Public Health Commons^™

Assessing The Implementation Of Syringe Exchange Programs In Kentucky: A Case Study, Alexandra Miller

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

Problem: There are currently 52 operating syringe exchange programs in Kentucky; a state that has 25% of the highly vulnerable counties for an HIV outbreak. The implementation process of syringe exchange programs can limit the potential for growth. The aims of this study were to identify key barriers and successes to the implementation process of syringe exchange programs in Kentucky. This was assessed by comparing various social and political factors that come into play in local communities.

Methods: The study was conducted using an exploratory case study approach. The researcher conducted interviews with three key informants at the Louisville Metro …

Exploring Methods To Increase Hiv Testing In Kentucky, Chukwudi Yagazie Mbagwu

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

This project was conducted to develop a policy proposal that would increase HIV testing after evaluating current Kentucky Law and Regulations, current health insurance laws, studies on acceptability of different HIV test, barriers to testing from both providers and patients/individuals, and factors associated with positive likelihood of HIV testing. Based on these findings a proposal was developed that would require changing Kentucky regulations on providers communicating test results to patients, change in what form HIV testing would be covered under certain insurances, develop incentives for patients to be tested and report their results to their provider (and hence increasing surveillance …

Second Hand Smoke Exposure And Memory Performance In An Appalachian Pediatric Cohort, Zaynab Al Abdali

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

Background: Smoking rates in Appalachian counties are about two times higher than in non- Appalachian counties. Apart from the detrimental effects smoking has on the smoker, exposure to second-hand smoke (SHS) can have negative health effects on both adults and children. SHS exposure can result in asthma exacerbations and other respiratory difficulties, impaired neuromotor function, neurobehavioral problems, and decreased performance in school.

Objective: The objective of this study was to determine whether SHS exposure, as measured by serum cotinine, is associated with learning and memory in children, as measured by the California Verbal Learning Test – Children's Version.

Methods: Children …

Ky Stroke Encounter Quality Improvement Project: An Evaluation Of The Differential Administration Of Tpa In Acute Ischemic Stroke, Payton Malone

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

No abstract available

Association Between Education And Health Outcomes Among Adults With Disabilities: Evidence From Shanghai, China, Tong Ge, Qi Zhang, Jun Lu, Gang Chen, Mei Sun, Xiaohong Li

Community & Environmental Health Faculty Publications

Background

Adults with disabilities often have worse health outcomes than do their peers without disabilities. While education is a key determinant of health, there is little research available on the health disparities across education levels among adults with disabilities in developing countries. We therefore examined the association between health outcomes and education among adults with disabilities in Shanghai, China.

Methods

We used the health examination records of 42,715 adults with disabilities in Shanghai in 2014. Five health outcomes, including two diseases (fatty liver and hemorrhoids) and three risk factors (overweight [body mass index ≥ 24]), high blood glucose, and high …

Just Culture: It's More Than Policy, Linda Paradiso, Nancy Sweeney

Ellmer School of Nursing Faculty Publications

[Description] Paradiso and Sweeney discuss the relationship between trust, just culture, and error reporting in medical care. Errors rarely occur in a vacuum, rather they're a sequence of events with multiple opportunities for correction. Clinical nurses can have a significant impact on reducing errors due to their proximity to patients. Just culture is a safe haven that supports reporting. In a just culture environment, organizations are accountable for systems they design and analysis of the incident, not the individual. The shift to a just culture is a slow process that takes years to develop and hardwire. Hospital-wide policies that incorporate …

Ecological Influences On Dietary Behavior: The Interaction Between Person And Neighborhood Environment In A Low-Ses, Hispanic Community, Emily Kiresich

CGU Theses & Dissertations

Despite existing knowledge about lifestyle choices and their relationships to obesity and diabetes, the prevalence of Type 2 Diabetes Mellitus (T2DM) is increasing, and the number of Americans at risk is greater than 70% (CDC, 2019). Obesity is a complex, multifactorial, and largely preventable disease, affecting, along with overweight, over a third of the world's population today. A significant factor in lifestyle management is the ecology of food choice. Literature suggests that environment and exposure can predict food-related health risk behaviors and health outcomes. The objective of this dissertation was to conceptualize and carry out a series of pilot studies …

