Public Health Commons^™

Improving Human Papillomavirus Vaccination Rates Among Kentucky Adolescents, Cori Arena

DNP Projects

Background: The Human Papillomavirus (HPV) is a significant factor associated with the development of HPV-associated cancers in the United States. The administration of the HPV vaccination is a critical prevention strategy in reducing HPV-related cancers in the United States. The state of Kentucky has lower than average HPV vaccination rates compared to the national average. There is a significant amount of evidence exploring barriers and facilitators of the HPV vaccination administration. There are several multi-level barriers associated with low uptake of the HPV vaccination in adolescents. Multiple sources of evidence have indicated that parents who receive a provider recommendation are …

Population Assessment To Determine The Eligibility For Birth Center Care At University Of Kentucky Midwife Clinic, Dolores Polito

DNP Projects

Background: The COVID-19 crisis prompted patients to inquire about their options to avoid going to the hospital for birth. Outside of the hospital, birth center care has been identified as an evidence-based model for healthy women during pregnancy and birth, but it is not available in Kentucky.

Purpose The purpose of this study was to determine if there are women eligible for birth center care who have been part of a nurse midwifery service and given birth in a large, academic, tertiary care setting.

Methods: A retrospective chart review was used for this study. It involved a collection of …

Characteristics And Outcomes Of In-Hospital Cardiac Arrest In Covid-19 A Systematic Review And Meta-Analysis, Lukasz Szarpak, Magdalena Borkowska, Frank W Peacock, Zubaid Rafique, Aleksandra Gasecka, Jacek Smereka, Katarzyna Pytkowska, Marta Jachowicz, Lukasz Iskrzycki, Natasza Gilis-Malinowska, Milosz J Jaguszewski

Faculty, Staff and Students Publications

BACKGROUND: The purpose herein, was to perform a systematic review of interventional outcome studies in patients with in-hospital cardiac arrest before and during the coronavirus disease 2019 (COVID-19) pandemic period.

METHODS: A meta-analysis was performed of publications meeting the following PICOS criteria: (1) participants, patients > 18 years of age with cardiac arrest due to any causes; (2) intervention, cardiac arrest in COVID-19 period; (3) comparison, cardiac arrest in pre-COVID-19 period; (4) outcomes, detailed information for survival; (5) study design, randomized controlled trials, quasi-randomized or observational studies comparing cardiac arrest in COVID-19 and pre-COVID-19 period for their effects in patients with …

Patient-Perceived Versus Actual Risk Of Cardiovascular Disease And Associated Willingness To Consider And Use Prevention Therapy, Ann Marie Navar, Tracy Y Wang, Shuang Li, Xiaojuan Mi, Zhuokai Li, Jennifer G Robinson, Salim S Virani, Eric D Peterson

Faculty, Staff and Students Publications

BACKGROUND: Cardiovascular prevention guidelines use estimated 10-year atherosclerotic cardiovascular disease (CVD) risk based on the pooled cohort equations to guide treatment decisions and engage patients in shared decision-making. We sought to determine patient perceived versus actual risk of atherosclerotic CVD and associations with willingness for preventive therapy.

METHODS: We evaluated calculated and perceived CVD risk among 4187 patients across 124 sites in the Patient and Provider Assessment of Lipid Management Registry. Ten-year risk was assessed using the pooled cohort equations; risk relative-to-peers was determined based on age-, sex-, and race-based percentiles; and patient estimates of risk were assessed using patient …

Nutritional Approach For Increasing Public Health During Pandemic Of Covid-19: A Comprehensive Review Of Antiviral Nutrients And Nutraceuticals, Vahideh Ebrahimzadeh-Attari, Ghodratollah Panahi, James R. Hébert Scd, Alireza Ostadrahimi, Maryam Saghafi-Asl, Neda Lotfi-Yaghin, Behzad Baradaran

Faculty Publications

Background: The novel coronavirus (COVID-19) is considered as the most life-threatening pandemic disease during the last decade. The individual nutritional status, though usually ignored in the management of COVID-19, plays a critical role in the immune function and pathogenesis of infection. Accordingly, the present review article aimed to report the effects of nutrients and nutraceuticals on respiratory viral infections including COVID-19, with a focus on their mechanisms of action.

