Other Public Health Commons^™

Rural Community Perspectives On Hurricane Helene In Western North Carolina, Jennifer A. Horney, Lilly Moreau, Search Wnc

Journal of Appalachian Health

Introduction: After making landfall on the Florida Gulf Coast in September 2024, Hurricane Helene impacted Western North Carolina (WNC) with historic flooding, landslides, and hurricane-force winds. More than 100 deaths in the region were attributed to the storm’s direct impacts.

Purpose: The purpose of this study was to assess community perspectives of long-term recovery in Mitchell and Yancey Counties, two rural WNC counties severely impacted by Hurricane Helene.

Methods: A 14-question interview guide was developed based on prior disaster research and the community engagement work of Sustaining Essential and Rural Community Healthcare (SEARCH). Questions covered post-Helene experiences related to access …

Starting With Story, Not Symptom: Narrative Collapse And Cultural Repair In Appalachia, Wayne Coombs Ph.D.

Journal of Appalachian Health

Appalachia’s opioid crisis reflects uneven burdens, especially in distressed coalfield counties, and it cannot be solved by symptom tracking alone. This commentary argues for a narrative shift, starting with story and cultural repair alongside clinical care. Narrative collapse is defined here as the loss of shared, dependable public meaning across groups, not the absence of storytelling in families, churches, and recovery circles. Trauma science suggests that chronic threat reshapes nervous systems across generations, making safety a prerequisite for renewed trust. Drawing on narrative identity research, the piece proposes peer story work as infrastructure that can reduce shame, support treatment engagement, …

Suicide Exposure In The Army National Guard: A Three Manuscript Dissertation, Rebecca Willis-Nichols

Theses and Dissertations--Social Work

Between 2000-2022, the U.S. suicide rate increased 36% with one death now occurring every 11 minutes (CDC, 2024). Despite the Department of Defense making a concerted effort to curb the suicide increases in their ranks, the rates have continued to rise. Active-duty component rates have slowly increased since 2011 while reserve and guard components have held steady (U.S. Department of Defense, 2023). After adjusting for age, the suicide rate in the veteran population was 57% greater than the civilian population in 2020 (CDC, 2024). There is a need for a better understanding of the impact of these deaths and the …

Evaluating Hiv Testing Strategies And Screening In The University Of Kentucky’S Target 4 Project, Emily E. Wagoner

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

The University of Kentucky’s Target 4 project aims to expand HIV testing and provide accessible, confidential services throughout Kentucky, focusing on individuals at highest risk for HIV and Hepatitis C. In December 2023, the Target 4 project implemented a new, expanded HIV screening form, increasing the number of questions from seven to eighteen. This study analyzes the impact of the new screening form on risk factor identification and HIV positivity rates in Region 9, a 16-county area in central Kentucky, from September 2021 to November 2023. Data from 11,187 encounters before the implementation of the new screening form and 2,585 …

Psychological Impacts In Exercise Riders And Professional Jockeys Following Injury, Kelley M. Renner

Theses and Dissertations--Kinesiology and Health Promotion

One of the most well-known equestrian sports, horse racing, is not only a cornerstone of Kentucky’s economy, but also a vital part of its culture, with professional jockeys playing an essential role in the local communities and traditions that define the state. Despite its popularity and financial impact, mental health challenges within the sport have continually been shrouded in silence and ignored in research (Ball et al., 2007). Equally concerning is the high injury prevalence, and psychological impact of these injuries (e.g., psychological distress, depression, anxiety, loss of identity, and self-esteem (King et al., 2022; Losty et al., 2019; McConn-Palfreyman …

Using Public Funeral And Obituary Listings To Identify Spikes In Excess Mortality In One Appalachian County, Allen Archer, Melissa White, Megan Quinn, Randy Wykoff

Journal of Appalachian Health

Introduction: Delays (10-22 months) in availability of official state and county-level mortality data could have significant public health consequences. The COVID-19 pandemic illuminated the need for health officials to access timely death data to identify unexpected increases in mortality in their communities.

Purpose: The purpose of this study is to determine if funeral home listings and/or newspaper obituaries could help identify excess mortality on the local level, prior to the availability of official death records.