The Intergenerational Transfer Of Criminal Justice Involvement: Risk And Protective Factors As Moderating Variables, Caitlin Storm

CGU Theses & Dissertations

Previous literature identified evidence of a transfer of criminal justice involvement between generations of family members. This relationship has proven especially strong between parents and children. Different demographic factors slightly alter the strength and significance of the transfer, but the established relationship between the criminal justice involvement of the parent and the increased likelihood of the child’s criminal justice involvement remains consistent. Data from the National Longitudinal Survey of Youth 1997 was used to analyze the effect of the father’s criminal justice involvement on his child’s. Using binary logistic regression models, predictor variables were included in a step-wise fashion to …

Put Your Money Where Your Mouth Is: Reforming Organized Dentistry To Address Persistent Oral Health Disparities In The U.S., Aparna Chintapalli

Pomona Senior Theses

The importance of oral health has been largely neglected from the conventional standards of healthcare in terms of public understanding & prioritization, the industrial infrastructure, and the scope of prevention & early-intervention services. Its adjunctive locus to the field of medicine has lead to the bifurcation of the oral cavity from the rest of the human body. As a result of this divide, there have been multiple factors that have allowed socially stratified oral health outcomes to manifest. This thesis examines the determinants of oral health disparities through a multidisciplinary lens (i.e. biology, public policy, infrastructure), and offers evidence of …

Iron Deficiency Anemia, Population Health And Frailty In A Modern Portuguese Skeletal Sample, Samantha M. Hens, Kanya Godde, Kristin M. Macak

Sociology & Criminal Justice Faculty Publications

INTRODUCTION

Portugal underwent significant political, demographic and epidemiological transitions during the 20th century resulting in migration to urban areas with subsequent overcrowding and issues with water sanitation. This study investigates population health during these transitions and interprets results within a framework of recent history and present-day public health information. We investigate skeletal evidence for anemia (cribra orbitalia and porotic hyperostosis) as indicators of stress and frailty-i.e., whether the lesions contribute to susceptibility for disease or increased risk of death.

METHODS

The presence and severity of skeletal lesions were compared against known sex and cause of death data to investigate potential …

Stress State Analysis And Tensile-Shear Fracture Criterion In Combined Puncture And Cutting Of Soft Materials, Ennouri Triki, Chantal Gauvin

Études primaires

The mechanics of the combined puncture and cutting of protective materials by a pointed blade are studied theoretically and experimentally, by means of stress state analysis. Through analysis of the stresses occurring during the puncture cutting of a variety of neoprene and nitrile rubber membranes by pointed blades with different cutting-edge angles, a force state of pushing/shear-dependent loading is formulated and discussed. By considering this combined loading as an asymmetric fracture, two equations—for pushing force component and shear force component—are then derived from the stress intensity factors. From this stress analysis, a model based on fracture mechanics theory is developed …

Impact Of Prescription Opioid Access Restrictions On Alcohol-Induced Mortality In Kentucky, Changwe Park

MPA/MPP/MPFM Capstone Projects

Prescription drug monitoring programs (PDMPs) are state policy tools to combat risky opioid prescribing. Since 2012, several states began to mandate PDMP use. As mandating use laws have settled down, evaluating potential adverse events becomes possible.

In this study, I focus on alcohol-induced mortality as a potential unintended consequence via substituting alcohol for prescription opioids, since alcohol and opioids are often concurrently misused as a part of pain self-management. Therefore, the aim of this study is to analyze the unintended consequences of prescription opioid access restrictions on alcohol-induced mortality.

I compare the alcohol-induced mortality among adults during pre- and post-revision …

Playing To Live: Outcome Evaluation Of A Community-Based Psychosocial Expressive Arts Program For Children During The Liberian Ebola Epidemic, Caroline A. Decosimo, J. Hanson, Megan Quinn, P. Badu, E. G. Smith

ETSU Faculty Works

Background. This paper reviews the efficacy of a community psychosocial arts program focused on building mental health capacity within post-Ebola Liberia. The aim of this paper was to evaluate the outcome effects of two groups using pre- and post-treatment data. We hypothesized that there would be a difference in symptoms pre- and post-treatment, and the longer program would yield more significant results.

