Medicine and Health Commons^™

The Rhetoric Of Responsibilization: A Rhetorical Analysis Of Pre-Exposure Prophylaxis Campaigns For Hiv Prevention, Catherine M. Pabalate

Kentucky Undergraduate Journal for the Health Humanities

Responsibilization refers to the process by which patients are made accountable for their health and wellbeing, which is determined by their habits and behaviors. Though responsibilization affords greater agency to patients, it can also result in anxiety and guilt when the patient appears "deviant" or "noncompliant." Because sexual behavior is attributed to the causality of HIV/AIDS, patients’ sexual patterns and choices are included within their medical decision-making. This rhetorical analysis focuses on pharmaceutical campaigns and commercials for pre-exposure prophylaxis (PrEP), which were released between 2012 and 2024 and are targeted towards patients at-risk for HIV/AIDS. Findings suggest that specific rhetorical …

Breaking Ground On Self-Efficacy: A Qualitative Exploration Of Intimate Partner Violence Survivors’ Experiences With Therapeutic Horticulture, Rachel Marie Reeves

Theses and Dissertations--Sociology

This dissertation explores how participation in a Therapeutic Horticulture program may support the self-efficacy of survivors of Intimate Partner Violence. Through a thematic analysis of interviews with 45 women living at a domestic violence shelter in Lexington, Kentucky, this study investigates whether and how gardening activities contributed to participants’ belief in their abilities to shape outcomes in their lives.

Findings are organized around Bandura’s four sources of self-efficacy: enactive mastery experiences, vicarious experience, verbal persuasion, and physiological/affective states. These insights contribute to feminist criminology and trauma-informed care literature by illuminating the transformative potential of nature-assisted healing programs.

Emplacing Deaths Of Despair Within The Rural Mortality Penalty: The Spatial Inequality Of Violent Death Across Rural America, Cameron A. Mcalister

Theses and Dissertations--Sociology

American life expectancy continues to diverge from most developed nations. Literature spanning several fields of scholarship has documented an uneven distribution of life expectancy between social groups and across geographic contexts. Frameworks such as “Deaths of Despair” and the rural mortality penalty describe the declining health trends among working class whites and rural America. But, conceptual development around these frameworks is still limited. This dissertation utilizes a rural sociological approach to bridging the gap between the Deaths of Despair framework and the rural mortality penalty by examining violent death patterns across diverse rural contexts. In doing so, I incorporate several …

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; …

The Seattle Amyotrophic Lateral Sclerosis (Als) Patient Project Database: Observational, Longitudinal, Dyadic Characterization Of People With Als And Their Partners, Suzanne C. Segerstrom, Edward J. Kasarskis

Neurology Faculty Publications

Introduction: The median survival time in ALS is approximately 3 years, but survival times range from less than a year to more than 10 years and much variance in disease course remains to be explained. As is true for physical outcomes, there is considerable variance in QOL, which is influenced by psychological health, coping, and social support, among other psychosocial factors. The Seattle ALS Patient Project Database (SALSPPD) provides a unique opportunity for researchers to address established and novel hypotheses about disease progression and QOL in ALS.

Methods: The SALSPPD is a longitudinal dataset of people with ALS (n = …

Voices Of Experience: Lay Perspectives On Severe Maternal Morbidity In Appalachia, Anna Hansen, Cassidy Carter, Nancy Schoenberg, Carrie B. Oser

UK CARES Faculty Publications

No abstract provided.

A Social Media–Delivered Melanoma Prevention Program For Young Women Engaged In Frequent Uv Tanning: Protocol For A Randomized Controlled Trial, Jerod L. Stapleton, Sharon L. Manne, Sherry L. Pagoto, Allison Leip, Kathryn Greene, Joel Hillhouse, Allison S. Merritt, Brent J. Shelton

UK CARES Faculty Publications

Background: Rates of melanoma have increased dramatically in the United States over the past 25 years, and it has become among the most prevalent cancers for young adult women. Intentional skin tanning leads to a pattern of intense and intermittent UV radiation exposure that is associated with increased risk of melanoma. Frequent tanning is most common among young women and is linked to a variety of sociocultural pressures that negatively impact body image and drive appearance control behaviors. Unfortunately, there are no established interventions designed for frequent tanners. This intervention addresses this gap with unique content informed by body image …