Methods: To calculate excess mortality, four years (2017–2020) of data were collected from three sources: the state health department, online funeral home listings, and newspaper …

Discussions Of Cancer Survivorship Care Needs: Are There Rural Versus Urban Inequities?, Tyrone F. Borders, Lindsey R. Hammerslag

Markey Cancer Center Faculty Publications

Background: Rural cancer survivors may face greater challenges receiving survivorship care than urban cancer survivors.

Purpose: To test for rural versus urban inequities and identify other correlates of discussions about cancer survivorship care with healthcare professionals.

Methods: Data are from the 2017 Medical Expenditure Panel Survey (MEPS), which included a cancer survivorship supplement. Adult survivors were asked if they discussed with a healthcare professional 5 components of survivorship care: need for follow-up services, lifestyle/health recommendations, emotional/social needs, long-term side effects, and a summary of treatments received. The Behavioral Model of Health Services guided the inclusion of predisposing, enabling, and need …

Smoking Cessation By Cancer Treatment Status Among Cervical Cancer Survivors, Cherell Cottrell-Daniels, Charles E. Hoogland, Bethany Shorey Fennell, Vani N. Simmons, Damon J. Vidrine, Jennifer I. Vidrine

Markey Cancer Center Faculty Publications

Introduction: Continued smoking following a cancer diagnosis is associated with poorer cancer treatment outcomes and survival times. Little is known about how cancer treatment status at the time of tobacco treatment enrollment impacts long-term smoking cessation outcomes. Using data from a smoking cessation RCT, this study compared long-term cessation outcomes of women undergoing active treatment for cervical cancer at trial enrollment (n=40) to outcomes of women with a history of cervical cancer or cervical intraepithelial neoplasia (CIN) who were not undergo- ing active cancer treatment at enrollment (n=154)

Methods: Participants (n=194) were randomized to Standard Treatment (ST) or ST plus …

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 …

A Case Study In Program Evaluation, Lydia Williams

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

The three core functions of public health are assessment, policy development, and assurance, and program evaluation falls under the latter category. A program is incomplete without an in-depth understanding of how well it works and what steps can be taken to make sure there is continuous progress and improvement.

In this case study, I developed an evaluation plan for the Lexington-Fayette County Health Department’s (LFCHD) infectious disease outbreak education program. The need for such a program was realized after a MRSA outbreak among a Kentucky high school football team. This case study employed the Center for Disease Control and Prevention …

Perfluorooctanesulfonic Acid Exposure Leads To Downregulation Of 3-Hydroxy-3-Methylglutaryl-Coa Synthase 2 Expression And Upregulation Of Markers Associated With Intestinal Carcinogenesis In Mouse Intestinal Tissues, Josiane Weber Tessmann, Pan Deng, Jerika Durham, Chang Li, Moumita Banerjee, Qingding Wang, Ryan A. Goettl, Daheng He, Chi Wang, Eun Y. Lee, B. Mark Evers, Bernhard Hennig, Yekaterina Y. Zaytseva

Markey Cancer Center Faculty Publications

Perfluorooctanesulfonic acid (PFOS) is a widely recognized environment pollutant known for its high bio- accumulation potential and a long elimination half-life. Several studies have shown that PFOS can alter multiple biological pathways and negatively affect human health. Considering the direct exposure to the gastrointestinal (GI) tract to environmental pollutants, PFOS can potentially disrupt intestinal homeostasis. However, there is limited knowledge about the effect of PFOS exposure on normal intestinal tissues, and its contribution to GI- associated diseases remains to be determined. In this study, we examined the effect of PFOS exposure on the gene expression profile of intestinal tissues of …

High-Risk Individuals And Naloxone Use: Implications For Thn Programs In Rural Appalachian Communities, Victor Garcia, Lisa Mccann, Erick Lauber, Christian Vaccaro, Melissa Swauger, Alex Daniel Heckert

Journal of Appalachian Health

Introduction: Take-home naloxone (THN) is being made available across rural Appalachia to curb opioid overdose fatalities. Despite this initiative, some opioid users do not possess naloxone, and if they do, do not administer it to others.

