Public Health Commons^™

Indoor Air Quality In Schools, Clint Pinion Jr.

EKU Faculty and Staff Scholarship

An indoor air quality study was conducted on a ‘net-zero energy’ school using a TSI Velocicalc Model 9555-p with probe model 982, passive radon monitors, visual inspection protocol, and an indoor environmental quality survey of school faculty and staff. Average indoor temperature, relative humidity, and carbon dioxide levels in several areas within the school were not within IAQ guidelines. Three rooms on the school’s grounds had radon levels exceeding the action level. Recommended solutions included installing return and supply air ducts in hallways and relative humidity and temperature monitors in classrooms with high-pitched ceilings.

The Potential Effects Of Exercise-Induced Cortisol Release On Executive Functioning In Preadolescents, Kory Matthew Bettencourt

Master's Theses

Purpose: Moderate-intensity aerobic exercise (MAE) has been shown to elicit improvements in cognition and subsequent academic performance among preadolescents. Aerobic exercise has also shown to increase cortisol release in response to increasing exercise intensity. However, it is unknown if increased cortisol levels following exercise are related to acute improvements in executive function following a bout of MAE in preadolescents. The purpose of this study was to examine the potential effects of increased cortisol release after acute MAE on attention and working memory among preadolescents. Methods: Eleven preadolescents [6 males, 5 females] volunteered to participate in this study (age=9.45±1.03). …

Association Of Objective Measures Of Sleep And Inflammation Markers On Police Officers: A Cross-Sectional Analysis, Megan R. Buss

Theses and Dissertations

Police officers are a unique occupational group due to the fact that they have more health problems than many other occupations. These health problems could be a result of elevated inflammation markers caused by poor sleep. Sleep influences circadian rhythms, which thereby influences the function of the immune system. The immune system is responsible for the body’s inflammatory response using pro-inflammatory cytokines such as IL-6, CRP, Fibrinogen, and TNF-a. These cytokines can become elevated if disruption of the sleep cycle occurs. Elevated levels of inflammatory markers are associated with increased risk of cardiovascular disease. Police officers also work shifts and …

Understanding The Mechanisms Linking Gendered Intrahousehold Bargaining Power And Child Nutrition In Rural Nepal, Shibani Kulkarni

Theses and Dissertations

Child undernutrition is a serious issue in Nepal as 36% of children below five years of age are chronically undernourished. Reducing child undernutrition is an important priority to prevent adverse effects through the life course that perpetuate the cycle of undernutrition and poverty.

Women’s intra-household bargaining power is an important determinant of child nutrition. Intra-household bargaining power is an individual’s relative social and economic position within the household to access and control resources, and influence decision-making. In our research, we use women’s intra-household bargaining power as a resource for care, which enables women to be exposed to nutrition information, gain …

A Longitudinal Analysis Of Shiftwork And Self-Reported Depression In A Police Cohort, Meghan Holst

Theses and Dissertations

Background: Shiftwork is associated with many chronic diseases stemming from the disruption of circadian rhythms. Police officers have a high risk for many adverse conditions including depression. Abnormal bodily functions, such as increased stress and disturbed sleeping patterns, may play an important role in the development and severity of depression. This study was designed to assess the association between depressive symptoms and shiftwork in a police cohort from Buffalo, NY

Methods: This longitudinal analysis consists of 470 police officers from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study. Data were collected during visit 3 between 2004-2005 and visit …

Effect Modification By Stroke To The Relationship Between Tooth Loss And Cognitive Decline, Amanda Collins

Theses and Dissertations

Background: A decline in cognitive functioning is one of the greatest burdens that older adults face. Studies indicate that periodontal disease is positively associated with cognitive decline. The link between stroke and cognitive decline is well-established, and literature supports that tooth loss and stroke are associated as well, but the role that stroke plays in the relationship between tooth loss and decline in cognitive functioning is, as of yet, unclear. This study uses data from the REGARDS cohort to examine the effect of stroke on the relationship between periodontal disease and cognitive function.

Methods: The REGARDS cohort is comprised of …

Food Insecurity And Hypertension Prevalence, Awareness, Treatment And Control, Alexandra N. Luttrell

Theses and Dissertations

Objective: To examine the association between food insecurity and the prevalence of pre-hypertension and hypertension among U.S. adults. Additionally, this project will examine the association between food insecurity and the awareness, treatment and control (ATC) of hypertension.

