Public Health Commons^™

Overdose Prevention And Naloxone Distribution In Jefferson County, Brittany Coleman

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

The United States in battling an opioid epidemic, and rates of overdose fatality have soared to record highs. Kentucky is among the states with highest rates of opioid overdose fatality, and Jefferson County is responsible for about a quarter of all cases. Overdose Prevention and Naloxone Distribution (OPND) programs have been shown to decrease fatality rates by providing a medication that literally reverses opioid overdose. The programs provide other services such as education and connection to recovery facilities.

Currently, the Kentucky Harm Reduction Coalition provides naloxone kits to the residents of Jefferson County, but they do not have a regular …

Long-Term Health Impacts Of Cell Phone-Driven Radiofrequency Radiation Exposure In Humans, Ndukaku Omelu

Walden Dissertations and Doctoral Studies

Uncertainties still exist about the safety of cell phone use and the level of cell phone-driven radiation. The purpose of the current inquiry was to determine the long-term health impacts of cell phone-driven radiation via the use of cell phones. In this cross-sectional study, which was based on socio-ecological theory, secondary data from the 2012 National Health Interview Survey were analyzed to assess the difference in the prevalence of thyroid cancer, mouth/tongue/lip cancer, and heart disease between exposed and non-exposed/less exposed cell phone-driven radiation groups in the United States. Logistic regression was used to address three research questions. Findings initially …

Effect Of Lung Cancer Treatment On Health-Related Quality Of Life, Festus Frempong Dokyi

Walden Dissertations and Doctoral Studies

Advances in lung cancer treatment among older adults require a risk-benefit analysis for health professionals, patients, and family members to assess increased survival and health-related quality of life (HRQL). The purpose of this study was to assess the effect of lung cancer treatment with surgery or tumor ablation on HRQL domains. A lung cancer quality of life model guided the study. The research design was a quantitative ancillary study in which 70 participants were recruited from those who had already consented to undergo a randomized clinical trial of lung cancer treatment. Data consisted of repeated administrations (baseline, 1- and 3-months) …

Low-Income Uninsured Perceptions, Beliefs, And Level Of Knowledge Concerning Primary Care Services, Pamela Ann Brown

Walden Dissertations and Doctoral Studies

In the United States, there is an issue with low-income uninsured patients using emergency services for nonurgent conditions instead of using primary care services. Primary care services are more beneficial than emergency services for such patients, in that they can receive continual or follow-up care through primary care and thus achieve better health outcomes over the long term. Though information is available concerning factors in (or the rationale for) low-income uninsured patients choosing the emergency department (ED) instead of primary services for nonurgent conditions, research focusing on low-income uninsured patients' perspectives, beliefs, and level of knowledge about this matter is …

Demographic Differences, Self-Esteem And Sexual Assertiveness Among Black Women, Sharon Lewis-Keith

Walden Dissertations and Doctoral Studies

There is a high HIV prevalence rate for Black women in Virginia; however, few scholars have examined how sexual assertiveness and self-esteem against HIV vary within this group. Black women who have low levels of self-esteem may increase their risk for HIV. The purpose of this quantitative cross-sectional study was to determine if four aspects of sexual assertiveness (sexual initiation, sexual refusal, HIV/AIDS/STD communication, and contraception/STD prevention) differed across demographic categories and were associated with self-esteem in a diversified group of Black women living in Virginia. A cross-sectional survey was conducted with a community-based sample of 117 adult Black women. …

Strategies Small Construction Business Managers Use To Reduce Safety Incidents In Their Organization, Peggy Ann Mcknight

Walden Dissertations and Doctoral Studies

Globally the construction industry struggles to prevent injurious and fatal safety incidents. The purpose of this single case study was to explore strategies used by construction business managers that had significantly reduced the occurance of safety incidents in a Northwest Ohio construction company. Data were collected from organizational records and interviews with 6 construction managers. The conceptual framework for this research was the concept of safety management systems. Data were compiled and organized, disassembled into fragments, grouped, and then interpreted for meaning. Methodological triangulation and member checking were used to enhance reliability and validity. Four themes emerged from the data: …

Minimizing Home Health Care-Acquired Pressure Injuries Through Effective Nursing Teamwork, Juliana Baah

