Cardinal's Blues: Implementation Of A School-Based Cognitive Behavioral Therapy Program For Jefferson County Public Schools In Louisville, Kentucky, Loui Chang

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

With the increasing rate of adolescent depression and anxiety1 2, developing mental health interventions is necessary. Many adolescents’ times spent in schools increased compared to 20 years ago5, which makes school-based intervention programs suitable for reaching adolescent population effectively. Though there are numerous treatment providers available in Jefferson County, Kentucky, the school-based prevention programs addressing adolescent’s negative mental health outcomes have never been implemented. The Blueprints for Healthy Youth Development developed a program called the Blues Program24. The Blues Program provides an adapted version of group Cognitive Behavioral Therapy sessions to train and educate adolescents coping skills and cognitive restructuring24. …

Impact Of Insurance Payer On Stage At Diagnosis Of Prostate Cancer, Hunter M. Stiff

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

Objectives: Prostate cancer (CaP) is the most common site of cancer in men in the United States and is very treatable when diagnosed in localized and regional stages. While there are widely available forms of screening that can detect CaP in its early stages, factors that can affect healthcare access such as health insurance, race, and Appalachian residency have been linked with differences in rates of distant-stage CaP diagnosis. This study aimed to explore the relationships between health insurance, race, Appalachian residency, and late-stage CaP diagnosis in the state of Kentucky.

Methods: A sample of 26,622 men from the state …

Prevalence Of Multimorbidity In The Atherosclerosis Risk In Communities Study At Baseline, Katie Highfill

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

Aim: The aim of this study is to examine the prevalence of multimorbidity among middle-aged adults in the Atherosclerosis Risk in Communities Study at baseline by examining the demographic and socioeconomic characteristics of the participants.

Methods

I included 15,698 participants from the Atherosclerosis Risk in Communities (ARIC) baseline visit. Participants were randomly selected from 4 different locations in the United States. Multimorbidity was defined as the prevalence of 2 or more chronic conditions in an individual. Three different multimorbidity definitions (MM1, MM2, and MM3) were created with different inclusion criterion. Prevalence of each multimorbidity definition was analyzed among participants using …

Real-Time Surveillance Of The Drug Epidemic: An Assessment And Comparative Visualization Of Substance Abuse In The Commonwealth Of Kentucky, Julia Van Hosen

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

The purpose of this study was to implement and examine a new surveillance system for Kentucky State Police’s forensics unit to track trends of illicit drugs and drug trafficking, and to see if the implementation of this new system was associated with a decrease in overall drug counts over a period of five months. An extensive review of the literature showed that the drug epidemic in the United States continues to worsen, with public health and law enforcement institutions leading the fight in attempting to end the epidemic, but little evidence showing these two joining forces to work together.

Results …

"Disparities In Suicide Mortality Among Healthcare Support Workers In The United States, 2003-2019", Sol Ngam

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

Objectives: To identify differences in demographic and contextual characteristics of suicide mortality among healthcare support workers (HCSWs) and to estimate annual suicide rates among HCSW in the United States from 2003-2019 using the National Violent Death Reporting System (NVDRS) and the United States Bureau of Labor Statistics (BLS).

Methods: Demographic variables of healthcare support worker suicide decedents were collected using the NVDRS. Odds ratios for circumstantial risk factors by sex were calculated. Crude rates for healthcare support worker suicide decedents were calculated and compared to the U.S. general population suicide crude rates.

Results: Male HCSW were more likely to have …

Gender Differences In Barriers To Entering Substance Use Treatment, Casey A. Baker

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

Background

Nationally representative data have indicated that less than one in ten individuals with a substance use disorder (SUD) have received recent treatment, suggesting a need for research to examine potential barriers to SUD services. Although research has been conducted to identify some barriers to treatment, there is little research focused on gender differences. To address this gap in research, the present study aimed to examine gender differences in barriers to entering SUD treatment, as well as differences in factors that may impact decisions to enter treatment.