Purpose: Research findings on risk factors that contribute to opioid overdose are presented. These factors, identified in a sample of 16 overdose cases, are (1) early onset age of opioid use; (2) progressive opioid use; (3) a transition from pain medication to heroin and fentanyl; (4) fears of being arrested at a naloxone intervention if first responders are contacted, and (5) limited knowledge of …

Studies Of Polypharmacy And Medication Therapy Management In Population-Based Cohorts, Ximena A. Oyarzun Gonzalez

Theses and Dissertations--Epidemiology and Biostatistics

According to the United States Census Bureau, 16.8% of the population was 65 years and older in 2021, and it is expected that by 2060 that number will increase to about 30% (about 114 million people). Aging is associated with physiological changes in all systems of the body. These changes impact the pharmacodynamics and pharmacokinetic characteristics of drugs. Furthermore, older adults usually have several chronic conditions, which increases their exposure to medications. Increased vulnerability combined with increasing exposure puts elderly people at higher risk for drug interactions and adverse events.

Charlesworth et al. (2014) found that the prevalence of polypharmacy, …

A Novel Nonparametric Test For Heterogeneity Detection And Assessment Of Fluid Removal Among Crrt Patients In Icu, Shaowli Kabir

Theses and Dissertations--Epidemiology and Biostatistics

Over the past decade acute kidney injury (AKI) has been occurring among 20%-50% of patients admitted to the intensive care unit (ICU) in United States. Continuous renal replacement therapy (CRRT) has become a popular treatment method among these critically ill patients. But there are multiple complications in implementing this treatment, including discrepancies in practiced and prescribed fluid removal, possibly related to the heterogeneity among these patients. With mixture modeling there have been several techniques in detecting heterogeneity with their specific limitations. In this dissertation a novel nonparametric ‘d test’ will be used to detect heterogeneity among CRRT patients in ICU. …

Opioid Use Disorder Treatment With Buprenorphine: Analysis Of Treatment Utilization And Associated Outcomes In Kentucky, Feitong Lei

Theses and Dissertations--Epidemiology and Biostatistics

Opioid use disorder (OUD) is chronic opioid use that results in clinically significant suffering, impairment, or even death. The opioid epidemic in the United States has become a public health and economic crisis, affecting patients' well-being and the nation's overall health and welfare. Eastern Kentucky was among the first regions affected by the opioid crisis, and Kentucky has historically ranked among the top five states for age-adjusted drug overdose mortality rate.

There are three medications (buprenorphine, methadone, naltrexone) approved by the U.S. Food and Drug Administration to treat OUD. As a partial opioid agonist, buprenorphine is a safe medication for …

The Effects Of Cultural Competency Training On Providers Knowledge, Skills And Attitudes Towards The Latino Population, Jennifer L. Peppiatt

DNP Projects

Background: Providers in the United States (U.S.) healthcare system need to understand the cultural values, beliefs, and traditions of the growing Latino population. As a result, academic institutions are incorporating cultural competency training in their curricula. However, a noticeable knowledge gap exists for those currently practicing in the healthcare arena, impacting patient and provider satisfaction and healthcare outcomes.

Purpose: The purpose of the study was to obtain a baseline assessment of the cultural competence of a select group of Advanced Practice Providers (APPs) caring for the Latino population at the University of Kentucky and provide a targeted educational intervention, followed …

Access To Health Care In Appalachia: Perception And Reality, Michele Morrone, Cory E. Cronin, Kristin Schuller, Shannon E. Nicks

Journal of Appalachian Health

Introduction: Health disparities such as cancer and diabetes are well documented in Appalachia. These disparities contribute to health status, and by many indicators, Appalachian people are less healthy than those who live in other parts of the country. Access to health care is one factor that contributes to health disparities. Access to care is complex and involves both intrinsic and extrinsic aspects, including satisfaction with quality of care. This research sought to compare Appalachian to non-Appalachian communities in terms of perceptions of access to care.

Methods: We implemented a statewide survey to quantify perceptions of multiple components of …

Prevalence And Correlates Of Secondary Syringe Exchange (Sse) Among People Who Inject Drugs (Pwid) In Rural Kentucky, Jordan R. Wilson

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

Aim: To describe the prevalence of secondary syringe exchange (SSE) in a sample of syringe service program (SSP) clients in rural Appalachian Kentucky and to identify the correlates of SSE.

Methods: Participants (n=338) completed interviewer-administered questionnaires. Only those who reported having ever exchanged syringes at a SSP (n=140) were included in analysis. SSE was measured through self-report of obtaining syringes for someone else at a SSP in the past 6 months. Prevalence and correlates of SSE were examined using bivariate analysis and multiple logistic regression.