Methods. There was a total of 870 child participants. Of 40 sites, 24 were selected for a 5-month treatment (TG1) while the remaining 16 sites received 3 months of treatment (TG2). Paired t tests and a mixed-model analysis …

Evaluating Ways To Reduce Errors In Medication Reconciliations Performed By Nurses In A Rural Hospital Setting, Kalen T. Freeman

MPA/MPP/MPFM Capstone Projects

Medication reconciliation, also known as “med recs”, are an important part of a patient’s care during their hospitalization. A med rec is when hospital personnel generate a list of the medications the patient takes at home. Med recs are vital in the hospital admission process because home medications need to be restarted at appropriate times to fully care for the patient. Also, mistakes in a home medication list can lead to serious consequences in the patient’s health. This study focuses on med recs being performed at Marcum and Wallace Hospital in Irvine, Kentucky. More specifically, the study explores the different …

Everybody’S Working (But The Weakened): An Assessment Of Medicaid Work Requirements And Their Administrative Burdens, Samuel Misleh

MPA/MPP/MPFM Capstone Projects

Although Medicaid work requirements are currently halted in both Arkansas and Kentucky, this analysis utilizes the data available to make an assessment and estimate of what Kentucky’s Medicaid enrollment will look like if work requirements similar to those Arkansas had are ever implemented. The relative severity of the administrative burden of such requirements provide a tool for comparison, and a difference-in-differences analysis of the change in Medicaid enrollment between Arkansas and West Virginia, a state that has not implemented and currently has no plans to implement Medicaid work requirements, provide the bases for this estimate. After coding the work requirements …

Impact Of Area-Under-The-Curve Monitoring For Vancomycin On Incidence Of Acute Kidney Injury In Orthopedic Patients, Kelli R. Keats

MPA/MPP/MPFM Capstone Projects

Vancomycin is an antibiotic used regularly in hospitals across the world. The most concerning adverse effect of vancomycin is its documented effect on kidney function. This study examines the impact of two dosing strategies of vancomycin on patients’ kidney function at the University of Kentucky Albert B. Chandler Medical Center. It specifically focuses on patients on the orthopedic service because these patients traditionally receive higher doses of vancomycin for longer periods of time due to the severity of their infections, which puts them at an increased risk of vancomycin-induced nephrotoxicity compared to other patients.

This study will serve as a …

Racial Disparities In The Diagnosis And Treatment Of Type 1 Diabetes In Black American Youth, Kierra Mitchell

Scripps Senior Theses

Introduction: Rates of childhood-onset type 1 diabetes (T1D) are steadily increasing among American youth, yet Black Americans are more likely to suffer from serious T1D-related complications caused by poor glycemic control. The aim of this thesis is to determine the external factors that are causing discrepancies in the development, diagnosis, treatment, and long-term management of T1D in Black youth.

Methods: Epidemiological studies were compiled from the American Diabetes Association, Center for Disease Control (CDC), International Diabetes Foundation (IDF), Kaiser Family Foundation (KFF), and the Claremont Colleges Library network to identify the sociocultural aspects that negatively affect long-term glycemic control in …

Associations Between Perceptions Of U.S. Immigration Enforcement Policies, Physical Health, Psychological Distress, And Health Care Utilization In A Hispanic Border Community, Isabel Katharina Maria Latz

Open Access Theses & Dissertations

Since the beginning of the current U.S. federal administration, immigration policies have become more restrictive and immigration enforcement has been strengthened. This cross-sectional survey study examines associations between perceptions of and experiences with current immigration enforcement policies and self-rated physical health, psychological distress, and health care utilization among Hispanic adults with different residency statuses in the U.S. Paso del Norte region. This study further investigates moderating effects of collective efficacy and engaged coping strategies on associations between policy perceptions and psychological distress.