Methods: Studies were identified via systematic searches of the databases including PubMed/ MEDLINE, ScienceDirect, Scopus, and Google Scholar from 2000 until April 2020, using keywords. All relevant clinical and experimental studies …

The Intellectual Property Of Covid-19, Ana Santos Rutschman

All Faculty Scholarship

The response to COVID-19 is indissolubly tied to intellectual property. In an increasingly globalized world in which infectious disease pathogens travel faster and wider than before, the development of vaccines, treatments and other forms of medical technology has become an integral part of public health preparedness and response frameworks. The development of these technologies, and to a certain extent the allocation and distribution of resulting outputs, is informed by intellectual property regimes. These regimes influence the commitment of R&D resources, shape scientific collaborations and, in some cases, may condition the widespread availability of emerging technologies. As seen throughout this chapter, …

Is There A Cure For Vaccine Nationalism?, Ana Santos Rutschman

All Faculty Scholarship

“[V]accine nationalism . . . should serve as a reality check for the status of global health cooperation in the twenty-first century.”

Covid-19 Employee Health Checks, Remote Work, And Disability Law, Elizabeth Pendo

All Faculty Scholarship

The Americans with Disabilities Act (ADA) prohibits discrimination against people with disabilities, about 61 million individuals in the U.S. The law’s protections in the workplace are especially important during COVID-19, which has worsened pre-existing disparities experienced by people with disabilities. The ADA also applies to new strategies to reduce the risk of COVID-19 infection in the workplace. This Chapter will focus on two strategies that impact individuals with and without disabilities – employee health screening, testing and vaccination policies, and new or expanded remote work programs.

Social Media Self-Regulation And The Rise Of Vaccine Misinformation, Ana Santos Rutschman

All Faculty Scholarship

This essay examines the main characteristics and shortcomings of mainstream social media responses to vaccine misinformation and disinformation. Parts I and II contextualize the recent expansion of vaccine information and disinformation in the online environment. Part III provides a survey and taxonomy of ongoing responses to vaccine misinformation adopted by mainstream social media. It further notes the limitations of current self-regulatory modes and illustrates these limitations by presenting a short case study on Facebook—the largest social media vehicle for vaccine-specific misinformation, currently estimated to harbor approximately half of the social media accounts linked to vaccine misinformation. Part IV examines potential …

The Need To Incorporate Communities In Compartmental Models, Michael J. Kane, Owais Gilani

Faculty Journal Articles

Tian et al. provide a framework for assessing population- level interventions of disease outbreaks through the construction of counterfactuals in a large-scale, natural experiment assessing the efficacy of mild, but early interventions compared to delayed interventions. The technique is applied to the recent SARS-CoV-2 outbreak with the population of Shenzhen, China acting as the mild-but-early treatment group and a combination of several US counties resembling Shenzhen but enacting a delayed intervention acting as the control. To help further the development of this framework and identify an avenue for further enhancement, we focus on the use and potential limitations of compartmental …

Seafaring And Impact On Seafaring Families In The Philippines: A Qualitative Study, Queenie Abad

Public Health Theses

Objective/Purpose: The Philippines is the largest occupational source of seafarers for the international shipping industry. Inherent to this occupation are the recurrent and long duration deployments overseas away from the seafarers’ families and communities which may negatively impact family wellness. In this qualitative study, we explored challenges that Filipino seafaring families face and identified protective factors for family and community well-being.Methods: Participants were selected by purposeful and snowball sampling. Participants were seafarers and their families. We conducted semi-structured interviews which were audio-recorded, transcribed, and loaded on Dedoose to facilitate line-by-line coding. Data was analyzed with a grounded theory approach using …

Prevalence And Health Burden Of Cardiovascular Disease In Older U.S. Veterans: Results From The 2019-2020 National Health And Resilience In Veterans Study, Cailin Arechiga

Public Health Theses

Importance. Cardiovascular disease (CVD) is one of the leading causes of death in the U.S. and is associated with a range of demographic, military, trauma, and clinical characteristics and physical and mental health conditions. Older military veterans may have an increased risk for CVD, given their advanced age and military experiences. However, the prevalence and health burden of CVD in population-based samples has not been well characterized. Objective. To characterize the current prevalence of CVD, and its association with sociodemographic, military, trauma, and clinical variables in a large, contemporary, and nationally representative sample of older U.S. veterans. Design. Cross-sectional study …

