Digital Commons Network^™

Incidence And Survival Of Children And Adolescents With Wilms Tumor, United States, 2001-2020, Andres F Espinoza, Ekene Onwuka, David A Siegel, Shifan Dai, Sanjeev A Vasudevan, Michael E Scheurer, Philip J Lupo

Center for Medical Ethics and Health Policy Staff Publications

Background: Wilms tumor (WT) is the most common pediatric malignancy of the kidney. Past studies describing WT incidence and survival used surveillance data with < 30% of the US population. We evaluated differences in WT incidence and survival comparing demographic groups and tumor characteristics.

Methods: We analyzed new cases of WT among patients aged < 20 years at diagnosis by using incidence data from US Cancer Statistics (USCS) for 2003-2020 and 5-year relative survival (RS) data from the National Program of Cancer Registries (NPCR) for 2001-2019. To assess incidence trends, average annual percent change (AAPC) was calculated by using joinpoint regression. Relative survival (RS) and all-cause survival were calculated overall and by demographic and clinical variables.

Results: During 2003-2020, 8218 cases of WT were reported in USCS, which represented an age-adjusted incidence rate of 5.7 cases per million. Rates were the highest among females (6.3), children aged 0-4 years (17.2), and non-Hispanic Black patients (7.1). Overall, trends remained stable (AAPC = -0.4, 95% CI: -1.4 to 0.4). Among 7567 cases of WT in NPCR, 5-year RS was 92.6%. Patients with the lowest …

Investigating Suicide Risk Factors Among Appalachian West Virginian Adults, Erin D. Caswell, Angela M. Dyer, Summer D. Hartley, Caroline P. Groth, Mary Christensen, Sahiti K. Tulabandu, Bryce K. Weaver, Ruchi Bhandari

Journal of Appalachian Health

Introduction: Suicide rates in the United States have increased over the past two decades, with rural areas, particularly the Appalachian Region, facing unique challenges that elevate suicide risk. These include economic hardships, social isolation, and limited access to mental health services.

Purpose: This study addresses critical gaps in understanding lifetime suicide risk in West Virginia (WV), a predominantly rural state entirely within the Appalachian Region. By identifying the factors driving urban-rural differences in suicide risk, this research seeks to inform interventions tailored to the state's distinct needs and provide insights applicable to the broader Appalachian Region

Methods: Using 2021 Mountain …

Current Attitudes And Barriers Among Appalachian Patients Towards Orthopaedic Surgery, Dylan Smith Md, Justin B. West Ms, Wade Smith Md, Micah Macaskill Md, Jonathan Lash, Matthew W. Bullock Do, Mpt

Journal of Appalachian Health

Introduction: This study explores the challenges faced by residents of rural West Virginia in accessing orthopaedic care due to geographic and socioeconomic barriers.

Purpose: This study seeks to survey rural West Virginia residents about their attitudes and experiences regarding access to orthopaedic care in southern West Virginia.

Methods: A total of 132 electronic surveys were collected from rural West Virginia residents during an appointment with their primary care provider located at an affiliated outreach clinic. The survey was designed to investigate various factors influencing their access to orthopaedic care.

Results: Delays in seeking orthpaedic care are common in rural West …

An Investigation Of Travel Distance And Timeliness Of Breast Cancer Treatment Among A Diverse Cohort In The United States, Swann Arp Adams, Oluwole Adeyemi Babatunde, Whitney Zahnd, Peiyin Hung, Karen E. Wickersham, Nathaniel Bell Ph.D., Jan M. Eberth Ph.D.

Publications

Travel to and from distant cancer treatment facilities can place a significant burden on cancer patients, particularly rural and minority survivors. Thus, the purpose of our investigation was to examine the association between patient travel distance and delays in types of treatment for breast cancer (surgery, radiation, chemotherapy, and hormonal therapy) and treatment delays. Using a novel linkage between the state cancer registry and administrative data from Medicaid and a private insurance plan, 2155 BC patients were successfully linked to create the cohort. ArcGIS was used to geocode all case residences and treatment facility addresses and calculate network distance between …

