Digital Commons Network^™

Understanding The Effects Of Real-Time Head Position Feedback On Postural Sway In Terms Of Changes In Underlying Deterministic And Stochastic Dynamical Processes, Steven J. Harrison, Benjamin De Bari, Ryan Poutre, Jeffrey M. Kinsella-Shaw

College of Humanities and Sciences Faculty Papers

Our perceptual systems detect information about how our body is moving relative to the surrounding environment. Such information is essential to our ability to maintain upright standing balance. Real-time postural feedback systems are technologies that appear to enhance our ability to detect information about the movements of our body, and as a consequence improve our capacity to control the posture of our body. Here we examine a system in which real-time measurements of head position were "felt" as changes in the intensity of vibration of tactors in a headband. Using this system, participants were able to stabilize their body posture, …

Epidemiology Of Lower Extremity Amputations In The United States: An Analysis Of The Global Burden Of Disease Database From 1990 To 2019., Peter B Spencer, Cameron J Sabet, Gabrielle Dykhouse, Taylor J Manes, Phillip C Mckegg, Ambrose Loc T Ngo, Ayah Ibrahim, Jack Weick

Surgery Articles

BACKGROUND: Lower extremity amputations (LEAs) are medically, psychologically, and functionally devastating. The objective of our study was to evaluate region- and sex-specific differences of unilateral and bilateral LEAs across the United States (US) from 1990 to 2019.

METHODS: The Global Burden of Disease database was used to analyze years lived with disability (YLDs), prevalence, and incidence rates per 100,000 people for LEAs in the US from 1990 to 2019. Data were stratified into four US Census Bureau-defined regions: Northeast, Midwest, South, and West. Differences between regions and sexes were assessed, with statistical significance defined as p < 0.05.

RESULTS: From 1990 to …

Community Firearm Violence And Dental Care Use In Middle Adulthood, Alexander Testa, Luis Mijares, Daniel Semenza, Richard Stansfield, Ian Silver, Dylan B Jackson, Ana Neumann, Jeff R Temple, Rahma Mungia

Faculty, Staff and Student Publications

Prior research links violence inside the home to reduced dental care utilization, yet little is known about how community firearm violence affects dental care behaviors. The current study used data from wave V (2016-2018) of the National Longitudinal Study of Adolescent to Adult Health (Add Health), linked to census tract-level fatal and nonfatal shooting data from the American Violence Project for the 100 largest cities in the United States. The analytic sample included 1925 respondents aged 33-42. The primary outcome was self-reported dental care use in the past year. Firearm violence exposure was categorized as 0, 1, or 2 + …

A Content Analysis Of Prison/Custodial Suicide In Bangladesh, Anisur Khan, Rasel Hussain

Journal of Social, Behavioral, and Health Sciences

Suicide is the leading cause of death in prisons and custodial settings globally. International studies have consistently shown that prisoners and detainees are at a higher risk of suicide compared to the general population. Despite Bangladesh having a large prison population, there is no scholarly work on suicide within these settings. Against this backdrop, this study explored online newspaper content analysis capturing the characteristics of prison and custodial suicide in Bangladesh from 2014–2024. A total of 20 suicide cases were identified during this period. The data were arranged based on year-wise trends, age, sex, type of custody, nature of criminality, …

Analysis Of Health Policy Impacts On Adolescent Tobacco And Alcohol Consumption In Asean: An Ecological Descriptive Study, Marzalyla Putri Hendriansyah, Syifa Azzahra Setiawan, Sabrina Aprilia Putri, Falah Nur Chusniati, Rizka Maulida

Journal of Indonesian Health Policy and Administration

The prevalence of tobacco and alcohol consumption among adolescents in Southeast Asia remains a public health concern despite the introduction of several national policies. This study assessed the relationship between policy implementation and consumption trends of tobacco and alcohol in selected ASEAN countries. Using a descriptive ecological design, we analyzed secondary data from the Global School-based Student Health Survey (GSHS) and policy documents from official government sources. We observed a rise in tobacco consumption in Indonesia (+4.2%) and Brunei (+5.5%), while Thailand experienced a slight increase (+0.3%). Conversely, alcohol consumption decreased marginally in Indonesia (-0.7%) and Brunei (-0.8%), but increased …

Analisis Potensial Kejadian Luar Biasa Dbd Berdasarkan Kasus Dbd 5 Tahun Terakhir 2019-2024 : Studi Ekologi Di Kota Lubuklinggau Provinsi Sumatera Selatan, Sely Anggraini, Tri Yunis Miko Wahyono, Fitria Fitria, Nadia Putri