Design: A cross-sectional study using data from the National Health and Nutritional Examination Survey (NHANES) 2011-2012 and 2013-2014 waves was deployed to examine the association between food insecurity and the prevalence and ATC of hypertension. Food security was measured by the cumulative number of affirmative responses to the 10-item U.S. Household Food Security Survey Module (HFSSM) questionnaire which were graded into four categories; …

Factors Affecting Patient Satisfaction With Healthcare System Of Turkey, Serdar Aydin

Theses and Dissertations

The World Health Organization (WHO) defines health system as comprising of all the organizations, resources, and institutions dedicated to improving health. Health systems have a responsibility not just to improve the health of the population they serve but to provide financial protection against the costs of illness and to respond to people’s expectation with dignity. Besides, healthcare satisfaction and consumer satisfaction have become the latest trend in measuring quality to have a competitive advantage or best practice in the healthcare industry. Over the past 30 years, consumer satisfaction has gained widespread recognition as a measure of quality in many services …

Hiv In The United States: A Spatial Examination Of Testing And Outcomes, Sazid Shameem Khan

Theses and Dissertations

The main objectives of this dissertation were to provide a complete depiction of the prevalence of HIV across the United States and to assess HIV testing trends among various subpopulations. Additionally, we focused on measuring spatial access to HIV testing resources across the U.S. South, where HIV is rapidly becoming more burdensome and resources have historically been allocated disproportionately. We sought to identify disparate populations and locations that require further focus moving forward to stem the HIV epidemic. We utilized a variety of data sources such as the Behavioral Risk Factor Surveillance System (BRFSS) which was used to assess national …

Examining Faith-Based Communities As Leverage Points For The Prevention Of Childhood And Adolescent Obesity, Caroline Glagola Dunn

Theses and Dissertations

Faith-based research and partnerships are becoming more popular as an approach to address the health of underserved populations including racial and ethnic minorities and rural populations. Despite growing interest in faith-health partnerships, little research is available assessing faith-based interventions as potential leverage points for the prevention of childhood and adolescent obesity and the promotion of healthy behaviors. This research aimed to examine the potential for such partnerships within the context of ongoing research partnerships in South Carolina. Specifically, the first study assessed current peer-reviewed literature to determine reporting of reach, effectiveness, adoption, implementation, and maintenance (RE-AIM elements) in faith-based nutrition …

Polyp Detection During Colonoscopy Among Uninsured Patients In South Carolina, Lauren Hill

Theses and Dissertations

Little information is known on what demographic, behavioral, and procedural factors influence the number of polyps found during a colonoscopy screening for colorectal cancer (CRC). The main objective of this study is to describe the polyp detection rate (PDR), number of polyps removed, and predictors of polyp count overall and for high-risk polyps among uninsured patients undergoing colonoscopy in the Colorectal Cancer Prevention Network (CCPN) program of South Carolina. We performed a secondary data analysis on CCPN data for colonoscopies performed between May 2014 and May 2017. We assessed the association of polyp count with the following variables: age, race, …

The Effect Of Neighborhood Characteristics And Acculturation On Vegetable Intake Among U.S. Hispanics, Anna Victoria Mesa

Theses and Dissertations

The growing prevalence of chronic disease among the U.S. Hispanic population has drawn increasing attention to modifiable behaviors such as diet in an effort to curb the burden of disease among this population. While factors affecting dietary intake among U.S. Hispanics have been largely studied, this study broadens the scope of existing analyses from examining the role of individual-level factors, including acculturation, to also include environmental factors such as neighborhood ethnic composition. Multilevel mixed modeling was employed to test the interaction of individual acculturation with neighborhood ethnic composition to predict vegetable intake among a sample of U.S. Hispanics. Individuals who …

Residential Mobility And Enrollment Churn In A Medicaid Population, John E. Stewart

Theses and Dissertations

Previous investigations show high rates of enrollment discontinuity, or churn, among Medicaid participants. Discontinuity of coverage can limit appropriate use of health care, increase emergency department utilization and in-patient hospitalization, negatively affect self-reported health, increase health care spending, and compound Medicaid administrative costs. Efforts to more fully understand and ultimately reduce enrollment churn thus are vital to Medicaid agencies and beneficiaries. Residential moves are life transitions, often marking other significant life events (e.g., changes in employment or family structure) that can alter eligibility for Medicaid benefits. Few studies have examined residential moves among Medicaid members, or considered residential mobility as …