The study sample included 211 Hispanic adult residents of the U.S. Paso del Norte Region (i.e., El Paso, …

Body Weight Self-Perceptions And Experiences Of Nigerian Women Immigrants, Fatimah Binta Ali

Walden Dissertations and Doctoral Studies

Low-income immigrants in the United States experience declining health with increasing length of stay in the country. Their declining health over time has been associated with increased smoking, obesity prevalence, and higher risk for developing diabetes and heart disease. How immigrants perceive their body weight and size, influenced by social interaction, culture, gender, and acculturation is also significant to healthy weight maintenance. Not knowing one's healthy weight could result in body weight misperception and resistance to attaining a healthy weight. The aim of this qualitative study, based on the social constructivist framework, was to understand Nigerian women immigrants' (NWI's) body …

Assessing Medical Expenditure Disparities Among U.S. Adults With Hiv Or Cardiovascular Diseases, Lorraine Nnacheta

Walden Dissertations and Doctoral Studies

Older adults with infectious and chronic diseases, such as cardiovascular disease and human immunodeficiency virus (HIV), are at high risk for associated chronic comorbidities, which are associated with increased medical expenditures to cover treatment costs. The purpose of this study was to investigate (a) whether adults 65 or older with either HIV or cardiovascular disease were predisposed to increased medical expenditures versus adults 64 and younger, and (b) the impact of race and type of health service used on total direct medical expenditures incurred among adults with HIV or cardiovascular disease. A quantitative, deductive, retrospective cross-sectional design was used, and …

The Effects Of Breastfeeding Support On Women Enrolled For Wic Benefits, Judith Marie Khanuja

Walden Dissertations and Doctoral Studies

Breastfeeding has been shown to protect both the mother and infant, and health care professionals consider it to be the best choice for feeding an infant. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides food, referrals to other social service programs, and nutrition and breastfeeding education for enrolled families. However, community support for the breastfeeding woman once she leaves the hospital is limited, especially in Philadelphia, PA. The purpose of this mixed-methods study was to explore the impact of prenatal breastfeeding education and understand the role that members of the community play in the infant feeding …

Acculturation And Diabetes Among New York's Bangladeshi Immigrants, Renee Mehrra

Walden Dissertations and Doctoral Studies

There are more than 3.4 million South Asians in the United States. Among this subgroup, Bangladeshis in New York have a high prevalence of Type 2 diabetes ranging from 15 to 24% compared to the general population. This study examined the effect of acculturation through length of stay in the United States and understanding of the English language, and the role of gender on self-efficacy (SE) and diabetes self-management among 336 New York Bangladeshi immigrants between the ages of 21 and 75 who had been diagnosed with type 2 diabetes with A1C -‰¥ 6.5%, as verified by their medical record …

Parent Perceptions Of Biofeedback Treatment Effectiveness For Pediatric Migraine, Andrea Grando Weber

Walden Dissertations and Doctoral Studies

Gate control theory posits the idea that the brain and spinal cord have the ability to control the perception of pain sensation throughout the body. Biofeedback provides a proven way to teach a person how they may control their heart rate, breathing, and skin temperature. Through this process, individuals learn to lessen their migraine frequency and intensity. There are no studies to date that have measured the effectiveness of biofeedback in conjunction with medication for migraines in children despite established evidence of success in adults. In this study, an online format via SurveyMonkey was used to document the perceptions of …

The Influence Of Obstetrician And Gynecologists' Avoidance Behaviors On Maternal Morbidities, Nakisha Rene'e Boulware

Walden Dissertations and Doctoral Studies

The prevalence of maternal morbidities continues to increase in U.S. women of lower socioeconomic status and non-Hispanic Black women despite the efforts of health care practitioners to reduce the disparities. Two decades of research has shown that physicians avoid patients based on insurance and socioeconomic status or their malpractice history. Reducing maternal illness and complications is one of the federal government's top 10 maternal health indicators in the Healthy People 2020 initiative. The purpose of this study was to evaluate the influence of malpractice allegations on patients at high-risk for maternal morbidity. Supported by the theoretical foundation of human factor …

Late-Stage Breast Cancer Diagnosis Among Haitian Women In The United States, Marie-Hortence Prosper