Health Care Utilization And Costs For Dementia Patients In China, Fang Ba

Public Health Theses

The number of people in the world living with Alzheimer’s Disease and related dementias (ADRD) continues to rise rapidly, which places a substantial burden on people with dementia (PWD), their families, and the society. Such a burden has been rising faster in low-income and middle-income countries (LMIC) where around two-thirds of PWD live. While prior research documents dementia prevalence in China and indicates its large geographic disparities, no study to date has documented the national pattern of health care utilization, quality and costs in China. The absence of knowledge would largely impede the effective allocation of resources for combating dementia …

United States Long-Term Trends In Adult Bmi From 1959 To 2018 By Income, Education, And Race/Ethnicity, Julia Banas

Public Health Theses

Obesity prevalence has increased dramatically since the 1950s. While cross-sectional comparisons across racial, ethnic, and socioeconomic groups are abundant, there is less work on long-term trends. We assessed trends in average adult body mass index (BMI) in the United States by income, education, and racial/ethnic groups from 1959 to 2018 using the National Health and Nutrition Examination Survey, which assesses repeated cross-sectional, representative samples of the United States population. Height, weight, income, education, and race variables were extracted from raw data files; income data was converted to constant dollars prior to analysis. BMI was calculated from height and weight measurements. …

Healthcare Provider Perspectives On The Influence Of Cultural Beliefs On Infant And Young Child Feeding Practices Within Ghanaian Refugee Camps: A Qualitative Analysis, Morgan Nadene Veronica Buchanan

Public Health Theses

Adherence to breastfeeding and complementary feeding recommendations is a proven strategy for promoting the well-being of infants and young children and ensuring their proper development. Cultural beliefs inform caregivers’ likelihood to follow these guidelines as they influence caregivers’ thoughts about maternal behavior during the prenatal and lactation periods, child feeding behaviors, and health. Refugee camps or settlements are a unique space to study the coexistence of cultural beliefs held by residents and staff. Understanding the pathways by which cultural beliefs modulate caregiver infant and young child feeding (IYCF) behavior (and therefore impact child health) within these settings is of paramount …

Effects Of Substance Use Disorder Section 1115 Waivers On Medicaid Population Utilization Of Buprenorphine And Naltrexone, Evangeline Cai

Public Health Theses

Background: In 2015, the Centers for Medicare and Medicaid Services (CMS) issued guidelines for a Medicaid Section 1115 behavioral health waiver with the intention of improving access to treatment for individuals with substance use disorder (SUD). One provision of the waiver allowed states to lift federal guidelines that originally prohibited states from using Medicaid funds to reimburse adults aged 21-64 years old for SUD services that occurred at “institutions for mental disease” (IMDs) with more than 16 beds. As of February 2021, 31 states have an approved the waiver.

Objective: To determine whether the Section 1115 SUD waivers, originally issued …

Caesarean Delivery Among Women Of Color Is Associated With Risk Of Early Childhood Developmental Delays In Brazil, Haley Case

Public Health Theses

Background. Poverty, racism, and other sources of oppression threaten children’s nurturing environments and associated early childhood development (ECD). Women of Color and their children are disproportionately exposed to risk factors for poor ECD in Brazil. There is a growing body of evidence supporting the claim that unnecessary cesarean section (CS) is associated with poor maternal health outcomes and ECD delays. There is an existing gap in the literature on risk factors, including obstetric factors, of poor ECD among children of Women of Color in Brazil.