Walden Dissertations and Doctoral Studies

Pressure injuries (PIs) affect an estimated 2.5 million people in America and cost the nation approximately $11.6 billion each year. The goal of this DNP project was to minimize the rate of PIs at a home health care agency through effective teamwork. Prevention of PIs is very important because PIs damage patients' skin integrity, cause significant amount of pain, are costly to treat, and cause life-threatening infections. The purpose of this DNP project was to evaluate nursing compliance with PI prevention measures and the level of nursing teamwork at the project agency. The Braden-Bergstrom conceptual framework was used to explain …

Health Literacy Best Practices In Policy Development, Stacie Lee Trueheart

Walden Dissertations and Doctoral Studies

Low health literacy is a problem the U.S. faces and, like health care itself, is a complex issue stemming from patient demographics and the healthcare providers being very diverse. Tools have been developed to mitigate the risks of low health literacy, however, without formal policy. The purpose of this qualitative case study was to explore and compare commonalities in health literacy best practices of organizations that are recognized as leaders in health literacy and are addressing low health literacy in their communities. By comparing the organizations' abilities to implement standards of plain language and health literacy tools/guidelines, best practice and …

African American Women Caring For Loved Ones With Alzheimer's Disease And Dementia, Lisa M. Forbes

Walden Dissertations and Doctoral Studies

Abstract

In 2016, a dramatic shift occurred in demographics in the United States because the oldest people in the baby boomer generation, which consists of people born between 1946 and 1964, reached age 65. The larger aging population and longer lifespans have produced an increased need for care and services. There are an estimated 5.4 million Americans of varying ages living with a diagnosis of dementia or Alzheimer's disease. Diagnoses of Alzheimer's disease are more prevalent among African Americans than other ethnicities. With little research found on culturally appropriate interventions for specific ethnic groups, a more detailed review of the …

Trauma-Informed Education Toolkit For Screening Pediatric Victims Of Sexual Abuse And Maltreatment, Analena Michelle Lunde

Walden Dissertations and Doctoral Studies

The complex challenges facing the sexual assault nurse examiners program in a midwest state are underreporting, late reporting, and poor coordination of care for pediatric victims of child maltreatment with sexual abuse. The main objective of this quality improvement project was the identification of necessary practice-related approaches to care to decrease barriers associated with reporting suspicions of abuse or neglect. An evidence-based, multidisciplinary assessment clinical toolkit that followed clinical components of trauma-sensitive, child-centered screenings triggering a coordinated response to conduct a forensic medical exam within 96 hours of the alleged incident was evaluated. During 3 rounds of surveys following the …

Challenges Of Aging With The Hiv Virus And Comorbidities, Rommie Navylia Abele

Walden Dissertations and Doctoral Studies

Since the introduction of antiretroviral therapy, the survival rate of infected HIV patients has been on the rise with a predicted increase by 2030. The longer a person lives with the virus, the more prone to HIV-associated chronic diseases he or she becomes, but it is not clear whether these diseases are solely from aging with the virus or from long-term use of antiretroviral therapy. Scientists demonstrated that the introduction of antiretroviral therapy led to an increased life expectancy yet early onset of comorbidities; however, they failed to address the challenges that people 50 years old or older face, as …

Perceived Usefulness And Perceived Ease Of Use Impact On Patient Portal Use, Dasantila Sherifi

Walden Dissertations and Doctoral Studies

Patient portals are web-based tools that provide patients with access to their health records and enhance communication with providers. Despite the efforts in expanding their use and patients interest in using them, patient portal usage remains low. Higher use of portals is associated with greater patient engagement and better healthcare quality and outcomes. This study investigated the impact of perceived usefulness (PU) and perceived ease of use (PEU) on patient portal usage. The conceptual framework was based on the Technology Acceptance Model, which suggests that PU and PEU of a system affect attitude and behavioral intention toward using the system, …

Catheter-Associated Urinary Tract Infection In New York And North Carolina, Kehinde O. Abiodun

