Digital Commons Network^™

Geographic Variation In Adrd Prevalence And Mortality And Their Association With Social Vulnerability Across Us Counties: A Spatial Epidemiological Analysis Using Norc And Cdc Svi Data, Dean Kyne

Sociology Faculty Publications

Introduction: Geographic disparities in Alzheimer’s disease and related dementias (ADRDs) remain insufficiently understood at the national scale, limiting efforts to address inequities in dementia burden across USA communities. This study examined county-level variation in ADRD prevalence and mortality and evaluates the association between social vulnerability and these outcomes.

Methods: This cross-sectional ecological study analyzes 2020 county-level ADRD prevalence and all-cause mortality among Medicare beneficiaries from the NORC Dementia DataHub. The analytic sample included 3,108 USA counties in the contiguous USA and the District of Columbia. ADRD outcomes included (1) prevalence of highly likely ADRD and (2) prevalence of all determinations, …

Space-Time Analysis Of Burgeoning Us Atrial Septal Defect Rates Driven By Cannabis, Albert Stuart Reece, Kenneth Hulse

Research outputs 2022 to 2026

Atrial septal defect (ASD) has become increasingly common in the USA and now affects 1 in 11.3 children in some places, but space–time analysis has not been applied to this emerging trend. ASD rate (ASDR) data were obtained from the National Birth Defects Prevention Network 2003–2020. Substance (cigarettes, alcohol, cannabis, analgesics, cocaine) use data were obtained from the National Survey of Drug Use and Health. Income data were obtained from the US Census. Analysis was limited to the Non-Hispanic White population by technical factors. Time-sequential univariate and bivariate maps were prepared for both covariates and outcomes and their combinations. Spatial …

Impact Of Cannabis And Cannabis Legalization On Us Atrial Septal Defect Rates, Albert Stuart Reece, Hulse

Research outputs 2022 to 2026

Atrial septal defect (ASD) affects 1:11.3 children in some US states; however, the antecedents of these trends are yet to be identified. A total of 1882 ASD rates (ASDRs) for 2003–2020 were sourced from the National Birth Defects Prevention Network reports. A total of 406,893 ASDs are reported. Substance (cigarettes, binge alcohol, cannabis, cannabinoids, analgesics, cocaine) exposure data were taken from the National Survey of Drug Use and Health. Income and ethnicity data were derived from the US Census. Adjustment was performed by mixed effects, survey and generalized additive regression. Causal analysis was by inverse probability weighting and E-values. Data …

Resuscitating Rapid Response And Code Blue Education, Danielle Fogel

Providence Nursing Research Conference 2023 – Present

No abstract provided.

Quality Of Prenatal Care, Provider Preference, And Preeclampsia Among African American Women In Georgia, Lyteasha Bass

Walden Dissertations and Doctoral Studies

African American women experience disproportionately high rates of preeclampsia in the United States; however, the contributions of prenatal care provider type, health care access, and quality of care to this disparity were insufficiently defined. Guided by the quality health outcomes model, this quantitative case-control study used primary data to examine associations between these factors and the occurrence of preeclampsia among African American women age 18–40 who had given birth within the previous 5 years in Georgia. Descriptive statistics and binary and multinomial logistic regression analyses were conducted. Prenatal care quality was measured using the Quality of Prenatal Care Questionnaire (QPCQ), …

Multilevel Analysis Of The Food And Physical Activity Environment And Adult Obesity Across U.S. Counties And States, Ann Mary Abraham, Michael D Swartz, Alexandra E Van Den Berg, Stephen H Linder

Faculty, Staff and Student Publications

Adult obesity rates have risen steadily across the United States over the past decade, with more than 40% of adults affected. Persistent geographic and demographic disparities exist in obesity prevalence across the nation. While prior research has examined individual or environmental associated factors of obesity, limited studies have addressed both physical activity and food environments across the nation using multilevel approaches. This cross-sectional ecological study (2014-2024) used a two-level random intercept model to assess the association between county- and state-level factors and adult obesity prevalence across over 3000 U.S. counties nested within 51 states. County-level associated factors included food insecurity, …