Coronavirus Disease 2019 (Covid-19) Real World Data Infrastructure: A Big-Data Resource For Study Of The Impact Of Covid-19 In Patient Populations With Immunocompromising Conditions, James M. Crawford, Lynne Penberthy, Ligia A. Pinto, Keri N. Althoff, Magdalene M. Assimon, Oren Cohen, Laura Gillim, Tracy L. Hammonds, Shilpa Kapur, Harvey W. Kaufman, David Kwasny, Jean W. Liew, William A. Meyer 3rd, Shannon L. Reynolds, Cheryl B. Schleicher, Suki Subbiah, Catherine Theruviparampil, Zachary S. Wallace, Jeremy L. Warner, Suhyeon Yoon, Yonah C. Ziemba

School of Medicine Faculty Publications

Background. We developed a United States–based real-world data resource to better understand the continued impact of the coronavirus disease 2019 (COVID-19) pandemic on immunocompromised patients, who are typically underrepresented in prospective studies and clinical trials. Methods. The COVID-19 Real World Data infrastructure (CRWDi) was created by linking and harmonizing de-identified HealthVerity medical and pharmacy claims data from 1 December 2018 to 31 December 2023, with severe acute respiratory syndrome coronavirus 2 virologic and serologic laboratory data from major commercial laboratories and Northwell Health; COVID-19 vaccination data; and, for patients with cancer, 2010 to 2021 National Cancer Institute Surveillance, Epidemiology, and …

Mental Health In Preprofessional And Professional Circus Artists: A Narrative Review, Melanie I. Stuckey, Stephanie Greenspan, Joanna Nicholas, Veronique Richard, Janine H. Stubbe, Fleur E.C.A. Van Rens

Research outputs 2022 to 2026

Mental health has received little attention in preprofessional and professional circus despite the performance demands, cognitive skill, and emotional labor required. This review aimed to consolidate the literature, identify research gaps, and guide practice priorities for mental health in preprofessional and professional circus artists. A narrative review of the literature was conducted based on the International Olympic Committee’s 2019 consensus statement for mental health in elite athletes. Articles reported on mental health symptoms and disorders (n = 13) and interventions (n = 3) in preprofessional and professional circus contexts. Circus artists may experience more symptoms of depression, anxiety, fatigue, and …

Racial And Ethnic Disparities In Human Papillomavirus Vaccination Among Us-Born And Foreign-Born Adults Aged 18 To 26 Years In The United States, Itunu Sokale, Jane Montealegre, Ann O Amuta, Abiodun Oluyomi, Aaron P Thrift

Faculty, Staff and Students Publications

Background/objectives: Human papillomavirus (HPV) is linked to multiple cancers that can be prevented through vaccination. While the optimal age for vaccination is in childhood and adolescence, vaccination recommendations include adults through age 26 who missed childhood/adolescent vaccination. There are limited data about disparities among adults eligible for catch-up HPV vaccination. We conducted a comprehensive examination of HPV vaccination among US young adults, disaggregating the group by race/ethnicity and nativity status to identify subgroups that may require additional interventions.

Methods: We analyzed 2019 and 2022 data of individuals aged 18-26 years from the National Health Interview Survey. Generalized linear models using …

Geographic Disparities Impacting Oral Vaccine Performance: Observations And Future Directions, Rachel M Burke, Sasirekha Ramani, Julia Lynch, Laura V Cooper, Haeun Cho, Ananda S Bandyopadhyay, Carl D Kirkwood, A Duncan Steele, Gagandeep Kang

Faculty, Staff and Students Publications

Oral vaccines have several advantages compared with parenteral administration: they can be relatively cheap to produce in high quantities, easier to administer, and induce intestinal mucosal immunity that can protect against infection. These characteristics have led to successful use of oral vaccines against rotavirus, polio, and cholera. Unfortunately, oral vaccines for all three diseases have demonstrated lower performance in the highest-burden settings where they are most needed. Rotavirus vaccines are estimated to have >85% effectiveness against hospitalization in children < 12 months in countries with low child mortality, but only ~65% effectiveness in countries with high child mortality. Similarly, oral polio vaccines have lower immunogenicity in developing country settings compared with high-resource settings. Data are more limited for oral cholera vaccines, but suggest lower titers among children compared with adults, and, for some vaccines, lower efficacy in endemic settings compared with non-endemic settings. These disparities are likely multifactorial, and available evidence suggests a role for maternal factors (e.g. transplacental antibodies, breastmilk), host factors (e.g. genetic polymorphisms-with the best evidence for rotavirus-or previous infection), and environmental factors (e.g. gut microbiome, co-infections). Overall, these data highlight the rather ambiguous and often contradictory nature of evidence on factors affecting oral vaccine response, cautioning against broad extrapolation of outcomes based on one population or one vaccine type. Meaningful impact on performance of oral vaccines will likely only be possible with a suite of interventions, given the complex and multifactorial nature of the problem, and the degree to which contributing factors are intertwined.