Results: Overall, 30% of participants reported SSE. Participants in the second [aOR= 3.83; 95% CI: …

Skin Cancer And Uv Exposure-Related Behaviors Among Appalachian And Non-Appalachian Adults, Minal Patel, Katrina Serrano, Elise Rice, Chan Thai, Kelly Blake, Robin C. Vanderpool

Journal of Appalachian Health

Introduction: Appalachian communities experience elevated rates of cancer incidence and mortality relative to other regions in the U.S. Specifically, melanoma mortality rates are higher in Appalachia compared to the national average, despite comparable incidence rates.

Purpose: To examine differences in self-reported history of skin cancer and prevalence of two UV exposure behaviors between Appalachian and non-Appalachian adults in a nationally representative sample.

Methods: Data are from four cross-sectional cycles of the Health Information National Trends Survey (2011–2014) (N=14,451). We examined sunscreen use and tanning bed use, and self-reported history of melanoma and non-melanoma skin cancer. Descriptive and weighted …

The Impact Of Covid-19 On Worksite Wellness Programs, Marilyn S. Campbell

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

Introduction: Worksite wellness programs are popular employer offerings as of the last few decades. The COVID-19 pandemic has caused major shifts in behavior since these programs have been implemented. The purpose of this study was to see how the pandemic has affected various offerings within a university worksite wellness program.

Methods: This study is a secondary analysis of a university worksite wellness program, and it compares participation in the various offerings in response to the COVID-19 pandemic by evaluating 2019 participation (pre-pandemic) to 2020 participation (including onset of the pandemic and after). This worksite wellness program, which is available to …

Trends In Clinical Billing By Local Health Departments, J. Mac Mccullough

Frontiers in Public Health Services and Systems Research

Background: Billing for clinical services is perceived to be increasingly important for local health departments (LHDs). Yet very little evidence exists regarding the frequency and relative financial importance of clinical billing revenues.

Purpose: The purpose of this study is to report on trends in the frequency and financial scope of clinical billing by LHDs from 2008 to 2013.

Methods: The study used data from the 2008, 2010, and 2013 National Association of City and County Health Officials Profile report surveys. Per capita revenues from clinical billing and percent of total LHD revenues from clinical billing were calculated. …

A “Health In All Policies” Evolution In New York City’S Planyc, Stephanie Noble, Kimberley R. Isett

Frontiers in Public Health Services and Systems Research

Background: Health in All Policies (HiAP) is a framework requiring that the promotion of health be embedded in all substantive policy areas to have a comprehensive approach to the health and well-being of local citizens.

Purpose: To determine the extent to which the Bloomberg Administration in New York City used an HiAP approach to promote attention to health outcomes in peer agencies (outside the Department of Health and Mental Hygiene) within the city bureaucracy.

Methods: Document analysis was completed on a hallmark sustainability plan in New York City, called PlaNYC: the 2007 PlaNYC report, 2011 PlaNYC update, …

Making Health A Priority: Constrained Choices At The Grocery Store, Christy F. Brady

Theses and Dissertations--Sociology

Mounting evidence of the deleterious health effects of poor diet, obesity, and correlated conditions underscore the need to understand how social factors influence food choices. A variety of factors contribute to the diets that Americans consume including limited time, limited income, lack of cooking skills, food deserts, and cheap, convenient foods in abundant portions in grocery stores and restaurants. These contextual factors serve as constraints that impact an individual’s ability to prioritize health when shopping for food. Using the three paper dissertation format, this project will utilize a Constrained Choice Theory (CCT) framework to investigate sociodemographic trends in priorities in …

Assessment Of Quality Improvement In Ontario Public Health Units, Madelyn P. Law, J. Ross Graham, Erica Bridge

Frontiers in Public Health Services and Systems Research

Background: Quality Improvement (QI) approaches are used extensively in healthcare settings and increasingly in public health. However, the proliferation of QI in Canadian public health settings is unknown.

Purpose: The purpose of this study was to (a) assess the QI maturity in Ontario local public health units in Canada, and (b) to determine the relevance of the QI Maturity Tool in a Canadian setting

Methods: The QI Maturity Tool (Version 5) was used to conduct a cross-sectional assessment of the QI maturity of 36 local public health units in Ontario, Canada. After tool items were reviewed for relevance, individuals most …

Measuring Population Care Performance: Development Of The Population-Patient Satisfaction Survey For Use With Community Groups, Michele Issel, Christine Lurie, Betty Bekemeier

Frontiers in Public Health Services and Systems Research

Background: Assessing the satisfaction of the “population-patient” requires conceptualizing the dimensions of satisfaction differently from that of individual patients.