Objective. The objective of this thesis was to investigate factors, including obstetric characteristics of CS …

Developing A Framework For Civilian-Military Public Health Operations Involving Non-State Armed Groups, Andrew James Chambers

Public Health Theses

Introduction: The interface of military forces, civilian actors and non-state armed groups (NSAGs) during a public health emergency within an active conflict is a situation fraught with legal and ethical challenges not adequately addressed in established doctrine or international guidance documents. Ongoing public health crises in Yemen and Afghanistan represent the real-world consequences of threats to population health and security if these critical gaps are not addressed. Methods: A list of five diverse medical scenarios was developed as an initial attempt to produce a practical, historically-informed framework for use in future civilian-military (CIV-MIL) training events and guidance. Ten virtual interviews …

Extreme Heat Vulnerability And Spatial Accessibility To Cooling Centers In Connecticut, Nicholas Elton

Public Health Theses

Extreme heat is becoming an increasingly prevalent and prominent environmental health issue under climate change. The goal of this study is to evaluate heat vulnerability at the census tract level in the state of Connecticut and assess the spatial accessibility to cooling centers – an extreme heat intervention. A variety of environmental and sociodemographic variables related to heat and health were identified based on previous literature and used in a varimax-rotated principal component analysis to reduce dimensionality and identify key components that constitute a heat vulnerability score. In addition, cooling center locations were identified based on news media and a …

Sexual Orientation Disclosure And Depression Among Thailand Men Who Have Sex With Men: Associations With Intimate Partner Violence And Social Support, Eduardo Encina

Public Health Theses

Objectives: The analytical goal of this project is to better understand the association of sexual orientation disclosure among different social networks of Thailand men who have sex with men (MSM) and depression. Along with this, we aim to extensively explore the intersectional influence of social support and intimate partner violence (IPV) experiences with each other, with disclosure, and ultimately depression outcomes.

Methods: The secondary dataset for this project was comprised of results from a cross-sectional study. This study utilized a web-based epidemiological and behavioral survey, distributed among young MSM ages 15-24. Self-reported data was provided through collaboration with Mahidol University …

Quantification Of Anesthetic And Analgesic Compounds In E-Liquids And Their Aerosols, Deyri Sugey Garcia

Public Health Theses

The unprecedented rise of vaping has resulted in gaps of scientific understanding of the health hazards this new phenomenon has created, as well as delayed regulations surrounding vape products, including coolants. Coolants are additives that create anesthetic, physical sense-reducing, and/or analgesic, properties that numbs the airways and add a minty flavor to vape products. However, it is unclear how much coolant is added to vape products electronic liquid (e-liquid), and how much of this content carries over into the aerosolized vaped form. To determine compositional analysis and carryover of common synthetic coolants, eugenol in 35 clove e-liquids and menthol, methone, …

‘I’M Never Saying A Damn Word Again’: Approaches To Community Support And Help Seeking Among Black Youth Experiencing Suicidal Thoughts, Alexis Renee Hopkins

Public Health Theses

Background. Suicidal behavior among Black youth is rising in the United States , yet little is known about how Black Youth engage and navigate suicidality. While we know that suicide ideation and death by suicide is decreasing overall among youth in the U.S., incidences of death by suicide are still rising among Black youth. There is very little understanding of what community support is accessible to Black youth who are experiencing suicidality. The present study examines how Black young adults who experienced suicidality in their youth turned to their social support systems and communities for support. Method. Seventeen semi-structured in-depth …

The Impact Of Economic Intimate Partner Violence On Women’S Sexual And Reproductive Health In Asia & The Pacific, Marina Katague

Public Health Theses

Intimate partner violence is a human rights violation and serious threat to global public health. Economic intimate partner violence is a unique form of abuse whose effects on health need clarification. Data from the 2011-2012 UN Multi-country Study on Men and Violence, comprised of cross-sectional samples in China, Papua New Guinea, and Sri Lanka were collected on ever-partnered women aged 18-49 years. The sample averaged some (1.14) economic violence exposure across summed behaviors (range 0-12; standard deviation=2.04). Multivariable regressions were run to assess the relationship between severity of IPV abuse types and 14 sexual and reproductive health outcomes. Adjusted analyses …

Factors Associated With Early Childhood Development Outcomes For Children Of Adolescent And Young Adult Mothers In Brazil, Lily Benson Kofke

Public Health Theses

Objectives: A descriptive analysis to explore the risks for early childhood development (ECD) delays among children of adolescent and young adult mothers in Brazil. Methods: A secondary analysis of cross-sectional data of a representative sample of children under age 2 and their mothers from community health centers in Brasília, Brazil. The Denver Developmental Screening Test II was used to assess overall and domain-specific ECD (personal-social, fine motor, gross motor, and language). Mothers were subset into two groups based on age. Bivariate analyses and multivariable logistic regressions were used to examine the associations between maternal age and risk of ECD delay, …

Gene-Gene Interactions Contributing To Asthma Susceptibility, An Exploration Using Uk Biobank Dataset, Yuyuan Lin

Public Health Theses

Background: Previous studies have attempted to identify gene-gene interactions for asthma. However, most of these studies suffered from lack of replication or insufficient statistical power. In this study, we aimed to explore the gene-gene interactions affecting asthma susceptibility and tried to replicate the results. Both the discovery and replication datasets were nested in UK Biobank data.