Jurnal Epidemiologi Kesehatan Indonesia

Dengue Hemorrhagic Fever (DHF) is an endemic disease in Indonesia, with a high potential for outbreaks, particularly in tropical and densely populated regions such as Lubuklinggau City. This study aimed to assess the outbreak potential of DHF in Lubuklinggau by analyzing the five-year trend of minimum and maximum case numbers (2019–2023) and comparing them with 2024 data using the epidemic threshold approach. A descriptive ecological study design was employed, with all primary health centers (puskesmas) in the city as units of analysis. Data sources included annual DHF surveillance reports from the District Health Office, field observations, demographic data from the …

Low Economic Level And The Risk Of Overweight Among Indonesian Junior And Senior High School Students, Ariyanto Nugroho, Purwo Setiyo Nugroho, Amarin Yudhana, Sri Sunarti

Kesmas

Overweight and obesity among Indonesian adolescents have emerged as a pressing public health issue, reflecting global trends. This study examines the relationship between economic status and overweight prevalence among junior and senior high school students in Indonesia, using secondary data from the Global School-based Health Survey (GSHS). This study analyzed data from 9,977 students aged 11–18 years through a cross-sectional design and binary logistic regression, adjusting for dietary habits, physical activity, and sedentary behavior. Overall, 14.7% of students were overweight; the prevalence was notably higher among low-income students (27.4%) compared to high-income groups (14.2%). Students from lower economic backgrounds were …

Government Health Spending And Life Expectancy: Evidence From Cities And Districts In Indonesia, Kurnia Sari, Budi Hidayat, Amal Chalik Sjaaf, Mardiati Nadjib

Kesmas

Life expectancy is widely recognized as a fundamental indicator of population health, and its improvement is often linked to government health spending, particularly in decentralized health systems. This study aimed to investigate the relationship between local government health expenditures and life expectancy in decentralized Indonesia. Data from 492 cities and districts, spanning from 2015 to 2019, were analyzed using a two-way fixed effects regression model to control for time-invariant district characteristics and common temporal shocks. The findings indicated that a 10% increase per capita in government health expenditure was associated with a 0.01% increase in life expectancy. This association was …

Eco-Emotions And Climate Activism In Adolescents, Julianna Sahoo

Master's Projects and Capstones

Background. Youth are especially vulnerable to climate change, both physically and psychologically. Combatting climate change will require a coordinated, global effort. Understanding the motivations and emotions behind climate activism is essential to coordinate efforts to combat climate change.

Methods. This research uses survey data collected from first and second year undergraduates (n=521) at a private, urban university in California in the Fall of 2022. Youth were surveyed on emotions related to climate change, activism, compassion, eco-anxiety, and well-being.

Results. Experiencing positive emotions had a stronger relationship with environmental activism compared to negative emotions.

Conclusion. Results suggest climate change communications should …

Leishmania In Texas: A Contemporary One Health Scoping Review Of Vectors, Reservoirs, And Human Health, Morgan H Jibowu, Richard Chung, Nina L Tang, Sarah Guo, Leigh-Anne Lawton, Brendan J Sullivan, Dawn M Wetzel, Sarah M Gunter

Faculty, Staff and Students Publications

Leishmaniasis, a vector-borne neglected tropical disease, affects over 6.2 million people globally. Case acquisition is increasingly recognized in the United States, and in Texas, most reported cases are locally acquired and speciated to Leishmania mexicana. We conducted a scoping literature review to systematically assess contemporary research on Leishmania in humans, animals, reservoir hosts, or vectors in Texas after 2000. Out of 22 eligible studies, the most prevalent themes were case reports, followed by studies on domestic animals, reservoirs, and vectors, with several studies bridging multiple disciplines. Climate change, urbanization, and habitat encroachment appear to be driving the northward expansion …

Exploring Factors Influencing Care And Outcome Among Stroke Patients In Tennessee, Omodele Agbejimi

Electronic Theses and Dissertations

Introduction: Stroke is the fifth leading cause of death in Tennessee. Socioeconomic variables influence the delivery of stroke treatment and its outcomes. Despite advances in acute stroke care, the burden of stroke keeps increasing. This study aimed to explore literature on factors contributing to stroke care and outcomes in the U.S., assess the determinants of stroke patients’ outcomes, and examine the geographical disparities in stroke hospitalization and stroke death rate and their association with stroke care accessibility in Tennessee.

