Environmental Public Health Commons^™

Environmental Predictors Of Human Lyme Disease Incidence Across Appalachian Counties In Kentucky, Virginia, And West Virginia, 2000-2019, Karlie D. Rennison

Theses and Dissertations--Epidemiology and Biostatistics

This ecological study examined county-level environmental, landscape, and host-related predictors of Lyme disease incidence across Kentucky, Virginia, and West Virginia from 2000-2019. Lyme disease is an emerging public health concern in the Appalachian region, where geographic expansion and shifting ecological conditions may influence disease risk.

Lyme disease case rates (per 10,000 population) were analyzed in relation to climate variables, land cover metrics, host density measures, and rurality using publicly available data sources. Descriptive and regression analyses were conducted to evaluate associations between candidate predictors and disease incidence.

Substantial geographic variation in Lyme disease incidence was observed, with higher case rates …

Prevalence Of Screening Patients For Alcohol Use In West Virginia: A Cross-Sectional Observational Study, Bayan Abuhalimeh, Christopher Waters, R. Constance Wiener

Journal of Appalachian Health

Introduction: Consequences of alcohol consumption are well-established and compounded by physiological changes of aging (increased sensitivity; medication interactions; etc.). Alcohol screening for all ages is recommended, especially as most Americans believe moderate drinking is acceptable. Screening is important in high alcohol use regions, such as rural areas where isolation is more likely, especially for older adults. The Appalachian Region has a significant rural population of older adults. West Virginia (WV) is representative of Appalachia. It is a rural state, has many older adults, and all counties are Appalachian.

Purpose: The purpose of this cross-sectional study is to determine the likelihood …

Proximity And Density Of Tobacco Retail Locations To Kentucky Schools And The Relationship To Youth Perceptions Of Harm And Susceptibility To E-Cigarette Use, Hannah Cardona

Theses and Dissertations--Kinesiology and Health Promotion

Purpose: To explore the potential relationship between tobacco retailer proximity/density around Kentucky elementary, middle, and high schools, and students’ perceptions, perceived norms, susceptibility to, and use of e-cigarettes. Design: A mixed-methods analysis of youth’s self-reported survey results and geographical data. Setting: 106 Kentucky elementary, middle, and high schools which participated in #iCANendthetrend’s tobacco education program between September 2023 and May 2024. Subjects: Convenience sample of students from Ky schools (N = 7,823) Measures: Items assessing e-cigarette use, susceptibility, perceptions, and perceived norms. Analysis: ANOVA tests used to compare responses of elementary, middle, and high school students. Chi-squared tests were used …

Pathogen Surveillance Of Viruses And Antimicrobial Resistance Through Wastewater Based Epidemiology, William Strike

Theses and Dissertations--Biomedical Engineering

Pandemic surveillance is a cornerstone in public health safety, as it enables identification of pathogens circulating within a community before they become widespread outbreaks. Wastewater based epidemiology has blossomed in recent years due to its success in the SARS-CoV-2 pandemic, but this form of public health surveillance has a global equity problem. A large majority of the wastewater-based surveillance work has been done in large metropolitan cities with access to advanced testing infrastructure, which poses a challenge as we consider where pandemics have historically emerged. Therefore, there is a need to identify, adapt, and develop workflows to meet the needs …

Environmental And Behavioral Determinants Of Congenital Defects: An Ecologic Study In Kentucky, Amelia G. Floyd

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

Congenital defects are a significant contributor to infant morbidity and mortality. The multifactorial etiology of such defects presents complex challenges for public health. This ecologic study investigates the association between environmental and behavioral exposures and congenital defects rates at the county level in Kentucky from 2010 to 2019. The Kentucky Department for Public Health, Office of Vital Statistics, provided all relevant defect data. County-level exposure data was collected from multiple sources.

