Public Health Commons^™

Using Public Health Accreditation (Phab) Standards To Improve Efficiency And Effectiveness In A Local Health Department (Bourbon County, Kentucky), Helen Karrick Sauer

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

Objectives: Small and rural local health departments face unique challenges in maintaining their operations amongst budget cuts. Accreditation of local health departments by the Public Health Accreditation Board (PHAB) has been identified as a strategy to help struggling health departments improve their efficiency and effectiveness. These health departments may be able to enjoy the benefits of accreditation even without ultimately achieving it by deliberately aligning themselves with PHAB standards. Methods: This capstone report presents a case study of the Bourbon County Health Department (BCHD). Using PHAB accreditation standards as a playbook, the public health director (PHD) reorganized BCHD to focus …

Organizational Effectiveness Frameworks In Public Health Nonprofit Systems: A Case Study, Morgan Floyd

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

Problem: Nonprofits, especially in public health, have become more and more prevalent in recent years. With that increase in support, come greater awareness from stakeholders evaluate nonprofits as effective and impactful on the communities they serve. Frameworks of Organization Effectiveness allow investigators to predict how effective an organization might be in their work. The aims of this study were to identify key Organizational Effectiveness frameworks that could be used to evaluate Nonprofits and use them in practice. Therefore, individuals wishing to become involved with effective nonprofits will be empowered to make good investments of volunteer time and donations

Method: This …

Policy Analysis Of Kentucky Senate Bill 192, Sierra Nicole Dantzler

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

Needle sharing has become an important factor in the prevalence of HIV and viral hepatitis rates as injection drug use of illicit substances, such as heroin and prescription opioids, has increased across the United States. Kentucky, much like the rest of the nation, has also been devastated by the recent surge of injection drug use. In 2010, drug overdose rates ranked Kentucky as the third highest state in the nation. Hepatitis B (HBV) and Hepatitis C (HCV) rates within Kentucky have been consistently higher than the national rate since 2007 and 2003, respectively. Hospital discharge costs related to HCV infections …

Concealed Weapon Proliferation And The Impact On Firearm-Related Fatalities And Injuries Due To Assault In Kentucky, 2005-2013, Travis Young

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

Objectives: The objective of our research was to look broadly at firearms and health in the state of Kentucky, where annual gun purchases are rising and laws eliminating restrictions on concealed carry have empowered more than 300,000 citizens to carry firearms in virtually any public setting. As guns become more prevalent, and more readily accessible, will violent crime decrease as some have predicted, or will the potential for conflict escalation cause the opposite effect?

Methods: Utilizing death records for firearm-related homicides and hospitalization and emergency department visit data for injuries occurring due to firearm-related assault, we correlated the rate of …

The Use Of Local Tax Dollars In Kentucky Local Health Departments To Sustain Programs From 2009-2013, Crystal A. Miller

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

This is a descriptive “case” study of public health finance in Kentucky, no data from other states were examined. The data used in this study were provided by the Kentucky Department for Public Health (KDPH). The data used in this study are longitudinal (2009-2013) and the core focus of this study is on: 1) changes in funding from the state to the 57-61 local health departments (single county and multi-county district departments) 2009-13, 2) changes in restricted and un-restricted fund reserves among local health departments, and 3) an examination of the local taxing districts and greater reliance on use of …

Tier 1 Genomic Applications: A Kentucky State Needs Assessment, Andrea L. Durst

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

Paper 1: An Assessment of Kentucky Cancer Registry Data for Appropriate Referral to Genetic Services for Hereditary Breast and Ovarian Cancer Syndrome and Lynch Syndrome, 2009-2012

BACKGROUND: It is estimated that over 1 million people in the United States have Hereditary Breast and Ovarian Cancer syndrome (HBOC) or Lynch syndrome (LS). Evidence-based guidelines for identifying individuals with HBOC and LS are available, and the CDC has developed a toolkit to provide guidance for the implementation of programs to increase identification of patients appropriate for cancer genetic services. However, most individuals with HBOC and LS remain undiagnosed. While some state public …

An Examination Of Intimate Partner Violence And Cigarette Smoking Among African American Women In 12 States, Eboneka Coleman

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

Abstract

Introduction. African American female intimate partner victims (IVP) are more likely to abuse substances, suffer from depression and anxiety, and experience mental health issues, including PTSD, all of which are risk factors for smoking. The purpose of this study is to determine among African American women who have ever experienced IPV the prevalence of smoking and whether it is influenced by education and income.

