Digital Commons Network^™

Environmental Predictors Of County-Level Drowning Rates In Georgia, Jeff Turner

Journal of the Georgia Public Health Association

Background: Recent increases in drowning rates, both nationally and within Georgia, have led to renewed interest in the individual, situational/behavioral, and environmental characteristics that impact drowning. This study examines the association between two environmental characteristics, natural surface water coverage and public pools, on drowning fatalities and drowning-related ER visits by county in Georgia

Methods: We gathered county-level data on drowning fatalities and drowning-related ER visits and the number of public pools from the Georgia DPH, surface water coverage from the US Census Bureau, and demographic measures from the CDC. We conducted a linear regression analysis to identify how …

Dinamika Spasial Dengue Di Provinsi Sulawesi Selatan: Fragmentasi Spasial Tanpa Hotspot Persisten, Nurul Muthiah Salahuddin, Trisari Anggondowati, Syifa Nurhakiki

Jurnal Biostatistik, Kependudukan, dan Informatika Kesehatan

Demam berdarah dengue (DBD) masih menjadi masalah utama kesehatan masyarakat di Sulawesi Selatan, dengan pola penularan yang bervariasi secara spasial maupun temporal. Pada tahun 2024, provinsi ini mencatat insidens DBD sebesar 66,04 per 100.000 penduduk, di mana hanya 12,5% kabupaten/kota yang mencapai target nasional (≤10 per 100.000). Belum diketahui pola spasial yang membentuk klaster yang persisten atau berubah antar waktu, sehingga dilakukan penelitian ini untuk menganalisis pola spasiotemporal serta persistensi klaster spasial kejadian DBD di Sulawesi Selatan. Penelitian ini merupakan studi ekologi dengan pendekatan repeated cross-sectional menggunakan data surveilans DBD tingkat kabupaten/kota periode 2021–2024 yang mencakup 24 kabupaten/kota. Analisis meliputi …

Early Immune Dysregulation In Mtb/Siv Co-Infection Resists Cart Treatment At The Single-Cell Level, Riti Sharan, Yi Zou, Zhao Lai, Korri Weldon, Todd Bradley, Xi Luo, Hulin Wu, Shabaana A Khader, Deepak Kaushal

Faculty, Staff and Student Publications

Using single-cell transcriptomics of bronchoalveolar lavage cells from Mtb/SIV co-infected rhesus macaques on cART, we reveal profound immune dysregulation during early SIV co-infection of latent tuberculosis. SIV induces a sharp decline in CD4+ T cells, NK, and NKT cells, with incomplete recovery of Mtb-specific TH1 effector responses despite viral suppression. Instead, a persistent TH17-skewed environment emerges, alongside sustained myeloid inflammation driven by Type I interferon signaling and pro-inflammatory regulators such as KLF6 and NFKB1. Ligand-receptor network analyses demonstrate expanded CD4+ T cell-macrophage crosstalk and loss of immune homeostasis that cART fails to fully restore. These findings expose …

From Fields To Flu: Mapping H5n1 Zoonotic Risk In California Rice Fields, Mariati Messinger

Walden Dissertations and Doctoral Studies

Highly Pathogenic Avian Influenza (HPAI) H5N1 threatens agriculture, wildlife, and public health in California, where flooded rice fields in the Central Valley provide surrogate wetland habitat for migratory waterfowl and may create ecological interfaces for viral spillover into poultry systems. This quantitative ecological study examined whether county-level rice acreage, Lesser Snow Goose activity, and their interaction were associated with poultry HPAI H5N1 outbreak incidence during complete winter seasons available for analysis. Guided by One Health and disease ecology frameworks, secondary data from USDA, eBird, PRISM, and public surveillance sources were analyzed for 36 county-winter observations using negative binomial regression, logistic …

Time Series Analysis Of Temperature And Pollen Exposure On Asthma Outcomes In Atlanta, Georgia, Victoria Okereke-Viktorsson

Walden Dissertations and Doctoral Studies

The effects of climate change contribute to volatile temperature changes, which coupled with pollen exposure pose a significant threat to asthmatic people, potentially impacting methods for asthma management. The purpose of this ecological time-series study was to use the carbon dioxide theory of climate change, Dutch hypothesis, and social ecological model to estimate the relationship between average temperature and average pollen concentrations on average asthma morbidity outcomes for adults living in metropolitan Atlanta from 2020 to 2022 (N = 37,913). Results varied in terms of years, socioeconomic status (SES) vulnerability, gender, and racial group. Overall, a linear regression model revealed …

Spatiotemporal Patterns Of Vaccine Uptake For Measles Outbreaks In Katsina State, Nigeria, Zeenat Kabir Asma'i