Walden Dissertations and Doctoral Studies

In the United States, many hospitalized patients with indwelling urinary catheters acquire catheter-associated urinary tract infections (CAUTI) during their hospital stay. CAUTI negatively affects peoples' health and quality of life and causes a financial burden to individuals and the nation. The purpose of this quantitative cross-sectional study was to explore the relationship between gender, age, and hospital types and CAUTI incidence in New York and North Carolina over a 3-year period. The theoretical framework of choice was the Donabedian model. Simple logistic regression and hierarchical multivariable logistic regression analysis were performed on archival data that was requested from Healthcare Cost …

Self-Disclosure Of Human Immunodeficiency Virus Status In Personal Relationships: Perceptions Of South Africans Living With Human Immunodeficiency Virus, Delile Gertrude Langeni

Walden Dissertations and Doctoral Studies

Despite enormous research on the experience of living with HIV, many questions remain regarding self-disclosure of HIV status to sexual partners by people living with HIV (PLWHIV), which is essential to reducing further infection. In this study, a phenomenological approach captured the experience of self-disclosure among South Africans living with HIV in Louwsburg, South Africa. The health belief model served as a theoretical framework, and in-depth interviews were conducted with 12 PLWHIV (8 women, 4 men) who self-disclosed their HIV status to their sexual partners. Their experiences were explored, discovering their illness, motives for self-disclosure, feelings regarding disclosing, responses of …

Streamlining Hospital Administrative Procedures To Reduce Costs, Dr. Claret Onukogu

Walden Dissertations and Doctoral Studies

Americans spent nearly $2.6 trillion, or $8,000 per person for medical and administrative costs in 2010. By 2015, healthcare spending in the United States increased to 5.8% reaching $3.2 trillion or $9,990 per individual. By tackling healthcare administrative costs, it is estimated that healthcare providers could reduce these costs by $20 billion yearly. This case study explored strategies for streamlining hospital administrative procedures to reduce costs. The business process reengineering model formed the conceptual framework for this study. Data were gathered through semistructured face-to-face interviews guided by open-ended questions with a purposeful sample of 4 hospital managers in Atlanta, Georgia. …

Complementary Infant Feeding Practices In Afghanistan, Hasibullah Na Niayesh

Walden Dissertations and Doctoral Studies

Children are at greater risk of malnutrition in Afghanistan than they are in many other countries. Malnutrition impairs the mental and physical growth of more than 50% of children in Afghanistan. It also exacerbates the risks of mortality by 45% in infants and children in Afghanistan. The purpose of this study was to determine the association between mothers' knowledge, attitudes, and practices regarding complementary feeding and malnutrition in children in Afghanistan. The precaution adoption process model served as a theoretical framework in this quantitative cross-sectional research study. Data analyzed were collected from 306 mothers and children at 6 randomly selected …

Association Between Altitude And Bronchopulmonary Cancer, Hung Ching

Walden Dissertations and Doctoral Studies

As a validation study, this study addressed an under-researched area of bronchopulmonary cancer mortality and incidence. The association between altitude and bronchopulmonary cancer mortality and incidence was investigated using data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research. The theoretical framework for my study was Bronfenbrenner's ecological model. This model emphasizes the relevance of social and physical environments that influence patterns of disease and injury and shape responses to these patterns of disease and injury. The age-adjusted bronchopulmonary cancer mortality and incidence rates per 100,000 people in the highest elevation and lowest elevation states …

Cultural Perspectives On African American Adolescent Sexual Risk Behavior In Central Mississippi, Debra Suzette Smith

Walden Dissertations and Doctoral Studies

In 2015, Mississippi had the 3rd highest adolescent birth rate in the United States, high rates of sexually transmitted diseases, and enduring racial disparities between African American and White teenagers. Few researchers have described the immediate cultural environment to determine how it may influence the sexual behaviors and attitudes of African American teens. The purpose of this qualitative ethnographic study was to describe the sociocultural environment of African American adolescents in Mississippi that influences their sexual behavior by exploring the knowledge, feelings, experiences and beliefs of African American adults. The social cognitive theory was used as a theoretical framework to …

Development Of A Staff Education Module On Adolescent Obesity, Deborah Ann Stallworth