Policy, Misinformation, And Mortality: The Effects Of Abortion Restrictions On Maternal Outcomes, Gabrielle Samiratedu Dmsc, Mcms, Pa-C

Lynchburg Journal of Medical Science

The objective of this review is to evaluate the effects of restrictive abortion laws on maternal mortality and morbidity in the United States. Even before the landmark reversal of Roe v. Wade, the US had one of the highest maternal mortality rates among other high-income countries, and rates are expected to continue to rise in states with restrictive abortion policies. Electronic databases and public health data were analyzed to assess clinical outcomes, access to care, and disparities associated with abortion restrictions nationally and internationally. The findings suggest that states with highly restrictive abortion policies experience higher rates of maternal morbidity …

Epinephrine In Cardiac Arrest: Is It Enough?, Zachary Gusler

The PA Department Journal of Medical Science

Introduction: Epinephrine has long been the clinical mainstay of pharmacologic treatment for cardiac arrest management. It provides both α- and β-adrenergic receptor activation. However, at higher dosages, it may lead to sympathetic overload, oxidative stress, and cardiac myocyte apoptosis. The purpose of this paper is to evaluate the rates of ROSC (return of spontaneous circulation) with in-hospital cardiac arrest between epinephrine monotherapy and VSE (vasopressin, steroid, and epinephrine).

Methods: A search via PubMed database using the keywords “Cardiac arrest” AND “VSE” AND “Vasopressor monotherapy” with additional specifiers resulted in 30 articles. 26 articles were removed due to study type and …

Meta-Analysis: Diabetes Mellitus And The Risk Of Endometrial Cancer, Tricia Ho, Marika Ongpauco, Han Ha Ngoc Nguyen

Physician Assistant Studies | Graduate Research Papers

Background: Many studies have looked at the relationship between diabetes mellitus and development of endometrial cancer. This study provides an updated systematic review and meta-analysis of the estimated effect of diabetes and the risk of endometrial cancer.

Methods: Some studies were found on databases such as PubMed and Iceberg. The remaining studies were extracted from the initial studies found. Binary data was collected and the raw data was imputed into a Fixed Effects Model.

Results: A total of 25 studies were included in this meta-analysis, generating statistically significant results (p < 0.001, OR 2.05, 95% Cl 1.92-2.19).

Discussion: Diabetes is found to be …

Bayesian Multivariate Modelling Of Lone Star (Amblyomma Americanum) Tick Life Stage Abundance And Temporal Trends To Inform Public Health Risk In Virginia, Thabo Lephoto, Henry Mwambi, Oliver Bodhlyera, Holly Gaff

Biological Sciences Faculty Publications

The increasing abundance of ticks poses a growing public health concern due to heightened human exposure to tick bites. The lone star tick (Amblyomma americanum: Ixodida: Ixodidae), a common human-biting species in the United States, has expanded its range in recent years. However, how its different life stages vary across time, habitats, and locations remains insufficiently understood. We analyzed tick abundance data collected in southeastern Virginia between 2009 and 2018, focusing on larval, nymphal, and adult life stages. A Bayesian multivariate modelling framework was used to examine seasonal patterns, habitat effects, spatial variation, and biological links between life stages. Two …

The Impact Of Food Insecurity And Associated Variables On Colon Cancer In Kentucky: An Ecologic Study, Claire E. Lynch

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

Objective: Given colorectal cancer incidence rates are increasing, especially in socioeconomic disadvantaged areas, this study aims to determine if there is an association between specific socioeconomic variables, such as food insecurity, and colon cancer at the county-level in Kentucky.