Building Sustainable Community-Academic Partnerships While Implementing A Nutrition-Based Blackberry Garden Program At A Senior Center, Dawn Brewer, Annie Koempel, Abbey L. Moellering, Tammy Stephenson, Amy Kostelic, Julie Plasencia, Alexis Sheffield, Ben Guerrant, Alethia Price

UK CARES Faculty Publications

Due to limited access to and low consumption of fruits and vege- tables, older adults are at increased risk of worsening or developing chronic diseases. This paper describes a community-academic partnership that provides a sustainable source of blackberries to attendees of a rural senior center. Qualitative research evaluated the partnership following implementation of a blackberry program. Focus groups and interviews included partners from a senior cen- ter, Cooperative Extension Service, and a detention center. Main themes: group power dynamics influenced communication between research and community leadership teams; unexpected project barriers emerged; and community leadership team sug- gested strategies to promote …

Recovery Capital In A Justice-Involved Population: An Asset-Based Approach To Recovery And Community Reentry, Evan Joseph Batty

Theses and Dissertations--Sociology

The burden of the opioid epidemic demands further efforts to facilitate recovery, particularly for disadvantaged populations and those recently released from prison. After community reentry, individuals face a period of vulnerability as they adjust to new roles and responsibilities to meet their basic needs. Prison-based substance use disorder treatment (SUD Tx) programs provide support to help prepare individuals with SUD for their release and facilitate successful recovery goals after community reentry. This dissertation has three aims: (1) further the understanding of potential barriers and facilitators of recovery after community reentry, (2) assess how prison-levels of recovery capital influence recovery outcomes …

Humor Matters: An Adapted Multiple Case Study Exploring Music Therapists’ Perspectives Of Humor With Older Adults, Caleb M. Posey

Theses and Dissertations--Music

Humor is a ubiquitous human experience and a skill retained in older adulthood. It is also an integral but elusive therapeutic tool with numerous benefits and risks to well-being. Therapeutic humor – the application of humor to client well-being – is an emerging area of study. However, scant music therapy literature on humor is available. The purpose of this qualitative thesis was to explore the use and function of humor in music therapy with older adults from the perspectives of experienced music therapists. There were three research questions: (1) how do music therapists describe their use of humor with older …

Insights From Obstetric Providers And Emergency Medical Technicians On Determinants Of Maternal Morbidity And Mortality Among Underserved, Rural Patients In The United States, Anna Hansen, Nancy Schoenberg, Carrie B. Oser

UK CARES Faculty Publications

Over the past two decades, individuals in the United States (US) have faced a steadily increasing risk of experiencing severe morbidities attributable to pregnancy and dying from pregnancy-related causes. The prevalence of severe maternal morbidity (SMM), defined as the occurrence of end-organ damage in the mother encompassing unexpected outcomes of labor and delivery, has nearly tripled since the turn of the 21st century (Creanga et al., 2014; Neggers, 2016). The prevalence of pregnancy related mortality (PRM), defined as the death of a woman during or within one year of pregnancy due to pregnancy-related complications or aggravated preexisting conditions, has nearly …

Making Home: The Role Of Social Networks On Identity, Health, And Quality Of Life Among Rural Lesbian And Gay Older Adults, Marc A. Guest, Elizabeth G. Hunter, Nancy E. Schoenberg

UK CARES Faculty Publications

Background and Objectives: Gay and lesbian older persons face a host of health inequalities related to their identity as they age. Challenges to health access and appropriate social support may be even more exacerbated for those living in rural environments; this may be due to the lack of supportive and affirming social connections. This project aimed to explore and describe the social networks and the relationship of these social networks to identity, health, and quality of life of gay and lesbian individuals in rural communities.