Methods. Data for this study comes from the 2005 Centers for Disease Control and Prevention (CDC) state-based Behavioral Risk Factor Surveillance System (BRFSS). This primary study population was African American females who answered IPV-related questions …

Key Nutrient Selection And Consumption By Elementary Students In The National School Lunch Program, Jocelyn Hayward Cowen

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

While the recent decline in the rate of obesity amongst preschool children in 19 states is encouraging,(1) the overall rate of obese children in the United States remains at 17%.(2) Obese children suffer physical, emotional, and psychological health consequences such as high blood pressure, high cholesterol, impaired glucose tolerance, breathing problems, fatty liver disease, poor selfZesteem, and depression.(3) Furthermore, obese children are more likely to become obese adults with their health problems worsening with age.(3)

The National School Lunch Program (NSLP), which provided meals to over 30 million students in 2013,(4) was recently revised to improve school food environments to …

The Effectiveness Of Sexual Education Programs On Teen Births Among Females With And Without A Family History Of Teen Births, Holly Poynter

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

Adolescents (ages 10 to 19) and young adults (ages 20 to 24) make up 21% of the population of the United States. Therefore, the topic of adolescent health is an important focus in Healthy People 2020.5 The HP 2020 initiative describes adolescent health as a fairly broad topical area that encompasses smaller subjects such as teen smoking, pregnancy, and suicide. Due to its recent decline, teen pregnancy is often overlooked as an epidemic problem in the United States. According to the CDC, “…the sexual and reproductive health of America’s young persons remains an important public health concern: a substantial number …

Flavored Milk And The National School Lunch Program, Ellen Hutchins

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

According to the National Health and Nutrition Examination Survey (NHANES) nearly 17% of children nineteen years of age and younger are obese.1 Obese children face many health ailments similar to those of obese adults including sleep apnea, asthma, hypertension, and early onset of type 2-diabetes.2 These problems continue into adulthood when additional risks such as cancer and cardiomyopathy begin to develop.2 Furthermore, obese children are at increased risk of adult obesity.3 Addressing the childhood obesity challenge has become a national priority, with significant initiatives from the White House, USDA, CDC, and other national health organizations as well as numerous intervention …

Associations Of Maternal Socio-Demographic And Psychosocial Characteristics With Alcohol Use During Pregnancy, Nneoma Adaobi Ilogu

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

Alcohol is reported to be one of the most used legal substances among women of reproductive age, and its use during pregnancy is one of the most preventable causes of birth defects and developmental disabilities.1 Due to its teratogenic nature, alcohol use during pregnancy has been associated with a condition referred to as Fetal Alcohol Spectrum Disorders (FASD).2 This comprises of a wide spectrum of disorders such as Fetal Alcohol Syndrome (FAS), alcohol-related birth defects, and alcohol-related neurodevelopmental disorders, which are estimated to affect 1% of all births in the United States and can be prevented through the modification of …

Are There Benefits Of Smoking Reduction During Pregnancy? Smoking Status Of Pregnant Women And The Effect On Pre-Term Delivery, Kelli Ann Mclane

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

Premature delivery is defined as a baby born before thirty-­‐seven completed weeks of pregnancy. Premature delivery can result in a longer hospital stay after delivery compared to babies born at full-­‐term.1 Babies born before 37 gestational weeks also have a greater potential for health problems such as acute respiratory, gastrointestinal, immunologic, central nervous system, hearing, and vision problems, as well as longer-­‐term motor, cognitive, visual, hearing, behavioral, social-­‐emotional, health, and growth problems.2 Premature births can impact at the individual level and at a societal level. “The birth of a preterm infant can bring considerable emotional and economic costs to families …

Factors Affecting School Health Scores: Wellsat Scores, School Policy, And The School Environment, Alicia Baker