Descriptive and geospatial analyses revealed substantial geographic variability, with notable high defect rates in northeastern Kentucky. Negative binomial regression models identified behavioral and socioeconomic factors to be the strongest …

Elucidating The Adverse Effects Of Chronic Pfos Exposure On Gastrointestinal Pathology And Colorectal Cancer, Jerika Durham

Theses and Dissertations--Toxicology and Cancer Biology

Commonly referred to as "forever chemicals," per- and polyfluoroalkyl substances (PFAS) have been linked to a number of detrimental health effects, including an elevated risk of cancer. One "long-chain" subtype of PFAS, perfluorooctanesulfonic acid (PFOS), has a long elimination half-life and a significant propensity for bioaccumulation. Because PFOS is commonly found in drinking water, the gastrointestinal system absorbs it at a high rate. Recent studies demonstrate that PFAS exposures promote intestinal inflammation and gut barrier dysfunction. However, how a long-term PFOS exposure affects colorectal cancer (CRC) progression is not known. Therefore, the purpose of this research is to understand how …

Weighted Family History Density Of Substance Use: Influence On Participant Substance Use Onset, Escalation, And Duration, Carleigh A. Litteral

Theses and Dissertations--Psychology

Substance use disorders impose a staggering toll on the United States (U.S.), straining healthcare systems, destabilizing communities, and profoundly impacting both individuals and families. Approximately one in six Americans aged 12 and older had a past-year substance use disorder in 2022 (Key Substance Use, 2022), and nearly one-third of adults experience a substance use disorder in their lifetime (Wu, 2010), contributing to an economic burden exceeding $400 billion annually (National Drug Threat Assessment, 2011). Family history of substance use disorders is a key predictor of vulnerability, with individuals who have affected relatives being 2–8 times more …

Planetary Health Learning Objectives: Foundational Knowledge For Global Health Education In An Era Of Climate Change, Kathryn H. Jacobsen, Caryl E. Waggett, Pamela Berenbaum, Brett R. Bayles, Gail L. Carlson, René English, Carlos A Faerron Guzmán, Meredith L. Gartin, Liz Grant, Thomas L. Henshaw, Lora L. Iannotti, Philip J. Landrigan, Nina Lansbury, Hao Li, Maureen Y. Lichtveld, Ketrell Mcwhorter, Jessica E. Rettig, Cecilia J. Sorensen, Eric J. Wetzel, Dawn Michele Whitehead, Peter J. Winch, Keith Martin

Earth and Environmental Sciences Faculty Publications

Planetary health is an emerging field that emphasises that humans depend on a healthy Earth for survival and, conversely, that the sustainability of Earth systems is dependent on human behaviours. In response to member demands for resources to support teaching and learning related to planetary health, the Consortium of Universities for Global Health (CUGH) convened a working group to develop a set of planetary health learning objectives (PHLOs) that would complement the existing ten CUGH global health learning objectives. The eight PHLOs feature Earth system changes, planetary boundaries, and climate change science; ecological systems and One Health; human health outcomes; …

Wastewater Surveillance For Xylazine In Kentucky, Chris Delcher, Dana Quesinberry, Soroosh Torabi, Scott Berry, James W. Keck, Abhya Rani, Bikram Subedi

UK CARES Faculty Publications

Introduction: In the U.S., xylazine, the veterinary non-opioid sedative, has emerged as a major threat to people who use illicitly manufactured fentanyl and other drugs. The aim of this study was to compare wastewater detection of xylazine with other public health and safety surveillance data from 2019 to 2023 in Kentucky.

Methods: Wastewater samples from 5 rest areas, 2 truck weigh stations, and 4 wastewater treat- ment plants were tested for xylazine. Wastewater xylazine positivity rates were compared with xyla- zine-positive submission rates from the National Forensic Laboratory Information System and Kentucky’s fatal overdoses in 6-month periods (Period 1=January−June; Period …

Willingness To Utilize A Mobile Treatment Unit In Five Counties At The Epicenter Of The Us Rural Opioid Epidemic., Snigdha R. Peddireddy, Melvin D. Livingston Iii, April M. Young, Patricia R. Freeman, Umedjon Ibragimov, Kelli A. Komro, Michelle R. Lofwall, Carrie B. Oser, Michele Staton, Hannah L. F. Cooper

Epidemiology and Environmental Health Faculty Publications

INTRODUCTION: US federal policies are evolving to expand the provision of mobile treatment units (MTUs) offering medications for opioid use disorder (MOUD). Mobile MOUD services are critical for rural areas with poor geographic access to fixed-site treatment providers. This study explored willingness to utilize an MTU among a sample of people who use opioids in rural Eastern Kentucky counties at the epicenter of the US opioid epidemic.