Methods

Participants (N = 62) were recruited from the community as part of …

Epidemiology Of Sars-Cov-2 Breakthrough Infections In Kentucky March 1st 2021 - December 31st, 2022, Harrison Hynes

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

Objective: Provide epidemiologic overview of SARS-CoV-2 breakthrough infections in Kentucky considering both demographic and geographic variables.

Background: We believe descriptive information of breakthrough cases for a defined population will provide public health practitioners with useful information relating to SARS-CoV-2 infection control and vaccination efforts.

Methods: We obtained SARS-CoV-2 case data from the Kentucky Department for Public Health COVID-19 case repository, which mirrors National Electronic Disease Surveillance System (NEDSS) data. The study sample used for analysis comprised 147,000 individuals who tested positive for SARS-CoV-2 in Kentucky between the dates of March 1^st, 2021 and December 31^st, 2022. …

Saint Louis, Missouri Maternal Mortality Prevention Program: Rose Program, Abbi Peck

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

In the United States, maternal mortality has become a growing public health concern after recent studies revealed significant disparities in maternal health outcomes when compared to other high-income countries (The Commonwealth Fund, 2020). The World Health Organization (WHO) defines maternal mortality as the death of a pregnant woman or the death of a woman within 42 days of delivery, miscarriage, termination, or ectopic pregnancy (Centers for Disease Control and Prevention, 2022a). From 2017-2019, the maternal mortality in Saint Louis, Missouri, the state’s largest and most populated metropolitan area, was determined to be 36.4 maternal deaths per 100,000 live births. This …

Physical Inactivity And Single-Female Caregivers, Johanna Hoch, Rachel Hogg-Graham Dr., John Lyons Dr., Maureen Jones Dr.

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

Physical activity is vital for human health. However, many adults in the United States and beyond do not reach the pre-determined recommended levels of activity needed for health benefits. Single-female caregivers present a unique and vulnerable population that is often more inactive than their partnered peers or single-male caregivers. The primary purpose of this cross-sectional investigation was to identify the prevalence of physical inactivity in single-family, female-led households and determine differences in personal factors and social determinants of health between single-female caregivers who indicated they were physically active compared to single-female caregivers who indicated they were not physically active. A …

Implementation Of A School-Based Adolescent Pregnancy Prevention Program In Harlan County, Kentucky, Jaycea Frederick

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

Kentucky has the 6^th highest rate of adolescent pregnancy in the United States and Harlan County ranks among the highest rates in the state. Adolescent pregnancy is a public health problem and costs taxpayers in the United States around $9.4 billion each year. Overall, there have been declines in adolescent pregnancy but the national average soars above those in other Western industrialized nations such as the United Kingdom. Implementing a comprehensive sexual health education program in a public school setting is an efficient strategy to reach numerous adolescents and influence sexual health knowledge and help to delay the initiation …

The Impact Of Flooding Events In Kentucky Counties On Preventable Asthma Hospitalizations, Mckaylee Copher

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

Objective: Given the frequency and intensity of flooding, along with the disparities in respiratory illnesses in Kentucky, this study aims to determine if there is an association between flooding and asthma is crucial to the health of the state population.

Methods: Preventable asthma hospitalizations in adults aged 18-39 were obtained from the Kentucky Cabinet of Health and Family Services, Health and Facility Services Data and included the count of admissions of an ICD-9 diagnosis of asthma, as determined by hospital discharge data. FEMA disaster declarations were used to identify 69 counties that had floods during the period of 2008-2015. A …

Sociodemographic Factors Related To Late-Stage Lung Cancer Diagnosis In Kentucky, Kaylee Stickler

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

Lung cancer is the leading cause of cancer mortality in the United States, and the state of Kentucky has a significant burden of lung cancer morbidity and mortality. The aim of this study is to examine the sociodemographic factors associated with late-stage lung cancer diagnosis in Kentucky. The present study is a retrospective, population-based cohort study that utilizes data from the Kentucky Cancer Registry to examine the associations between late-stage lung cancer diagnosis and sociodemographic factors. Descriptive, bivariate, and multivariable analyses were conducted to estimate the significance of these associations. Significant relationships between the variables of sex, age, Appalachian status, …

