Date of Award

Summer 8-2019

Degree Name

Doctor of Public Health (DrPH)



Second Advisor


Third Advisor



On January 2016, Texas State Department of Health Services (DSHS) Public Health Region 1 (PHR 1) conducted T-SPOT.TB tests in response to two requests to screen dairy workers potentially exposed to cattle infected with Mycobacterium bovis or bovine tuberculosis (bTB) in Bailey County, Texas. Out of 140 workers tested, 14 had confirmed latent tuberculosis infection (LTBI)—prevalence of 10.0%. This first study gave rise to questions concerning tuberculosis (TB) knowledge and exposure history among dairy workers in this same county. The second study focused on determining TB knowledge among dairy workers through a series of questions administered by research personnel on iPad tablets. Category of cattle exposure was used as a proxy for exposure by categorizing job positions into high and medium/low groups. Overall, the average score was 7.1 (SD 4.9) out of 17 (41.8% out of 100.0%). Results indicated that there was no statistically significant difference between the mean TB knowledge score for the high group compared to the medium/low group (t =-1.9193, p =0.0562). This study found TB knowledge deficiencies at all quizzed measures: (1) TB characteristics, (2) TB transmission, (3) TB symptoms, (4) TB diagnosis, (5) TB treatment, and (6) bovine TB. The third study used questions obtained in the same survey to determine the history of TB among the same dairy workers. A large majority of workers (78.2%) reported having been vaccinated with the BCG vaccine as an infant. A total of 4/225 individuals identified having been diagnosed with active TB in the past. However, only 2/4 reported seeking TB treatment which was successfully finished. Future research should use TB knowledge deficiencies found to create, deliver, and evaluate a health and safety TB training for dairy workers. In addition, determining the need and feasibility of Total Worker Health ® fairs on dairy farms could contribute to closing the gap on TB history among dairy workers. This dissertation took a public health case to assess need, burden, and potential impact of TB interventions among dairy workers in Bailey County, Texas.