Walden Dissertations and Doctoral Studies

Adolescent obesity is a growing health concern in the United States due to its increasing prevalence and comorbidities that can reduce longevity and increase morbidity. Advanced practice nurses (APNs) providing care in school-based health centers (SBHC) located in marginalized communities are uniquely positioned to work with adolescent students challenged with obesity. The management of adolescent obesity requires advanced skills and knowledge to promote healthy lifestyles, prevent obesity, and to directly address the many factors that contribute to the condition. The purpose of this project was to develop an education program for APNs to prepare them to work with students in …

Association Of Dietary Intake With Suicidal Ideation Or Suicide Attempts In Adolescents, Zenobia J. Bryant

Walden Dissertations and Doctoral Studies

Suicide is among the leading cause of adolescent deaths worldwide and thus a significant public health concern. Risk factors for suicidal behavior include drinking alcohol, smoking, and engaging in risky sexual behaviors. One area of concern is dietary patterns and their association with depressive symptoms and suicidal ideation. Bandura's social cognitive theory emphasizes the assumption that one can perform specific actions to bring about desired outcomes. The primary research questions for this quantitative, retrospective, cross-sectional study concerned whether there is a statistically significant interaction between fruit and vegetable intake and suicidal ideation or suicide attempts. Data from 71,776 adolescents in …

Aggressive Diuresis And Severity-Adjusted Length Of Hospital Stay In Acute Congestive Heart Failure Patients, Muhammad U. Butt

Theses and Dissertations--Clinical Research Design

To see if aggressive diuresis in first twenty four hours is associated with a comparable number of total days in the hospital as compared to non-aggressive diuresis. In this retrospective cohort study, we compared the length of hospital stay of consecutive patients admitted in one year based on their diuresis during the first twenty-four hours of hospitalization: aggressive diuresis (group 1) i.e. > 2400mL versus non-aggressive diuresis (group 2) i.e. ≤ 2400mL urine output. Patients were excluded if in cardiogenic shock, had creatinine level above 3 mg/dL on admission, or on dialysis. A total of 194 patients were enrolled (29 in …

Uterine Corpus Malignancies In Appalachia Kentucky: Incidence, Survival And Related Health Disparities, Marian Symmes Johnson

Theses and Dissertations--Clinical Research Design

Uterine cancer is the nation’s most common gynecologic malignancy but is understudied in the geographically and socioeconomically diverse state of Kentucky (KY). This study assessed the frequency, distribution, and survival of uterine corpus malignancies in KY, and specifically the differences between Appalachia (AP) and non-Appalachia (NAP).

This study utilizes SEER and Kentucky Cancer Registries to study uterine corpus malignancy between January 1, 2000 and December 31, 2014. The analysis looks at incidence between diagnoses in AP and NAP. Evaluation criteria includes: tumor histology (Type I, Type II, sarcoma, and mixed uterine malignancy), age, race, smoking status, stage at diagnosis, insurance …

Modeling Geographic Factors And Assessing Their Accuracy In Identifying Health Disparities In Fayette County, Ian Jones

Lewis Honors College Capstone Collection

The purpose of this capstone is to conduct a review of existing literature to determine the effects of a variety of geographic variables on health and wellness. The student will use their findings to create a visual aid to displaying these geographic factors and their distributions within Fayette County. Furthermore, the student will analyze the intersection of these variables to predict potential pockets of discrepancy within Fayette County. Based on this analysis, the student will propose possible interventions with a basis in current literature. This project will provide the student with the opportunity to conduct a study of existing literature, …

Health Promotion In Elementary School Students, Madelyn J. Miles

Lewis Honors College Capstone Collection

The following project was created to address the rising epidemic of childhood obesity. Childhood obesity is caused by many factors such as genetics, metabolism, community and neighborhood design, diet, exercise, and short sleep duration (Center for Disease Control: Childhood Obesity Facts). Social determinants of health, systems of oppression, and stigma can all influence the obesity epidemic. These include but are not limited to social status, location, culture, age, sexuality, ethnicity, and race. These identities can influence affordability and access to healthcare and further contribute to the obesity epidemic. It is important to understand these issues as a future provider. A …

Temporal And Geospatial Trends Of Pediatric Cancer Incidence In Nebraska Over A 24-Year Period, Evi A. Farazi, Shinobu Watanabe-Galloway, L. Westman, B. Rettig, P. Hunt, R. Cammack, John W. Sparks, Don W. Coulter

Journal Articles: Epidemiology

BACKGROUND: Data from the Surveillance, Epidemiology, and End Results (SEER) revealed that the incidence of pediatric cancer in Nebraska exceeded the national average during 2009-2013. Further investigation could help understand these patterns.