Implementing A Mobile Saliva Rinse Screening For P16 Markers For Hpv (Human Papillomavirus) Positive Head And Neck Cancers In Central Kentucky, Madeline Brown

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

Rates of HPV-related head and neck cancers are increasing across the nation and more specifically, there has been a significant increase in the state of Kentucky. This study focuses on the implementation of a mobile clinic saliva-rinse screening program. This program will be set up at UK Athletics Men's basketball and football games in hopes of recruiting middle aged men ages 45-60, who are the target audience of the study. This is the population with highest prevalence for HPV positive head and neck cancers and also the population least likely to visit their health providers regularly. A quick saliva rinse …

Characterizing Region Iv State Health Agency - Central Office's Workforce Needs: Results From The 2021 Public Health Workforce Interest And Needs Survey (Ph Wins), Ashley Carroll

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

The purpose of this project was to examine the Region IV State Health Agency – Central Office workforce in regards to retention and reasons for leaving; workforce satisfaction levels and how that influences retention; and training gaps among non-supervisors. An extensive review of existing literature was completed and showed that since the great recession, there has been a loss of 40,000 positions at state and local governmental health agencies (Castrucci & Lupi, 2020). In addition, from 2008 to 2019, there has been a 16 percent decline in the national public health workforce, and 47 percent of public health workers plan …

A Case Study In Program Evaluation: Evaluation Of A Hypertension Self Management Program, Bailey N. Schenk

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

The CDC's program evaluation process framework is a six-step approach that guides public health practitioners in the evaluation of public health programs. The framework includes engaging stakeholders, describing the program, focusing the evaluation design, gathering credible evidence, justifying conclusions, and ensuring use and sharing of lessons learned. Each step is important in developing a comprehensive and effective program evaluation. This evaluation discusses the application of the six steps of the CDC's program evaluation process framework and how it was utilized in evaluating a hypertension self-management program at a local health department.

Changes In Severity Of Diabetes At Diagnosis Following The Onset Of The Sars-Cov-2 Pandemic, Annelise King

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

During the SARS-CoV-2 pandemic it was seen that diabetes was a risk factor for severe COVID-19. The objective of this study is to assess the severity of diabetes at diagnosis during the COVID-19 pandemic compared to pre-pandemic to see how the pandemic and SARS-CoV-2 infection impacted the severity of diabetes. This study used University of Kentucky electronic health records of 13,794 patients who developed diabetes. The majority of patients were female, white non-Hispanic, 65+, and living in an urban area. There were differences seen between the COVID-19 positive and negative cohorts in the DKA and HbA₁c variables, with …

Effect Of Medicaid Expansion On Inflammatory Bowel Disease And Healthcare Utilization, Brittany Levy

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

Inflammatory bowel disease (IBD) affects over 3 million adults in America, relaying a

need for chronic disease management. Along with 24 other states, Kentucky expanded the

Medicaid program January 1, 2014. We hypothesize, Medicaid expansion adoption results in

reduced emergency healthcare services, and increased elective healthcare services with a

reduction in overall healthcare utilization by individuals in the adult IBD population.

The Hospital Inpatient Discharge and Outpatient Services Database identify encounters

related to ulcerative colitis or Crohn’s disease from 2009-2020, in Kentucky. Patient

demographics, admission type, discharge, length of stay, and hospital charges were compared.

3386 pre-expansion and 24255 post …

Health Management And Policy Capstone: A Case Study In Program Evaluation, Kelsey R. Gatton

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

Program evaluation of a hypothetical comprehensive hypertension self-management program as directed by the CDC Framework for Program Evaluation in Public Health.

Evaluation Of Facebook Social Media Messages Following The 2022 Eastern Kentucky Floods, Delaney Bonds

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

Purpose: The goal of this study is to examine the availability of disaster-related information online from local health departments in flood-impacted counties in the month following 2022 Eastern Kentucky Floods. This study aims to evaluate Facebook messages by (1) when messages were posted (2) types of posts (3) message content.