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

A recent trend in school health intervention has been through policy creation and development. Studies have shown that changes in school health policy can improve student health behaviors, particularly in physical activity and nutrition. This study looked at how potential factors could affect the scores of a school policy assessment tool called the Wellness School Assessment Tool (WellSAT). Using a combination of t-tests, chi-square tests, and logistic regression, schools’ strength and comprehensiveness nutrition scores from the WellSAT were analyzed when compared to Free and Reduced Lunch Rates, type of school, and whether schools had separate policies from their school district. …

Effects Of Locality And Risk Of Late Stage Breast Cancer Diagnosis In Kentucky Females, 2001-2011, Michael Jacob Sither

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

Breast cancer survival is heavily dependent on stage at diagnosis. Recent evidence supports rural women are more likely than urban women to be diagnosed with advanced stage disease but historically these findings have been mixed when investigated at the state level. Cancer surveillance in the Appalachian region suggests Kentucky females are at significantly greater risk of premature breast cancer mortality due to consistently lower prevalence of screening mammography utilization. In the literature, disparities in breast cancer outcomes have been largely explained by population demographics, areabased measures of socioeconomic deprivation, shortages of referring providers as well as differences in spatial access …

Evaluating Oral Health Trends In Kentucky, 2006-2012, Briana Michelle Forsythe

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

According to the former US Surgeon General, C. Everett Koop, “You’re not healthy without good oral health.” Poor oral health, comprising of the presence of caries and/or periodontal disease, can lead to edentulism, which in turn can yield poor physical health, inability to communicate properly, poor mental health, and a lesser quality of life. In Kentucky, over one quarter of the adult population has lost six or more teeth due to decay or gum disease, a figure 10% higher than the national average. Objectives: The purpose of this study was to examine: a) Kentucky’s Statewide Oral Health Strategic Plan, implemented …

Factors Influencing Differential Oral Health Care Use Between Hispanics And Non-Hispanic Whites In The U.S., Nathalie Astudillo

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

Oral health is often considered merely the absence of disease. However, oral health involves much more. Good oral health facilitates very basic functions like eating and speaking; a healthy smile is also associated with good self-esteem and productivity.1 Most oral health diseases are largely preventable. Despite this, a large portion of the population in the United States still suffer from untreated dental decay.2 Poor oral health has a direct effect on systemic health, quality of nutrition, digestion, phonetics, selfimage and self-esteem.5 Whether considered individually or combined, each of these factors has a direct impact on the quality of life of …

Injuries Among Miners In Kentucky During 2010-2012 From Workers Compensation Data, Evelyn Thomas

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

Introduction: Coal miners in Kentucky have higher rates of injury morbidity and mortality than national rates. In order to understand better what is happening in this area, we not only analyzed the injuries and deaths, but also identified common characteristics between these nonfatal and fatal injuries. The objectives of this study were to 1) Identify injuries among coal miners in Kentucky; 2) Determine if there are any other risk factors for injuries other than working in a mine; and 3) Determine the different health effects on coal mine workers. Methods: Data from Kentucky Workers’ Compensation First Reports of Injuries and …

Influence Of Marianismo On Colorectal Cancer Screening Behavior Among Hispanic Women In The United States, Robin Thompson

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

Colorectal cancer (CRC) is the third most commonly diagnosed cancer and the second leading cause of cancer death in the United States (U.S).1 Although early detection and treatment can reduce CRC-related morbidity and mortality, almost twothirds of patients are diagnosed with advanced stage disease indicating non-adherence to recommended screening guidelines.1 Indeed, less than half of individuals over 50 years of age get screened at recommended intervals.2 More specifically, lower rates of CRC screening exist among these groups: those identifying as being of Hispanic origin, the uninsured, disabled individuals, and women.3 In a 2011 report from the National Center on Health …

An Exploration Of Empowerment, Sexual Violence, And Hiv Among Indian Women, Brigid Kyung-Hwa Cecil

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

Empowerment plays a major role in sexual violence and HIV among women worldwide. Findings on empowerment in relation to domestic violence or HIV are scarce and are conflicting. The purpose of this study was to examine the relationship between empowerment and HIV status by means of sexual violence, and to compare this relationship between previously married women (N = 2,658) and currently married women (N = 37,539) living in India. The Baron and Kenny mediated regression model was used, involving simple logistic and multiple logistic regression, drawing from the National Family Health Survey 2005-2006 (NFHS-3). Sexual violence was not found …

Association Of Hiv Testing, Educational Attainment, And Age Among Black And Non-Black Men, Ashley N. Martell