The Effects Of The Affordable Care Act On The Receipt Of Colonoscopies Among Insured Elderly, Min Jee Lee

Theses and Dissertations

Background: The Affordable Care Act (ACA) waived deductibles and eliminated coinsurance for colonoscopies for Medicare beneficiaries beginning on January 1, 2011. This study investigated the effect of the ACA’s removing of financial barriers on the receipt of colonoscopies among insured elderly, who are predominantly covered by Medicare. Moreover, this study examined how income-related disparities in colonoscopy use have changed over the past decade and attempted to quantify various contributions to income-related disparity in the use of colonoscopies among insured elderly. Methods: Five cycles (2008, 2010, 2012, 2014, and 2016) of the Behavioral Risk Factor Surveillance System (BRFSS) were utilized to …

Metabolomic Profiles In Breast Cancer: A Pilot Case-Control Study In The Breast Cancer Family Registry, Marcelle Dougan, Yuqing Li, Lisa Chu, Robert Haile, Alice Whittemore, Summer Han, Steven Moore, Joshua Sampson, Irene Andrulis, Esther John, Ann Hsing

Faculty Publications

Background Metabolomics is emerging as an important tool for detecting differences between diseased and non-diseased individuals. However, prospective studies are limited. Methods We examined the detectability, reliability, and distribution of metabolites measured in pre-diagnostic plasma samples in a pilot study of women enrolled in the Northern California site of the Breast Cancer Family Registry. The study included 45 cases diagnosed with breast cancer at least one year after the blood draw, and 45 controls. Controls were matched on age (within 5 years), family status, BRCA status, and menopausal status. Duplicate samples were included for reliability assessment. We used a liquid …

Body Mass Index Trajectories And The Relationship Between Stressful Life Changes And Nutrition-Related Health Outcomes Among United States Army Soldiers, Julianna Marie Jayne

Theses and Dissertations

Body mass index (BMI) has risen among members of the military, though to a lesser degree than in civilian populations. BMI as an anthropometric tool has been essential for population surveillance and documenting the obesity epidemic and its health consequences. One use for BMI in population surveillance is to model the BMI trajectories of a population over time. Many studies are available on the BMI trajectories and determinants of BMI in civilians, but few studies of this nature in military populations exist. Establishing the shape and determinants of BMI trajectories among Soldiers is critical given the importance of weight management …

A Qualitative Exploration Of Experiences And Motivations For Diabetes Self-Management In African American Men Between The Ages Of 40-85 With Type 2 Diabetes, Anthony Q. Walker

Theses and Dissertations

Diabetes is a devastating disease that can affect an individual’s health and quality of life, but if managed properly, individuals with diabetes can have a good quality of life. Diabetes strikes African American men at a high rate. This study used a qualitative design to explore African American men between the ages of 40-85 with type 2 diabetes (T2DM) and their definition of diabetes and motivation, their experience of living with diabetes, their self-management behaviors, their motivations for managing diabetes, and what they and healthcare providers believe motivates them to self-manage diabetes and to attend diabetes self-management education (DSME) programs. …

Sleep, Shiftwork Adaptation, Autonomic Dysfunction, And Metabolic Syndrome, Torrance Torrance

Theses and Dissertations

Background: Sleep is considered a physiological necessity and its disruption is associated with a wide variety of adverse mental and physical health outcomes including increased incidence of obesity, cancer, hypertension, cardiovascular disease, type 2 diabetes mellitus, stroke, depression, post-traumatic stress disorder (PTSD), work-related and vehicle accidents, and aberration of the autonomic nervous system.