Methods: Colorectal cancer age-adjusted incidence rates at the county-level were collected from the Kentucky Cancer Registry. Conty-level data was collected from County Health Ranking, The U.S Census Bureau, National Institute on Minority Health and Health Disparities and the Behavioral Risk Factor Surveillance System from 2019 to 2023. R was used to run statical analyses such as a linear regression and a …

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 …

Occupational Exposure To Pesticides Increases The Risk Of Amyotrophyc Lateral Sclerosis: A Systematic Review And Meta-Analysis, France Labrèche, Pamela Prudhomme, Maryse Gagnon, Nicolas Dupré, Sabrina Gravel

Études primaires

Objective To systematically review the evidence on the association between occupational exposure to pesticides and the risk of amyotrophic lateral sclerosis (ALS).

Methods A systematic search, conducted in eight bibliographic databases for publications between 1990 and 2025, identified observational studies estimating the risk of ALS after occupational pesticide exposure. Study quality was assessed using the WHO Risk of Bias (RoB) assessment instrument for systematic reviews, with the ROBINS-E (RoB in non-randomised studies of exposure) tool domains of bias. Pooled risk estimates were produced using random-effects models with restricted maximum likelihood, heterogeneity was assessed with I² statistics, and meta-regressions and publication …

Place Matters: Investigating The Social And Environmental Drivers Of Hypertension In Nashville, Marquinta Harvey, Michael D. Oliver, Tatum Brown, Deya Rassul, Thomas Strickler, Jarod Parrish, Catherine Bass

Funded Scholarship

Hypertension disparities persist across communities, driven by interactions between social determinants of health (SDOH) and behavioral factors. This study examines geographic and demographic patterns of hypertension in Nashville, Tennessee, to assess how socioeconomic, environmental, and behavioral factors contribute to inequities in prevalence, treatment, and control. Granular ZIP code-level analyses highlight community-specific drivers and the need for policy reforms to advance health equity.

Understanding The Syphilis Resurgence Among Females Of Childbearing Age: Informing Prevention Efforts In New York State, Salvatore Currenti

Electronic Theses & Dissertations (2024 - present)

Syphilis is caused by Treponema pallidum and transmitted through direct contact with infected mucosal lesions and via vertical transmission during pregnancy (i.e., congenital). Transmission of syphilis to an infant during pregnancy (i.e., congenital syphilis [CS]) can lead to early fetal death, stillbirth, neonatal death, preterm birth, low birthweight, and congenital infection in infants. The United States (U.S.) is experiencing epidemic increases in both females of reproductive age with syphilis and infants with CS. In New York State (NYS), these trends have also occurred, especially after COVID-19 emergence, and increases in reported cases and incidence rates are comparable to national statistics. …

Antiviral Activity And Mucosal Safety Of Novel Human-Milk-Inspired Antimicrobial Peptides, Nazita Yousefieh, Louise A. Ouattara, Maimoona Bhutta, Ishita M. Shah, Carolina Herrera, Gustavo F. Doncel

CONRAD Publications

Background: Sexually transmitted infections (STIs) remain a major global health concern, with over one million new curable cases reported daily and limited long-term treatment options. Additionally, there are limited treatment options for women with bacterial vaginosis (BV), a dysbiotic condition predisposing them to STIs. Computationally designed human-milk-inspired antimicrobial peptides (AMPs) are promising candidates for novel antiviral and antibacterial therapies. This study evaluated the cervicovaginal mucosal safety and antiviral activity of three human-milk-inspired AMPs (MAT-006, UCD-MAT-001, and UCD-MAT-002) previously shown to exhibit antimicrobial activity against BV-causing pathogens. Methods: AMP cytotoxicity and inflammatory responses were assessed in relevant genital tract cell lines …

Prenatal Exposure To Nicotine And Postpartum Depression: A Systematic Review And Meta-Analysis, Reem Sharaf-Alddin, May Salama, Denise Mckinney, George Saade, Qi Zhang

Health Behavior, Policy & Management Faculty Publications

Purpose: Postpartum Depression (PPD) is the most common mental health complication of childbirth, and has short-term and long-term consequences for mother, child, and the entire family. PPD is a function of several factors. Prenatal exposure to nicotine (PEN) by Active Tobacco Smoking (ATS), Secondhand Smoking (SHS), or Electronic Nicotine Products (ENPs) is a major potential risk factor. This systematic review and meta-analysis aim to summarize and evaluate all evidence regarding the association between PEN and PPD.