Cete Newsletter Volume 3, Tasbeeh Fayaz

Centre of Excellence for Trauma and Emergencies (CETE) Archives

This semiannual newsletter (Volume 3) from the Centre of Excellence for Trauma and Emergencies (CETE) at Aga Khan University highlights the Centre’s milestones and initiatives in 2024. It features messages from CETE’s leadership, updates on the Pakistan Life Savers Programme (PLSP), new partnerships, climate change advocacy, and community-based disaster preparedness. The issue also showcases CETE’s groundbreaking research projects, including the Trauma Registry, CONNECT-HTN, FEAMER telemedicine trial, Equi-Injury, iRise, and the EMS Data System. Special features include curriculum integration of life-saving skills in Sindh textbooks, the landmark #CPRUnitedPakistan event training 6,000 students simultaneously, and capacity-building programs for Lady Health Workers and …

Decriminalizing Disease: A Health Justice Approach To Infectious Diseases And Criminal Law, Sean E. Bland

Arkansas Law Review

Infectious diseases, also called communicable diseases, are largely a public health issue and should not be criminalized. This Article seeks to re-frame the discussion around the legal framework for infectious diseases in a way that moves beyond a punishment mindset and toward a health justice mindset. The focus in this Article is on health justice rather than traditional understandings of public health, defined as the science and practice of improving the health of people and their communities. The Article makes three novel contributions. First, it applies a health justice framework to the critique of infectious disease criminalization. Second, the Article …

Synesis As A Framework To Enable Safety Interventions In Complex Healthcare Environments, Aarti Bavare, Tiffany Wrenn, Anne Lam, Jamie Cargill, Lauren Salinas, Itode Idowu, Asma Razavi, Venessa Lynn Pinto, Eric Williams

Faculty, Staff and Students Publications

BACKGROUND: Despite wide adoption in the healthcare of safety event report (SER) systems, there is a paucity of unified structures for prompt analysis and action while retaining reporter confidentiality. We used a synesis framework to change siloed reviews of safety reports to a comprehensive appraisal of quality, safety, productivity and reliability to facilitate interventions.

METHODS: After a needs assessment survey, we launched serial plan-do-study-act cycles to (1) enhance teams' ability to access SERs, (2) facilitate regular multidisciplinary review of SERs to identify actionable opportunities, (3) allocate action priority using failure mode and effects analysis, and (4) launch actions and summarise …

Adverse Childhood Experiences: Healing Through Storytelling And Mindful Narrative Therapy, Julie Kemp

Mindfulness Studies Theses

This study presents research about the nature and prevalence of adverse childhood experiences (ACEs), the mental and physical impacts to individuals exposed to ACEs, and incorporating mindfulness practices into therapeutic approaches to treating them, particularly Mindfulness-Based Narrative Therapy (MBNT). It is important because ACEs have become a global crisis, with the potential for interfering with psychological and physical development, early mortality, and other harmful life outcomes. This thesis provides critical information for mindfulness teachers and practitioners, therapists, educators, regulators, parents, and individuals subjected to ACEs.

The methodology includes extensive literature searches for narrative therapy and mindfulness-based interventions (MBIs) in peer-reviewed …

A Proposed Mhealth Intervention To Address Patient Barriers To Colposcopy Attendance: Qualitative Interview Study Of Clinic Staff And Patient Perspectives, Jennifer Hemler, Rachel Wagner, Brittany Sullivan, Myneka Macenat, Erin Tagai, Jazmarie Vega, Enrique Hernandez, Suzanne Miller, Kuang-Yi Wen, Charletta Ayers, Mark Einstein, Shawna Hudson, Racquel Kohler

Department of Medical Oncology Faculty Papers

BACKGROUND: Cervical cancer disparities persist among minoritized women due to infrequent screening and poor follow-up. Structural and psychosocial barriers to following up with colposcopy are problematic for minoritized women. Evidence-based interventions using patient navigation and tailored telephone counseling, including the Tailored Communication for Cervical Cancer Risk (TC3), have modestly improved colposcopy attendance. However, the efficacious TC3 intervention is human resource-intense and could have greater reach if adapted for mobile health, which increases convenience and access to health information.