Walden Dissertations and Doctoral Studies

Breast cancer is the 2nd leading cause of death among women. While a significant amount of research has been done to understand the different disparities related to this disease, there is still more to learn about the relationship between a person's nationality and the staging of breast cancer. Using the Surveillance, Epidemiology, and End Results Program as the data source, this retrospective cohort study was aimed at assessing late-stage breast cancer among Caribbean immigrants, specifically comparing Haitian women with Americans and other immigrant populations in the United States. The research questions addressed the link between nationality and the likelihood of …

Preconception Health And Preterm Birth Differences Among U.S.-Born And Foreign-Born Black Women, Sheree Holmes Keitt

Walden Dissertations and Doctoral Studies

Foreign-born Black women giving birth in the United States have superior preterm birth outcomes compared to their U.S-born Black peers. Many studies have focused on tobacco use and medical risk factors, but few have focused solely on preconception health. The purpose of this study was to examine preconception health and preterm birth differences among U.S.-born and foreign-born Black women. Three theoretical frameworks guided this study: the life course theory, healthy migrant theory/immigrant paradox, and weathering theory. Primary research questions assessed (a) if there were an association between chronic preconception risk factors, prepregnancy obesity, diabetes, and hypertension, in U.S.-born and foreign-born …

Association Of Health Facility Delivery And Risk Of Infant Mortality In Nigeria, Susan Adaku Ukwu

Walden Dissertations and Doctoral Studies

Infant mortality (IM) incidence in health facility systems during or after infant delivery is

substantially high in Nigeria. In this quantitative, cross-sectional study, the effects of skill

birth attendants (SBAs), prenatal care, and providers of prenatal care on IM in health

facility delivery centers were examined. The Mosley and Chen theoretical framework

informed this study and was used to explain the relationship between SBAs, prenatal

care, and providers of prenatal care and IM. One hundred and sixty infant deaths were

examined among mothers who used an SBA versus those who did not, mothers who had

prenatal care versus those without, …

Instrumental Role Modeling And The Sensitive Topic Of Obesity: A Grounded Theory, Tulie Blot Gay

Walden Dissertations and Doctoral Studies

The nurse practitioner (NP) role is more prominent now than ever before in primary healthcare, positioning them as providers who defend initiatives and ongoing health agendas. Obesity is among those agendas. The concept of instrumental role modeling was explained as a combination of understanding and physical presence that gives meaning and quality to inspire change. It implied that health professionals are not merely insightful clinicians but suggested their expertise is complimented by demonstrations of wellness in knowledge and practice. This topic of weight was perceived as sensitive but must be addressed. In this grounded theory study, the perspectives of NPs …

Abstract Hiv Testing And Multiple Sexual Partnerships Among Men In Nigeria, Kelvin Meyeyin-Bala

Walden Dissertations and Doctoral Studies

Low Human Immunodeficiency Virus [HIV] test uptake and multiple partnerships among men in Nigeria are contributing factors to HIV transmission. The purpose of this quantitative cross-sectional study was to examine the relationship between HIV test uptake, sociodemographic characteristics, HIV knowledge, attitude, and multiple sexual partnerships. The health belief model provided the framework for the study. Data were collected from the 2013 Nigerian National Demographic Health Survey, which surveyed 17,359 Nigerian men ages 15-49 years. Chi-square and binary logistic regression analysis showed that sociodemographic variables (age, residence, marital status, religion, wealth status, ethnicity, and educational level), HIV test uptake, HIV knowledge, …

Predictors Of Poor Pregnancy Outcomes Among Pregnant Women In Island Maternity, Nigeria, Letam Nwi-Ue

Walden Dissertations and Doctoral Studies

Pregnancy outcomes have improved tremendously in developed countries. Notwithstanding, it is still a huge challenge in developing countries, especially Sub-Saharan Africa. In 2015 in Nigeria, about 145 women died daily from pregnancy-related causes. Similarly, nearly 2,300 children under 5 years were lost in the same year. Nigeria consistently underperformed in some of the critical pregnancy indicators such as maternal and neonatal mortality, second worst only to India in the world. Studies on poor pregnancy outcomes are scarce in Nigeria. The purpose of this quantitative, retrospective cross-sectional study was to use local evidence to ascertain the risk factors that predict poor …