Methods: This mix-methods environmental scan of Facebook messages posted by 8 flood-impacted Eastern Kentucky local health departments from July 26^th, 2022, to August 26^th, 2022. Messages were coded for absence or presence of a message feature. These message features were examined to identify features relevant to …

The Prepare Mobile Program For Hiv Prevention In Washington D.C., Gabrielle Cochran

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

Incidence rates of HIV have decreased in the United States in the past decade, but the southern United States has higher rates of HIV than other regions, and cities in the south, like Washington D.C., have some of the highest rates of HIV incidence in the nation. Risky sexual behavior, needle sharing, and substance use increase the risk of transmitting or acquiring HIV, and these behaviors are more common among unhoused people (CDC, 2021; CPPH, 2022).

Expansion of community resources in cities with high levels of HIV have allowed for many people at high risk for HIV to comply with …

Retrospective Analysis Of Non-Ketotic Hyperglycinemia Patients In Central And Eastern Kentucky, Shane Reeves

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

Aim: To obtain a better understanding of the non-ketotic hyperglycinemia (NKH) patient population in regards to clinical features, mortality, geographic clustering, genetics, and incidence rate within the University of Kentucky (UK) catchment area of Central and Eastern Kentucky.

Methods: Patients with ICD codes corresponding to NKH who were treated at UK between January 1, 2008, and July 1, 2022, and who had clinical documentation available for review were identified through UK’s medical records (N=15). Demographic and clinical data were obtained through review of these patient’s charts in the electronic medical record. Differences in features among patients was assessed utilizing Fisher …

Trends In Respirable Coal Mine Dust Concentration (Mg/M3) Based On Coal Miners’ Occupational Designation: An Analysis Of The Msha Coal Dust Samples Data Set (2000-2022), Aaron Blake Charles

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

Rates of Coal Workers' Pneumoconiosis (CWP) have recently increased in prevalence over the past 20 years. Recent regulation (Phase III) by the Mining Safety and Health Administration to lower the coal dust standard to 1.5 mg/m3 has been mandated to assist in reducing the burden of CWP. Occupations in the coal mining industry have different exposures to coal dust depending on their occupational responsibilities. This study examined the respirable coal dust trends for underground and surface mining occupations from 2000 to 2022. The ultimate goal is to see how respirable coal dust exposures have changed in multiple occupations over this …

Health Management And Policy Capstone: A Case Study In Program Evaluation, Bradford Brewer

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

Hypertension has risen steadily among adults in United States over the past 30 years. This increase has also been marked by a significant increase in reported prevalence rates of cardiovascular diseases. In response, the Centers for Disease Control and Prevention (CDC) funded the Lexington-Fayette County Health Department to deliver a hypertension self-management program for adults aged 35 and older. This manuscript follows the six steps of CDC program evaluation to aid Lexington citizens with uncontrolled high blood pressure (≥140/90 mmHg) in successful hypertension self-management. This evidence-based community intervention helps patients take responsibility for managing their hypertension with assistance from health …

Rapid Scoping Review Of The Epidemiological Evidence For Mercury Exposure And Prevalence Of Alzheimer’S Disease, Rebecca Mattingly

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

This rapid scoping review examines the current body of epidemiologic research evaluating the potential linkage between environmental exposure to mercury and Alzheimer's disease (AD). Alzheimer’s disease accounts for 60-80% of all neurodegenerative disease in the United States and was the seventh leading cause of death in Kentucky in 2020. The exact etiology of AD needs further investigation; however, environmental factors such as pesticides, arsenic, cadmium, lead, and mercury have been correlated with development of AD lesions, cognitive decline, and AD. Mercury is a toxic metal that can be found in air, water, and soil, both from natural and human-made sources. …

Blue Oval Sk Battery Park Environmental Impact And Community Guide, Warren Rummage

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

This Capstone Project Paper will discuss the potential effects of the BlueOval SK Battery Park being constructed in Glendale, Kentucky based on knowledge attained from open records requests and available publicly online. Based on the process of attaining said information, a Community Guide has been generated and is available to distribute to concerned community members. It is the hope that this work will enable those in Hardin County, and possibly beyond, to ensure their environment and community health are prioritized during the construction phase and eventual operation of the EV-battery manufacturing faciliities on this massive 1,500 acre plot of land.