METHODS: The study analyzed Cross-sectional survey data from the Kentucky Communities and Researchers Engaging to Halt the Opioid Epidemic (CARE2HOPE) study covering five rural counties in the state. Logistic regression models investigated the …

Role Of Social Determinants Of Health And The Renin- Angiotensin Aldosterone System In Risk For Hypertensive Disorders Of Pregnancy And Related Adverse Outcomes., Esther Letushila Ndashaala

Theses and Dissertations--Nutrition and Food Systems

Background: Hypertensive disorders of pregnancy (HDP) represent a significant public health issue, contributing to maternal and fetal morbidity and mortality. Women from lower socioeconomic backgrounds or marginalized racial and ethnic groups face higher risks of HDP, which have been incompletely described. In addition, risk for HDP may be linked to a reduction in the normal activity of the renin-angiotensin-aldosterone system (RAAS). This study investigates the role of socioeconomic factors and RAAS components in the risk for HDP and adverse maternal and neonatal outcomes. Methods: This study is a secondary analysis of data from 180 pregnant individuals from a high-risk maternal-fetal …

Evaluating A High School Mrsa Prevention Program: A Case Study, Jamie Henning

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

MRSA poses a significant health risk to athletes nationwide. This case study examines the application of an online training module to address knowledge gaps regarding Methicillin-resistant Staphylococcus aureus (MRSA) among key decision-makers for high school athletes. It reviews the development and initial evaluation of a web-based training program designed to empower decision-makers with the knowledge to prevent MRSA infection and respond to suspected cases. Program evaluation recommended expanding the training module to wrestling staff with improved evaluation methods while continuing implementation and effectiveness assessment for the football staff. Despite initial data quality limitations, the online training module evaluation offered valuable …

Self-Reported Consumption Of Bottled Water V. Tap Water In Appalachian And Non-Appalachian Kentucky, Jason W. Marion

Journal of Appalachian Health

Introduction: Quantitative studies on drinking water perceptions in Appalachia are limited. High-profile water infrastructure failures in the U.S. and Eastern Kentucky, coupled with human-made and natural disasters in the Appalachian Region, have likely impacted opinions regarding tap water.

Purpose: To use existing unexplored data to describe baseline tap water v. bottled water consumption in Kentucky.

Methods: Telephone-based cross-sectional data were obtained from the 2013 Kentucky Health Issues Poll (KHIP) directed by the Foundation for a Healthy Kentucky. Among many items in KHIP, self-reported consumption of bottled water over tap water, reasons for bottled water use, and demographic data were obtained. …

Lung And Colorectal Cancer Disparities In Appalachian Kentucky: Spatial Analysis On The Influence Of Education And Literacy, Nicole Robertson Mph, Todd Burus, Lauren Hudson, Pamela C. Hull, Lee Park, Nathan L. Vanderford

Markey Cancer Center Faculty Publications

Low educational attainment and high cancer incidence and mortality rates have long been a challenge in Appalachian Kentucky. Prior studies have reported disparities in cancer incidence and mortality between Appalachian and non-Appalachian populations, but the influence of education on this disparity has not been extensively studied. Herein, all cancers and two cancer sites with available screenings (colorectal and lung) were joined with education indicators (educational attainment and literacy) and one geographic indicator across all 120 Kentucky counties. This dataset was used to build choropleth maps and perform simple linear and spatial regression to assess statistical significance and to measure the …

Adult Asthma Associated With Roadway Density And Housing In Rural Appalachia: The Mountain Air Project (Map)., W Jay Christian, John Flunker, Beverly May, Susan Westneat, Wayne T Sanderson, Nancy Schoenberg, Steven R Browning

UK CARES Faculty Publications

BACKGROUND: Appalachian Kentucky is a rural area with a high prevalence of asthma among adults. The relative contribution of environmental exposures in the etiology of adult asthma in these populations has been understudied.

OBJECTIVE: This manuscript describes the aims, study design, methods, and characteristics of participants for the Mountain Air Project (MAP), and focuses on associations between small area environmental exposures, including roadways and mining operations, and lifetime and current asthma in adults.