Walden Dissertations and Doctoral Studies

Measles remains a public health concern in Nigeria despite the availability of effective vaccines, yet limited research has comprehensively examined spatiotemporal patterns and contextual determinants of vaccination coverage and measles incidence in Katsina State. Guided by the socioecological model, this quantitative ecological study examined spatiotemporal patterns of measles incidence among children aged 9–59 months of age across 183 wards in 34 local government areas of Katsina State, Nigeria, from 2018 to 2022. Confirmed cases (n = 376) were analyzed using negative binomial regression and spatial methods, including Moran’s I, SaTScan, and geographically weighted regression (GWR). Urban wards had higher incidence …

Just Opt For Caesarean Section And Pick The Birthdate': A Qualitative Study Exploring Women's Delivery Preferences After Caesarean Section In Urban Tanzania, Daudi Gidion, Columba Mbekenga, Miriam Mgonja, Marleen Temmerman, Muzdalfat Abeid

Obstetrics and Gynaecology, East Africa

Objectives To explore perspectives, preferences and decision-making regarding mode of delivery after a previous caesarean section among women in urban Tanzania.

Design A descriptive qualitative study using semi-structured in-depth interviews. Data were analysed using thematic analysis.

Setting A private tertiary hospital in Dar es Salaam, Tanzania.

Participants 11 women with one previous caesarean section who delivered at the study site were interviewed on the third day after delivery. Participants were purposively sampled to include both modes of delivery: five women underwent repeat caesarean section and six attempted a trial of labour after caesarean (TOLAC).

Results Thematic analysis identified four key …

The Relationship Between Access To Basic Safe Drinking Water And Under-Five Mortality In Indonesia: An Ecological Study, Jasmin Jadevra Fezantino, Raquel Amanda Salmasari, Hanania Carrisa, Zahra Annisaa Hudaya

Jurnal Nasional Kesehatan Lingkungan Global

Infant mortality remains a worrying public health issue, particularly in areas with poor access to drinking water and sanitation. In 2020, Papua Province recorded an infant mortality rate of 49.04 per 1,000 live births and West Papua 47.23. These figures are far above the national average. This study aims to determine the relationship between access to safe drinking water and infant mortality rates in provinces in Indonesia. This study used an ecological design with secondary data from the 2023 Indonesian Health Survey and the 2023 Directorate of Public Health. The analysis was descriptive and followed by a Spearman correlation test. …

Spatial Mapping Of Malaria Cases And Risk Factors Of Its Spread In West Java Province In 2019: An Ecological Study, Nazhira Haliza Putri, Azkia Afiatun Najah Wahyudi, Suhayla Bilqisth Abdi, Mutmainnah Mutmainnah, Nasywan Grananda Rahmantoro, Grace Napitupulu

Jurnal Nasional Kesehatan Lingkungan Global

Malaria is a significant health problem in Indonesia, especially in West Java Province which is at high risk due to its population density and environmental conditions. The incidence of malaria is associated with climate factors (rainfall, humidity, and air temperature). This study aims to study the spatial mapping of malaria cases and their relationship with climate factors. This study used an ecological study design. Secondary data from the West Java Health Office and the West Java Central Statistics Agency in 2019. Univariate and bivariate analysis with the study population covering the entire population of West Java, with a sample of …

Patterns And Determinants Of Measles Among Suspected Cases In Jakarta: Insight From Surveillance Data 2022-2024, Widya Inayah, Nurhayati Adnan Prihartono, Retno Henderiawati, Oktaviana Nugraheni, Dwi Gayatri

Jurnal Epidemiologi Kesehatan Indonesia

Measles remains a public health concern in Indonesia, including Jakarta, contributing to the country’s disease burden. Sustained transmission during 2022-2024, despite reported vaccination coverage above  90%, suggests the presence of vulnerable groups. This study aimed to describe patterns and identify factors associated with laboratory-confirmed measles in Jakarta during 2022-2024. A cross-sectional study was conducted using routine surveillance data from all individuals reported as suspected measles cases during the study period. Descriptive analysis summarizes the distribution, while multivariable analysis identifies associated factors. Of the 4,194 suspected cases of measles, 22.8% were laboratory-confirmed positive. Showed a fluctuating temporal pattern, increasing from 20.6 …

Air Pollution And Public Health: Global Evidence And Implications, Mohammed Obaid Al-Mansoori

Al-Bahir

Globally, the issue of air pollution keep being one of most serious challenges that affecting environment and human health, coming from emissions of industries, transport, agriculture and also from the fuel people use in homes, in addition to natural events that make the situation worse. This review try to bring together the available evidences about the sources, types, and the health impacts of the main air pollutants, including the gaseous ones like SO₂, O₃, NO₂, and CO, and the particulate matter (PM₁₀, PM₂.₅). Exposure for short or long time to these pollutants is linked with many harmful outcomes, such as …

The Impact Of The Covid-19 Pandemic On Obstetric Access In Rural And Urban Areas In The United States, Sandali Chandradasa

Walden Dissertations and Doctoral Studies

No abstract provided.