Methods: We searched the following databases, PubMed, Medline, Cochrane, EMBASE, and CINHAL, for studies published between Jan.1st ,2000&Sep.19th ,2024, with the outcome PPD. Studies …

The Effects Of Physical Activity Timing And Adherence To Physical Activity Guidelines On Sleep In Children With Adhd, Xiao Liang, Mengping Zhao, Li Su, Justin A. Haegele, Richard H. Xu, Jingjing Li, Andy Choi-Yeung Tse, Shirley X. Li

Human Movement Studies & Special Education Faculty Publications

Regular physical activity (PA) has been shown to benefit sleep. However, the effects of PA timing and adherence to the WHO's recommended 60-min moderate-to-vigorous physical activity (MVPA) guideline on sleep are unclear, especially for children with ADHD who often experience sleep problems. This study examined whether timing of MVPA influenced objectively measured sleep, including sleep latency (SL), sleep efficiency (SE), total sleep time (TST), and wake after sleep onset (WASO), among children with ADHD. This cross-sectional study involved 253 children with ADHD (Mage = 8.60 ± 1.31 years, 81% boys). MVPA timing was categorized as more than 8 h before …

The Role Of Climate And Population Density In The Spread Of Dengue Fever: A Spatial Analysis Of Padang City 2022–2024, Nailul Hikmi, Aria Gusti

Preventia: The Indonesian Journal of Public Health

In 2023, Padang city had a dengue fever incidence rate of 46.5 per 100,000 population, an increase compared to the previous year. Climate change, with the transition from the dry to the rainy season, contributed to a surge in dengue fever cases. This study aims to determine the relationship between environmental factors and the incidence of dengue fever in Padang City from 2022 to 2024. This study uses an ecological study design with a sample of all dengue fever cases recorded by the Padang City Health Office. Climate data was obtained from the Indonesian Agency for Meteorological, Climatological, and Geophysical …

Analisis Spasial Sebaran Kejadian Diare Berdasarkan Faktor Iklim Di Kota Batam Tahun 2020-2023, Syofetim Esther Novi Triyanti

Jurnal Nasional Kesehatan Lingkungan Global

Diarrhea is the leading cause of morbidity in coastal regions. Batam City is highly vulnerable to climate change. This study aims to analyze the relationship between rainfall, air humidity, population density, safe drinking water facilities, and access to latrines with the incidence of diarrhea and the spatial distribution based on climate factors in Batam City from 2020 to 2023. The study used an ecological study design with subdistricts as the unit of analysis. Aggregate secondary data were obtained from the Batam City Public Health Office, Statistics Indonesia (BPS) Batam City, and NASA POWER. The analysis of the data included univariate …

Hubungan Faktor Iklim, Faktor Polutan Dan Faktor Sosioekonomi Terhadap Proporsi Pneumonia Balita Provinsi Dki Jakarta Tahun 2013 – 2022, Fayza Chairunnisa Permana, Zakianis Zakianis, Laila Fitria, Erni Pelita Fitratunnisa

Jurnal Nasional Kesehatan Lingkungan Global

In 2022, the Province of DKI Jakarta ranked fourth with the highest coverage of pneumonia in toddlers (53.2%), exceeding Indonesia's toddler pneumonia coverage (38.78%). Pneumonia is influenced by various risk factors, including environmental factors such as climate and weather conditions as well as air pollution, and social and behavioral factors such as toddler characteristics, parental socioeconomic status, and access to health care services. This study aimed to analyze the relationship between climate factors (air temperature, relative humidity, rainfall, and air pressure), pollutant factors (PM₁₀, SO₂, CO, O₃, NO₂), and parents' socioeconomic …

Hubungan Ruang Terbuka Hijau Dengan Prevalensi Diabetes Melitus Di Provinsi Dki Jakarta Tahun 2022, Nurcholiza Hayati, Zakianis Zakianis, Al Asyary, Yulia Fitria Ningrum