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

Human Immunodeficiency Virus (HIV) infection can lead to a chronic condition, Acquired Immunodeficiency Syndrome (AIDS), but can be well managed with a combination of medications, treatments, and remedies.1 The emergence of HIV in the United States in 1981 created an atmosphere unlike any other at that time. Overtime, the science community has worked diligently to combat this disease through research, practice, and intervention. Although many efforts have been put forth over the past thirty years, millions of Americans still remain infected with HIV.2 Among those who are infected with HIV/AIDS we see disproportionate rates among specific races and gender. Research …

Patterns Of Pneumoconiosis Mortality In Kentucky: Analysis Of Death Certificate Data, Jake Beggs

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

ABSTRACT

Background: Despite ongoing surveillance efforts, mortality rates associated with total pneumoconiosis, and particularly coal worker’s pneumoconiosis, have remained elevated. Methods: Kentucky death certificate data from 2003-2011 was statistically compared to other coal mining states and descriptively analyzed from 2011-2013 to determine the mortality burden and public health implications of pneumoconiosis and coal worker pneumoconiosis (CWP) on Kentucky residents from 2003-2013. Results: Kentucky’s total pneumoconiosis and coal workers’ pneumoconiosis mortality rates decreased from 2003-2009, then increased in following years, showing a significant quadratic trend from 2003-2013 (p<.05) compared to West Virginia, Pennsylvania, and the overall United States rates that had significant negative linear trends from 2003-2011(p<.05). Deaths from pneumoconiosis primarily occurred in white males from CWP in the Appalachian region. Individuals diagnosed with pneumoconiosis died from respiratory illness 50% of the time, heart-related problems (23%) and cancer (12%). Autopsies were only performed on 12% of decedents over the three year study period and the primary locations of death were in hospital (47%) and at home (36%). Conclusions: Increased coal mining industry worker environmental exposure protection should be enhanced in Kentucky. Additionally, healthcare efforts should focus on increasing patient education to ensure early detection and treatment for individuals suffering from pneumoconiosis as well as for comorbid conditions such as Chronic Obstructive Pulmonary Disease. To further target healthcare and treatment of pneumoconiosis patients, increased autopsies of individuals with pneumoconiosis should be performed to identify involvement of other conditions such as silicosis and optimize pneumoconiosis fatality surveillance.

Breast Health And Access To Care In The Kentucky Women's Health Registry, Sarah Yeiser

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

Breast cancer is the second leading cause of death (14%) among all cancers in women in Kentucky.1 In 2010 the United States incident rates of breast cancer in white women were 122.6 per 100,000, and 118 per 100,000 in black women.2 Although breast cancer is diagnosed more in white women, black women are more likely to die from breast cancer and usually have more advanced stages of breast cancer upon diagnosis.2 In Kentucky from 2003-2007 the age-adjusted breast cancer mortality rate was 23.6 per 100,00 in white women and 32.8 per 100,000 black women. Black women die from breast cancer …

The Effect Of Television Watching On Condom Use Among 9th-12th Graders, Rashidat Mohammed

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

Abstract: At least one out of every three youth will acquire a Sexually Transmitted Infection (STI) by the time they reach 25 years old. Although this may be caused by a variety of factors, sexually-charged media are believed to play a significant role. In television, there are more sexually inaccurate messages than there are portrayals of sexually responsible behaviors. These messages are not only unrealistic, but they could potentially have negative effects on adolescent sexual behavior. Among these negative effects is failure to use condoms. When used correctly, male condoms are about 98% effective. Recommendations are presented to help address …

Improvement Of Tobacco-Free Policy Enforcement At The University Of Kentucky, Muchen Bai

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

Smoking has been known as the leading preventable cause of death and premature disease in the United States (DHHS, 2014). Every year, cigarette smoking causes more than 480,000, approximately, one in five deaths (DHHS, 2014). According to the Centers for Disease Control and Prevention (CDC), "smoking causes more deaths each year than all of the listed combined: Human immunodeficiency virus (HIV), Illegal drug use, Alcohol use, Motor vehicle injuries, and Firearm-related incidents" (CDC, 2014). Since 1964, 31 Surgeon General's Reports have revealed the causal relationship between health outcomes and tobacco smoke exposure (DHHS, 2014). The report, The Health Consequences of …

