and intrapersonal violence.

Methods

Data from the Kentucky Violent Death Reporting System was used to look at all suicides in Kentucky from 2005 to 2012 amongst individuals 10 or older (n= 4691). Trends of opiates, amphetamines, cocaine, marijuana, benzodiazepine, and barbiturates were examined. The relationship of a positive drug test and time and intrapersonal violence were evaluated with an ANOVA test and …

Variation In Colorectal Screening Rates In Kentucky Since The Development Of The Colon Cancer Screening Program In 2008, Pranav Rane

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

Objective

The purpose of this study is to analyze colorectal cancer (CRC) screening rates post-enactment of KRS 214.540 through 214.540. More specifically this study seeks to highlight the variation in CRC screening rates post-policy vs. pre-policy among the target population: uninsured individuals between the ages of 50 – 64.

Methods

Behavioral Risk Factor Surveillance System (BRFSS) was utilized to obtain individual-level data regarding CRC screening in Kentucky from 2004-2012. Statistical Analysis System (SAS) version 9.1 was utilized to compile data and the variables for home blood-stool and for sigmoid/colonoscopy were combined into one variable to identify individuals who had received …

Regional Differences Of Hepatitis C Virus Infection In Kentucky, Yvette N. Achuo-Egbe

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

Objective: Few studies have been conducted in Kentucky to investigate the statewide prevalence of HCV infection and its associated risk factors. The purpose of this study was to examine the factors related to HCV infection in the state, and specifically to investigate geographical differences of HCV infection between those residing in Appalachian vs. Non-Appalachian counties in Kentucky.

Methods: The study sample (n =5205) was selected from a pool of 8300 high-risk individuals participating in a pilot cross-sectional study on HCV conducted by the Kentucky Department for Public Health. The pilot study involved serologically testing participants for antibodies against HCV infection …

Assessment Of Breastfeeding Policies In A Sample Of Inner City Child-Care Centers In North-Central Kentucky, Ana Maria Machado

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

Protection, promotion, and support of breastfeeding (BF) are critical public health needs. Breastfeeding has been proven to provide the healthiest start in life and has been shown to have a myriad of health benefits for infants, mothers and society at large. Exclusive and long term breastfeeding has been found to have protective function against the prevalence of obesity as well as many other adverse health outcomes. Higher levels of breastfeeding support in the child-care setting have been associated with higher likelihood of duration of breastfeeding for mothers and infants. The primary objective of this study was to assess the current …

Correlates Of Depression And Poor Respiratory Health: A Cohort Study In A Rural County, Stephanie Courtney

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

Objective

High rates of depression are widespread globally and are among the leading causes of disability. To better understand the effects of depression on health outcomes, more research is necessary. This study examines the associations between depression and adverse respiratory outcomes among a cohort of Iowa residents living in a rural county. This study also investigates differences in the reporting of chronic and incident respiratory outcomes.

Methods

Data were obtained from the Keokuk County Rural Health Study (1994-2004) for individuals 18 years of age or older (N=1012). The primary outcome, poor respiratory health (PRH), was based on self-reported diagnoses for …

Salmonellosis In Kentucky Cattle - 2003-2014, Azia Elizabeth Ramirez

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

The group of bacteria known collectively as Salmonella has historically been a major cause of both health and economic hardships. In particular, Salmonella in bovine has been estimated to cause the economy to lose billions of dollars annually, both due to the increased morbidity and mortality rates of the cattle themselves and the indirect loss of potential profits, and also results in the spread of the bacteria to humans to ill effect. Salmonella thus can be quite taxing to agricultural communities, the animals upon which they rely, and the consumers that buy said communities’ commodities. Thus, the importance of an …

Enhancing The Value Care Of Lung Cancer Treatment For Medically Underserved Population In Kentucky, Morita Sari

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

Background

For many years Kentucky has had the nation’s highest lung cancer incidence. Kentucky is one of the thirteen states in Appalachia in which the difference in wealth is a key determinant of health, since residents of Appalachia do not have access to the same financial resources as the rest of the US population. The disparities in lung cancer mortality within the Commonwealth of Kentucky are not completely clear, but some postulate that poor access to care or substandard care may contribute. In this study the value of lung cancer treatment for a medically underserved population (Appalachia) will be evaluated …

Outbreak Severity Index: The International Response To The Global Outbreaks, Mohamed A. Abofaye

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

Outbreaks are emergency situations that carry hazards of death, disability, loss of home and property, and variety of other calamities. With technological advancement, not only people and commodities are easy to transfer but also disease outbreaks. However, outbreaks are dealt with by different countries based on the differences in their healthcare systems and their ability to achieve effective control of the outbreak. SARS, MERS, and Ebola are example of such outbreaks that traveled around the globe and successful control was different according to the virulence of outbreak agent and to the effectiveness of local health system control measures. This capstone …

Injury Prevention In An Industrial Environment Via Strategic Job Placement, Michelle Cooper

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

Objectives. This study investigated the effects of an injury prevention program, specific to work related musculoskeletal disorders (WMSDs), which placed employees into jobs based on their physical abilities compared to the physical demands of their prospective jobs.

Methods. Employee injury data (N=3550) from a large auto manufacturer in the U.S. was analyzed to examine changes in injury rates for employees that were hired pre versus post-strategic placement. Bivariate and multivariate analyses were used to determine dependence between placement, injury within 120 days of hire and gender.

Results. Chi-square tests of independence revealed that injury rates and job placement may be …