Methods: A scoping review was conducted using socio-ecological models to explore literature on factors contributing to stroke care and outcomes. A …

Association Between Homelessness And Maternal Health Outcomes Among Non-Hispanic Black Women In Georgia, Miranda Weaver

Walden Dissertations and Doctoral Studies

Maternal health disparities among homeless non-Hispanic Black women in Georgia represent a critical public health concern, driven by inequitable access to care and elevated risks of adverse pregnancy outcomes. This study examined how homelessness influences perinatal care utilization (timing and frequency of prenatal visits and postpartum checkups) and pregnancy complications (gestational diabetes, hypertension, and depression), and whether these associations differ by geographic context (urban versus rural). Grounded in the Social Determinants of Health framework, the study used a quantitative cross-sectional design, analyzing secondary data (n = 1,540; weighted ≈ 203,571) from Phase 8 (2017–2021) of the Pregnancy Risk Assessment Monitoring …

Environmental Advocacy As An Occupation: Perceived Self-Efficacy And Occupational Justice In Community Programming, Emma Sims, Laura H. Vanpuymbrouck

The Open Journal of Occupational Therapy

Background: Current occupational therapy literature demonstrates a gap in knowledge of environmental advocacy as an occupation, which directly impacts occupational justice in those experiencing environmental racism or discrimination. This study’s purpose was to provide foundational information on the importance of advocacy work in the sphere of environmental and occupational justice through the lived experiences of those directly involved in community environmental advocacy.

Method: Qualitative data was collected via three focus groups using semi-structured interviews focused on perceptions of participant experiences in environmental advocacy occupations. Thematic analysis was used to identify themes relating to research questions.

Results: When …

Pola Sebaran Spasial Pada Kejadian Stunting Di Provinsi Lampung Tahun 2019 -2023, R Nasrullah Nur Nugroho, Indang Trihandini, Martya Rahmaniati Makful

Jurnal Biostatistik, Kependudukan, dan Informatika Kesehatan

Stunting merupakan gangguan pertumbuhan dan perkembangan yang dialami anak-anak akibat gizi buruk, infeksi berulang dan stimulasi psikososial yang tidak memadai. Menurut Survei Kesehatan Indonesia (SKI) 2023, prevalensi stunting di Indonesia sebesar 21,5%, sementara Lampung 14,9% yang menempatkannya pada posisi ke-empat terendah setelah Bali, Jambi dan Riau. Penelitian ini bertujuan untuk menganalisis pola sebaran spasial dan autokorelasi spasial kejadian stunting di Provinsi Lampung tahun 2019–2023 dengan pendekatan studi ekologi. Sampel penelitian adalah 13 kabupaten dan 2 kota di Provinsi Lampung. Metode analisis spasial yang digunakan adalah Moran’s I untuk mengukur autokorelasi spasial global dan Local Indicators of Spatial Association (LISA) untuk …

The Impact Of Genetic Ancestry On Survival Outcomes In Pediatric Rhabdomyosarcoma: A Report From The Children’S Oncology Group, Ekene A Onwuka, Christina L Magyar, Bailey A Martin-Giacalone, Michael E Scheurer, Deborah A Marquez-Do, Mark Zobeck, Elizabeth G Atkinson, Erin R Rudzinski, Michael A Arnold, Donald A Barkauskas, David Hall, Javed Khan, Jack F Shern, Paul Scheet, Brian Crompton, Corinne M Linardic, Douglas S Hawkins, Rajkumar Venkatramani, Lisa Mirabello, Chad D Huff, Melissa A Richard, Philip J Lupo

Faculty, Staff and Student Publications

Emerging evidence suggests genetic ancestry may influence childhood cancer outcomes, but its impact on pediatric rhabdomyosarcoma (RMS) is unknown. We explored genetic ancestry's impact on survival among children with RMS. This multi-center observational cohort study is a secondary analysis of previously collected biobanking, genomic, and clinical data. The study included 920 individuals with newly diagnosed RMS under 40 years of age enrolled from 2005 to 2017 under the COG soft tissue sarcoma biobanking protocol D9902. The primary endpoints were (1) event-free survival (EFS), defined as the time from study enrollment to tumor recurrence/progression, secondary malignancy, or death from any cause; …

Reaction Control Mechanism In Deoxyuridine 5'-Triphosphate Nucleotidohydrolase, Aaron Delay

School of Biological Sciences: Dissertations, Theses, and Student Research

Deoxyuridine 5'-triphosphate nucleotidohydrolase (dUTPase) is an enzyme involved in the pyrimidine biosynthesis pathway, a key component of cellular DNA metabolism. It regulates intracellular uracil carrying triphosphate levels by hydrolyzing dUTP, thereby providing a substrate for thymidylate synthase (TS). The effective inhibition of dUTPase is expected to enhance TS-targeted chemotherapy by promoting thymine-less apoptosis.