METHODS: A cohort of residents, aged 21 and older, in two Kentucky counties, was enrolled in a community-based, cross-sectional study. Stratified cluster sampling was used to select …

An Analysis Of The Clear Horizons Program In Perry County, Kentucky On Smoking Cessation, Julia Kollitz

Lewis Honors College Thesis Collection

Perry County is an Appalachian county located in southeastern Kentucky. The population is 28,473 people (United States Census Bureau, 2020). It is a predominately white community, with 95.9% of people falling in this category, which is higher than the national percentage of 75.8% (United States Census Bureau, 2020). Being a rural county, this community uses few news sources, with the primary outlet being WYMT Eastern Kentucky News. This news outlet is a subset of CBS (WYMT, 2023). When comparing statewide and nationwide data, Perry County does consistently worse. They have a high school graduation rate that is lower than the …

Examining The Utility Of A Kentucky Fcs Cooperative Extension Curriculum On Community Members’ Healthy And Sustainable Diet-Related Behaviors, Catharine Pickford

Theses and Dissertations--Nutrition and Food Systems

Experts recommend individuals adopt healthy and sustainable dietary behaviors to improve human and environmental health. The objective of this study was to pilot a sustainable eating Family and Consumer Sciences (FCS) Cooperative Extension curriculum and evaluate the effectiveness of the lesson series by measuring participants’ changes in knowledge, perceptions, and intentions towards healthy and sustainable dietary behaviors as well as overall satisfaction with lessons. A five-lesson sustainable eating curriculum was developed with topics focused on: reducing food waste; eating more seasonal, local plant-based foods; varying protein sources; maintaining energy balance; and consuming fewer highly processed and packaged foods. To assess …

The Effect Of Land-Cover/Land-Use And Habitat Fragmentation On Spatial Patterns Of Lyme Disease In The Eastern United States, Maria Elizabeth Topmiller

Theses and Dissertations--Forestry and Natural Resources

Lyme disease has been of national concern for the past few decades. As our understanding of the role of landscape structure in epidemiology expands, it is essential to apply the principles of landscape ecology to the research of vector-borne and zoonotic disease. This study examined the strength of the relationship between land-cover class, degree of habitat fragmentation and county-level Lyme disease cases. Forest, agricultural, and urban land cover types were the categories of interest, while percent cover, edge density, and patch density were the landscape metric used to measure habitat amount and fragmentation. The general linear trends were modelled with …

Surveillance For Ticks And Tick-Borne Pathogens In Kentucky, Anna Rosalee Pasternak

Theses and Dissertations--Entomology

Tick-borne diseases are an emerging threat to human and animal health. In Kentucky, tick-borne disease surveillance has identified rising incidences of spotted fever rickettsiosis, ehrlichiosis, and Lyme disease. Since these diseases occur through the bites of infected ticks, effective prevention efforts are reliant upon knowing where the risk of exposure to tick bites exists. Historical data on tick distribution in Kentucky is variable, with very little reported on a statewide scale, leaving vector control workers, public health personnel, physicians, veterinarians, and others to rely on outdated, intermittent, or out-of-state information. In my dissertation, I surveyed ticks and select tick-borne pathogens …

The Effect Of An Educational Handout On Knowledge, Awareness And Attitudes Of Pre-Exposure Prophylaxis (Prep) Among Participants At A Needle And Syringe Exchange Site, Mckenzie Buckel

DNP Projects

Background: In 2018, the total number of HIV cases in the United States was 1.2 million. Almost 186,500 of these cases were attributed to intravenous drug use. With the adherence to pre-exposure prophylaxis (PrEP) there is approximately a 49% decrease in the rates of HIV among people who inject drugs and the most significant barrier to PrEP among this population is a lack of awareness and knowledge.

Objective: The purpose of this study was to determine participants’ of a needle and syringe exchange site knowledge, awareness and attitudes of PrEP after reviewing an educational handout about PrEP.