Jurnal Nasional Kesehatan Lingkungan Global

Background: Diabetes Mellitus is a metabolic disease characterized by high blood sugar levels. According to Riskesdas (2018), Jakarta has the highest prevalence rate at 2.6%. Objective: To analyze the relationship between green open spaces, socio-economic factors, demographics, and physically active residents with the prevalence of diabetes mellitus. Method: An ecological study design with the unit of analysis is districts and the population consisting of 44 districts in DKI Jakarta Province in 2022. The dependent variable is the prevalence of diabetes mellitus, and the independent variables include education, employment status, population density, gender, age, physically active residents, the area of green …

Geospatial Analysis Of Breast Cancer Incidence, Mortality, And Access To Screening In Rural And Appalachian Virginia, Jennifer Osher, Caleb Brown, Phillip Nichols, Tariq Ayubi, Jeremy Powers

Journal of Appalachian Health

Introduction: Breast cancer is the most common malignancy among women in the United States (U.S.), despite recent survival rates improving nationally. However, rural and Appalachian regions have experienced slower mortality declines. These communities face unique health care-related challenges that may contribute to observed disparities.

Purpose: The purpose of this study is to assess differences in breast cancer incidence, mortality, and mortality-to-incidence ratio (MIR) between Appalachian and non-Appalachian counties, as well as rural and non-rural counties in Virginia (VA). Furthermore, we aim to evaluate whether availability of mammography is associated with these differences.

Methods: County-level breast cancer incidence and mortality data …

Risk For Infant Mortality Among Childbearing Women In Alabama, Michael Rutalira Koko

Journal of Public Health in the Deep South

Background: Infant mortality is an important indicator of the health of a population. From 2016 to 2020, the infant mortality rate in Alabama significantly decreased. However, disparities remain among different groups. The objective of this analysis is to evaluate risk factors and disparities of infant mortality for the past five years.

Methods: We used the Alabama Center for Health Statistics database, a population-based state vital records registry. We included 290,832 births to women aged 15 to 44 years linked to 1,575 infant deaths from 2016 to 2020. We excluded births at less than 20 weeks of gestation and weighing 500 …

Endocrine-Disrupting Chemicals And Thyroid Cancer, Özge Baş Aksu, Mustafa Şahi̇n

Turkish Journal of Medical Sciences

Environmental endocrine-disrupting chemicals (EDCs) have emerged as a critical global health concern because of their role in various diseases, including thyroid cancer. Defined as exogenous substances that disrupt endocrine system functions, EDCs can affect multiple generations through mechanisms such as hormone receptor modulation, altered hormone synthesis, and epigenetic modifications.The increasing global incidence of thyroid cancer has heightened interest in environmental factors, with EDC exposure recognized as a significant contributor. Compounds such as heavy metals, persistent organic pollutants, per- and polyfluoroalkyl substances, and bisphenol A play crucial roles in disrupting thyroid homeostasis. Emerging evidence underscores the synergistic effects of multiple EDC …

Mapping Climatic And Environmental Determinants Of Parasitic Helminth Prevalence In Southeast Asia, Angelica Avisado

UNLV Theses, Dissertations, Professional Papers, and Capstones

Climate change is reshaping environmental conditions across Southeast Asia (SEA) through rising temperatures, altered precipitation patterns, and increased droughts. These changes alter transmission dynamics of neglected tropical diseases (NTDs) by shifting spatial distribution, increasing larval development rates, faster pathogen growth development, and increasing transmission rates. NTDs are a group of preventable and treatable infections that disproportionately affect more than 1 billion people globally, specifically in tropical and subtropical regions. A subgroup of NTDs, parasitic helminth infections (PHIs) - particularly schistosomiasis, soil-transmitted helminths, and lymphatic filariasis remains a public health concern in the Southeast Asian region. PHIs and their ecological responses …

The Relationship Between Religious Attitude And Breastfeeding Attitude: A Cross-Sectional Study From Türkiye, Melike Yavaş Çelik, Cuma Tunçkaşık

Makara Journal of Health Research

Background: This study aimed to evaluate the relationship between religious attitudes and breastfeeding attitudes and the effect of this relationship on breastfeeding practices.