OBJECTIVE: This study aimed to describe feedback from clinic staff members involved in colposcopy processes and patients referred for colposcopy regarding adaptions …

Society For Immunotherapy Of Cancer: Updates And Best Practices For Multiplex Immunohistochemistry (Ihc) And Immunofluorescence (If) Image Analysis And Data Sharing, Janis M Taube, Joel C Sunshine, Michael Angelo, Guray Akturk, Margaret Eminizer, Logan L Engle, Cláudia S Ferreira, Sacha Gnjatic, Benjamin Green, Shirley Greenbaum, Noah F Greenwald, Cyrus V Hedvat, Travis J Hollmann, Daniel Jiménez-Sánchez, Konstanty Korski, Ana Lako, Edwin R Parra, Marlon C Rebelatto, David L Rimm, Scott J Rodig, Jamie Rodriguez-Canales, Jeffrey S Roskes, Kurt A Schalper, Emanuel Schenck, Keith E Steele, Michael J Surace, Alexander S Szalay, Michael T Tetzlaff, Ignacio I Wistuba, Jennifer H Yearley, Carlo B Bifulco

Faculty, Staff and Student Publications

Objectives: Multiplex immunohistochemistry and immunofluorescence (mIHC/IF) are emerging technologies that can be used to help define complex immunophenotypes in tissue, quantify immune cell subsets, and assess the spatial arrangement of marker expression. mIHC/IF assays require concerted efforts to optimize and validate the multiplex staining protocols prior to their application on slides. The best practice guidelines for staining and validation of mIHC/IF assays across platforms were previously published by this task force. The current effort represents a complementary manuscript for mIHC/IF analysis focused on the associated image analysis and data management.

Methods: The Society for Immunotherapy of Cancer convened a task …

Ada News - 01/06/2025, American Dental Association, Publishing Division

ADA News

Established in 1970 as the official newspaper of the American Dental Association, the ADA News serves practicing dentists and others allied to the dental profession in the U.S. and internationally. It is the No. 1 source of news and information about the many benefits and services the ADA delivers to members daily as well as timely information on scientific, social, political and economic developments affecting dentistry and health care.

Gateways, Barriers, And Facilitators To Opioid Use Treatment For Low-Income Pregnant And Postpartum Women In The State Of Alabama, Lindsey Allison Rice Bender

All ETDs from UAB

Low income, pregnant and postpartum women who misuse opioids in the state of Alabama face potentially life-threatening challenges when seeking substance misuse treatment and recovery support services. Our study used an explanatory sequential mixed-methods approach to explore gateways, barriers, and facilitators to opioid use disorder (OUD) treatment for pregnant and postpartum women in the state of Alabama. Surveys from 32 pregnant and postpartum individuals and in-depth interviews with 15 pregnant and postpartum individuals (four pregnant, four 0-6 months postpartum, four 7-12 months postpartum and three 13-18 months postpartum) were used to identify gateways, barriers, and facilitators to OUD treatment. Our …

Covid-19 Vaccine Hesitancy Among Black Women In The Us, Brittany C Slatton, Farrah G Cambrice, Serwaa S Omowale

Faculty, Staff and Student Publications

IMPORTANCE: COVID-19 vaccine hesitancy among Black women is a critical public health concern, potentially exacerbating existing health disparities and impacting community-wide vaccination efforts.

OBJECTIVE: To explore the factors associated with COVID-19 vaccine hesitancy among Black women in the US and identify the specific concerns and experiences shaping hesitant attitudes toward vaccination.

DESIGN, SETTING, AND PARTICIPANTS: Qualitative study using in-depth, semistructured interviews conducted virtually between June and November 2021. Thematic analysis was used to identify key themes from the interview data. Participants were recruited through social media platforms and word-of-mouth referrals from various regions of the US. Interviews were conducted remotely …

An Evaluation Of Nhmrc Funded Dementia And Diabetes Research, Etienne Vignola-Gagné Phd, Dmitrii Malkov, Elisabeth Browning, Jörg Hellwig Phd, Luigi Rocco Phd, Henrique Pinheiro, Alexandre Bédard-Vallée

Public Reports

This report, commissioned by the National Health and Medical Research Council (NHMRC), provides comprehensive insights into the research outputs, outcomes, and impacts of NHMRC-funded health and medical research in the areas of dementia and diabetes to support NHMRC's mission of ‘building a healthy Australia.’