Research Design and Methods: Social network data on network type, size, and social capital were …

The Last Of Us In Therapy: How Mind-Controlling Fungi And Gut Bacteria Affect Your Mental Health, Anastasia Lyon

Journal of Pharmacology & Nutritional Sciences

The "psilocybiome" represents the mutually beneficial relationship between ourselves, our bacteria, and psychedelic drugs. This short review briefly discusses the benefits and limitations surrounding the potential for psychedelic therapy to synergize with gut bacteria to help regulate and maintain proper balance in the immune system, diet, and stress levels. Psychedelic therapy is a novel treatment strategy that has the potential to improve patient mental health, and, by identifying the types of gut bacteria present in patients, it can aid in personalizing medicine by determining how well their "psilocybiome" may respond.

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 …

Parenthood, Mental Health, And Intergenerational Adversity: Exploring Gender Role Ideologies, Household Composition And Work-Family Conflict, Ashley Vowels

Theses and Dissertations--Sociology

To date, research at the intersections of parenting, stress, gender, and mental health has yielded complicated and inconsistent results. The objective of this dissertation was to deepen our understanding of how parenting stress contributes to the mental health of both parents and their children, especially within the context of balancing work and family responsibilities. A three-study approach was used to assess differences by sex, gender role ideology, and household composition. Additionally, it explored the impact of parents’ characteristics on their children’s well-being in adulthood.

This project utilized secondary data from the Panel Study of Income Dynamics (PSID). Multivariate regression analyses …

Social And Biological Determinants Of Pregnancy-Related Mortality And Morbidity In A Rural, Underserved Population, Anna Hansen

Theses and Dissertations--Sociology

Cases of severe maternal morbidity (SMM) and pregnancy-related mortality (PRM) are increasing in the US. Research concerning SMM and PRM has neglected women in Central Appalachia; a largely rural, health-disparate population. The aims of this study are two-fold: (1) Examine patient-level and place-based predictors of SMM/PRM via hierarchical logistic regression modeling, and (2) Elucidate Appalachian healthcare patients’ and providers’ experiences with SMM/PRM, perceptions of contributing factors, and insights on points of intervention.

This study uses a mixed methods approach guided by the WHO’s conceptual framework for action on social determinants of health to identify determinants of SMM and PRM among …

An Examination Of Three Transitional Events In The Substance Misuse Trajectories Of Women With Criminal Legal System Involvement, Martha Tillson

Theses and Dissertations--Sociology

Research has consistently demonstrated that criminal legal system (CLS)-involved women are distinct from men in initiation and course of drug use, with important differences on biological, environmental, and sociocultural levels. Thus, the unique pathways and transitions into and out of drug use for women with CLS involvement are critical to consider from a research perspective, but also from a need to develop and support evidence-based, women-centered services in correctional contexts. This dissertation project uses a three-paper format to investigate three aims: (1) to understand CLS-involved women’s initiations to injection drug use and their experiences providing injection initiation assistance (IIA) to …

Examining Food Security, Choices And Barriers Among Community Supported Agriculture Participants During Covid- 19 In Kentucky, Martha J. Biddle, Junghee Kang, Julie Derringer, Anna Rose, Dawn Brewer, Misook L. Chung, Terry A. Lennie, Gia Mudd-Martin, Timothy A. Woods

UK CARES Faculty Publications

The coronavirus disease (COVID-19) pandemic is challenging food security. Our study’s purpose was to examine relationships among food security status, eating patterns and perceived barriers to food choices among shareholders (N = 209) in a Community Supported Agriculture (CSA) program during stay- at-home restrictions due to the pandemic. The food insecure group (n = 33) reported lower consumption of fruits/vegetables, whole grains and greater consumption of fast foods and more barriers to food choices compared to the food secure group (p < .05). A low food insecure proportion (16%) among the CSA participants suggests a potential role of a CSA program to prevent food insecurity.

Addressing Diabetes Distress In Self-Management Programs: Results Of A Randomized Feasibility Study, Ranjita Misra, Samantha Shawley-Brzoska, Raihan Khan, Brenna O. Kirk, Sijin Wen, Usha Sambamoorthi

Journal of Appalachian Health

Background: West Virginia ranks 1st nationally in the prevalence of hypertension (HTN; 43.8%) and diabetes (16.2%). Patients with type 2 diabetes mellitus (T2DM) are distressed over physical and psychological burden of disease self-management.