Methods: This study was conducted with 203 mothers with babies aged 0–24 months. Simple random sampling was used in sample selection. The Religious Attitude Scale and Breastfeeding Attitudes of the Evaluation Scale were used in data collection.

Results: A significant relationship was found between religious attitudes and breastfeeding attitudes. Additionally, mothers' negative breastfeeding attitudes and positive breastfeeding attitudes were found to be close to each other. The time it took for mothers to start breastfeeding their …

White Nose Syndrome In Bats And Infant Mortality In Georgia, Rhys Medcalfe, Sean Medcalfe, Simon Medcalfe

Journal of the Georgia Public Health Association

Background: White nose syndrome (WNS) is a disease in bats caused by the fungus Pseudogymnoascus destructans that can result in bat mortality rates of over 90%. WNS was discovered in Georgia in 2012 in 3 counties but has continued to spread to 14 counties as of 2023, with P. destructans detected in a further seven. Biodiversity loss has been linked to human health outcomes including infant mortality. Understanding the link between WNS, biodiversity loss, and infant mortality in Georgia is important because Georgia ranks 42^nd out of the 50 states for infant mortality rate.

Methods: Using panel data from …

The Role Of Fast-Food Consumption, Residential Fast-Food Exposures, And Urinary Essential Trace Heavy Metals In Colorectal Cancer (Crc) Outcomes., Jeevan Adhikari

Electronic Theses and Dissertations

Background: Colorectal cancer (CRC) is a public health concern. Within the United States (US), fast-food consumption and environmental exposure to heavy metals have increased. The impact of fast-food consumption frequency from fast-food restaurants, residential fast-food exposures, and urinary essential trace heavy metals in relation to CRC outcomes have not yet been rigorously evaluated in the US. Methods: Within the LEAPS-CRC study, we used geographic information systems (GIS) and logistic regression to study the association of fast-food consumption, residential proximity to a fast-food outlet, and urinary essential trace metals with CRC incidence. Additionally, within Kentucky Cancer Registry (KCR) CRC cases, the …

Social Determinants Of Health Patterns In Children With Severe Disease Due To Sars-Cov-2 Infection-An Exploratory Approach, Joshua Prabhu, Sebastian Acosta, Fabio Savorgnan, Ananth V Annapragada, Usha Sethuraman

Faculty, Staff and Students Publications

Background/Objectives: Research on the association of adverse social determinants of health (SDOH) with severe pediatric coronavirus disease (COVID-19) is limited. We examined associations between SDOH patterns and COVID-19 severity in children.

Methods: We conducted a prospective, observational study of children (< 18 years) with symptomatic SARS-CoV-2 infection evaluated in an urban pediatric emergency department (March 2021-April 2022) in Detroit, Michigan. Caregivers completed a 34-item survey based on the Healthy People 2030 framework. Severe disease was defined as the occurrence of respiratory/cardiac failure or death within four weeks of diagnosis. Continuous and categorical variables were described using medians and percentages, respectively. Associations between disease severity and risk factors were determined using chi-square tests. Association rule mining was used for feature selection, followed by multivariate logistic regression.

Results: We analyzed data from 354 children [6-12 years: 31.1%, Female: 51.1%, Black: 59%, not Hispanic: 84.7%, public insurance: 77.1%, chronic condition: 27.4%]. Of the total, 113 children had severe disease. Most caregivers were 30-44 years old (53.1%), had less than a college degree (70.4%), and income < USD 50,000 (75.2%). Adverse SDOH reported included food/housing insecurity (24.6%), no support (64.7%), unmet childcare needs (35.9%), and lack of transportation (12.7%). After controlling for age, sex, medical history, income, and obesity, severe disease was associated with caregiver use of drugs/alcohol (OR:5.92, p < 0.001) and social discrimination/lack of support (OR: 1.74, p = 0.030).

Conclusions: Two SDOH patterns (caregiver use of drugs/alcohol …