Examining The Relationship Between Teen Pregnancy And Educational Outcomes In Ohio, Andrea Szep, Maryyam Durrani

Scholarship in Medicine - All Papers

Objective: The aim of this study is to explore the relationship between educational outcomes,school funding, and teen birth rates in Ohio counties between 2020 and 2024. Methods: Usingdata from County Health Rankings, we performed regression, correlation, and paired t-testanalyses through the SPSS software. Results: The results of our tests showed significantnegative correlations between markers of educational success, including high school graduationrates math and reading standardized test scores, and teen birth rates in both 2020 and 2024.Between 2020 and 2024, the teen birth rate decreased in the state of Ohio, and in 2024, publicschool funding was able to predict 14.8% of …

Burnout In The Emergency Room: Corrective Measures Vs. The Absence Of Solutions, Zane Walters, Zachary Woodall

Theses, Dissertations and Capstones

Introduction: Physician burnout has become an increasingly prevalent and critical issue in healthcare systems worldwide, particularly among emergency room physicians who face high-stress, high-demand working conditions. Burnout manifests as emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment, leading to negative outcomes for physicians’ mental health, job satisfaction, and overall career longevity. This phenomenon not only threatens the well-being of physicians but also compromises patient care quality and contributes to costly turnover within healthcare organizations.

Purpose of the Study: The aim of this study was to systematically investigate the impact of burnout interventions on emergency room physicians. …

Beyond The Screen: Assessing The Impact Of Hospitalist Reliance On Electronic Medical Records In Patient-Centered Care, Brian H. Cox

Theses, Dissertations and Capstones

The integration of Electronic Medical Record (EMR) systems has transformed healthcare delivery, offering enhanced data accessibility, improved communication, and operational efficiency. However, concerns persist regarding the potential erosion of patient-centered care due to EMR overutilization. This study investigated how hospitalists’ use of EMR systems correlates with patient satisfaction, focusing on the dynamics of physician communication, hospital length of stay, and regional characteristics. Using a comprehensive framework combining Resource Dependency Theory and Donabedian’s Structure-Process-Outcome model, the research examines the influence of demographic, technological, and structural factors on healthcare outcomes.

The analysis, based on patient survey data from a large integrated delivery …

Transportation Barriers To Healthcare Access: A Scoping Review Of Measurement Approaches And Associated Health Outcomes, Josiane Kabayundo, Muskan Ahuja, Snehal Jadhav, Lisa C. Smith, Farzana A. Bithi, Shamim Shahi, George Johnson, Siddhi Munde, Kendra L. Ratnapradipa

Journal Articles: Epidemiology

Background

Objectives

Methods

Research Annual Report Fy2025, Children's Mercy Kansas City

Research Annual Reports

Annual report of the research at Children's Mercy Kansas City in Kansas City MO, a pediatric medical center.

A Scoping Review Of Population Diversity In The Common Genomic Aberrations Of Clear Cell Renal Cell Carcinoma, Sean S. Kumar, Ninad Khandekar, Komal Dani, Saina R. Bhatt, Vinay Duddalwar, Anishka D' Souza

Department of Medicine Faculty Publications

Introduction: Previous literature has shown that clear cell renal cell carcinoma (ccRCC) is becoming a more prevalent diagnosis and that the incidence and mortality differ both regionally and racially. While the molecular profiles for ccRCC are studied regionally through biopsy and sequencing techniques, the genomic landscape and ccRCC diversity data are not well studied. We conducted a review of the known genomic data on 6 of the most clinically relevant DNA biomarkers in ccRCC: von Hippel-Lindau (vHL), Polybromo-1 (PBRM1), Breast Cancer Gene 1-Associated Protein 1 (BAP1), Histone-Lysine N-Methyltransferase Domain-Containing 2 (SETD2), Mammalian Target of Rapamycin (mTOR), and Lysine-Specific Demethylase 5C …

The Relationship Between Mental Health Disclosures, Employee Sentiments And Turnover Intention In The Workplace, Steve G. Winkel