Exploring Racial And Ethnic Diversity Trajectories And Diabetes Prevalence In The United States, Jiue-An Yang, Calvin P Tribby, Anna Dmowska, Qian Xiao, Marta M Jankowska

Faculty, Staff and Student Publications

This study investigates whether long-term changes in neighborhood racial and ethnic diversity are associated with adult diabetes prevalence across the contiguous United States. We calculated diversity indexes for US census tracts (n = 72,033) using decennial census data from 1990 to 2020. Five diversity trajectory clusters were identified using K-means clustering. Diabetes prevalence in 2019 was obtained from the CDC's PLACES dataset. Linear mixed models (LMMs) assessed global associations between diversity trajectories and diabetes prevalence, adjusting for age, sex, poverty, marital status, and public insurance. Geographically weighted regression (GWR) examined local variations in these associations. Compared to the reference group …

Factors Associated With Public Health Centers’ Achievement Of Health Service Target In Yahukimo District, Highland Papua Province, Indonesia, Emaus Heluka, Venty Suryanti, Indasah Indasah, Prima Dewi Kusumawati

Kesmas

The achievement of the Minimum Service Standards (MSS) in Yahukimo District, Highland Papua Province, Indonesia, warrants examination. This study aimed to analyze factors associated with the achievement of health service targets among Public Health Centers (PHCs) in Yahukimo District. An ecological study design was employed. The participants were 400 health workers from 33 PHCs and were examined using Likert-scale questionnaires. Data were processed using Structural Equation Modeling-Partial Least Squares (SEM-PLS) to assess the association of each variable. The results showed that health target indicators were associated with the achievement of health service targets (T = 3.320; p-value = 0.012). Health …

Quantifying Black Carbon Concentrations In Georgia And Analyzing Associated Public Health Risks, Khloe R. Osborne

Honors Theses

Quantifying Black Carbon Concentrations in Georgia and Analyzing Associated Public Health Risks

One of the most daunting challenges of the industrial world is air pollution. Within this broad spectrum, there is an inhalable particle group named PM2.5, which contains black carbon. Black carbon has evidence that supports the generation and worsening of adverse health impacts, which may include birth complications, cognitive deficits in children, pulmonary aggravation, asthma, cardiovascular issues, neurological degenerative patterns, and cancer risk. This is especially seen in vulnerable populations, like children, elderly, and those who already suffer from weakened health, many of which reside in the southern …

Bio 340 Final Project: Rural Population Structure And Food Production Interact To Shape Global Undernourishment, Ava Ripanti

Biology Student Scholarship

Ava Ripanti - Environmental Biology '27

Undernourishment remains a major global public health challenge, reflecting the proportion of a population lacking sufficient dietary energy intake. While food availability is central to food security, undernourishment is also shaped by structural and socioeconomic factors such as population distribution and access to resources. Although rural populations are closely tied to agriculture, they often experience higher food insecurity due to limited infrastructure, market access, and healthcare. Prior research emphasizes that broader determinants, particularly inequality and development, are stronger predictors of undernourishment than agricultural output alone, that food insecurity exists in both rural and urban …

Spatial Distribution Patterns Of Determinants Of Hypertension In West Java In 2023, Meirina Nur Asih Susanti, Wahyu Septiono

Preventia: The Indonesian Journal of Public Health

Hypertension is a public health issue that is unevenly distributed across regions. The high prevalence in West Java (34.4%) with a large population makes the management of hypertension crucial. Differences in economic and environmental conditions are thought to influence the distribution of hypertension, thus requiring spatial analysis. This study used an ecological approach by analyzing data from districts/cities in West Java in 2023. Secondary data were used to measure hypertension prevalence and to assess socioeconomic and environmental factors. The analysis was conducted using univariate Moran's Index, Local Indicators of Spatial Association (LISA), and the Spatial Autoregressive Model (SAR). The prevalence …

Using Geospatial Environmental And Income Variables As Predictors Of Diabetes In Appalachia, John Kunicki Huth

Walden Dissertations and Doctoral Studies

Diabetes remains disproportionately prevalent in Appalachia, and macroenvironmental contributors remain poorly understood. Guided by spatial epidemiology, this quantitative, cross-sectional ecological study examined whether county-level environmental factors including distance to mine, distance to landfill, distance to water, mean annual precipitation, mean annual temperature, forest classification, distance to impervious surface, and median income were independently and collectively associated with diabetes cases per capita in West Virginia, used as a surrogate for Appalachia. Research questions addressed environmental predictors of diabetes cases per capita with and without controlling for median income. Publicly available county-level data from 53 West Virginia counties representing adults aged 20 …

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 …

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 …

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 …

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. …