Methods: This study investigated the effectiveness of an intervention to reduce diabetes distress and outcomes [glycemic control, blood pressure (BP)] among T2DM adults with comorbid HTN. Participants were randomized to a 12-week diabetes and hypertension self-management program versus a 3-month wait-listed control group. Trained health coaches and experts implemented the lifestyle program in a faith-based setting using an adapted evidence-based curriculum. Twenty adults with T2DM and HTN …

Rural Re-Entry And Opioid Use: Identifying Health-Related Predictors Of Relapse Among Formerly Incarcerated Women In Appalachia, Joseph M. Calvert, Megan F. Dickson, Martha Tillson, Erika Pike, Michele Staton

Journal of Appalachian Health

Introduction: Despite improved knowledge of the health care needs of formerly incarcerated women, there exists a gap regarding the relationship between health, health care access, and relapse among rural women returning to the community during the opioid epidemic.

Purpose: With an emphasis on health care access, this study examined health-related factors associated with opioid relapse among women reentering the community in rural Appalachia.

Methods: As part of a larger study, 400 rural women reporting a history of substance use were recruited from three Appalachian jails in Kentucky. Analyses focused on participants reporting a history of illicit opioid use prior to …

Other People’S Families: How Social Ties Shape Entrance Into The Medical Profession, Lillian Sims

Theses and Dissertations--Educational Policy Studies and Evaluation

Not enough members of low-income, rural, and minoritized populations are successfully prepared for and recruited into medical school, exacerbating issues of unequal access to healthcare and limiting access to the profession. While a multitude of factors contribute to this problem, early social exposure to others in a field can act as a key contributor to career interest and a key advantage for entering the profession. Meanwhile, students without early social exposure to healthcare may take unconventional paths to medical school or may struggle to fit into the unique culture of medicine when they do enter training, especially if they belong …

A Population-Based Investigation Of Health-Care Needs And Preferences In American Adults With Multiple Sclerosis, Chungyi Chiu, Malachy Bishop, Bradley Mcdaniels, Byung-Jin Kim, Lebogang Tiro

Early Childhood, Special Education, and Counselor Education Faculty Publications

Background: Comprehensive and effective multiple sclerosis (MS) health care requires understanding of patients’ needs, preferences, and priorities. Objective: To evaluate priorities of patients with MS for their MS care. Methods: Participants included 3003 Americans with MS recruited through the National MS Society and the North American Research Committee on Multiple Sclerosis patient registry. Participants completed a comprehensive questionnaire on aspects of their health-care experiences. Results: Participants identified the top 3 health-care priorities as (1) the affordability of MS health care, (2) ensuring that non-MS health-care providers have more education about MS and how it can interact with other conditions, and …

Is Secondhand Discrimination Harmful For The Mental Health Of Black Americans? Findings From A Community Epidemiological Study, Myles Moody

Theses and Dissertations--Sociology

In recent years, there has been a growing concern about not only the deleterious health effects of direct experiences of racism, but also how individuals are affected by others’ experiences of racism. It has been firmly established that direct exposure to discrimination can negatively impact the mental health of Black Americans and other minorities. But there is a dearth of empirical evidence that may answer the question of how indirect experiences of racism affects health. The purpose of this study is threefold: 1) to examine the social distribution of personal and vicarious experiences of discrimination among Black adults, 2) to …

Gay Men And Satisfaction With Health Care Interactions, Michael Huggins

Theses and Dissertations--Nursing

The purpose of this research was to determine relationships among depression, anxiety, self-rated physical and mental health, self-advocacy, internalized homophobia, and quality of patient-provider communication to satisfaction with health care interactions. These were measured while controlling for select demographic variables: age; ethnicity; urban or rural domicile; relationship status; household income; highest educational attainment; health insurance; disclosure to health care provider as a gay man; reason for last healthcare visit; and, general health self-rating. The specific aims of this study were to: 1) identify general characteristics of gay men in this sample; 2) examine how levels of satisfaction with health care …

Maternal Relationships, Bullying, And Deviance: A Comparison Of Adolescents With And Without Medical Conditions, Kristina M. Hayes