Methods: Three studies were conducted from three separate populations. The first study examined the latent trajectories of self-reported sleep quality in active duty Army soldiers over a 3-year period using data from the Global Assessment 2.0 survey and Repeated Measures Latent Class Analysis (RMCLA) procedures. Generalized Estimating …

Healthy Motivations For Moms-To-Be (Healthy Mom2b) Study: A Mobile Health Intervention Targeting Gestational Weight Gain Among U.S. Women, Alicia Anne Dahl

Theses and Dissertations

INTRODUCTION: Almost one-half of all pregnant women in the U.S. exceed the Institute of Medicine’s (IOM) gestational weight gain (GWG) guidelines. Healthy GWG is critical for reducing adverse health outcomes associated with excessive GWG for the mother and infant. Electronic health (e-health) interventions delivered through mobile apps and websites hold potential as readily available resources for targeting health behaviors and monitoring GWG during pregnancy. The development of the Healthy Motivations for Moms-To-Be (HM2B) intervention was informed by health behavior theories, a systematic review of existing in-person and technology mediated interventions (Aim 1 of this dissertation), and results of an online …

The Impact Of The Medicaid Coverage Expansion And The Removal Of Cost-Sharing Under The Affordable Care Act On Mammography And Pap Tests, Abeer Alharbi

Theses and Dissertations

Background: The Affordable Care Act (ACA) aimed at making health care affordable and accessible including the use of preventive care services. To achieve these aims, the ACA expanded Medicaid coverage to population with income below 138% of FPL and removed cost-sharing when using preventive care services recommended by the USPSTF. This study tried to assess the impact of these provisions on the rate of mammography and Pap tests among women. Methods: Data was obtained from the Medical Expenditure Panel Survey - Household Component MEPS-HC. A difference-indifference design was used to determine the effect of Medicaid eligibility expansion on the outcomes …

Investigating Drug-Related Violence In Indian Country: The Lumbee Tribe Of North Carolina, Asa Alena Revels

Theses and Dissertations

Drug-related violence (DRV) impacts the over-all wellbeing of communities, with disparate health outcomes observable in many poor, minority communities. The purpose of this study was to better understand the multi-level social and environmental factors influencing elevated rates and prevention of DRV within the Lumbee, a southeastern American Indian Tribe. This was accomplished via in-depth, one-on-one interviews with 37 Lumbee Tribal Members and Key Leaders. The findings align with existing research, revealing the influence of such factors as poor socioeconomic conditions, coping strategies, broken family structures, and the influence of federal policy. Of interest was the substantial influence of the local …

Patient Characteristics, Discharge Disposition, And Hospital Factors Associated With All Cause 30-Day Hospital Readmission For Total Joint Arthroplasty In 2014, Hamad Yahya Alzamanan

Theses and Dissertations

Objective: Recent improvements in hospital care have come from a growing knowledge of factors that contribute to readmission. The objective of this work is to identify and describe the national readmission rate after Total Joint Arthroplasty, and to evaluate selected hospitals’ and patients’ factors for their association with the all-cause 30-day readmission rate after TJA in the United States in 2014. Method: Retrospective analysis of 938,504 TJA acute care hospital discharge records was performed, using a nationally representative database that is dedicated to the study of hospital readmissions, and accounts for 51% of total US hospitalizations. Logistic regression models were …

Chronic Conditions Profiles And Cardiometabolic Risk Factor Control Among A Diverse Sample Of Older Adults With Type 2 Diabetes Mellitus, Tsion Kidanie

Theses and Dissertations

Background: Multiple chronic condition is common in older adults with diabetes. Several prior studies have shown that having multiple chronic condition impact cardiometabolic risk factor controls (i.e., blood pressure, High-density lipoprotein (HDL) cholesterol level, and high glycated hemoglobin (HbA1c). However, it is not clear whether these results extend to a multiethnic sample of older adults.

Objectives: 1). Examine the association between Comorbidity profile and ABCs goals achievement. 2). Examine whether the association between comorbidity profile and ABCs goals achievement is moderated by race/ethnicity.

Methods: A sample of 3532 participants from Health and Retirement Study (HRS) years 2010 and 2012 and …

Food Acquisition And Shopping Patterns And Associations With Body Mass Index, Xiaonan Ma

Theses and Dissertations

Background: Obesity is a big public health concern in the US. Previous studies examined its association with food shopping practices measured by distance to the food store, shopping frequency, and type of store selected. However, not much is known about the actual food acquisition and shopping habits integrating multi-dimensional aspects. The purpose of this study was to identify distinct food acquisition and shopping patterns in populations primarily residing in food deserts in South Carolina (SC) and a general population in the US and characterize these patterns with respect to socioeconomic status (SES), nutritional knowledge, and perceptions and store selection …

Association Of Insurance And Provider Type With Patients’ Perceived Cost And Ease Of Access To Healthcare Services Among Medicare Beneficiaries Diagnosed With Diabetes, Metria Harris