Open Access Dissertations

Purpose. The purpose of this study is to examine the relationship between employees’ disclosure of mental health conditions in the workplace and these employees’ sentiments, feelings, and associated outcomes. Utilizing constructs of job satisfaction, affective commitment, normative commitment, motivation, and turnover intentions, the research aims to understand quantifiable differences in the employment experience between employees who disclose and do not disclose (non-disclosure) mental health conditions, as well as the mediating roles of human resources management (HRM), supervisors support, and employee authenticity. Through self-reported data detailing employees’ disclosure experiences, the research also aims to understand the disclosure conversation's specific impact …

Building Place-Based Experiential Learning Into The Honors Curriculum At Ohio University, Geoffrey L. Buckley, Nicole Finnicum, Michelle O'Malley, Jennifer Bowie, Yolonda Youngs

Honors in Practice Online Archive

Observing the demand for interdisciplinary experiential learning opportunities post-COVID, authors present a place-based curriculum in honors. Workshop-style special topics classes provide students with an immersive and flexible learning environment, energize faculty, and engage alumni and community partners. Coursework, fieldwork, internships, and study abroad opportunities all contribute to the development of an informed and engaged citizenry. Authors address challenges in funding, access, and equity, and they suggest ways these challenges might be met.

Revoluntionizing Brain Research Using Portable Mri In Field Settings: Public Perspectives On The Ethical And Legal Challenges, Molly K. Madzelan, Frances Lawrenz, Susan Wolf, Francis X. Shen

Articles

Introduction

New, highly portable MRI (pMRI) technology promises to revolutionize brain research by facilitating field-based studies that can expand research to new settings beyond the traditional MRI suite in a medical center. At this early stage of development, understanding public knowledge and attitudes about pMRI research is crucial.

Objective In this article we present the first empirical study of the general public’s willingness to participate in pMRI research, and their perceptions of expected benefits and concerns.

Methods & Results

We conducted a nationally representative online survey (N = 2,001) administered Aug. 15-31, 2022. We found that respondents were overwhelmingly willing …

Navigating Barriers: Challenges And Strategies For Adopting Artificial Intelligence In Qualitative Research In Low-Income African Contexts, Kahabi Isangula

School of Nursing & Midwifery, East Africa

Introduction:

 AI is transforming qualitative research. It enhances efficiency, accuracy, and depth in studies. Technologies like machine learning (ML), natural language processing (NLP), and large language models (LLMs) simplify tasks like transcription, coding, and thematic analysis. However, in low-income African settings, there are barriers to AI adoption. These include ethical concerns, infrastructure limitations, financial constraints, and technical skill gaps. Issues around data privacy and the dehumanization of research also add challenges.

Methods: 

This paper explores the challenges and opportunities of AI in qualitative research in low-income African contexts. It uses a descriptive approach, reviewing literature and personal experiences from rural …

Reducing Unnecessary Antibiotics For The Treatment Of Urinary Tract Infections, Megan A. Carullo

West Chester University Doctoral Projects

Urinary tract infections (UTIs) are among the most common infections in women and are often a reason for prescribing antibiotics. Appropriately treating these infections is vital to prevent significant health concerns such as pyelonephritis or sepsis. Providers commonly prescribe antibiotics as a preventive measure, but incorrect usage can lead to unnecessary use of antibiotics. This is a large concern for the medical community, given the increased rates of antibiotic resistance. This quality improvement project aimed to answer the following research question: In women with recurrent UTIs (rUTIs), does presumptive treatment compared to standard treatment upon confirmed infection increase the number …

Regional Variation And Correlation Of Big Five Personality Traits With Rates Of Insufficient Sleep And Diabetes In The United States, Isabella Chirakos, Brennan Schroeder

Scholarship in Medicine - All Papers

Background: Diabetes and insufficient sleep are prevalent health concerns, and determining potential contributing factors could help decrease the incidence of these issues. This study aims to explore potential associations between insufficient sleep and diabetes mellitus, examining whether these negative health outcomes can be linked geographically and by personality traits. Results could help create more effective programs to combat diabetes and insufficient sleep.
Materials and Methods: The study utilized longitudinal health data and roadmaps from 2016 and 2023 for each state, categorizing the data into four regions: Northeast, Midwest, South, and West. We incorporated personality data from the Synthetic Aperture Personality …