Theses and Dissertations--Family Sciences

The purpose of the current study was to examine and compare the quality of the mother-adolescent relationship, the prevalence of bullying and cyberbullying perpetration and victimization, and the prevalence of externalizing behaviors, as well as the relationship among these constructs, in a clinical and a nonclinical sample of adolescents. It tested a series of hypotheses focused on group differences in the mother-adolescent relationship, peer victimization, and externalizing behaviors (i.e. deviant behaviors and bullying perpetration) for the clinical and nonclinical samples. It also tested the relationships between the mother-adolescent relationship and peer victimization, deviant behaviors, and bullying perpetration, and whether these …

Consuming Appalachia: An Archaeology Of Company Coal Towns, Zada Komara

Theses and Dissertations--Anthropology

Material culture is an understudied aspect of social life in Appalachian Studies, the multi- disciplinary investigation of social life in the Appalachian region. Historically, material culture in the region has been largely studied for its semiotic properties, decoded as a tangible symbol of “a region apart,” lagging behind the rest of America in terms of moral, mental, economic, and social development. Critical material studies from archaeology and other disciplines paint a different picture, however, and construct a region as American as any other. This study utilizes discourse analysis of material rhetoric about Appalachia and archaeological and oral historical data from …

Clinician Identified Barriers To Treatment For Individuals In Appalachia With Opioid Use Disorder Following Release From Prison: A Social Ecological Approach, Amanda M. Bunting, Carrie B. Oser, Michele Staton, Katherine S. Eddens, Hannah K. Knudsen

Sociology Faculty Publications

Background: The non-medical use of opioids has reached epidemic levels nationwide, and rural areas have been particularly affected by increasing rates of overdose mortality as well as increases in the prison population. Individuals with opioid use disorder (OUD) are at increased risk for relapse and overdose upon reentry to the community due to decreased tolerance during incarceration. It is crucial to identify barriers to substance use disorder treatment post-release from prison because treatment can be particularly difficult to access in resource-limited rural Appalachia.

Methods: A social ecological framework was utilized to examine barriers to community-based substance use treatment among individuals …

Measuring Women's Empowerment In Sub-Saharan Africa: Exploratory And Confirmatory Factor Analyses Of The Demographic And Health Surveys, Ibitola O. Asaolu, Halimatou Alaofè, Jayleen K. L. Gunn, Akosua K. Adu, Amanda J. Monroy, John E. Ehiri, Mary H. Hayden, Kacey C. Ernst

Epidemiology and Environmental Health Faculty Publications

Background: Women's status and empowerment influence health, nutrition, and socioeconomic status of women and their children. Despite its benefits, however, research on women's empowerment in Sub-Saharan Africa (SSA) is limited in scope and geography. Empowerment is variably defined and data for comparison across regions is often limited. The objective of the current study was to identify domains of empowerment from a widely available data source, Demographic and Health Surveys, across multiple regions in SSA.

Methods: Demographic and Health Surveys from nineteen countries representing four African regions were used for the analysis. A total of 26 indicators across different dimensions (economic, …

Disadvantaged Status And Health Matters Networks Among Low-Income African American Women, Erin Pullen, Carrie B. Oser

Sociology Faculty Publications

A significant gap in current network research relates to understanding the factors that shape the health matters (HM) networks of marginalized, socially disadvantaged populations. This is noteworthy, given that these networks represent a critical resource for mitigating the adverse health effects of both acute and chronic strains associated with marginalized status. Further, research has suggested that the networks of such populations—especially low-income African American women—are unique, and may operate in substantively different ways than those of other groups. Using two waves of data from a sample of low-income African American women, this research identifies the demographic, health status, and health …

The “Weight” Of Socio-Economic Status, Race/Ethnicity, And Gender: A Systematic Examination Of Obesity And Its Co-Morbidities, Gabriele Ciciurkaite

Theses and Dissertations--Sociology

Although extensive research exists on the association between SES and obesity and its patterning across separate gender and racial/ethnic groups, critical gaps remain. In particular, the majority of studies on the SES-BMI association have examined it in additive models without simultaneously considering the influence of gender and race/ethnicity. An additional limitation of the current obesity scholarship concerns the lack of scholarship addressing the interplay between social factors, such as SES, race/ethnicity, gender, and proximate health risk factors, such as BMI, in shaping obesity-related chronic health outcomes, especially considering that health outcomes may vary in the extent to which they may …