Pfas Clinical Guidance, John Bingham

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

Introduction

A broad category of synthetic organic compounds, per- and polyfluorinated alkyl substances (PFAS), forms the impetus for this project. Known compounds in this category are numerous and diverse, with over 4700 identified molecular entities (Panieri, Baralic, Djukic-Cosic, Buha Djordjevic, & Saso, 2022). Their only commonality is the presence of at least one carbon atom that is saturated with fluoride groups. These chemical bonds are exceptionally difficult to break (Tansel, 2022), which incepts both the utility of PFAS compounds and the concerns they raise for human health (Cousins et al., 2020). While PFAS are …

The Relationship Between Maternal Depressive Symptoms And Unsafe Infant Sleep Practices In A Low-Resource Community, Rebecca D. Day, Ketrell L. Mcwhorter, Hartley C. Feld, Steven R. Bronwing

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

Objectives: To determine the relationship between maternal depressive symptoms and unsafe infant sleep intention and practices during and after pregnancy.

Methods: This study recruited 100 women from a small clinic in a low-resource community of Santo Domingo, Ecuador from 2018 to 2020. Information on intention to practice safe sleep was collected during the third trimester of pregnancy and safe sleep practices were assessed at 1 month and 6 months postpartum via survey. Depressive symptoms were measured using the Patient Health Questionnaire 2 (PHQ-2). Using log-binomial regression, we estimated prevalence ratios (PR) and 95% confidence intervals (CI) cross-sectionally at …

Fork It, Kylee Pipgrass

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

Obesity prevalence is at an alarmingly high rate within the United States, but especially in rural areas of Kentucky. Obesity can lead to a variety of negative physical health outcomes including heart disease, diabetes, stroke, and some cancers. There are also mental disorders associated with obesity through mechanisms such as weight stigma and self-perception. Similar to obesity rates, prevalence and mortality associated of these health outcomes are also seen at disproportionately higher rates in rural, Appalachian Kentucky. Causes for increased obesity and obesity related consequences include some genetic factors as well as behavioral factors like physical inactivity, poor diet, stress, …

Epidemiology Of Angiosarcomas In Kentucky, 2000-2019, Emma Gough

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

Background/Objective: Angiosarcomas are rare, highly aggressive malignant soft-tissue sarcomas of vascular or lymphatic origin. The purpose of this study is to describe geographical distribution of angiosarcoma in Kentucky and to examine the epidemiology of angiosarcoma in Kentucky from 2000 to 2019, including the most common sites where angiosarcomas occurred and risk factors affecting survival. Methods: A sample of 246 angiosarcoma patients was received from the Kentucky Cancer Registry (KCR). Kaplan-Meier curves were produced to examine overall survival, as well as survival by age, insurance type, tumor size, and SEER site. A Cox proportional hazards regression analysis was conducted to estimate …

Roadway Density And Lung Cancer Histology In Kentucky, Mahala Pettus

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

The purpose of this article was to examine the relationship between a proxy measure of exposure to automotive exhaust – roadway density – and risk for adenocarcinoma lung cancer. Using data from the Kentucky Cancer Registry and the Kentucky Geoportal Data Clearinghouse, we conducted a cross-sectional study of the distribution of adult lung cancer cases by histological type across the state of Kentucky. The north-central region of Kentucky has a higher prevalence of adenocarcinomas and greater roadway density. Among adenocarcinoma cases in Kentucky, there are more non-smokers than other types of tobacco use. As smoking rates decrease in Kentucky, and …