Methods: Nested case-control design was used. In the discovery analysis (N= 306,859, cases = 35,483, controls = 271,376), Univariate genome-wide association analysis was performed to prioritize loci for the interaction analysis. Pairwise search for epistasis was conducted among 5,389 SNPs. Replication of the top …

The Impact Of Ww’S Multi-City Fvrx Program On Children, Damaris Lopez Mercado

Public Health Theses

Introduction and background: Higher F&V intake are associated with healthier BMI in children, but cost of F&V has been found to be a barrier to access for some families. To mitigate this barrier, Wholesome Wave (WW) implemented a six-month F&V incentive program that included a $25 weekly financial incentive for families to spend on F&V in three U.S. cities. The primary objectives of this paper are to assess whether this program significantly impacted child F&V consumption and child anthropometry from baseline to end-of-program and to assess whether F&V intake and food insecurity and end-of-program are significant predictors of healthy child …

Co-Distribution Of Ambient Light At Night And Incidence Of Human Cancers And Covid-19, Yidan Meng

Public Health Theses

Introduction and BackgroundThere are increasing concerns about the effects of artificial lights on human health, including hormone-related disease and immune functions. In January 2020, the outbreak of COVID-19 disrupted everyone’s life, and people who infected have various severity. Thus, we want to analyze whether people exposed to different ambient light at night (LAN) levels make them more susceptible to COVID-19 for our summer research. Besides the effects of LAN on immune functions, we also discussed the association of LAN and multiple cancers in seven states of Northeastern U.S. We used similar statistical and geographic analysis methods and separate them into …

Impact Of Covid-19 On Participants Of A Fruit And Vegetable Program, Christabelle Ong

Public Health Theses

Objective: To investigate the impact of COVID-19 on the participants of a multi-city fruit and vegetable incentive program.Design: A six-month cohort study was conducted. Pre-program and post-program data were collected using an online survey platform. Setting: Eight cities across the United States. Participants: A total of 822 individuals were recruited through local site partners to participate in a fruit and vegetable incentive program (n=822; 79.4% women, 20.6% men; median age: 57 years old). Intervention: Participants received $50 monthly fruit and vegetable vouchers, a sneaker gift card or gift basket, and access to a weight loss app. Main Outcome Measures: The …

Health-Related Quality Of Life In Endometrial Cancer Survivors, Michelle Sodipo

Public Health Theses

Background: Endometrial cancer is the most common cancer of the female reproductive organs and one of few cancers in the United States with rising incidence and mortality rates. Few studies have examined factors that influence health-related quality of life (HRQOL) of endometrial cancer survivors after active treatment and existing studies have been limited in sample size. In this study, we examined sociodemographic and clinical factors associated with HRQOL and symptom burden in a national sample of endometrial cancer survivors.

Methods: We evaluated 331 endometrial cancer survivors from the longitudinal American Cancer Society’s Study of Cancer Survivors-I who completed self-administered questionnaires …

Long-Term Cancer Survivors' Use Of Healthcare Providers, Madeleine Tessier-Kay

Public Health Theses

Abstract

Introduction: The number of long-term (>5 years post-diagnosis) cancer survivors in the United States is growing, making it critical to understand how they utilize healthcare for their past cancer diagnosis. There are limited data on patient characteristics associated with care utilization patterns. Methods: Data are reported from the 9-year post-diagnosis follow-up of the Connecticut participants (n=399) in the American Cancer Society’s Study of Cancer Survivors-I. We assessed characteristics associated with long-term primary cancer care provider (cancer specialist vs. primary care physician (PCP), shared care vs. PCP) and number of PCP visits in the past year via multinomial logistic …