Theses and Dissertations

Medicare beneficiaries diagnosed with diabetes are likely to have health complications or episodes associated with diabetes, resulting in higher health care utilization and costs. Andersen’s Health Care Utilization Behavior Model (HCBM) includes predisposing, enabling, and need factors, but it excludes perception. Ajzen’s Theory of Planned Behavior (TPB) shows that perception influences health service use. This study was performed using a real-world model integrating Andersen’s HCBM and Ajzen’s TPB to determine whether there was an association between insurance type (Medicare Part D versus non-Part D) and perceived ease of access or cost among Medicare beneficiaries with diabetes. The second objective was …

The Impact Of False Positive Mammography Results On Breast Cancer Screening Intention Among Black Women, Deeonna E. Farr

Theses and Dissertations

Extensive research indicates that false-positive mammograms (FPM) have been associated with negative psychosocial and cancer-related beliefs, but only a handful of studies examine Black women’s reactions to this experience. Additionally, these studies do not investigate how organizational and provider-level factors in concert with individual patient characteristics shape Black women’s experiences and reactions to FPM results. The purpose of this study was to determine the impact of organizational, provider, and individual-level factors on the processes and outcomes associated with FPM results in Black women. This study had two specific aims:

1) To describe, using a mixed methods approach, the organizational and …

Workplace Bullying: A Survey Of Virginia Dental Hygienists, Gayle B. Mccombs, S. Lynn Tolle, Tara L. Newcomb, Ann M. Bruhn, Amber W. Hunt, Lanah K. Stafford

Dental Hygiene Faculty Publications

Purpose: Workplace bullying in health care has been identified as a problem that negatively affects career satisfaction, career longevity and patient outcomes. The purpose of this pilot study was to determine the prevalence of workplace bullying in a convenience sample of dental hygienists in the state of Virginia.

Methods: Two hundred and forty Virginia dental hygienists attending a continuing education seminar were invited to participate. Using the Negative Acts Questionnaire-Revised (NAQ-R), respondents were asked to indicate how often they had experienced 22 negative acts or behaviors according to rate of occurrence (never, now and then or monthly, weekly or …

Public Health Implications Of Metal Ash Concentrations From Prescribed Burns: A Study Of Open Jarrah Forests, John Edwards

Theses: Doctorates and Masters

Ash is not a homogenous product. It is the solid residue of combustion and contains a complex mixture of chemical products. The fire that produces ash is non-discriminatory in that it will burn anything that is combustible. The ash residue resulting from fires varies and is dependent on its source, and burn characteristics such as the temperature of the fire. Ash comprises particles of carbon, soot and trace elements. Ash presents public health risk to people and communities, through direct and indirect ingestion, inhalation and absorption. The health effects of ash exposure are not limited to symptoms affecting the eyes, …

Does Facial Physiognomy In The Context Of Anoccupational Safety And Health Message Predict Outcomes?, Ian Parker

Theses: Doctorates and Masters

Physiognomy, the practice of looking to another person’s outward facial appearance to unmask the inner character of that person, has had a diverse historical impact within art, medicine, theology, anthropology, law, criminology, political history, psychology, psychiatry, and popular culture, since it was conceptualised in Greece during the 5th and 4th centuries B.C (Physiognomy, 1999-2009, 2009a). Aristotle, the prominent Greek philosopher, penned many chapters on physiognomic properties and touched upon strength/weakness, genius/stupidity, and other trait characteristics and their opposites in so far as such characteristics were associated with facial form (Physiognomy, 2006, 2009b).

In more modern times, facial recognition and evaluation …

معالجة التقزم وفقر الدم في مصر, Abeer Alanwar, Hend Ahmed, Sabreen Mahmoud, Wessam Adly

Papers, Posters, and Presentations

Stunting and anemia rates in children between the age of 0-24 months (0-2 years) have been two of the most persistent public health problems facing the Egyptian society and government. Based on the researchers' analysis of the problem, current policies, and on the opportunities Egypt has, this policy paper targets the Egyptian Ministry of Health and Population and recommends reformulating a specific nutrition policy to tackle stunting and anemia as well providing awareness and education about the appropriate IYCF and to give high priority to strengthening the health provision of the required micronutrients in family care units (FCU), as well …