METHODS: This retrospective cohort study investigated pediatric cancer (0-19 years old) age adjusted incidence rates (AAR) in Nebraska using the Nebraska Cancer Registry. SEER AARs were also calculated as a proxy for pediatric cancer incidence in the United States (1990-2013) and compared to the Nebraska data. Geographic Information System (GIS) mapping was also used to display the spatial distribution of cancer in Nebraska at the county level. Finally, …

Hiv Intervention For The Dc Community, Evelyn Rosales, Elias Belhocine, Daniel Ndagha, Tiana Young

DC Health and Academic Prep Program (DC HAPP)

Before the 1980s, the world had little to no knowledge about HIV. Now there has been research conducted on HIV/AIDs that has helped people prevent and be aware of their status. However, there is still an increasing amount of HIV cases in adults (18-34), especially in DC communities. Such disparities in HIV cases occur based on people’s race, gender, sexual orientation, income and geographical location. The social determinants of health also play a role in these cases such as poverty, access to care, stigma and racism. Our program will tackle these issues by providing an emphasis on existing programs by …

Early Results Demonstrate The Importance Of Early Treatment Of Hiv And The Feasibility And Acceptability Of Community-Based Antiretroviral Treatment Delivery For Female Sex Workers In Tanzania, Project Soar

HIV and AIDS

Project SOAR in collaboration with the National AIDS Control Program of the government of Tanzania, National Institute of Medical Research, and Jhpiego’s Sauti Program, is conducting implementation science research to investigate the delivery of community-based antiretroviral treatment (ART) services to female sex workers (FSWs) in Tanzania. This brief summarizes key findings from a baseline survey administered to a cohort of FSWs enrolled in the study, qualitative interviews with FSWs conducted three months after the start of the community-based ART services, and routine monitoring data. Early findings support the feasibility and acceptability of Sauti’s community-based antiretroviral treatment model—important first steps in …

Leadership In Community Public-Private Partnership Health And Social Care Initiatives, Hawa Yatera Mshana, Magdeline Aagard, Cheryl Cullen, Patrick A. Tschida

Journal of Sustainable Social Impact

Although the public–private partnerships in health have been adopted as the best pathway to improving health outcomes in many developing nations, implementation lacks collaborative leadership. The purpose of this empirical qualitative case study was to determine key factors that promote leadership synergy (LS) between partners that enhance ownership and accountability of community health and social initiatives in Tanzania. The diffusion of innovation theory and public–private integrated partnership module were the theoretical framework guided this study. Diffusion of innovation theory is based on the importance of effective communication to spread new ideas and foster change in behavior in a social group …

Comparative Effectiveness Of Conventional And Novel Sampling Methods For The Recruitment Of Sexual Minority Identified Women, Sarah M. Piperato

Theses and Dissertations

Sexual minority identified (SMI) women have an amplified risk for risky health behaviors and chronic health conditions. Current research on mechanisms related to health disparities in SMI women is limited. Research targeting SMI women has relied on small, convenience samples to address health disparities. Due to the nature of this population, probability sampling methods are ineffective and inefficient and cost prohibitive. The purpose of this dissertation was threefold. First, we examined the current state of literature to gain insight on prevalent sampling strategies used to access SMI women for health-related research. Second, we compared the efficacy of two sampling strategies, …

Collaboration Across The Curriculum: Urban Planning & Public Health, Lula Geyre

Senior Honors Theses and Projects

The way our communities are designed impacts our health. and there is an increasing need for collaboration between urban planners and public health professionals. Yet, it is not clear to what extent universities are preparing public health and planning students to work together. Our research will shed light on this important topic by evaluating the course requirements for both of these disciplines in accredited institutions and look at how they are addressing interprofessional issues such as land development, transportation policies, air/water quality, and community growth issues. The current study explores the availability of interdisciplinary courses in accredited undergraduate and graduate …