Purpose: The focus of this study was to develop and pilot test a short questionnaire that can reliably assess satisfaction with the care provided by public health nurses (PHNs) carrying out population-level activities in their communities.

Methods: An instrument-development approach was used. With input from five experts, items were developed to assess seven dimensions of population-patient satisfaction, and then refined before use in the community with a convenience sample of community participants recruited by PHNs in six counties across two states. …

Local Health Departments’ Costs Of Providing Environmental Health Services, Simone Singh, Nancy L. Winterbauer, Ashley Tucker, Lisa Macon Harrison

Frontiers in Public Health Services and Systems Research

Background: A detailed understanding of the costs that local health departments (LHDs) incur in the provision of public health services plays an important role in their efforts to provide services in an effective and efficient manner. However, surprisingly little evidence exists about the key cost components that LHDs incur in the provision of services.

Purpose: The purpose of this report was to provide empirical estimates of LHDs’ cost structure.

Methods: Using cost information for 2012 from 15 LHDs in North Carolina for two public health services—food and lodging and onsite water—this report first presents estimates of the total costs per …

Impact Of Organizational Networks On The Cost Of Core Services In Ohio’S Local Health Departments, Jason E. Orcena, Michael Petros, Patrick M. Bernet

Frontiers in Public Health Services and Systems Research

Introduction: Although several studies have linked population size to the cost of service delivery in local health departments, none have looked at the network position of the LHD. This study expands the understanding of how the position of an LHD in Ohio’s local health department network affects its expenditures in providing core, or nonclinical, services.

Methods: In 2014, 44% (55 of 124 eligible) of Ohio’s health officers responded to the PARTNER survey, a web-based network analysis program, with the analysis completed by the spring of 2015. Network data were then included in a regression analysis of the Core Plus-Scale model …

Measuring Changes In Local Surveillance And Investigation Capacity, Christine A. Bevc, Mary V. Davis, Anna P. Schenck

Frontiers in Public Health Services and Systems Research

Background: The outbreak of Ebola virus disease in West Africa and confirmation of the first cases in the United States highlight the need for robust and responsive public health surveillance system. With a 25% decline in funding since 2007, the impact on local surveillance capacities has not previously been described.

Purpose: The Surveillance & Investigation domain of the Local Health Department Preparedness Capacities Survey (PCAS) was reweighted to reflect the national profile of LHDs. Changes in subdomain performance of capacities and the effect of population size on subdomain capacity performance were examined over time.

Methods: Participating LHDs (n=208) …

Perceptions Of School And Health Department Emergency Preparedness Collaboration, Kaitlin A. O'Keefe, Katharine D. Arrington, Michael Prelip, Kimberley I. Shoaf

Frontiers in Public Health Services and Systems Research

Background: School systems often have the vital responsibility of protecting students during emergency situations. Collaborations with the local health department (LHD) can be invaluable in helping schools effectively fulfill this responsibility.

Purpose: An evaluation of existing organizational collaborations is needed to describe attitudes toward current efforts and to form recommendations for enhancing the effectiveness of future joint programs.

Methods: Questionnaires regarding perceptions of existing collaborations were distributed to a sample of LHDs and schools districts in spring and summer 2011. Participant responses from each organization were paired on jurisdictional area, forming 25 paired observations. Analyses were conducted in …

College Students’ Use Of Social Media To Communicate About Alcohol And Drinking Behaviors, Jenna E. Reno

Theses and Dissertations--Communication

Social networking sites (SNSs) are an increasingly popular channel for communication among college students. Often students disclose more freely via social networking sites than they would in other situations. These disclosures commonly include information about engaging in risky health behaviors (e.g., binge drinking). Study 1 examined students’ impression management goals and self-presentation tactics specifically related to self-disclosures of drinking behavior on SNSs. Findings suggest that students use differing self-presentation tactics across various SNSs in order to achieve their impression management goals and to avoid consequences associated with disclosing about risky health behaviors to certain audiences. Study 2 sought to develop …