Although the reaction mechanism of dUTPase has been studied, the human nuclear homotrimeric form remains complex, as all three subunits cooperatively form a single active site. As a result, the detailed molecular dynamics of its catalysis are still not fully understood. In this study, I investigated the …

Investigating Environmental And Socioeconomic Contributors To Adult Obesity In The Rio Grande Valley, John Nicholas Cauba, Jihoo Woo, Russel Wiggins, Shizue Mito

School of Medicine Publications

Obesity in the Rio Grande Valley (RGV) of Texas remains a critical public health concern, with rates (46.9%) significantly exceeding those of Texas (36%) and the U.S. (34%) (p < 0.001). This study used 2024 County Health Rankings data to analyze environmental and socioeconomic contributors to obesity across 240 Texas counties, with a population-weighted focus on Hidalgo, Cameron, Starr, and Willacy counties. The RGV exhibited markedly poorer access to exercise, higher rates of physical inactivity, lower Food Environment Index scores (FEI = 4.3 vs. 5.7 in Texas), higher rates of uninsurance, worse patient-to–primary care physician (PCP) ratios (2152:1 vs. Texas 1660:1), and increased preventable hospitalizations. Multiple linear regression identified physical inactivity (β = 0.6, p = 0.01) and access to exercise (β = −0.02, p = 0.02) as significant predictors of obesity. Notably, higher uninsured rates were associated with lower reported obesity, likely due to underdiagnosis in the absence of routine care. These findings emphasize the need for targeted interventions addressing food access, environmental and recreational infrastructure, along with healthcare infrastructure in the RGV, where socioeconomic disadvantage and structural barriers magnify the impact of national obesity trends on the regional level.

Mycetohabitans Rhizoxinica Bacteremia In The Setting Of Invasive Fungal Disease In An Immunocompromised Patient, Marisa Orbea, Mary Fortini, Megan H Amerson-Brown, Debra L Palazzi, James J Dunn

Faculty, Staff and Students Publications

Background: Mycetohabitans [Burkholderia] rhizoxinica is an endosymbiotic bacteria of Rhizopus microsporus that normally causes rice seedling blight. In our case report, we present one of the first known cases of concomitant bacteremia with M. rhizoxinica and invasive mold infection due to Rhizopus spp. in an immunocompromised child.

Case summary: A 3 year old male recently diagnosed with B-cell acute lymphoblastic leukemia developed febrile neutropenia. His workup was significant for invasive fungal sinusitis due to Exserohilum spp. based on histopathology and culture, a right middle lobe infiltrate, and a blood culture positive for gram-negative coccobacilli, later identified as M. …

A Phase 2 Trial Of Short-Term Intravenous N-Acetylcysteine In Biliary Atresia After Kasai Portoenterostomy, Sanjiv Harpavat, Kristin A Borovsky, Michael E Scheurer, Laurel Cavallo, Franca E Erhiawarie, Sanjeev Vasudevan, Adam M Vogel, Dana Cerminara, Elizabeth M Tessier, Kalyani R Patel, Sridevi Devaraj, Benjamin L Shneider

Center for Medical Ethics and Health Policy Staff Publications

Background: For infants with biliary atresia, the only treatment that can establish bile flow and delay need for liver transplant is the Kasai portoenterostomy (KP). Unfortunately, the KP has variable success. In this study, we hypothesized that intravenous N-acetylcysteine (IV NAC) treatment following KP would improve bile flow.

Methods: This was a phase 2 study following the two-stage "minimax" trial design. Participants received IV NAC (150 mg/kg/day) for 7 days after KP, and the primary endpoint was achieving total serum bile acids (TSBA) ≤10 μmol/L within 24 weeks of KP. Secondary endpoints were clinical markers and the occurrence of sentinel …

Distribusi Kejadian Diare Pada Balita Dan Kualitas Sumber Air Minum Di Indonesia: Studi Ekologi, Nadia Z. Sabira, Naijla I. Shaliha, Sandrina H. Salsabila, Wellsa D. Kusumaningrum