Methods: A quasi …

Using Culturally Focused Storytelling To Empower Appalachian Kentucky Youth To Understand And Address Cancer Disparities In Their Communities, Lauren K. Collett, Lauren Hudson, Chris Prichard, Nathan L. Vanderford

Markey Cancer Center Faculty Publications

Kentucky has the highest cancer incidence and mortality rates in the nation with the Appalachian region of the state being most affected. These rates are driven by health behaviors and inequities in social determinants of health. Herein, Appalachian Kentucky students with the University of Kentucky’s Appalachian Career Training in Oncology (ACTION) program were engaged in a storytelling exercise by writing culturally framed essays. Students discussed their personal experiences with cancer and their thoughts on the causes of and potential solutions to Appalachian Kentucky’s cancer disparities. Content analysis was used to identify common themes, subthemes, and subtopics in the essays regarding …

Characteristics And Assessing Biological Risks Of Airborne Bacteria In Waste Sorting Plant, Abbas Norouzian Baghani, Somayeh Golbaz, Gholamreza Ebrahimzadeh, Marcelo I. Guzman, Mahdieh Delikhoon, Mehdi Jamshidi Rastani, Abdullah Barkhordari, Ramin Nabizadeh

Chemistry Faculty Publications

Examining the concentration and types of airborne bacteria in waste paper and cardboard sorting plants (WPCSP) is an urgent matter to inform policy makers about the health impacts on exposed workers. Herein, we collected 20 samples at 9 points of a WPCSP every 6 winter days, and found that the most abundant airborne bacteria were positively and negatively correlated to relative humidity and temperature, respectively. The most abundant airborne bacteria (in units of CFU m⁻³) were: Staphylococcus sp. (72.4) > Micrococcus sp. (52.2) > Bacillus sp. (30.3) > Enterococcus sp. (24.0) > Serratia marcescens (20.1) > E. coli (19.1) > Pseudomonas sp. (16.0) > Nocardia …

An Ecological Study Of Glyphosate Use And Non-Hodgkin’S Lymphoma, Dexter Corlett, Steven R. Browning

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

Glyphosate is currently the most widely used herbicide in the world. Initially thought to be non-carcinogenic in humans, in 2015 glyphosate was classified as a “probable carcinogen” by the International Agency for Research on Cancer due to several small epidemiological studies indicating a link between the pesticide and hematologic cancers, especially non-Hodgkin’s lymphoma (NHL). The current work is an ecological study using counties in Kentucky, Arkansas, and Iowa to compare glyphosate usage to NHL incidence using a multivariate Poisson regression. We found no significant correlation between glyphosate use and NHL incidence, though caution should be taken to draw significance from …

Policy Implications Of The Covid-19 Pandemic On Food Security In Rural America: Evidence From Appalachia, Kathryn M. Cardarelli, Emily M. Dewitt, Rachel Gillespie, Rachel Hogg-Graham, Heather Norman-Burgdolf, Janet T. Mullins

Dietetics and Human Nutrition Faculty Publications

Rural communities are disproportionally affected by food insecurity, making them vulnerable to the consequences of supply disruptions caused by the COVID-19 pandemic. While access to food was initially diminished due to food supply disruptions, little is known about the mechanisms through which federal emergency assistance programs impacted food access in rural populations. Through a series of five focus groups in spring 2021, we examined the impact of the COVID-19 pandemic on food access in a rural Appalachian community in Kentucky. Data were analyzed using a Grounded Theory Approach. Findings revealed the following four primary themes: food scarcity in grocery stores; …

Serum Concentrations Of Legacy And Emerging Per- And Polyfluoroalkyl Substances In The Anniston Community Health Surveys (Achs I And Achs Ii), Michael C. Petriello, M. Abdul Mottaleb, Tara C. Serio, Bharat Balyan, Matthew C. Cave, Marian Pavuk, Linda S. Birnbaum, Andrew J. Morris

Internal Medicine Faculty Publications

Background

Residents of Anniston Alabama were highly exposed to polychlorinated biphenyls (PCBs) due to longstanding manufacturing in the area. The Anniston Community Health Surveys (ACHS I-2005–2007 and II, 2014) have linked these exposures with a variety of deletereous health outcomes. In addition to PCBs, these individuals were likely simultaneously exposed to other persistent organic pollutants including per and polyfluoroalkyl substances (PFAS), which are an emerging class of ubiquitous industrial chemicals that are measurable in the blood of most individuals and have themselves been linked increased risk of some non communicable diseases.