Association Between Co-Sleeping And Breastfeeding: Does Prenatal Care Make A Difference?, Brynne Kathleen Adams

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

Prenatal care is important to ensure a healthy pregnancy for both a woman and her baby. According to the Mayo Clinic, prenatal care should start as soon as there is a positive pregnancy test and should continue throughout the pregnancy.1 The more prenatal care visits a woman attends, the more opportunities to detect potential problems and offer health education materials to help ensure a healthy pregnancy. Prenatal care visits are also used to discuss what may happen after the woman delivers particularly early infant care and breastfeeding. Mothers who do not receive adequate prenatal care are three times more likely …

The Relationship Between Perceived High Levels Of Stress And Non-Condom Usage Among College Students At The University Of Kentucky, Samantha Bearman

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

Introduction: Due to the paucity of research that specifically examines the non-use of condoms, during sexual encounters, as a maladaptive coping strategy for stress among college students; the purpose of my study, is to determine if there is an association between perceived high levels of stress and the decreased likelihood of condom use during sex among students at the University of Kentucky. Method: The cross-sectional descriptive study investigated health behaviors and attitudes towards health behaviors in a sample of 7,000 University of Kentucky students enrolled in courses for fall 2013. Participants were randomly selected to partake in an anonymous online …

Impact Of Routine Immunization Coverage In Controlling Measles And Progressing Toward The Introduction Of Rubella Containing Vaccine: A Comparison Study Between Rwanda And Uganda, Carmen Kupangi Dibaya

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

Despite the existence of safe and effective vaccines, measles and rubella present a major public health problem in many developing countries, disproportionally affecting low-income populations.1-3 Indeed, measles and rubella remain two of the leading causes of death and congenital defects in children worldwide.4-6 In 2008, an estimated 10 million new cases and 164,000 deaths were reported from measles alone.3 During the same time period, the United Nations International Children's Emergency Fund (UNICEF) reported an estimated 110,000 cases of Congenital Rubella Syndrome (CRS) in developing countries, with the continent of Africa shouldering 38% of the disease burden.7 Measles is a highly …

An Evaluation Of Three Positive Parenting Practices And Their Combined Impact On Developmental, Social, Or Behavioral Delays In Children Ages 1-5 In The United States, Sarah Cprek

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

Objectives: (1) Determine whether three individual positive parenting practices (PPP) – reading to children, engaging in storytelling or singing, and eating meals together as a family – decrease the risk of developmental, behavioral, or social delays among children between the ages of 1-5 years in the United States. (2) Determine if a combination of these parenting practices has an additive effect on the outcome. Methods: Multiple logistic regression and chi-square analyses were used to analyze data from the National Survey of Children’s Health 2011/2012 in regards to the relationship between each of the three individual PPP as well as a …

Distribution Of Wildlife Rabies In Central Appalachia And Analysis Of Factors Influencing Human Exposure, Sara J. Reilly

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

Abstract Background: The rabies virus is a Lyssavirus of the family Rhabdoviridae which affects all mammals and causes progressive encephalomyelitis that is fatal in nearly one hundred percent of untreated cases. In the United States, wildlife act as the primary reservoir for rabies and prevention, surveillance, and control costs remain high. The purpose of this study is to understand the current distribution of wildlife rabies in Central Appalachia, as well as identify any demographic or geographic factors which may affect the risk of human exposure at the county level. Methods: A spatial statistical analysis using StatScan was performed to identify …

Narrative And Qualitative Analyses Of Workers' Compensation-Covered Injuries In Short-Haul Vs. Long-Haul Trucking Industries, Mark D. Chandler

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

ABSTRACT

Problem: Trucking transportation remains one of the most dangerous industries in the US. The aims of the current study were to (1) identify and characterize differences in injury types between workers in short-haul and long-haul trucking; (2) analyze and code narrative text to identify and characterize the on-the-job activities associated with injuries within each trucking industry group; and (3) identify areas for targeted improvement of safety interventions. Method: Quantitative and narrative analyses of 2012 Kentucky short-haul and long-haul truck transportation workers’ compensation first reports of injury and narrative text data were performed. Chi-square tests assessed differences in demographics, injuries, …