Jurnal Nasional Kesehatan Lingkungan Global

Background: Diarrhea is an infectious disease with the third highest mortality rate in children under 5 years of age globally. The Indonesian Ministry of Health states that 88% of deaths from diarrhea in children are caused by poor sanitation practices and inadequate quality of drinking water sources. This study aims to describe the distribution of the quality of drinking water sources and the prevalence of diarrhea in all provinces in Indonesia. Methods: This study used an ecological study approach with secondary aggregate data from Survei Kesehatan Indonesia (SKI) 2023 and Studi Kualitas Air Minum Rumah Tangga (SKAM RT) 2020. The …

Diarrhea Risk Factors Of Toddlers In Jember District, 2022, Annisa Fitrah Aini, Yunus Ariyanto, Adistha Eka Noveyani

Preventia: The Indonesian Journal of Public Health

Diarrhea is a disease characterized by passing feces three or more times a day. The occurrence of diarrhea is also influenced by sociodemographic factors (nutritional status) and environmental factors (access to clean water, access to sanitary latrines, and living in flood-prone areas). The purpose of this research focuses on finding risk factors for diarrhea and mapping the risk factors of diarrhea. This study used an ecological study design, in which the population is all sub-districts in Jember. Secondary data were used in this research. The data were analyzed using statistical correlation analysis using SPSS and mapping using GIS software. The …

"You Need To Make The Decision You Can Live With": An Observational Study Of Anti-Abortion Centers In Tampa Bay, Anna Broich

USF Tampa Graduate Theses and Dissertations

Anti-Abortion Centers (AACs) pose a grave threat to the reproductive health outcomes of Americans. Disguising themselves as licensed health clinics, AACs target vulnerable communities to prevent or delay abortion care through the spread of medical misinformation, contributing to abortion stigmatization. Situated in a state with a near-total abortion ban, this secret-shopper study aimed to understand the ways in which AACs in Tampa, Florida communicate anti-abortion rhetoric to pregnant people seeking abortions. Under the guise of people who suspect they are pregnant searching for abortion care, the main researcher and her assistants conducted the first phase of the study through 25 …

The Factors Affecting The Distribution Of Scorpions (Arachnida: Scorpions) In Iran, Hassan Nasirian

Chulalongkorn Medical Journal

Background: The distribution of scorpions is influenced by various factors that determine their presence and abundance in different regions. Understanding these factors is crucial for comprehending scorpion ecology and predicting their potential impact on ecosystems. Objective: These subtopics aim to provide an overview of the distribution of scorpions within Iran and the factors affecting their distribution, highlighting their ecological preferences and adaptations to different regions.

Methods: Forty-nine documents were collected from well-known indexing services, including Elsevier, Google Scholar, PubMed, ScienceDirect, Scopus, Springer, and Web of Science. After carefully studying the documents, they were classified into specific topics and discussed.

Results: …

Assessment Of Contextualized Reinforcement Pathology In A Community Sample Of Young Adult Substance Users, Ángel García-Pérez, Alba González-Roz, Roberto Secades-Villa, Gema Aonso-Diego, Sara Weidberg, Jin H Yoon

Faculty, Staff and Student Publications

Background: Alcohol, tobacco, and cannabis are the most commonly used substances among young populations, often leading to polysubstance use, which correlates with problematic consumption and adverse health outcomes. The contextualized reinforcer pathology (CRP) model explains addictive behaviors through several constructs, including the following: drug demand, delay discounting (DD), and substance-free and substance-related reinforcement. Most previous studies have focused on a single CRP construct and the couse of only two substances. This study aimed to characterize three subgroups of young adults reporting past month use of alcohol only, alcohol + tobacco or cannabis, and alcohol + tobacco + cannabis, in terms …

Developmental Lead Exposure And Aggression In Male Rats: Influences Of Maternal Care And Environmental Enrichment, Shamaila Zafar, Courtney K. Williams, Jaehyun Joo, Blanca E. Himes, Jay S. Schneider

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Developmental lead (Pb) exposure results in a variety of cognitive deficits and behavioral issues including increased antisocial behavior and aggression. This study investigated the effect of developmental Pb exposure on aggression and violent behavior in male rats and the potential modulatory influences of quality of maternal care and enriched/non-enriched housing conditions. Long-Evans male rats with or without Pb exposure (perinatal or early postnatal) from low or high maternal care mothers (based on amounts of licking/grooming and arched- back nursing) were randomly assigned to live in enriched or non-enriched environments at weaning. At post- natal day 120–190, offensive aggression was assessed …

Spatiotemporal Association Of Coronavirus Disease 2019 Cases And Deaths With Exposure To Wildfire Particulate Matter In 2020, Thomas C Mchale, David R Boulware, Kelly Searle, Leda Kobziar, Phinehas Lampman, Julio C Zuniga-Moya, Ben Papadopoulos, Andrej Spec, Naomi E Hauser, George R Thompson

2020-Current year OA Pubs

BACKGROUND: Climate change is anticipated to have profound effects on human health, including in infectious diseases. Wildfires have been increasing in frequency and intensity due to climate change and have been linked to worsening respiratory disease outcomes. We aimed to demonstrate whether there was an association between wildfire smoke and coronavirus disease 2019 (COVID-19) in California during 2020.