Methods

To characterize PFAS exposures in ACHS I and …

Association Of Manganese Biomarker Concentrations With Blood Pressure And Kidney Parameters Among Healthy Adolescents: Nhanes 2013–2018, Maria D. Politis, Jacob C. Freedman, Erin N. Haynes, Alison P. Sanders

Epidemiology and Environmental Health Faculty Publications

Deficiency or excess exposure to manganese (Mn), an essential mineral, may have potentially adverse health effects. The kidneys are a major organ of Mn site-specific toxicity because of their unique role in filtration, metabolism, and excretion of xenobiotics. We hypothesized that Mn concentrations were associated with poorer blood pressure (BP) and kidney parameters such as estimated glomerular filtration rate (eGFR), blood urea nitrogen (BUN), and albumin creatinine ratio (ACR). We conducted a cross-sectional analysis of 1931 healthy U.S. adolescents aged 12–19 years participating in National Health and Nutrition Examination Survey cycles 2013–2014, 2015–2016, and 2017–2018. Blood and urine Mn concentrations …

Knowledge And Beliefs Associated With Environmental Health Literacy: A Case Study Focused On Toxic Metals Contamination Of Well Water, Kathleen M. Gray, Victoria Triana, Marti Lindsey, Benjamin Richmond, Anna G. Hoover, Chris Wiesen

Preventive Medicine and Environmental Health Faculty Publications

Environmental health literacy (EHL) is developing as a framework that can inform educational interventions designed to facilitate individual and collective action to protect health, yet EHL measurement poses several challenges. While some studies have measured environmental health knowledge resulting from interventions, few have incorporated skills and self-efficacy. In this study, a process-focused EHL instrument was developed, using the Newest Vital Sign (NVS) health literacy instrument as a model and tailoring it for the context of private well contamination with toxic metals. Forty-seven (47) participants, including undergraduate students and residents of communities with contaminated well water, piloted a prototype EHL instrument …

Letter To Editor Regarding The Ocean Study, Barbara P. Yawn, Barry Make, David M. Mannino, Fernando J. Martinez, Meilan K. Han

Preventive Medicine and Environmental Health Faculty Publications

No abstract provided.

Informing The Pathway Of Copd Treatment (Impact) Trial: Fibrinogen Levels Predict Risk Of Moderate Or Severe Exacerbations, Dave Singh, Gerard J. Criner, Mark T. Dransfield, David M. G. Halpin, Meilan K. Han, Peter Lange, Sally Lettis, David A. Lipson, David M. Mannino, Neil Martin, Fernando J. Martinez, Bruce E. Miller, Robert Wise, Chang-Qing Zhu, David Lomas

Preventive Medicine and Environmental Health Faculty Publications

Background: Fibrinogen is the frst qualifed prognostic/predictive biomarker for exacerbations in patients with chronic obstructive pulmonary disease (COPD). The IMPACT trial investigated futicasone furoate/umeclidinium/ vilanterol (FF/UMEC/VI) triple therapy versus FF/VI and UMEC/VI in patients with symptomatic COPD at risk of exacer‑ bations. This analysis used IMPACT trial data to examine the relationship between fbrinogen levels and exacerbation outcomes in patients with COPD.

Methods: 8094 patients with a fbrinogen assessment at Week 16 were included, baseline fbrinogen data were not measured. Post hoc analyses were performed by fbrinogen quartiles and by 3.5 g/L threshold. Endpoints included on-treatment exacerbations and adverse events …

Maternal Proximity To Mountaintop Removal Mining And Birth Defects In Appalachian Kentucky, 1997-2003, Daniel B. Cooper

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

Background: Extraction of coal through mountaintop removal mining (MTR) alters many dimensions of the landscape, and explosive blasts, exposed rock, and coal washing have the potential to pollute air and water with substances known to increase risk of developmental and birth anomalies. Previous research suggests that infants born to mothers living in MTR coal mining counties have higher prevalence of most types of birth defects.

Objectives: This study seeks to examine further the relationship between MTR activity and birth defects by employing individual level exposure estimation through precise satellite data of MTR activity in the Appalachian region and maternal residence …