METHODS: We used an ecologic cohort study with a spatial autoregressive model to test for associations between wildfire smoke, measured as particulate matter < 2.5 µg/m

RESULTS: In an adjusted analysis, we found a 1-month lag increase of 203 COVID-19 cases per 10 000 persons …

Candidate Interventions For Integrating Hypertension And Cardiovascular-Kidney-Metabolic Care In Primary Health Settings: Hearts 2.0 Phase 1, Andres Rosende, Mark D Huffman, Et Al.

2020-Current year OA Pubs

BACKGROUND: HEARTS in the Americas is the regional adaptation of the WHO Global HEARTS Initiative, aimed at helping countries enhance hypertension and cardiovascular disease (CVD) risk management in primary care settings. Its core implementation tool, the HEARTS Clinical Pathway, has been adopted by 28 countries. To improve the care of hypertension, diabetes, and chronic kidney disease (CKD), HEARTS 2.0 was developed as a three-phase process to integrate evidence-based interventions into a unified care pathway, ensuring consistency across fragmented guidelines. This paper focuses on Phase 1, highlighting targeted interventions to improve and update the HEARTS Clinical Pathway.

METHODS: First, the coordinating …

Clinical Predictors Of Inherited Breast Cancer At A Comprehensive Cancer Centre In Oman: Is It Time For Universal Germline Genetic Testing?, Reem Abdulrahim, Hasan Al-Sayegh, Sara Al-Kiyumi, Ilse Crouse, Khalid Albaimani, Adil Aljarrah, Chantel Van Wyk, Abeer Alsayegh

Sultan Qaboos University Medical Journal

Objectives: This study aimed to explore the clinical, histopathological and demographic characteristics of female Omani breast cancer (BC) patients to identify possible predictors of a positive test result. Additionally, it aimed to evaluate the applicability of the National Comprehensive Cancer Network (NCCN) guidelines for germline genetic testing in risk assessment. Methods: This study was conducted at the Sultan Qaboos Comprehensive Cancer Centre, Oman, between September 2021 and September 2022. The variables examined included age, disease stage, presence of metastasis at diagnosis, hormone receptor status, human epidermal growth factor receptor 2 status, histopathological type, Ki-67 levels, family history of …

Heartache In The Heartland: Unraveling The Social Roots Of Deaths Of Despair In Kentucky, Lyndsey K. Blair, Madeline M. Tomlinson, Michele Abee-Biskis, Jessica Hume, Gabri Warren

Journal of Appalachian Health

Introduction: Deaths of despair (DoD), encompassing suicides, drug overdoses, and alcohol-related liver diseases, have emerged as a critical public health crisis in the United States, with their rise particularly pronounced from 1995 to 2013 and exacerbated by the COVID-19 pandemic. Kentucky, grappling with high rates of substance use disorder, poor mental health, and economic hardship, is at the forefront of this issue, particularly in its rural and Appalachian regions.

Purpose: This study explores the social determinants contributing to DoD in Kentucky, focusing on economic and social factors that influence rising rates of suicide, drug overdose, and alcohol-related liver disease. The …

Racial Disparity And Environmental Influences On Perinatal Health In Jefferson County, Kentucky., Felicia A Pugh

Electronic Theses and Dissertations

Background: Severe maternal morbidity (SMM) risk has tripled over the past 30 years. Adverse infant birth outcomes in the U.S. have also increased with substantial Black-White disparities. Objectives: This work compares the frequency of adverse maternal and infant birth outcomes by maternal race (Black vs White) and examines associations between maternal ambient heavy metal exposures and birth outcomes in Jefferson County, Kentucky, 2017-2022. Methods: Jefferson County inpatient hospital delivery and birth certificate records of self-identified Black or White birthing parents were used. Incidence of SMM, stillbirth, preterm birth (PTB), and small for gestational age (SGA) with 95% confidence intervals (CI) …